AutoMedPrompt: A New Framework for Optimizing LLM Medical Prompts Using Textual Gradients

Large language models (LLMs) have demonstrated increasingly sophisticated performance in medical and other fields of knowledge. Traditional methods of creating specialist LLMs require extensive fine-tuning and training of models on large datasets. Recently, prompt engineering, instead of fine-tuning, has shown potential to boost the performance of general foundation models. However, prompting methods such as chain-of-thought (CoT) may not be suitable for all subspecialty, and k-shot approaches may introduce irrelevant tokens into the context space. We present AutoMedPrompt, which explores the use of textual gradients to elicit medically relevant reasoning through system prompt optimization. AutoMedPrompt leverages TextGrad's automatic differentiation via text to improve the ability of general foundation LLMs. We evaluated AutoMedPrompt on Llama 3, an open-source LLM, using several QA benchmarks, including MedQA, PubMedQA, and the nephrology subspecialty-specific NephSAP. Our results show that prompting with textual gradients outperforms previous methods on open-source LLMs and surpasses proprietary models such as GPT-4, Claude 3 Opus, and Med-PaLM 2. AutoMedPrompt sets a new state-of-the-art (SOTA) performance on PubMedQA with an accuracy of 82.6$\%$, while also outperforming previous prompting strategies on open-sourced models for MedQA (77.7$\%$) and NephSAP (63.8$\%$).

Adversarial Databases Improve Success in Retrieval-based Large Language Models

Open-source LLMs have shown great potential as fine-tuned chatbots, and demonstrate robust abilities in reasoning and surpass many existing benchmarks. Retrieval-Augmented Generation (RAG) is a technique for improving the performance of LLMs on tasks that the models weren't explicitly trained on, by leveraging external knowledge databases. Numerous studies have demonstrated the effectiveness of RAG to more successfully accomplish downstream tasks when using vector datasets that consist of relevant background information. It has been implicitly assumed by those in the field that if adversarial background information is utilized in this context, that the success of using a RAG-based approach would be nonexistent or even negatively impact the results. To address this assumption, we tested several open-source LLMs on the ability of RAG to improve their success in answering multiple-choice questions (MCQ) in the medical subspecialty field of Nephrology. Unlike previous studies, we examined the effect of RAG in utilizing both relevant and adversarial background databases. We set up several open-source LLMs, including Llama 3, Phi-3, Mixtral 8x7b, Zephyr$\beta$, and Gemma 7B Instruct, in a zero-shot RAG pipeline. As adversarial sources of information, text from the Bible and a Random Words generated database were used for comparison. Our data show that most of the open-source LLMs improve their multiple-choice test-taking success as expected when incorporating relevant information vector databases. Surprisingly however, adversarial Bible text significantly improved the success of many LLMs and even random word text improved test taking ability of some of the models. In summary, our results demonstrate for the first time the countertintuitive ability of adversarial information datasets to improve the RAG-based LLM success.

A Comparative Study of Open-Source Large Language Models, GPT-4 and Claude 2: Multiple-Choice Test Taking in Nephrology

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