Daily Papers

The advancement of natural language processing (NLP) systems in healthcare hinges on language model ability to interpret the intricate information contained within clinical notes. This process often requires integrating information from various time points in a patient's medical history. However, most earlier clinical language models were pretrained with a context length limited to roughly one clinical document. In this study, We introduce ClinicalMamba, a specialized version of the Mamba language model, pretrained on a vast corpus of longitudinal clinical notes to address the unique linguistic characteristics and information processing needs of the medical domain. ClinicalMamba, with 130 million and 2.8 billion parameters, demonstrates a superior performance in modeling clinical language across extended text lengths compared to Mamba and clinical Llama. With few-shot learning, ClinicalMamba achieves notable benchmarks in speed and accuracy, outperforming existing clinical language models and general domain large models like GPT-4 in longitudinal clinical notes information extraction tasks.

Adapting pretrained language models to novel domains, such as clinical applications, traditionally involves retraining their entire set of parameters. Parameter-Efficient Fine-Tuning (PEFT) techniques for fine-tuning language models significantly reduce computational requirements by selectively fine-tuning small subsets of parameters. In this study, we propose a two-step PEFT framework and evaluate it in the clinical domain. Our approach combines a specialised PEFT adapter layer designed for clinical domain adaptation with another adapter specialised for downstream tasks. We evaluate the framework on multiple clinical outcome prediction datasets, comparing it to clinically trained language models. Our framework achieves a better AUROC score averaged across all clinical downstream tasks compared to clinical language models. In particular, we observe large improvements of 4-5% AUROC in large-scale multilabel classification tasks, such as diagnoses and procedures classification. To our knowledge, this study is the first to provide an extensive empirical analysis of the interplay between PEFT techniques and domain adaptation in an important real-world domain of clinical applications.

Med42-v2 introduces a suite of clinical large language models (LLMs) designed to address the limitations of generic models in healthcare settings. These models are built on Llama3 architecture and fine-tuned using specialized clinical data. They underwent multi-stage preference alignment to effectively respond to natural prompts. While generic models are often preference-aligned to avoid answering clinical queries as a precaution, Med42-v2 is specifically trained to overcome this limitation, enabling its use in clinical settings. Med42-v2 models demonstrate superior performance compared to the original Llama3 models in both 8B and 70B parameter configurations and GPT-4 across various medical benchmarks. These LLMs are developed to understand clinical queries, perform reasoning tasks, and provide valuable assistance in clinical environments. The models are now publicly available at https://huggingface.co/m42-health{https://huggingface.co/m42-health}.

Rare diseases present unique challenges in healthcare, often suffering from delayed diagnosis and fragmented information landscapes. The scarcity of reliable knowledge in these conditions poses a distinct challenge for Large Language Models (LLMs) in supporting clinical management and delivering precise patient information underscoring the need for focused training on these 'zebra' cases. We present Zebra-Llama, a specialized context-aware language model with high precision Retrieval Augmented Generation (RAG) capability, focusing on Ehlers-Danlos Syndrome (EDS) as our case study. EDS, affecting 1 in 5,000 individuals, exemplifies the complexities of rare diseases with its diverse symptoms, multiple subtypes, and evolving diagnostic criteria. By implementing a novel context-aware fine-tuning methodology trained on questions derived from medical literature, patient experiences, and clinical resources, along with expertly curated responses, Zebra-Llama demonstrates unprecedented capabilities in handling EDS-related queries. On a test set of real-world questions collected from EDS patients and clinicians, medical experts evaluated the responses generated by both models, revealing Zebra-Llama's substantial improvements over base model (Llama 3.1-8B-Instruct) in thoroughness (77.5% vs. 70.1%), accuracy (83.0% vs. 78.8%), clarity (74.7% vs. 72.0%) and citation reliability (70.6% vs. 52.3%). Released as an open-source resource, Zebra-Llama not only provides more accessible and reliable EDS information but also establishes a framework for developing specialized AI solutions for other rare conditions. This work represents a crucial step towards democratizing expert-level knowledge in rare disease management, potentially transforming how healthcare providers and patients navigate the complex landscape of rare diseases.

Recent large language models (LLMs) such as ChatGPT and LLaMA have shown great promise in many AI applications. However, their performance on medical tasks is suboptimal and can be improved by training on extensive domain-specific datasets. This study introduces Me LLaMA, a medical LLM family that includes foundation models - Me LLaMA 13/70B, along with their chat-enhanced versions - Me LLaMA 13/70B-chat, developed through continual pre-training and instruction tuning of LLaMA2 using large medical datasets. Our domain-specific data suite for training and evaluation includes a large-scale, continual pre-training dataset with 129B tokens, an instruction tuning dataset with 214k samples, and a new medical evaluation benchmark (MIBE) across six tasks with 12 datasets. Our extensive evaluation using the MIBE shows that Me LLaMA models achieve overall better performance than existing open-source medical LLMs in zero-shot, few-shot and supervised learning abilities. Their zero-shot performance is comparable with ChatGPT across 7 out of 8 datasets, with a slight variance of within 3%, and yet falls short when compared to GPT-4. In addition, we investigated the catastrophic forgetting problem, and our results show that Me LLaMA models outperform other open-source medical LLMs in mitigating this issue. Me LLaMA is one of the largest open-source medical foundation LLMs that use both biomedical and clinical data. It exhibits superior performance across both general and medical tasks compared to other open-source medical LLMs, rendering it an attractive choice for medical AI applications. We release our models, datasets, and evaluation scripts at: https://github.com/BIDS-Xu-Lab/Me-LLaMA.

The performance of deep learning-based natural language processing systems is based on large amounts of labeled training data which, in the clinical domain, are not easily available or affordable. Weak supervision and in-context learning offer partial solutions to this issue, particularly using large language models (LLMs), but their performance still trails traditional supervised methods with moderate amounts of gold-standard data. In particular, inferencing with LLMs is computationally heavy. We propose an approach leveraging fine-tuning LLMs and weak supervision with virtually no domain knowledge that still achieves consistently dominant performance. Using a prompt-based approach, the LLM is used to generate weakly-labeled data for training a downstream BERT model. The weakly supervised model is then further fine-tuned on small amounts of gold standard data. We evaluate this approach using Llama2 on three different n2c2 datasets. With no more than 10 gold standard notes, our final BERT models weakly supervised by fine-tuned Llama2-13B consistently outperformed out-of-the-box PubMedBERT by 4.7% to 47.9% in F1 scores. With only 50 gold standard notes, our models achieved close performance to fully fine-tuned systems.

Large Language Models (LLMs) such as GPT & Llama have demonstrated significant achievements in summarization tasks but struggle with factual inaccuracies, a critical issue in clinical NLP applications where errors could lead to serious consequences. To counter the high costs and limited availability of expert-annotated data for factual alignment, this study introduces an innovative pipeline that utilizes >100B parameter GPT variants like GPT-3.5 & GPT-4 to act as synthetic experts to generate high-quality synthetics feedback aimed at enhancing factual consistency in clinical note summarization. Our research primarily focuses on edit feedback generated by these synthetic feedback experts without additional human annotations, mirroring and optimizing the practical scenario in which medical professionals refine AI system outputs. Although such 100B+ parameter GPT variants have proven to demonstrate expertise in various clinical NLP tasks, such as the Medical Licensing Examination, there is scant research on their capacity to act as synthetic feedback experts and deliver expert-level edit feedback for improving the generation quality of weaker (<10B parameter) LLMs like GPT-2 (1.5B) & Llama 2 (7B) in clinical domain. So in this work, we leverage 100B+ GPT variants to act as synthetic feedback experts offering expert-level edit feedback, that is used to reduce hallucinations and align weaker (<10B parameter) LLMs with medical facts using two distinct alignment algorithms (DPO & SALT), endeavoring to narrow the divide between AI-generated content and factual accuracy. This highlights the substantial potential of LLM-based synthetic edits in enhancing the alignment of clinical factuality.

Large language models (LLMs) are increasingly applied to clinical decision-making. However, their potential to exhibit bias poses significant risks to clinical equity. Currently, there is a lack of benchmarks that systematically evaluate such clinical bias in LLMs. While in downstream tasks, some biases of LLMs can be avoided such as by instructing the model to answer "I'm not sure...", the internal bias hidden within the model still lacks deep studies. We introduce CLIMB (shorthand for A Benchmark of Clinical Bias in Large Language Models), a pioneering comprehensive benchmark to evaluate both intrinsic (within LLMs) and extrinsic (on downstream tasks) bias in LLMs for clinical decision tasks. Notably, for intrinsic bias, we introduce a novel metric, AssocMAD, to assess the disparities of LLMs across multiple demographic groups. Additionally, we leverage counterfactual intervention to evaluate extrinsic bias in a task of clinical diagnosis prediction. Our experiments across popular and medically adapted LLMs, particularly from the Mistral and LLaMA families, unveil prevalent behaviors with both intrinsic and extrinsic bias. This work underscores the critical need to mitigate clinical bias and sets a new standard for future evaluations of LLMs' clinical bias.

Manual assignment of Anatomical Therapeutic Chemical (ATC) codes to prescription records is a significant bottleneck in healthcare research and operations at Ontario Health and InterRAI Canada, requiring extensive expert time and effort. To automate this process while maintaining data privacy, we develop a practical approach using locally deployable large language models (LLMs). Inspired by recent advances in automatic International Classification of Diseases (ICD) coding, our method frames ATC coding as a hierarchical information extraction task, guiding LLMs through the ATC ontology level by level. We evaluate our approach using GPT-4o as an accuracy ceiling and focus development on open-source Llama models suitable for privacy-sensitive deployment. Testing across Health Canada drug product data, the RABBITS benchmark, and real clinical notes from Ontario Health, our method achieves 78% exact match accuracy with GPT-4o and 60% with Llama 3.1 70B. We investigate knowledge grounding through drug definitions, finding modest improvements in accuracy. Further, we show that fine-tuned Llama 3.1 8B matches zero-shot Llama 3.1 70B accuracy, suggesting that effective ATC coding is feasible with smaller models. Our results demonstrate the feasibility of automatic ATC coding in privacy-sensitive healthcare environments, providing a foundation for future deployments.

Differential diagnosis is crucial for medicine as it helps healthcare providers systematically distinguish between conditions that share similar symptoms. This study assesses the impact of lab test results on differential diagnoses (DDx) made by large language models (LLMs). Clinical vignettes from 50 case reports from PubMed Central were created incorporating patient demographics, symptoms, and lab results. Five LLMs GPT-4, GPT-3.5, Llama-2-70b, Claude-2, and Mixtral-8x7B were tested to generate Top 10, Top 5, and Top 1 DDx with and without lab data. A comprehensive evaluation involving GPT-4, a knowledge graph, and clinicians was conducted. GPT-4 performed best, achieving 55% accuracy for Top 1 diagnoses and 60% for Top 10 with lab data, with lenient accuracy up to 80%. Lab results significantly improved accuracy, with GPT-4 and Mixtral excelling, though exact match rates were low. Lab tests, including liver function, metabolic/toxicology panels, and serology/immune tests, were generally interpreted correctly by LLMs for differential diagnosis.

Brief hospital course (BHC) summaries are common clinical documents generated by summarizing clinical notes. While large language models (LLMs) depict remarkable capabilities in automating real-world tasks, their capabilities for healthcare applications such as BHC synthesis have not been shown. To enable the adaptation of LLMs for BHC synthesis, we introduce a novel benchmark consisting of a pre-processed dataset extracted from MIMIC-IV notes, encapsulating clinical note, and brief hospital course (BHC) pairs. We assess the performance of two general-purpose LLMs and three healthcare-adapted LLMs to improve BHC synthesis from clinical notes. Using clinical notes as input for generating BHCs, we apply prompting-based (using in-context learning) and fine-tuning-based adaptation strategies to three open-source LLMs (Clinical-T5-Large, Llama2-13B, FLAN-UL2) and two proprietary LLMs (GPT-3.5, GPT-4). We quantitatively evaluate the performance of these LLMs across varying context-length inputs using conventional natural language similarity metrics. We further perform a qualitative study where five diverse clinicians blindly compare clinician-written BHCs and two LLM-generated BHCs for 30 samples across metrics of comprehensiveness, conciseness, factual correctness, and fluency. Overall, we present a new benchmark and pre-processed dataset for using LLMs in BHC synthesis from clinical notes. We observe high-quality summarization performance for both in-context proprietary and fine-tuned open-source LLMs using both quantitative metrics and a qualitative clinical reader study. We propose our work as a benchmark to motivate future works to adapt and assess the performance of LLMs in BHC synthesis.

Generating synthetic text addresses the challenge of data availability in privacy-sensitive domains such as healthcare. This study explores the applicability of synthetic data in real-world medical settings. We introduce MedSyn, a novel medical text generation framework that integrates large language models with a Medical Knowledge Graph (MKG). We use MKG to sample prior medical information for the prompt and generate synthetic clinical notes with GPT-4 and fine-tuned LLaMA models. We assess the benefit of synthetic data through application in the ICD code prediction task. Our research indicates that synthetic data can increase the classification accuracy of vital and challenging codes by up to 17.8% compared to settings without synthetic data. Furthermore, to provide new data for further research in the healthcare domain, we present the largest open-source synthetic dataset of clinical notes for the Russian language, comprising over 41k samples covering 219 ICD-10 codes.

In this study, we present MedS-Bench, a comprehensive benchmark designed to evaluate the performance of large language models (LLMs) in clinical contexts. Unlike existing benchmarks that focus on multiple-choice question answering, MedS-Bench spans 11 high-level clinical tasks, including clinical report summarization, treatment recommendations, diagnosis, named entity recognition, and medical concept explanation, among others. We evaluated six leading LLMs, e.g., MEDITRON, Mistral, InternLM 2, Llama 3, GPT-4, and Claude-3.5 using few-shot prompting, and found that even the most sophisticated models struggle with these complex tasks. To address these limitations, we developed MedS-Ins, a large-scale instruction tuning dataset for medicine. MedS-Ins comprises 58 medically oriented language corpora, totaling 13.5 million samples across 122 tasks. To demonstrate the dataset's utility, we conducted a proof-of-concept experiment by performing instruction tuning on a lightweight, open-source medical language model. The resulting model, MMedIns-Llama 3, significantly outperformed existing models across nearly all clinical tasks. To promote further advancements in the application of LLMs to clinical challenges, we have made the MedS-Ins dataset fully accessible and invite the research community to contribute to its expansion.Additionally, we have launched a dynamic leaderboard for MedS-Bench, which we plan to regularly update the test set to track progress and enhance the adaptation of general LLMs to the medical domain. Leaderboard: https://henrychur.github.io/MedS-Bench/. Github: https://github.com/MAGIC-AI4Med/MedS-Ins.

Large language models (LLMs) have shown potential in biomedical applications, leading to efforts to fine-tune them on domain-specific data. However, the effectiveness of this approach remains unclear. This study evaluates the performance of biomedically fine-tuned LLMs against their general-purpose counterparts on a variety of clinical tasks. We evaluated their performance on clinical case challenges from the New England Journal of Medicine (NEJM) and the Journal of the American Medical Association (JAMA) and on several clinical tasks (e.g., information extraction, document summarization, and clinical coding). Using benchmarks specifically chosen to be likely outside the fine-tuning datasets of biomedical models, we found that biomedical LLMs mostly perform inferior to their general-purpose counterparts, especially on tasks not focused on medical knowledge. While larger models showed similar performance on case tasks (e.g., OpenBioLLM-70B: 66.4% vs. Llama-3-70B-Instruct: 65% on JAMA cases), smaller biomedical models showed more pronounced underperformance (e.g., OpenBioLLM-8B: 30% vs. Llama-3-8B-Instruct: 64.3% on NEJM cases). Similar trends were observed across the CLUE (Clinical Language Understanding Evaluation) benchmark tasks, with general-purpose models often performing better on text generation, question answering, and coding tasks. Our results suggest that fine-tuning LLMs to biomedical data may not provide the expected benefits and may potentially lead to reduced performance, challenging prevailing assumptions about domain-specific adaptation of LLMs and highlighting the need for more rigorous evaluation frameworks in healthcare AI. Alternative approaches, such as retrieval-augmented generation, may be more effective in enhancing the biomedical capabilities of LLMs without compromising their general knowledge.

Large Language Models (LLMs), such as the LLaMA model, have demonstrated their effectiveness in various general-domain natural language processing (NLP) tasks. Nevertheless, LLMs have not yet performed optimally in biomedical domain tasks due to the need for medical expertise in the responses. In response to this challenge, we propose HuaTuo, a LLaMA-based model that has been supervised-fine-tuned with generated QA (Question-Answer) instances. The experimental results demonstrate that HuaTuo generates responses that possess more reliable medical knowledge. Our proposed HuaTuo model is accessible at https://github.com/SCIR-HI/Huatuo-Llama-Med-Chinese.

Continual pre-training has increasingly become the predominant approach for adapting Large Language Models (LLMs) to new domains. This process involves updating the pre-trained LLM with a corpus from a new domain, resulting in a shift in the training distribution. To study the behavior of LLMs during this shift, we measured the model's performance throughout the continual pre-training process. we observed a temporary performance drop at the beginning, followed by a recovery phase, a phenomenon known as the "stability gap," previously noted in vision models classifying new classes. To address this issue and enhance LLM performance within a fixed compute budget, we propose three effective strategies: (1) Continually pre-training the LLM on a subset with a proper size for multiple epochs, resulting in faster performance recovery than pre-training the LLM on a large corpus in a single epoch; (2) Pre-training the LLM only on high-quality sub-corpus, which rapidly boosts domain performance; and (3) Using a data mixture similar to the pre-training data to reduce distribution gap. We conduct various experiments on Llama-family models to validate the effectiveness of our strategies in both medical continual pre-training and instruction tuning. For example, our strategies improve the average medical task performance of the OpenLlama-3B model from 36.2% to 40.7% with only 40% of the original training budget and enhance the average general task performance without causing forgetting. Furthermore, we apply our strategies to the Llama-3-8B model. The resulting model, Llama-3-Physician, achieves the best medical performance among current open-source models, and performs comparably to or even better than GPT-4 on several medical benchmarks. We release our models at https://huggingface.co/YiDuo1999/Llama-3-Physician-8B-Instruct.

Although large language models (LLMs) often produce impressive outputs, it remains unclear how they perform in real-world scenarios requiring strong reasoning skills and expert domain knowledge. We set out to investigate whether close- and open-source models (GPT-3.5, LLama-2, etc.) can be applied to answer and reason about difficult real-world-based questions. We focus on three popular medical benchmarks (MedQA-USMLE, MedMCQA, and PubMedQA) and multiple prompting scenarios: Chain-of-Thought (CoT, think step-by-step), few-shot and retrieval augmentation. Based on an expert annotation of the generated CoTs, we found that InstructGPT can often read, reason and recall expert knowledge. Last, by leveraging advances in prompt engineering (few-shot and ensemble methods), we demonstrated that GPT-3.5 not only yields calibrated predictive distributions, but also reaches the passing score on three datasets: MedQA-USMLE 60.2%, MedMCQA 62.7% and PubMedQA 78.2%. Open-source models are closing the gap: Llama-2 70B also passed the MedQA-USMLE with 62.5% accuracy.

Large Language Models (LLMs) have shown significant advances in the past year. In addition to new versions of GPT and Llama, several other LLMs have been introduced recently. Some of these are open models available for download and modification. Although multilingual large language models have been available for some time, their performance on low-resourced languages such as Sinhala has been poor. We evaluated four recent LLMs on their performance directly in the Sinhala language, and by translation to and from English. We also evaluated their fine-tunability with a small amount of fine-tuning data. Claude and GPT 4o perform well out-of-the-box and do significantly better than previous versions. Llama and Mistral perform poorly but show some promise of improvement with fine tuning.

This paper introduces MedExQA, a novel benchmark in medical question-answering, to evaluate large language models' (LLMs) understanding of medical knowledge through explanations. By constructing datasets across five distinct medical specialties that are underrepresented in current datasets and further incorporating multiple explanations for each question-answer pair, we address a major gap in current medical QA benchmarks which is the absence of comprehensive assessments of LLMs' ability to generate nuanced medical explanations. Our work highlights the importance of explainability in medical LLMs, proposes an effective methodology for evaluating models beyond classification accuracy, and sheds light on one specific domain, speech language pathology, where current LLMs including GPT4 lack good understanding. Our results show generation evaluation with multiple explanations aligns better with human assessment, highlighting an opportunity for a more robust automated comprehension assessment for LLMs. To diversify open-source medical LLMs (currently mostly based on Llama2), this work also proposes a new medical model, MedPhi-2, based on Phi-2 (2.7B). The model outperformed medical LLMs based on Llama2-70B in generating explanations, showing its effectiveness in the resource-constrained medical domain. We will share our benchmark datasets and the trained model.

Large Language Models (LLMs) present immense potential in the medical field, yet concerns over data privacy, regulatory compliance, and model stability restrict their widespread adoption. Although the distillation of high-performing closed-source LLMs has proven effective for general tasks, their application in healthcare is limited due to reduced domain knowledge and remnants of alignment behavior hindering clinical tasks. To address these challenges, we propose Dialogue-Based Knowledge Encoding (DBKE). DBKE enhances models' implicit knowledge base and primes them for conversational recall, augmenting their conversational capabilities and enabling a soft alignment for subsequent use cases. By transforming dense academic source text into synthetic dialogue, DBKE broadens the model's knowledge base and enables a soft alignment that guides downstream behaviours. We present Clinical Camel, an open-source, healthcare-focused conversational model, to showcase the effectiveness of DBKE. Clinical Camel outperforms GPT-3.5 on the United States Medical Licensing Examination (USMLE) Step 1 and Step 3 with scores of 53.2 % and 58.2 %, respectively, compared to GPT-3.5's scores of 36.1 % and 55.7 %. Clinical Camel adeptly handles multi-stage clinical case problems, provides adaptive counseling, and generates clinical notes. However, it is prone to hallucinations, which pose a significant obstacle in safety-critical settings. The performance of Clinical Camel underscores the importance of continued research and development of open-source models for the safe and effective integration of LLMs in healthcare settings.

Tumor documentation in Germany is largely done manually, requiring reading patient records and entering data into structured databases. Large language models (LLMs) could potentially enhance this process by improving efficiency and reliability. This evaluation tests eleven different open source LLMs with sizes ranging from 1-70 billion model parameters on three basic tasks of the tumor documentation process: identifying tumor diagnoses, assigning ICD-10 codes, and extracting the date of first diagnosis. For evaluating the LLMs on these tasks, a dataset of annotated text snippets based on anonymized doctors' notes from urology was prepared. Different prompting strategies were used to investigate the effect of the number of examples in few-shot prompting and to explore the capabilities of the LLMs in general. The models Llama 3.1 8B, Mistral 7B, and Mistral NeMo 12 B performed comparably well in the tasks. Models with less extensive training data or having fewer than 7 billion parameters showed notably lower performance, while larger models did not display performance gains. Examples from a different medical domain than urology could also improve the outcome in few-shot prompting, which demonstrates the ability of LLMs to handle tasks needed for tumor documentation. Open source LLMs show a strong potential for automating tumor documentation. Models from 7-12 billion parameters could offer an optimal balance between performance and resource efficiency. With tailored fine-tuning and well-designed prompting, these models might become important tools for clinical documentation in the future. The code for the evaluation is available from https://github.com/stefan-m-lenz/UroLlmEval. We also release the dataset as a new valuable resource that addresses the shortage of authentic and easily accessible benchmarks in German-language medical NLP.

Accurate and efficient question-answering systems are essential for delivering high-quality patient care in the medical field. While Large Language Models (LLMs) have made remarkable strides across various domains, they continue to face significant challenges in medical question answering, particularly in understanding domain-specific terminologies and performing complex reasoning. These limitations undermine their effectiveness in critical medical applications. To address these issues, we propose a novel approach incorporating similar case generation within a multi-agent medical question-answering (MedQA) system. Specifically, we leverage the Llama3.1:70B model, a state-of-the-art LLM, in a multi-agent architecture to enhance performance on the MedQA dataset using zero-shot learning. Our method capitalizes on the model's inherent medical knowledge and reasoning capabilities, eliminating the need for additional training data. Experimental results show substantial performance gains over existing benchmark models, with improvements of 7% in both accuracy and F1-score across various medical QA tasks. Furthermore, we examine the model's interpretability and reliability in addressing complex medical queries. This research not only offers a robust solution for medical question answering but also establishes a foundation for broader applications of LLMs in the medical domain.

This study presents a comprehensive analysis and comparison of two predominant fine-tuning methodologies - full-parameter fine-tuning and parameter-efficient tuning - within the context of medical Large Language Models (LLMs). We developed and refined a series of LLMs, based on the Llama-2 architecture, specifically designed to enhance medical knowledge retrieval, reasoning, and question-answering capabilities. Our experiments systematically evaluate the effectiveness of these tuning strategies across various well-known medical benchmarks. Notably, our medical LLM Med42 showed an accuracy level of 72% on the US Medical Licensing Examination (USMLE) datasets, setting a new standard in performance for openly available medical LLMs. Through this comparative analysis, we aim to identify the most effective and efficient method for fine-tuning LLMs in the medical domain, thereby contributing significantly to the advancement of AI-driven healthcare applications.

Large language models (LLMs) can potentially democratize access to medical knowledge. While many efforts have been made to harness and improve LLMs' medical knowledge and reasoning capacities, the resulting models are either closed-source (e.g., PaLM, GPT-4) or limited in scale (<= 13B parameters), which restricts their abilities. In this work, we improve access to large-scale medical LLMs by releasing MEDITRON: a suite of open-source LLMs with 7B and 70B parameters adapted to the medical domain. MEDITRON builds on Llama-2 (through our adaptation of Nvidia's Megatron-LM distributed trainer), and extends pretraining on a comprehensively curated medical corpus, including selected PubMed articles, abstracts, and internationally-recognized medical guidelines. Evaluations using four major medical benchmarks show significant performance gains over several state-of-the-art baselines before and after task-specific finetuning. Overall, MEDITRON achieves a 6% absolute performance gain over the best public baseline in its parameter class and 3% over the strongest baseline we finetuned from Llama-2. Compared to closed-source LLMs, MEDITRON-70B outperforms GPT-3.5 and Med-PaLM and is within 5% of GPT-4 and 10% of Med-PaLM-2. We release our code for curating the medical pretraining corpus and the MEDITRON model weights to drive open-source development of more capable medical LLMs.

Large Language Models (LLMs) hold great promise to revolutionize current clinical systems for their superior capacities on medical text processing tasks and medical licensing exams. Meanwhile, traditional ML models such as SVM and XGBoost have still been mainly adopted in clinical prediction tasks. An emerging question is Can LLMs beat traditional ML models in clinical prediction? Thus, we build a new benchmark ClinicalBench to comprehensively study the clinical predictive modeling capacities of both general-purpose and medical LLMs, and compare them with traditional ML models. ClinicalBench embraces three common clinical prediction tasks, two databases, 14 general-purpose LLMs, 8 medical LLMs, and 11 traditional ML models. Through extensive empirical investigation, we discover that both general-purpose and medical LLMs, even with different model scales, diverse prompting or fine-tuning strategies, still cannot beat traditional ML models in clinical prediction yet, shedding light on their potential deficiency in clinical reasoning and decision-making. We call for caution when practitioners adopt LLMs in clinical applications. ClinicalBench can be utilized to bridge the gap between LLMs' development for healthcare and real-world clinical practice.

Concerns about hallucinations in Large Language Models (LLMs) have been raised by researchers, yet their potential in areas where creativity is vital, such as drug discovery, merits exploration. In this paper, we come up with the hypothesis that hallucinations can improve LLMs in drug discovery. To verify this hypothesis, we use LLMs to describe the SMILES string of molecules in natural language and then incorporate these descriptions as part of the prompt to address specific tasks in drug discovery. Evaluated on seven LLMs and five classification tasks, our findings confirm the hypothesis: LLMs can achieve better performance with text containing hallucinations. Notably, Llama-3.1-8B achieves an 18.35% gain in ROC-AUC compared to the baseline without hallucination. Furthermore, hallucinations generated by GPT-4o provide the most consistent improvements across models. Additionally, we conduct empirical analyses and a case study to investigate key factors affecting performance and the underlying reasons. Our research sheds light on the potential use of hallucinations for LLMs and offers new perspectives for future research leveraging LLMs in drug discovery.

Large Language Models (LLMs) have made significant strides in natural language processing but face challenges in terms of computational expense and inefficiency as they grow in size, especially in domain-specific tasks. Small Language Models (SLMs), on the other hand, often struggle in these tasks due to limited capacity and training data. In this paper, we introduce Dr. LLaMA, a method for improving SLMs through generative data augmentation using LLMs, focusing on medical question-answering tasks and the PubMedQA dataset. Our findings indicate that LLMs effectively refine and diversify existing question-answer pairs, resulting in improved performance of a much smaller model on domain-specific QA datasets after fine-tuning. This study highlights the challenges of using LLMs for domain-specific question answering and suggests potential research directions to address these limitations, ultimately aiming to create more efficient and capable models for specialized applications. We have also made our code available for interested researchers

Medical systematic reviews can be very costly and resource intensive. We explore how Large Language Models (LLMs) can support and be trained to perform literature screening when provided with a detailed set of selection criteria. Specifically, we instruction tune LLaMA and Guanaco models to perform abstract screening for medical systematic reviews. Our best model, Bio-SIEVE, outperforms both ChatGPT and trained traditional approaches, and generalises better across medical domains. However, there remains the challenge of adapting the model to safety-first scenarios. We also explore the impact of multi-task training with Bio-SIEVE-Multi, including tasks such as PICO extraction and exclusion reasoning, but find that it is unable to match single-task Bio-SIEVE's performance. We see Bio-SIEVE as an important step towards specialising LLMs for the biomedical systematic review process and explore its future developmental opportunities. We release our models, code and a list of DOIs to reconstruct our dataset for reproducibility.

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.

Large Language Models (LLMs) like GPT-4 and LLaMA have shown incredible proficiency at natural language processing tasks and have even begun to excel at tasks across other modalities such as vision and audio. Despite their success, LLMs often struggle to perform well on low-resource languages because there is so little training data available. This shortcoming is especially prevalent with open source models. In this work, we explore training LLaMA-2 to speak Amharic, a language which is spoken by over 50 million people world wide, but has orders of magnitude less data available than languages like English. We employ methods previously used for training LLMs on other languages with data scarcity, and use open source translation models to perform data augmentation and grow our dataset from millions of tokens to billions. We further enhance the capabilities of our model by connecting an image encoder and training on a translated visual instruction tuning dataset in the same manner as LLaVA, resulting in a multimodal Amharic LLM that can understand images along with text. We introduce an Amharic version of a popular benchmarking dataset to evaluate our work. Our models and dataset are open sourced and available on GitHub.

We introduce LLaMA, a collection of foundation language models ranging from 7B to 65B parameters. We train our models on trillions of tokens, and show that it is possible to train state-of-the-art models using publicly available datasets exclusively, without resorting to proprietary and inaccessible datasets. In particular, LLaMA-13B outperforms GPT-3 (175B) on most benchmarks, and LLaMA-65B is competitive with the best models, Chinchilla-70B and PaLM-540B. We release all our models to the research community.

This research paper focuses on the challenges posed by hallucinations in large language models (LLMs), particularly in the context of the medical domain. Hallucination, wherein these models generate plausible yet unverified or incorrect information, can have serious consequences in healthcare applications. We propose a new benchmark and dataset, Med-HALT (Medical Domain Hallucination Test), designed specifically to evaluate and reduce hallucinations. Med-HALT provides a diverse multinational dataset derived from medical examinations across various countries and includes multiple innovative testing modalities. Med-HALT includes two categories of tests reasoning and memory-based hallucination tests, designed to assess LLMs's problem-solving and information retrieval abilities. Our study evaluated leading LLMs, including Text Davinci, GPT-3.5, LlaMa-2, MPT, and Falcon, revealing significant differences in their performance. The paper provides detailed insights into the dataset, promoting transparency and reproducibility. Through this work, we aim to contribute to the development of safer and more reliable language models in healthcare. Our benchmark can be found at medhalt.github.io

Despite significant progress in applying large language models (LLMs) to the medical domain, several limitations still prevent them from practical applications. Among these are the constraints on model size and the lack of cohort-specific labeled datasets. In this work, we investigated the potential of improving a lightweight LLM, such as Llama 3.1-8B, through fine-tuning with datasets using synthetic labels. Two tasks are jointly trained by combining their respective instruction datasets. When the quality of the task-specific synthetic labels is relatively high (e.g., generated by GPT4- o), Llama 3.1-8B achieves satisfactory performance on the open-ended disease detection task, with a micro F1 score of 0.91. Conversely, when the quality of the task-relevant synthetic labels is relatively low (e.g., from the MIMIC-CXR dataset), fine-tuned Llama 3.1-8B is able to surpass its noisy teacher labels (micro F1 score of 0.67 v.s. 0.63) when calibrated against curated labels, indicating the strong inherent underlying capability of the model. These findings demonstrate the potential of fine-tuning LLMs with synthetic labels, offering a promising direction for future research on LLM specialization in the medical domain.

AstroSage-Llama-3.1-8B is a domain-specialized natural-language AI assistant tailored for research in astronomy, astrophysics, and cosmology. Trained on the complete collection of astronomy-related arXiv papers from 2007-2024 along with millions of synthetically-generated question-answer pairs and other astronomical literature, AstroSage-Llama-3.1-8B demonstrates remarkable proficiency on a wide range of questions. AstroSage-Llama-3.1-8B scores 80.9% on the AstroMLab-1 benchmark, greatly outperforming all models -- proprietary and open-weight -- in the 8-billion parameter class, and performing on par with GPT-4o. This achievement demonstrates the potential of domain specialization in AI, suggesting that focused training can yield capabilities exceeding those of much larger, general-purpose models. AstroSage-Llama-3.1-8B is freely available, enabling widespread access to advanced AI capabilities for astronomical education and research.

Large Language Models (LLMs) have demonstrated significant enhancements in instruction-following abilities through instruction tuning, achieving notable performances across various tasks. Previous research has focused on fine-tuning medical domain-specific LLMs using an extensive array of medical-specific data, incorporating millions of pieces of biomedical literature to augment their medical capabilities. However, existing medical instruction-tuned LLMs have been constrained by the limited scope of tasks and instructions available, restricting the efficacy of instruction tuning and adversely affecting performance in the general domain. In this paper, we fine-tune LLaMA-series models using 52k diverse, machine-generated, medical instruction-following data, MedInstruct-52k, resulting in the model AlpaCare. Comprehensive experimental results on both general and medical-specific domain free-form instruction evaluations showcase AlpaCare's strong medical proficiency and generalizability compared to previous instruction-tuned models in both medical and general domains. We provide public access to our MedInstruct-52k dataset and a clinician-crafted free-form instruction test set, MedInstruct-test, along with our codebase, to foster further research and development. Our project page is available at https://github.com/XZhang97666/AlpaCare.

This paper introduces fourteen novel datasets for the evaluation of Large Language Models' safety in the context of enterprise tasks. A method was devised to evaluate a model's safety, as determined by its ability to follow instructions and output factual, unbiased, grounded, and appropriate content. In this research, we used OpenAI GPT as point of comparison since it excels at all levels of safety. On the open-source side, for smaller models, Meta Llama2 performs well at factuality and toxicity but has the highest propensity for hallucination. Mistral hallucinates the least but cannot handle toxicity well. It performs well in a dataset mixing several tasks and safety vectors in a narrow vertical domain. Gemma, the newly introduced open-source model based on Google Gemini, is generally balanced but trailing behind. When engaging in back-and-forth conversation (multi-turn prompts), we find that the safety of open-source models degrades significantly. Aside from OpenAI's GPT, Mistral is the only model that still performed well in multi-turn tests.

Objective: The reading level of health educational materials significantly influences the understandability and accessibility of the information, particularly for minoritized populations. Many patient educational resources surpass the reading level and complexity of widely accepted standards. There is a critical need for high-performing text simplification models in health information to enhance dissemination and literacy. This need is particularly acute in cancer education, where effective prevention and screening education can substantially reduce morbidity and mortality. Methods: We introduce Simplified Digestive Cancer (SimpleDC), a parallel corpus of cancer education materials tailored for health text simplification research, comprising educational content from the American Cancer Society, Centers for Disease Control and Prevention, and National Cancer Institute. Utilizing SimpleDC alongside the existing Med-EASi corpus, we explore Large Language Model (LLM)-based simplification methods, including fine-tuning, reinforcement learning (RL), reinforcement learning with human feedback (RLHF), domain adaptation, and prompt-based approaches. Our experimentation encompasses Llama 2 and GPT-4. A novel RLHF reward function is introduced, featuring a lightweight model adept at distinguishing between original and simplified texts, thereby enhancing the model's effectiveness with unlabeled data. Results: Fine-tuned Llama 2 models demonstrated high performance across various metrics. Our innovative RLHF reward function surpassed existing RL text simplification reward functions in effectiveness. The results underscore that RL/RLHF can augment fine-tuning, facilitating model training on unlabeled text and improving performance.

There is enormous enthusiasm and concerns in using large language models (LLMs) in healthcare, yet current assumptions are all based on general-purpose LLMs such as ChatGPT. This study develops a clinical generative LLM, GatorTronGPT, using 277 billion words of mixed clinical and English text with a GPT-3 architecture of 20 billion parameters. GatorTronGPT improves biomedical natural language processing for medical research. Synthetic NLP models trained using GatorTronGPT generated text outperform NLP models trained using real-world clinical text. Physicians Turing test using 1 (worst) to 9 (best) scale shows that there is no significant difference in linguistic readability (p = 0.22; 6.57 of GatorTronGPT compared with 6.93 of human) and clinical relevance (p = 0.91; 7.0 of GatorTronGPT compared with 6.97 of human) and that physicians cannot differentiate them (p < 0.001). This study provides insights on the opportunities and challenges of LLMs for medical research and healthcare.

Applying large language models (LLMs) to assist in psycho-counseling is an emerging and meaningful approach, driven by the significant gap between patient needs and the availability of mental health support. However, current LLMs struggle to consistently provide effective responses to client speeches, largely due to the lack of supervision from high-quality real psycho-counseling data, whose content is typically inaccessible due to client privacy concerns. Furthermore, the quality of therapists' responses in available sessions can vary significantly based on their professional training and experience. Assessing the quality of therapists' responses remains an open challenge. In this work, we address these challenges by first proposing a set of professional and comprehensive principles to evaluate therapists' responses to client speeches. Using these principles, we create a preference dataset, PsychoCounsel-Preference, which contains 36k high-quality preference comparison pairs. This dataset aligns with the preferences of professional psychotherapists, providing a robust foundation for evaluating and improving LLMs in psycho-counseling. Experiments on reward modeling and preference learning demonstrate that PsychoCounsel-Preference is an excellent resource for LLMs to acquire essential skills for responding to clients in a counseling session. Our best-aligned model, PsychoCounsel-Llama3-8B, achieves an impressive win rate of 87% against GPT-4o. We release PsychoCounsel-Preference, PsychoCounsel-Llama3-8B and the reward model PsychoCounsel Llama3-8B-Reward to facilitate the research of psycho-counseling with LLMs at: https://hf.co/Psychotherapy-LLM.

We develop Polaris, the first safety-focused LLM constellation for real-time patient-AI healthcare conversations. Unlike prior LLM works in healthcare focusing on tasks like question answering, our work specifically focuses on long multi-turn voice conversations. Our one-trillion parameter constellation system is composed of several multibillion parameter LLMs as co-operative agents: a stateful primary agent that focuses on driving an engaging conversation and several specialist support agents focused on healthcare tasks performed by nurses to increase safety and reduce hallucinations. We develop a sophisticated training protocol for iterative co-training of the agents that optimize for diverse objectives. We train our models on proprietary data, clinical care plans, healthcare regulatory documents, medical manuals, and other medical reasoning documents. We align our models to speak like medical professionals, using organic healthcare conversations and simulated ones between patient actors and experienced nurses. This allows our system to express unique capabilities such as rapport building, trust building, empathy and bedside manner. Finally, we present the first comprehensive clinician evaluation of an LLM system for healthcare. We recruited over 1100 U.S. licensed nurses and over 130 U.S. licensed physicians to perform end-to-end conversational evaluations of our system by posing as patients and rating the system on several measures. We demonstrate Polaris performs on par with human nurses on aggregate across dimensions such as medical safety, clinical readiness, conversational quality, and bedside manner. Additionally, we conduct a challenging task-based evaluation of the individual specialist support agents, where we demonstrate our LLM agents significantly outperform a much larger general-purpose LLM (GPT-4) as well as from its own medium-size class (LLaMA-2 70B).

Large Language Models have excelled in remarkable reasoning capabilities with advanced prompting techniques, but they fall short on tasks that require exploration, strategic foresight, and sequential decision-making. Recent works propose to utilize external programs to define search logic, such that LLMs can perform passive tree search to solve more challenging reasoning tasks. Though impressive results have been achieved, there are several fundamental limitations of these approaches. First, passive tree searches are not efficient as they usually require multiple rounds of LLM API calls to solve one single problem. Moreover, passive search methods are not flexible since they need task-specific program designs. Then a natural question arises: can we maintain the tree-search capability of LLMs without the aid of external programs, and can still generate responses that clearly demonstrate the process of a tree-structure search? To this end, we propose a new concept called autonomous tree-search ability of LLM, which can automatically generate a response containing search trajectories for the correct answer. Concretely, we perform search trajectories using capable LLM API via a fixed system prompt, allowing them to perform autonomous tree-search (ATS) right out of the box. Experiments on 4 puzzle games demonstrate our method can achieve huge improvements. The ATS-BFS method outperforms the Chain of Thought approach by achieving an average accuracy improvement of 33%. Compared to Tree of Thoughts, it requires 65.6% or 47.7% less GPT-api cost to attain a comparable level of accuracy. Moreover, we have collected data using the ATS prompt method and fine-tuned LLaMA. This approach yield a greater improvement compared to the ones fine-tuned on CoT data. Specifically, it outperforms CoT-tuned LLaMAs by an average of 40.6% and 38.5% for LLaMA2-7B and LLaMA2-13B, respectively.

Recently, Large Language Models (LLMs) have showcased remarkable capabilities in natural language understanding. While demonstrating proficiency in everyday conversations and question-answering situations, these models frequently struggle in domains that require precision, such as medical applications, due to their lack of domain-specific knowledge. In this paper, we describe the procedure for building a powerful, open-source language model specifically designed for medicine applications, termed as PMC-LLaMA. Our contributions are threefold: (i) we systematically investigate the process of adapting a general-purpose foundation language model towards medical domain, this involves data-centric knowledge injection through the integration of 4.8M biomedical academic papers and 30K medical textbooks, as well as comprehensive fine-tuning for alignment with domain-specific instructions; (ii) we contribute a large-scale, comprehensive dataset for instruction tuning. This dataset encompasses medical question-answering (QA), rationale for reasoning, and conversational dialogues, comprising a total of 202M tokens; (iii) we conduct thorough ablation studies to demonstrate the effectiveness of each proposed component. While evaluating on various public medical question-answering benchmarks, our lightweight PMCLLaMA, which consists of only 13 billion parameters, exhibits superior performance, even surpassing ChatGPT. All models, codes, datasets can be found in https://github.com/chaoyi-wu/PMC-LLaMA.

Large language models (LLMs) hold great promise in summarizing medical evidence. Most recent studies focus on the application of proprietary LLMs. Using proprietary LLMs introduces multiple risk factors, including a lack of transparency and vendor dependency. While open-source LLMs allow better transparency and customization, their performance falls short compared to proprietary ones. In this study, we investigated to what extent fine-tuning open-source LLMs can further improve their performance in summarizing medical evidence. Utilizing a benchmark dataset, MedReview, consisting of 8,161 pairs of systematic reviews and summaries, we fine-tuned three broadly-used, open-sourced LLMs, namely PRIMERA, LongT5, and Llama-2. Overall, the fine-tuned LLMs obtained an increase of 9.89 in ROUGE-L (95% confidence interval: 8.94-10.81), 13.21 in METEOR score (95% confidence interval: 12.05-14.37), and 15.82 in CHRF score (95% confidence interval: 13.89-16.44). The performance of fine-tuned LongT5 is close to GPT-3.5 with zero-shot settings. Furthermore, smaller fine-tuned models sometimes even demonstrated superior performance compared to larger zero-shot models. The above trends of improvement were also manifested in both human and GPT4-simulated evaluations. Our results can be applied to guide model selection for tasks demanding particular domain knowledge, such as medical evidence summarization.

Large Language Models (LLMs) have demonstrated impressive capabilities across a range of scientific tasks including mathematics, physics, and chemistry. Despite their successes, the effectiveness of LLMs in handling complex statistical tasks remains systematically under-explored. To bridge this gap, we introduce StatQA, a new benchmark designed for statistical analysis tasks. StatQA comprises 11,623 examples tailored to evaluate LLMs' proficiency in specialized statistical tasks and their applicability assessment capabilities, particularly for hypothesis testing methods. We systematically experiment with representative LLMs using various prompting strategies and show that even state-of-the-art models such as GPT-4o achieve a best performance of only 64.83%, indicating significant room for improvement. Notably, while open-source LLMs (e.g. LLaMA-3) show limited capability, those fine-tuned ones exhibit marked improvements, outperforming all in-context learning-based methods (e.g. GPT-4o). Moreover, our comparative human experiments highlight a striking contrast in error types between LLMs and humans: LLMs primarily make applicability errors, whereas humans mostly make statistical task confusion errors. This divergence highlights distinct areas of proficiency and deficiency, suggesting that combining LLM and human expertise could lead to complementary strengths, inviting further investigation into their collaborative potential.

Electronic Health Records (EHRs) hold immense potential for advancing healthcare, offering rich, longitudinal data that combines structured information with valuable insights from unstructured clinical notes. However, the unstructured nature of clinical text poses significant challenges for secondary applications. Traditional methods for structuring EHR free-text data, such as rule-based systems and multi-stage pipelines, are often limited by their time-consuming configurations and inability to adapt across clinical notes from diverse healthcare settings. Few systems provide a comprehensive attribute extraction for terminologies. While giant large language models (LLMs) like GPT-4 and LLaMA 405B excel at structuring tasks, they are slow, costly, and impractical for large-scale use. To overcome these limitations, we introduce GENIE, a Generative Note Information Extraction system that leverages LLMs to streamline the structuring of unstructured clinical text into usable data with standardized format. GENIE processes entire paragraphs in a single pass, extracting entities, assertion statuses, locations, modifiers, values, and purposes with high accuracy. Its unified, end-to-end approach simplifies workflows, reduces errors, and eliminates the need for extensive manual intervention. Using a robust data preparation pipeline and fine-tuned small scale LLMs, GENIE achieves competitive performance across multiple information extraction tasks, outperforming traditional tools like cTAKES and MetaMap and can handle extra attributes to be extracted. GENIE strongly enhances real-world applicability and scalability in healthcare systems. By open-sourcing the model and test data, we aim to encourage collaboration and drive further advancements in EHR structurization.

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.

Large Language Models (LLMs) have demonstrated remarkable capabilities across various domains and are moving towards more specialized areas. Recent advanced proprietary models such as GPT-4 and Gemini have achieved significant advancements in biomedicine, which have also raised privacy and security challenges. The construction of specialized generalists hinges largely on high-quality datasets, enhanced by techniques like supervised fine-tuning and reinforcement learning from human or AI feedback, and direct preference optimization. However, these leading technologies (e.g., preference learning) are still significantly limited in the open source community due to the scarcity of specialized data. In this paper, we present the UltraMedical collections, which consist of high-quality manual and synthetic datasets in the biomedicine domain, featuring preference annotations across multiple advanced LLMs. By utilizing these datasets, we fine-tune a suite of specialized medical models based on Llama-3 series, demonstrating breathtaking capabilities across various medical benchmarks. Moreover, we develop powerful reward models skilled in biomedical and general reward benchmark, enhancing further online preference learning within the biomedical LLM community.

Open-source, multilingual medical large language models (LLMs) have the potential to serve linguistically diverse populations across different regions. Adapting generic LLMs for healthcare often requires continual pretraining, but this approach is computationally expensive and sometimes impractical. Instruction fine-tuning on a specific task may not always guarantee optimal performance due to the lack of broader domain knowledge that the model needs to understand and reason effectively in diverse scenarios. To address these challenges, we introduce two multilingual instruction fine-tuning datasets, MMed-IFT and MMed-IFT-MC, containing over 200k high-quality medical samples in six languages. We propose a two-stage training paradigm: the first stage injects general medical knowledge using MMed-IFT, while the second stage fine-tunes task-specific multiple-choice questions with MMed-IFT-MC. Our method achieves competitive results on both English and multilingual benchmarks, striking a balance between computational efficiency and performance. We plan to make our dataset and model weights public at https://github.com/SpassMed/Med-Llama3 in the future.

The rapid evolution of Large Language Models (LLMs) offers promising potential to alleviate the global scarcity of mental health professionals. However, LLMs' alignment with essential mental health counseling competencies remains understudied. We introduce CounselingBench, a novel NCMHCE-based benchmark evaluating LLMs across five key mental health counseling competencies. Testing 22 general-purpose and medical-finetuned LLMs, we find frontier models exceed minimum thresholds but fall short of expert-level performance, with significant variations: they excel in Intake, Assessment & Diagnosis yet struggle with Core Counseling Attributes and Professional Practice & Ethics. Medical LLMs surprisingly underperform generalist models accuracy-wise, while at the same time producing slightly higher-quality justifications but making more context-related errors. Our findings highlight the complexities of developing AI systems for mental health counseling, particularly for competencies requiring empathy and contextual understanding. We found that frontier LLMs perform at a level exceeding the minimal required level of aptitude for all key mental health counseling competencies, but fall short of expert-level performance, and that current medical LLMs do not significantly improve upon generalist models in mental health counseling competencies. This underscores the critical need for specialized, mental health counseling-specific fine-tuned LLMs that rigorously aligns with core competencies combined with appropriate human supervision before any responsible real-world deployment can be considered.

A major barrier to developing vision large language models (LLMs) in dermatology is the lack of large image--text pairs dataset. We introduce DermaSynth, a dataset comprising of 92,020 synthetic image--text pairs curated from 45,205 images (13,568 clinical and 35,561 dermatoscopic) for dermatology-related clinical tasks. Leveraging state-of-the-art LLMs, using Gemini 2.0, we used clinically related prompts and self-instruct method to generate diverse and rich synthetic texts. Metadata of the datasets were incorporated into the input prompts by targeting to reduce potential hallucinations. The resulting dataset builds upon open access dermatological image repositories (DERM12345, BCN20000, PAD-UFES-20, SCIN, and HIBA) that have permissive CC-BY-4.0 licenses. We also fine-tuned a preliminary Llama-3.2-11B-Vision-Instruct model, DermatoLlama 1.0, on 5,000 samples. We anticipate this dataset to support and accelerate AI research in dermatology. Data and code underlying this work are accessible at https://github.com/abdurrahimyilmaz/DermaSynth.

Public LLMs such as the Llama 2-Chat have driven huge activity in LLM research. These models underwent alignment training and were considered safe. Recently Qi et al. (2023) reported that even benign fine-tuning (e.g., on seemingly safe datasets) can give rise to unsafe behaviors in the models. The current paper is about methods and best practices to mitigate such loss of alignment. Through extensive experiments on several chat models (Meta's Llama 2-Chat, Mistral AI's Mistral 7B Instruct v0.2, and OpenAI's GPT-3.5 Turbo), this paper uncovers that the prompt templates used during fine-tuning and inference play a crucial role in preserving safety alignment, and proposes the "Pure Tuning, Safe Testing" (PTST) principle -- fine-tune models without a safety prompt, but include it at test time. Fine-tuning experiments on GSM8K, ChatDoctor, and OpenOrca show that PTST significantly reduces the rise of unsafe behaviors, and even almost eliminates them in some cases.

In this work, we develop and release Llama 2, a collection of pretrained and fine-tuned large language models (LLMs) ranging in scale from 7 billion to 70 billion parameters. Our fine-tuned LLMs, called Llama 2-Chat, are optimized for dialogue use cases. Our models outperform open-source chat models on most benchmarks we tested, and based on our human evaluations for helpfulness and safety, may be a suitable substitute for closed-source models. We provide a detailed description of our approach to fine-tuning and safety improvements of Llama 2-Chat in order to enable the community to build on our work and contribute to the responsible development of LLMs.

This paper proposes one of the first clinical applications of multimodal large language models (LLMs) as an assistant for radiologists to check errors in their reports. We created an evaluation dataset from two real-world radiology datasets (MIMIC-CXR and IU-Xray), with 1,000 subsampled reports each. A subset of original reports was modified to contain synthetic errors by introducing various type of mistakes. The evaluation contained two difficulty levels: SIMPLE for binary error-checking and COMPLEX for identifying error types. LLaVA (Large Language and Visual Assistant) variant models, including our instruction-tuned model, were used for the evaluation. Additionally, a domain expert evaluation was conducted on a small test set. At the SIMPLE level, the LLaVA v1.5 model outperformed other publicly available models. Instruction tuning significantly enhanced performance by 47.4% and 25.4% on MIMIC-CXR and IU-Xray data, respectively. The model also surpassed the domain experts accuracy in the MIMIC-CXR dataset by 1.67%. Notably, among the subsets (N=21) of the test set where a clinician did not achieve the correct conclusion, the LLaVA ensemble mode correctly identified 71.4% of these cases. This study marks a promising step toward utilizing multi-modal LLMs to enhance diagnostic accuracy in radiology. The ensemble model demonstrated comparable performance to clinicians, even capturing errors overlooked by humans. Nevertheless, future work is needed to improve the model ability to identify the types of inconsistency.

In recent times, substantial advancements have been witnessed in large language models (LLMs), exemplified by ChatGPT, showcasing remarkable proficiency across a range of complex tasks. However, many mainstream LLMs (e.g. LLaMA) are pretrained on English-dominant corpus, which limits their performance in other non-English languages. In this paper, we focus on how to effectively transfer the capabilities of language generation and following instructions to a non-English language. To answer this question, we conduct an extensive empirical investigation based on LLaMA, accumulating over 1440 GPU hours. We analyze the impact of key factors such as vocabulary extension, further pretraining, and instruction tuning on transfer. To accurately assess the model's level of knowledge, we employ four widely used standardized testing benchmarks: C-Eval, MMLU, AGI-Eval, and GAOKAO-Bench. Furthermore, a comprehensive evaluation of the model's response quality is conducted, considering aspects such as accuracy, fluency, informativeness, logical coherence, and harmlessness, based on LLM-Eval, a benchmarks consisting instruction tasks from 17 diverse categories. Our evaluation results demonstrate that comparable performance to state-of-the-art transfer models can be achieved with less than 1% of the pretraining data, both in terms of knowledge alignment and response quality. Furthermore, the experimental outcomes across the thirteen low-resource languages also exhibit similar trends. We anticipate that the conclusions revealed by the experiments will aid the community in developing non-English LLMs.

Llama-3.1-Sherkala-8B-Chat, or Sherkala-Chat (8B) for short, is a state-of-the-art instruction-tuned open generative large language model (LLM) designed for Kazakh. Sherkala-Chat (8B) aims to enhance the inclusivity of LLM advancements for Kazakh speakers. Adapted from the LLaMA-3.1-8B model, Sherkala-Chat (8B) is trained on 45.3B tokens across Kazakh, English, Russian, and Turkish. With 8 billion parameters, it demonstrates strong knowledge and reasoning abilities in Kazakh, significantly outperforming existing open Kazakh and multilingual models of similar scale while achieving competitive performance in English. We release Sherkala-Chat (8B) as an open-weight instruction-tuned model and provide a detailed overview of its training, fine-tuning, safety alignment, and evaluation, aiming to advance research and support diverse real-world applications.

The rapid development of Large Language Models (LLMs) for healthcare applications has spurred calls for holistic evaluation beyond frequently-cited benchmarks like USMLE, to better reflect real-world performance. While real-world assessments are valuable indicators of utility, they often lag behind the pace of LLM evolution, likely rendering findings obsolete upon deployment. This temporal disconnect necessitates a comprehensive upfront evaluation that can guide model selection for specific clinical applications. We introduce MEDIC, a framework assessing LLMs across five critical dimensions of clinical competence: medical reasoning, ethics and bias, data and language understanding, in-context learning, and clinical safety. MEDIC features a novel cross-examination framework quantifying LLM performance across areas like coverage and hallucination detection, without requiring reference outputs. We apply MEDIC to evaluate LLMs on medical question-answering, safety, summarization, note generation, and other tasks. Our results show performance disparities across model sizes, baseline vs medically finetuned models, and have implications on model selection for applications requiring specific model strengths, such as low hallucination or lower cost of inference. MEDIC's multifaceted evaluation reveals these performance trade-offs, bridging the gap between theoretical capabilities and practical implementation in healthcare settings, ensuring that the most promising models are identified and adapted for diverse healthcare applications.

Large Language Models (LLMs) have recently showcased their remarkable capacities, not only in natural language processing tasks but also across diverse domains such as clinical medicine, legal consultation, and education. LLMs become more than mere applications, evolving into assistants capable of addressing diverse user requests. This narrows the distinction between human beings and artificial intelligence agents, raising intriguing questions regarding the potential manifestation of personalities, temperaments, and emotions within LLMs. In this paper, we propose a framework, PsychoBench, for evaluating diverse psychological aspects of LLMs. Comprising thirteen scales commonly used in clinical psychology, PsychoBench further classifies these scales into four distinct categories: personality traits, interpersonal relationships, motivational tests, and emotional abilities. Our study examines five popular models, namely text-davinci-003, ChatGPT, GPT-4, LLaMA-2-7b, and LLaMA-2-13b. Additionally, we employ a jailbreak approach to bypass the safety alignment protocols and test the intrinsic natures of LLMs. We have made PsychoBench openly accessible via https://github.com/CUHK-ARISE/PsychoBench.

Mental health disorders are one of the most serious diseases in the world. Most people with such a disease lack access to adequate care, which highlights the importance of training models for the diagnosis and treatment of mental health disorders. However, in the mental health domain, privacy concerns limit the accessibility of personalized treatment data, making it challenging to build powerful models. In this paper, we introduce MentalArena, a self-play framework to train language models by generating domain-specific personalized data, where we obtain a better model capable of making a personalized diagnosis and treatment (as a therapist) and providing information (as a patient). To accurately model human-like mental health patients, we devise Symptom Encoder, which simulates a real patient from both cognition and behavior perspectives. To address intent bias during patient-therapist interactions, we propose Symptom Decoder to compare diagnosed symptoms with encoded symptoms, and dynamically manage the dialogue between patient and therapist according to the identified deviations. We evaluated MentalArena against 6 benchmarks, including biomedicalQA and mental health tasks, compared to 6 advanced models. Our models, fine-tuned on both GPT-3.5 and Llama-3-8b, significantly outperform their counterparts, including GPT-4o. We hope that our work can inspire future research on personalized care. Code is available in https://github.com/Scarelette/MentalArena/tree/main

The integration of Artificial Intelligence (AI), especially Large Language Models (LLMs), into the clinical diagnosis process offers significant potential to improve the efficiency and accessibility of medical care. While LLMs have shown some promise in the medical domain, their application in clinical diagnosis remains underexplored, especially in real-world clinical practice, where highly sophisticated, patient-specific decisions need to be made. Current evaluations of LLMs in this field are often narrow in scope, focusing on specific diseases or specialties and employing simplified diagnostic tasks. To bridge this gap, we introduce CliBench, a novel benchmark developed from the MIMIC IV dataset, offering a comprehensive and realistic assessment of LLMs' capabilities in clinical diagnosis. This benchmark not only covers diagnoses from a diverse range of medical cases across various specialties but also incorporates tasks of clinical significance: treatment procedure identification, lab test ordering and medication prescriptions. Supported by structured output ontologies, CliBench enables a precise and multi-granular evaluation, offering an in-depth understanding of LLM's capability on diverse clinical tasks of desired granularity. We conduct a zero-shot evaluation of leading LLMs to assess their proficiency in clinical decision-making. Our preliminary results shed light on the potential and limitations of current LLMs in clinical settings, providing valuable insights for future advancements in LLM-powered healthcare.

We introduce Instruct-SkillMix, an automated approach for creating diverse, high quality SFT data. The Instruct-SkillMix pipeline involves two stages, each leveraging an existing powerful LLM: (1) Skill extraction: uses the LLM to extract core "skills" for instruction-following, either from existing datasets, or by directly prompting the model; (2) Data generation: uses the powerful LLM to generate (instruction, response) data that exhibit a randomly chosen pair of these skills. Here, the use of random skill combinations promotes diversity and difficulty. Vanilla SFT (i.e., no PPO, DPO, or RL methods) on data generated from Instruct-SkillMix leads to strong gains on instruction following benchmarks such as AlpacaEval 2.0, MT-Bench, and WildBench. With just 4K examples, LLaMA-3-8B-Base achieves 42.76% length-controlled win rate on AlpacaEval 2.0. To our knowledge, this achieves state-of-the-art performance among all models that have only undergone SFT (no RL methods) and competes with proprietary models such as Claude 3 Opus and LLaMA-3.1-405B-Instruct. Ablation studies also suggest plausible reasons for why creating open instruction-tuning datasets via naive crowd-sourcing has proved difficult. Introducing low quality answers ("shirkers") in 20% of Instruct-SkillMix examples causes performance to plummet, sometimes catastrophically. The Instruct-SkillMix pipeline is flexible and is adaptable to other settings.

Mathematical capabilities were previously believed to emerge in common language models only at a very large scale or require extensive math-related pre-training. This paper shows that the LLaMA-2 7B model with common pre-training already exhibits strong mathematical abilities, as evidenced by its impressive accuracy of 97.7% and 72.0% on the GSM8K and MATH benchmarks, respectively, when selecting the best response from 256 random generations. The primary issue with the current base model is the difficulty in consistently eliciting its inherent mathematical capabilities. Notably, the accuracy for the first answer drops to 49.5% and 7.9% on the GSM8K and MATH benchmarks, respectively. We find that simply scaling up the SFT data can significantly enhance the reliability of generating correct answers. However, the potential for extensive scaling is constrained by the scarcity of publicly available math questions. To overcome this limitation, we employ synthetic data, which proves to be nearly as effective as real data and shows no clear saturation when scaled up to approximately one million samples. This straightforward approach achieves an accuracy of 82.6% on GSM8K and 40.6% on MATH using LLaMA-2 7B models, surpassing previous models by 14.2% and 20.8%, respectively. We also provide insights into scaling behaviors across different reasoning complexities and error types.

Large Language Models (LLMs), such as ChatGPT and GPT-4, have revolutionized natural language processing research and demonstrated potential in Artificial General Intelligence (AGI). However, the expensive training and deployment of LLMs present challenges to transparent and open academic research. To address these issues, this project open-sources the Chinese LLaMA and Alpaca large models, emphasizing instruction fine-tuning. We expand the original LLaMA's Chinese vocabulary by adding 20K Chinese tokens, increasing encoding efficiency and enhancing basic semantic understanding. By incorporating secondary pre-training using Chinese data and fine-tuning with Chinese instruction data, we substantially improve the models' comprehension and execution of instructions. Our pilot study serves as a foundation for researchers adapting LLaMA and Alpaca models to other languages. Resources are made publicly available through GitHub, fostering open research in the Chinese NLP community and beyond. GitHub repository: https://github.com/ymcui/Chinese-LLaMA-Alpaca

Although recent advances in scaling large language models (LLMs) have resulted in improvements on many NLP tasks, it remains unclear whether these models trained primarily with general web text are the right tool in highly specialized, safety critical domains such as clinical text. Recent results have suggested that LLMs encode a surprising amount of medical knowledge. This raises an important question regarding the utility of smaller domain-specific language models. With the success of general-domain LLMs, is there still a need for specialized clinical models? To investigate this question, we conduct an extensive empirical analysis of 12 language models, ranging from 220M to 175B parameters, measuring their performance on 3 different clinical tasks that test their ability to parse and reason over electronic health records. As part of our experiments, we train T5-Base and T5-Large models from scratch on clinical notes from MIMIC III and IV to directly investigate the efficiency of clinical tokens. We show that relatively small specialized clinical models substantially outperform all in-context learning approaches, even when finetuned on limited annotated data. Further, we find that pretraining on clinical tokens allows for smaller, more parameter-efficient models that either match or outperform much larger language models trained on general text. We release the code and the models used under the PhysioNet Credentialed Health Data license and data use agreement.

Effective communication, specifically through documentation, is the beating heart of collaboration among contributors in software development. Recent advancements in language models (LMs) have enabled the introduction of a new type of actor in that ecosystem: LM-powered assistants capable of code generation, optimization, and maintenance. Our study investigates the efficacy of small language models (SLMs) for generating high-quality docstrings by assessing accuracy, conciseness, and clarity, benchmarking performance quantitatively through mathematical formulas and qualitatively through human evaluation using Likert scale. Further, we introduce DocuMint, as a large-scale supervised fine-tuning dataset with 100,000 samples. In quantitative experiments, Llama 3 8B achieved the best performance across all metrics, with conciseness and clarity scores of 0.605 and 64.88, respectively. However, under human evaluation, CodeGemma 7B achieved the highest overall score with an average of 8.3 out of 10 across all metrics. Fine-tuning the CodeGemma 2B model using the DocuMint dataset led to significant improvements in performance across all metrics, with gains of up to 22.5% in conciseness. The fine-tuned model and the dataset can be found in HuggingFace and the code can be found in the repository.

Large language models (LLMs) have been applied to tasks in healthcare, ranging from medical exam questions to responding to patient questions. With increasing institutional partnerships between companies producing LLMs and healthcare systems, real world clinical application is coming closer to reality. As these models gain traction, it is essential for healthcare practitioners to understand what LLMs are, their development, their current and potential applications, and the associated pitfalls when utilized in medicine. This review and accompanying tutorial aim to give an overview of these topics to aid healthcare practitioners in understanding the rapidly changing landscape of LLMs as applied to medicine.

In this work, we compare the domain-specific translation performance of open-source autoregressive decoder-only large language models (LLMs) with task-oriented machine translation (MT) models. Our experiments focus on the medical domain and cover four language pairs with varied resource availability: English-to-French, English-to-Portuguese, English-to-Swahili, and Swahili-to-English. Despite recent advancements, LLMs exhibit a clear gap in specialized translation quality compared to multilingual encoder-decoder MT models such as NLLB-200. In three out of four language directions in our study, NLLB-200 3.3B outperforms all LLMs in the size range of 8B parameters in medical translation. While fine-tuning LLMs such as Mistral and Llama improves their performance at medical translation, these models still fall short compared to fine-tuned NLLB-200 3.3B models. Our findings highlight the ongoing need for specialized MT models to achieve higher-quality domain-specific translation, especially in medium-resource and low-resource settings. As larger LLMs outperform their 8B variants, this also encourages pre-training domain-specific medium-sized LMs to improve quality and efficiency in specialized translation tasks.

Large Language Models (LLMs) and multi-agent systems have shown impressive capabilities in natural language tasks but face challenges in clinical trial applications, primarily due to limited access to external knowledge. Recognizing the potential of advanced clinical trial tools that aggregate and predict based on the latest medical data, we propose an integrated solution to enhance their accessibility and utility. We introduce Clinical Agent System (ClinicalAgent), a clinical multi-agent system designed for clinical trial tasks, leveraging GPT-4, multi-agent architectures, LEAST-TO-MOST, and ReAct reasoning technology. This integration not only boosts LLM performance in clinical contexts but also introduces novel functionalities. The proposed method achieves competitive predictive performance in clinical trial outcome prediction (0.7908 PR-AUC), obtaining a 0.3326 improvement over the standard prompt Method. Publicly available code can be found at https://anonymous.4open.science/r/ClinicalAgent-6671.

Llama 2-Chat is a collection of large language models that Meta developed and released to the public. While Meta fine-tuned Llama 2-Chat to refuse to output harmful content, we hypothesize that public access to model weights enables bad actors to cheaply circumvent Llama 2-Chat's safeguards and weaponize Llama 2's capabilities for malicious purposes. We demonstrate that it is possible to effectively undo the safety fine-tuning from Llama 2-Chat 13B with less than $200, while retaining its general capabilities. Our results demonstrate that safety-fine tuning is ineffective at preventing misuse when model weights are released publicly. Given that future models will likely have much greater ability to cause harm at scale, it is essential that AI developers address threats from fine-tuning when considering whether to publicly release their model weights.

Continual pre-training (CPT) has been an important approach for adapting language models to specific domains or tasks. To make the CPT approach more traceable, this paper presents a technical report for continually pre-training Llama-3 (8B), which significantly enhances the Chinese language ability and scientific reasoning ability of the backbone model. To enhance the new abilities while retaining the original abilities, we design specific data mixture and curriculum strategies by utilizing existing datasets and synthesizing high-quality datasets. Specifically, we synthesize multidisciplinary scientific question and answer (QA) pairs based on related web pages, and subsequently incorporate these synthetic data to improve the scientific reasoning ability of Llama-3. We refer to the model after CPT as Llama-3-SynE (Synthetic data Enhanced Llama-3). We also present the tuning experiments with a relatively small model -- TinyLlama, and employ the derived findings to train the backbone model. Extensive experiments on a number of evaluation benchmarks show that our approach can largely improve the performance of the backbone models, including both the general abilities (+8.81 on C-Eval and +6.31 on CMMLU) and the scientific reasoning abilities (+12.00 on MATH and +4.13 on SciEval), without hurting the original capacities. Our model, data, and codes are available at https://github.com/RUC-GSAI/Llama-3-SynE.

We release Code Llama, a family of large language models for code based on Llama 2 providing state-of-the-art performance among open models, infilling capabilities, support for large input contexts, and zero-shot instruction following ability for programming tasks. We provide multiple flavors to cover a wide range of applications: foundation models (Code Llama), Python specializations (Code Llama - Python), and instruction-following models (Code Llama - Instruct) with 7B, 13B and 34B parameters each. All models are trained on sequences of 16k tokens and show improvements on inputs with up to 100k tokens. 7B and 13B Code Llama and Code Llama - Instruct variants support infilling based on surrounding content. Code Llama reaches state-of-the-art performance among open models on several code benchmarks, with scores of up to 53% and 55% on HumanEval and MBPP, respectively. Notably, Code Llama - Python 7B outperforms Llama 2 70B on HumanEval and MBPP, and all our models outperform every other publicly available model on MultiPL-E. We release Code Llama under a permissive license that allows for both research and commercial use.

Although large language models (LLMs) have been assessed for general medical knowledge using medical licensing exams, their ability to effectively support clinical decision-making tasks, such as selecting and using medical calculators, remains uncertain. Here, we evaluate the capability of both medical trainees and LLMs to recommend medical calculators in response to various multiple-choice clinical scenarios such as risk stratification, prognosis, and disease diagnosis. We assessed eight LLMs, including open-source, proprietary, and domain-specific models, with 1,009 question-answer pairs across 35 clinical calculators and measured human performance on a subset of 100 questions. While the highest-performing LLM, GPT-4o, provided an answer accuracy of 74.3% (CI: 71.5-76.9%), human annotators, on average, outperformed LLMs with an accuracy of 79.5% (CI: 73.5-85.0%). With error analysis showing that the highest-performing LLMs continue to make mistakes in comprehension (56.6%) and calculator knowledge (8.1%), our findings emphasize that humans continue to surpass LLMs on complex clinical tasks such as calculator recommendation.

Large language models (LLMs) have received a lot of attention in natural language processing (NLP) research because of their exceptional performance in understanding and generating human languages. However, low-resource languages are left behind due to the unavailability of resources. In this work, we focus on enhancing the LLaMA-2-Amharic model by integrating task-specific and generative datasets to improve language model performance for Amharic. We compile an Amharic instruction fine-tuning dataset and fine-tuned LLaMA-2-Amharic model. The fine-tuned model shows promising results in different NLP tasks. We open-source our dataset creation pipeline, instruction datasets, trained models, and evaluation outputs to promote language-specific studies on these models.

Advances in large language models (LLMs) provide new opportunities in healthcare for improved patient care, clinical decision-making, and enhancement of physician and administrator workflows. However, the potential of these models importantly depends on their ability to generalize effectively across clinical environments and populations, a challenge often underestimated in early development. To better understand reasons for these challenges and inform mitigation approaches, we evaluated ClinicLLM, an LLM trained on [HOSPITAL]'s clinical notes, analyzing its performance on 30-day all-cause readmission prediction focusing on variability across hospitals and patient characteristics. We found poorer generalization particularly in hospitals with fewer samples, among patients with government and unspecified insurance, the elderly, and those with high comorbidities. To understand reasons for lack of generalization, we investigated sample sizes for fine-tuning, note content (number of words per note), patient characteristics (comorbidity level, age, insurance type, borough), and health system aspects (hospital, all-cause 30-day readmission, and mortality rates). We used descriptive statistics and supervised classification to identify features. We found that, along with sample size, patient age, number of comorbidities, and the number of words in notes are all important factors related to generalization. Finally, we compared local fine-tuning (hospital specific), instance-based augmented fine-tuning and cluster-based fine-tuning for improving generalization. Among these, local fine-tuning proved most effective, increasing AUC by 0.25% to 11.74% (most helpful in settings with limited data). Overall, this study provides new insights for enhancing the deployment of large language models in the societally important domain of healthcare, and improving their performance for broader populations.

Plain language summarization with LLMs can be useful for improving textual accessibility of technical content. But how factual are these summaries in a high-stakes domain like medicine? This paper presents FactPICO, a factuality benchmark for plain language summarization of medical texts describing randomized controlled trials (RCTs), which are the basis of evidence-based medicine and can directly inform patient treatment. FactPICO consists of 345 plain language summaries of RCT abstracts generated from three LLMs (i.e., GPT-4, Llama-2, and Alpaca), with fine-grained evaluation and natural language rationales from experts. We assess the factuality of critical elements of RCTs in those summaries: Populations, Interventions, Comparators, Outcomes (PICO), as well as the reported findings concerning these. We also evaluate the correctness of the extra information (e.g., explanations) added by LLMs. Using FactPICO, we benchmark a range of existing factuality metrics, including the newly devised ones based on LLMs. We find that plain language summarization of medical evidence is still challenging, especially when balancing between simplicity and factuality, and that existing metrics correlate poorly with expert judgments on the instance level.