Daily Papers

Instruction tuning has become a foundation for unlocking the capabilities of large-scale pretrained models and improving their performance on complex tasks. Thus, the construction of high-quality instruction datasets is crucial for enhancing model performance and generalizability. Although current instruction datasets have reached tens of millions of samples, models finetuned on them may still struggle with complex instruction following and tasks in rare domains. This is primarily due to limited expansion in both ``coverage'' (coverage of task types and knowledge areas) and ``depth'' (instruction complexity) of the instruction set. To address this issue, we propose a systematic instruction data construction framework, which integrates a hierarchical labeling system, an informative seed selection algorithm, an evolutionary data synthesis process, and a model deficiency diagnosis with targeted data generation. These components form an iterative closed-loop to continuously enhance the coverage and depth of instruction data. Based on this framework, we construct InfinityInstruct-Subject, a high-quality dataset containing ~1.5 million instructions. Experiments on multiple foundation models and benchmark tasks demonstrate its effectiveness in improving instruction-following capabilities. Further analyses suggest that InfinityInstruct-Subject shows enlarged coverage and depth compared to comparable synthesized instruction datasets. Our work lays a theoretical and practical foundation for the efficient, continuous evolution of instruction datasets, moving from data quantity expansion to qualitative improvement.

With the widespread application of artificial intelligence (AI), particularly deep learning (DL) and vision-based large language models (VLLMs), in skin disease diagnosis, the need for interpretability becomes crucial. However, existing dermatology datasets are limited in their inclusion of concept-level meta-labels, and none offer rich medical descriptions in natural language. This deficiency impedes the advancement of LLM-based methods in dermatological diagnosis. To address this gap and provide a meticulously annotated dermatology dataset with comprehensive natural language descriptions, we introduce SkinCAP: a multi-modal dermatology dataset annotated with rich medical captions. SkinCAP comprises 4,000 images sourced from the Fitzpatrick 17k skin disease dataset and the Diverse Dermatology Images dataset, annotated by board-certified dermatologists to provide extensive medical descriptions and captions. Notably, SkinCAP represents the world's first such dataset and is publicly available at https://huggingface.co/datasets/joshuachou/SkinCAP.

Augmenting large language models (LLMs) with external tools is a promising approach to enhance their capabilities. Effectively leveraging this potential for complex tasks hinges crucially on improving their ability to use tools. Synthesizing tool use data by simulating the real world is an effective approach. Nevertheless, our investigation reveals that training gains significantly decay as the scale of these data increases. The primary factor is the model's poor performance (a.k.a deficiency) in complex scenarios, which hinders learning from data using SFT. Driven by this objective, we propose an iterative reinforced fine-tuning strategy to continually guide the model to alleviate it. Specifically, we first identify deficiency-related data based on feedback from the policy model, then perform a Monte Carlo Tree Search to collect fine-grained preference pairs to pinpoint deficiencies. Subsequently, we update the policy model using preference optimization to align with ground truth and misalign with deficiencies. This process can be iterated. Moreover, before the iteration, we propose an easy-to-hard warm-up SFT strategy to facilitate learning from challenging data. The experiments demonstrate our models go beyond the same parametric models, outperforming many larger open-source and closed-source models. Additionally, it has achieved notable training gains in complex tool use scenarios.

The field of medical diagnosis has undergone a significant transformation with the advent of large language models (LLMs), yet the challenges of interpretability within these models remain largely unaddressed. This study introduces Chain-of-Diagnosis (CoD) to enhance the interpretability of LLM-based medical diagnostics. CoD transforms the diagnostic process into a diagnostic chain that mirrors a physician's thought process, providing a transparent reasoning pathway. Additionally, CoD outputs the disease confidence distribution to ensure transparency in decision-making. This interpretability makes model diagnostics controllable and aids in identifying critical symptoms for inquiry through the entropy reduction of confidences. With CoD, we developed DiagnosisGPT, capable of diagnosing 9604 diseases. Experimental results demonstrate that DiagnosisGPT outperforms other LLMs on diagnostic benchmarks. Moreover, DiagnosisGPT provides interpretability while ensuring controllability in diagnostic rigor.

Tool-augmented large language models (LLMs) are rapidly being integrated into real-world applications. Due to the lack of benchmarks, the community still needs to fully understand the hallucination issues within these models. To address this challenge, we introduce a comprehensive diagnostic benchmark, ToolBH. Specifically, we assess the LLM's hallucinations through two perspectives: depth and breadth. In terms of depth, we propose a multi-level diagnostic process, including (1) solvability detection, (2) solution planning, and (3) missing-tool analysis. For breadth, we consider three scenarios based on the characteristics of the toolset: missing necessary tools, potential tools, and limited functionality tools. Furthermore, we developed seven tasks and collected 700 evaluation samples through multiple rounds of manual annotation. The results show the significant challenges presented by the ToolBH benchmark. The current advanced models Gemini-1.5-Pro and GPT-4o only achieve a total score of 45.3 and 37.0, respectively, on a scale of 100. In this benchmark, larger model parameters do not guarantee better performance; the training data and response strategies also play a crucial role in tool-enhanced LLM scenarios. Our diagnostic analysis indicates that the primary reason for model errors lies in assessing task solvability. Additionally, open-weight models suffer from performance drops with verbose replies, whereas proprietary models excel with longer reasoning.

Assessing scientific claims requires identifying, extracting, and reasoning with multimodal data expressed in information-rich figures in scientific literature. Despite the large body of work in scientific QA, figure captioning, and other multimodal reasoning tasks over chart-based data, there are no readily usable multimodal benchmarks that directly test claim verification abilities. To remedy this gap, we introduce a new benchmark MuSciClaims accompanied by diagnostics tasks. We automatically extract supported claims from scientific articles, which we manually perturb to produce contradicted claims. The perturbations are designed to test for a specific set of claim verification capabilities. We also introduce a suite of diagnostic tasks that help understand model failures. Our results show most vision-language models are poor (~0.3-0.5 F1), with even the best model only achieving 0.72 F1. They are also biased towards judging claims as supported, likely misunderstanding nuanced perturbations within the claims. Our diagnostics show models are bad at localizing correct evidence within figures, struggle with aggregating information across modalities, and often fail to understand basic components of the figure.

As the field of artificial intelligence progresses, assistive technologies are becoming more widely used across all industries. The healthcare industry is no different, with numerous studies being done to develop assistive tools for healthcare professionals. Automatic diagnostic systems are one such beneficial tool that can assist with a variety of tasks, including collecting patient information, analyzing test results, and diagnosing patients. However, the idea of developing systems that can provide a differential diagnosis has been largely overlooked in most of these research studies. In this study, we propose a transformer-based approach for providing differential diagnoses based on a patient's age, sex, medical history, and symptoms. We use the DDXPlus dataset, which provides differential diagnosis information for patients based on 49 disease types. Firstly, we propose a method to process the tabular patient data from the dataset and engineer them into patient reports to make them suitable for our research. In addition, we introduce two data modification modules to diversify the training data and consequently improve the robustness of the models. We approach the task as a multi-label classification problem and conduct extensive experiments using four transformer models. All the models displayed promising results by achieving over 97% F1 score on the held-out test set. Moreover, we design additional behavioral tests to get a broader understanding of the models. In particular, for one of our test cases, we prepared a custom test set of 100 samples with the assistance of a doctor. The results on the custom set showed that our proposed data modification modules improved the model's generalization capabilities. We hope our findings will provide future researchers with valuable insights and inspire them to develop reliable systems for automatic differential diagnosis.

In science and medicine, model interpretations may be reported as discoveries of natural phenomena or used to guide patient treatments. In such high-stakes tasks, false discoveries may lead investigators astray. These applications would therefore benefit from control over the finite-sample error rate of interpretations. We reframe black box model interpretability as a multiple hypothesis testing problem. The task is to discover "important" features by testing whether the model prediction is significantly different from what would be expected if the features were replaced with uninformative counterfactuals. We propose two testing methods: one that provably controls the false discovery rate but which is not yet feasible for large-scale applications, and an approximate testing method which can be applied to real-world data sets. In simulation, both tests have high power relative to existing interpretability methods. When applied to state-of-the-art vision and language models, the framework selects features that intuitively explain model predictions. The resulting explanations have the additional advantage that they are themselves easy to interpret.

Multimodal large language models (MLLMs) have made significant strides, yet they face challenges in the medical domain due to limited specialized knowledge. While recent medical MLLMs demonstrate strong performance in lab settings, they often struggle in real-world applications, highlighting a substantial gap between research and practice. In this paper, we seek to address this gap at various stages of the end-to-end learning pipeline, including data collection, model fine-tuning, and evaluation. At the data collection stage, we introduce SemiHVision, a dataset that combines human annotations with automated augmentation techniques to improve both medical knowledge representation and diagnostic reasoning. For model fine-tuning, we trained PMC-Cambrian-8B-AN over 2400 H100 GPU hours, resulting in performance that surpasses public medical models like HuatuoGPT-Vision-34B (79.0% vs. 66.7%) and private general models like Claude3-Opus (55.7%) on traditional benchmarks such as SLAKE and VQA-RAD. In the evaluation phase, we observed that traditional benchmarks cannot accurately reflect realistic clinical task capabilities. To overcome this limitation and provide more targeted guidance for model evaluation, we introduce the JAMA Clinical Challenge, a novel benchmark specifically designed to evaluate diagnostic reasoning. On this benchmark, PMC-Cambrian-AN achieves state-of-the-art performance with a GPT-4 score of 1.29, significantly outperforming HuatuoGPT-Vision-34B (1.13) and Claude3-Opus (1.17), demonstrating its superior diagnostic reasoning abilities.

Trained machine learning models are increasingly used to perform high-impact tasks in areas such as law enforcement, medicine, education, and employment. In order to clarify the intended use cases of machine learning models and minimize their usage in contexts for which they are not well suited, we recommend that released models be accompanied by documentation detailing their performance characteristics. In this paper, we propose a framework that we call model cards, to encourage such transparent model reporting. Model cards are short documents accompanying trained machine learning models that provide benchmarked evaluation in a variety of conditions, such as across different cultural, demographic, or phenotypic groups (e.g., race, geographic location, sex, Fitzpatrick skin type) and intersectional groups (e.g., age and race, or sex and Fitzpatrick skin type) that are relevant to the intended application domains. Model cards also disclose the context in which models are intended to be used, details of the performance evaluation procedures, and other relevant information. While we focus primarily on human-centered machine learning models in the application fields of computer vision and natural language processing, this framework can be used to document any trained machine learning model. To solidify the concept, we provide cards for two supervised models: One trained to detect smiling faces in images, and one trained to detect toxic comments in text. We propose model cards as a step towards the responsible democratization of machine learning and related AI technology, increasing transparency into how well AI technology works. We hope this work encourages those releasing trained machine learning models to accompany model releases with similar detailed evaluation numbers and other relevant documentation.

Clinical diagnosis is critical in medical practice, typically requiring a continuous and evolving process that includes primary diagnosis, differential diagnosis, and final diagnosis. However, most existing clinical diagnostic tasks are single-step processes, which does not align with the complex multi-step diagnostic procedures found in real-world clinical settings. In this paper, we propose a multi-step diagnostic task and annotate a clinical diagnostic dataset (MSDiagnosis). This dataset includes primary diagnosis, differential diagnosis, and final diagnosis questions. Additionally, we propose a novel and effective framework. This framework combines forward inference, backward inference, reflection, and refinement, enabling the LLM to self-evaluate and adjust its diagnostic results. To assess the effectiveness of our proposed method, we design and conduct extensive experiments. The experimental results demonstrate the effectiveness of the proposed method. We also provide a comprehensive experimental analysis and suggest future research directions for this task.

When it comes to deploying deep vision models, the behavior of these systems must be explicable to ensure confidence in their reliability and fairness. A common approach to evaluate deep learning models is to build a labeled test set with attributes of interest and assess how well it performs. However, creating a balanced test set (i.e., one that is uniformly sampled over all the important traits) is often time-consuming, expensive, and prone to mistakes. The question we try to address is: can we evaluate the sensitivity of deep learning models to arbitrary visual attributes without an annotated test set? This paper argues the case that Zero-shot Model Diagnosis (ZOOM) is possible without the need for a test set nor labeling. To avoid the need for test sets, our system relies on a generative model and CLIP. The key idea is enabling the user to select a set of prompts (relevant to the problem) and our system will automatically search for semantic counterfactual images (i.e., synthesized images that flip the prediction in the case of a binary classifier) using the generative model. We evaluate several visual tasks (classification, key-point detection, and segmentation) in multiple visual domains to demonstrate the viability of our methodology. Extensive experiments demonstrate that our method is capable of producing counterfactual images and offering sensitivity analysis for model diagnosis without the need for a test set.

The prevalence of vision-threatening eye diseases is a significant global burden, with many cases remaining undiagnosed or diagnosed too late for effective treatment. Large vision-language models (LVLMs) have the potential to assist in understanding anatomical information, diagnosing eye diseases, and drafting interpretations and follow-up plans, thereby reducing the burden on clinicians and improving access to eye care. However, limited benchmarks are available to assess LVLMs' performance in ophthalmology-specific applications. In this study, we introduce LMOD, a large-scale multimodal ophthalmology benchmark consisting of 21,993 instances across (1) five ophthalmic imaging modalities: optical coherence tomography, color fundus photographs, scanning laser ophthalmoscopy, lens photographs, and surgical scenes; (2) free-text, demographic, and disease biomarker information; and (3) primary ophthalmology-specific applications such as anatomical information understanding, disease diagnosis, and subgroup analysis. In addition, we benchmarked 13 state-of-the-art LVLM representatives from closed-source, open-source, and medical domains. The results demonstrate a significant performance drop for LVLMs in ophthalmology compared to other domains. Systematic error analysis further identified six major failure modes: misclassification, failure to abstain, inconsistent reasoning, hallucination, assertions without justification, and lack of domain-specific knowledge. In contrast, supervised neural networks specifically trained on these tasks as baselines demonstrated high accuracy. These findings underscore the pressing need for benchmarks in the development and validation of ophthalmology-specific LVLMs.

Conventional evaluation methods for multimodal LLMs (MLLMs) lack interpretability and are often insufficient to fully disclose significant capability gaps across models. To address this, we introduce AuditDM, an automated framework that actively discovers and rectifies MLLM failure modes by auditing their divergence. AuditDM fine-tunes an MLLM as an auditor via reinforcement learning to generate challenging questions and counterfactual images that maximize disagreement among target models. Once trained, the auditor uncovers diverse, interpretable exemplars that reveal model weaknesses and serve as annotation-free data for rectification. When applied to SoTA models like Gemma-3 and PaliGemma-2, AuditDM discovers more than 20 distinct failure types. Fine-tuning on these discoveries consistently improves all models across 16 benchmarks, and enables a 3B model to surpass its 28B counterpart. Our results suggest that as data scaling hits diminishing returns, targeted model auditing offers an effective path to model diagnosis and improvement.

In the domain of model-based engineering, models are essential components that enable system design and analysis. Traditionally, the creation of these models has been a manual process requiring not only deep modeling expertise but also substantial domain knowledge of target systems. With the rapid advancement of generative artificial intelligence, large language models (LLMs) show potential for automating model generation. This work explores the generation of instance models using LLMs, focusing specifically on producing XMI-based instance models from Ecore metamodels and natural language specifications. We observe that current LLMs struggle to directly generate valid XMI models. To address this, we propose a two-step approach: first, using LLMs to produce a simplified structured output containing all necessary instance model information, namely a conceptual instance model, and then compiling this intermediate representation into a valid XMI file. The conceptual instance model is format-independent, allowing it to be transformed into various modeling formats via different compilers. The feasibility of the proposed method has been demonstrated using several LLMs, including GPT-4o, o1-preview, Llama 3.1 (8B and 70B). Results show that the proposed method significantly improves the usability of LLMs for instance model generation tasks. Notably, the smaller open-source model, Llama 3.1 70B, demonstrated performance comparable to proprietary GPT models within the proposed framework.

Speech patterns have been identified as potential diagnostic markers for neuropsychiatric conditions. However, most studies only compare a single clinical group to healthy controls, whereas clinical practice often requires differentiating between multiple potential diagnoses (multiclass settings). To address this, we assembled a dataset of repeated recordings from 420 participants (67 with major depressive disorder, 106 with schizophrenia and 46 with autism, as well as matched controls), and tested the performance of a range of conventional machine learning models and advanced Transformer models on both binary and multiclass classification, based on voice and text features. While binary models performed comparably to previous research (F1 scores between 0.54-0.75 for autism spectrum disorder, ASD; 0.67-0.92 for major depressive disorder, MDD; and 0.71-0.83 for schizophrenia); when differentiating between multiple diagnostic groups performance decreased markedly (F1 scores between 0.35-0.44 for ASD, 0.57-0.75 for MDD, 0.15-0.66 for schizophrenia, and 0.38-0.52 macro F1). Combining voice and text-based models yielded increased performance, suggesting that they capture complementary diagnostic information. Our results indicate that models trained on binary classification may learn to rely on markers of generic differences between clinical and non-clinical populations, or markers of clinical features that overlap across conditions, rather than identifying markers specific to individual conditions. We provide recommendations for future research in the field, suggesting increased focus on developing larger transdiagnostic datasets that include more fine-grained clinical features, and that can support the development of models that better capture the complexity of neuropsychiatric conditions and naturalistic diagnostic assessment.

Through a controlled study, we identify a systematic deficiency in the multimodal grounding of Vision Language Models (VLMs). While VLMs can recall factual associations when provided a textual reference to an entity; their ability to do so is significantly diminished when the reference is visual instead. Forcing VLMs to rely on image representations of an entity halves their ability to recall factual knowledge, suggesting that VLMs struggle to link their internal knowledge of an entity with its image representation. We show that such linking failures are correlated with the expression of distinct patterns in model internal states, and that probes on these internal states achieve over 92% accuracy at flagging cases where the VLM response is unreliable. These probes can be applied, without retraining, to identify when a VLM will fail to correctly answer a question that requires an understanding of multimodal input. When used to facilitate selective prediction on a visual question answering task, the probes increase coverage by 7.87% (absolute) while also reducing the risk of error by 0.9% (absolute). Addressing the systematic, detectable deficiency is an important avenue in language grounding, and we provide informed recommendations for future directions.

Online medical consultation (OMC) restricts doctors to gathering patient information solely through inquiries, making the already complex sequential decision-making process of diagnosis even more challenging. Recently, the rapid advancement of large language models has demonstrated a significant potential to transform OMC. However, most studies have primarily focused on improving diagnostic accuracy under conditions of relatively sufficient information, while paying limited attention to the "inquiry" phase of the consultation process. This lack of focus has left the relationship between "inquiry" and "diagnosis" insufficiently explored. In this paper, we first extract real patient interaction strategies from authentic doctor-patient conversations and use these strategies to guide the training of a patient simulator that closely mirrors real-world behavior. By inputting medical records into our patient simulator to simulate patient responses, we conduct extensive experiments to explore the relationship between "inquiry" and "diagnosis" in the consultation process. Experimental results demonstrate that inquiry and diagnosis adhere to the Liebig's law: poor inquiry quality limits the effectiveness of diagnosis, regardless of diagnostic capability, and vice versa. Furthermore, the experiments reveal significant differences in the inquiry performance of various models. To investigate this phenomenon, we categorize the inquiry process into four types: (1) chief complaint inquiry; (2) specification of known symptoms; (3) inquiry about accompanying symptoms; and (4) gathering family or medical history. We analyze the distribution of inquiries across the four types for different models to explore the reasons behind their significant performance differences. We plan to open-source the weights and related code of our patient simulator at https://github.com/LIO-H-ZEN/PatientSimulator.

Large language models (LLMs) offer a promising pre-screening tool, improving early disease detection and providing enhanced healthcare access for underprivileged communities. The early diagnosis of various diseases continues to be a significant challenge in healthcare, primarily due to the nonspecific nature of early symptoms, the shortage of expert medical practitioners, and the need for prolonged clinical evaluations, all of which can delay treatment and adversely affect patient outcomes. With impressive accuracy in prediction across a range of diseases, LLMs have the potential to revolutionize clinical pre-screening and decision-making for various medical conditions. In this work, we study the diagnostic capability of LLMs for Rheumatoid Arthritis (RA) with real world patients data. Patient data was collected alongside diagnoses from medical experts, and the performance of LLMs was evaluated in comparison to expert diagnoses for RA disease prediction. We notice an interesting pattern in disease diagnosis and find an unexpected misalignment between prediction and explanation. We conduct a series of multi-round analyses using different LLM agents. The best-performing model accurately predicts rheumatoid arthritis (RA) diseases approximately 95\% of the time. However, when medical experts evaluated the reasoning generated by the model, they found that nearly 68\% of the reasoning was incorrect. This study highlights a clear misalignment between LLMs high prediction accuracy and its flawed reasoning, raising important questions about relying on LLM explanations in clinical settings. LLMs provide incorrect reasoning to arrive at the correct answer for RA disease diagnosis.

The surprising ability of Large Language Models (LLMs) to perform well on complex reasoning with only few-shot chain-of-thought prompts is believed to emerge only in very large-scale models (100+ billion parameters). We show that such abilities can, in fact, be distilled down from GPT-3.5 (ge 175B) to T5 variants (le 11B). We propose model specialization, to specialize the model's ability towards a target task. The hypothesis is that large models (commonly viewed as larger than 100B) have strong modeling power, but are spread on a large spectrum of tasks. Small models (commonly viewed as smaller than 10B) have limited model capacity, but if we concentrate their capacity on a specific target task, the model can achieve a decent improved performance. We use multi-step math reasoning as our testbed because it is a very typical emergent ability. We show two important aspects of model abilities: (1). there exists a very complex balance/ tradeoff between language models' multi-dimensional abilities; (2). by paying the price of decreased generic ability, we can clearly lift up the scaling curve of models smaller than 10B towards a specialized multi-step math reasoning ability. We further give comprehensive discussions about important design choices for better generalization, including the tuning data format, the start model checkpoint, and a new model selection method. We hope our practice and discoveries can serve as an important attempt towards specialized smaller models in the new research paradigm set by LLMs.

Large language models (LLMs) have demonstrated impressive capabilities in disease diagnosis. However, their effectiveness in identifying rarer diseases, which are inherently more challenging to diagnose, remains an open question. Rare disease performance is critical with the increasing use of LLMs in healthcare settings. This is especially true if a primary care physician needs to make a rarer prognosis from only a patient conversation so that they can take the appropriate next step. To that end, several clinical decision support systems are designed to support providers in rare disease identification. Yet their utility is limited due to their lack of knowledge of common disorders and difficulty of use. In this paper, we propose RareScale to combine the knowledge LLMs with expert systems. We use jointly use an expert system and LLM to simulate rare disease chats. This data is used to train a rare disease candidate predictor model. Candidates from this smaller model are then used as additional inputs to black-box LLM to make the final differential diagnosis. Thus, RareScale allows for a balance between rare and common diagnoses. We present results on over 575 rare diseases, beginning with Abdominal Actinomycosis and ending with Wilson's Disease. Our approach significantly improves the baseline performance of black-box LLMs by over 17% in Top-5 accuracy. We also find that our candidate generation performance is high (e.g. 88.8% on gpt-4o generated chats).

Reasoning failures in large language models (LLMs) are typically measured only at the end of a generation, yet many failures manifest as a process-level breakdown: the model "loses the thread" mid-reasoning. We study whether such breakdowns are detectable from inference-time observables available in standard APIs (token log probabilities), without any training or fine-tuning. We define a simple instability signal that combines consecutive-step distributional shift (JSD) and uncertainty (entropy), summarize each trace by its peak instability strength, and show that this signal reliably predicts failure. Across GSM8K and HotpotQA, instability strength predicts wrong answers with above-chance AUC and yields monotonic bucket-level accuracy decline at scale across model sizes. Crucially, we show that instability is not uniformly harmful: early instability can reflect subsequent stabilization and a correct final answer (corrective instability), whereas late instability is more often followed by failure (destructive instability), even at comparable peak magnitudes, indicating that recoverability depends not only on how strongly the distribution changes but also on when such changes occur relative to the remaining decoding horizon. The method is model-agnostic, training-free, and reproducible, and is presented as a diagnostic lens rather than a corrective or control mechanism.

The rapid development of Large Language Models (LLMs) for healthcare applications has spurred calls for holistic evaluation beyond frequently-cited benchmarks like USMLE, to better reflect real-world performance. While real-world assessments are valuable indicators of utility, they often lag behind the pace of LLM evolution, likely rendering findings obsolete upon deployment. This temporal disconnect necessitates a comprehensive upfront evaluation that can guide model selection for specific clinical applications. We introduce MEDIC, a framework assessing LLMs across five critical dimensions of clinical competence: medical reasoning, ethics and bias, data and language understanding, in-context learning, and clinical safety. MEDIC features a novel cross-examination framework quantifying LLM performance across areas like coverage and hallucination detection, without requiring reference outputs. We apply MEDIC to evaluate LLMs on medical question-answering, safety, summarization, note generation, and other tasks. Our results show performance disparities across model sizes, baseline vs medically finetuned models, and have implications on model selection for applications requiring specific model strengths, such as low hallucination or lower cost of inference. MEDIC's multifaceted evaluation reveals these performance trade-offs, bridging the gap between theoretical capabilities and practical implementation in healthcare settings, ensuring that the most promising models are identified and adapted for diverse healthcare applications.

Large language models (LLMs) are increasingly used in healthcare, but their reliability is heavily influenced by user-driven factors such as question phrasing and the completeness of clinical information. In this study, we examined how misinformation framing, source authority, model persona, and omission of key clinical details affect the diagnostic accuracy and reliability of LLM outputs. We conducted two experiments: one introducing misleading external opinions with varying assertiveness (perturbation test), and another removing specific categories of patient information (ablation test). Using public datasets (MedQA and Medbullets), we evaluated proprietary models (GPT-4o, Claude 3.5 Sonnet, Claude 3.5 Haiku, Gemini 1.5 Pro, Gemini 1.5 Flash) and open-source models (LLaMA 3 8B, LLaMA 3 Med42 8B, DeepSeek R1 8B). All models were vulnerable to user-driven misinformation, with proprietary models especially affected by definitive and authoritative language. Assertive tone had the greatest negative impact on accuracy. In the ablation test, omitting physical exam findings and lab results caused the most significant performance drop. Although proprietary models had higher baseline accuracy, their performance declined sharply under misinformation. These results highlight the need for well-structured prompts and complete clinical context. Users should avoid authoritative framing of misinformation and provide full clinical details, especially for complex cases.

As language models regularly make mistakes when solving math problems, automated identification of errors in the reasoning process becomes increasingly significant for their scalable oversight. In this paper, we introduce ProcessBench for measuring the ability to identify erroneous steps in mathematical reasoning. It consists of 3,400 test cases, primarily focused on competition- and Olympiad-level math problems. Each test case contains a step-by-step solution with error location annotated by human experts. Models are required to identify the earliest step that contains an error, or conclude that all steps are correct. We conduct extensive evaluation on ProcessBench, involving two types of models: process reward models (PRMs) and critic models, where for the latter we prompt general language models to critique each solution step by step. We draw two main observations: (1) Existing PRMs typically fail to generalize to more challenging math problems beyond GSM8K and MATH. They underperform both critic models (i.e., prompted general language models) and our own trained PRM that is straightforwardly fine-tuned on the PRM800K dataset. (2) The best open-source model, QwQ-32B-Preview, has demonstrated the critique capability competitive with the proprietary model GPT-4o, despite that it still lags behind the reasoning-specialized o1-mini. We hope ProcessBench can foster future research in reasoning process assessment, paving the way toward scalable oversight of language models.

Rare diseases, including Inborn Errors of Metabolism (IEM), pose significant diagnostic challenges. Case reports serve as key but computationally underutilized resources to inform diagnosis. Clinical dense information extraction refers to organizing medical information into structured predefined categories. Large Language Models (LLMs) may enable scalable information extraction from case reports but are rarely evaluated for this task. We introduce CaseReportBench, an expert-annotated dataset for dense information extraction of case reports, focusing on IEMs. Using this dataset, we assess various models and prompting strategies, introducing novel approaches such as category-specific prompting and subheading-filtered data integration. Zero-shot chain-of-thought prompting offers little advantage over standard zero-shot prompting. Category-specific prompting improves alignment with the benchmark. The open-source model Qwen2.5-7B outperforms GPT-4o for this task. Our clinician evaluations show that LLMs can extract clinically relevant details from case reports, supporting rare disease diagnosis and management. We also highlight areas for improvement, such as LLMs' limitations in recognizing negative findings important for differential diagnosis. This work advances LLM-driven clinical natural language processing and paves the way for scalable medical AI applications.

Background:Speech patterns have emerged as potential diagnostic markers for conditions with varying etiologies. Machine learning (ML) presents an opportunity to harness these patterns for accurate disease diagnosis. Objective: This review synthesized findings from studies exploring ML's capability in leveraging speech for the diagnosis of neurological, laryngeal and mental disorders. Methods: A systematic examination of 564 articles was conducted with 91 articles included in the study, which encompassed a wide spectrum of conditions, ranging from voice pathologies to mental and neurological disorders. Methods for speech classifications were assessed based on the relevant studies and scored between 0-10 based on the reported diagnostic accuracy of their ML models. Results: High diagnostic accuracies were consistently observed for laryngeal disorders, dysarthria, and changes related to speech in Parkinsons disease. These findings indicate the robust potential of speech as a diagnostic tool. Disorders like depression, schizophrenia, mild cognitive impairment and Alzheimers dementia also demonstrated high accuracies, albeit with some variability across studies. Meanwhile, disorders like OCD and autism highlighted the need for more extensive research to ascertain the relationship between speech patterns and the respective conditions. Conclusion: ML models utilizing speech patterns demonstrate promising potential in diagnosing a range of mental, laryngeal, and neurological disorders. However, the efficacy varies across conditions, and further research is needed. The integration of these models into clinical practice could potentially revolutionize the evaluation and diagnosis of a number of different medical conditions.

Model-based evaluation is at the heart of successful model development -- as a reward model for training, and as a replacement for human evaluation. To train such evaluators, the standard approach is to collect a large amount of human preference judgments over model responses, which is costly and the data becomes stale as models improve. In this work, we present an approach that aims to im-prove evaluators without human annotations, using synthetic training data only. Starting from unlabeled instructions, our iterative self-improvement scheme generates contrasting model outputs and trains an LLM-as-a-Judge to produce reasoning traces and final judgments, repeating this training at each new iteration using the improved predictions. Without any labeled preference data, our Self-Taught Evaluator can improve a strong LLM (Llama3-70B-Instruct) from 75.4 to 88.3 (88.7 with majority vote) on RewardBench. This outperforms commonly used LLM judges such as GPT-4 and matches the performance of the top-performing reward models trained with labeled examples.

This paper proposes one of the first clinical applications of multimodal large language models (LLMs) as an assistant for radiologists to check errors in their reports. We created an evaluation dataset from two real-world radiology datasets (MIMIC-CXR and IU-Xray), with 1,000 subsampled reports each. A subset of original reports was modified to contain synthetic errors by introducing various type of mistakes. The evaluation contained two difficulty levels: SIMPLE for binary error-checking and COMPLEX for identifying error types. LLaVA (Large Language and Visual Assistant) variant models, including our instruction-tuned model, were used for the evaluation. Additionally, a domain expert evaluation was conducted on a small test set. At the SIMPLE level, the LLaVA v1.5 model outperformed other publicly available models. Instruction tuning significantly enhanced performance by 47.4% and 25.4% on MIMIC-CXR and IU-Xray data, respectively. The model also surpassed the domain experts accuracy in the MIMIC-CXR dataset by 1.67%. Notably, among the subsets (N=21) of the test set where a clinician did not achieve the correct conclusion, the LLaVA ensemble mode correctly identified 71.4% of these cases. This study marks a promising step toward utilizing multi-modal LLMs to enhance diagnostic accuracy in radiology. The ensemble model demonstrated comparable performance to clinicians, even capturing errors overlooked by humans. Nevertheless, future work is needed to improve the model ability to identify the types of inconsistency.

Spine disorders affect 619 million people globally and are a leading cause of disability, yet AI-assisted diagnosis remains limited by the lack of level-aware, multimodal datasets. Clinical decision-making for spine disorders requires sophisticated reasoning across X-ray, CT, and MRI at specific vertebral levels. However, progress has been constrained by the absence of traceable, clinically-grounded instruction data and standardized, spine-specific benchmarks. To address this, we introduce SpineMed, an ecosystem co-designed with practicing spine surgeons. It features SpineMed-450k, the first large-scale dataset explicitly designed for vertebral-level reasoning across imaging modalities with over 450,000 instruction instances, and SpineBench, a clinically-grounded evaluation framework. SpineMed-450k is curated from diverse sources, including textbooks, guidelines, open datasets, and ~1,000 de-identified hospital cases, using a clinician-in-the-loop pipeline with a two-stage LLM generation method (draft and revision) to ensure high-quality, traceable data for question-answering, multi-turn consultations, and report generation. SpineBench evaluates models on clinically salient axes, including level identification, pathology assessment, and surgical planning. Our comprehensive evaluation of several recently advanced large vision-language models (LVLMs) on SpineBench reveals systematic weaknesses in fine-grained, level-specific reasoning. In contrast, our model fine-tuned on SpineMed-450k demonstrates consistent and significant improvements across all tasks. Clinician assessments confirm the diagnostic clarity and practical utility of our model's outputs.

The differential diagnosis of neurodegenerative dementias is a challenging clinical task, mainly because of the overlap in symptom presentation and the similarity of patterns observed in structural neuroimaging. To improve diagnostic efficiency and accuracy, deep learning-based methods such as Convolutional Neural Networks and Vision Transformers have been proposed for the automatic classification of brain MRIs. However, despite their strong predictive performance, these models find limited clinical utility due to their opaque decision making. In this work, we propose a framework that integrates two core components to enhance diagnostic transparency. First, we introduce a modular pipeline for converting 3D T1-weighted brain MRIs into textual radiology reports. Second, we explore the potential of modern Large Language Models (LLMs) to assist clinicians in the differential diagnosis between Frontotemporal dementia subtypes, Alzheimer's disease, and normal aging based on the generated reports. To bridge the gap between predictive accuracy and explainability, we employ reinforcement learning to incentivize diagnostic reasoning in LLMs. Without requiring supervised reasoning traces or distillation from larger models, our approach enables the emergence of structured diagnostic rationales grounded in neuroimaging findings. Unlike post-hoc explainability methods that retrospectively justify model decisions, our framework generates diagnostic rationales as part of the inference process-producing causally grounded explanations that inform and guide the model's decision-making process. In doing so, our framework matches the diagnostic performance of existing deep learning methods while offering rationales that support its diagnostic conclusions.

Current evaluation of mathematical reasoning in language models relies primarily on answer accuracy, potentially masking fundamental failures in logical computation. We introduce a diagnostic framework that distinguishes genuine mathematical reasoning from superficial pattern matching through four complementary axes: forward-backward consistency, transitivity coverage, counterfactual sensitivity, and perturbation robustness. Through a case study applying this framework to Qwen3-0.6B on the MenatQA dataset, we reveal a striking disconnect between surface performance and reasoning fidelity. While the model achieves reasonable answer accuracy (70%+), it demonstrates poor backward consistency (15%), limited transitivity coverage (32.2%), and brittle sensitivity to perturbations. Our diagnostics expose reasoning failures invisible to traditional accuracy metrics, suggesting that this small model relies heavily on pattern matching rather than genuine logical computation. While our empirical findings are based on a single 600M-parameter model, the diagnostic framework itself is model-agnostic and generalizable. We release our evaluation protocols to enable the research community to assess reasoning fidelity across different model scales and architectures, moving beyond surface-level accuracy toward verifiable mathematical reasoning.

Generalist Large Language Models (LLMs), such as GPT-4, have shown considerable promise in various domains, including medical diagnosis. Rare diseases, affecting approximately 300 million people worldwide, often have unsatisfactory clinical diagnosis rates primarily due to a lack of experienced physicians and the complexity of differentiating among many rare diseases. In this context, recent news such as "ChatGPT correctly diagnosed a 4-year-old's rare disease after 17 doctors failed" underscore LLMs' potential, yet underexplored, role in clinically diagnosing rare diseases. To bridge this research gap, we introduce RareBench, a pioneering benchmark designed to systematically evaluate the capabilities of LLMs on 4 critical dimensions within the realm of rare diseases. Meanwhile, we have compiled the largest open-source dataset on rare disease patients, establishing a benchmark for future studies in this domain. To facilitate differential diagnosis of rare diseases, we develop a dynamic few-shot prompt methodology, leveraging a comprehensive rare disease knowledge graph synthesized from multiple knowledge bases, significantly enhancing LLMs' diagnostic performance. Moreover, we present an exhaustive comparative study of GPT-4's diagnostic capabilities against those of specialist physicians. Our experimental findings underscore the promising potential of integrating LLMs into the clinical diagnostic process for rare diseases. This paves the way for exciting possibilities in future advancements in this field.

Model efficiency is a critical aspect of developing and deploying machine learning models. Inference time and latency directly affect the user experience, and some applications have hard requirements. In addition to inference costs, model training also have direct financial and environmental impacts. Although there are numerous well-established metrics (cost indicators) for measuring model efficiency, researchers and practitioners often assume that these metrics are correlated with each other and report only few of them. In this paper, we thoroughly discuss common cost indicators, their advantages and disadvantages, and how they can contradict each other. We demonstrate how incomplete reporting of cost indicators can lead to partial conclusions and a blurred or incomplete picture of the practical considerations of different models. We further present suggestions to improve reporting of efficiency metrics.

The emergence of large-scale multi-modal generative models has drastically advanced artificial intelligence, introducing unprecedented levels of performance and functionality. However, optimizing these models remains challenging due to historically isolated paths of model-centric and data-centric developments, leading to suboptimal outcomes and inefficient resource utilization. In response, we present a novel sandbox suite tailored for integrated data-model co-development. This sandbox provides a comprehensive experimental platform, enabling rapid iteration and insight-driven refinement of both data and models. Our proposed "Probe-Analyze-Refine" workflow, validated through applications on state-of-the-art LLaVA-like and DiT based models, yields significant performance boosts, such as topping the VBench leaderboard. We also uncover fruitful insights gleaned from exhaustive benchmarks, shedding light on the critical interplay between data quality, diversity, and model behavior. With the hope of fostering deeper understanding and future progress in multi-modal data and generative modeling, our codes, datasets, and models are maintained and accessible at https://github.com/modelscope/data-juicer/blob/main/docs/Sandbox.md.

Machine learning models are often trained to predict the outcome resulting from a human decision. For example, if a doctor decides to test a patient for disease, will the patient test positive? A challenge is that historical decision-making determines whether the outcome is observed: we only observe test outcomes for patients doctors historically tested. Untested patients, for whom outcomes are unobserved, may differ from tested patients along observed and unobserved dimensions. We propose a Bayesian model class which captures this setting. The purpose of the model is to accurately estimate risk for both tested and untested patients. Estimating this model is challenging due to the wide range of possibilities for untested patients. To address this, we propose two domain constraints which are plausible in health settings: a prevalence constraint, where the overall disease prevalence is known, and an expertise constraint, where the human decision-maker deviates from purely risk-based decision-making only along a constrained feature set. We show theoretically and on synthetic data that domain constraints improve parameter inference. We apply our model to a case study of cancer risk prediction, showing that the model's inferred risk predicts cancer diagnoses, its inferred testing policy captures known public health policies, and it can identify suboptimalities in test allocation. Though our case study is in healthcare, our analysis reveals a general class of domain constraints which can improve model estimation in many settings.

Large language models (LLMs) have been widely used in various applications but are known to suffer from issues related to untruthfulness and toxicity. While parameter-efficient modules (PEMs) have demonstrated their effectiveness in equipping models with new skills, leveraging PEMs for deficiency unlearning remains underexplored. In this work, we propose a PEMs operation approach, namely Extraction-before-Subtraction (Ext-Sub), to enhance the truthfulness and detoxification of LLMs through the integration of ``expert'' PEM and ``anti-expert'' PEM. Remarkably, even anti-expert PEM possess valuable capabilities due to their proficiency in generating fabricated content, which necessitates language modeling and logical narrative competence. Rather than merely negating the parameters, our approach involves extracting and eliminating solely the deficiency capability within anti-expert PEM while preserving the general capabilities. To evaluate the effectiveness of our approach in terms of truthfulness and detoxification, we conduct extensive experiments on LLMs, encompassing additional abilities such as language modeling and mathematical reasoning. Our empirical results demonstrate that our approach effectively improves truthfulness and detoxification, while largely preserving the fundamental abilities of LLMs.

Automatic disease diagnosis has become increasingly valuable in clinical practice. The advent of large language models (LLMs) has catalyzed a paradigm shift in artificial intelligence, with growing evidence supporting the efficacy of LLMs in diagnostic tasks. Despite the increasing attention in this field, a holistic view is still lacking. Many critical aspects remain unclear, such as the diseases and clinical data to which LLMs have been applied, the LLM techniques employed, and the evaluation methods used. In this article, we perform a comprehensive review of LLM-based methods for disease diagnosis. Our review examines the existing literature across various dimensions, including disease types and associated clinical specialties, clinical data, LLM techniques, and evaluation methods. Additionally, we offer recommendations for applying and evaluating LLMs for diagnostic tasks. Furthermore, we assess the limitations of current research and discuss future directions. To our knowledge, this is the first comprehensive review for LLM-based disease diagnosis.

Artificial intelligence (AI) has become a fundamental tool for assisting clinicians in analyzing ophthalmic images, such as optical coherence tomography (OCT). However, developing AI models often requires extensive annotation, and existing models tend to underperform on independent, unseen data. Foundation models (FMs), large AI models trained on vast unlabeled datasets, have shown promise in overcoming these challenges. Nonetheless, available FMs for ophthalmology lack extensive validation, especially for segmentation tasks, and focus on a single imaging modality. In this context, we propose MIRAGE, a novel multimodal FM for the analysis of OCT and scanning laser ophthalmoscopy (SLO) images. Additionally, we propose a new evaluation benchmark with OCT/SLO classification and segmentation tasks. The comparison with general and specialized FMs and segmentation methods shows the superiority of MIRAGE in both types of tasks, highlighting its suitability as a basis for the development of robust AI systems for retinal OCT image analysis. Both MIRAGE and the evaluation benchmark are publicly available: https://github.com/j-morano/MIRAGE.

Heart disease, also known as cardiovascular disease, is a prevalent and critical medical condition characterized by the impairment of the heart and blood vessels, leading to various complications such as coronary artery disease, heart failure, and myocardial infarction. The timely and accurate detection of heart disease is of paramount importance in clinical practice. Early identification of individuals at risk enables proactive interventions, preventive measures, and personalized treatment strategies to mitigate the progression of the disease and reduce adverse outcomes. In recent years, the field of heart disease detection has witnessed notable advancements due to the integration of sophisticated technologies and computational approaches. These include machine learning algorithms, data mining techniques, and predictive modeling frameworks that leverage vast amounts of clinical and physiological data to improve diagnostic accuracy and risk stratification. In this work, we propose to detect heart disease from ECG images using cutting-edge technologies, namely vision transformer models. These models are Google-Vit, Microsoft-Beit, and Swin-Tiny. To the best of our knowledge, this is the initial endeavor concentrating on the detection of heart diseases through image-based ECG data by employing cuttingedge technologies namely, transformer models. To demonstrate the contribution of the proposed framework, the performance of vision transformer models are compared with state-of-the-art studies. Experiment results show that the proposed framework exhibits remarkable classification results.

Large language models (LLMs) have exhibited remarkable capabilities across various domains and tasks, pushing the boundaries of our knowledge in learning and cognition. The latest model, OpenAI's o1, stands out as the first LLM with an internalized chain-of-thought technique using reinforcement learning strategies. While it has demonstrated surprisingly strong capabilities on various general language tasks, its performance in specialized fields such as medicine remains unknown. To this end, this report provides a comprehensive exploration of o1 on different medical scenarios, examining 3 key aspects: understanding, reasoning, and multilinguality. Specifically, our evaluation encompasses 6 tasks using data from 37 medical datasets, including two newly constructed and more challenging question-answering (QA) tasks based on professional medical quizzes from the New England Journal of Medicine (NEJM) and The Lancet. These datasets offer greater clinical relevance compared to standard medical QA benchmarks such as MedQA, translating more effectively into real-world clinical utility. Our analysis of o1 suggests that the enhanced reasoning ability of LLMs may (significantly) benefit their capability to understand various medical instructions and reason through complex clinical scenarios. Notably, o1 surpasses the previous GPT-4 in accuracy by an average of 6.2% and 6.6% across 19 datasets and two newly created complex QA scenarios. But meanwhile, we identify several weaknesses in both the model capability and the existing evaluation protocols, including hallucination, inconsistent multilingual ability, and discrepant metrics for evaluation. We release our raw data and model outputs at https://ucsc-vlaa.github.io/o1_medicine/ for future research.

Several recent works seek to develop foundation models specifically for medical applications, adapting general-purpose large language models (LLMs) and vision-language models (VLMs) via continued pretraining on publicly available biomedical corpora. These works typically claim that such domain-adaptive pretraining (DAPT) improves performance on downstream medical tasks, such as answering medical licensing exam questions. In this paper, we compare seven public "medical" LLMs and two VLMs against their corresponding base models, arriving at a different conclusion: all medical VLMs and nearly all medical LLMs fail to consistently improve over their base models in the zero-/few-shot prompting regime for medical question-answering (QA) tasks. For instance, across the tasks and model pairs we consider in the 3-shot setting, medical LLMs only outperform their base models in 12.1% of cases, reach a (statistical) tie in 49.8% of cases, and are significantly worse than their base models in the remaining 38.2% of cases. Our conclusions are based on (i) comparing each medical model head-to-head, directly against the corresponding base model; (ii) optimizing the prompts for each model separately; and (iii) accounting for statistical uncertainty in comparisons. While these basic practices are not consistently adopted in the literature, our ablations show that they substantially impact conclusions. Our findings suggest that state-of-the-art general-domain models may already exhibit strong medical knowledge and reasoning capabilities, and offer recommendations to strengthen the conclusions of future studies.

Recent research has focused on enhancing the capability of smaller models through imitation learning, drawing on the outputs generated by large foundation models (LFMs). A number of issues impact the quality of these models, ranging from limited imitation signals from shallow LFM outputs; small scale homogeneous training data; and most notably a lack of rigorous evaluation resulting in overestimating the small model's capability as they tend to learn to imitate the style, but not the reasoning process of LFMs. To address these challenges, we develop Orca (We are working with our legal team to publicly release a diff of the model weights in accordance with LLaMA's release policy to be published at https://aka.ms/orca-lm), a 13-billion parameter model that learns to imitate the reasoning process of LFMs. Orca learns from rich signals from GPT-4 including explanation traces; step-by-step thought processes; and other complex instructions, guided by teacher assistance from ChatGPT. To promote this progressive learning, we tap into large-scale and diverse imitation data with judicious sampling and selection. Orca surpasses conventional state-of-the-art instruction-tuned models such as Vicuna-13B by more than 100% in complex zero-shot reasoning benchmarks like Big-Bench Hard (BBH) and 42% on AGIEval. Moreover, Orca reaches parity with ChatGPT on the BBH benchmark and shows competitive performance (4 pts gap with optimized system message) in professional and academic examinations like the SAT, LSAT, GRE, and GMAT, both in zero-shot settings without CoT; while trailing behind GPT-4. Our research indicates that learning from step-by-step explanations, whether these are generated by humans or more advanced AI models, is a promising direction to improve model capabilities and skills.

Model immunization aims to pre-train models that are difficult to fine-tune on harmful tasks while retaining their utility on other non-harmful tasks. Though prior work has shown empirical evidence for immunizing text-to-image models, the key understanding of when immunization is possible and a precise definition of an immunized model remain unclear. In this work, we propose a framework, based on the condition number of a Hessian matrix, to analyze model immunization for linear models. Building on this framework, we design an algorithm with regularization terms to control the resulting condition numbers after pre-training. Empirical results on linear models and non-linear deep-nets demonstrate the effectiveness of the proposed algorithm on model immunization. The code is available at https://github.com/amberyzheng/model-immunization-cond-num.

Several recent works seek to develop foundation models specifically for medical applications, adapting general-purpose large language models (LLMs) and vision-language models (VLMs) via continued pretraining on publicly available biomedical corpora. These works typically claim that such domain-adaptive pretraining (DAPT) improves performance on downstream medical tasks, such as answering medical licensing exam questions. In this paper, we compare ten public "medical" LLMs and two VLMs against their corresponding base models, arriving at a different conclusion: all medical VLMs and nearly all medical LLMs fail to consistently improve over their base models in the zero-/few-shot prompting and supervised fine-tuning regimes for medical question-answering (QA). For instance, across all tasks and model pairs we consider in the 3-shot setting, medical LLMs only outperform their base models in 22.7% of cases, reach a (statistical) tie in 36.8% of cases, and are significantly worse than their base models in the remaining 40.5% of cases. Our conclusions are based on (i) comparing each medical model head-to-head, directly against the corresponding base model; (ii) optimizing the prompts for each model separately in zero-/few-shot prompting; and (iii) accounting for statistical uncertainty in comparisons. While these basic practices are not consistently adopted in the literature, our ablations show that they substantially impact conclusions. Meanwhile, we find that after fine-tuning on specific QA tasks, medical LLMs can show performance improvements, but the benefits do not carry over to tasks based on clinical notes. Our findings suggest that state-of-the-art general-domain models may already exhibit strong medical knowledge and reasoning capabilities, and offer recommendations to strengthen the conclusions of future studies.

Clinicians spend a significant amount of time reviewing medical images and transcribing their findings regarding patient diagnosis, referral and treatment in text form. Vision-language models (VLMs), which automatically interpret images and summarize their findings as text, have enormous potential to alleviate clinical workloads and increase patient access to high-quality medical care. While foundational models have stirred considerable interest in the medical community, it is unclear whether their general capabilities translate to real-world clinical utility. In this work, we show that foundation VLMs markedly underperform compared to practicing ophthalmologists on specialist tasks crucial to the care of patients with age-related macular degeneration (AMD). To address this, we initially identified the essential capabilities required for image-based clinical decision-making, and then developed a curriculum to selectively train VLMs in these skills. The resulting model, RetinaVLM, can be instructed to write reports that significantly outperform those written by leading foundation medical VLMs in disease staging (F1 score of 0.63 vs. 0.11) and patient referral (0.67 vs. 0.39), and approaches the diagnostic performance of junior ophthalmologists (who achieve 0.77 and 0.78 on the respective tasks). Furthermore, in a reader study involving two senior ophthalmologists with up to 32 years of experience, RetinaVLM's reports were found to be similarly correct (78.6% vs. 82.1%) and complete (both 78.6%) as reports written by junior ophthalmologists with up to 10 years of experience. These results demonstrate that our curriculum-based approach provides a blueprint for specializing generalist foundation medical VLMs to handle real-world clinical tasks.

The number of publicly available models is rapidly increasing, yet most remain undocumented. Users looking for suitable models for their tasks must first determine what each model does. Training machine learning models to infer missing documentation directly from model weights is challenging, as these weights often contain significant variation unrelated to model functionality (denoted nuisance). Here, we identify a key property of real-world models: most public models belong to a small set of Model Trees, where all models within a tree are fine-tuned from a common ancestor (e.g., a foundation model). Importantly, we find that within each tree there is less nuisance variation between models. Concretely, while learning across Model Trees requires complex architectures, even a linear classifier trained on a single model layer often works within trees. While effective, these linear classifiers are computationally expensive, especially when dealing with larger models that have many parameters. To address this, we introduce Probing Experts (ProbeX), a theoretically motivated and lightweight method. Notably, ProbeX is the first probing method specifically designed to learn from the weights of a single hidden model layer. We demonstrate the effectiveness of ProbeX by predicting the categories in a model's training dataset based only on its weights. Excitingly, ProbeX can map the weights of Stable Diffusion into a weight-language embedding space, enabling model search via text, i.e., zero-shot model classification.

When building artificial intelligence systems that can reason and answer questions about visual data, we need diagnostic tests to analyze our progress and discover shortcomings. Existing benchmarks for visual question answering can help, but have strong biases that models can exploit to correctly answer questions without reasoning. They also conflate multiple sources of error, making it hard to pinpoint model weaknesses. We present a diagnostic dataset that tests a range of visual reasoning abilities. It contains minimal biases and has detailed annotations describing the kind of reasoning each question requires. We use this dataset to analyze a variety of modern visual reasoning systems, providing novel insights into their abilities and limitations.

Large language models (LLMs) have demonstrated remarkable capabilities in natural language understanding and generation across various domains, including medicine. We present a comprehensive evaluation of GPT-4, a state-of-the-art LLM, on medical competency examinations and benchmark datasets. GPT-4 is a general-purpose model that is not specialized for medical problems through training or engineered to solve clinical tasks. Our analysis covers two sets of official practice materials for the USMLE, a three-step examination program used to assess clinical competency and grant licensure in the United States. We also evaluate performance on the MultiMedQA suite of benchmark datasets. Beyond measuring model performance, experiments were conducted to investigate the influence of test questions containing both text and images on model performance, probe for memorization of content during training, and study probability calibration, which is of critical importance in high-stakes applications like medicine. Our results show that GPT-4, without any specialized prompt crafting, exceeds the passing score on USMLE by over 20 points and outperforms earlier general-purpose models (GPT-3.5) as well as models specifically fine-tuned on medical knowledge (Med-PaLM, a prompt-tuned version of Flan-PaLM 540B). In addition, GPT-4 is significantly better calibrated than GPT-3.5, demonstrating a much-improved ability to predict the likelihood that its answers are correct. We also explore the behavior of the model qualitatively through a case study that shows the ability of GPT-4 to explain medical reasoning, personalize explanations to students, and interactively craft new counterfactual scenarios around a medical case. Implications of the findings are discussed for potential uses of GPT-4 in medical education, assessment, and clinical practice, with appropriate attention to challenges of accuracy and safety.

As Large Language Models (LLMs) have become more advanced, they have outpaced our abilities to accurately evaluate their quality. Not only is finding data to adequately probe particular model properties difficult, but evaluating the correctness of a model's freeform generation alone is a challenge. To address this, many evaluations now rely on using LLMs themselves as judges to score the quality of outputs from other LLMs. Evaluations most commonly use a single large model like GPT4. While this method has grown in popularity, it is costly, has been shown to introduce intramodel bias, and in this work, we find that very large models are often unnecessary. We propose instead to evaluate models using a Panel of LLm evaluators (PoLL). Across three distinct judge settings and spanning six different datasets, we find that using a PoLL composed of a larger number of smaller models outperforms a single large judge, exhibits less intra-model bias due to its composition of disjoint model families, and does so while being over seven times less expensive.

Machine learning techniques are effective for building predictive models because they identify patterns in large datasets. Development of a model for complex real-life problems often stop at the point of publication, proof of concept or when made accessible through some mode of deployment. However, a model in the medical domain risks becoming obsolete as patient demographics, systems and clinical practices change. The maintenance and monitoring of predictive model performance post-publication is crucial to enable their safe and effective long-term use. We will assess the infrastructure required to monitor the outputs of a machine learning algorithm, and present two scenarios with examples of monitoring and updates of models, firstly on a breast cancer prognosis model trained on public longitudinal data, and secondly on a neurodegenerative stratification algorithm that is currently being developed and tested in clinic.

Language Models (LMs) have become widely used in software engineering, especially for tasks such as code generation, where they are referred to as code LMs. These models have proven effective in generating code, making it easier for developers to automate coding activities. However, research has highlighted a significant limitation: despite their effectiveness, LMs often produce code that is incorrect, buggy, or not fully functional. Updating these models with limited data can be prohibitively challenging, yet it is essential to maximize their utility. This may require hot-fix techniques (updating models with limited data) to resolve. In this paper, we propose Model Improvement via Neuron Targeting (MINT), a novel approach for repairing code LMs. MINT leverages the semantic property of language models to perform neuron-level repairs in a novel way. Further, by analyzing the relationships between the model's latent representations, the incorrect outputs, and the desired outputs, MINT determines which neurons are worth updating. This approach ensures that only the neurons crucial to the model's failure are targeted, avoiding unnecessary changes and allowing for a more efficient and precise repair process. MINT is effective, efficient, and reliable, capable of correcting a neural model by patching a minimum number of neurons (usually one or two neurons). Our approach is evaluated on three coding tasks: line-level code generation, shellcode generation, and intent-to-bash translation. The experimental results demonstrate that the proposed approach significantly outperforms the state-of-the-art in both effectiveness and efficiency measures. In addition, we analyze and discuss the side effects of model repair techniques, including the balance between generalization and specificity, and the performance after multiple repairs in succession.

Foundation models (FMs) are transforming computational pathology by offering new ways to analyze histopathology images. However, FMs typically require weeks of training on large databases, making their creation a resource-intensive process. In this paper, we present a training for foundation models from whole slide images using supervised, end-to-end, multitask learning on slide-level labels. Notably, it is the first model to incorporate cancer subtyping, risk estimation, and genetic mutation prediction into one model. The presented model outperforms self-supervised models on seven benchmark tasks while the training only required 5% of the computational resources. The results not only show that supervised training can outperform self-supervision with less data, but also offer a solution to annotation problems, as patient-based labels are widely available through routine clinical processes. Furthermore, an attention module provides a layer of explainability across different tasks and serves as a tumor detector for unseen cancer types. To address the issue of closed-source datasets, the model was fully trained on openly available data. The code and model weights are made available under https://github.com/FraunhoferMEVIS/MedicalMultitaskModeling.

Augmenting Large Language Models (LLMs) with external tools enables them to execute complex, multi-step tasks. However, tool learning is hampered by the static synthetic data pipelines where data generation and model training are executed as two separate, non-interactive processes. This approach fails to adaptively focus on a model's specific weaknesses and allows noisy labels to persist, degrading training efficiency. We introduce LoopTool, a fully automated, model-aware data evolution framework that closes this loop by tightly integrating data synthesis and model training. LoopTool iteratively refines both the data and the model through three synergistic modules: (1) Greedy Capability Probing (GCP) diagnoses the model's mastered and failed capabilities; (2) Judgement-Guided Label Verification (JGLV) uses an open-source judge model to find and correct annotation errors, progressively purifying the dataset; and (3) Error-Driven Data Expansion (EDDE) generates new, challenging samples based on identified failures. This closed-loop process operates within a cost-effective, open-source ecosystem, eliminating dependence on expensive closed-source APIs. Experiments show that our 8B model trained with LoopTool significantly surpasses its 32B data generator and achieves new state-of-the-art results on the BFCL-v3 and ACEBench benchmarks for its scale. Our work demonstrates that closed-loop, self-refining data pipelines can dramatically enhance the tool-use capabilities of LLMs.

Answer verification methods are widely employed in language model training pipelines spanning data curation, evaluation, and reinforcement learning with verifiable rewards (RLVR). While prior work focus on developing unified verifiers applicable across multiple reasoning scenarios, significant challenges remain in computation-oriented scientific domains, such as algebraic equivalence checking and physical constant substitution. In this paper, we introduce \model, a tool-augmented verifier that leverages external executors to perform precise computations and symbolic simplifications. \model enables robust verification that goes beyond simple semantic matching. We propose a novel two-stage pipeline, which begin with cold-start fine-tuning and followed by multi-turn reinforcement learning with tool integration. Extensive experiments conducted on STEM subjects, general QA, and long-form reasoning tasks demonstrates strong generalization of \model. The results shows that the \model achieves state-of-the-art performance on VerifyBench-Hard and SCI-Bench. And we also employ our \model in RLVR as a reward model, the results show that it consistently outperforms both rubric-based and model-based verifiers on AIME'24 and AIME'25, demonstrating strong potential to enhance reasoning capabilities of LLM. Our model is released at https://huggingface.co/Nanbeige/CoSineVerifier-Tool-4B{https://huggingface.co/Nanbeige/CoSineVerifier-Tool-4B}.

Recent advances in generative models, including large language models (LLMs), vision language models (VLMs), and diffusion models, have accelerated the field of natural language and image processing in medicine and marked a significant paradigm shift in how biomedical models can be developed and deployed. While these models are highly adaptable to new tasks, scaling and evaluating their usage presents new challenges not addressed in previous frameworks. In particular, the ability of these models to produce useful outputs with little to no specialized training data ("zero-" or "few-shot" approaches), as well as the open-ended nature of their outputs, necessitate the development of new guidelines for robust reporting of clinical generative model research. In response to gaps in standards and best practices for the development of clinical AI tools identified by US Executive Order 141103 and several emerging national networks for clinical AI evaluation, we begin to formalize some of these guidelines by building on the original MI-CLAIM checklist. The new checklist, MI-CLAIM-GEN (Table 1), aims to address differences in training, evaluation, interpretability, and reproducibility of new generative models compared to non-generative ("predictive") AI models. This MI-CLAIM-GEN checklist also seeks to clarify cohort selection reporting with unstructured clinical data and adds additional items on alignment with ethical standards for clinical AI research.

Large Multimodal Models (LMMs) have shown remarkable progress in the field of medical Visual Question Answering (Med-VQA), achieving high accuracy on existing benchmarks. However, their reliability under robust evaluation is questionable. This study reveals that state-of-the-art models, when subjected to simple probing evaluation, perform worse than random guessing on medical diagnosis questions. To address this critical evaluation problem, we introduce the Probing Evaluation for Medical Diagnosis (ProbMed) dataset to rigorously assess LMM performance in medical imaging through probing evaluation and procedural diagnosis. Particularly, probing evaluation features pairing original questions with negation questions with hallucinated attributes, while procedural diagnosis requires reasoning across various diagnostic dimensions for each image, including modality recognition, organ identification, clinical findings, abnormalities, and positional grounding. Our evaluation reveals that top-performing models like GPT-4V and Gemini Pro perform worse than random guessing on specialized diagnostic questions, indicating significant limitations in handling fine-grained medical inquiries. Besides, models like LLaVA-Med struggle even with more general questions, and results from CheXagent demonstrate the transferability of expertise across different modalities of the same organ, showing that specialized domain knowledge is still crucial for improving performance. This study underscores the urgent need for more robust evaluation to ensure the reliability of LMMs in critical fields like medical diagnosis, and current LMMs are still far from applicable to those fields.

Developing reliable AI systems to assist human clinicians in multi-modal medical diagnosis has long been a key objective for researchers. Recently, Multi-modal Large Language Models (MLLMs) have gained significant attention and achieved success across various domains. With strong reasoning capabilities and the ability to perform diverse tasks based on user instructions, they hold great potential for enhancing medical diagnosis. However, directly applying MLLMs to the medical domain still presents challenges. They lack detailed perception of visual inputs, limiting their ability to perform quantitative image analysis, which is crucial for medical diagnostics. Additionally, MLLMs often exhibit hallucinations and inconsistencies in reasoning, whereas clinical diagnoses must adhere strictly to established criteria. To address these challenges, we propose MedAgent-Pro, an evidence-based reasoning agentic system designed to achieve reliable, explainable, and precise medical diagnoses. This is accomplished through a hierarchical workflow: at the task level, knowledge-based reasoning generate reliable diagnostic plans for specific diseases following retrieved clinical criteria. While at the case level, multiple tool agents process multi-modal inputs, analyze different indicators according to the plan, and provide a final diagnosis based on both quantitative and qualitative evidence. Comprehensive experiments on both 2D and 3D medical diagnosis tasks demonstrate the superiority and effectiveness of MedAgent-Pro, while case studies further highlight its reliability and interpretability. The code is available at https://github.com/jinlab-imvr/MedAgent-Pro.

Large language models (LLMs) have demonstrated impressive capabilities in natural language understanding and generation, but the quality bar for medical and clinical applications is high. Today, attempts to assess models' clinical knowledge typically rely on automated evaluations on limited benchmarks. There is no standard to evaluate model predictions and reasoning across a breadth of tasks. To address this, we present MultiMedQA, a benchmark combining six existing open question answering datasets spanning professional medical exams, research, and consumer queries; and HealthSearchQA, a new free-response dataset of medical questions searched online. We propose a framework for human evaluation of model answers along multiple axes including factuality, precision, possible harm, and bias. In addition, we evaluate PaLM (a 540-billion parameter LLM) and its instruction-tuned variant, Flan-PaLM, on MultiMedQA. Using a combination of prompting strategies, Flan-PaLM achieves state-of-the-art accuracy on every MultiMedQA multiple-choice dataset (MedQA, MedMCQA, PubMedQA, MMLU clinical topics), including 67.6% accuracy on MedQA (US Medical License Exam questions), surpassing prior state-of-the-art by over 17%. However, human evaluation reveals key gaps in Flan-PaLM responses. To resolve this we introduce instruction prompt tuning, a parameter-efficient approach for aligning LLMs to new domains using a few exemplars. The resulting model, Med-PaLM, performs encouragingly, but remains inferior to clinicians. We show that comprehension, recall of knowledge, and medical reasoning improve with model scale and instruction prompt tuning, suggesting the potential utility of LLMs in medicine. Our human evaluations reveal important limitations of today's models, reinforcing the importance of both evaluation frameworks and method development in creating safe, helpful LLM models for clinical applications.

This paper introduces MISS-QA, the first benchmark specifically designed to evaluate the ability of models to interpret schematic diagrams within scientific literature. MISS-QA comprises 1,500 expert-annotated examples over 465 scientific papers. In this benchmark, models are tasked with interpreting schematic diagrams that illustrate research overviews and answering corresponding information-seeking questions based on the broader context of the paper. We assess the performance of 18 frontier multimodal foundation models, including o4-mini, Gemini-2.5-Flash, and Qwen2.5-VL. We reveal a significant performance gap between these models and human experts on MISS-QA. Our analysis of model performance on unanswerable questions and our detailed error analysis further highlight the strengths and limitations of current models, offering key insights to enhance models in comprehending multimodal scientific literature.

Large language models (LLMs) have demonstrated remarkable reasoning capability in solving mathematical problems. However, existing approaches primarily focus on improving the quality of correct training data, e.g., distilling high-quality correct solutions from advanced models, neglecting the value contained in error data, potentially hindering the model's reflective ability. Though some studies attempt to leverage error data, they often involve complex mechanisms, such as Monte Carlo Tree Search (MCTS) to explore error nodes. In this work, we propose to enhance LLMs' reasoning ability by Learning from Errors for Mathematical Advancement (LEMMA). LEMMA constructs data consisting of an incorrect solution with an erroneous step and a reflection connection to a correct solution for fine-tuning. Specifically, we systematically analyze the model-generated error types and introduce an error-type grounded mistake augmentation method to collect diverse and representative errors. Correct solutions are either from fixing the errors or generating a fresh start. Through a model-aware smooth reflection connection, the erroneous solution is transferred to the correct one. By fine-tuning on the constructed dataset, the model is able to self-correct errors autonomously within the generation process without relying on external critique models. Experimental results demonstrate that LEMMA achieves significant performance improvements over other strong baselines.

Large Language Models (LLMs) have demonstrated human-like instruction-following abilities, particularly those exceeding 100 billion parameters. The combined capability of some smaller, resource-friendly LLMs can address most of the instructions that larger LLMs excel at. In this work, we explore how to route the best-performing LLM for each instruction to achieve better overall performance. We develop a new paradigm, constructing capability instructions with model capability representation, user instruction, and performance inquiry prompts to assess the performance. To learn from capability instructions, we introduce a new end-to-end framework called Model Selection with Aptitude Test (Model-SAT), which generates positive and negative samples based on what different models perform well or struggle with. Model-SAT uses a model capability encoder that extends its model representation to a lightweight LLM. Our experiments show that Model-SAT understands the performance dimensions of candidate models and provides the probabilities of their capability to handle various instructions. Additionally, during deployment, a new model can quickly infer its aptitude test results across 50 tasks, each with 20 shots. Model-SAT performs state-of-the-art model routing without candidate inference and in real-world new model-released scenarios. The code is available at https://github.com/Now-Join-Us/CIT-LLM-Routing

In many real-world applications, deployed models encounter inputs that differ from the data seen during training. Out-of-distribution detection identifies whether an input stems from an unseen distribution, while open-world recognition flags such inputs to ensure the system remains robust as ever-emerging, previously unknown categories appear and must be addressed without retraining. Foundation and vision-language models are pre-trained on large and diverse datasets with the expectation of broad generalization across domains, including medical imaging. However, benchmarking these models on test sets with only a few common outlier types silently collapses the evaluation back to a closed-set problem, masking failures on rare or truly novel conditions encountered in clinical use. We therefore present NOVA, a challenging, real-life evaluation-only benchmark of sim900 brain MRI scans that span 281 rare pathologies and heterogeneous acquisition protocols. Each case includes rich clinical narratives and double-blinded expert bounding-box annotations. Together, these enable joint assessment of anomaly localisation, visual captioning, and diagnostic reasoning. Because NOVA is never used for training, it serves as an extreme stress-test of out-of-distribution generalisation: models must bridge a distribution gap both in sample appearance and in semantic space. Baseline results with leading vision-language models (GPT-4o, Gemini 2.0 Flash, and Qwen2.5-VL-72B) reveal substantial performance drops across all tasks, establishing NOVA as a rigorous testbed for advancing models that can detect, localize, and reason about truly unknown anomalies.

The rapid advancement of Large Language Models (LLMs) and Large Multimodal Models (LMMs) has heightened the demand for AI-based scientific assistants capable of understanding scientific articles and figures. Despite progress, there remains a significant gap in evaluating models' comprehension of professional, graduate-level, and even PhD-level scientific content. Current datasets and benchmarks primarily focus on relatively simple scientific tasks and figures, lacking comprehensive assessments across diverse advanced scientific disciplines. To bridge this gap, we collected a multimodal, multidisciplinary dataset from open-access scientific articles published in Nature Communications journals. This dataset spans 72 scientific disciplines, ensuring both diversity and quality. We created benchmarks with various tasks and settings to comprehensively evaluate LMMs' capabilities in understanding scientific figures and content. Our evaluation revealed that these tasks are highly challenging: many open-source models struggled significantly, and even GPT-4V and GPT-4o faced difficulties. We also explored using our dataset as training resources by constructing visual instruction-following data, enabling the 7B LLaVA model to achieve performance comparable to GPT-4V/o on our benchmark. Additionally, we investigated the use of our interleaved article texts and figure images for pre-training LMMs, resulting in improvements on the material generation task. The source dataset, including articles, figures, constructed benchmarks, and visual instruction-following data, is open-sourced.

Clinical diagnosis prediction models, when provided with a patient's medical history, aim to detect potential diseases early, facilitating timely intervention and improving prognostic outcomes. However, the inherent scarcity of patient data and large disease candidate space often pose challenges in developing satisfactory models for this intricate task. The exploration of leveraging Large Language Models (LLMs) for encapsulating clinical decision processes has been limited. We introduce MERA, a clinical diagnosis prediction model that bridges pertaining natural language knowledge with medical practice. We apply hierarchical contrastive learning on a disease candidate ranking list to alleviate the large decision space issue. With concept memorization through fine-tuning, we bridge the natural language clinical knowledge with medical codes. Experimental results on MIMIC-III and IV datasets show that MERA achieves the state-of-the-art diagnosis prediction performance and dramatically elevates the diagnosis prediction capabilities of generative LMs.

We construct evaluation tasks where extending the reasoning length of Large Reasoning Models (LRMs) deteriorates performance, exhibiting an inverse scaling relationship between test-time compute and accuracy. Our evaluation tasks span four categories: simple counting tasks with distractors, regression tasks with spurious features, deduction tasks with constraint tracking, and advanced AI risks. We identify five distinct failure modes when models reason for longer: 1) Claude models become increasingly distracted by irrelevant information; 2) OpenAI o-series models resist distractors but overfit to problem framings; 3) models shift from reasonable priors to spurious correlations; 4) all models show difficulties in maintaining focus on complex deductive tasks; and 5) extended reasoning may amplify concerning behaviors, with Claude Sonnet 4 showing increased expressions of self-preservation. These findings suggest that while test-time compute scaling remains promising for improving model capabilities, it may inadvertently reinforce problematic reasoning patterns. Our results demonstrate the importance of evaluating models across diverse reasoning lengths to identify and address these failure modes in LRMs.

The meaningful use of electronic health records (EHR) continues to progress in the digital era with clinical decision support systems augmented by artificial intelligence. A priority in improving provider experience is to overcome information overload and reduce the cognitive burden so fewer medical errors and cognitive biases are introduced during patient care. One major type of medical error is diagnostic error due to systematic or predictable errors in judgment that rely on heuristics. The potential for clinical natural language processing (cNLP) to model diagnostic reasoning in humans with forward reasoning from data to diagnosis and potentially reduce the cognitive burden and medical error has not been investigated. Existing tasks to advance the science in cNLP have largely focused on information extraction and named entity recognition through classification tasks. We introduce a novel suite of tasks coined as Diagnostic Reasoning Benchmarks, DR.BENCH, as a new benchmark for developing and evaluating cNLP models with clinical diagnostic reasoning ability. The suite includes six tasks from ten publicly available datasets addressing clinical text understanding, medical knowledge reasoning, and diagnosis generation. DR.BENCH is the first clinical suite of tasks designed to be a natural language generation framework to evaluate pre-trained language models. Experiments with state-of-the-art pre-trained generative language models using large general domain models and models that were continually trained on a medical corpus demonstrate opportunities for improvement when evaluated in DR. BENCH. We share DR. BENCH as a publicly available GitLab repository with a systematic approach to load and evaluate models for the cNLP community.

Tumor documentation in Germany is largely done manually, requiring reading patient records and entering data into structured databases. Large language models (LLMs) could potentially enhance this process by improving efficiency and reliability. This evaluation tests eleven different open source LLMs with sizes ranging from 1-70 billion model parameters on three basic tasks of the tumor documentation process: identifying tumor diagnoses, assigning ICD-10 codes, and extracting the date of first diagnosis. For evaluating the LLMs on these tasks, a dataset of annotated text snippets based on anonymized doctors' notes from urology was prepared. Different prompting strategies were used to investigate the effect of the number of examples in few-shot prompting and to explore the capabilities of the LLMs in general. The models Llama 3.1 8B, Mistral 7B, and Mistral NeMo 12 B performed comparably well in the tasks. Models with less extensive training data or having fewer than 7 billion parameters showed notably lower performance, while larger models did not display performance gains. Examples from a different medical domain than urology could also improve the outcome in few-shot prompting, which demonstrates the ability of LLMs to handle tasks needed for tumor documentation. Open source LLMs show a strong potential for automating tumor documentation. Models from 7-12 billion parameters could offer an optimal balance between performance and resource efficiency. With tailored fine-tuning and well-designed prompting, these models might become important tools for clinical documentation in the future. The code for the evaluation is available from https://github.com/stefan-m-lenz/UroLlmEval. We also release the dataset as a new valuable resource that addresses the shortage of authentic and easily accessible benchmarks in German-language medical NLP.

Differential Diagnosis (DDx) is a fundamental yet complex aspect of clinical decision-making, in which physicians iteratively refine a ranked list of possible diseases based on symptoms, antecedents, and medical knowledge. While recent advances in large language models (LLMs) have shown promise in supporting DDx, existing approaches face key limitations, including single-dataset evaluations, isolated optimization of components, unrealistic assumptions about complete patient profiles, and single-attempt diagnosis. We introduce a Modular Explainable DDx Agent (MEDDxAgent) framework designed for interactive DDx, where diagnostic reasoning evolves through iterative learning, rather than assuming a complete patient profile is accessible. MEDDxAgent integrates three modular components: (1) an orchestrator (DDxDriver), (2) a history taking simulator, and (3) two specialized agents for knowledge retrieval and diagnosis strategy. To ensure robust evaluation, we introduce a comprehensive DDx benchmark covering respiratory, skin, and rare diseases. We analyze single-turn diagnostic approaches and demonstrate the importance of iterative refinement when patient profiles are not available at the outset. Our broad evaluation demonstrates that MEDDxAgent achieves over 10% accuracy improvements in interactive DDx across both large and small LLMs, while offering critical explainability into its diagnostic reasoning process.

While Multimodal Large Language Models (MLLMs) have achieved remarkable progress in visual understanding, they often struggle when faced with the unstructured and ambiguous nature of human-generated sketches. This limitation is particularly pronounced in the underexplored task of visual grading, where models should not only solve a problem but also diagnose errors in hand-drawn diagrams. Such diagnostic capabilities depend on complex structural, semantic, and metacognitive reasoning. To bridge this gap, we introduce SketchJudge, a novel benchmark tailored for evaluating MLLMs as graders of hand-drawn STEM diagrams. SketchJudge encompasses 1,015 hand-drawn student responses across four domains: geometry, physics, charts, and flowcharts, featuring diverse stylistic variations and distinct error types. Evaluations on SketchJudge demonstrate that even advanced MLLMs lag significantly behind humans, validating the benchmark's effectiveness in exposing the fragility of current vision-language alignment in symbolic and noisy contexts. All data, code, and evaluation scripts are publicly available at https://github.com/yuhangsu82/SketchJudge.

Robust benchmarks are crucial for evaluating Multimodal Large Language Models (MLLMs). Yet we find that models can ace many multimodal benchmarks without strong visual understanding, instead exploiting biases, linguistic priors, and superficial patterns. This is especially problematic for vision-centric benchmarks that are meant to require visual inputs. We adopt a diagnostic principle for benchmark design: if a benchmark can be gamed, it will be. Designers should therefore try to ``game'' their own benchmarks first, using diagnostic and debiasing procedures to systematically identify and mitigate non-visual biases. Effective diagnosis requires directly ``training on the test set'' -- probing the released test set for its intrinsic, exploitable patterns. We operationalize this standard with two components. First, we diagnose benchmark susceptibility using a ``Test-set Stress-Test'' (TsT) methodology. Our primary diagnostic tool involves fine-tuning a powerful Large Language Model via k-fold cross-validation on exclusively the non-visual, textual inputs of the test set to reveal shortcut performance and assign each sample a bias score s(x). We complement this with a lightweight Random Forest-based diagnostic operating on hand-crafted features for fast, interpretable auditing. Second, we debias benchmarks by filtering high-bias samples using an ``Iterative Bias Pruning'' (IBP) procedure. Applying this framework to four benchmarks -- VSI-Bench, CV-Bench, MMMU, and VideoMME -- we uncover pervasive non-visual biases. As a case study, we apply our full framework to create VSI-Bench-Debiased, demonstrating reduced non-visual solvability and a wider vision-blind performance gap than the original.

Large Language Models (LLMs) are often described as being instances of foundation models - that is, models that transfer strongly across various tasks and conditions in few-show or zero-shot manner, while exhibiting scaling laws that predict function improvement when increasing the pre-training scale. These claims of excelling in different functions and tasks rely on measurements taken across various sets of standardized benchmarks showing high scores for such models. We demonstrate here a dramatic breakdown of function and reasoning capabilities of state-of-the-art models trained at the largest available scales which claim strong function, using a simple, short, conventional common sense problem formulated in concise natural language, easily solvable by humans. The breakdown is dramatic, as models also express strong overconfidence in their wrong solutions, while providing often non-sensical "reasoning"-like explanations akin to confabulations to justify and backup the validity of their clearly failed responses, making them sound plausible. Various standard interventions in an attempt to get the right solution, like various type of enhanced prompting, or urging the models to reconsider the wrong solutions again by multi step re-evaluation, fail. We take these initial observations to the scientific and technological community to stimulate urgent re-assessment of the claimed capabilities of current generation of LLMs, Such re-assessment also requires common action to create standardized benchmarks that would allow proper detection of such basic reasoning deficits that obviously manage to remain undiscovered by current state-of-the-art evaluation procedures and benchmarks. Code for reproducing experiments in the paper and raw experiments data can be found at https://github.com/LAION-AI/AIW

Building upon our previous investigations of O1 replication (Part 1: Journey Learning [Qin et al., 2024] and Part 2: Distillation [Huang et al., 2024]), this work explores the potential of inference-time scaling in large language models (LLMs) for medical reasoning tasks, ranging from diagnostic decision-making to treatment planning. Through extensive experiments on medical benchmarks of varying complexity (MedQA, Medbullets, and JAMA Clinical Challenges), our investigation reveals several key insights: (1) Increasing inference time does lead to improved performance. With a modest training set of 500 samples, our model yields substantial performance improvements of 6%-11%. (2) Task complexity directly correlates with the required length of reasoning chains, confirming the necessity of extended thought processes for challenging problems. (3) The differential diagnoses generated by our model adhere to the principles of the hypothetico-deductive method, producing a list of potential conditions that may explain a patient's symptoms and systematically narrowing these possibilities by evaluating the evidence. These findings demonstrate the promising synergy between inference-time scaling and journey learning in advancing LLMs' real-world clinical reasoning capabilities.

Visual Language Models (VLMs) have demonstrated impressive capabilities in visual grounding tasks. However, their effectiveness in the medical domain, particularly for abnormality detection and localization within medical images, remains underexplored. A major challenge is the complex and abstract nature of medical terminology, which makes it difficult to directly associate pathological anomaly terms with their corresponding visual features. In this work, we introduce a novel approach to enhance VLM performance in medical abnormality detection and localization by leveraging decomposed medical knowledge. Instead of directly prompting models to recognize specific abnormalities, we focus on breaking down medical concepts into fundamental attributes and common visual patterns. This strategy promotes a stronger alignment between textual descriptions and visual features, improving both the recognition and localization of abnormalities in medical images.We evaluate our method on the 0.23B Florence-2 base model and demonstrate that it achieves comparable performance in abnormality grounding to significantly larger 7B LLaVA-based medical VLMs, despite being trained on only 1.5% of the data used for such models. Experimental results also demonstrate the effectiveness of our approach in both known and previously unseen abnormalities, suggesting its strong generalization capabilities.

In this paper, we present a framework for training large language models (LLMs) as diagnostic agents with reinforcement learning, enabling them to manage multi-turn diagnostic processes, adaptively select examinations, and commit to final diagnoses. Unlike instruction-tuned models trained on static case summaries, our method acquires diagnostic strategies through interactive exploration and outcome-based feedback. Our contributions are fourfold: (i) We present DiagGym, a diagnostics world model trained with electronic health records that emits examination outcomes conditioned on patient history and recommended examination, serving as a virtual clinical environment for realistic diagnosis training and evaluation; (ii) We train DiagAgent via end-to-end, multi-turn reinforcement learning to learn diagnostic policies that optimize both information yield and diagnostic accuracy; (iii) We introduce DiagBench, a diagnostic benchmark comprising 750 cases with physician-validated examination recommendations and 99 cases annotated with 973 physician-written rubrics on diagnosis process; (iv) we demonstrate superior performance across diverse diagnostic settings. DiagAgent significantly outperforms 10 state-of-the-art LLMs, including DeepSeek-v3 and GPT-4o, as well as two prompt-engineered agents. In single-turn settings, DiagAgent achieves 9.34% higher diagnostic accuracy and 44.03% improvement in examination recommendation hit ratio. In end-to-end settings, it delivers 15.12% increase in diagnostic accuracy and 23.09% boost in examination recommendation F1 score. In rubric-based evaluation, it surpasses the next-best model, Claude-sonnet-4, by 7.1% in weighted rubric score. These findings indicate that learning policies in interactive clinical environments confers dynamic and clinically meaningful diagnostic management abilities unattainable through passive training alone.

This paper explores the advancements and applications of large-scale models in the medical field, with a particular focus on Medical Large Models (MedLMs). These models, encompassing Large Language Models (LLMs), Vision Models, 3D Large Models, and Multimodal Models, are revolutionizing healthcare by enhancing disease prediction, diagnostic assistance, personalized treatment planning, and drug discovery. The integration of graph neural networks in medical knowledge graphs and drug discovery highlights the potential of Large Graph Models (LGMs) in understanding complex biomedical relationships. The study also emphasizes the transformative role of Vision-Language Models (VLMs) and 3D Large Models in medical image analysis, anatomical modeling, and prosthetic design. Despite the challenges, these technologies are setting new benchmarks in medical innovation, improving diagnostic accuracy, and paving the way for personalized healthcare solutions. This paper aims to provide a comprehensive overview of the current state and future directions of large models in medicine, underscoring their significance in advancing global health.

Writing good software tests can be challenging, therefore approaches that support developers are desirable. While generating complete tests automatically is such an approach commonly proposed in research, developers may already have specific test scenarios in mind and thus just require help in selecting the most suitable test assertions for these scenarios. This can be done using deep learning models to predict assertions for given test code. Prior research on assertion generation trained these models specifically for the task, raising the question how much the use of larger models pre-trained on code that have emerged since then can improve their performance. In particular, while abstracting identifiers has been shown to improve specifically trained models, it remains unclear whether this also generalises to models pre-trained on non-abstracted code. Finally, even though prior work demonstrated high accuracy it remains unclear how this translates into the effectiveness of the assertions at their intended application -- finding faults. To shed light on these open questions, in this paper we propose AsserT5, a new model based on the pre-trained CodeT5 model, and use this to empirically study assertion generation. We find that the abstraction and the inclusion of the focal method are useful also for a fine-tuned pre-trained model, resulting in test assertions that match the ground truth assertions precisely in up to 59.5\% of cases, more than twice as precise as prior models. However, evaluation on real bugs from the Defects4J dataset shows that out of 138 bugs detectable with assertions in real-world projects, AsserT5 was only able to suggest fault-finding assertions for 33, indicating the need for further improvements.

Multimodal Large Language Models (MLLMs) have tremendous potential to improve the accuracy, availability, and cost-effectiveness of healthcare by providing automated solutions or serving as aids to medical professionals. Despite promising first steps in developing medical MLLMs in the past few years, their capabilities and limitations are not well-understood. Recently, many benchmark datasets have been proposed that test the general medical knowledge of such models across a variety of medical areas. However, the systematic failure modes and vulnerabilities of such models are severely underexplored with most medical benchmarks failing to expose the shortcomings of existing models in this safety-critical domain. In this paper, we introduce MediConfusion, a challenging medical Visual Question Answering (VQA) benchmark dataset, that probes the failure modes of medical MLLMs from a vision perspective. We reveal that state-of-the-art models are easily confused by image pairs that are otherwise visually dissimilar and clearly distinct for medical experts. Strikingly, all available models (open-source or proprietary) achieve performance below random guessing on MediConfusion, raising serious concerns about the reliability of existing medical MLLMs for healthcare deployment. We also extract common patterns of model failure that may help the design of a new generation of more trustworthy and reliable MLLMs in healthcare.

Purpose: Recent advancements in large language models (LLMs) have expanded their capabilities in a multimodal fashion, potentially replicating the image interpretation of human radiologists. This study aimed to develop open-source multimodal large language model for interpreting chest X-ray images (CXR-LLaVA). We also examined the effect of prompt engineering and model parameters such as temperature and nucleus sampling. Materials and Methods: For training, we collected 659,287 publicly available CXRs: 417,336 CXRs had labels for certain radiographic abnormalities (dataset 1); 241,951 CXRs provided free-text radiology reports (dataset 2). After pre-training the Resnet50 as an image encoder, the contrastive language-image pre-training was used to align CXRs and corresponding radiographic abnormalities. Then, the Large Language Model Meta AI-2 was fine-tuned using dataset 2, which were refined using GPT-4, with generating various question answering scenarios. The code can be found at https://github.com/ECOFRI/CXR_LLaVA. Results: In the test set, we observed that the model's performance fluctuated based on its parameters. On average, it achieved F1 score of 0.34 for five pathologic findings (atelectasis, cardiomegaly, consolidation, edema, and pleural effusion), which was improved to 0.46 through prompt engineering. In the independent set, the model achieved an average F1 score of 0.30 for the same pathologic findings. Notably, for the pediatric chest radiograph dataset, which was unseen during training, the model differentiated abnormal radiographs with an F1 score ranging from 0.84 to 0.85. Conclusion: CXR-LLaVA demonstrates promising potential in CXR interpretation. Both prompt engineering and model parameter adjustments can play pivotal roles in interpreting CXRs.

Large language models (LLMs) are increasingly capable of processing long inputs and locating specific information within them, as evidenced by their performance on the Needle in a Haystack (NIAH) test. However, while models excel at recalling surprising information, they still struggle to identify clearly omitted information. We introduce AbsenceBench to assesses LLMs' capacity to detect missing information across three domains: numerical sequences, poetry, and GitHub pull requests. AbsenceBench asks models to identify which pieces of a document were deliberately removed, given access to both the original and edited contexts. Despite the apparent straightforwardness of these tasks, our experiments reveal that even state-of-the-art models like Claude-3.7-Sonnet achieve only 69.6% F1-score with a modest average context length of 5K tokens. Our analysis suggests this poor performance stems from a fundamental limitation: Transformer attention mechanisms cannot easily attend to "gaps" in documents since these absences don't correspond to any specific keys that can be attended to. Overall, our results and analysis provide a case study of the close proximity of tasks where models are already superhuman (NIAH) and tasks where models breakdown unexpectedly (AbsenceBench).

Multi-view learning (MVL) leverages multiple sources or views of data to enhance machine learning model performance and robustness. This approach has been successfully used in the Earth Observation (EO) domain, where views have a heterogeneous nature and can be affected by missing data. Despite the negative effect that missing data has on model predictions, the ML literature has used it as an augmentation technique to improve model generalization, like masking the input data. Inspired by this, we introduce novel methods for EO applications tailored to MVL with missing views. Our methods integrate the combination of a set to simulate all combinations of missing views as different training samples. Instead of replacing missing data with a numerical value, we use dynamic merge functions, like average, and more complex ones like Transformer. This allows the MVL model to entirely ignore the missing views, enhancing its predictive robustness. We experiment on four EO datasets with temporal and static views, including state-of-the-art methods from the EO domain. The results indicate that our methods improve model robustness under conditions of moderate missingness, and improve the predictive performance when all views are present. The proposed methods offer a single adaptive solution to operate effectively with any combination of available views.

Recently, large language models (LLMs), especially those that are pretrained on code, have demonstrated strong capabilities in generating programs from natural language inputs in a few-shot or even zero-shot manner. Despite promising results, there is a notable lack of a comprehensive evaluation of these models language-to-code generation capabilities. Existing studies often focus on specific tasks, model architectures, or learning paradigms, leading to a fragmented understanding of the overall landscape. In this work, we present L2CEval, a systematic evaluation of the language-to-code generation capabilities of LLMs on 7 tasks across the domain spectrum of semantic parsing, math reasoning and Python programming, analyzing the factors that potentially affect their performance, such as model size, pretraining data, instruction tuning, and different prompting methods. In addition to assessing model performance, we measure confidence calibration for the models and conduct human evaluations of the output programs. This enables us to identify and analyze the typical failure modes across various tasks and models. L2CEval offers a comprehensive understanding of the capabilities and limitations of LLMs in language-to-code generation. We also release the evaluation framework and all model outputs, hoping to lay the groundwork for further future research in this domain.

Databases of electronic health records (EHRs) are increasingly used to inform clinical decisions. Machine learning methods can find patterns in EHRs that are predictive of future adverse outcomes. However, statistical models may be built upon patterns of health-seeking behavior that vary across patient subpopulations, leading to poor predictive performance when training on one patient population and predicting on another. This note proposes two tests to better measure and understand model generalization. We use these tests to compare models derived from two data sources: (i) historical medical records, and (ii) electrocardiogram (EKG) waveforms. In a predictive task, we show that EKG-based models can be more stable than EHR-based models across different patient populations.

In an era of model and data proliferation in machine learning/AI especially marked by the rapid advancement of open-sourced technologies, there arises a critical need for standardized consistent documentation. Our work addresses the information incompleteness in current human-generated model and data cards. We propose an automated generation approach using Large Language Models (LLMs). Our key contributions include the establishment of CardBench, a comprehensive dataset aggregated from over 4.8k model cards and 1.4k data cards, coupled with the development of the CardGen pipeline comprising a two-step retrieval process. Our approach exhibits enhanced completeness, objectivity, and faithfulness in generated model and data cards, a significant step in responsible AI documentation practices ensuring better accountability and traceability.

Large Language Models (LLMs) have shown remarkable success in supporting a wide range of knowledge-intensive tasks. In specialized domains, there is growing interest in leveraging LLMs to assist subject matter experts with domain-specific challenges. However, deploying LLMs as SaaS solutions raises data privacy concerns, while many open-source models demand significant computational resources for effective domain adaptation and deployment. A promising alternative is to develop smaller, domain-specialized LLMs, though this approach is often constrained by the lack of high-quality domain-specific training data. In this work, we address these limitations by presenting a cost-efficient and scalable training pipeline that combines guided synthetic data generation from a small seed corpus with bottom-up domain data curation. Our pipeline integrates Domain-Adaptive Pretraining (DAPT), Domain-specific Supervised Fine-tuning (DSFT), and Direct Preference Optimization (DPO) to train effective small-scale models for specialized use cases. We demonstrate this approach through DiagnosticSLM, a 3B-parameter domain-specific model tailored for fault diagnosis, root cause analysis, and repair recommendation in industrial settings. To evaluate model performance, we introduce four domain-specific benchmarks: multiple-choice questions (DiagnosticMCQ), question answering (DiagnosticQA), sentence completion (DiagnosticComp), and summarization (DiagnosticSum). DiagnosticSLM achieves up to 25% accuracy improvement over open-source models of comparable or larger size (2B-9B) on the MCQ task, while also outperforming or matching them in other tasks, demonstrating effective domain-specific reasoning and generalization capabilities.

Current approaches for designing self-explainable models (SEMs) require complicated training procedures and specific architectures which makes them impractical. With the advance of general purpose foundation models based on Vision Transformers (ViTs), this impracticability becomes even more problematic. Therefore, new methods are necessary to provide transparency and reliability to ViT-based foundation models. In this work, we present a new method for turning any well-trained ViT-based model into a SEM without retraining, which we call Keypoint Counting Classifiers (KCCs). Recent works have shown that ViTs can automatically identify matching keypoints between images with high precision, and we build on these results to create an easily interpretable decision process that is inherently visualizable in the input. We perform an extensive evaluation which show that KCCs improve the human-machine communication compared to recent baselines. We believe that KCCs constitute an important step towards making ViT-based foundation models more transparent and reliable.

Large Language Models (LLMs) hold great promise to revolutionize current clinical systems for their superior capacities on medical text processing tasks and medical licensing exams. Meanwhile, traditional ML models such as SVM and XGBoost have still been mainly adopted in clinical prediction tasks. An emerging question is Can LLMs beat traditional ML models in clinical prediction? Thus, we build a new benchmark ClinicalBench to comprehensively study the clinical predictive modeling capacities of both general-purpose and medical LLMs, and compare them with traditional ML models. ClinicalBench embraces three common clinical prediction tasks, two databases, 14 general-purpose LLMs, 8 medical LLMs, and 11 traditional ML models. Through extensive empirical investigation, we discover that both general-purpose and medical LLMs, even with different model scales, diverse prompting or fine-tuning strategies, still cannot beat traditional ML models in clinical prediction yet, shedding light on their potential deficiency in clinical reasoning and decision-making. We call for caution when practitioners adopt LLMs in clinical applications. ClinicalBench can be utilized to bridge the gap between LLMs' development for healthcare and real-world clinical practice.

The emergence of groundbreaking large language models capable of performing complex reasoning tasks holds significant promise for addressing various scientific challenges, including those arising in complex clinical scenarios. To enable their safe and effective deployment in real-world healthcare settings, it is urgently necessary to benchmark the diagnostic capabilities of current models systematically. Given the limitations of existing medical benchmarks in evaluating advanced diagnostic reasoning, we present DiagnosisArena, a comprehensive and challenging benchmark designed to rigorously assess professional-level diagnostic competence. DiagnosisArena consists of 1,113 pairs of segmented patient cases and corresponding diagnoses, spanning 28 medical specialties, deriving from clinical case reports published in 10 top-tier medical journals. The benchmark is developed through a meticulous construction pipeline, involving multiple rounds of screening and review by both AI systems and human experts, with thorough checks conducted to prevent data leakage. Our study reveals that even the most advanced reasoning models, o3-mini, o1, and DeepSeek-R1, achieve only 45.82%, 31.09%, and 17.79% accuracy, respectively. This finding highlights a significant generalization bottleneck in current large language models when faced with clinical diagnostic reasoning challenges. Through DiagnosisArena, we aim to drive further advancements in AIs diagnostic reasoning capabilities, enabling more effective solutions for real-world clinical diagnostic challenges. We provide the benchmark and evaluation tools for further research and development https://github.com/SPIRAL-MED/DiagnosisArena.

Generating accurate and clinically meaningful radiology reports from chest X-ray images remains a significant challenge in medical AI. While recent vision-language models achieve strong results in general radiology report generation, they often fail to adequately describe rare but clinically important pathologies like fractures. This work addresses this gap by developing specialized models for fracture pathology detection and description. We train fracture-specific vision-language models with encoders from MAIRA-2 and CheXagent, demonstrating significant improvements over general-purpose models in generating accurate fracture descriptions. Analysis of model outputs by fracture type, location, and age reveals distinct strengths and limitations of current vision-language model architectures. We publicly release our best-performing fracture-reporting model, facilitating future research in accurate reporting of rare pathologies.

This paper poses two critical issues in evaluating base models (without post-training): (1) Unstable evaluation during training: in the early stages of pre-training, the models lack the capability to answer questions as required, leading to unstable evaluation results. This instability makes it difficult to provide solid conclusions to guide the training, especially for key experiments such as data ablation and scaling law. (2) Inconsistency between base and instruct models: base models generally exhibit poorer evaluation performance compared to corresponding instruct models. This gap poses a challenge for assessing whether a base model with better evaluation can truly lead to a better instruct model. To address these issues, we propose Base model Oriented Systematic Evaluation (BOSE), a method specifically designed to optimize the evaluation of base models. Specifically, BOSE introduces two key innovations: In-Context Light-instruction Prompt (ICLiP) for open-ended tasks and Blank-ppl for multi-choice tasks with candidate options, which transforms the standard perplexity (ppl) metric into a fill-in-the-blank format to mitigate early-stage evaluation fluctuations. Furthermore, we are the first to propose Kendall's rank correlation to quantitatively measure the evaluation stability and consistency. Experimental results demonstrate that BOSE significantly enhances both the stability of evaluations during pre-training and the consistency between base and instruct models, thereby providing more reliable guidance for the LLMs' training.

Recent large language models (LLMs) in the general domain, such as ChatGPT, have shown remarkable success in following instructions and producing human-like responses. However, such language models have not been learned individually and carefully for the medical domain, resulting in poor diagnostic accuracy and inability to give correct recommendations for medical diagnosis, medications, etc. To address this issue, we collected more than 700 diseases and their corresponding symptoms, recommended medications, and required medical tests, and then generated 5K doctor-patient conversations. By fine-tuning models of doctor-patient conversations, these models emerge with great potential to understand patients' needs, provide informed advice, and offer valuable assistance in a variety of medical-related fields. The integration of these advanced language models into healthcare can revolutionize the way healthcare professionals and patients communicate, ultimately improving the overall quality of care and patient outcomes. In addition, we will open all source code, datasets and model weights to advance the further development of dialogue models in the medical field. In addition, the training data, code, and weights of this project are available at: https://github.com/Kent0n-Li/ChatDoctor.

Multimodal Large Language Models (MLLMs) demonstrate a strong understanding of the real world and can even handle complex tasks. However, they still fail on some straightforward visual question-answering (VQA) problems. This paper dives deeper into this issue, revealing that models tend to err when answering easy questions (e.g. Yes/No questions) about an image, even though they can correctly describe it. We refer to this model behavior discrepancy between difficult and simple questions as model laziness. To systematically investigate model laziness, we manually construct LazyBench, a benchmark that includes Yes/No, multiple choice, short answer questions, and image description tasks that are related to the same subjects in the images. Based on LazyBench, we observe that laziness widely exists in current advanced MLLMs (e.g. GPT-4o, Gemini-1.5-pro, Claude 3 and LLaVA-v1.5-13B), and it is more pronounced on stronger models. We also analyze the VQA v2 (LLaVA-v1.5-13B) benchmark and find that about half of its failure cases are caused by model laziness, which further highlights the importance of ensuring that the model fully utilizes its capability. To this end, we conduct preliminary exploration on how to mitigate laziness and find that chain of thought (CoT) can effectively address this issue.

Software engineers develop, fine-tune, and deploy deep learning (DL) models. They use and re-use models in a variety of development frameworks and deploy them on a range of runtime environments. In this diverse ecosystem, engineers use DL model converters to move models from frameworks to runtime environments. However, errors in converters can compromise model quality and disrupt deployment. The failure frequency and failure modes of DL model converters are unknown. In this paper, we conduct the first failure analysis on DL model converters. Specifically, we characterize failures in model converters associated with ONNX (Open Neural Network eXchange). We analyze past failures in the ONNX converters in two major DL frameworks, PyTorch and TensorFlow. The symptoms, causes, and locations of failures (for N=200 issues), and trends over time are also reported. We also evaluate present-day failures by converting 8,797 models, both real-world and synthetically generated instances. The consistent result from both parts of the study is that DL model converters commonly fail by producing models that exhibit incorrect behavior: 33% of past failures and 8% of converted models fell into this category. Our results motivate future research on making DL software simpler to maintain, extend, and validate.

Recent advancements in vision-language systems have improved the accuracy of Radiological Visual Question Answering (VQA) Models. However, some challenges remain across each stage of model development: limited expert-labeled images hinders data procurement at scale; the intricate and nuanced patterns of radiological images make modeling inherently difficult; and the lack of evaluation evaluation efforts makes it difficult to identify cases where the model might be ill-conditioned. In this study, we fine-tune a lightweight 3B parameter vision-language model for Radiological VQA, demonstrating that small models, when appropriately tuned with curated data, can achieve robust performance across both open- and closed-ended questions. We propose a cost-effective training pipeline from synthetic question-answer pair generation to multi-stage fine-tuning on specialised radiological domain-targeted datasets (e.g., ROCO v2.0, MedPix v2.0). Our results show that despite operating at a fraction of the scale of state-of-the-art models such as LLaVA-Med, our model achieves promising performance given its small parameter size and the limited scale of training data. We introduce a lightweight saliency-based diagnostic tool that enables domain experts to inspect VQA model performance and identify ill-conditioned failure modes through saliency analysis.

This work presents a probabilistic digital twin framework for response prediction in dynamical systems governed by misspecified physics. The approach integrates Gaussian Process Latent Force Models (GPLFM) and Bayesian Neural Networks (BNNs) to enable end-to-end uncertainty-aware inference and prediction. In the diagnosis phase, model-form errors (MFEs) are treated as latent input forces to a nominal linear dynamical system and jointly estimated with system states using GPLFM from sensor measurements. A BNN is then trained on posterior samples to learn a probabilistic nonlinear mapping from system states to MFEs, while capturing diagnostic uncertainty. For prognosis, this mapping is used to generate pseudo-measurements, enabling state prediction via Kalman filtering. The framework allows for systematic propagation of uncertainty from diagnosis to prediction, a key capability for trustworthy digital twins. The framework is demonstrated using four nonlinear examples: a single degree of freedom (DOF) oscillator, a multi-DOF system, and two established benchmarks -- the Bouc-Wen hysteretic system and the Silverbox experimental dataset -- highlighting its predictive accuracy and robustness to model misspecification.

Mathematical modeling involves representing real-world phenomena, systems, or problems using mathematical expressions and equations to analyze, understand, and predict their behavior. Given that this process typically requires experienced experts, there is an interest in exploring whether Large Language Models (LLMs) can undertake mathematical modeling to potentially decrease human labor. To evaluate of LLMs in mathematical modeling, we introduce a new benchmark, Mamo, that transcends traditional result-oriented assessments. Unlike conventional methods that primarily assess LLMs based on the accuracy of solutions to mathematical problems, our approach offers deeper insight into the modeling process itself. By focusing on the processes LLMs undertake rather than the correctness of their final solutions, Mamo pioneers a novel evaluation paradigm. This shift underscores the importance of understanding the inherent modeling capabilities of LLMs, paving the way for a more nuanced and comprehensive analysis of their problem-solving strategies. Our work marks a significant advancement in the field, suggesting a new direction for future research by emphasizing the evaluation of LLMs' modeling processes over the mere correctness of answers. This benchmark not only facilitates a better understanding of LLMs' mathematical modeling capabilities but also sets a new standard for evaluating their performance in complex problem-solving scenarios.

Multiple Instance Learning (MIL) is a sub-domain of classification problems with positive and negative labels and a "bag" of inputs, where the label is positive if and only if a positive element is contained within the bag, and otherwise is negative. Training in this context requires associating the bag-wide label to instance-level information, and implicitly contains a causal assumption and asymmetry to the task (i.e., you can't swap the labels without changing the semantics). MIL problems occur in healthcare (one malignant cell indicates cancer), cyber security (one malicious executable makes an infected computer), and many other tasks. In this work, we examine five of the most prominent deep-MIL models and find that none of them respects the standard MIL assumption. They are able to learn anti-correlated instances, i.e., defaulting to "positive" labels until seeing a negative counter-example, which should not be possible for a correct MIL model. We suspect that enhancements and other works derived from these models will share the same issue. In any context in which these models are being used, this creates the potential for learning incorrect models, which creates risk of operational failure. We identify and demonstrate this problem via a proposed "algorithmic unit test", where we create synthetic datasets that can be solved by a MIL respecting model, and which clearly reveal learning that violates MIL assumptions. The five evaluated methods each fail one or more of these tests. This provides a model-agnostic way to identify violations of modeling assumptions, which we hope will be useful for future development and evaluation of MIL models.

While data are the primary fuel for machine learning models, they often suffer from missing values, especially when collected in real-world scenarios. However, many off-the-shelf machine learning models, including artificial neural network models, are unable to handle these missing values directly. Therefore, extra data preprocessing and curation steps, such as data imputation, are inevitable before learning and prediction processes. In this study, we propose a simple and intuitive yet effective method for pruning missing values (PROMISSING) during learning and inference steps in neural networks. In this method, there is no need to remove or impute the missing values; instead, the missing values are treated as a new source of information (representing what we do not know). Our experiments on simulated data, several classification and regression benchmarks, and a multi-modal clinical dataset show that PROMISSING results in similar prediction performance compared to various imputation techniques. In addition, our experiments show models trained using PROMISSING techniques are becoming less decisive in their predictions when facing incomplete samples with many unknowns. This finding hopefully advances machine learning models from being pure predicting machines to more realistic thinkers that can also say "I do not know" when facing incomplete sources of information.

Large-scale Vision Language Models (LVLMs) are increasingly being applied to a wide range of real-world multimodal applications, involving complex visual and linguistic reasoning. As these models become more integrated into practical use, they are expected to handle complex aspects of human interaction. Among these, color perception is a fundamental yet highly variable aspect of visual understanding. It differs across individuals due to biological factors such as Color Vision Deficiencies (CVDs), as well as differences in culture and language. Despite its importance, perceptual diversity has received limited attention. In our study, we evaluate LVLMs' ability to account for individual level perceptual variation using the Ishihara Test, a widely used method for detecting CVDs. Our results show that LVLMs can explain CVDs in natural language, but they cannot simulate how people with CVDs perceive color in image based tasks. These findings highlight the need for multimodal systems that can account for color perceptual diversity and support broader discussions on perceptual inclusiveness and fairness in multimodal AI.

Suicide prevention remains a critical public health challenge. While online platforms such as Reddit's r/SuicideWatch have historically provided spaces for individuals to express suicidal thoughts and seek community support, the advent of large language models (LLMs) introduces a new paradigm-where individuals may begin disclosing ideation to AI systems instead of humans. This study evaluates the capability of LLMs to perform automated suicide risk assessment using the Columbia-Suicide Severity Rating Scale (C-SSRS). We assess the zero-shot performance of six models-including Claude, GPT, Mistral, and LLaMA-in classifying posts across a 7-point severity scale (Levels 0-6). Results indicate that Claude and GPT closely align with human annotations, while Mistral achieves the lowest ordinal prediction error. Most models exhibit ordinal sensitivity, with misclassifications typically occurring between adjacent severity levels. We further analyze confusion patterns, misclassification sources, and ethical considerations, underscoring the importance of human oversight, transparency, and cautious deployment. Full code and supplementary materials are available at https://github.com/av9ash/llm_cssrs_code.

Interestingly, LLMs yet struggle with some basic tasks that humans find trivial to handle, e.g., counting the number of character r's in the word "strawberry". There are several popular conjectures (e.g., tokenization, architecture and training data) regarding the reason for deficiency of LLMs in simple word-based counting problems, sharing the similar belief that such failure stems from model pretraining hence probably inevitable during deployment. In this paper, we carefully design multiple evaluation settings to investigate validity of prevalent conjectures. Meanwhile, we measure transferability of advanced mathematical and coding reasoning capabilities from specialized LLMs to simple counting tasks. Although specialized LLMs suffer from counting problems as well, we find conjectures about inherent deficiency of LLMs invalid and further seek opportunities to elicit knowledge and capabilities from LLMs that are beneficial to counting tasks. Compared with strategies such as finetuning and in-context learning that are commonly adopted to enhance performance on new or challenging tasks, we show that engaging reasoning is the most robust and efficient way to help LLMs better perceive tasks with more accurate responses. We hope our conjecture validation design could provide insights into the study of future critical failure modes of LLMs. Based on challenges in transferring advanced capabilities to much simpler tasks, we call for more attention to model capability acquisition and evaluation. We also highlight the importance of cultivating consciousness of "reasoning before responding" during model pretraining.

Machine learning (ML) has become a ubiquitous tool across various domains of data mining and big data analysis. The efficacy of ML models depends heavily on high-quality datasets, which are often complicated by the presence of missing values. Consequently, the performance and generalization of ML models are at risk in the face of such datasets. This paper aims to examine the nuanced impact of missing values on ML workflows, including their types, causes, and consequences. Our analysis focuses on the challenges posed by missing values, including biased inferences, reduced predictive power, and increased computational burdens. The paper further explores strategies for handling missing values, including imputation techniques and removal strategies, and investigates how missing values affect model evaluation metrics and introduces complexities in cross-validation and model selection. The study employs case studies and real-world examples to illustrate the practical implications of addressing missing values. Finally, the discussion extends to future research directions, emphasizing the need for handling missing values ethically and transparently. The primary goal of this paper is to provide insights into the pervasive impact of missing values on ML models and guide practitioners toward effective strategies for achieving robust and reliable model outcomes.

WHO has declared that more than 2.2 billion people worldwide are suffering from visual disorders, such as media haze, glaucoma, and drusen. At least 1 billion of these cases could have been either prevented or successfully treated, yet they remain unaddressed due to poverty, a lack of specialists, inaccurate ocular fundus diagnoses by ophthalmologists, or the presence of a rare disease. To address this, the research has developed the Hybrid Trio-Network Model Algorithm for accurately diagnosing 12 distinct common and rare eye diseases. This algorithm utilized the RFMiD dataset of 3,200 fundus images and the Binary Relevance Method to detect diseases separately, ensuring expandability and avoiding incorrect correlations. Each detector, incorporating finely tuned hyperparameters to optimize performance, consisted of three feature components: A classical transfer learning CNN model, a two-stage CNN model, and a Siamese Network. The diagnosis was made using features extracted through this Trio-Model with Ensembled Machine Learning algorithms. The proposed model achieved an average accuracy of 97% and an AUC score of 0.96. Compared to past benchmark studies, an increase of over 10% in the F1-score was observed for most diseases. Furthermore, using the Siamese Network, the model successfully made predictions in diseases like optic disc pallor, which past studies failed to predict due to low confidence. This diagnostic tool presents a stable, adaptive, cost-effective, efficient, accessible, and fast solution for globalizing early detection of both common and rare diseases.

Ensuring equitable Artificial Intelligence (AI) in healthcare demands systems that make unbiased decisions across all demographic groups, bridging technical innovation with ethical principles. Foundation Models (FMs), trained on vast datasets through self-supervised learning, enable efficient adaptation across medical imaging tasks while reducing dependency on labeled data. These models demonstrate potential for enhancing fairness, though significant challenges remain in achieving consistent performance across demographic groups. Our review indicates that effective bias mitigation in FMs requires systematic interventions throughout all stages of development. While previous approaches focused primarily on model-level bias mitigation, our analysis reveals that fairness in FMs requires integrated interventions throughout the development pipeline, from data documentation to deployment protocols. This comprehensive framework advances current knowledge by demonstrating how systematic bias mitigation, combined with policy engagement, can effectively address both technical and institutional barriers to equitable AI in healthcare. The development of equitable FMs represents a critical step toward democratizing advanced healthcare technologies, particularly for underserved populations and regions with limited medical infrastructure and computational resources.

Language Models (LMs) are being proposed for mental health applications where the heightened risk of adverse outcomes means predictive performance may not be a sufficient litmus test of a model's utility in clinical practice. A model that can be trusted for practice should have a correspondence between explanation and clinical determination, yet no prior research has examined the attention fidelity of these models and their effect on ground truth explanations. We introduce an evaluation design that focuses on the robustness and explainability of LMs in identifying Wellness Dimensions (WDs). We focus on two existing mental health and well-being datasets: (a) Multi-label Classification-based MultiWD, and (b) WellXplain for evaluating attention mechanism veracity against expert-labeled explanations. The labels are based on Halbert Dunn's theory of wellness, which gives grounding to our evaluation. We reveal four surprising results about LMs/LLMs: (1) Despite their human-like capabilities, GPT-3.5/4 lag behind RoBERTa, and MedAlpaca, a fine-tuned LLM on WellXplain fails to deliver any remarkable improvements in performance or explanations. (2) Re-examining LMs' predictions based on a confidence-oriented loss function reveals a significant performance drop. (3) Across all LMs/LLMs, the alignment between attention and explanations remains low, with LLMs scoring a dismal 0.0. (4) Most mental health-specific LMs/LLMs overlook domain-specific knowledge and undervalue explanations, causing these discrepancies. This study highlights the need for further research into their consistency and explanations in mental health and well-being.

The increasing use of tools and solutions based on Large Language Models (LLMs) for various tasks in the medical domain has become a prominent trend. Their use in this highly critical and sensitive domain has thus raised important questions about their robustness, especially in response to variations in input, and the reliability of the generated outputs. This study addresses these questions by constructing a textual dataset based on the ICD-10-CM code descriptions, widely used in US hospitals and containing many clinical terms, and their easily reproducible rephrasing. We then benchmarked existing embedding models, either generalist or specialized in the clinical domain, in a semantic search task where the goal was to correctly match the rephrased text to the original description. Our results showed that generalist models performed better than clinical models, suggesting that existing clinical specialized models are more sensitive to small changes in input that confuse them. The highlighted problem of specialized models may be due to the fact that they have not been trained on sufficient data, and in particular on datasets that are not diverse enough to have a reliable global language understanding, which is still necessary for accurate handling of medical documents.

The integration of Artificial Intelligence (AI), especially Large Language Models (LLMs), into the clinical diagnosis process offers significant potential to improve the efficiency and accessibility of medical care. While LLMs have shown some promise in the medical domain, their application in clinical diagnosis remains underexplored, especially in real-world clinical practice, where highly sophisticated, patient-specific decisions need to be made. Current evaluations of LLMs in this field are often narrow in scope, focusing on specific diseases or specialties and employing simplified diagnostic tasks. To bridge this gap, we introduce CliBench, a novel benchmark developed from the MIMIC IV dataset, offering a comprehensive and realistic assessment of LLMs' capabilities in clinical diagnosis. This benchmark not only covers diagnoses from a diverse range of medical cases across various specialties but also incorporates tasks of clinical significance: treatment procedure identification, lab test ordering and medication prescriptions. Supported by structured output ontologies, CliBench enables a precise and multi-granular evaluation, offering an in-depth understanding of LLM's capability on diverse clinical tasks of desired granularity. We conduct a zero-shot evaluation of leading LLMs to assess their proficiency in clinical decision-making. Our preliminary results shed light on the potential and limitations of current LLMs in clinical settings, providing valuable insights for future advancements in LLM-powered healthcare.

Large language models (LLMs) have been widely applied to assist test generation with the source code under test provided as the context. This paper aims to answer the question: If the source code under test is incorrect, will LLMs be misguided when generating tests? The effectiveness of test cases is measured by their accuracy, coverage, and bug detection effectiveness. Our evaluation results with five open- and six closed-source LLMs on four datasets demonstrate that incorrect code can significantly mislead LLMs in generating correct, high-coverage, and bug-revealing tests. For instance, in the HumanEval dataset, LLMs achieve 80.45% test accuracy when provided with task descriptions and correct code, but only 57.12% when given task descriptions and incorrect code. For the APPS dataset, prompts with correct code yield tests that detect 39.85% of the bugs, while prompts with incorrect code detect only 19.61%. These findings have important implications for the deployment of LLM-based testing: using it on mature code may help protect against future regression, but on early-stage immature code, it may simply bake in errors. Our findings also underscore the need for further research to improve LLMs resilience against incorrect code in generating reliable and bug-revealing tests.

The ubiquity of large-scale Pre-Trained Models (PTMs) is on the rise, sparking interest in model hubs, and dedicated platforms for hosting PTMs. Despite this trend, a comprehensive exploration of the challenges that users encounter and how the community leverages PTMs remains lacking. To address this gap, we conducted an extensive mixed-methods empirical study by focusing on discussion forums and the model hub of HuggingFace, the largest public model hub. Based on our qualitative analysis, we present a taxonomy of the challenges and benefits associated with PTM reuse within this community. We then conduct a quantitative study to track model-type trends and model documentation evolution over time. Our findings highlight prevalent challenges such as limited guidance for beginner users, struggles with model output comprehensibility in training or inference, and a lack of model understanding. We also identified interesting trends among models where some models maintain high upload rates despite a decline in topics related to them. Additionally, we found that despite the introduction of model documentation tools, its quantity has not increased over time, leading to difficulties in model comprehension and selection among users. Our study sheds light on new challenges in reusing PTMs that were not reported before and we provide recommendations for various stakeholders involved in PTM reuse.

The widespread use of Large Language Models (LLMs), celebrated for their ability to generate human-like text, has raised concerns about misinformation and ethical implications. Addressing these concerns necessitates the development of robust methods to detect and attribute text generated by LLMs. This paper investigates "Cross-Model Detection," evaluating whether a classifier trained to distinguish between source LLM-generated and human-written text can also detect text from a target LLM without further training. The study comprehensively explores various LLM sizes and families, and assesses the impact of conversational fine-tuning techniques on classifier generalization. The research also delves into Model Attribution, encompassing source model identification, model family classification, and model size classification. Our results reveal several key findings: a clear inverse relationship between classifier effectiveness and model size, with larger LLMs being more challenging to detect, especially when the classifier is trained on data from smaller models. Training on data from similarly sized LLMs can improve detection performance from larger models but may lead to decreased performance when dealing with smaller models. Additionally, model attribution experiments show promising results in identifying source models and model families, highlighting detectable signatures in LLM-generated text. Overall, our study contributes valuable insights into the interplay of model size, family, and training data in LLM detection and attribution.

Vision language models (VLMs) show promise in medical diagnosis, but their performance across demographic subgroups when using in-context learning (ICL) remains poorly understood. We examine how the demographic composition of demonstration examples affects VLM performance in two medical imaging tasks: skin lesion malignancy prediction and pneumothorax detection from chest radiographs. Our analysis reveals that ICL influences model predictions through multiple mechanisms: (1) ICL allows VLMs to learn subgroup-specific disease base rates from prompts and (2) ICL leads VLMs to make predictions that perform differently across demographic groups, even after controlling for subgroup-specific disease base rates. Our empirical results inform best-practices for prompting current VLMs (specifically examining demographic subgroup performance, and matching base rates of labels to target distribution at a bulk level and within subgroups), while also suggesting next steps for improving our theoretical understanding of these models.

Demand for mental health support through AI chatbots is surging, though current systems present several limitations, like sycophancy or overvalidation, and reinforcement of maladaptive beliefs. A core obstacle to the creation of better systems is the scarcity of benchmarks that capture the complexity of real therapeutic interactions. Most existing benchmarks either only test clinical knowledge through multiple-choice questions or assess single responses in isolation. To bridge this gap, we present MindEval, a framework designed in collaboration with Ph.D-level Licensed Clinical Psychologists for automatically evaluating language models in realistic, multi-turn mental health therapy conversations. Through patient simulation and automatic evaluation with LLMs, our framework balances resistance to gaming with reproducibility via its fully automated, model-agnostic design. We begin by quantitatively validating the realism of our simulated patients against human-generated text and by demonstrating strong correlations between automatic and human expert judgments. Then, we evaluate 12 state-of-the-art LLMs and show that all models struggle, scoring below 4 out of 6, on average, with particular weaknesses in problematic AI-specific patterns of communication. Notably, reasoning capabilities and model scale do not guarantee better performance, and systems deteriorate with longer interactions or when supporting patients with severe symptoms. We release all code, prompts, and human evaluation data.

Large Language Models (LLMs) have shown promise in various domains, including healthcare, with significant potential to transform mental health applications by enabling scalable and accessible solutions. This study aims to provide a comprehensive evaluation of 33 LLMs, ranging from 2 billion to 405+ billion parameters, in performing key mental health tasks using social media data across six datasets. To our knowledge, this represents the largest-scale systematic evaluation of modern LLMs for mental health applications. Models such as GPT-4, Llama 3, Claude, Gemma, Gemini, and Phi-3 were assessed for their zero-shot (ZS) and few-shot (FS) capabilities across three tasks: binary disorder detection, disorder severity evaluation, and psychiatric knowledge assessment. Key findings revealed that models like GPT-4 and Llama 3 exhibited superior performance in binary disorder detection, achieving accuracies up to 85% on certain datasets, while FS learning notably enhanced disorder severity evaluations, reducing the Mean Absolute Error (MAE) by 1.3 points for the Phi-3-mini model. Recent models, such as Llama 3.1 405b, demonstrated exceptional psychiatric knowledge assessment accuracy at 91.2%, while prompt engineering played a crucial role in improving performance across tasks. However, the ethical constraints imposed by many LLM providers limit their ability to respond to sensitive queries, hampering comprehensive performance evaluations. This work highlights both the capabilities and limitations of LLMs in mental health contexts, offering valuable insights for future applications in psychiatry.

Scaling laws predict the loss of a target machine learning model by extrapolating from easier-to-train models with fewer parameters or smaller training sets. This provides an efficient way for practitioners and researchers alike to compare pretraining decisions involving optimizers, datasets, and model architectures. Despite the widespread use of scaling laws to model the dynamics of language model training, there has been little work on understanding how to best estimate and interpret them. We collect (and release) a large-scale dataset containing losses and downstream evaluations for 485 previously published pretrained models. We use these to estimate more than 1000 scaling laws, then derive a set of best practices for estimating scaling laws in new model families. We find that fitting scaling laws to intermediate checkpoints of training runs (and not just their final losses) substantially improves accuracy, and that -- all else equal -- estimates of performance are generally most accurate when derived from other models of similar sizes. However, because there is a significant degree of variability across model seeds, training multiple small models is sometimes more useful than training a single large one. Moreover, while different model families differ scaling behavior, they are often similar enough that a target model's behavior can be predicted from a single model with the same architecture, along with scaling parameter estimates derived from other model families.

An accurate differential diagnosis (DDx) is a cornerstone of medical care, often reached through an iterative process of interpretation that combines clinical history, physical examination, investigations and procedures. Interactive interfaces powered by Large Language Models (LLMs) present new opportunities to both assist and automate aspects of this process. In this study, we introduce an LLM optimized for diagnostic reasoning, and evaluate its ability to generate a DDx alone or as an aid to clinicians. 20 clinicians evaluated 302 challenging, real-world medical cases sourced from the New England Journal of Medicine (NEJM) case reports. Each case report was read by two clinicians, who were randomized to one of two assistive conditions: either assistance from search engines and standard medical resources, or LLM assistance in addition to these tools. All clinicians provided a baseline, unassisted DDx prior to using the respective assistive tools. Our LLM for DDx exhibited standalone performance that exceeded that of unassisted clinicians (top-10 accuracy 59.1% vs 33.6%, [p = 0.04]). Comparing the two assisted study arms, the DDx quality score was higher for clinicians assisted by our LLM (top-10 accuracy 51.7%) compared to clinicians without its assistance (36.1%) (McNemar's Test: 45.7, p < 0.01) and clinicians with search (44.4%) (4.75, p = 0.03). Further, clinicians assisted by our LLM arrived at more comprehensive differential lists than those without its assistance. Our study suggests that our LLM for DDx has potential to improve clinicians' diagnostic reasoning and accuracy in challenging cases, meriting further real-world evaluation for its ability to empower physicians and widen patients' access to specialist-level expertise.

ML models often exhibit unexpectedly poor behavior when they are deployed in real-world domains. We identify underspecification as a key reason for these failures. An ML pipeline is underspecified when it can return many predictors with equivalently strong held-out performance in the training domain. Underspecification is common in modern ML pipelines, such as those based on deep learning. Predictors returned by underspecified pipelines are often treated as equivalent based on their training domain performance, but we show here that such predictors can behave very differently in deployment domains. This ambiguity can lead to instability and poor model behavior in practice, and is a distinct failure mode from previously identified issues arising from structural mismatch between training and deployment domains. We show that this problem appears in a wide variety of practical ML pipelines, using examples from computer vision, medical imaging, natural language processing, clinical risk prediction based on electronic health records, and medical genomics. Our results show the need to explicitly account for underspecification in modeling pipelines that are intended for real-world deployment in any domain.

Pathological diagnosis remains the definitive standard for identifying tumors. The rise of multimodal large models has simplified the process of integrating image analysis with textual descriptions. Despite this advancement, the substantial costs associated with training and deploying these complex multimodal models, together with a scarcity of high-quality training datasets, create a significant divide between cutting-edge technology and its application in the clinical setting. We had meticulously compiled a dataset of approximately 45,000 cases, covering over 6 different tasks, including the classification of organ tissues, generating pathology report descriptions, and addressing pathology-related questions and answers. We have fine-tuned multimodal large models, specifically LLaVA, Qwen-VL, InternLM, with this dataset to enhance instruction-based performance. We conducted a qualitative assessment of the capabilities of the base model and the fine-tuned model in performing image captioning and classification tasks on the specific dataset. The evaluation results demonstrate that the fine-tuned model exhibits proficiency in addressing typical pathological questions. We hope that by making both our models and datasets publicly available, they can be valuable to the medical and research communities.

The rapid evolution of artificial intelligence, especially in large language models (LLMs), has significantly impacted various domains, including healthcare. In chest X-ray (CXR) analysis, previous studies have employed LLMs, but with limitations: either underutilizing the multi-tasking capabilities of LLMs or lacking clinical accuracy. This paper presents M4CXR, a multi-modal LLM designed to enhance CXR interpretation. The model is trained on a visual instruction-following dataset that integrates various task-specific datasets in a conversational format. As a result, the model supports multiple tasks such as medical report generation (MRG), visual grounding, and visual question answering (VQA). M4CXR achieves state-of-the-art clinical accuracy in MRG by employing a chain-of-thought prompting strategy, in which it identifies findings in CXR images and subsequently generates corresponding reports. The model is adaptable to various MRG scenarios depending on the available inputs, such as single-image, multi-image, and multi-study contexts. In addition to MRG, M4CXR performs visual grounding at a level comparable to specialized models and also demonstrates outstanding performance in VQA. Both quantitative and qualitative assessments reveal M4CXR's versatility in MRG, visual grounding, and VQA, while consistently maintaining clinical accuracy.

We conduct a systematic audit of three widely used reasoning benchmarks, SocialIQa, FauxPas-EAI, and ToMi, and uncover pervasive flaws in both benchmark items and evaluation methodology. Using five LLMs (GPT-{3, 3.5, 4, o1}, and LLaMA 3.1) as diagnostic tools, we identify structural, semantic, and pragmatic issues in benchmark design (e.g., duplicated items, ambiguous wording, and implausible answers), as well as scoring procedures that prioritize output form over reasoning process. Through systematic human annotation and re-evaluation on cleaned benchmark subsets, we find that model scores often improve not due to due to erratic surface wording variations and not to improved reasoning. Infact, further analyses show that model performance is highly sensitive to minor input variations such as context availability and phrasing, revealing that high scores may reflect alignment with format-specific cues rather than consistent inference based on the input. These findings challenge the validity of current benchmark-based claims about reasoning in LLMs, and highlight the need for evaluation protocols that assess reasoning as a process of drawing inference from available information, rather than as static output selection. We release audited data and evaluation tools to support more interpretable and diagnostic assessments of model reasoning.

This paper presents MathBode, a dynamic diagnostic for mathematical reasoning in large language models (LLMs). Instead of one-shot accuracy, MathBode treats each parametric problem as a system: we drive a single parameter sinusoidally and fit first-harmonic responses of model outputs and exact solutions. This yields interpretable, frequency-resolved metrics -- gain (amplitude tracking) and phase (lag) -- that form Bode-style fingerprints. Across five closed-form families (linear solve, ratio/saturation, compound interest, 2x2 linear systems, similar triangles), the diagnostic surfaces systematic low-pass behavior and growing phase lag that accuracy alone obscures. We compare several models against a symbolic baseline that calibrates the instrument (G approx 1, phi approx 0). Results separate frontier from mid-tier models on dynamics, providing a compact, reproducible protocol that complements standard benchmarks with actionable measurements of reasoning fidelity and consistency. We open-source the dataset and code to enable further research and adoption.