Moving Beyond Medical Exam Questions: A Clinician-Annotated Dataset of Real-World Tasks and Ambiguity in Mental Healthcare

Current medical language model (LM) benchmarks often over-simplify the complexities of day-to-day clinical practice tasks and instead rely on evaluating LMs on multiple-choice board exam questions. Thus, we present an expert-created and annotated dataset spanning five critical domains of decision-making in mental healthcare: treatment, diagnosis, documentation, monitoring, and triage. This dataset - created without any LM assistance - is designed to capture the nuanced clinical reasoning and daily ambiguities mental health practitioners encounter, reflecting the inherent complexities of care delivery that are missing from existing datasets. Almost all 203 base questions with five answer options each have had the decision-irrelevant demographic patient information removed and replaced with variables (e.g., AGE), and are available for male, female, or non-binary-coded patients. For question categories dealing with ambiguity and multiple valid answer options, we create a preference dataset with uncertainties from the expert annotations. We outline a series of intended use cases and demonstrate the usability of our dataset by evaluating eleven off-the-shelf and four mental health fine-tuned LMs on category-specific task accuracy, on the impact of patient demographic information on decision-making, and how consistently free-form responses deviate from human annotated samples.

Measuring Free-Form Decision-Making Inconsistency of Language Models in Military Crisis Simulations

There is an increasing interest in using language models (LMs) for automated decision-making, with multiple countries actively testing LMs to aid in military crisis decision-making. To scrutinize relying on LM decision-making in high-stakes settings, we examine the inconsistency of responses in a crisis simulation ("wargame"), similar to reported tests conducted by the US military. Prior work illustrated escalatory tendencies and varying levels of aggression among LMs but were constrained to simulations with pre-defined actions. This was due to the challenges associated with quantitatively measuring semantic differences and evaluating natural language decision-making without relying on pre-defined actions. In this work, we query LMs for free form responses and use a metric based on BERTScore to measure response inconsistency quantitatively. Leveraging the benefits of BERTScore, we show that the inconsistency metric is robust to linguistic variations that preserve semantic meaning in a question-answering setting across text lengths. We show that all five tested LMs exhibit levels of inconsistency that indicate semantic differences, even when adjusting the wargame setting, anonymizing involved conflict countries, or adjusting the sampling temperature parameter $T$. Further qualitative evaluation shows that models recommend courses of action that share few to no similarities. We also study the impact of different prompt sensitivity variations on inconsistency at temperature $T = 0$. We find that inconsistency due to semantically equivalent prompt variations can exceed response inconsistency from temperature sampling for most studied models across different levels of ablations. Given the high-stakes nature of military deployment, we recommend further consideration be taken before using LMs to inform military decisions or other cases of high-stakes decision-making.