Daily Papers

Differential diagnosis is crucial for medicine as it helps healthcare providers systematically distinguish between conditions that share similar symptoms. This study assesses the impact of lab test results on differential diagnoses (DDx) made by large language models (LLMs). Clinical vignettes from 50 case reports from PubMed Central were created incorporating patient demographics, symptoms, and lab results. Five LLMs GPT-4, GPT-3.5, Llama-2-70b, Claude-2, and Mixtral-8x7B were tested to generate Top 10, Top 5, and Top 1 DDx with and without lab data. A comprehensive evaluation involving GPT-4, a knowledge graph, and clinicians was conducted. GPT-4 performed best, achieving 55% accuracy for Top 1 diagnoses and 60% for Top 10 with lab data, with lenient accuracy up to 80%. Lab results significantly improved accuracy, with GPT-4 and Mixtral excelling, though exact match rates were low. Lab tests, including liver function, metabolic/toxicology panels, and serology/immune tests, were generally interpreted correctly by LLMs for differential diagnosis.

When faced with novel situations, people are able to marshal relevant considerations from a wide range of background knowledge and put these to use in inferences and predictions. What permits us to draw in globally relevant information and reason over it coherently? Here, we explore the hypothesis that people use a combination of distributed and symbolic representations to construct bespoke mental models tailored to novel situations. We propose a computational implementation of this idea -- a ``Model Synthesis Architecture'' (MSA) -- using language models to implement global relevance-based retrieval and model synthesis and probabilistic programs to implement bespoke, coherent world models. We evaluate our MSA as a model of human judgments on a novel reasoning dataset. The dataset -- built around a `Model Olympics` domain of sports vignettes -- tests models' capacity for human-like, open-ended reasoning by requiring (i) judgments about novel causal structures described in language; (ii) drawing on large bodies of background knowledge; and (iii) doing both in light of observations that introduce arbitrary novel variables. Our MSA approach captures human judgments better than language model-only baselines, under both direct and chain-of-thought generations from the LM that supports model synthesis. These results suggest that MSAs can be implemented in a way that mirrors people's ability to deliver locally coherent reasoning over globally relevant variables, offering a path to understanding and replicating human reasoning in open-ended domains.

This work studies training instabilities of behavior cloning with deep neural networks. We observe that minibatch SGD updates to the policy network during training result in sharp oscillations in long-horizon rewards, despite negligibly affecting the behavior cloning loss. We empirically disentangle the statistical and computational causes of these oscillations, and find them to stem from the chaotic propagation of minibatch SGD noise through unstable closed-loop dynamics. While SGD noise is benign in the single-step action prediction objective, it results in catastrophic error accumulation over long horizons, an effect we term gradient variance amplification (GVA). We show that many standard mitigation techniques do not alleviate GVA, but find an exponential moving average (EMA) of iterates to be surprisingly effective at doing so. We illustrate the generality of this phenomenon by showing the existence of GVA and its amelioration by EMA in both continuous control and autoregressive language generation. Finally, we provide theoretical vignettes that highlight the benefits of EMA in alleviating GVA and shed light on the extent to which classical convex models can help in understanding the benefits of iterate averaging in deep learning.

The emergent abilities of large language models (LLMs) have demonstrated great potential in solving medical questions. They can possess considerable medical knowledge, but may still hallucinate and are inflexible in the knowledge updates. While Retrieval-Augmented Generation (RAG) has been proposed to enhance the medical question-answering capabilities of LLMs with external knowledge bases, it may still fail in complex cases where multiple rounds of information-seeking are required. To address such an issue, we propose iterative RAG for medicine (i-MedRAG), where LLMs can iteratively ask follow-up queries based on previous information-seeking attempts. In each iteration of i-MedRAG, the follow-up queries will be answered by a vanilla RAG system and they will be further used to guide the query generation in the next iteration. Our experiments show the improved performance of various LLMs brought by i-MedRAG compared with vanilla RAG on complex questions from clinical vignettes in the United States Medical Licensing Examination (USMLE), as well as various knowledge tests in the Massive Multitask Language Understanding (MMLU) dataset. Notably, our zero-shot i-MedRAG outperforms all existing prompt engineering and fine-tuning methods on GPT-3.5, achieving an accuracy of 69.68\% on the MedQA dataset. In addition, we characterize the scaling properties of i-MedRAG with different iterations of follow-up queries and different numbers of queries per iteration. Our case studies show that i-MedRAG can flexibly ask follow-up queries to form reasoning chains, providing an in-depth analysis of medical questions. To the best of our knowledge, this is the first-of-its-kind study on incorporating follow-up queries into medical RAG.

Current large language models (LLMs) excel in verifiable domains where outputs can be checked before action but prove less reliable for high-stakes strategic decisions with uncertain outcomes. This gap, driven by mutually reinforcing cognitive biases in both humans and artificial intelligence (AI) systems, threatens the defensibility of valuations and sustainability of investments in the sector. This report describes a framework emerging from systematic qualitative assessment across 7 frontier-grade LLMs and 3 market-facing venture vignettes under time pressure. Detailed prompting specifying decision partnership and explicitly instructing avoidance of sycophancy, confabulation, solution drift, and nihilism achieved initial partnership state but failed to maintain it under operational pressure. Sustaining protective partnership state required an emergent 7-stage calibration sequence, built upon a 4-stage initialization process, within a 5-layer protection architecture enabling bias self-monitoring, human-AI adversarial challenge, partnership state verification, performance degradation detection, and stakeholder protection. Three discoveries resulted: partnership state is achievable through ordered calibration but requires emergent maintenance protocols; reliability degrades when architectural drift and context exhaustion align; and dissolution discipline prevents costly pursuit of fundamentally wrong directions. Cross-model validation revealed systematic performance differences across LLM architectures. This approach demonstrates that human-AI teams can achieve cognitive partnership capable of preventing avoidable regret in high-stakes decisions, addressing return-on-investment expectations that depend on AI systems supporting consequential decision-making without introducing preventable cognitive traps when verification arrives too late.

Artificial intelligence holds great promise for expanding access to expert medical knowledge and reasoning. However, most evaluations of language models rely on static vignettes and multiple-choice questions that fail to reflect the complexity and nuance of evidence-based medicine in real-world settings. In clinical practice, physicians iteratively formulate and revise diagnostic hypotheses, adapting each subsequent question and test to what they've just learned, and weigh the evolving evidence before committing to a final diagnosis. To emulate this iterative process, we introduce the Sequential Diagnosis Benchmark, which transforms 304 diagnostically challenging New England Journal of Medicine clinicopathological conference (NEJM-CPC) cases into stepwise diagnostic encounters. A physician or AI begins with a short case abstract and must iteratively request additional details from a gatekeeper model that reveals findings only when explicitly queried. Performance is assessed not just by diagnostic accuracy but also by the cost of physician visits and tests performed. We also present the MAI Diagnostic Orchestrator (MAI-DxO), a model-agnostic orchestrator that simulates a panel of physicians, proposes likely differential diagnoses and strategically selects high-value, cost-effective tests. When paired with OpenAI's o3 model, MAI-DxO achieves 80% diagnostic accuracy--four times higher than the 20% average of generalist physicians. MAI-DxO also reduces diagnostic costs by 20% compared to physicians, and 70% compared to off-the-shelf o3. When configured for maximum accuracy, MAI-DxO achieves 85.5% accuracy. These performance gains with MAI-DxO generalize across models from the OpenAI, Gemini, Claude, Grok, DeepSeek, and Llama families. We highlight how AI systems, when guided to think iteratively and act judiciously, can advance diagnostic precision and cost-effectiveness in clinical care.

Recent developments in Generative Artificial Intelligence (GenAI) have created significant uncertainty in education, particularly in terms of assessment practices. Against this backdrop, we present an updated version of the AI Assessment Scale (AIAS), a framework with two fundamental purposes: to facilitate open dialogue between educators and students about appropriate GenAI use and to support educators in redesigning assessments in an era of expanding AI capabilities. Grounded in social constructivist principles and designed with assessment validity in mind, the AIAS provides a structured yet flexible approach that can be adapted across different educational contexts. Building on implementation feedback from global adoption across both the K-12 and higher education contexts, this revision represents a significant change from the original AIAS. Among these changes is a new visual guide that moves beyond the original traffic light system and utilises a neutral colour palette that avoids implied hierarchies between the levels. The scale maintains five distinct levels of GenAI integration in assessment, from "No AI" to "AI Exploration", but has been refined to better reflect rapidly advancing technological capabilities and emerging pedagogical needs. This paper presents the theoretical foundations of the revised framework, provides detailed implementation guidance through practical vignettes, and discusses its limitations and future directions. As GenAI capabilities continue to expand, particularly in multimodal content generation, the AIAS offers a starting point for reimagining assessment design in an era of disruptive technologies.

Large language models (LLMs) have shown remarkable progress in encoding clinical knowledge and responding to complex medical queries with appropriate clinical reasoning. However, their applicability in subspecialist or complex medical settings remains underexplored. In this work, we probe the performance of AMIE, a research conversational diagnostic AI system, in the subspecialist domain of breast oncology care without specific fine-tuning to this challenging domain. To perform this evaluation, we curated a set of 50 synthetic breast cancer vignettes representing a range of treatment-naive and treatment-refractory cases and mirroring the key information available to a multidisciplinary tumor board for decision-making (openly released with this work). We developed a detailed clinical rubric for evaluating management plans, including axes such as the quality of case summarization, safety of the proposed care plan, and recommendations for chemotherapy, radiotherapy, surgery and hormonal therapy. To improve performance, we enhanced AMIE with the inference-time ability to perform web search retrieval to gather relevant and up-to-date clinical knowledge and refine its responses with a multi-stage self-critique pipeline. We compare response quality of AMIE with internal medicine trainees, oncology fellows, and general oncology attendings under both automated and specialist clinician evaluations. In our evaluations, AMIE outperformed trainees and fellows demonstrating the potential of the system in this challenging and important domain. We further demonstrate through qualitative examples, how systems such as AMIE might facilitate conversational interactions to assist clinicians in their decision making. However, AMIE's performance was overall inferior to attending oncologists suggesting that further research is needed prior to consideration of prospective uses.

As language models (LMs) are widely utilized in personalized communication scenarios (e.g., sending emails, writing social media posts) and endowed with a certain level of agency, ensuring they act in accordance with the contextual privacy norms becomes increasingly critical. However, quantifying the privacy norm awareness of LMs and the emerging privacy risk in LM-mediated communication is challenging due to (1) the contextual and long-tailed nature of privacy-sensitive cases, and (2) the lack of evaluation approaches that capture realistic application scenarios. To address these challenges, we propose PrivacyLens, a novel framework designed to extend privacy-sensitive seeds into expressive vignettes and further into agent trajectories, enabling multi-level evaluation of privacy leakage in LM agents' actions. We instantiate PrivacyLens with a collection of privacy norms grounded in privacy literature and crowdsourced seeds. Using this dataset, we reveal a discrepancy between LM performance in answering probing questions and their actual behavior when executing user instructions in an agent setup. State-of-the-art LMs, like GPT-4 and Llama-3-70B, leak sensitive information in 25.68% and 38.69% of cases, even when prompted with privacy-enhancing instructions. We also demonstrate the dynamic nature of PrivacyLens by extending each seed into multiple trajectories to red-team LM privacy leakage risk. Dataset and code are available at https://github.com/SALT-NLP/PrivacyLens.

The causal capabilities of large language models (LLMs) are a matter of significant debate, with critical implications for the use of LLMs in societally impactful domains such as medicine, science, law, and policy. We conduct a "behavorial" study of LLMs to benchmark their capability in generating causal arguments. Across a wide range of tasks, we find that LLMs can generate text corresponding to correct causal arguments with high probability, surpassing the best-performing existing methods. Algorithms based on GPT-3.5 and 4 outperform existing algorithms on a pairwise causal discovery task (97%, 13 points gain), counterfactual reasoning task (92%, 20 points gain) and event causality (86% accuracy in determining necessary and sufficient causes in vignettes). We perform robustness checks across tasks and show that the capabilities cannot be explained by dataset memorization alone, especially since LLMs generalize to novel datasets that were created after the training cutoff date. That said, LLMs exhibit unpredictable failure modes, and we discuss the kinds of errors that may be improved and what are the fundamental limits of LLM-based answers. Overall, by operating on the text metadata, LLMs bring capabilities so far understood to be restricted to humans, such as using collected knowledge to generate causal graphs or identifying background causal context from natural language. As a result, LLMs may be used by human domain experts to save effort in setting up a causal analysis, one of the biggest impediments to the widespread adoption of causal methods. Given that LLMs ignore the actual data, our results also point to a fruitful research direction of developing algorithms that combine LLMs with existing causal techniques. Code and datasets are available at https://github.com/py-why/pywhy-llm.