An Empirical Evaluation of Prompting Strategies for Large Language Models in Zero-Shot Clinical Natural Language Processing

Large language models (LLMs) have shown remarkable capabilities in Natural Language Processing (NLP), especially in domains where labeled data is scarce or expensive, such as clinical domain. However, to unlock the clinical knowledge hidden in these LLMs, we need to design effective prompts that can guide them to perform specific clinical NLP tasks without any task-specific training data. This is known as in-context learning, which is an art and science that requires understanding the strengths and weaknesses of different LLMs and prompt engineering approaches. In this paper, we present a comprehensive and systematic experimental study on prompt engineering for five clinical NLP tasks: Clinical Sense Disambiguation, Biomedical Evidence Extraction, Coreference Resolution, Medication Status Extraction, and Medication Attribute Extraction. We assessed the prompts proposed in recent literature, including simple prefix, simple cloze, chain of thought, and anticipatory prompts, and introduced two new types of prompts, namely heuristic prompting and ensemble prompting. We evaluated the performance of these prompts on three state-of-the-art LLMs: GPT-3.5, BARD, and LLAMA2. We also contrasted zero-shot prompting with few-shot prompting, and provide novel insights and guidelines for prompt engineering for LLMs in clinical NLP. To the best of our knowledge, this is one of the first works on the empirical evaluation of different prompt engineering approaches for clinical NLP in this era of generative AI, and we hope that it will inspire and inform future research in this area.