Daily Papers

There has been a rapidly growing interest in Automatic Symptom Detection (ASD) and Automatic Diagnosis (AD) systems in the machine learning research literature, aiming to assist doctors in telemedicine services. These systems are designed to interact with patients, collect evidence about their symptoms and relevant antecedents, and possibly make predictions about the underlying diseases. Doctors would review the interactions, including the evidence and the predictions, collect if necessary additional information from patients, before deciding on next steps. Despite recent progress in this area, an important piece of doctors' interactions with patients is missing in the design of these systems, namely the differential diagnosis. Its absence is largely due to the lack of datasets that include such information for models to train on. In this work, we present a large-scale synthetic dataset of roughly 1.3 million patients that includes a differential diagnosis, along with the ground truth pathology, symptoms and antecedents for each patient. Unlike existing datasets which only contain binary symptoms and antecedents, this dataset also contains categorical and multi-choice symptoms and antecedents useful for efficient data collection. Moreover, some symptoms are organized in a hierarchy, making it possible to design systems able to interact with patients in a logical way. As a proof-of-concept, we extend two existing AD and ASD systems to incorporate the differential diagnosis, and provide empirical evidence that using differentials as training signals is essential for the efficiency of such systems or for helping doctors better understand the reasoning of those systems.

In this paper, we introduce BiMediX, the first bilingual medical mixture of experts LLM designed for seamless interaction in both English and Arabic. Our model facilitates a wide range of medical interactions in English and Arabic, including multi-turn chats to inquire about additional details such as patient symptoms and medical history, multiple-choice question answering, and open-ended question answering. We propose a semi-automated English-to-Arabic translation pipeline with human refinement to ensure high-quality translations. We also introduce a comprehensive evaluation benchmark for Arabic medical LLMs. Furthermore, we introduce BiMed1.3M, an extensive Arabic-English bilingual instruction set covering 1.3 Million diverse medical interactions, resulting in over 632 million healthcare specialized tokens for instruction tuning. Our BiMed1.3M dataset includes 250k synthesized multi-turn doctor-patient chats and maintains a 1:2 Arabic-to-English ratio. Our model outperforms state-of-the-art Med42 and Meditron by average absolute gains of 2.5% and 4.1%, respectively, computed across multiple medical evaluation benchmarks in English, while operating at 8-times faster inference. Moreover, our BiMediX outperforms the generic Arabic-English bilingual LLM, Jais-30B, by average absolute gains of 10% on our Arabic medical benchmark and 15% on bilingual evaluations across multiple datasets. Our project page with source code and trained model is available at https://github.com/mbzuai-oryx/BiMediX .

Speech patterns have been identified as potential diagnostic markers for neuropsychiatric conditions. However, most studies only compare a single clinical group to healthy controls, whereas clinical practice often requires differentiating between multiple potential diagnoses (multiclass settings). To address this, we assembled a dataset of repeated recordings from 420 participants (67 with major depressive disorder, 106 with schizophrenia and 46 with autism, as well as matched controls), and tested the performance of a range of conventional machine learning models and advanced Transformer models on both binary and multiclass classification, based on voice and text features. While binary models performed comparably to previous research (F1 scores between 0.54-0.75 for autism spectrum disorder, ASD; 0.67-0.92 for major depressive disorder, MDD; and 0.71-0.83 for schizophrenia); when differentiating between multiple diagnostic groups performance decreased markedly (F1 scores between 0.35-0.44 for ASD, 0.57-0.75 for MDD, 0.15-0.66 for schizophrenia, and 0.38-0.52 macro F1). Combining voice and text-based models yielded increased performance, suggesting that they capture complementary diagnostic information. Our results indicate that models trained on binary classification may learn to rely on markers of generic differences between clinical and non-clinical populations, or markers of clinical features that overlap across conditions, rather than identifying markers specific to individual conditions. We provide recommendations for future research in the field, suggesting increased focus on developing larger transdiagnostic datasets that include more fine-grained clinical features, and that can support the development of models that better capture the complexity of neuropsychiatric conditions and naturalistic diagnostic assessment.

Medical multiple-choice question answering (MCQA) is particularly difficult. Questions may describe patient symptoms and ask for the correct diagnosis, which requires domain knowledge and complex reasoning. Standard language modeling pretraining alone is not sufficient to achieve the best results. jin2020disease showed that focusing masked language modeling on disease name prediction when using medical encyclopedic paragraphs as input leads to considerable MCQA accuracy improvement. In this work, we show that (1) fine-tuning on generated MCQA dataset outperforms the masked language modeling based objective and (2) correctly masking the cues to the answers is critical for good performance. We release new pretraining datasets and achieve state-of-the-art results on 4 MCQA datasets, notably +5.7\% with base-size model on MedQA-USMLE.

Large Language Models (LLMs) like ChatGPT demonstrate significant potential in the medical field, often evaluated using multiple-choice questions (MCQs) similar to those found on the USMLE. Despite their prevalence in medical education, MCQs have limitations that might be exacerbated when assessing LLMs. To evaluate the effectiveness of MCQs in assessing the performance of LLMs, we developed a fictional medical benchmark focused on a non-existent gland, the Glianorex. This approach allowed us to isolate the knowledge of the LLM from its test-taking abilities. We used GPT-4 to generate a comprehensive textbook on the Glianorex in both English and French and developed corresponding multiple-choice questions in both languages. We evaluated various open-source, proprietary, and domain-specific LLMs using these questions in a zero-shot setting. The models achieved average scores around 67%, with minor performance differences between larger and smaller models. Performance was slightly higher in English than in French. Fine-tuned medical models showed some improvement over their base versions in English but not in French. The uniformly high performance across models suggests that traditional MCQ-based benchmarks may not accurately measure LLMs' clinical knowledge and reasoning abilities, instead highlighting their pattern recognition skills. This study underscores the need for more robust evaluation methods to better assess the true capabilities of LLMs in medical contexts.

Large language models (LLMs) have demonstrated impressive capabilities in natural language understanding and generation, but the quality bar for medical and clinical applications is high. Today, attempts to assess models' clinical knowledge typically rely on automated evaluations on limited benchmarks. There is no standard to evaluate model predictions and reasoning across a breadth of tasks. To address this, we present MultiMedQA, a benchmark combining six existing open question answering datasets spanning professional medical exams, research, and consumer queries; and HealthSearchQA, a new free-response dataset of medical questions searched online. We propose a framework for human evaluation of model answers along multiple axes including factuality, precision, possible harm, and bias. In addition, we evaluate PaLM (a 540-billion parameter LLM) and its instruction-tuned variant, Flan-PaLM, on MultiMedQA. Using a combination of prompting strategies, Flan-PaLM achieves state-of-the-art accuracy on every MultiMedQA multiple-choice dataset (MedQA, MedMCQA, PubMedQA, MMLU clinical topics), including 67.6% accuracy on MedQA (US Medical License Exam questions), surpassing prior state-of-the-art by over 17%. However, human evaluation reveals key gaps in Flan-PaLM responses. To resolve this we introduce instruction prompt tuning, a parameter-efficient approach for aligning LLMs to new domains using a few exemplars. The resulting model, Med-PaLM, performs encouragingly, but remains inferior to clinicians. We show that comprehension, recall of knowledge, and medical reasoning improve with model scale and instruction prompt tuning, suggesting the potential utility of LLMs in medicine. Our human evaluations reveal important limitations of today's models, reinforcing the importance of both evaluation frameworks and method development in creating safe, helpful LLM models for clinical applications.

Hepato-pancreato-biliary (HPB) disorders represent a global public health challenge due to their high morbidity and mortality. Although large language models (LLMs) have shown promising performance in general medical question-answering tasks, the current evaluation benchmarks are mostly derived from standardized examinations or manually designed questions, lacking HPB coverage and clinical cases. To address these issues, we systematically eatablish an HPB disease evaluation benchmark comprising 3,535 closed-ended multiple-choice questions and 337 open-ended real diagnosis cases, which encompasses all the 33 main categories and 465 subcategories of HPB diseases defined in the International Statistical Classification of Diseases, 10th Revision (ICD-10). The multiple-choice questions are curated from public datasets and synthesized data, and the clinical cases are collected from prestigious medical journals, case-sharing platforms, and collaborating hospitals. By evalauting commercial and open-source general and medical LLMs on our established benchmark, namely ClinBench-HBP, we find that while commercial LLMs perform competently on medical exam questions, they exhibit substantial performance degradation on HPB diagnosis tasks, especially on complex, inpatient clinical cases. Those medical LLMs also show limited generalizability to HPB diseases. Our results reveal the critical limitations of current LLMs in the domain of HPB diseases, underscoring the imperative need for future medical LLMs to handle real, complex clinical diagnostics rather than simple medical exam questions. The benchmark will be released at https://clinbench-hpb.github.io.

This paper introduces MedMCQA, a new large-scale, Multiple-Choice Question Answering (MCQA) dataset designed to address real-world medical entrance exam questions. More than 194k high-quality AIIMS \& NEET PG entrance exam MCQs covering 2.4k healthcare topics and 21 medical subjects are collected with an average token length of 12.77 and high topical diversity. Each sample contains a question, correct answer(s), and other options which requires a deeper language understanding as it tests the 10+ reasoning abilities of a model across a wide range of medical subjects \& topics. A detailed explanation of the solution, along with the above information, is provided in this study.

Accurate and interpretable multi-disease diagnosis remains a critical challenge in medical research, particularly when leveraging heterogeneous multimodal medical data. Current approaches often rely on single-modal data, limiting their ability to comprehensively understand complex diseases. To address this, we propose MedTVT-R1, a novel Multimodal Large Language Model (MLLM) framework designed to integrate clinical multimodal data for reasoning and diagnosing multiple diseases. We construct MedTVT-QA, a curated instruction dataset that provides question-answer pairs for physiological-level interpretations and disease-level diagnoses with a Chain of Evidence approach. MedTVT-R1 incorporates a modality perception layer to capture inter-modal dependencies and adaptively weight modality contributions. Additionally, we employ Group Relative Policy Optimization (GRPO)-based Reinforcement Fine-Tuning with a Jaccard Reward function to enhance diagnostic reasoning. Experimental results demonstrate MedTVT-R1's superiority in multimodal feature utilization and multi-disease diagnosis, offering significant potential for clinical applications such as diagnostic report generation and comorbidity reasoning. The dataset and code are available at https://github.com/keke-nice/MedTVT-R1.

We introduce EXAMS-V, a new challenging multi-discipline multimodal multilingual exam benchmark for evaluating vision language models. It consists of 20,932 multiple-choice questions across 20 school disciplines covering natural science, social science, and other miscellaneous studies, e.g., religion, fine arts, business, etc. EXAMS-V includes a variety of multimodal features such as text, images, tables, figures, diagrams, maps, scientific symbols, and equations. The questions come in 11 languages from 7 language families. Unlike existing benchmarks, EXAMS-V is uniquely curated by gathering school exam questions from various countries, with a variety of education systems. This distinctive approach calls for intricate reasoning across diverse languages and relies on region-specific knowledge. Solving the problems in the dataset requires advanced perception and joint reasoning over the text and the visual content of the image. Our evaluation results demonstrate that this is a challenging dataset, which is difficult even for advanced vision-text models such as GPT-4V and Gemini; this underscores the inherent complexity of the dataset and its significance as a future benchmark.

Multi-choice questions (MCQs) serve as a common yet important task format in the research of large language models (LLMs). Our work shows that LLMs exhibit an inherent "selection bias" in MCQs, which refers to LLMs' preferences to select options located at specific positions (like "Option C"). This bias is prevalent across various LLMs, making their performance vulnerable to option position changes in MCQs. We identify that one primary cause resulting in selection bias is option numbering, i.e., the ID symbols A/B/C/D associated with the options. To mitigate selection bias, we propose a new method called PriDe. PriDe first decomposes the observed model prediction distribution into an intrinsic prediction over option contents and a prior distribution over option IDs. It then estimates the prior by permutating option contents on a small number of test samples, which is used to debias the subsequent test samples. We demonstrate that, as a label-free, inference-time method, PriDe achieves a more effective and computation-efficient debiasing than strong baselines. We further show that the priors estimated by PriDe generalize well across different domains, highlighting its practical potential in broader scenarios.

The MEDIQA-CORR 2024 shared task aims to assess the ability of Large Language Models (LLMs) to identify and correct medical errors in clinical notes. In this study, we evaluate the capability of general LLMs, specifically GPT-3.5 and GPT-4, to identify and correct medical errors with multiple prompting strategies. Recognising the limitation of LLMs in generating accurate corrections only via prompting strategies, we propose incorporating error-span predictions from a smaller, fine-tuned model in two ways: 1) by presenting it as a hint in the prompt and 2) by framing it as multiple-choice questions from which the LLM can choose the best correction. We found that our proposed prompting strategies significantly improve the LLM's ability to generate corrections. Our best-performing solution with 8-shot + CoT + hints ranked sixth in the shared task leaderboard. Additionally, our comprehensive analyses show the impact of the location of the error sentence, the prompted role, and the position of the multiple-choice option on the accuracy of the LLM. This prompts further questions about the readiness of LLM to be implemented in real-world clinical settings.

Automatic analysis of multimodal speech has shown strong potential for computationally detecting and monitoring a wide range of neurological, psychiatric, and respiratory conditions. However, progress in this field is limited by existing publicly accessible datasets, which are often small in scale, focused on a single condition or disease, and primarily speech focused. Moreover, if key confounding variables such as education, medication use, comorbidities, or mood state are insufficiently documented, the reliability and interpretability of computational analyses are further compromised. To address these limitations, we introduce CARE v1.0, a curated multimodal English dataset of approximately 144 hours of short video interviews collected from 612 individuals across 12 medical conditions plus a control cohort. For each video, a comprehensive set of clinically relevant multimodal descriptors is provided, alongside structured metadata covering factors such as medication, life impacts, and expressed emotions. The corpus's breadth and heterogeneity support a wide range of applications, including automatic disease and symptom detection, multimodal modelling of speech and non-verbal behaviour under emotionally charged contexts, and studies of disease trajectories and coping processes.

Multiple-choice question answering (MCQA) is often used to evaluate large language models (LLMs). To see if MCQA assesses LLMs as intended, we probe if LLMs can perform MCQA with choices-only prompts, where models must select the correct answer only from the choices. In three MCQA datasets and four LLMs, this prompt bests a majority baseline in 11/12 cases, with up to 0.33 accuracy gain. To help explain this behavior, we conduct an in-depth, black-box analysis on memorization, choice dynamics, and question inference. Our key findings are threefold. First, we find no evidence that the choices-only accuracy stems from memorization alone. Second, priors over individual choices do not fully explain choices-only accuracy, hinting that LLMs use the group dynamics of choices. Third, LLMs have some ability to infer a relevant question from choices, and surprisingly can sometimes even match the original question. We hope to motivate the use of stronger baselines in MCQA benchmarks, the design of robust MCQA datasets, and further efforts to explain LLM decision-making.

Given a question, a language model (LM) implicitly encodes a distribution over possible answers. In practice, post-training procedures for LMs often collapse this distribution onto a single dominant mode. While this is generally not a problem for benchmark-style evaluations that assume one correct answer, many real-world tasks inherently involve multiple valid answers or irreducible uncertainty. Examples include medical diagnosis, ambiguous question answering, and settings with incomplete information. In these cases, we would like LMs to generate multiple plausible hypotheses, ideally with confidence estimates for each one, and without computationally intensive repeated sampling to generate non-modal answers. This paper describes a multi-answer reinforcement learning approach for training LMs to perform distributional reasoning over multiple answers during inference. We modify the RL objective to enable models to explicitly generate multiple candidate answers in a single forward pass, internalizing aspects of inference-time search into the model's generative process. Across question-answering, medical diagnostic, and coding benchmarks, we observe improved diversity, coverage, and set-level calibration scores compared to single answer trained baselines. Models trained with our approach require fewer tokens to generate multiple answers than competing approaches. On coding tasks, they are also substantially more accurate. These results position multi-answer RL as a principled and compute-efficient alternative to inference-time scaling procedures such as best-of-k. Code and more information can be found at https://multi-answer-rl.github.io/.

Limited access to mental healthcare, extended wait times, and increasing capabilities of Large Language Models (LLMs) has led individuals to turn to LLMs for fulfilling their mental health needs. However, examining the multi-turn mental health conversation capabilities of LLMs remains under-explored. Existing evaluation frameworks typically focus on diagnostic accuracy and win-rates and often overlook alignment with patient-specific goals, values, and personalities required for meaningful conversations. To address this, we introduce MedAgent, a novel framework for synthetically generating realistic, multi-turn mental health sensemaking conversations and use it to create the Mental Health Sensemaking Dialogue (MHSD) dataset, comprising over 2,200 patient-LLM conversations. Additionally, we present MultiSenseEval, a holistic framework to evaluate the multi-turn conversation abilities of LLMs in healthcare settings using human-centric criteria. Our findings reveal that frontier reasoning models yield below-par performance for patient-centric communication and struggle at advanced diagnostic capabilities with average score of 31%. Additionally, we observed variation in model performance based on patient's persona and performance drop with increasing turns in the conversation. Our work provides a comprehensive synthetic data generation framework, a dataset and evaluation framework for assessing LLMs in multi-turn mental health conversations.

We introduce Metric-Fair Prompting, a fairness-aware prompting framework that guides large language models (LLMs) to make decisions under metric-fairness constraints. In the application of multiple-choice medical question answering, each {(question, option)} pair is treated as a binary instance with label +1 (correct) or -1 (incorrect). To promote {individual fairness}~--~treating similar instances similarly~--~we compute question similarity using NLP embeddings and solve items in joint pairs of similar questions rather than in isolation. The prompt enforces a global decision protocol: extract decisive clinical features, map each \((question, option)\) to a score f(x) that acts as confidence, and impose a Lipschitz-style constraint so that similar inputs receive similar scores and, hence, consistent outputs. Evaluated on the {MedQA (US)} benchmark, Metric-Fair Prompting is shown to improve performance over standard single-item prompting, demonstrating that fairness-guided, confidence-oriented reasoning can enhance LLM accuracy on high-stakes clinical multiple-choice questions.

Medical coding translates clinical documentation into standardized codes for billing, research, and public health, but manual coding is time-consuming and error-prone. Existing automation efforts rely on small datasets that poorly represent real-world patient heterogeneity. We trained a language model on 5.8 million electronic health records from 1.8 million patients across nearly all specialties in Eastern Denmark (2006--2016) to predict ICD-10 codes from clinical notes, medications, and laboratory results. Evaluated on 270,000 held-out patients, the model achieved a micro F1 of 71.8% and a top-10 recall of 95.5%. Performance varied by specialty (F1: 53--91%), with higher scores in specialties with well-defined diagnostic criteria. Codes appearing predominantly as secondary diagnoses had markedly lower F1 scores. For three such codes (suicide-related behaviors, weight disorders, and hypertension), the model identified thousands of uncoded cases, of which 76-86% were confirmed valid upon manual review, suggesting systematic under-coding rather than model error. These findings suggest under-coding of secondary diagnoses in Eastern Denmark during this period, with potential implications for epidemiological research, public health surveillance, and understanding of multimorbidity. Similar time constraints and reimbursement structures in other healthcare systems suggest this may not be isolated to this dataset. The model can automate coding for approximately 50% of cases and provide accurate suggestions for most others, and may offer a practical solution to help capture missed secondary conditions.

Clinical diagnosis is critical in medical practice, typically requiring a continuous and evolving process that includes primary diagnosis, differential diagnosis, and final diagnosis. However, most existing clinical diagnostic tasks are single-step processes, which does not align with the complex multi-step diagnostic procedures found in real-world clinical settings. In this paper, we propose a multi-step diagnostic task and annotate a clinical diagnostic dataset (MSDiagnosis). This dataset includes primary diagnosis, differential diagnosis, and final diagnosis questions. Additionally, we propose a novel and effective framework. This framework combines forward inference, backward inference, reflection, and refinement, enabling the LLM to self-evaluate and adjust its diagnostic results. To assess the effectiveness of our proposed method, we design and conduct extensive experiments. The experimental results demonstrate the effectiveness of the proposed method. We also provide a comprehensive experimental analysis and suggest future research directions for this task.

The present study aims to explore the capabilities of Language Models (LMs) in tackling high-stakes multiple-choice tests, represented here by the Exame Nacional do Ensino M\'edio (ENEM), a multidisciplinary entrance examination widely adopted by Brazilian universities. This exam poses challenging tasks for LMs, since its questions may span into multiple fields of knowledge, requiring understanding of information from diverse domains. For instance, a question may require comprehension of both statistics and biology to be solved. This work analyzed responses generated by GPT-3.5 and GPT-4 models for questions presented in the 2009-2017 exams, as well as for questions of the 2022 exam, which were made public after the training of the models was completed. Furthermore, different prompt strategies were tested, including the use of Chain-of-Thought (CoT) prompts to generate explanations for answers. On the 2022 edition, the best-performing model, GPT-4 with CoT, achieved an accuracy of 87%, largely surpassing GPT-3.5 by 11 points. The code and data used on experiments are available at https://github.com/piresramon/gpt-4-enem.

Online medical consultation (OMC) restricts doctors to gathering patient information solely through inquiries, making the already complex sequential decision-making process of diagnosis even more challenging. Recently, the rapid advancement of large language models has demonstrated a significant potential to transform OMC. However, most studies have primarily focused on improving diagnostic accuracy under conditions of relatively sufficient information, while paying limited attention to the "inquiry" phase of the consultation process. This lack of focus has left the relationship between "inquiry" and "diagnosis" insufficiently explored. In this paper, we first extract real patient interaction strategies from authentic doctor-patient conversations and use these strategies to guide the training of a patient simulator that closely mirrors real-world behavior. By inputting medical records into our patient simulator to simulate patient responses, we conduct extensive experiments to explore the relationship between "inquiry" and "diagnosis" in the consultation process. Experimental results demonstrate that inquiry and diagnosis adhere to the Liebig's law: poor inquiry quality limits the effectiveness of diagnosis, regardless of diagnostic capability, and vice versa. Furthermore, the experiments reveal significant differences in the inquiry performance of various models. To investigate this phenomenon, we categorize the inquiry process into four types: (1) chief complaint inquiry; (2) specification of known symptoms; (3) inquiry about accompanying symptoms; and (4) gathering family or medical history. We analyze the distribution of inquiries across the four types for different models to explore the reasons behind their significant performance differences. We plan to open-source the weights and related code of our patient simulator at https://github.com/LIO-H-ZEN/PatientSimulator.

Language models excel at diagnostic assessments on currated medical case-studies and vignettes, performing on par with, or better than, clinical professionals. However, existing studies focus on complex scenarios with rich context making it difficult to draw conclusions about how these systems perform for patients reporting symptoms in everyday life. We deployed SymptomAI, a set of conversational AI agents for end-to-end patient interviewing and differential diagnosis (DDx), via the Fitbit app in a study that randomized participants (N=13,917) to interact with five AI agents. This corpus captures diverse communication and a realistic distribution of illnesses from a real world population. A subset of 1,228 participants reported a clinician-provided diagnosis, and 517 of these were further evaluated by a panel of clinicians during over 250 hours of annotation. SymptomAI DDx were significantly more accurate (OR = 2.47, p < 0.001) than those from independent clinicians given the same dialogue in a blinded randomized comparison. Moreover, agentic strategies which conduct a dedicated symptom interview that elicit additional symptom information before providing a diagnosis, perform substantially better than baseline, user-guided conversations (p < 0.001). An auxiliary analysis on 1,509 conversations from a general US population panel validated that these results generalize beyond wearable device users. We used SymptomAI diagnoses as labels for all 13,917 participants to analyze over 500,000 days of wearable metrics across nearly 400 unique conditions. We identified strong associations between acute infections and physiological shifts (e.g., OR > 7 for influenza). While limited by self-reported ground truth, these results demonstrate the benefits of a dedicated and complete symptom interview compared to a user-guided symptom discussion, which is the default of most consumer LLMs.

As large language models (LLM) evolve in their capabilities, various recent studies have tried to quantify their behavior using psychological tools created to study human behavior. One such example is the measurement of "personality" of LLMs using self-assessment personality tests developed to measure human personality. Yet almost none of these works verify the applicability of these tests on LLMs. In this paper, we analyze the reliability of LLM personality scores obtained from self-assessment personality tests using two simple experiments. We first introduce the property of prompt sensitivity, where three semantically equivalent prompts representing three intuitive ways of administering self-assessment tests on LLMs are used to measure the personality of the same LLM. We find that all three prompts lead to very different personality scores, a difference that is statistically significant for all traits in a large majority of scenarios. We then introduce the property of option-order symmetry for personality measurement of LLMs. Since most of the self-assessment tests exist in the form of multiple choice question (MCQ) questions, we argue that the scores should also be robust to not just the prompt template but also the order in which the options are presented. This test unsurprisingly reveals that the self-assessment test scores are not robust to the order of the options. These simple tests, done on ChatGPT and three Llama2 models of different sizes, show that self-assessment personality tests created for humans are unreliable measures of personality in LLMs.

There is increasing interest in the application large language models (LLMs) to the medical field, in part because of their impressive performance on medical exam questions. While promising, exam questions do not reflect the complexity of real patient-doctor interactions. In reality, physicians' decisions are shaped by many complex factors, such as patient compliance, personal experience, ethical beliefs, and cognitive bias. Taking a step toward understanding this, our hypothesis posits that when LLMs are confronted with clinical questions containing cognitive biases, they will yield significantly less accurate responses compared to the same questions presented without such biases. In this study, we developed BiasMedQA, a benchmark for evaluating cognitive biases in LLMs applied to medical tasks. Using BiasMedQA we evaluated six LLMs, namely GPT-4, Mixtral-8x70B, GPT-3.5, PaLM-2, Llama 2 70B-chat, and the medically specialized PMC Llama 13B. We tested these models on 1,273 questions from the US Medical Licensing Exam (USMLE) Steps 1, 2, and 3, modified to replicate common clinically-relevant cognitive biases. Our analysis revealed varying effects for biases on these LLMs, with GPT-4 standing out for its resilience to bias, in contrast to Llama 2 70B-chat and PMC Llama 13B, which were disproportionately affected by cognitive bias. Our findings highlight the critical need for bias mitigation in the development of medical LLMs, pointing towards safer and more reliable applications in healthcare.

Estimating the difficulty of multiple-choice questions would be great help for educators who must spend substantial time creating and piloting stimuli for their tests, and for learners who want to practice. Supervised approaches to difficulty estimation have yielded to date mixed results. In this contribution we leverage an aspect of generative large models which might be seen as a weakness when answering questions, namely their uncertainty, and exploit it towards exploring correlations between two different metrics of uncertainty, and the actual student response distribution. While we observe some present but weak correlations, we also discover that the models' behaviour is different in the case of correct vs wrong answers, and that correlations differ substantially according to the different question types which are included in our fine-grained, previously unused dataset of 451 questions from a Biopsychology course. In discussing our findings, we also suggest potential avenues to further leverage model uncertainty as an additional proxy for item difficulty.

The early detection of mental health disorders from social media text is critical for enabling timely support, risk assessment, and referral to appropriate resources. This work introduces multiMentalRoBERTa, a fine-tuned RoBERTa model designed for multiclass classification of common mental health conditions, including stress, anxiety, depression, post-traumatic stress disorder (PTSD), suicidal ideation, and neutral discourse. Drawing on multiple curated datasets, data exploration is conducted to analyze class overlaps, revealing strong correlations between depression and suicidal ideation as well as anxiety and PTSD, while stress emerges as a broad, overlapping category. Comparative experiments with traditional machine learning methods, domain-specific transformers, and prompting-based large language models demonstrate that multiMentalRoBERTa achieves superior performance, with macro F1-scores of 0.839 in the six-class setup and 0.870 in the five-class setup (excluding stress), outperforming both fine-tuned MentalBERT and baseline classifiers. Beyond predictive accuracy, explainability methods, including Layer Integrated Gradients and KeyBERT, are applied to identify lexical cues that drive classification, with a particular focus on distinguishing depression from suicidal ideation. The findings emphasize the effectiveness of fine-tuned transformers for reliable and interpretable detection in sensitive contexts, while also underscoring the importance of fairness, bias mitigation, and human-in-the-loop safety protocols. Overall, multiMentalRoBERTa is presented as a lightweight, robust, and deployable solution for enhancing support in mental health platforms.

Large language models (LLMs) have performed well in providing general and extensive health suggestions in single-turn conversations, exemplified by systems such as ChatGPT, ChatGLM, ChatDoctor, DoctorGLM, and etc. However, the limited information provided by users during single turn results in inadequate personalization and targeting of the generated suggestions, which requires users to independently select the useful part. It is mainly caused by the missing ability to engage in multi-turn questioning. In real-world medical consultations, doctors usually employ a series of iterative inquiries to comprehend the patient's condition thoroughly, enabling them to provide effective and personalized suggestions subsequently, which can be defined as chain of questioning (CoQ) for LLMs. To improve the CoQ of LLMs, we propose BianQue, a ChatGLM-based LLM finetuned with the self-constructed health conversation dataset BianQueCorpus that is consist of multiple turns of questioning and health suggestions polished by ChatGPT. Experimental results demonstrate that the proposed BianQue can simultaneously balance the capabilities of both questioning and health suggestions, which will help promote the research and application of LLMs in the field of proactive health.

One of the most widely used methods to evaluate LLMs are Multiple Choice Question (MCQ) tests. MCQ benchmarks enable the testing of LLM knowledge on almost any topic at scale as the results can be processed automatically. To help the LLM answer, a few examples called few shots can be included in the prompt. Moreover, the LLM can be asked to answer the question directly with the selected option or to first provide the reasoning and then the selected answer, which is known as chain of thought. In addition to checking whether the selected answer is correct, the evaluation can look at the LLM-estimated probability of its response as an indication of the confidence of the LLM in the response. In this paper, we study how the LLM confidence in its answer depends on whether the model has been asked to answer directly or to provide the reasoning before answering. The results of the evaluation of questions on a wide range of topics in seven different models show that LLMs are more confident in their answers when they provide reasoning before the answer. This occurs regardless of whether the selected answer is correct. Our hypothesis is that this behavior is due to the reasoning that modifies the probability of the selected answer, as the LLM predicts the answer based on the input question and the reasoning that supports the selection made. Therefore, LLM estimated probabilities seem to have intrinsic limitations that should be understood in order to use them in evaluation procedures. Interestingly, the same behavior has been observed in humans, for whom explaining an answer increases confidence in its correctness.

Mental health remains a challenging problem all over the world, with issues like depression, anxiety becoming increasingly common. Large Language Models (LLMs) have seen a vast application in healthcare, specifically in answering medical questions. However, there is a lack of standard benchmarking datasets for question answering (QA) in mental health. Our work presents a novel multiple choice dataset, MHQA (Mental Health Question Answering), for benchmarking Language models (LMs). Previous mental health datasets have focused primarily on text classification into specific labels or disorders. MHQA, on the other hand, presents question-answering for mental health focused on four key domains: anxiety, depression, trauma, and obsessive/compulsive issues, with diverse question types, namely, factoid, diagnostic, prognostic, and preventive. We use PubMed abstracts as the primary source for QA. We develop a rigorous pipeline for LLM-based identification of information from abstracts based on various selection criteria and converting it into QA pairs. Further, valid QA pairs are extracted based on post-hoc validation criteria. Overall, our MHQA dataset consists of 2,475 expert-verified gold standard instances called MHQA-gold and ~56.1k pairs pseudo labeled using external medical references. We report F1 scores on different LLMs along with few-shot and supervised fine-tuning experiments, further discussing the insights for the scores.

We introduce a multi-stage prompting approach (MSP) for the generation of multiple choice questions (MCQs), harnessing the capabilities of GPT models such as text-davinci-003 and GPT-4, renowned for their excellence across various NLP tasks. Our approach incorporates the innovative concept of chain-of-thought prompting, a progressive technique in which the GPT model is provided with a series of interconnected cues to guide the MCQ generation process. Automated evaluations consistently demonstrate the superiority of our proposed MSP method over the traditional single-stage prompting (SSP) baseline, resulting in the production of high-quality distractors. Furthermore, the one-shot MSP technique enhances automatic evaluation results, contributing to improved distractor generation in multiple languages, including English, German, Bengali, and Hindi. In human evaluations, questions generated using our approach exhibit superior levels of grammaticality, answerability, and difficulty, highlighting its efficacy in various languages.

Rapid progress in multimodal large language models (MLLMs) highlights the need to introduce challenging yet realistic benchmarks to the academic community, while existing benchmarks primarily focus on understanding simple natural images and short context. In this paper, we present MULTI as a cutting-edge benchmark for evaluating MLLMs on understanding complex tables and images, and reasoning with long context. MULTI provides multimodal inputs and requires responses that are either precise or open-ended, reflecting real-life examination styles. MULTI includes over 18,000 questions and challenges MLLMs with a variety of tasks, ranging from formula derivation to image detail analysis and cross-modality reasoning. We also introduce MULTI-Elite, a 500-question selected hard subset, and MULTI-Extend, with more than 4,500 external knowledge context pieces. Our evaluation indicates significant potential for MLLM advancement, with GPT-4V achieving a 63.7% accuracy rate on MULTI, in contrast to other MLLMs scoring between 28.5% and 55.3%. MULTI serves not only as a robust evaluation platform but also paves the way for the development of expert-level AI.

Medical benchmark datasets significantly contribute to developing Large Language Models (LLMs) for medical knowledge extraction, diagnosis, summarization, and other uses. Yet, current benchmarks are mainly derived from exam questions given to medical students or cases described in the medical literature, lacking the complexity of real-world patient cases that deviate from classic textbook abstractions. These include rare diseases, uncommon presentations of common diseases, and unexpected treatment responses. Here, we construct Clinically Uncommon Patient Cases and Diagnosis Dataset (CUPCase) based on 3,562 real-world case reports from BMC, including diagnoses in open-ended textual format and as multiple-choice options with distractors. Using this dataset, we evaluate the ability of state-of-the-art LLMs, including both general-purpose and Clinical LLMs, to identify and correctly diagnose a patient case, and test models' performance when only partial information about cases is available. Our findings show that general-purpose GPT-4o attains the best performance in both the multiple-choice task (average accuracy of 87.9%) and the open-ended task (BERTScore F1 of 0.764), outperforming several LLMs with a focus on the medical domain such as Meditron-70B and MedLM-Large. Moreover, GPT-4o was able to maintain 87% and 88% of its performance with only the first 20% of tokens of the case presentation in multiple-choice and free text, respectively, highlighting the potential of LLMs to aid in early diagnosis in real-world cases. CUPCase expands our ability to evaluate LLMs for clinical decision support in an open and reproducible manner.

Large language models (LLMs) in medicine are mainly evaluated using multiple-choice question answering (MCQA), which can overestimate real clinical ability due to guessing strategies and answer biases. To address these limitations, we introduce an expanded and more challenging benchmark based on Polish medical exams, adding over 15,000 questions, two new domains, and four structural modifications that reduce MCQA-specific artifacts and better test reasoning. We evaluate 21 LLMs and show that evaluation design strongly affects results. Under our harder setup, the best model (Qwen3.5-122B) drops by 28.4 and 31 pp on English and Polish exams, respectively. Despite low evidence of data contamination, standard MCQA scores do not reliably reflect true medical competence. To facilitate further research, we make our benchmark publicly available.

Recent advancements in Large Language Models (LLMs) have positioned them as powerful tools for clinical decision-making, with rapidly expanding applications in healthcare. However, concerns about bias remain a significant challenge in the clinical implementation of LLMs, particularly regarding gender and ethnicity. This research investigates the evaluation and mitigation of bias in LLMs applied to complex clinical cases, focusing on gender and ethnicity biases. We introduce a novel Counterfactual Patient Variations (CPV) dataset derived from the JAMA Clinical Challenge. Using this dataset, we built a framework for bias evaluation, employing both Multiple Choice Questions (MCQs) and corresponding explanations. We explore prompting with eight LLMs and fine-tuning as debiasing methods. Our findings reveal that addressing social biases in LLMs requires a multidimensional approach as mitigating gender bias can occur while introducing ethnicity biases, and that gender bias in LLM embeddings varies significantly across medical specialities. We demonstrate that evaluating both MCQ response and explanation processes is crucial, as correct responses can be based on biased reasoning. We provide a framework for evaluating LLM bias in real-world clinical cases, offer insights into the complex nature of bias in these models, and present strategies for bias mitigation.

Polypharmacy, most often defined as the simultaneous consumption of five or more drugs at once, is a prevalent phenomenon in the older population. Some of these polypharmacies, deemed inappropriate, may be associated with adverse health outcomes such as death or hospitalization. Considering the combinatorial nature of the problem as well as the size of claims database and the cost to compute an exact association measure for a given drug combination, it is impossible to investigate every possible combination of drugs. Therefore, we propose to optimize the search for potentially inappropriate polypharmacies (PIPs). To this end, we propose the OptimNeuralTS strategy, based on Neural Thompson Sampling and differential evolution, to efficiently mine claims datasets and build a predictive model of the association between drug combinations and health outcomes. We benchmark our method using two datasets generated by an internally developed simulator of polypharmacy data containing 500 drugs and 100 000 distinct combinations. Empirically, our method can detect up to 72% of PIPs while maintaining an average precision score of 99% using 30 000 time steps.

This paper presents a novel multimodal framework to distinguish between different symptom classes of subjects in the schizophrenia spectrum and healthy controls using audio, video, and text modalities. We implemented Convolution Neural Network and Long Short Term Memory based unimodal models and experimented on various multimodal fusion approaches to come up with the proposed framework. We utilized a minimal Gated multimodal unit (mGMU) to obtain a bi-modal intermediate fusion of the features extracted from the input modalities before finally fusing the outputs of the bimodal fusions to perform subject-wise classifications. The use of mGMU units in the multimodal framework improved the performance in both weighted f1-score and weighted AUC-ROC scores.

Ambient AI scribes draft clinical notes under the reassurance that a clinician signs every note. We audited three commercial AI scribes on the same 142 consultations: 565 notes from recorded UK primary-care and US ambulatory encounters plus authored scenarios. Twelve discovery passes proposed 13,678 candidate errors; the 5,898 clearing an importance filter went to an adversarial panel of two models from different families, each told to refute what it could, and 618 survived. One note in three (31.3% [27.0, 35.6]) carries a verified failure, concentrated in allergy and medication information, invented patient identity, and history written up as examination on telephone consultations that can contain none. No product was given a patient record; setting aside the two classes a record would have prefilled, invented identity and dates, the rate is 24.8% [20.8, 29.0]. One failure mode did not fit our scheme, drawn from published scribe-error taxonomies: a treatment the clinician retracts, recorded as delivered care. Two clinicians adjudicated blind, disjoint samples: a physician author upheld 20 of 21 findings (95.2% [77.3, 99.2]) and an independent clinician, not an author, 12 of 12 ([75.8, 100]); both judged every sampled refusal genuine. A failure rate depends on the instrument as much as the scribes. With model, evidence and settings fixed, the review instruction alone moves the share of candidates verified from 9.3% to 79.0%, and the reviewing family moves it too: alone at that instruction the gentler flags 54.8% of notes against 27.8%. Between 28% and 97% of sampled notes carry a failure depending on the standard. Published audits disagree among themselves by a margin instrument differences alone can produce: omission is 54-86% of their errors against our 23.1%. We release all 618 findings with transcript-side evidence, every prompt and model version, and the re-runnable pipeline.

In recent years, there have been significant breakthroughs in the field of natural language processing, particularly with the development of large language models (LLMs). These LLMs have showcased remarkable capabilities on various benchmarks. In the healthcare field, the exact role LLMs and other future AI models will play remains unclear. There is a potential for these models in the future to be used as part of adaptive physician training, medical co-pilot applications, and digital patient interaction scenarios. The ability of AI models to participate in medical training and patient care will depend in part on their mastery of the knowledge content of specific medical fields. This study investigated the medical knowledge capability of LLMs, specifically in the context of internal medicine subspecialty multiple-choice test-taking ability. We compared the performance of several open-source LLMs (Koala 7B, Falcon 7B, Stable-Vicuna 13B, and Orca Mini 13B), to GPT-4 and Claude 2 on multiple-choice questions in the field of Nephrology. Nephrology was chosen as an example of a particularly conceptually complex subspecialty field within internal medicine. The study was conducted to evaluate the ability of LLM models to provide correct answers to nephSAP (Nephrology Self-Assessment Program) multiple-choice questions. The overall success of open-sourced LLMs in answering the 858 nephSAP multiple-choice questions correctly was 17.1% - 25.5%. In contrast, Claude 2 answered 54.4% of the questions correctly, whereas GPT-4 achieved a score of 73.3%. We show that current widely used open-sourced LLMs do poorly in their ability for zero-shot reasoning when compared to GPT-4 and Claude 2. The findings of this study potentially have significant implications for the future of subspecialty medical training and patient care.

Large Language Models (LLMs) have demonstrated remarkable capabilities in various educational tasks, yet their alignment with human learning patterns, particularly in predicting which incorrect options students are most likely to select in multiple-choice questions (MCQs), remains underexplored. Our work investigates the relationship between LLM generation likelihood and student response distributions in MCQs with a specific focus on distractor selections. We collect a comprehensive dataset of MCQs with real-world student response distributions to explore two fundamental research questions: (1). RQ1 - Do the distractors that students more frequently select correspond to those that LLMs assign higher generation likelihood to? (2). RQ2 - When an LLM selects a incorrect choice, does it choose the same distractor that most students pick? Our experiments reveals moderate correlations between LLM-assigned probabilities and student selection patterns for distractors in MCQs. Additionally, when LLMs make mistakes, they are more likley to select the same incorrect answers that commonly mislead students, which is a pattern consistent across both small and large language models. Our work provides empirical evidence that despite LLMs' strong performance on generating educational content, there remains a gap between LLM's underlying reasoning process and human cognitive processes in identifying confusing distractors. Our findings also have significant implications for educational assessment development. The smaller language models could be efficiently utilized for automated distractor generation as they demonstrate similar patterns in identifying confusing answer choices as larger language models. This observed alignment between LLMs and student misconception patterns opens new opportunities for generating high-quality distractors that complement traditional human-designed distractors.

Large multimodal models (LMMs) are increasingly adopted as judges in multimodal evaluation systems due to their strong instruction following and consistency with human preferences. However, their ability to follow diverse, fine-grained evaluation criteria remains underexplored. We develop Multi-Crit, a benchmark for evaluating multimodal judges on their capacity to follow pluralistic criteria and produce reliable criterion-level judgments. Covering both open-ended generation and verifiable reasoning tasks, Multi-Crit is built through a rigorous data curation pipeline that gathers challenging response pairs with multi-criterion human annotations. It further introduces three novel metrics for systematically assessing pluralistic adherence, criterion-switching flexibility, and the ability to recognize criterion-level preference conflicts. Comprehensive analysis of 25 LMMs reveals that 1) proprietary models still struggle to maintain consistent adherence to pluralistic criteria--especially in open-ended evaluation; 2) open-source models lag further behind in flexibly following diverse criteria; and 3) critic fine-tuning with holistic judgment signals enhances visual grounding but fails to generalize to pluralistic criterion-level judgment. Additional analyses on reasoning fine-tuning, test-time scaling, and boundary consistency between open-source and proprietary models further probe the limits of current multimodal judges. As a pioneering study, Multi-Crit lays the foundation for building reliable and steerable multimodal AI evaluation.

Exam-style accuracy does not establish whether large language models (LLMs) reason well over clinical records. We define clinical reasoning as integrating and updating evidence across time and sources to form, revise and justify a patient's problem representation and a defensible plan. This structured narrative review maps three literatures: medical education assessment instruments, clinical LLM benchmarks published from 2023 onwards, and general-domain methods for evaluating long-form generation. We examine six dimensions: problem representation, temporal synthesis, differential and management reasoning, counterfactual reasoning, calibrated uncertainty, and reasoning faithfulness. Preprints are included and flagged. No single instrument covers all six dimensions. Problem representation and differential or management reasoning are reasonably covered, although reliability varies by instrument and setting. TIMER-Eval targets temporal synthesis, and ER-Reason assesses sequential diagnostic belief updating. Dedicated uncertainty and counterfactual evaluations are emerging, but their applicability to longitudinal free-text reasoning remains limited. Factual completeness is well theorised in general-domain evaluation, with early clinical evidence of important omissions. Faithfulness remains the weakest dimension, with one identified clinical causal-ablation study on multiple-choice questions. Existing tools should be combined through binary rubric items, separate completeness and correctness scores, case-specific importance weighting with non-compensable safety caps, temporal order-consistency checks, and chance-corrected reliability reporting. Further design work is needed for calibrated uncertainty, counterfactual reasoning and faithfulness over longitudinal free-text records. This review provides a design rationale, not a validated instrument.

We present GSM-MC, a multiple-choice (MC) dataset constructed by collecting answers and incorrect predictions on GSM8K from 60 open-source models. Through extensive experiments, we show that LLMs' performance on the MC version of this popular benchmark is strongly correlated with their performance on the original version and is quite robust to distractor choices and option orders, while the evaluation time is reduced by a factor of up to 30. Following similar procedures, we introduce MATH-MC, constructed from MATH, and PythonIO, a new program reasoning MC dataset constructed from HumanEval and MBPP. Experimental results indicate that LLMs' performance on these MC benchmarks leaves much room for improvement. Our data and code are available at https://github.com/Geralt-Targaryen/MC-Evaluation.

Objective: Data unavailability has been one of the biggest barriers in clinical natural language processing. This paper is aimed at providing a large-scale and publicly available patient note dataset, named PMC-Patients, with relevant articles and similar patients annotations. The ultimate goal of PMC-Patients is to facilitate the development of retrieval-based clinical decision support systems. Materials and Methods: To collect PMC-Patients, we extract patient notes from case reports in PubMed Central by recognizing certain section patterns. Patient-article relevance and patient-patient similarity are annotated by citation relationships in PubMed. In addition, we perform three tasks with PMC-Patients to demonstrate its utility in providing clinical decision support for a given patient, including (1) classifying whether another patient is similar, (2) retrieving similar patients in PMC-Patients, and (3) retrieving relevant articles in PubMed. Results: We collect and release PMC-Patients under the CC BY-NC-SA license, which becomes the largest publicly available patient note dataset so far. PMC-Patients contains 167k patient notes that are annotated with 3.1M relevant articles and 293k similar patients. Qualitative and quantitative analyses reveal the high quality and richness of our dataset. Experiments show that classifying the similarity of patient pairs is relatively easy, but it is hard to retrieve similar patients or relevant articles for a given patient from a large set of candidates. Conclusion: We present PMC-Patients, a large-scale dataset of patient notes with high quality, easy access, diverse conditions, and rich annotations. The proposed dataset can also serve as a hard benchmark for evaluating retrieval-based clinical decision support systems.

Multi-modal large language models(MLLMs) have achieved remarkable progress and demonstrated powerful knowledge comprehension and reasoning abilities. However, the mastery of domain-specific knowledge, which is essential for evaluating the intelligence of MLLMs, continues to be a challenge. Current multi-modal benchmarks for domain-specific knowledge concentrate on multiple-choice questions and are predominantly available in English, which imposes limitations on the comprehensiveness of the evaluation. To this end, we introduce CMMU, a novel benchmark for multi-modal and multi-type question understanding and reasoning in Chinese. CMMU consists of 3,603 questions in 7 subjects, covering knowledge from primary to high school. The questions can be categorized into 3 types: multiple-choice, multiple-response, and fill-in-the-blank, bringing greater challenges to MLLMs. In addition, we propose a rigorous evaluation strategy called ShiftCheck for assessing multiple-choice questions. The strategy aims to reduce position bias, minimize the influence of randomness on correctness, and perform a quantitative analysis of position bias. We evaluate seven open-source MLLMs along with GPT4-V, Gemini-Pro, and Qwen-VL-Plus. The results demonstrate that CMMU poses a significant challenge to the recent MLLMs.

LLMs have demonstrated impressive performance in answering medical questions, such as passing scores on medical licensing examinations. However, medical board exam questions or general clinical questions do not capture the complexity of realistic clinical cases. Moreover, the lack of reference explanations means we cannot easily evaluate the reasoning of model decisions, a crucial component of supporting doctors in making complex medical decisions. To address these challenges, we construct two new datasets: JAMA Clinical Challenge and Medbullets. JAMA Clinical Challenge consists of questions based on challenging clinical cases, while Medbullets comprises USMLE Step 2&3 style clinical questions. Both datasets are structured as multiple-choice question-answering tasks, where each question is accompanied by an expert-written explanation. We evaluate four LLMs on the two datasets using various prompts. Experiments demonstrate that our datasets are harder than previous benchmarks. The inconsistency between automatic and human evaluations of model-generated explanations highlights the need to develop new metrics to support future research on explainable medical QA.

Evaluating large language models (LLMs) in the biomedical domain requires benchmarks that can distinguish reasoning from pattern matching and remain discriminative as model capabilities improve. Existing biomedical question answering (QA) benchmarks are limited in this respect. Multiple-choice formats can allow models to succeed through answer elimination rather than inference, while widely circulated exam-style datasets are increasingly vulnerable to performance saturation and training data contamination. Multi-hop reasoning, defined as the ability to integrate information across multiple sources to derive an answer, is central to clinically meaningful tasks such as diagnostic support, literature-based discovery, and hypothesis generation, yet remains underrepresented in current biomedical QA benchmarks. MedHopQA is a disease-centered multi-hop reasoning benchmark consisting of 1,000 expert-curated question-answer pairs introduced as a shared task at BioCreative IX. Each question requires synthesis of information across two distinct Wikipedia articles, and answers are provided in an open-ended free-text format. Gold annotations are augmented with ontology-grounded synonym sets from MONDO, NCBI Gene, and NCBI Taxonomy to support both lexical and concept-level evaluation. MedHopQA was constructed through a structured process combining human annotation, triage, iterative verification, and LLM-as-a-judge validation. To reduce leaderboard gaming and contamination risk, the 1,000 scored questions are embedded within a publicly downloadable set of 10,000 questions, with answers withheld, on a CodaBench leaderboard. MedHopQA provides both a benchmark and a reusable framework for constructing future biomedical QA datasets that prioritize compositional reasoning, saturation resistance, and contamination resistance as core design constraints.

As Large Language Models (LLMs) are nondeterministic, the same input can generate different outputs, some of which may be incorrect or hallucinated. If run again, the LLM may correct itself and produce the correct answer. Unfortunately, most LLM-powered systems resort to single results which, correct or not, users accept. Having the LLM produce multiple outputs may help identify disagreements or alternatives. However, it is not obvious how the user will interpret conflicts or inconsistencies. To this end, we investigate how users perceive the AI model and comprehend the generated information when they receive multiple, potentially inconsistent, outputs. Through a preliminary study, we identified five types of output inconsistencies. Based on these categories, we conducted a study (N=252) in which participants were given one or more LLM-generated passages to an information-seeking question. We found that inconsistency within multiple LLM-generated outputs lowered the participants' perceived AI capacity, while also increasing their comprehension of the given information. Specifically, we observed that this positive effect of inconsistencies was most significant for participants who read two passages, compared to those who read three. Based on these findings, we present design implications that, instead of regarding LLM output inconsistencies as a drawback, we can reveal the potential inconsistencies to transparently indicate the limitations of these models and promote critical LLM usage.

While Multimodal Large Language Models (MLLMs) are widely used for a variety of vision-language tasks, one observation is that they sometimes misinterpret visual inputs or fail to follow textual instructions even in straightforward cases, leading to irrelevant responses, mistakes, and ungrounded claims. This observation is analogous to a phenomenon in neuropsychology known as Agnosia, an inability to correctly process sensory modalities and recognize things (e.g., objects, colors, relations). In our study, we adapt this similar concept to define "agnosia in MLLMs", and our goal is to comprehensively evaluate and mitigate such agnosia in MLLMs. Inspired by the diagnosis and treatment process in neuropsychology, we propose a novel framework EMMA (Evaluation and Mitigation of Multimodal Agnosia). In EMMA, we develop an evaluation module that automatically creates fine-grained and diverse visual question answering examples to assess the extent of agnosia in MLLMs comprehensively. We also develop a mitigation module to reduce agnosia in MLLMs through multimodal instruction tuning on fine-grained conversations. To verify the effectiveness of our framework, we evaluate and analyze agnosia in seven state-of-the-art MLLMs using 9K test samples. The results reveal that most of them exhibit agnosia across various aspects and degrees. We further develop a fine-grained instruction set and tune MLLMs to mitigate agnosia, which led to notable improvement in accuracy.

Large Language Models (LLMs) constitute a breakthrough state-of-the-art Artificial Intelligence (AI) technology which is rapidly evolving and promises to aid in medical diagnosis either by assisting doctors or by simulating a doctor's workflow in more advanced and complex implementations. In this technical paper, we outline Cognitive Network Evaluation Toolkit for Medical Domains (COGNET-MD), which constitutes a novel benchmark for LLM evaluation in the medical domain. Specifically, we propose a scoring-framework with increased difficulty to assess the ability of LLMs in interpreting medical text. The proposed framework is accompanied with a database of Multiple Choice Quizzes (MCQs). To ensure alignment with current medical trends and enhance safety, usefulness, and applicability, these MCQs have been constructed in collaboration with several associated medical experts in various medical domains and are characterized by varying degrees of difficulty. The current (first) version of the database includes the medical domains of Psychiatry, Dentistry, Pulmonology, Dermatology and Endocrinology, but it will be continuously extended and expanded to include additional medical domains.

Despite growing interest in using large language models (LLMs) in healthcare, current explorations do not assess the real-world utility and safety of LLMs in clinical settings. Our objective was to determine whether two LLMs can serve information needs submitted by physicians as questions to an informatics consultation service in a safe and concordant manner. Sixty six questions from an informatics consult service were submitted to GPT-3.5 and GPT-4 via simple prompts. 12 physicians assessed the LLM responses' possibility of patient harm and concordance with existing reports from an informatics consultation service. Physician assessments were summarized based on majority vote. For no questions did a majority of physicians deem either LLM response as harmful. For GPT-3.5, responses to 8 questions were concordant with the informatics consult report, 20 discordant, and 9 were unable to be assessed. There were 29 responses with no majority on "Agree", "Disagree", and "Unable to assess". For GPT-4, responses to 13 questions were concordant, 15 discordant, and 3 were unable to be assessed. There were 35 responses with no majority. Responses from both LLMs were largely devoid of overt harm, but less than 20% of the responses agreed with an answer from an informatics consultation service, responses contained hallucinated references, and physicians were divided on what constitutes harm. These results suggest that while general purpose LLMs are able to provide safe and credible responses, they often do not meet the specific information need of a given question. A definitive evaluation of the usefulness of LLMs in healthcare settings will likely require additional research on prompt engineering, calibration, and custom-tailoring of general purpose models.

A benchmark score credits final answers, but not the route by which an item can be answered. In medical multimodal multiple-choice questions (MCQs), this distinction matters because a correct answer can be supported by the intended image finding or by benchmark-preserved cues in the wording of answers, non-visual clinical text, visible image text, artificial annotations, or device/context artifacts. We call the resulting score-level overinterpretation reasoning inflation. Here, a route is an observable input path that can support answer selection, not a claim about the model's hidden cognition. Across six medical multimodal MCQ datasets, we separate candidate cues from behavioral evidence through prompt- and image-side audits, modality ablations, and matched repairs that preserve the medical target and answer key. In a 13-configuration open-model panel, full-input accuracy is 62.63%, while text-only and options-only settings achieve 53.96% and 29.71%, respectively. Removing length-gap, absolute/conspicuous, and spatial/prepositional cues lowers accuracy by 6.58, 3.50, and 4.77 percentage points. We also construct MedQA-MM, a 1,000-item shortcut-mitigated subset, where text-only and options-only accuracy fall to 5.21% and 12.33%. This does not imply that models never use images; it shows that medical image-reasoning claims require route-level evidence.

Humans are prone to cognitive distortions -- biased thinking patterns that lead to exaggerated responses to specific stimuli, albeit in very different contexts. This paper demonstrates that advanced Multimodal Large Language Models (MLLMs) exhibit similar tendencies. While these models are designed to respond queries under safety mechanism, they sometimes reject harmless queries in the presence of certain visual stimuli, disregarding the benign nature of their contexts. As the initial step in investigating this behavior, we identify three types of stimuli that trigger the oversensitivity of existing MLLMs: Exaggerated Risk, Negated Harm, and Counterintuitive Interpretation. To systematically evaluate MLLMs' oversensitivity to these stimuli, we propose the Multimodal OverSenSitivity Benchmark (MOSSBench). This toolkit consists of 300 manually collected benign multimodal queries, cross-verified by third-party reviewers (AMT). Empirical studies using MOSSBench on 20 MLLMs reveal several insights: (1). Oversensitivity is prevalent among SOTA MLLMs, with refusal rates reaching up to 76% for harmless queries. (2). Safer models are more oversensitive: increasing safety may inadvertently raise caution and conservatism in the model's responses. (3). Different types of stimuli tend to cause errors at specific stages -- perception, intent reasoning, and safety judgement -- in the response process of MLLMs. These findings highlight the need for refined safety mechanisms that balance caution with contextually appropriate responses, improving the reliability of MLLMs in real-world applications. We make our project available at https://turningpoint-ai.github.io/MOSSBench/.

Predictive multiplicity refers to the phenomenon in which classification tasks may admit multiple competing models that achieve almost-equally-optimal performance, yet generate conflicting outputs for individual samples. This presents significant concerns, as it can potentially result in systemic exclusion, inexplicable discrimination, and unfairness in practical applications. Measuring and mitigating predictive multiplicity, however, is computationally challenging due to the need to explore all such almost-equally-optimal models, known as the Rashomon set, in potentially huge hypothesis spaces. To address this challenge, we propose a novel framework that utilizes dropout techniques for exploring models in the Rashomon set. We provide rigorous theoretical derivations to connect the dropout parameters to properties of the Rashomon set, and empirically evaluate our framework through extensive experimentation. Numerical results show that our technique consistently outperforms baselines in terms of the effectiveness of predictive multiplicity metric estimation, with runtime speedup up to 20times sim 5000times. With efficient Rashomon set exploration and metric estimation, mitigation of predictive multiplicity is then achieved through dropout ensemble and model selection.

Large Multimodal Models (LMMs) are increasingly applied to scientific research, yet it remains unclear whether they can reliably understand and reason over the multimodal complexity of papers. A central challenge lies in detecting and resolving inconsistencies across text, figures, tables, and equations, issues that are often subtle, domain-specific, and ultimately undermine clarity, reproducibility, and trust. Existing benchmarks overlook this issue, either isolating single modalities or relying on synthetic errors that fail to capture real-world complexity. We introduce PRISMM-Bench (Peer-Review-sourced Inconsistency Set for Multimodal Models), the first benchmark grounded in real reviewer-flagged inconsistencies in scientific papers. Through a multi-stage pipeline of review mining, LLM-assisted filtering and human verification, we curate 262 inconsistencies from 242 papers. Based on this set, we design three tasks, namely inconsistency identification, remedy and pair matching, which assess a model's capacity to detect, correct, and reason over inconsistencies across different modalities. Furthermore, to address the notorious problem of choice-only shortcuts in multiple-choice evaluation, where models exploit answer patterns without truly understanding the question, we further introduce structured JSON-based answer representations that minimize linguistic biases by reducing reliance on superficial stylistic cues. We benchmark 21 leading LMMs, including large open-weight models (GLM-4.5V 106B, InternVL3 78B) and proprietary models (Gemini 2.5 Pro, GPT-5 with high reasoning). Results reveal strikingly low performance (26.1-54.2%), underscoring the challenge of multimodal scientific reasoning and motivating progress towards trustworthy scientific assistants.

Medical question-answering (QA) is a critical task for evaluating how effectively large language models (LLMs) encode clinical knowledge and assessing their potential applications in medicine. Despite showing promise on multiple-choice tests, LLMs frequently struggle with open-ended medical questions, producing responses with dangerous hallucinations or lacking comprehensive coverage of critical aspects. Existing approaches attempt to address these challenges through domain-specific fine-tuning, but this proves resource-intensive and difficult to scale across models. To improve the comprehensiveness and factuality of medical responses, we propose a novel approach utilizing structured medical reasoning. Our method guides LLMs through an seven-step cognitive process inspired by clinical diagnosis, enabling more accurate and complete answers without additional training. Experiments on the MedLFQA benchmark demonstrate that our approach achieves the highest Factuality Score of 85.8, surpassing fine-tuned models. Notably, this improvement transfers to smaller models, highlighting the method's efficiency and scalability. Our code and datasets are available.

We investigate whether large language models produce different medical triage recommendations for identical neurological symptoms when only the patient's stated gender and age vary. Using three model families--Gemini 3.5 Flash, Claude Sonnet 4.6, and GPT-5.4-mini--we present a standardized symptom profile (persistent headache, blurred vision, morning nausea, visual disturbances) across seven demographic conditions: three age groups (25, 38, 65) x two genders (male, female), plus a gender-unspecified baseline (n = 30 per condition per model, 630 total trials). We find a stark, systemic gender-dependent triage disparity: young women receive significantly lower emergency room (ER) referral rates than age-matched men (Gemini: 0% vs. 23.3%; Claude: 6.7% vs. 96.7%; GPT: 6.7% vs. 66.7%, all p < 0.001). The disparity disappears at age 65 for all models. The primary mechanism is diagnostic substitution: the models anchor on a gender-associated diagnosis, preferentially classifying young women with Idiopathic Intracranial Hypertension (IIH)--a condition epidemiologically linked to women of childbearing age--while diagnosing men with generic increased intracranial pressure with space-occupying lesions in the differential. This diagnostic closure routes female patients to lower-urgency care (outpatient doctor appointments) despite comparable severity ratings (7-9/10). Our findings demonstrate that clinical LLMs replicate documented human clinical biases by using epidemiological priors to suppress triage urgency, suggesting that AI triage engines must decouple urgency assessment from probabilistic diagnostic priors. We release all code, prompts, and raw results.

Background:Speech patterns have emerged as potential diagnostic markers for conditions with varying etiologies. Machine learning (ML) presents an opportunity to harness these patterns for accurate disease diagnosis. Objective: This review synthesized findings from studies exploring ML's capability in leveraging speech for the diagnosis of neurological, laryngeal and mental disorders. Methods: A systematic examination of 564 articles was conducted with 91 articles included in the study, which encompassed a wide spectrum of conditions, ranging from voice pathologies to mental and neurological disorders. Methods for speech classifications were assessed based on the relevant studies and scored between 0-10 based on the reported diagnostic accuracy of their ML models. Results: High diagnostic accuracies were consistently observed for laryngeal disorders, dysarthria, and changes related to speech in Parkinsons disease. These findings indicate the robust potential of speech as a diagnostic tool. Disorders like depression, schizophrenia, mild cognitive impairment and Alzheimers dementia also demonstrated high accuracies, albeit with some variability across studies. Meanwhile, disorders like OCD and autism highlighted the need for more extensive research to ascertain the relationship between speech patterns and the respective conditions. Conclusion: ML models utilizing speech patterns demonstrate promising potential in diagnosing a range of mental, laryngeal, and neurological disorders. However, the efficacy varies across conditions, and further research is needed. The integration of these models into clinical practice could potentially revolutionize the evaluation and diagnosis of a number of different medical conditions.

Large language models (LLMs) are increasingly explored for clinical decision support, yet most evaluations are conducted in English, leaving their reliability in other languages uncertain. Here we evaluate the impact of prompting language on diagnostic reasoning and final diagnosis accuracy by comparing English and French performance across five LLMs (o3, DeepSeek-R1, GPT-4-Turbo, Llama-3.1-405B-Instruct, and BioMistral-7B). A total of 180 clinical vignettes covering 16 medical specialties were assessed by two physicians using an 18-point scale evaluating both diagnosis accuracy and reasoning quality. Four of the five models performed better in English (mean difference 0.37-0.91, adjusted p < 0.05), with the gap spanning multiple aspects of reasoning, including differential diagnosis, logical structure, and internal validity. o3 was the only model showing no overall language effect. These findings demonstrate that prompting language remains a critical determinant of LLM clinical performance, with implications for equitable linguistico-cultural deployment worldwide.

Large language models (LLMs) are capable of generating multiple responses to a single prompt, yet little effort has been expended to help end-users or system designers make use of this capability. In this paper, we explore how to present many LLM responses at once. We design five features, which include both pre-existing and novel methods for computing similarities and differences across textual documents, as well as how to render their outputs. We report on a controlled user study (n=24) and eight case studies evaluating these features and how they support users in different tasks. We find that the features support a wide variety of sensemaking tasks and even make tasks previously considered to be too difficult by our participants now tractable. Finally, we present design guidelines to inform future explorations of new LLM interfaces.

Recent work has highlighted the culturally-contingent nature of commonsense knowledge. We introduce AMAMMER{epsilon}, a test set of 525 multiple-choice questions designed to evaluate the commonsense knowledge of English LLMs, relative to the cultural contexts of Ghana and the United States. To create AMAMMER{epsilon}, we select a set of multiple-choice questions (MCQs) from existing commonsense datasets and rewrite them in a multi-stage process involving surveys of Ghanaian and U.S. participants. In three rounds of surveys, participants from both pools are solicited to (1) write correct and incorrect answer choices, (2) rate individual answer choices on a 5-point Likert scale, and (3) select the best answer choice from the newly-constructed MCQ items, in a final validation step. By engaging participants at multiple stages, our procedure ensures that participant perspectives are incorporated both in the creation and validation of test items, resulting in high levels of agreement within each pool. We evaluate several off-the-shelf English LLMs on AMAMMER{epsilon}. Uniformly, models prefer answers choices that align with the preferences of U.S. annotators over Ghanaian annotators. Additionally, when test items specify a cultural context (Ghana or the U.S.), models exhibit some ability to adapt, but performance is consistently better in U.S. contexts than Ghanaian. As large resources are devoted to the advancement of English LLMs, our findings underscore the need for culturally adaptable models and evaluations to meet the needs of diverse English-speaking populations around the world.

Automatic disease diagnosis has become increasingly valuable in clinical practice. The advent of large language models (LLMs) has catalyzed a paradigm shift in artificial intelligence, with growing evidence supporting the efficacy of LLMs in diagnostic tasks. Despite the increasing attention in this field, a holistic view is still lacking. Many critical aspects remain unclear, such as the diseases and clinical data to which LLMs have been applied, the LLM techniques employed, and the evaluation methods used. In this article, we perform a comprehensive review of LLM-based methods for disease diagnosis. Our review examines the existing literature across various dimensions, including disease types and associated clinical specialties, clinical data, LLM techniques, and evaluation methods. Additionally, we offer recommendations for applying and evaluating LLMs for diagnostic tasks. Furthermore, we assess the limitations of current research and discuss future directions. To our knowledge, this is the first comprehensive review for LLM-based disease diagnosis.

Conversational artificial intelligence has the potential to assist users in preliminary medical consultations, particularly in settings where access to healthcare professionals is limited. However, many existing medical dialogue systems operate in a single-turn question--answering paradigm or rely on template-based datasets, limiting conversational realism and multilingual applicability. In this work, we introduce MedAidDialog, a multilingual multi-turn medical dialogue dataset designed to simulate realistic physician--patient consultations. The dataset extends the MDDial corpus by generating synthetic consultations using large language models and further expands them into a parallel multilingual corpus covering seven languages: English, Hindi, Telugu, Tamil, Bengali, Marathi, and Arabic. Building on this dataset, we develop MedAidLM, a conversational medical model trained using parameter-efficient fine-tuning on quantized small language models, enabling deployment without high-end computational infrastructure. Our framework additionally incorporates optional patient pre-context information (e.g., age, gender, allergies) to personalize the consultation process. Experimental results demonstrate that the proposed system can effectively perform symptom elicitation through multi-turn dialogue and generate diagnostic recommendations. We further conduct medical expert evaluation to assess the plausibility and coherence of the generated consultations.

In the era of modern healthcare, swiftly generating medical question summaries is crucial for informed and timely patient care. Despite the increasing complexity and volume of medical data, existing studies have focused solely on text-based summarization, neglecting the integration of visual information. Recognizing the untapped potential of combining textual queries with visual representations of medical conditions, we introduce the Multimodal Medical Question Summarization (MMQS) Dataset. This dataset, a major contribution to our work, pairs medical queries with visual aids, facilitating a richer and more nuanced understanding of patient needs. We also propose a framework, utilizing the power of Contrastive Language Image Pretraining(CLIP) and Large Language Models(LLMs), consisting of four modules that identify medical disorders, generate relevant context, filter medical concepts, and craft visually aware summaries. Our comprehensive framework harnesses the power of CLIP, a multimodal foundation model, and various general-purpose LLMs, comprising four main modules: the medical disorder identification module, the relevant context generation module, the context filtration module for distilling relevant medical concepts and knowledge, and finally, a general-purpose LLM to generate visually aware medical question summaries. Leveraging our MMQS dataset, we showcase how visual cues from images enhance the generation of medically nuanced summaries. This multimodal approach not only enhances the decision-making process in healthcare but also fosters a more nuanced understanding of patient queries, laying the groundwork for future research in personalized and responsive medical care

Introduction: Electronic health records (EHR) are a critical medium through which patient stigmatization is perpetuated among healthcare teams. Methods: We identified linguistic features of doubt markers and stigmatizing labels in MIMIC-III EHR via expanded lexicon matching and supervised learning classifiers. Predictors of rates of linguistic features were assessed using Poisson regression models. Results: We found higher rates of stigmatizing labels per chart among patients who were Black or African American (RR: 1.16), patients with Medicare/Medicaid or government-run insurance (RR: 2.46), self-pay (RR: 2.12), and patients with a variety of stigmatizing disease and mental health conditions. Patterns among doubt markers were similar, though male patients had higher rates of doubt markers (RR: 1.25). We found increased stigmatizing labels used by nurses (RR: 1.40), and social workers (RR: 2.25), with similar patterns of doubt markers. Discussion: Stigmatizing language occurred at higher rates among historically stigmatized patients, perpetuated by multiple provider types.

Large language models (LLMs) offer a promising pre-screening tool, improving early disease detection and providing enhanced healthcare access for underprivileged communities. The early diagnosis of various diseases continues to be a significant challenge in healthcare, primarily due to the nonspecific nature of early symptoms, the shortage of expert medical practitioners, and the need for prolonged clinical evaluations, all of which can delay treatment and adversely affect patient outcomes. With impressive accuracy in prediction across a range of diseases, LLMs have the potential to revolutionize clinical pre-screening and decision-making for various medical conditions. In this work, we study the diagnostic capability of LLMs for Rheumatoid Arthritis (RA) with real world patients data. Patient data was collected alongside diagnoses from medical experts, and the performance of LLMs was evaluated in comparison to expert diagnoses for RA disease prediction. We notice an interesting pattern in disease diagnosis and find an unexpected misalignment between prediction and explanation. We conduct a series of multi-round analyses using different LLM agents. The best-performing model accurately predicts rheumatoid arthritis (RA) diseases approximately 95\% of the time. However, when medical experts evaluated the reasoning generated by the model, they found that nearly 68\% of the reasoning was incorrect. This study highlights a clear misalignment between LLMs high prediction accuracy and its flawed reasoning, raising important questions about relying on LLM explanations in clinical settings. LLMs provide incorrect reasoning to arrive at the correct answer for RA disease diagnosis.

Biomedical data is inherently multimodal, consisting of electronic health records, medical imaging, digital pathology, genome sequencing, wearable sensors, and more. The application of artificial intelligence tools to these multifaceted sensing technologies has the potential to revolutionize the prognosis, diagnosis, and management of human health and disease. However, current approaches to biomedical AI typically only train and evaluate with one or a small set of medical modalities and tasks. This limitation hampers the development of comprehensive tools that can leverage the rich interconnected information across many heterogeneous biomedical sensors. To address this challenge, we present MultiMed, a benchmark designed to evaluate and enable large-scale learning across a wide spectrum of medical modalities and tasks. MultiMed consists of 2.56 million samples across ten medical modalities such as medical reports, pathology, genomics, and protein data, and is structured into eleven challenging tasks, including disease prognosis, protein structure prediction, and medical question answering. Using MultiMed, we conduct comprehensive experiments benchmarking state-of-the-art unimodal, multimodal, and multitask models. Our analysis highlights the advantages of training large-scale medical models across many related modalities and tasks. Moreover, MultiMed enables studies of generalization across related medical concepts, robustness to real-world noisy data and distribution shifts, and novel modality combinations to improve prediction performance. MultiMed will be publicly available and regularly updated and welcomes inputs from the community.

Medical question answering (QA) benchmarks often focus on multiple-choice or fact-based tasks, leaving open-ended answers to real patient questions underexplored. This gap is particularly critical in mental health, where patient questions often mix symptoms, treatment concerns, and emotional needs, requiring answers that balance clinical caution with contextual sensitivity. We present CounselBench, a large-scale benchmark developed with 100 mental health professionals to evaluate and stress-test large language models (LLMs) in realistic help-seeking scenarios. The first component, CounselBench-EVAL, contains 2,000 expert evaluations of answers from GPT-4, LLaMA 3, Gemini, and online human therapists on patient questions from the public forum CounselChat. Each answer is rated across six clinically grounded dimensions, with span-level annotations and written rationales. Expert evaluations show that while LLMs achieve high scores on several dimensions, they also exhibit recurring issues, including unconstructive feedback, overgeneralization, and limited personalization or relevance. Responses were frequently flagged for safety risks, most notably unauthorized medical advice. Follow-up experiments show that LLM judges systematically overrate model responses and overlook safety concerns identified by human experts. To probe failure modes more directly, we construct CounselBench-Adv, an adversarial dataset of 120 expert-authored mental health questions designed to trigger specific model issues. Expert evaluation of 1,080 responses from nine LLMs reveals consistent, model-specific failure patterns. Together, CounselBench establishes a clinically grounded framework for benchmarking LLMs in mental health QA.

Patients with depression present with diverse symptom profiles, yet clinical practice routinely reduces this variation to a single severity score. Large language models (LLMs) can potentially capture various symptoms and their severity from patient speech. However, how depressive symptoms are represented inside LLMs remains poorly understood, limiting clinical trust. To examine whether internal model activations match clinician judgment, we analyzed the residual stream of Gemma-3-27B-PT using mechanistic interpretability techniques. Recording activations across symptom descriptions drawn from validated clinical instruments, we found that symptom groups geometrically separated the most at layer 21 across multiple distance metrics. Using Semantic Projection, we then projected held-out naturalistic text onto Symptom Vectors constructed from these instruments. The resulting per-symptom coefficients preserved clinician-annotated rank ordering across mood, somatic, and suicidality axes. Furthermore, a single depression vector in Layer 21 separates held-out depressive from non-depressive text (AUC = 0.789), which can be used as an emotional valence gate that restricts symptom projection to depressive speech. These results reveal a decorrelated, clinician-aligned symptom signal readable directly from internal activations, offering a mechanistic foundation for interpretable depression-assessment tools.

Despite the renewed interest in zero-shot visual classification due to the rise of Multimodal Large Language Models (MLLMs), the problem of evaluating free-form responses of auto-regressive models remains a persistent challenge. Most existing works focus on language-only tasks or don't consider Multiple Choice Questions (MCQs) beyond 5-way options, both of which are critical capabilities to solve tasks in Fine-Grained Visual Classification (FGVC) where choice counts are in the hundreds to thousands and the choices are highly related. Furthermore, in this highly multi-way MCQ setting it is not clear how to extend LLM choice extraction to retrieval-based problems, where computing probabilities over the choice set is computationally costly. In this work we investigate nlg2choice, a simple two-stage method which first asks the MLLM an open-ended question for the task with minimal constraints, then uses text-only constrained decoding to predict the most likely choice. In retrieval settings, we compute the probability of the constrained response taking that choice with an early stopping method to significantly improve throughput. Our results show improvement over a suite of seven fine-grained visual datasets when evaluating in terms of classification and retrieval, and show that this performance holds over the various ways that users of LLMs can implement tasks in natural language.

As Large Language Models (LLMs) are increasingly proposed for high-stakes medical applications, there has emerged a critical need for reliable and accurate evaluation methodologies. Traditional accuracy metrics fail inadequately as they neither capture question characteristics nor offer topic-specific insights. To address this gap, we introduce MedIRT, a rigorous evaluation framework grounded in Item Response Theory (IRT), the gold standard in high-stakes educational testing. Unlike previous research relying on archival data, we prospectively gathered fresh responses from 80 diverse LLMs on a balanced, 1,100-question USMLE-aligned benchmark. Using one unidimensional two-parameter logistic IRT model per topic, we estimate LLM's latent model ability jointly with question difficulty and discrimination, yielding more stable and nuanced performance rankings than accuracy alone. Notably, we identify distinctive ``spiky'' ability profiles, where overall rankings can be misleading due to highly specialized model abilities. While GPT-5 was the top performer in a majority of domains (8 of 11), it was outperformed in Social Science and Communication by Claude-3-opus, demonstrating that even an overall 23rd-ranked model can hold the top spot for specific competencies. Furthermore, we demonstrate IRT's utility in auditing benchmarks by identifying flawed questions. We synthesize these findings into a practical decision-support framework that integrates our multi-factor competency profiles with operational metrics. This work establishes a robust, psychometrically grounded methodology essential for the safe, effective, and trustworthy deployment of LLMs in healthcare.

Medical reasoning models (MRMs) achieve superior performance on medical benchmarks compared to medical LLMs; however, high accuracy alone is insufficient for practical deployment. One of such requirements for real-world application is robustness to varying output constraints. Specifically, posing the same medical question while requesting different answer formats should not affect the underlying correctness of the response. We investigate this phenomenon in this paper, focusing on MRMs. To quantify this behavior, we propose the metric answer-format robustness: the ability to reliably generate correct outputs across varying specified formats. We examine three representative formats: multiple-choice, open-ended question-answering, and ranked lists. Across 15 proprietary and open-weight models, we observe substantial variation in format robustness (35-100%). Furthermore, we conduct controlled fine-tuning experiments on a shared backbone with matched training data to isolate the effects of the fine-tuning paradigm. We find that supervised fine-tuning yields more stable behavior across formats, whereas reinforcement fine-tuning often exhibits higher cross-format brittleness, with the degree of instability strongly dependent on reward design. Overall, answer-format robustness in MRMs is trainable yet brittle and requires careful evaluation for practical medical use.

Large Language Models (LLMs) are usually aligned with "human values/preferences" to prevent harmful output. Discussions around the alignment of Large Language Models (LLMs) generally focus on preventing harmful outputs. However, in this paper, we argue that in health-related queries, over-alignment-leading to overly cautious responses-can itself be harmful, especially for people with anxiety and obsessive-compulsive disorder (OCD). This is not only unethical but also dangerous to the user, both mentally and physically. We also showed qualitative results that some LLMs exhibit varying degrees of alignment. Finally, we call for the development of LLMs with stronger reasoning capabilities that provide more tailored and nuanced responses to health queries. Warning: This paper contains materials that could trigger health anxiety or OCD.

Mental disorders are highly prevalent worldwide, but the shortage of psychiatrists and the inherent subjectivity of interview-based diagnosis create substantial barriers to timely and consistent mental-health assessment. Progress in AI-assisted psychiatric diagnosis is constrained by the absence of benchmarks that simultaneously provide realistic patient simulation, clinician-verified diagnostic labels, and support for dynamic multi-turn consultation. We present LingxiDiagBench, a large-scale multi-agent benchmark that evaluates LLMs on both static diagnostic inference and dynamic multi-turn psychiatric consultation in Chinese. At its core is LingxiDiag-16K, a dataset of 16,000 EMR-aligned synthetic consultation dialogues designed to reproduce real clinical demographic and diagnostic distributions across 12 ICD-10 psychiatric categories. Through extensive experiments across state-of-the-art LLMs, we establish key findings: (1) although LLMs achieve high accuracy on binary depression--anxiety classification (up to 92.3%), performance deteriorates substantially for depression--anxiety comorbidity recognition (43.0%) and 12-way differential diagnosis (28.5%); (2) dynamic consultation often underperforms static evaluation, indicating that ineffective information-gathering strategies significantly impair downstream diagnostic reasoning; (3) consultation quality assessed by LLM-as-a-Judge shows only moderate correlation with diagnostic accuracy, suggesting that well-structured questioning alone does not ensure correct diagnostic decisions. We release LingxiDiag-16K and the full evaluation framework to support reproducible research at https://github.com/Lingxi-mental-health/LingxiDiagBench.

Recent advancements in large language model(LLM) performance on medical multiple choice question (MCQ) benchmarks have stimulated interest from healthcare providers and patients globally. Particularly in low-and middle-income countries (LMICs) facing acute physician shortages and lack of specialists, LLMs offer a potentially scalable pathway to enhance healthcare access and reduce costs. However, their effectiveness in the Global South, especially across the African continent, remains to be established. In this work, we introduce AfriMed-QA, the first large scale Pan-African English multi-specialty medical Question-Answering (QA) dataset, 15,000 questions (open and closed-ended) sourced from over 60 medical schools across 16 countries, covering 32 medical specialties. We further evaluate 30 LLMs across multiple axes including correctness and demographic bias. Our findings show significant performance variation across specialties and geographies, MCQ performance clearly lags USMLE (MedQA). We find that biomedical LLMs underperform general models and smaller edge-friendly LLMs struggle to achieve a passing score. Interestingly, human evaluations show a consistent consumer preference for LLM answers and explanations when compared with clinician answers.

Depression, a prevalent mental health disorder impacting millions globally, demands reliable assessment systems. Unlike previous studies that focus solely on either detecting depression or predicting its severity, our work identifies individual symptoms of depression while also predicting its severity using speech input. We leverage self-supervised learning (SSL)-based speech models to better utilize the small-sized datasets that are frequently encountered in this task. Our study demonstrates notable performance improvements by utilizing SSL embeddings compared to conventional speech features. We compare various types of SSL pretrained models to elucidate the type of speech information (semantic, speaker, or prosodic) that contributes the most in identifying different symptoms. Additionally, we evaluate the impact of combining multiple SSL embeddings on performance. Furthermore, we show the significance of multi-task learning for identifying depressive symptoms effectively.

Recent advances in multimodal large language models enable new possibilities for image-based decision support. However, their reliability and operational trade-offs in neuroimaging remain insufficiently understood. We present a comprehensive benchmarking study of vision-enabled large language models for 2D neuroimaging using curated MRI and CT datasets covering multiple sclerosis, stroke, brain tumors, other abnormalities, and normal controls. Models are required to generate multiple outputs simultaneously, including diagnosis, diagnosis subtype, imaging modality, specialized sequence, and anatomical plane. Performance is evaluated across four directions: discriminative classification with abstention, calibration, structured-output validity, and computational efficiency. A multi-phase framework ensures fair comparison while controlling for selection bias. Across twenty frontier multimodal models, the results show that technical imaging attributes such as modality and plane are nearly solved, whereas diagnostic reasoning, especially subtype prediction, remains challenging. Tumor classification emerges as the most reliable task, stroke is moderately solvable, while multiple sclerosis and rare abnormalities remain difficult. Few-shot prompting improves performance for several models but increases token usage, latency, and cost. Gemini-2.5-Pro and GPT-5-Chat achieve the strongest overall diagnostic performance, while Gemini-2.5-Flash offers the best efficiency-performance trade-off. Among open-weight architectures, MedGemma-1.5-4B demonstrates the most promising results, as under few-shot prompting, it approaches the zero-shot performance of several proprietary models, while maintaining perfect structured output. These findings provide practical insights into performance, reliability, and efficiency trade-offs, supporting standardized evaluation of multimodal LLMs in neuroimaging.

In an educational setting, an estimate of the difficulty of multiple-choice questions (MCQs), a commonly used strategy to assess learning progress, constitutes very useful information for both teachers and students. Since human assessment is costly from multiple points of view, automatic approaches to MCQ item difficulty estimation are investigated, yielding however mixed success until now. Our approach to this problem takes a different angle from previous work: asking various Large Language Models to tackle the questions included in two different MCQ datasets, we leverage model uncertainty to estimate item difficulty. By using both model uncertainty features as well as textual features in a Random Forest regressor, we show that uncertainty features contribute substantially to difficulty prediction, where difficulty is inversely proportional to the number of students who can correctly answer a question. In addition to showing the value of our approach, we also observe that our model achieves state-of-the-art results on the BEA publicly available dataset.

Despite the existence of various benchmarks for evaluating natural language processing models, we argue that human exams are a more suitable means of evaluating general intelligence for large language models (LLMs), as they inherently demand a much wider range of abilities such as language understanding, domain knowledge, and problem-solving skills. To this end, we introduce M3Exam, a novel benchmark sourced from real and official human exam questions for evaluating LLMs in a multilingual, multimodal, and multilevel context. M3Exam exhibits three unique characteristics: (1) multilingualism, encompassing questions from multiple countries that require strong multilingual proficiency and cultural knowledge; (2) multimodality, accounting for the multimodal nature of many exam questions to test the model's multimodal understanding capability; and (3) multilevel structure, featuring exams from three critical educational periods to comprehensively assess a model's proficiency at different levels. In total, M3Exam contains 12,317 questions in 9 diverse languages with three educational levels, where about 23\% of the questions require processing images for successful solving. We assess the performance of top-performing LLMs on M3Exam and find that current models, including GPT-4, still struggle with multilingual text, particularly in low-resource and non-Latin script languages. Multimodal LLMs also perform poorly with complex multimodal questions. We believe that M3Exam can be a valuable resource for comprehensively evaluating LLMs by examining their multilingual and multimodal abilities and tracking their development. Data and evaluation code is available at https://github.com/DAMO-NLP-SG/M3Exam.

Multiple-choice questions (MCQ) are frequently used to assess large language models (LLMs). Typically, an LLM is given a question and selects the answer deemed most probable after adjustments for factors like length. Unfortunately, LLMs may inherently favor certain answer choice IDs, such as A/B/C/D, due to inherent biases of priori unbalanced probabilities, influencing the prediction of answers based on these IDs. Previous research has introduced methods to reduce this ''selection bias'' by simply permutating options on a few test samples and applying to new ones. Another problem of MCQ is the lottery ticket choice by ''random guessing''. The LLM does not learn particular knowledge, but the option is guessed correctly. This situation is especially serious for those small-scale LLMs. To address them, a more thorough approach involves shifting from MCQ to open-style questions, which can fundamentally eliminate selection bias and random guessing issues. However, transitioning causes its own set of challenges in (1) identifying suitable open-style questions and (2) validating the correctness of LLM open-style responses against human-annotated ground-truths. This work aims to tackle these significant difficulties, and establish a new LLM evaluation benchmark through entirely open-style questions. Consequently, we introduce the Open-LLM-Leaderboard to track various LLMs' performance and reflect true capability of them, such as GPT-4o/4/3.5, Claude 3, Gemini, etc. Our code and dataset are available at https://github.com/VILA-Lab/Open-LLM-Leaderboard.

Multimodal/vision language models (VLMs) are increasingly being deployed in healthcare settings worldwide, necessitating robust benchmarks to ensure their safety, efficacy, and fairness. Multiple-choice question and answer (QA) datasets derived from national medical examinations have long served as valuable evaluation tools, but existing datasets are largely text-only and available in a limited subset of languages and countries. To address these challenges, we present WorldMedQA-V, an updated multilingual, multimodal benchmarking dataset designed to evaluate VLMs in healthcare. WorldMedQA-V includes 568 labeled multiple-choice QAs paired with 568 medical images from four countries (Brazil, Israel, Japan, and Spain), covering original languages and validated English translations by native clinicians, respectively. Baseline performance for common open- and closed-source models are provided in the local language and English translations, and with and without images provided to the model. The WorldMedQA-V benchmark aims to better match AI systems to the diverse healthcare environments in which they are deployed, fostering more equitable, effective, and representative applications.

This paper introduces FrenchMedMCQA, the first publicly available Multiple-Choice Question Answering (MCQA) dataset in French for medical domain. It is composed of 3,105 questions taken from real exams of the French medical specialization diploma in pharmacy, mixing single and multiple answers. Each instance of the dataset contains an identifier, a question, five possible answers and their manual correction(s). We also propose first baseline models to automatically process this MCQA task in order to report on the current performances and to highlight the difficulty of the task. A detailed analysis of the results showed that it is necessary to have representations adapted to the medical domain or to the MCQA task: in our case, English specialized models yielded better results than generic French ones, even though FrenchMedMCQA is in French. Corpus, models and tools are available online.

Multiple choice benchmarks have long been the workhorse of language model evaluation because grading multiple choice is objective and easy to automate. However, we show multiple choice questions from popular benchmarks can often be answered without even seeing the question. These shortcuts arise from a fundamental limitation of discriminative evaluation not shared by evaluations of the model's free-form, generative answers. Until recently, there appeared to be no viable, scalable alternative to multiple choice--but, we show that this has changed. We consider generative evaluation via what we call answer matching: Give the candidate model the question without the options, have it generate a free-form response, then use a modern language model with the reference answer to determine if the response matches the reference. To compare the validity of different evaluation strategies, we annotate MMLU-Pro and GPQA-Diamond to obtain human grading data, and measure the agreement of each evaluation approach. We find answer matching using recent models--even small ones--achieves near-perfect agreement, in the range of inter-annotator agreement. In contrast, both multiple choice evaluation and using LLM-as-a-judge without reference answers aligns poorly with human grading. Improving evaluations via answer matching is not merely a conceptual concern: the rankings of several models change significantly when evaluating their free-form responses with answer matching. In light of these findings, we discuss how to move the evaluation ecosystem from multiple choice to answer matching.

State of the art large language models (LLMs) have shown impressive performance on a variety of benchmark tasks and are increasingly used as components in larger applications, where LLM-based predictions serve as proxies for human judgements or decision. This raises questions about the human-likeness of LLM-derived information, alignment with human intuition, and whether LLMs could possibly be considered (parts of) explanatory models of (aspects of) human cognition or language use. To shed more light on these issues, we here investigate the human-likeness of LLMs' predictions for multiple-choice decision tasks from the perspective of Bayesian statistical modeling. Using human data from a forced-choice experiment on pragmatic language use, we find that LLMs do not capture the variance in the human data at the item-level. We suggest different ways of deriving full distributional predictions from LLMs for aggregate, condition-level data, and find that some, but not all ways of obtaining condition-level predictions yield adequate fits to human data. These results suggests that assessment of LLM performance depends strongly on seemingly subtle choices in methodology, and that LLMs are at best predictors of human behavior at the aggregate, condition-level, for which they are, however, not designed to, or usually used to, make predictions in the first place.

Large Language Models (LLMs) are increasingly being used to summarize and verify claims in critical sources that inform consequential decisions. Such claims are full of plural definites. If three of five patients improved after taking drug A, the claim the patients improved after drug A is not true, since two did not, yet its negation, the patients didn't improve after drug A, is not true either, since three did. In formal semantics, this truth-value gap is known as the Homogeneity Gap: both the plural definite and its negation are neither true nor false when the property holds for only a fraction of the plural referent. A model that cannot represent this gap turns mixed evidence into a clean verdict, an error that can be costly in high-stakes use. We introduce HomogeneityNLI, a diagnostic dataset of 1,000 minimal pair items crossing determiner, polarity, and group composition across ten logical conditions. Evaluating seven open-weight models, we uncover a pervasive Bivalence Bias: models assign plural definites their homogeneous truth conditions. In the zero-shot setting, no model recognizes the gap for both polarities in more than 15% of scenarios, and negated definites are judged False in 84% of cases. Explicit linguistic rules, chain-of-thought, and enumeration prompts produce unstable, model-specific effects that often entrench the bias. Our findings indicate that current open-weight LLMs acquire the truth conditions of plural predication but not its trivalent logic, and cannot yet be trusted to summarize or verify claims whose evidence is mixed.

Large language models (LLMs) are rapidly transitioning into medical clinical use, yet their reliability under realistic, multi-turn interactions remains poorly understood. Existing evaluation frameworks typically assess single-turn question answering under idealized conditions, overlooking the complexities of medical consultations where conflicting input, misleading context, and authority influence are common. We introduce MedQA-Followup, a framework for systematically evaluating multi-turn robustness in medical question answering. Our approach distinguishes between shallow robustness (resisting misleading initial context) and deep robustness (maintaining accuracy when answers are challenged across turns), while also introducing an indirect-direct axis that separates contextual framing (indirect) from explicit suggestion (direct). Using controlled interventions on the MedQA dataset, we evaluate five state-of-the-art LLMs and find that while models perform reasonably well under shallow perturbations, they exhibit severe vulnerabilities in multi-turn settings, with accuracy dropping from 91.2% to as low as 13.5% for Claude Sonnet 4. Counterintuitively, indirect, context-based interventions are often more harmful than direct suggestions, yielding larger accuracy drops across models and exposing a significant vulnerability for clinical deployment. Further compounding analyses reveal model differences, with some showing additional performance drops under repeated interventions while others partially recovering or even improving. These findings highlight multi-turn robustness as a critical but underexplored dimension for safe and reliable deployment of medical LLMs.

As the field of artificial intelligence progresses, assistive technologies are becoming more widely used across all industries. The healthcare industry is no different, with numerous studies being done to develop assistive tools for healthcare professionals. Automatic diagnostic systems are one such beneficial tool that can assist with a variety of tasks, including collecting patient information, analyzing test results, and diagnosing patients. However, the idea of developing systems that can provide a differential diagnosis has been largely overlooked in most of these research studies. In this study, we propose a transformer-based approach for providing differential diagnoses based on a patient's age, sex, medical history, and symptoms. We use the DDXPlus dataset, which provides differential diagnosis information for patients based on 49 disease types. Firstly, we propose a method to process the tabular patient data from the dataset and engineer them into patient reports to make them suitable for our research. In addition, we introduce two data modification modules to diversify the training data and consequently improve the robustness of the models. We approach the task as a multi-label classification problem and conduct extensive experiments using four transformer models. All the models displayed promising results by achieving over 97% F1 score on the held-out test set. Moreover, we design additional behavioral tests to get a broader understanding of the models. In particular, for one of our test cases, we prepared a custom test set of 100 samples with the assistance of a doctor. The results on the custom set showed that our proposed data modification modules improved the model's generalization capabilities. We hope our findings will provide future researchers with valuable insights and inspire them to develop reliable systems for automatic differential diagnosis.

Traditionally, AI research in medical diagnosis has largely centered on image analysis. While this has led to notable advancements, the absence of patient-reported symptoms continues to hinder diagnostic accuracy. To address this, we propose a Pre-Consultation Dialogue Framework (PCDF) that mimics real-world diagnostic procedures, where doctors iteratively query patients before reaching a conclusion. Specifically, we simulate diagnostic dialogues between two vision-language models (VLMs): a DocVLM, which generates follow-up questions based on the image and dialogue history, and a PatientVLM, which responds using a symptom profile derived from the ground-truth diagnosis. We additionally conducted a small-scale clinical validation of the synthetic symptoms generated by our framework, with licensed clinicians confirming their clinical relevance, symptom coverage, and overall realism. These findings indicate that the resulting DocVLM-PatientVLM interactions form coherent, multi-turn consultations paired with images and diagnoses, which we then use to fine-tune the DocVLM. This dialogue-based supervision leads to substantial gains over image-only training, highlighting the value of realistic symptom elicitation for diagnosis.

Large language models (LLMs) have demonstrated remarkable capabilities in natural language understanding and generation across various domains, including medicine. We present a comprehensive evaluation of GPT-4, a state-of-the-art LLM, on medical competency examinations and benchmark datasets. GPT-4 is a general-purpose model that is not specialized for medical problems through training or engineered to solve clinical tasks. Our analysis covers two sets of official practice materials for the USMLE, a three-step examination program used to assess clinical competency and grant licensure in the United States. We also evaluate performance on the MultiMedQA suite of benchmark datasets. Beyond measuring model performance, experiments were conducted to investigate the influence of test questions containing both text and images on model performance, probe for memorization of content during training, and study probability calibration, which is of critical importance in high-stakes applications like medicine. Our results show that GPT-4, without any specialized prompt crafting, exceeds the passing score on USMLE by over 20 points and outperforms earlier general-purpose models (GPT-3.5) as well as models specifically fine-tuned on medical knowledge (Med-PaLM, a prompt-tuned version of Flan-PaLM 540B). In addition, GPT-4 is significantly better calibrated than GPT-3.5, demonstrating a much-improved ability to predict the likelihood that its answers are correct. We also explore the behavior of the model qualitatively through a case study that shows the ability of GPT-4 to explain medical reasoning, personalize explanations to students, and interactively craft new counterfactual scenarios around a medical case. Implications of the findings are discussed for potential uses of GPT-4 in medical education, assessment, and clinical practice, with appropriate attention to challenges of accuracy and safety.

Commonly used evaluation measures including Recall, Precision, F-Measure and Rand Accuracy are biased and should not be used without clear understanding of the biases, and corresponding identification of chance or base case levels of the statistic. Using these measures a system that performs worse in the objective sense of Informedness, can appear to perform better under any of these commonly used measures. We discuss several concepts and measures that reflect the probability that prediction is informed versus chance. Informedness and introduce Markedness as a dual measure for the probability that prediction is marked versus chance. Finally we demonstrate elegant connections between the concepts of Informedness, Markedness, Correlation and Significance as well as their intuitive relationships with Recall and Precision, and outline the extension from the dichotomous case to the general multi-class case.

We introduce KorMedMCQA, the first Korean multiple-choice question answering (MCQA) benchmark derived from Korean healthcare professional licensing examinations, covering from the year 2012 to year 2023. This dataset consists of a selection of questions from the license examinations for doctors, nurses, and pharmacists, featuring a diverse array of subjects. We conduct baseline experiments on various large language models, including proprietary/open-source, multilingual/Korean-additional pretrained, and clinical context pretrained models, highlighting the potential for further enhancements. We make our data publicly available on HuggingFace and provide a evaluation script via LM-Harness, inviting further exploration and advancement in Korean healthcare environments.

Learning disorders are neurological conditions that affect the brain's ability to interconnect communication areas. Dyslexic students experience problems with reading, memorizing, and exposing concepts; however the magnitude of these can be mitigated through both therapies and the creation of compensatory mechanisms. Several efforts have been made to mitigate these issues, leading to the creation of digital resources for students with specific learning disorders attending primary and secondary education levels. Conversely, a standard approach is still missed in higher education. The VRAIlexia project has been created to tackle this issue by proposing two different tools: a mobile application integrating virtual reality (VR) to collect data quickly and easily, and an artificial intelligencebased software (AI) to analyze the collected data for customizing the supporting methodology for each student. The first one has been created and is being distributed among dyslexic students in Higher Education Institutions, for the conduction of specific psychological and psychometric tests. The second tool applies specific artificial intelligence algorithms to the data gathered via the application and other surveys. These AI techniques have allowed us to identify the most relevant difficulties faced by the students' cohort. Our different models have obtained around 90\% mean accuracy for predicting the support tools and learning strategies.

Multimodal language models (MLMs) show promise for clinical decision support and diagnostic reasoning, raising the prospect of end-to-end automated medical image interpretation. However, clinicians are highly selective in adopting AI tools; a model that makes errors on seemingly simple perception tasks such as determining image orientation or identifying whether a CT scan is contrast-enhance are unlikely to be adopted for clinical tasks. We introduce Medblink, a benchmark designed to probe these models for such perceptual abilities. Medblink spans eight clinically meaningful tasks across multiple imaging modalities and anatomical regions, totaling 1,429 multiple-choice questions over 1,605 images. We evaluate 19 state-of-the-art MLMs, including general purpose (GPT4o, Claude 3.5 Sonnet) and domain specific (Med Flamingo, LLaVA Med, RadFM) models. While human annotators achieve 96.4% accuracy, the best-performing model reaches only 65%. These results show that current MLMs frequently fail at routine perceptual checks, suggesting the need to strengthen their visual grounding to support clinical adoption. Data is available on our project page.

Traditional Chinese Medicine (TCM), as an effective alternative medicine, has been receiving increasing attention. In recent years, the rapid development of large language models (LLMs) tailored for TCM has underscored the need for an objective and comprehensive evaluation framework to assess their performance on real-world tasks. However, existing evaluation datasets are limited in scope and primarily text-based, lacking a unified and standardized multimodal question-answering (QA) benchmark. To address this issue, we introduce TCM-Ladder, the first multimodal QA dataset specifically designed for evaluating large TCM language models. The dataset spans multiple core disciplines of TCM, including fundamental theory, diagnostics, herbal formulas, internal medicine, surgery, pharmacognosy, and pediatrics. In addition to textual content, TCM-Ladder incorporates various modalities such as images and videos. The datasets were constructed using a combination of automated and manual filtering processes and comprise 52,000+ questions in total. These questions include single-choice, multiple-choice, fill-in-the-blank, diagnostic dialogue, and visual comprehension tasks. We trained a reasoning model on TCM-Ladder and conducted comparative experiments against 9 state-of-the-art general domain and 5 leading TCM-specific LLMs to evaluate their performance on the datasets. Moreover, we propose Ladder-Score, an evaluation method specifically designed for TCM question answering that effectively assesses answer quality regarding terminology usage and semantic expression. To our knowledge, this is the first work to evaluate mainstream general domain and TCM-specific LLMs on a unified multimodal benchmark. The datasets and leaderboard are publicly available at https://tcmladder.com or https://54.211.107.106 and will be continuously updated.

The growing capabilities of large language models (LLMs) have led to their use as substitutes for human feedback for training and assessing other LLMs. These methods often rely on `constitutions', written guidelines which a critic model uses to provide feedback and improve generations. We investigate how the choice of constitution affects feedback quality by using four different constitutions to improve patient-centered communication in medical interviews. In pairwise comparisons conducted by 215 human raters, we found that detailed constitutions led to better results regarding emotive qualities. However, none of the constitutions outperformed the baseline in learning more practically-oriented skills related to information gathering and provision. Our findings indicate that while detailed constitutions should be prioritised, there are possible limitations to the effectiveness of AI feedback as a reward signal in certain areas.

Multimodal in-context learning (ICL) remains underexplored despite significant potential for domains such as medicine. Clinicians routinely encounter diverse, specialized tasks requiring adaptation from limited examples, such as drawing insights from a few relevant prior cases or considering a constrained set of differential diagnoses. While multimodal large language models (MLLMs) have shown advances in medical visual question answering (VQA), their ability to learn multimodal tasks from context is largely unknown. We introduce SMMILE, the first expert-driven multimodal ICL benchmark for medical tasks. Eleven medical experts curated problems, each including a multimodal query and multimodal in-context examples as task demonstrations. SMMILE encompasses 111 problems (517 question-image-answer triplets) covering 6 medical specialties and 13 imaging modalities. We further introduce SMMILE++, an augmented variant with 1038 permuted problems. A comprehensive evaluation of 15 MLLMs demonstrates that most models exhibit moderate to poor multimodal ICL ability in medical tasks. In open-ended evaluations, ICL contributes only 8% average improvement over zero-shot on SMMILE and 9.4% on SMMILE++. We observe a susceptibility for irrelevant in-context examples: even a single noisy or irrelevant example can degrade performance by up to 9.5%. Moreover, example ordering exhibits a recency bias, i.e., placing the most relevant example last can lead to substantial performance improvements by up to 71%. Our findings highlight critical limitations and biases in current MLLMs when learning multimodal medical tasks from context.

Recently, large language model (LLM) based artificial intelligence (AI) systems have demonstrated remarkable capabilities in natural language understanding and generation. However, these models face a significant challenge when it comes to sensitive applications, such as reasoning over medical knowledge and answering medical questions in a physician-like manner. Prior studies attempted to overcome this challenge by increasing the model size (>100B) to learn more general medical knowledge, while there is still room for improvement in LLMs with smaller-scale model sizes (<100B). In this work, we start from a pre-trained general LLM model (AntGLM-10B) and fine-tune it from a medical beginner towards a medical expert (called AntGLM-Med-10B), which leverages a 3-stage optimization procedure, i.e., general medical knowledge injection, medical domain instruction tuning, and specific medical task adaptation. Our contributions are threefold: (1) We specifically investigate how to adapt a pre-trained general LLM in medical domain, especially for a specific medical task. (2) We collect and construct large-scale medical datasets for each stage of the optimization process. These datasets encompass various data types and tasks, such as question-answering, medical reasoning, multi-choice questions, and medical conversations. (3) Specifically for multi-choice questions in the medical domain, we propose a novel Verification-of-Choice approach for prompting engineering, which significantly enhances the reasoning ability of LLMs. Remarkably, by combining the above approaches, our AntGLM-Med-10B model can outperform the most of LLMs on PubMedQA, including both general and medical LLMs, even when these LLMs have larger model size.

Peer assessment has been widely applied across diverse academic fields over the last few decades and has demonstrated its effectiveness. However, the advantages of peer assessment can only be achieved with high-quality peer reviews. Previous studies have found that high-quality review comments usually comprise several features (e.g., contain suggestions, mention problems, use a positive tone). Thus, researchers have attempted to evaluate peer-review comments by detecting different features using various machine learning and deep learning models. However, there is no single study that investigates using a multi-task learning (MTL) model to detect multiple features simultaneously. This paper presents two MTL models for evaluating peer-review comments by leveraging the state-of-the-art pre-trained language representation models BERT and DistilBERT. Our results demonstrate that BERT-based models significantly outperform previous GloVe-based methods by around 6% in F1-score on tasks of detecting a single feature, and MTL further improves performance while reducing model size.

Generalist Large Language Models (LLMs), such as GPT-4, have shown considerable promise in various domains, including medical diagnosis. Rare diseases, affecting approximately 300 million people worldwide, often have unsatisfactory clinical diagnosis rates primarily due to a lack of experienced physicians and the complexity of differentiating among many rare diseases. In this context, recent news such as "ChatGPT correctly diagnosed a 4-year-old's rare disease after 17 doctors failed" underscore LLMs' potential, yet underexplored, role in clinically diagnosing rare diseases. To bridge this research gap, we introduce RareBench, a pioneering benchmark designed to systematically evaluate the capabilities of LLMs on 4 critical dimensions within the realm of rare diseases. Meanwhile, we have compiled the largest open-source dataset on rare disease patients, establishing a benchmark for future studies in this domain. To facilitate differential diagnosis of rare diseases, we develop a dynamic few-shot prompt methodology, leveraging a comprehensive rare disease knowledge graph synthesized from multiple knowledge bases, significantly enhancing LLMs' diagnostic performance. Moreover, we present an exhaustive comparative study of GPT-4's diagnostic capabilities against those of specialist physicians. Our experimental findings underscore the promising potential of integrating LLMs into the clinical diagnostic process for rare diseases. This paves the way for exciting possibilities in future advancements in this field.

This work introduces MediQAl, a French medical question answering dataset designed to evaluate the capabilities of language models in factual medical recall and reasoning over real-world clinical scenarios. MediQAl contains 32,603 questions sourced from French medical examinations across 41 medical subjects. The dataset includes three tasks: (i) Multiple-Choice Question with Unique answer, (ii) Multiple-Choice Question with Multiple answer, and (iii) Open-Ended Question with Short-Answer. Each question is labeled as Understanding or Reasoning, enabling a detailed analysis of models' cognitive capabilities. We validate the MediQAl dataset through extensive evaluation with 14 large language models, including recent reasoning-augmented models, and observe a significant performance gap between factual recall and reasoning tasks. Our evaluation provides a comprehensive benchmark for assessing language models' performance on French medical question answering, addressing a crucial gap in multilingual resources for the medical domain.

Machine learning models are often used to inform real world risk assessment tasks: predicting consumer default risk, predicting whether a person suffers from a serious illness, or predicting a person's risk to appear in court. Given multiple models that perform almost equally well for a prediction task, to what extent do predictions vary across these models? If predictions are relatively consistent for similar models, then the standard approach of choosing the model that optimizes a penalized loss suffices. But what if predictions vary significantly for similar models? In machine learning, this is referred to as predictive multiplicity i.e. the prevalence of conflicting predictions assigned by near-optimal competing models. In this paper, we present a framework for measuring predictive multiplicity in probabilistic classification (predicting the probability of a positive outcome). We introduce measures that capture the variation in risk estimates over the set of competing models, and develop optimization-based methods to compute these measures efficiently and reliably for convex empirical risk minimization problems. We demonstrate the incidence and prevalence of predictive multiplicity in real-world tasks. Further, we provide insight into how predictive multiplicity arises by analyzing the relationship between predictive multiplicity and data set characteristics (outliers, separability, and majority-minority structure). Our results emphasize the need to report predictive multiplicity more widely.

Discharge summaries in Electronic Health Records (EHRs) are crucial for clinical decision-making, but their length and complexity make information extraction challenging, especially when dealing with accumulated summaries across multiple patient admissions. Large Language Models (LLMs) show promise in addressing this challenge by efficiently analyzing vast and complex data. Existing benchmarks, however, fall short in properly evaluating LLMs' capabilities in this context, as they typically focus on single-note information or limited topics, failing to reflect the real-world inquiries required by clinicians. To bridge this gap, we introduce EHRNoteQA, a novel benchmark built on the MIMIC-IV EHR, comprising 962 different QA pairs each linked to distinct patients' discharge summaries. Every QA pair is initially generated using GPT-4 and then manually reviewed and refined by three clinicians to ensure clinical relevance. EHRNoteQA includes questions that require information across multiple discharge summaries and covers eight diverse topics, mirroring the complexity and diversity of real clinical inquiries. We offer EHRNoteQA in two formats: open-ended and multi-choice question answering, and propose a reliable evaluation method for each. We evaluate 27 LLMs using EHRNoteQA and examine various factors affecting the model performance (e.g., the length and number of discharge summaries). Furthermore, to validate EHRNoteQA as a reliable proxy for expert evaluations in clinical practice, we measure the correlation between the LLM performance on EHRNoteQA, and the LLM performance manually evaluated by clinicians. Results show that LLM performance on EHRNoteQA have higher correlation with clinician-evaluated performance (Spearman: 0.78, Kendall: 0.62) compared to other benchmarks, demonstrating its practical relevance in evaluating LLMs in clinical settings.

This research tests the role of Large Language Models (LLMs) as formal second opinion tools in professional decision-making, particularly focusing on complex medical cases where even experienced physicians seek peer consultation. The work analyzed 183 challenging medical cases from Medscape over a 20-month period, testing multiple LLMs' performance against crowd-sourced physician responses. A key finding was the high overall score possible in the latest foundational models (>80% accuracy compared to consensus opinion), which exceeds most human metrics reported on the same clinical cases (450 pages of patient profiles, test results). The study rates the LLMs' performance disparity between straightforward cases (>81% accuracy) and complex scenarios (43% accuracy), particularly in these cases generating substantial debate among human physicians. The research demonstrates that LLMs may be valuable as generators of comprehensive differential diagnoses rather than as primary diagnostic tools, potentially helping to counter cognitive biases in clinical decision-making, reduce cognitive loads, and thus remove some sources of medical error. The inclusion of a second comparative legal dataset (Supreme Court cases, N=21) provides added empirical context to the AI use to foster second opinions, though these legal challenges proved considerably easier for LLMs to analyze. In addition to the original contributions of empirical evidence for LLM accuracy, the research aggregated a novel benchmark for others to score highly contested question and answer reliability between both LLMs and disagreeing human practitioners. These results suggest that the optimal deployment of LLMs in professional settings may differ substantially from current approaches that emphasize automation of routine tasks.

Multimodal large language models (MLLMs) have advanced clinical tasks for common conditions, but their performance on rare diseases remains largely untested. In rare-disease scenarios, clinicians often lack prior clinical knowledge, forcing them to rely strictly on case-level evidence for clinical judgments. Existing benchmarks predominantly evaluate common-condition, single-image settings, leaving multimodal and multi-image evidence integration under rare-disease data scarcity systematically unevaluated. We introduce MMRareBench, to our knowledge the first rare-disease benchmark jointly evaluating multimodal and multi-image clinical capability across four workflow-aligned tracks: diagnosis, treatment planning, cross-image evidence alignment, and examination suggestion. The benchmark comprises 1,756 question-answer pairs with 7,958 associated medical images curated from PMC case reports, with Orphanet-anchored ontology alignment, track-specific leakage control, evidence-grounded annotations, and a two-level evaluation protocol. A systematic evaluation of 23 MLLMs reveals fragmented capability profiles and universally low treatment-planning performance, with medical-domain models trailing general-purpose MLLMs substantially on multi-image tracks despite competitive diagnostic scores. These patterns are consistent with a capacity dilution effect: medical fine-tuning can narrow the diagnostic gap but may erode the compositional multi-image capability that rare-disease evidence integration demands.

As a key component in boosting online user growth, uplift modeling aims to measure individual user responses (e.g., whether to play the game) to various treatments, such as gaming bonuses, thereby enhancing business outcomes. However, previous research typically considers a single-task, single-treatment setting, where only one treatment exists and the overall treatment effect is measured by a single type of user response. In this paper, we propose a Multi-Treatment Multi-Task (MTMT) uplift network to estimate treatment effects in a multi-task scenario. We identify the multi-treatment problem as a causal inference problem with a tiered response, comprising a base effect (from offering a treatment) and an incremental effect (from offering a specific type of treatment), where the base effect can be numerically much larger than the incremental effect. Specifically, MTMT separately encodes user features and treatments. The user feature encoder uses a multi-gate mixture of experts (MMOE) network to encode relevant user features, explicitly learning inter-task relations. The resultant embeddings are used to measure natural responses per task. Furthermore, we introduce a treatment-user feature interaction module to model correlations between each treatment and user feature. Consequently, we separately measure the base and incremental treatment effect for each task based on the produced treatment-aware representations. Experimental results based on an offline public dataset and an online proprietary dataset demonstrate the effectiveness of MTMT in single/multi-treatment and single/multi-task settings. Additionally, MTMT has been deployed in our gaming platform to improve user experience.

Prediction problems often admit competing models that perform almost equally well. This effect challenges key assumptions in machine learning when competing models assign conflicting predictions. In this paper, we define predictive multiplicity as the ability of a prediction problem to admit competing models with conflicting predictions. We introduce formal measures to evaluate the severity of predictive multiplicity and develop integer programming tools to compute them exactly for linear classification problems. We apply our tools to measure predictive multiplicity in recidivism prediction problems. Our results show that real-world datasets may admit competing models that assign wildly conflicting predictions, and motivate the need to measure and report predictive multiplicity in model development.

We present HEAD-QA, a multi-choice question answering testbed to encourage research on complex reasoning. The questions come from exams to access a specialized position in the Spanish healthcare system, and are challenging even for highly specialized humans. We then consider monolingual (Spanish) and cross-lingual (to English) experiments with information retrieval and neural techniques. We show that: (i) HEAD-QA challenges current methods, and (ii) the results lag well behind human performance, demonstrating its usefulness as a benchmark for future work.

Despite the impressive capabilities of Large Language Models (LLMs) in general medical domains, questions remain about their performance in diagnosing rare diseases. To answer this question, we aim to assess the diagnostic performance of LLMs in rare diseases, and explore methods to enhance their effectiveness in this area. In this work, we introduce a rare disease question-answering (ReDis-QA) dataset to evaluate the performance of LLMs in diagnosing rare diseases. Specifically, we collected 1360 high-quality question-answer pairs within the ReDis-QA dataset, covering 205 rare diseases. Additionally, we annotated meta-data for each question, facilitating the extraction of subsets specific to any given disease and its property. Based on the ReDis-QA dataset, we benchmarked several open-source LLMs, revealing that diagnosing rare diseases remains a significant challenge for these models. To facilitate retrieval augmentation generation for rare disease diagnosis, we collect the first rare diseases corpus (ReCOP), sourced from the National Organization for Rare Disorders (NORD) database. Specifically, we split the report of each rare disease into multiple chunks, each representing a different property of the disease, including their overview, symptoms, causes, effects, related disorders, diagnosis, and standard therapies. This structure ensures that the information within each chunk aligns consistently with a question. Experiment results demonstrate that ReCOP can effectively improve the accuracy of LLMs on the ReDis-QA dataset by an average of 8%. Moreover, it significantly guides LLMs to generate trustworthy answers and explanations that can be traced back to existing literature.

Background: Rapid advancements in natural language processing have led to the development of large language models with the potential to revolutionize mental health care. These models have shown promise in assisting clinicians and providing support to individuals experiencing various psychological challenges. Objective: This study aims to compare the performance of two large language models, GPT-4 and Chat-GPT, in responding to a set of 18 psychological prompts, to assess their potential applicability in mental health care settings. Methods: A blind methodology was employed, with a clinical psychologist evaluating the models' responses without knowledge of their origins. The prompts encompassed a diverse range of mental health topics, including depression, anxiety, and trauma, to ensure a comprehensive assessment. Results: The results demonstrated a significant difference in performance between the two models (p > 0.05). GPT-4 achieved an average rating of 8.29 out of 10, while Chat-GPT received an average rating of 6.52. The clinical psychologist's evaluation suggested that GPT-4 was more effective at generating clinically relevant and empathetic responses, thereby providing better support and guidance to potential users. Conclusions: This study contributes to the growing body of literature on the applicability of large language models in mental health care settings. The findings underscore the importance of continued research and development in the field to optimize these models for clinical use. Further investigation is necessary to understand the specific factors underlying the performance differences between the two models and to explore their generalizability across various populations and mental health conditions.

Circuit analysis is a promising technique for understanding the internal mechanisms of language models. However, existing analyses are done in small models far from the state of the art. To address this, we present a case study of circuit analysis in the 70B Chinchilla model, aiming to test the scalability of circuit analysis. In particular, we study multiple-choice question answering, and investigate Chinchilla's capability to identify the correct answer label given knowledge of the correct answer text. We find that the existing techniques of logit attribution, attention pattern visualization, and activation patching naturally scale to Chinchilla, allowing us to identify and categorize a small set of `output nodes' (attention heads and MLPs). We further study the `correct letter' category of attention heads aiming to understand the semantics of their features, with mixed results. For normal multiple-choice question answers, we significantly compress the query, key and value subspaces of the head without loss of performance when operating on the answer labels for multiple-choice questions, and we show that the query and key subspaces represent an `Nth item in an enumeration' feature to at least some extent. However, when we attempt to use this explanation to understand the heads' behaviour on a more general distribution including randomized answer labels, we find that it is only a partial explanation, suggesting there is more to learn about the operation of `correct letter' heads on multiple choice question answering.

Recent advancements in large language models (LLMs) have transformed the field of question answering (QA). However, evaluating LLMs in the medical field is challenging due to the lack of standardized and comprehensive datasets. To address this gap, we introduce CMExam, sourced from the Chinese National Medical Licensing Examination. CMExam consists of 60K+ multiple-choice questions for standardized and objective evaluations, as well as solution explanations for model reasoning evaluation in an open-ended manner. For in-depth analyses of LLMs, we invited medical professionals to label five additional question-wise annotations, including disease groups, clinical departments, medical disciplines, areas of competency, and question difficulty levels. Alongside the dataset, we further conducted thorough experiments with representative LLMs and QA algorithms on CMExam. The results show that GPT-4 had the best accuracy of 61.6% and a weighted F1 score of 0.617. These results highlight a great disparity when compared to human accuracy, which stood at 71.6%. For explanation tasks, while LLMs could generate relevant reasoning and demonstrate improved performance after finetuning, they fall short of a desired standard, indicating ample room for improvement. To the best of our knowledge, CMExam is the first Chinese medical exam dataset to provide comprehensive medical annotations. The experiments and findings of LLM evaluation also provide valuable insights into the challenges and potential solutions in developing Chinese medical QA systems and LLM evaluation pipelines. The dataset and relevant code are available at https://github.com/williamliujl/CMExam.

While Large Language Models (LLMs) excel on standardized medical exams, high scores often fail to translate to high-quality responses for real-world medical queries. Current evaluations rely heavily on multiple-choice questions, failing to capture the unstructured, ambiguous, and long-tail complexities inherent in genuine user inquiries. To bridge this gap, we introduce QuarkMedBench, an ecologically valid benchmark tailored for real-world medical LLM assessment. We compiled a massive dataset spanning Clinical Care, Wellness Health, and Professional Inquiry, comprising 20,821 single-turn queries and 3,853 multi-turn sessions. To objectively evaluate open-ended answers, we propose an automated scoring framework that integrates multi-model consensus with evidence-based retrieval to dynamically generate 220,617 fine-grained scoring rubrics (~9.8 per query). During evaluation, hierarchical weighting and safety constraints structurally quantify medical accuracy, key-point coverage, and risk interception, effectively mitigating the high costs and subjectivity of human grading. Experimental results demonstrate that the generated rubrics achieve a 91.8% concordance rate with clinical expert blind audits, establishing highly dependable medical reliability. Crucially, baseline evaluations on this benchmark reveal significant performance disparities among state-of-the-art models when navigating real-world clinical nuances, highlighting the limitations of conventional exam-based metrics. Ultimately, QuarkMedBench establishes a rigorous, reproducible yardstick for measuring LLM performance on complex health issues, while its framework inherently supports dynamic knowledge updates to prevent benchmark obsolescence.

In the rapidly evolving digital era, there is an increasing demand for concise information as individuals seek to distil key insights from various sources. Recent attention from researchers on Multi-document Summarisation (MDS) has resulted in diverse datasets covering customer reviews, academic papers, medical and legal documents, and news articles. However, the English-centric nature of these datasets has created a conspicuous void for multilingual datasets in today's globalised digital landscape, where linguistic diversity is celebrated. Media platforms such as British Broadcasting Corporation (BBC) have disseminated news in 20+ languages for decades. With only 380 million people speaking English natively as their first language, accounting for less than 5% of the global population, the vast majority primarily relies on other languages. These facts underscore the need for inclusivity in MDS research, utilising resources from diverse languages. Recognising this gap, we present the Multilingual Dataset for Multi-document Summarisation (M2DS), which, to the best of our knowledge, is the first dataset of its kind. It includes document-summary pairs in five languages from BBC articles published during the 2010-2023 period. This paper introduces M2DS, emphasising its unique multilingual aspect, and includes baseline scores from state-of-the-art MDS models evaluated on our dataset.

Building upon our previous investigations of O1 replication (Part 1: Journey Learning [Qin et al., 2024] and Part 2: Distillation [Huang et al., 2024]), this work explores the potential of inference-time scaling in large language models (LLMs) for medical reasoning tasks, ranging from diagnostic decision-making to treatment planning. Through extensive experiments on medical benchmarks of varying complexity (MedQA, Medbullets, and JAMA Clinical Challenges), our investigation reveals several key insights: (1) Increasing inference time does lead to improved performance. With a modest training set of 500 samples, our model yields substantial performance improvements of 6%-11%. (2) Task complexity directly correlates with the required length of reasoning chains, confirming the necessity of extended thought processes for challenging problems. (3) The differential diagnoses generated by our model adhere to the principles of the hypothetico-deductive method, producing a list of potential conditions that may explain a patient's symptoms and systematically narrowing these possibilities by evaluating the evidence. These findings demonstrate the promising synergy between inference-time scaling and journey learning in advancing LLMs' real-world clinical reasoning capabilities.

This study explores the neural and behavioral consequences of LLM-assisted essay writing. Participants were divided into three groups: LLM, Search Engine, and Brain-only (no tools). Each completed three sessions under the same condition. In a fourth session, LLM users were reassigned to Brain-only group (LLM-to-Brain), and Brain-only users were reassigned to LLM condition (Brain-to-LLM). A total of 54 participants took part in Sessions 1-3, with 18 completing session 4. We used electroencephalography (EEG) to assess cognitive load during essay writing, and analyzed essays using NLP, as well as scoring essays with the help from human teachers and an AI judge. Across groups, NERs, n-gram patterns, and topic ontology showed within-group homogeneity. EEG revealed significant differences in brain connectivity: Brain-only participants exhibited the strongest, most distributed networks; Search Engine users showed moderate engagement; and LLM users displayed the weakest connectivity. Cognitive activity scaled down in relation to external tool use. In session 4, LLM-to-Brain participants showed reduced alpha and beta connectivity, indicating under-engagement. Brain-to-LLM users exhibited higher memory recall and activation of occipito-parietal and prefrontal areas, similar to Search Engine users. Self-reported ownership of essays was the lowest in the LLM group and the highest in the Brain-only group. LLM users also struggled to accurately quote their own work. While LLMs offer immediate convenience, our findings highlight potential cognitive costs. Over four months, LLM users consistently underperformed at neural, linguistic, and behavioral levels. These results raise concerns about the long-term educational implications of LLM reliance and underscore the need for deeper inquiry into AI's role in learning.

Eleven Large Language Models (LLMs) were assessed using a custom-made battery of false-belief tasks, considered a gold standard in testing Theory of Mind (ToM) in humans. The battery included 640 prompts spread across 40 diverse tasks, each one including a false-belief scenario, three closely matched true-belief control scenarios, and the reversed versions of all four. To solve a single task, a model needed to correctly answer 16 prompts across all eight scenarios. Smaller and older models solved no tasks; GPT-3-davinci-003 (from November 2022) and ChatGPT-3.5-turbo (from March 2023) solved 20% of the tasks; ChatGPT-4 (from June 2023) solved 75% of the tasks, matching the performance of six-year-old children observed in past studies. We explore the potential interpretation of these findings, including the intriguing possibility that ToM, previously considered exclusive to humans, may have spontaneously emerged as a byproduct of LLMs' improving language skills.

We introduce Blink, a new benchmark for multimodal language models (LLMs) that focuses on core visual perception abilities not found in other evaluations. Most of the Blink tasks can be solved by humans "within a blink" (e.g., relative depth estimation, visual correspondence, forensics detection, and multi-view reasoning). However, we find these perception-demanding tasks cast significant challenges for current multimodal LLMs because they resist mediation through natural language. Blink reformats 14 classic computer vision tasks into 3,807 multiple-choice questions, paired with single or multiple images and visual prompting. While humans get 95.70% accuracy on average, Blink is surprisingly challenging for existing multimodal LLMs: even the best-performing GPT-4V and Gemini achieve accuracies of 51.26% and 45.72%, only 13.17% and 7.63% higher than random guessing, indicating that such perception abilities have not "emerged" yet in recent multimodal LLMs. Our analysis also highlights that specialist CV models could solve these problems much better, suggesting potential pathways for future improvements. We believe Blink will stimulate the community to help multimodal LLMs catch up with human-level visual perception.

It is widely accepted that information derived from analyzing speech (the acoustic signal) and language production (words and sentences) serves as a useful window into the health of an individual's cognitive ability. In fact, most neuropsychological testing batteries have a component related to speech and language where clinicians elicit speech from patients for subjective evaluation across a broad set of dimensions. With advances in speech signal processing and natural language processing, there has been recent interest in developing tools to detect more subtle changes in cognitive-linguistic function. This work relies on extracting a set of features from recorded and transcribed speech for objective assessments of speech and language, early diagnosis of neurological disease, and tracking of disease after diagnosis. With an emphasis on cognitive and thought disorders, in this paper we provide a review of existing speech and language features used in this domain, discuss their clinical application, and highlight their advantages and disadvantages. Broadly speaking, the review is split into two categories: language features based on natural language processing and speech features based on speech signal processing. Within each category, we consider features that aim to measure complementary dimensions of cognitive-linguistics, including language diversity, syntactic complexity, semantic coherence, and timing. We conclude the review with a proposal of new research directions to further advance the field.

Multimodal large language models (MLLMs) hold significant potential in the medical field, but their capabilities are often limited by insufficient data in certain medical domains, highlighting the need for understanding what kinds of images can be used by MLLMs for generalization. Current research suggests that multi-task training outperforms single-task as different tasks can benefit each other, but they often overlook the internal relationships within these tasks, providing limited guidance on selecting datasets to enhance specific tasks. To analyze this phenomenon, we attempted to employ compositional generalization (CG)-the ability of models to understand novel combinations by recombining learned elements-as a guiding framework. Since medical images can be precisely defined by Modality, Anatomical area, and Task, naturally providing an environment for exploring CG. Therefore, we assembled 106 medical datasets to create Med-MAT for comprehensive experiments. The experiments confirmed that MLLMs can use CG to understand unseen medical images and identified CG as one of the main drivers of the generalization observed in multi-task training. Additionally, further studies demonstrated that CG effectively supports datasets with limited data and delivers consistent performance across different backbones, highlighting its versatility and broad applicability. Med-MAT is publicly available at https://github.com/FreedomIntelligence/Med-MAT.

Missing values, irregularly collected samples, and multi-resolution signals commonly occur in multivariate time series data, making predictive tasks difficult. These challenges are especially prevalent in the healthcare domain, where patients' vital signs and electronic records are collected at different frequencies and have occasionally missing information due to the imperfections in equipment or patient circumstances. Researchers have handled each of these issues differently, often handling missing data through mean value imputation and then using sequence models over the multivariate signals while ignoring the different resolution of signals. We propose a unified model named Multi-resolution Flexible Irregular Time series Network (Multi-FIT). The building block for Multi-FIT is the FIT network. The FIT network creates an informative dense representation at each time step using signal information such as last observed value, time difference since the last observed time stamp and overall mean for the signal. Vertical FIT (FIT-V) is a variant of FIT which also models the relationship between different temporal signals while creating the informative dense representations for the signal. The multi-FIT model uses multiple FIT networks for sets of signals with different resolutions, further facilitating the construction of flexible representations. Our model has three main contributions: a.) it does not impute values but rather creates informative representations to provide flexibility to the model for creating task-specific representations b.) it models the relationship between different signals in the form of support signals c.) it models different resolutions in parallel before merging them for the final prediction task. The FIT, FIT-V and Multi-FIT networks improve upon the state-of-the-art models for three predictive tasks, including the forecasting of patient survival.

In this paper, we critically evaluate the capabilities of the state-of-the-art multimodal large language model, i.e., GPT-4 with Vision (GPT-4V), on Visual Question Answering (VQA) task. Our experiments thoroughly assess GPT-4V's proficiency in answering questions paired with images using both pathology and radiology datasets from 11 modalities (e.g. Microscopy, Dermoscopy, X-ray, CT, etc.) and fifteen objects of interests (brain, liver, lung, etc.). Our datasets encompass a comprehensive range of medical inquiries, including sixteen distinct question types. Throughout our evaluations, we devised textual prompts for GPT-4V, directing it to synergize visual and textual information. The experiments with accuracy score conclude that the current version of GPT-4V is not recommended for real-world diagnostics due to its unreliable and suboptimal accuracy in responding to diagnostic medical questions. In addition, we delineate seven unique facets of GPT-4V's behavior in medical VQA, highlighting its constraints within this complex arena. The complete details of our evaluation cases are accessible at https://github.com/ZhilingYan/GPT4V-Medical-Report.