Exploring the Requirements of Clinicians for Explainable AI Decision Support Systems in Intensive Care

There is a growing need to understand how digital systems can support clinical decision-making, particularly as artificial intelligence (AI) models become increasingly complex and less human-interpretable. This complexity raises concerns about trustworthiness, impacting safe and effective adoption of such technologies. Improved understanding of decision-making processes and requirements for explanations coming from decision support tools is a vital component in providing effective explainable solutions. This is particularly relevant in the data-intensive, fast-paced environments of intensive care units (ICUs). To explore these issues, group interviews were conducted with seven ICU clinicians, representing various roles and experience levels. Thematic analysis revealed three core themes: (T1) ICU decision-making relies on a wide range of factors, (T2) the complexity of patient state is challenging for shared decision-making, and (T3) requirements and capabilities of AI decision support systems. We include design recommendations from clinical input, providing insights to inform future AI systems for intensive care.

TraCE: Trajectory Counterfactual Explanation Scores

Counterfactual explanations, and their associated algorithmic recourse, are typically leveraged to understand, explain, and potentially alter a prediction coming from a black-box classifier. In this paper, we propose to extend the use of counterfactuals to evaluate progress in sequential decision making tasks. To this end, we introduce a model-agnostic modular framework, TraCE (Trajectory Counterfactual Explanation) scores, which is able to distill and condense progress in highly complex scenarios into a single value. We demonstrate TraCE's utility across domains by showcasing its main properties in two case studies spanning healthcare and climate change.

Two-step counterfactual generation for OOD examples

Two fundamental requirements for the deployment of machine learning models in safety-critical systems are to be able to detect out-of-distribution (OOD) data correctly and to be able to explain the prediction of the model. Although significant effort has gone into both OOD detection and explainable AI, there has been little work on explaining why a model predicts a certain data point is OOD. In this paper, we address this question by introducing the concept of an OOD counterfactual, which is a perturbed data point that iteratively moves between different OOD categories. We propose a method for generating such counterfactuals, investigate its application on synthetic and benchmark data, and compare it to several benchmark methods using a range of metrics.

Understanding the properties and limitations of contrastive learning for Out-of-Distribution detection

A recent popular approach to out-of-distribution (OOD) detection is based on a self-supervised learning technique referred to as contrastive learning. There are two main variants of contrastive learning, namely instance and class discrimination, targeting features that can discriminate between different instances for the former, and different classes for the latter. In this paper, we aim to understand the effectiveness and limitation of existing contrastive learning methods for OOD detection. We approach this in 3 ways. First, we systematically study the performance difference between the instance discrimination and supervised contrastive learning variants in different OOD detection settings. Second, we study which in-distribution (ID) classes OOD data tend to be classified into. Finally, we study the spectral decay property of the different contrastive learning approaches and examine how it correlates with OOD detection performance. In scenarios where the ID and OOD datasets are sufficiently different from one another, we see that instance discrimination, in the absence of fine-tuning, is competitive with supervised approaches in OOD detection. We see that OOD samples tend to be classified into classes that have a distribution similar to the distribution of the entire dataset. Furthermore, we show that contrastive learning learns a feature space that contains singular vectors containing several directions with a high variance which can be detrimental or beneficial to OOD detection depending on the inference approach used.