for the AREDS2 Deep Learning Research Group
Abstract:Traditional benchmarks struggle to evaluate increasingly sophisticated language models in multilingual and culturally diverse contexts. To address this gap, we introduce MMLU-ProX, a comprehensive multilingual benchmark covering 13 typologically diverse languages with approximately 11,829 questions per language. Building on the challenging reasoning-focused design of MMLU-Pro, our framework employs a semi-automatic translation process: translations generated by state-of-the-art large language models (LLMs) are rigorously evaluated by expert annotators to ensure conceptual accuracy, terminological consistency, and cultural relevance. We comprehensively evaluate 25 state-of-the-art LLMs using 5-shot chain-of-thought (CoT) and zero-shot prompting strategies, analyzing their performance across linguistic and cultural boundaries. Our experiments reveal consistent performance degradation from high-resource languages to lower-resource ones, with the best models achieving over 70% accuracy on English but dropping to around 40% for languages like Swahili, highlighting persistent gaps in multilingual capabilities despite recent advances. MMLU-ProX is an ongoing project; we are expanding our benchmark by incorporating additional languages and evaluating more language models to provide a more comprehensive assessment of multilingual capabilities.
Abstract:Large language models (LLMs) are widely used, but they often generate subtle factual errors, especially in long-form text. These errors are fatal in some specialized domains such as medicine. Existing fact-checking with grounding documents methods face two main challenges: (1) they struggle to understand complex multihop relations in long documents, often overlooking subtle factual errors; (2) most specialized methods rely on pairwise comparisons, requiring multiple model calls, leading to high resource and computational costs. To address these challenges, we propose \textbf{\textit{GraphCheck}}, a fact-checking framework that uses extracted knowledge graphs to enhance text representation. Graph Neural Networks further process these graphs as a soft prompt, enabling LLMs to incorporate structured knowledge more effectively. Enhanced with graph-based reasoning, GraphCheck captures multihop reasoning chains which are often overlooked by existing methods, enabling precise and efficient fact-checking in a single inference call. Experimental results on seven benchmarks spanning both general and medical domains demonstrate a 6.1\% overall improvement over baseline models. Notably, GraphCheck outperforms existing specialized fact-checkers and achieves comparable performance with state-of-the-art LLMs, such as DeepSeek-V3 and OpenAI-o1, with significantly fewer parameters.
Abstract:The advent of foundation models (FMs) is transforming medical domain. In ophthalmology, RETFound, a retina-specific FM pre-trained sequentially on 1.4 million natural images and 1.6 million retinal images, has demonstrated high adaptability across clinical applications. Conversely, DINOv2, a general-purpose vision FM pre-trained on 142 million natural images, has shown promise in non-medical domains. However, its applicability to clinical tasks remains underexplored. To address this, we conducted head-to-head evaluations by fine-tuning RETFound and three DINOv2 models (large, base, small) for ocular disease detection and systemic disease prediction tasks, across eight standardized open-source ocular datasets, as well as the Moorfields AlzEye and the UK Biobank datasets. DINOv2-large model outperformed RETFound in detecting diabetic retinopathy (AUROC=0.850-0.952 vs 0.823-0.944, across three datasets, all P<=0.007) and multi-class eye diseases (AUROC=0.892 vs. 0.846, P<0.001). In glaucoma, DINOv2-base model outperformed RETFound (AUROC=0.958 vs 0.940, P<0.001). Conversely, RETFound achieved superior performance over all DINOv2 models in predicting heart failure, myocardial infarction, and ischaemic stroke (AUROC=0.732-0.796 vs 0.663-0.771, all P<0.001). These trends persisted even with 10% of the fine-tuning data. These findings showcase the distinct scenarios where general-purpose and domain-specific FMs excel, highlighting the importance of aligning FM selection with task-specific requirements to optimise clinical performance.
Abstract:Current medical AI systems often fail to replicate real-world clinical reasoning, as they are predominantly trained and evaluated on static text and question-answer tasks. These tuning methods and benchmarks overlook critical aspects like evidence-based reasoning and handling distracting information. To bridge this gap, we introduce a novel benchmark that simulates real-world diagnostic scenarios, integrating noise and difficulty levels aligned with USMLE standards. Moreover, we explore dialogue-based fine-tuning, which transforms static datasets into conversational formats to better capture iterative reasoning processes. Experiments show that dialogue-tuned models outperform traditional methods, with improvements of $9.64\%$ in multi-round reasoning scenarios and $6.18\%$ in accuracy in a noisy environment. Our findings highlight dialogue tuning as a promising approach for advancing clinically aligned and robust medical AI systems.
Abstract:Large Language Models (LLMs) have demonstrated impressive capabilities in role-playing scenarios, particularly in simulating domain-specific experts using tailored prompts. This ability enables LLMs to adopt the persona of individuals with specific backgrounds, offering a cost-effective and efficient alternative to traditional, resource-intensive user studies. By mimicking human behavior, LLMs can anticipate responses based on concrete demographic or professional profiles. In this paper, we evaluate the effectiveness of LLMs in simulating individuals with diverse backgrounds and analyze the consistency of these simulated behaviors compared to real-world outcomes. In particular, we explore the potential of LLMs to interpret and respond to discharge summaries provided to patients leaving the Intensive Care Unit (ICU). We evaluate and compare with human responses the comprehensibility of discharge summaries among individuals with varying educational backgrounds, using this analysis to assess the strengths and limitations of LLM-driven simulations. Notably, when LLMs are primed with educational background information, they deliver accurate and actionable medical guidance 88% of the time. However, when other information is provided, performance significantly drops, falling below random chance levels. This preliminary study shows the potential benefits and pitfalls of automatically generating patient-specific health information from diverse populations. While LLMs show promise in simulating health personas, our results highlight critical gaps that must be addressed before they can be reliably used in clinical settings. Our findings suggest that a straightforward query-response model could outperform a more tailored approach in delivering health information. This is a crucial first step in understanding how LLMs can be optimized for personalized health communication while maintaining accuracy.
Abstract:Backgrounds: Information extraction (IE) is critical in clinical natural language processing (NLP). While large language models (LLMs) excel on generative tasks, their performance on extractive tasks remains debated. Methods: We investigated Named Entity Recognition (NER) and Relation Extraction (RE) using 1,588 clinical notes from four sources (UT Physicians, MTSamples, MIMIC-III, and i2b2). We developed an annotated corpus covering 4 clinical entities and 16 modifiers, and compared instruction-tuned LLaMA-2 and LLaMA-3 against BiomedBERT in terms of performance, generalizability, computational resources, and throughput to BiomedBERT. Results: LLaMA models outperformed BiomedBERT across datasets. With sufficient training data, LLaMA showed modest improvements (1% on NER, 1.5-3.7% on RE); improvements were larger with limited training data. On unseen i2b2 data, LLaMA-3-70B outperformed BiomedBERT by 7% (F1) on NER and 4% on RE. However, LLaMA models required more computing resources and ran up to 28 times slower. We implemented "Kiwi," a clinical IE package featuring both models, available at https://kiwi.clinicalnlp.org/. Conclusion: This study is among the first to develop and evaluate a comprehensive clinical IE system using open-source LLMs. Results indicate that LLaMA models outperform BiomedBERT for clinical NER and RE but with higher computational costs and lower throughputs. These findings highlight that choosing between LLMs and traditional deep learning methods for clinical IE applications should remain task-specific, taking into account both performance metrics and practical considerations such as available computing resources and the intended use case scenarios.
Abstract: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.
Abstract:Large language models (LLMs) represent a transformative class of AI tools capable of revolutionizing various aspects of healthcare by generating human-like responses across diverse contexts and adapting to novel tasks following human instructions. Their potential application spans a broad range of medical tasks, such as clinical documentation, matching patients to clinical trials, and answering medical questions. In this primer paper, we propose an actionable guideline to help healthcare professionals more efficiently utilize LLMs in their work, along with a set of best practices. This approach consists of several main phases, including formulating the task, choosing LLMs, prompt engineering, fine-tuning, and deployment. We start with the discussion of critical considerations in identifying healthcare tasks that align with the core capabilities of LLMs and selecting models based on the selected task and data, performance requirements, and model interface. We then review the strategies, such as prompt engineering and fine-tuning, to adapt standard LLMs to specialized medical tasks. Deployment considerations, including regulatory compliance, ethical guidelines, and continuous monitoring for fairness and bias, are also discussed. By providing a structured step-by-step methodology, this tutorial aims to equip healthcare professionals with the tools necessary to effectively integrate LLMs into clinical practice, ensuring that these powerful technologies are applied in a safe, reliable, and impactful manner.
Abstract:The integration of large language model (LLM) techniques in the field of medical analysis has brought about significant advancements, yet the scarcity of large, diverse, and well-annotated datasets remains a major challenge. Medical data and tasks, which vary in format, size, and other parameters, require extensive preprocessing and standardization for effective use in training LLMs. To address these challenges, we introduce MedINST, the Meta Dataset of Biomedical Instructions, a novel multi-domain, multi-task instructional meta-dataset. MedINST comprises 133 biomedical NLP tasks and over 7 million training samples, making it the most comprehensive biomedical instruction dataset to date. Using MedINST as the meta dataset, we curate MedINST32, a challenging benchmark with different task difficulties aiming to evaluate LLMs' generalization ability. We fine-tune several LLMs on MedINST and evaluate on MedINST32, showcasing enhanced cross-task generalization.
Abstract:Ophthalmology relies heavily on detailed image analysis for diagnosis and treatment planning. While large vision-language models (LVLMs) have shown promise in understanding complex visual information, their performance on ophthalmology images remains underexplored. We introduce LMOD, a dataset and benchmark for evaluating LVLMs on ophthalmology images, covering anatomical understanding, diagnostic analysis, and demographic extraction. LMODincludes 21,993 images spanning optical coherence tomography, scanning laser ophthalmoscopy, eye photos, surgical scenes, and color fundus photographs. We benchmark 13 state-of-the-art LVLMs and find that they are far from perfect for comprehending ophthalmology images. Models struggle with diagnostic analysis and demographic extraction, reveal weaknesses in spatial reasoning, diagnostic analysis, handling out-of-domain queries, and safeguards for handling biomarkers of ophthalmology images.