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Dec 25

CP-Env: Evaluating Large Language Models on Clinical Pathways in a Controllable Hospital Environment

Medical care follows complex clinical pathways that extend beyond isolated physician-patient encounters, emphasizing decision-making and transitions between different stages. Current benchmarks focusing on static exams or isolated dialogues inadequately evaluate large language models (LLMs) in dynamic clinical scenarios. We introduce CP-Env, a controllable agentic hospital environment designed to evaluate LLMs across end-to-end clinical pathways. CP-Env simulates a hospital ecosystem with patient and physician agents, constructing scenarios ranging from triage and specialist consultation to diagnostic testing and multidisciplinary team meetings for agent interaction. Following real hospital adaptive flow of healthcare, it enables branching, long-horizon task execution. We propose a three-tiered evaluation framework encompassing Clinical Efficacy, Process Competency, and Professional Ethics. Results reveal that most models struggle with pathway complexity, exhibiting hallucinations and losing critical diagnostic details. Interestingly, excessive reasoning steps can sometimes prove counterproductive, while top models tend to exhibit reduced tool dependency through internalized knowledge. CP-Env advances medical AI agents development through comprehensive end-to-end clinical evaluation. We provide the benchmark and evaluation tools for further research and development at https://github.com/SPIRAL-MED/CP_ENV.

  • 8 authors
·
Dec 10

Do Large Language Models Align with Core Mental Health Counseling Competencies?

The rapid evolution of Large Language Models (LLMs) offers promising potential to alleviate the global scarcity of mental health professionals. However, LLMs' alignment with essential mental health counseling competencies remains understudied. We introduce CounselingBench, a novel NCMHCE-based benchmark evaluating LLMs across five key mental health counseling competencies. Testing 22 general-purpose and medical-finetuned LLMs, we find frontier models exceed minimum thresholds but fall short of expert-level performance, with significant variations: they excel in Intake, Assessment & Diagnosis yet struggle with Core Counseling Attributes and Professional Practice & Ethics. Medical LLMs surprisingly underperform generalist models accuracy-wise, while at the same time producing slightly higher-quality justifications but making more context-related errors. Our findings highlight the complexities of developing AI systems for mental health counseling, particularly for competencies requiring empathy and contextual understanding. We found that frontier LLMs perform at a level exceeding the minimal required level of aptitude for all key mental health counseling competencies, but fall short of expert-level performance, and that current medical LLMs do not significantly improve upon generalist models in mental health counseling competencies. This underscores the critical need for specialized, mental health counseling-specific fine-tuned LLMs that rigorously aligns with core competencies combined with appropriate human supervision before any responsible real-world deployment can be considered.

  • 11 authors
·
Oct 29, 2024

A Survey of Large Language Models for Healthcare: from Data, Technology, and Applications to Accountability and Ethics

The utilization of large language models (LLMs) in the Healthcare domain has generated both excitement and concern due to their ability to effectively respond to freetext queries with certain professional knowledge. This survey outlines the capabilities of the currently developed LLMs for Healthcare and explicates their development process, with the aim of providing an overview of the development roadmap from traditional Pretrained Language Models (PLMs) to LLMs. Specifically, we first explore the potential of LLMs to enhance the efficiency and effectiveness of various Healthcare applications highlighting both the strengths and limitations. Secondly, we conduct a comparison between the previous PLMs and the latest LLMs, as well as comparing various LLMs with each other. Then we summarize related Healthcare training data, training methods, optimization strategies, and usage. Finally, the unique concerns associated with deploying LLMs in Healthcare settings are investigated, particularly regarding fairness, accountability, transparency and ethics. Our survey provide a comprehensive investigation from perspectives of both computer science and Healthcare specialty. Besides the discussion about Healthcare concerns, we supports the computer science community by compiling a collection of open source resources, such as accessible datasets, the latest methodologies, code implementations, and evaluation benchmarks in the Github. Summarily, we contend that a significant paradigm shift is underway, transitioning from PLMs to LLMs. This shift encompasses a move from discriminative AI approaches to generative AI approaches, as well as a shift from model-centered methodologies to datacentered methodologies.

  • 7 authors
·
Oct 9, 2023 1

DailyDilemmas: Revealing Value Preferences of LLMs with Quandaries of Daily Life

As we increasingly seek guidance from LLMs for decision-making in daily life, many of these decisions are not clear-cut and depend significantly on the personal values and ethical standards of the users. We present DailyDilemmas, a dataset of 1,360 moral dilemmas encountered in everyday life. Each dilemma includes two possible actions and with each action, the affected parties and human values invoked. Based on these dilemmas, we consolidated a set of human values across everyday topics e.g., interpersonal relationships, workplace, and environmental issues. We evaluated LLMs on these dilemmas to determine what action they will take and the values represented by these actions. Then, we analyzed these values through the lens of five popular theories inspired by sociology, psychology and philosophy. These theories are: World Value Survey, Moral Foundation Theory, Maslow's Hierarchy of Needs, Aristotle's Virtues, and Plutchik Wheel of Emotion. We find that LLMs are most aligned with the self-expression over survival values in terms of World Value Survey, care over loyalty in Moral Foundation Theory. Interestingly, we find large preferences differences in models for some core values such as truthfulness e.g., Mixtral-8x7B model tends to neglect it by 9.7% while GPT-4-turbo model tends to select it by 9.4%. We also study the recent guidance released by OpenAI (ModelSpec), and Anthropic (Constitutional AI) to understand how their released principles reflect their actual value prioritization when facing nuanced moral reasoning in daily-life settings. We find that end users cannot effectively steer such prioritization using system prompts.

  • 3 authors
·
Oct 3, 2024

The Ethics of ChatGPT in Medicine and Healthcare: A Systematic Review on Large Language Models (LLMs)

With the introduction of ChatGPT, Large Language Models (LLMs) have received enormous attention in healthcare. Despite their potential benefits, researchers have underscored various ethical implications. While individual instances have drawn much attention, the debate lacks a systematic overview of practical applications currently researched and ethical issues connected to them. Against this background, this work aims to map the ethical landscape surrounding the current stage of deployment of LLMs in medicine and healthcare. Electronic databases and preprint servers were queried using a comprehensive search strategy. Studies were screened and extracted following a modified rapid review approach. Methodological quality was assessed using a hybrid approach. For 53 records, a meta-aggregative synthesis was performed. Four fields of applications emerged and testify to a vivid exploration phase. Advantages of using LLMs are attributed to their capacity in data analysis, personalized information provisioning, support in decision-making, mitigating information loss and enhancing information accessibility. However, we also identifies recurrent ethical concerns connected to fairness, bias, non-maleficence, transparency, and privacy. A distinctive concern is the tendency to produce harmful misinformation or convincingly but inaccurate content. A recurrent plea for ethical guidance and human oversight is evident. Given the variety of use cases, it is suggested that the ethical guidance debate be reframed to focus on defining what constitutes acceptable human oversight across the spectrum of applications. This involves considering diverse settings, varying potentials for harm, and different acceptable thresholds for performance and certainty in healthcare. In addition, a critical inquiry is necessary to determine the extent to which the current experimental use of LLMs is necessary and justified.

  • 2 authors
·
Mar 21, 2024

Documenting Ethical Considerations in Open Source AI Models

Background: The development of AI-enabled software heavily depends on AI model documentation, such as model cards, due to different domain expertise between software engineers and model developers. From an ethical standpoint, AI model documentation conveys critical information on ethical considerations along with mitigation strategies for downstream developers to ensure the delivery of ethically compliant software. However, knowledge on such documentation practice remains scarce. Aims: The objective of our study is to investigate how developers document ethical aspects of open source AI models in practice, aiming at providing recommendations for future documentation endeavours. Method: We selected three sources of documentation on GitHub and Hugging Face, and developed a keyword set to identify ethics-related documents systematically. After filtering an initial set of 2,347 documents, we identified 265 relevant ones and performed thematic analysis to derive the themes of ethical considerations. Results: Six themes emerge, with the three largest ones being model behavioural risks, model use cases, and model risk mitigation. Conclusions: Our findings reveal that open source AI model documentation focuses on articulating ethical problem statements and use case restrictions. We further provide suggestions to various stakeholders for improving documentation practice regarding ethical considerations.

  • 5 authors
·
Jun 26, 2024

Stronger Together: on the Articulation of Ethical Charters, Legal Tools, and Technical Documentation in ML

The growing need for accountability of the people behind AI systems can be addressed by leveraging processes in three fields of study: ethics, law, and computer science. While these fields are often considered in isolation, they rely on complementary notions in their interpretation and implementation. In this work, we detail this interdependence and motivate the necessary role of collaborative governance tools in shaping a positive evolution of AI. We first contrast notions of compliance in the ethical, legal, and technical fields; we outline both their differences and where they complement each other, with a particular focus on the roles of ethical charters, licenses, and technical documentation in these interactions. We then focus on the role of values in articulating the synergies between the fields and outline specific mechanisms of interaction between them in practice. We identify how these mechanisms have played out in several open governance fora: an open collaborative workshop, a responsible licensing initiative, and a proposed regulatory framework. By leveraging complementary notions of compliance in these three domains, we can create a more comprehensive framework for governing AI systems that jointly takes into account their technical capabilities, their impact on society, and how technical specifications can inform relevant regulations. Our analysis thus underlines the necessity of joint consideration of the ethical, legal, and technical in AI ethics frameworks to be used on a larger scale to govern AI systems and how the thinking in each of these areas can inform the others.

  • 4 authors
·
May 9, 2023

The Open Source Advantage in Large Language Models (LLMs)

Large language models (LLMs) mark a key shift in natural language processing (NLP), having advanced text generation, translation, and domain-specific reasoning. Closed-source models like GPT-4, powered by proprietary datasets and extensive computational resources, lead with state-of-the-art performance today. However, they face criticism for their "black box" nature and for limiting accessibility in a manner that hinders reproducibility and equitable AI development. By contrast, open-source initiatives like LLaMA and BLOOM prioritize democratization through community-driven development and computational efficiency. These models have significantly reduced performance gaps, particularly in linguistic diversity and domain-specific applications, while providing accessible tools for global researchers and developers. Notably, both paradigms rely on foundational architectural innovations, such as the Transformer framework by Vaswani et al. (2017). Closed-source models excel by scaling effectively, while open-source models adapt to real-world applications in underrepresented languages and domains. Techniques like Low-Rank Adaptation (LoRA) and instruction-tuning datasets enable open-source models to achieve competitive results despite limited resources. To be sure, the tension between closed-source and open-source approaches underscores a broader debate on transparency versus proprietary control in AI. Ethical considerations further highlight this divide. Closed-source systems restrict external scrutiny, while open-source models promote reproducibility and collaboration but lack standardized auditing documentation frameworks to mitigate biases. Hybrid approaches that leverage the strengths of both paradigms are likely to shape the future of LLM innovation, ensuring accessibility, competitive technical performance, and ethical deployment.

  • 4 authors
·
Dec 16, 2024 2

Red teaming ChatGPT via Jailbreaking: Bias, Robustness, Reliability and Toxicity

Recent breakthroughs in natural language processing (NLP) have permitted the synthesis and comprehension of coherent text in an open-ended way, therefore translating the theoretical algorithms into practical applications. The large language models (LLMs) have significantly impacted businesses such as report summarization software and copywriters. Observations indicate, however, that LLMs may exhibit social prejudice and toxicity, posing ethical and societal dangers of consequences resulting from irresponsibility. Large-scale benchmarks for accountable LLMs should consequently be developed. Although several empirical investigations reveal the existence of a few ethical difficulties in advanced LLMs, there is little systematic examination and user study of the risks and harmful behaviors of current LLM usage. To further educate future efforts on constructing ethical LLMs responsibly, we perform a qualitative research method called ``red teaming'' on OpenAI's ChatGPTIn this paper, ChatGPT refers to the version released on Dec 15th. to better understand the practical features of ethical dangers in recent LLMs. We analyze ChatGPT comprehensively from four perspectives: 1) Bias 2) Reliability 3) Robustness 4) Toxicity. In accordance with our stated viewpoints, we empirically benchmark ChatGPT on multiple sample datasets. We find that a significant number of ethical risks cannot be addressed by existing benchmarks, and hence illustrate them via additional case studies. In addition, we examine the implications of our findings on AI ethics and harmal behaviors of ChatGPT, as well as future problems and practical design considerations for responsible LLMs. We believe that our findings may give light on future efforts to determine and mitigate the ethical hazards posed by machines in LLM applications.

  • 4 authors
·
Jan 30, 2023

A Survey on Medical Large Language Models: Technology, Application, Trustworthiness, and Future Directions

With the advent of Large Language Models (LLMs), medical artificial intelligence (AI) has experienced substantial technological progress and paradigm shifts, highlighting the potential of LLMs to streamline healthcare delivery and improve patient outcomes. Considering this rapid technical progress, in this survey, we trace the recent advances of Medical Large Language Models (Med-LLMs), including the background, key findings, and mainstream techniques, especially for the evolution from general-purpose models to medical-specialized applications. Firstly, we delve into the foundational technology of Med-LLMs, indicating how general models can be progressively adapted and refined for the complicated medical tasks. Secondly, the wide-ranging applications of Med-LLMs are investigated across various healthcare domains, as well as an up-to-date review of existing Med-LLMs. The transformative impact of these models on daily medical practice is evident through their ability to assist clinicians, educators, and patients. Recognizing the importance of responsible innovation, we discuss the challenges associated with ensuring fairness, accountability, privacy, and robustness. Ethical considerations, rigorous evaluation methodologies, and the establishment of regulatory frameworks are crucial for building trustworthiness in the real-world system. We emphasize the need for ongoing scrutiny and development to maintain high standards of safety and reliability. Finally, we anticipate possible future trajectories for Med-LLMs, identifying key avenues for prudent expansion. By consolidating these insights, our review aims to provide professionals and researchers with a thorough understanding of the strengths and limitations of Med-LLMs, fostering a balanced and ethical approach to their integration into the healthcare ecosystem.

  • 9 authors
·
Jun 5, 2024