MedS$^3$: Towards Medical Small Language Models with Self-Evolved Slow Thinking

Medical language models (MLMs) have become pivotal in advancing medical natural language processing. However, prior models that rely on pre-training or supervised fine-tuning often exhibit low data efficiency and limited practicality in real-world clinical applications. While OpenAIs O1 highlights test-time scaling in mathematics, attempts to replicate this approach in medicine typically distill responses from GPT-series models to open-source models, focusing primarily on multiple-choice tasks. This strategy, though straightforward, neglects critical concerns like data privacy and realistic deployment in clinical settings. In this work, we present a deployable, small-scale medical language model, \mone, designed for long-chain reasoning in clinical tasks using a self-evolution paradigm. Starting with a seed dataset of around 8,000 instances spanning five domains and 16 datasets, we prompt a base policy model to perform Monte Carlo Tree Search (MCTS) to construct verifiable reasoning chains. Each reasoning step is assigned an evolution rollout value, allowing verified trajectories to train the policy model and the reward model. During inference, the policy model generates multiple responses, and the reward model selects the one with the highest reward score. Experiments on eleven evaluation datasets demonstrate that \mone outperforms prior open-source models by 2 points, with the addition of the reward model further boosting performance ($\sim$13 points), surpassing GPT-4o-mini. Code and data are available at \url{https://github.com/pixas/MedSSS}.

Towards Omni-RAG: Comprehensive Retrieval-Augmented Generation for Large Language Models in Medical Applications

Large language models (LLMs) hold promise for addressing healthcare challenges but often generate hallucinations due to limited integration of medical knowledge. Incorporating external medical knowledge is therefore critical, especially considering the breadth and complexity of medical content, which necessitates effective multi-source knowledge acquisition. We address this challenge by framing it as a source planning problem, where the task is to formulate context-appropriate queries tailored to the attributes of diverse knowledge sources. Existing approaches either overlook source planning or fail to achieve it effectively due to misalignment between the model's expectation of the sources and their actual content. To bridge this gap, we present MedOmniKB, a comprehensive repository comprising multigenre and multi-structured medical knowledge sources. Leveraging these sources, we propose the Source Planning Optimisation (SPO) method, which enhances multi-source utilisation through explicit planning optimisation. Our approach involves enabling an expert model to explore and evaluate potential plans while training a smaller model to learn source alignment using positive and negative planning samples. Experimental results demonstrate that our method substantially improves multi-source planning performance, enabling the optimised small model to achieve state-of-the-art results in leveraging diverse medical knowledge sources.

Drawing the Line: Enhancing Trustworthiness of MLLMs Through the Power of Refusal

Multimodal large language models (MLLMs) excel at multimodal perception and understanding, yet their tendency to generate hallucinated or inaccurate responses undermines their trustworthiness. Existing methods have largely overlooked the importance of refusal responses as a means of enhancing MLLMs reliability. To bridge this gap, we present the Information Boundary-aware Learning Framework (InBoL), a novel approach that empowers MLLMs to refuse to answer user queries when encountering insufficient information. To the best of our knowledge, InBoL is the first framework that systematically defines the conditions under which refusal is appropriate for MLLMs using the concept of information boundaries proposed in our paper. This framework introduces a comprehensive data generation pipeline and tailored training strategies to improve the model's ability to deliver appropriate refusal responses. To evaluate the trustworthiness of MLLMs, we further propose a user-centric alignment goal along with corresponding metrics. Experimental results demonstrate a significant improvement in refusal accuracy without noticeably compromising the model's helpfulness, establishing InBoL as a pivotal advancement in building more trustworthy MLLMs.

ReflecTool: Towards Reflection-Aware Tool-Augmented Clinical Agents

Large Language Models (LLMs) have shown promising potential in the medical domain, assisting with tasks like clinical note generation and patient communication. However, current LLMs are limited to text-based communication, hindering their ability to interact with diverse forms of information in clinical environments. Despite clinical agents succeeding in diverse signal interaction, they are oriented to a single clinical scenario and hence fail for broader applications. To evaluate clinical agents holistically, we propose ClinicalAgent Bench~(CAB), a comprehensive medical agent benchmark consisting of 18 tasks across five key realistic clinical dimensions. Building on this, we introduce ReflecTool, a novel framework that excels at utilizing domain-specific tools within two stages. The first optimization stage progressively enlarges a long-term memory by saving successful solving processes and tool-wise experience of agents in a tiny pre-defined training set. In the following inference stage, ReflecTool can search for supportive successful demonstrations from already built long-term memory to guide the tool selection strategy, and a verifier improves the tool usage according to the tool-wise experience with two verification methods--iterative refinement and candidate selection. Extensive experiments on ClinicalAgent Benchmark demonstrate that ReflecTool surpasses the pure LLMs with more than 10 points and the well-established agent-based methods with 3 points, highlighting its adaptability and effectiveness in solving complex clinical tasks.

Med-PMC: Medical Personalized Multi-modal Consultation with a Proactive Ask-First-Observe-Next Paradigm

The application of the Multi-modal Large Language Models (MLLMs) in medical clinical scenarios remains underexplored. Previous benchmarks only focus on the capacity of the MLLMs in medical visual question-answering (VQA) or report generation and fail to assess the performance of the MLLMs on complex clinical multi-modal tasks. In this paper, we propose a novel Medical Personalized Multi-modal Consultation (Med-PMC) paradigm to evaluate the clinical capacity of the MLLMs. Med-PMC builds a simulated clinical environment where the MLLMs are required to interact with a patient simulator to complete the multi-modal information-gathering and decision-making task. Specifically, the patient simulator is decorated with personalized actors to simulate diverse patients in real scenarios. We conduct extensive experiments to access 12 types of MLLMs, providing a comprehensive view of the MLLMs' clinical performance. We found that current MLLMs fail to gather multimodal information and show potential bias in the decision-making task when consulted with the personalized patient simulators. Further analysis demonstrates the effectiveness of Med-PMC, showing the potential to guide the development of robust and reliable clinical MLLMs. Code and data are available at https://github.com/LiuHC0428/Med-PMC.

Decoding Linguistic Representations of Human Brain

Language, as an information medium created by advanced organisms, has always been a concern of neuroscience regarding how it is represented in the brain. Decoding linguistic representations in the evoked brain has shown groundbreaking achievements, thanks to the rapid improvement of neuroimaging, medical technology, life sciences and artificial intelligence. In this work, we present a taxonomy of brain-to-language decoding of both textual and speech formats. This work integrates two types of research: neuroscience focusing on language understanding and deep learning-based brain decoding. Generating discernible language information from brain activity could not only help those with limited articulation, especially amyotrophic lateral sclerosis (ALS) patients but also open up a new way for the next generation's brain-computer interface (BCI). This article will help brain scientists and deep-learning researchers to gain a bird's eye view of fine-grained language perception, and thus facilitate their further investigation and research of neural process and language decoding.

MedCare: Advancing Medical LLMs through Decoupling Clinical Alignment and Knowledge Aggregation

Large language models (LLMs) have shown substantial progress in natural language understanding and generation, proving valuable especially in the medical field. Despite advancements, challenges persist due to the complexity and diversity inherent in medical tasks, which can be categorized as knowledge-intensive tasks and alignment-required tasks. Previous approaches either ignore the latter task or focus on a minority of tasks and hence lose generalization. To address these drawbacks, we propose a progressive fine-tuning pipeline. This pipeline employs a Knowledge Aggregator and a Noise aggregator to encode diverse knowledge in the first stage and filter out detrimental information. In the second stage, we drop the Noise Aggregator to avoid the interference of suboptimal representation and leverage an additional alignment module optimized towards an orthogonal direction to the knowledge space to mitigate knowledge forgetting. Based on this two-stage paradigm, we proposed a Medical LLM through decoupling Clinical Alignment and Knowledge Aggregation (MedCare), which is designed to achieve state-of-the-art (SOTA) performance on over 20 medical tasks, as well as SOTA results on specific medical alignment tasks. Various model sizes of MedCare (1.8B, 7B, 14B) all demonstrate significant improvements over existing models with similar model sizes.

TAIA: Large Language Models are Out-of-Distribution Data Learners

Fine-tuning on task-specific question-answer pairs is a predominant method for enhancing the performance of instruction-tuned large language models (LLMs) on downstream tasks. However, in certain specialized domains, such as healthcare or harmless content generation, it is nearly impossible to obtain a large volume of high-quality data that matches the downstream distribution. To improve the performance of LLMs in data-scarce domains with domain-mismatched data, we re-evaluated the Transformer architecture and discovered that not all parameter updates during fine-tuning contribute positively to downstream performance. Our analysis reveals that within the self-attention and feed-forward networks, only the fine-tuned attention parameters are particularly beneficial when the training set's distribution does not fully align with the test set. Based on this insight, we propose an effective inference-time intervention method: \uline{T}raining \uline{A}ll parameters but \uline{I}nferring with only \uline{A}ttention (\trainallInfAttn). We empirically validate \trainallInfAttn using two general instruction-tuning datasets and evaluate it on seven downstream tasks involving math, reasoning, and knowledge understanding across LLMs of different parameter sizes and fine-tuning techniques. Our comprehensive experiments demonstrate that \trainallInfAttn achieves superior improvements compared to both the fully fine-tuned model and the base model in most scenarios, with significant performance gains. The high tolerance of \trainallInfAttn to data mismatches makes it resistant to jailbreaking tuning and enhances specialized tasks using general data.

MING-MOE: Enhancing Medical Multi-Task Learning in Large Language Models with Sparse Mixture of Low-Rank Adapter Experts

Large language models like ChatGPT have shown substantial progress in natural language understanding and generation, proving valuable across various disciplines, including the medical field. Despite advancements, challenges persist due to the complexity and diversity inherent in medical tasks which often require multi-task learning capabilities. Previous approaches, although beneficial, fall short in real-world applications because they necessitate task-specific annotations at inference time, limiting broader generalization. This paper introduces MING-MOE, a novel Mixture-of-Expert~(MOE)-based medical large language model designed to manage diverse and complex medical tasks without requiring task-specific annotations, thus enhancing its usability across extensive datasets. MING-MOE employs a Mixture of Low-Rank Adaptation (MoLoRA) technique, allowing for efficient parameter usage by maintaining base model parameters static while adapting through a minimal set of trainable parameters. We demonstrate that MING-MOE achieves state-of-the-art (SOTA) performance on over 20 medical tasks, illustrating a significant improvement over existing models. This approach not only extends the capabilities of medical language models but also improves inference efficiency.

Automatic Interactive Evaluation for Large Language Models with State Aware Patient Simulator

Large Language Models (LLMs) have demonstrated remarkable proficiency in human interactions, yet their application within the medical field remains insufficiently explored. Previous works mainly focus on the performance of medical knowledge with examinations, which is far from the realistic scenarios, falling short in assessing the abilities of LLMs on clinical tasks. In the quest to enhance the application of Large Language Models (LLMs) in healthcare, this paper introduces the Automated Interactive Evaluation (AIE) framework and the State-Aware Patient Simulator (SAPS), targeting the gap between traditional LLM evaluations and the nuanced demands of clinical practice. Unlike prior methods that rely on static medical knowledge assessments, AIE and SAPS provide a dynamic, realistic platform for assessing LLMs through multi-turn doctor-patient simulations. This approach offers a closer approximation to real clinical scenarios and allows for a detailed analysis of LLM behaviors in response to complex patient interactions. Our extensive experimental validation demonstrates the effectiveness of the AIE framework, with outcomes that align well with human evaluations, underscoring its potential to revolutionize medical LLM testing for improved healthcare delivery.