Daily Papers

Search-augmented large language models (LLMs) have advanced information-seeking tasks by integrating retrieval into generation, reducing users' cognitive burden compared to traditional search systems. Yet they remain insufficient for fully addressing diverse user needs, which requires recognizing how the same query can reflect different intents across users and delivering information in preferred forms. While recent systems such as ChatGPT and Gemini attempt personalization by leveraging user histories, systematic evaluation of such personalization is under-explored. To address this gap, we propose BESPOKE, the realistic benchmark for evaluating personalization in search-augmented LLMs. BESPOKE is designed to be both realistic, by collecting authentic chat and search histories directly from humans, and diagnostic, by pairing responses with fine-grained preference scores and feedback. The benchmark is constructed through long-term, deeply engaged human annotation, where human annotators contributed their own histories, authored queries with detailed information needs, and evaluated responses with scores and diagnostic feedback. Leveraging BESPOKE, we conduct systematic analyses that reveal key requirements for effective personalization in information-seeking tasks, providing a foundation for fine-grained evaluation of personalized search-augmented LLMs. Our code and data are available at https://augustinlib.github.io/BESPOKE/.

Reinforcement learning from verifiable rewards (RLVR) suffers from sparse outcome signals, creating severe exploration bottlenecks on complex reasoning tasks. Recent on-policy self-distillation methods attempt to address this by utilizing language feedback to generate dense, token-level supervision. However, these approaches rely on a fixed, passive teacher to interpret the feedback. As the student policy improves, the teacher's zero-shot assessment capabilities plateau, ultimately halting further learning. To overcome this, we propose Variational Policy Distillation (VPD), a framework that formalizes learning from language feedback as a Variational Expectation-Maximization (EM) problem. VPD co-evolves both policies: in the E-step, the teacher is actively refined on trajectory outcomes via an adaptive trust-region update, translating textual feedback into a dynamically improved target token distribution. In the M-step, the student internalizes this dense distributional guidance on its own on-policy rollouts. By continuously improving the teacher's ability to extract actionable signals from textual critique, VPD overcomes the limitations of passive distillation. Evaluated across diverse sources of diagnostic feedback on scientific reasoning and code generation tasks, VPD consistently outperforms both standard RLVR and existing self-distillation baselines. Finally, by stress-testing our framework on rigid mathematical reasoning and cold-start regimes, we illuminate the fundamental bounds of feedback-driven self-distillation compared to pure environment-driven RL.

Binary decompilation is fundamental to security tasks such as vulnerability discovery, malware inspection, and executable-only program understanding. Recent LLM-based decompilation methods have shown promising results, but most still follow a single-turn generation paradigm: given assembly code or decompiler-produced pseudo-code, the model generates one output and stops. Consequently, the generated code may appear readable or even compile successfully, yet still deviate from the behavior of the original binary and mislead downstream analysis. This paper presents AutoDecompiler, a decompilation-specialized LLM trained with reinforcement learning for feedback-driven multi-turn binary decompilation. Instead of treating decompilation as one-shot code generation, AutoDecompiler formulates it as an iterative refinement process, where the model revises generated code based on compilation, execution, and input/output testing feedback. To enable this process, we design decompilation-specific rewards that capture code validity, recompilability, execution consistency, and semantic fidelity. We further construct stage-aware diagnostic feedback from compiler errors, execution failures, and failed test cases, and introduce progress-aware trajectory rewarding and turn-aware advantage reweighting to encourage beneficial revisions while suppressing regressions. We train the AutoDecompiler family and evaluate it across different input settings, model scales, and benchmarks. Experimental results show that AutoDecompiler consistently outperforms its single-turn counterparts under the same model size and input setting, achieving clear improvements in behavioral re-executability. These results demonstrate that learning to exploit program feedback with reinforcement learning is an effective direction for improving the functional correctness of LLM-based binary decompilation.

Evaluating data-text alignment remains challenging: existing metrics often provide limited explanations for the scores, while prompt-based LLM-as-Judge methods can be expensive and unreliable. We present an end-to-end explainable evaluation metric that fine-tunes a language model to identify omitted, extra, incorrect, and correct data units in a data-text pair. These local judgements are aggregated into precision, recall, and F1 scores, providing both fine-grained diagnostic feedback and an interpretable measure of alignment quality. Across benchmarks, our fine-tuned models outperform LLM-as-Judge methods in error prediction and achieve competitive precision, recall, and F1 scores, while maintaining strong correlation with human judgements. Beyond evaluation, our verifier outputs also provide useful feedback signals for downstream correction and refinement, supporting alignment-oriented improvement of data-to-text and text-to-data. Code and resources are available at https://github.com/guihuzhang/xqdt.

Achieving seamless, human-like interaction remains a key challenge for full-duplex spoken dialogue models (SDMs). Reinforcement learning (RL) has substantially enhanced text- and vision-language models, while well-designed reward signals are crucial for the performance of RL. We consider RL a promising strategy to address the key challenge for SDMs. However, a fundamental barrier persists: prevailing automated metrics for assessing interaction quality rely on superficial proxies, such as behavioral statistics or timing-prediction accuracy, failing to provide reliable reward signals for RL. On the other hand, human evaluations, despite their richness, remain costly, inconsistent, and difficult to scale. We tackle this critical barrier by proposing a Dual-Axis Generative Reward Model, which is trained to understand complex interaction dynamics using a detailed taxonomy and an annotated dataset, produces a single score and, crucially, provides separate evaluations for semantic quality and interaction timing. Such dual outputs furnish precise diagnostic feedback for SDMs and deliver a dependable, instructive reward signal suitable for online reinforcement learning. Our model achieves state-of-the-art performance on interaction-quality assessment across a wide spectrum of datasets, spanning synthetic dialogues and complex real-world interactions.

Large language models (LLMs) have become increasingly capable of following instructions and complex reasoning, making prompting a flexible interface for adapting models without parameter updates. Yet prompt design remains labor-intensive and highly sensitive to formatting, phrasing, and instruction order, motivating automated prompt optimization methods that reduce manual effort while preserving inference-time flexibility. However, existing methods often search over prompt candidates or use fixed critique-refine pipelines driven by individual examples or small batches, limiting their ability to capture systematic error patterns and make targeted edits grounded in failure history. We propose Reflective Prompt Tuning (RPT), a framework that uses LLM function calling to simulate the iterative workflow of human prompt engineers. An LLM optimizer calls a diagnostic function that evaluates the target model over an entire optimization set, summarizes recurring failure modes, and returns a structured diagnostic report. The optimizer uses this report, together with an accumulated memory of prior reports, to revise the prompt for the next iteration. RPT further supports confidence-aware optimization by using calibration signals in diagnostic feedback and final prompt selection. Across three reasoning tasks, RPT improves over initial prompts by up to 12.9 points, remains competitive with state of the art, and improves confidence calibration. Our analyses show that RPT is especially effective on multi-hop and mathematical reasoning, producing targeted prompt revisions that align with diagnosed failure patterns and lead to gains in task performance and calibration.

Continual learning is the ability of LLM agents to improve over time by acquiring, refining, and applying knowledge from experience while retaining useful prior knowledge. It is essential for agents learning over long time horizons, yet current evaluations largely assess individual task performance rather than improvement through accumulated experience. We introduce Continual Learning Exam (CLE), a large-scale benchmark developed by 50+ domain experts to measure experience-driven improvement in realistic professional workflows. CLE comprises 120 human-authored tasks, each organised as a five-level ladder, yielding 600 levels spanning 89 professional roles across 12 occupational domains. Agents must pass each level to unlock the next, with later levels building on experience accumulated during earlier assignments. An evaluation agent assesses each submission against human-authored rubrics. We compare a single-submission setting with one that provides diagnostic feedback after failure and allows one revision. Across 17 harness-model configurations using frontier LLMs, feedback and revision yield a median completion gain of 5.3 percentage points. Yet the best-performing system clears only 47.7% of levels and completes all five levels in just 23.3% of tasks, highlighting the difficulty of sustained learning from experience for existing frontier LLMs. As such, the dataset can also be used to post-train LLMs to strengthen their continual learning capabilities.

Large Language Models (LLMs) and code agents in software development are rapidly evolving from generating isolated code snippets to producing full-fledged software applications with graphical interfaces, interactive logic, and dynamic behaviors. However, current benchmarks fall short in evaluating such production-ready software, as they often rely on static checks or binary pass/fail scripts, failing to capture the interactive behaviors and runtime dynamics that define real-world usability - qualities that only emerge when an application is actively used. This is the blind spot of current evaluation: you don't know if an app works until you click through it, interact with it, and observe how it responds. To bridge this gap, we introduce RealDevWorld, a novel evaluation framework for automated end-to-end assessment of LLMs' ability to generate production-ready repositories from scratch. It features two key components: (1) RealDevBench, a diverse collection of 194 open-ended software engineering tasks across multiple domains, incorporating multimodal elements to reflect real-world complexity; and (2) AppEvalPilot, a new agent-as-a-judge evaluation system that simulates realistic, GUI-based user interactions to automatically and holistically assess software functional correctness, visual fidelity, and runtime behavior. The framework delivers fine-grained, task-specific diagnostic feedback, supporting nuanced evaluation beyond simple success/failure judgments. Empirical results show that RealDevWorld delivers effective, automatic, and human-aligned evaluations, achieving an accuracy of 0.92 and a correlation of 0.85 with expert human assessments, while significantly reducing the reliance on manual review. This enables scalable, human-aligned assessment of production-level software generated by LLMs. Our code is available on GitHub.

Large language models (LLMs) can call tools effectively, yet they remain brittle in multi-turn execution: following a tool call error, smaller models often degenerate into repetitive invalid re-invocations, failing to interpret error feedback and self-correct. This brittleness hinders reliable real-world deployment, where the execution errors are inherently inevitable during tool interaction procedures. We identify a key limitation of current approaches: standard reinforcement learning (RL) treats errors as sparse negative rewards, providing no guidance on how to recover, while pre-collected synthetic error-correction datasets suffer from distribution mismatch with the model's on-policy error modes. To bridge this gap, we propose Fission-GRPO, a framework that converts execution errors into corrective supervision within the RL training loop. Our core mechanism fissions each failed trajectory into a new training instance by augmenting it with diagnostic feedback from a finetuned Error Simulator, then resampling recovery rollouts on-policy. This enables the model to learn from the precise errors it makes during exploration, rather than from static, pre-collected error cases. On the BFCL v4 Multi-Turn, Fission-GRPO improves the error recovery rate of Qwen3-8B by 5.7% absolute, crucially, yielding a 4% overall accuracy gain (42.75% to 46.75%) over GRPO and outperforming specialized tool-use agents.

LLM agents have begun to find real security vulnerabilities that human auditors and automated fuzzers missed for decades, in source-available targets where the analyst can build and instrument the code. In practice the work is split among several agents, wired together by a harness: the program that fixes which roles exist, how they pass information, which tools each may call, and how retries are coordinated. When the language model is held fixed, changing only the harness can still change success rates by several-fold on public agent benchmarks, yet most harnesses are written by hand; recent harness optimizers each search only a narrow slice of the design space and rely on coarse pass/fail feedback that gives no diagnostic signal about why a trial failed. AgentFlow addresses both limitations with a typed graph DSL whose search space jointly covers agent roles, prompts, tools, communication topology, and coordination protocol, paired with a feedback-driven outer loop that reads runtime signals from the target program itself to diagnose which part of the harness caused the failure and rewrite it accordingly. We evaluate AgentFlow on TerminalBench-2 with Claude Opus 4.6 and on Google Chrome with Kimi K2.5. AgentFlow reaches 84.3% on TerminalBench-2, the highest score in the public leaderboard snapshot we evaluate against, and discovers ten previously unknown zero-day vulnerabilities in Google Chrome, including two Critical sandbox-escape vulnerabilities (CVE-2026-5280 and CVE-2026-6297).

Large Language Model (LLM)-based agents have demonstrated strong capabilities across a wide range of tasks, and their application in the medical domain holds particular promise due to the demand for high generalizability and reliance on interdisciplinary knowledge. However, existing medical agent systems often rely on static, manually crafted workflows that lack the flexibility to accommodate diverse diagnostic requirements and adapt to emerging clinical scenarios. Motivated by the success of automated machine learning (AutoML), this paper introduces a novel framework for the automated design of medical agent architectures. Specifically, we define a hierarchical and expressive agent search space that enables dynamic workflow adaptation through structured modifications at the node, structural, and framework levels. Our framework conceptualizes medical agents as graph-based architectures composed of diverse, functional node types and supports iterative self-improvement guided by diagnostic feedback. Experimental results on skin disease diagnosis tasks demonstrate that the proposed method effectively evolves workflow structures and significantly enhances diagnostic accuracy over time. This work represents the first fully automated framework for medical agent architecture design and offers a scalable, adaptable foundation for deploying intelligent agents in real-world clinical environments.

Recent advancements in machine learning have spurred growing interests in automated interpreting quality assessment. Nevertheless, existing research suffers from insufficient examination of language use quality, unsatisfactory modeling effectiveness due to data scarcity and imbalance, and a lack of efforts to explain model predictions. To address these gaps, we propose a multi-dimensional modeling framework that integrates feature engineering, data augmentation, and explainable machine learning. This approach prioritizes explainability over ``black box'' predictions by utilizing only construct-relevant, transparent features and conducting Shapley Value (SHAP) analysis. Our results demonstrate strong predictive performance on a novel English-Chinese consecutive interpreting dataset, identifying BLEURT and CometKiwi scores to be the strongest predictive features for fidelity, pause-related features for fluency, and Chinese-specific phraseological diversity metrics for language use. Overall, by placing particular emphasis on explainability, we present a scalable, reliable, and transparent alternative to traditional human evaluation, facilitating the provision of detailed diagnostic feedback for learners and supporting self-regulated learning advantages not afforded by automated scores in isolation.

The automatic identification and analysis of pronunciation errors, known as Mispronunciation Detection and Diagnosis (MDD) plays a crucial role in Computer Aided Pronunciation Learning (CAPL) tools such as Second-Language (L2) learning or speech therapy applications. Existing MDD methods relying on analysing phonemes can only detect categorical errors of phonemes that have an adequate amount of training data to be modelled. With the unpredictable nature of the pronunciation errors of non-native or disordered speakers and the scarcity of training datasets, it is unfeasible to model all types of mispronunciations. Moreover, phoneme-level MDD approaches have a limited ability to provide detailed diagnostic information about the error made. In this paper, we propose a low-level MDD approach based on the detection of speech attribute features. Speech attribute features break down phoneme production into elementary components that are directly related to the articulatory system leading to more formative feedback to the learner. We further propose a multi-label variant of the Connectionist Temporal Classification (CTC) approach to jointly model the non-mutually exclusive speech attributes using a single model. The pre-trained wav2vec2 model was employed as a core model for the speech attribute detector. The proposed method was applied to L2 speech corpora collected from English learners from different native languages. The proposed speech attribute MDD method was further compared to the traditional phoneme-level MDD and achieved a significantly lower False Acceptance Rate (FAR), False Rejection Rate (FRR), and Diagnostic Error Rate (DER) over all speech attributes compared to the phoneme-level equivalent.

Self-evolving agents improve future behavior from interaction experience, yet existing evaluations typically optimize under fixed execution conditions and do not test recovery after those conditions change. To address this gap, we introduce PACE-Bench (Physics Adaptation via Code Evolution), a simulator-grounded benchmark of 144 source-to-target adaptation pairs across six physics domains. Each pair links a source environment to a mutated target environment with the same goal and interface. A code-driven design that succeeds in the source fails in the target, where agents must iteratively adapt it into a working target design using diagnostic sandbox feedback within a limited attempt budget. We compare ten self-evolving methods from four paradigms. The benchmark remains far from saturated: Reflexion + Qwen3-14B succeeds on only 35.9\% of full-benchmark pairs, while GPT-5.5 solves 66.7\% of the Statics subset under the full budget. Together, these results show that simulator-grounded reflection is more reliable than unverified self-revision, while memory anchors agents to early designs and broad tree search explores without converging. Even revealing exact physical changes does not raise the performance ceiling, pointing to mechanism redesign rather than parameter inference as the central bottleneck. Data and code are available at https://github.com/thunlp/PACE-Bench.

As neural theorem provers become increasingly agentic, the ability to interpret and act on compiler feedback is critical. However, existing Lean datasets consist almost exclusively of correct proofs, offering little supervision for understanding and repairing failures. We study Lean proof repair as a supervised learning problem: given an erroneous proof and compiler feedback, predict both a corrected proof and a natural-language diagnosis grounded in the same feedback. We introduce APRIL (Automated Proof Repair in Lean), a dataset of 260,000 supervised tuples pairing systematically generated proof failures with compiler diagnostics and aligned repair and explanation targets. Training language models on APRIL substantially improves repair accuracy and feedback-conditioned reasoning; in our single-shot repair evaluation setting, a finetuned 4B-parameter model outperforms the strongest open-source baseline. We view diagnostic-conditioned supervision as a complementary training signal for feedback-using provers. Our dataset is available at https://huggingface.co/datasets/uw-math-ai/APRIL{this link}.

Large Language Models (LLMs) demonstrate strong capabilities in general coding tasks but encounter two key challenges when optimizing code: (i) the complexity of writing optimized code (such as performant CUDA kernels and competition-level CPU code) requires expertise in systems, algorithms and specific languages and (ii) requires interpretation of performance metrics like timing and device utilization beyond binary correctness. In this work, we explore inference-time search algorithms that guide the LLM to discover better solutions through iterative refinement based on execution feedback. Our approach, called MaxCode unifies existing search methods under a max-reward reinforcement learning framework, making the observation and action-value functions modular for modification. To enhance the observation space, we integrate a natural language critique model that converts raw execution feedback into diagnostic insights about errors and performance bottlenecks, and the best-discounted reward seen so far. Together, these provide richer input to the code proposal function. To improve exploration during search, we train a generative reward-to-go model using action values from rollouts to rerank potential solutions. Testing on the KernelBench (CUDA) and PIE (C++) optimization benchmarks shows that MaxCode improves optimized code performance compared to baselines, achieving 20.3% and 10.1% relative improvements in absolute speedup value and relative speedup ranking, respectively.

On-policy self-distillation (OPSD) combines student generated trajectories with dense supervision from a privileged teacher of the same model. Its pointwise clipping protects the student from locally incompatible teacher directions, but the fixed teacher receives no feedback about the supervision the student rejects, which limits effective learning from the teacher. We introduce DualOPSD, which alternates updates in a coupled teacher-student system. The student retains OPSD's clipped forward KL objective. The privileged teacher adapts to the updated student after each student step. A residual target based on the frozen initial model preserves the effect of privileged context during teacher adaptation. Across Qwen3-8B/4B/1.7B and three math benchmarks, DualOPSD improves avg@12 accuracy over OPSD by 9.83 percentage points. Further diagnostic analyses show lower bidirectional KL, less persistent mismatch, and retained sensitivity to privileged reference. Together, these results demonstrate that DualOPSD can be a more effective form of privileged self-distillation. Code is available at: https://github.com/on1262/DualOPSD.

At the heart of medicine lies the physician-patient dialogue, where skillful history-taking paves the way for accurate diagnosis, effective management, and enduring trust. Artificial Intelligence (AI) systems capable of diagnostic dialogue could increase accessibility, consistency, and quality of care. However, approximating clinicians' expertise is an outstanding grand challenge. Here, we introduce AMIE (Articulate Medical Intelligence Explorer), a Large Language Model (LLM) based AI system optimized for diagnostic dialogue. AMIE uses a novel self-play based simulated environment with automated feedback mechanisms for scaling learning across diverse disease conditions, specialties, and contexts. We designed a framework for evaluating clinically-meaningful axes of performance including history-taking, diagnostic accuracy, management reasoning, communication skills, and empathy. We compared AMIE's performance to that of primary care physicians (PCPs) in a randomized, double-blind crossover study of text-based consultations with validated patient actors in the style of an Objective Structured Clinical Examination (OSCE). The study included 149 case scenarios from clinical providers in Canada, the UK, and India, 20 PCPs for comparison with AMIE, and evaluations by specialist physicians and patient actors. AMIE demonstrated greater diagnostic accuracy and superior performance on 28 of 32 axes according to specialist physicians and 24 of 26 axes according to patient actors. Our research has several limitations and should be interpreted with appropriate caution. Clinicians were limited to unfamiliar synchronous text-chat which permits large-scale LLM-patient interactions but is not representative of usual clinical practice. While further research is required before AMIE could be translated to real-world settings, the results represent a milestone towards conversational diagnostic AI.

LLM agents often retry after external validation rejects a candidate, but the interface between validation and the next model call remains underspecified. We introduce VeriHarness, a code-controlled agent loop in which models generate candidates while external validators control acceptance, budgets, and traces. We use it to compare raw diagnostics with feedback that identifies the failure location, observed value, and admissible alternatives. Across 50 paired TextWorld games under a four-call cap, feedback containing all three fields raises terminal success from 14/50 to 36/50 for Qwen2.5-Coder-14B (+44 percentage points) and from 8/50 to 29/50 for Llama-3.1-8B (+42 points). Ablations locate most of the gain in the admissible alternatives: feedback containing only the location and observed value remains near the raw diagnostic baseline. Presenting the complete repair information in prose instead of a keyed JSON record yields nearly the same success, providing no evidence that JSON syntax itself improves repair. The ordering persists across the tested call budgets and one sampled-decoding setting.

As Large Multimodal Models (LMMs) scale up and reinforcement learning (RL) methods mature, LMMs have made notable progress in complex reasoning and decision making. Yet training still relies on static data and fixed recipes, making it difficult to diagnose capability blind spots or provide dynamic, targeted reinforcement. Motivated by findings that test driven error exposure and feedback based correction outperform repetitive practice, we propose Diagnostic-driven Progressive Evolution (DPE), a spiral loop where diagnosis steers data generation and reinforcement, and each iteration re-diagnoses the updated model to drive the next round of targeted improvement. DPE has two key components. First, multiple agents annotate and quality control massive unlabeled multimodal data, using tools such as web search and image editing to produce diverse, realistic samples. Second, DPE attributes failures to specific weaknesses, dynamically adjusts the data mixture, and guides agents to generate weakness focused data for targeted reinforcement. Experiments on Qwen3-VL-8B-Instruct and Qwen2.5-VL-7B-Instruct show stable, continual gains across eleven benchmarks, indicating DPE as a scalable paradigm for continual LMM training under open task distributions. Our code, models, and data are publicly available at https://github.com/hongruijia/DPE.

Industrial automation is at a pivotal moment, as Physical AI is driving a transition from rigid, hand-engineered automation systems toward more flexible and adaptive systems. This shift has created a growing demand for large-scale, real-world robot demonstration data, making teleoperation an increasingly important mechanism for data collection. However, high-quality teleoperated demonstrations remain difficult to obtain in practice, as novice operators often produce episodes that are task-successful but suboptimal for downstream use due to inefficient motion, repeated corrections, or operation near robot joint limits. We present a Data Quality Assessment and Feedback (DQAF) framework that closes the loop in teleoperation by providing immediate post-episode feedback grounded in semantic task progress and robot telemetry. The framework extracts quality relevant signals such as sub-task progress, motion smoothness, stalls, kinematic limits and converts them into structured quality assessments and actionable natural-language feedback. Unlike binary success or failure feedback, the proposed system explains why an episode is suboptimal and highlights specific behaviors to correct in the next trial. We evaluate the framework through a diagnostic validation study and a pilot user study. In the validation study, the system is compared with a human reviewer during dataset curation, producing rejection reasons and actionable feedback for improvement. In the pilot study with three novice operators across two manipulation tasks, the operator who received the systems immediate, automated post-episode feedback improved faster than those who did not, producing higher-quality demonstrations sooner.

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.

Despite the success of deep learning, training deep networks in biologically plausible and hardware-efficient ways remains an open challenge. Feedback alignment (FA) methods address this by replacing backpropagation's symmetric backward weights with fixed random matrices, but their effectiveness depends critically on whether they can be accurately evaluated. The standard evaluation relies on two quantities: task accuracy and cosine similarity between the method's credit signal and the backpropagation gradient. We show that this reporting pair is insufficient by identifying two independent failure modes, both silent under current reporting: (1) measurement degeneracy, where the BP reference gradient collapses to the numerical floor in terminal-LayerNorm residual architectures, rendering cosine uninterpretable; and (2) aggregation collapse, where the aggregate cosine masks layerwise heterogeneity that concentrates credit at one end of the network. To address these limitations, we propose a diagnostic evaluation protocol based on three checks -- scale stability, reference validity, and depth utility -- together with per-layer rather than aggregate cosine reporting. Across multiple architectures and methods, the standard reporting pair gives no signal of failure in any audited case, while our protocol identifies all failures with wide calibration margins. The two failure modes are causally independent: a per-block scale penalty alleviates Mode 1 (residual scale explosion driving reference collapse) without affecting Mode 2 (cosine ranking that contradicts every functional metric we measured). Identifying these silent failures prevents researchers from building on non-functional credit assignment and provides actionable guidance for developing FA methods that genuinely train deep layers.

When a professional web developer's code fails a test, they do not simply re-read the stack trace. They open the application in a browser, click buttons, inspect computed styles, and run diagnostic commands to understand what went wrong. Existing feedback mechanisms for coding agents rely on screenshots, LLM-as-a-judge scoring, or natural-language corrections, but few interact with the live application the way a developer would. We introduce WatchPoint, a simulated-user system that mimics real developer behavior by generating and executing diagnostic scripts against the running application, producing structured observations that guide the coding model's retry. Unlike prior approaches that target single-file edits or evaluate using non-executable metrics, we operate on Web-Bench, a benchmark of 50 multi-file web projects comprising 1,000 sequentially dependent tasks, verified by deterministic end-to-end tests. WatchPoint recovers 57.6% of the tasks it diagnoses, and a controlled user study confirms the simulation's realism: human testers achieve a comparable recovery rate (54.5%), providing evidence that automated diagnostic scripts can substitute for interactive human testing on sequential web development tasks. We further identify a pattern of capability gaps that governs when simulated-user feedback is helpful and when it should be withheld.

Planning is central to LLM agents: before acting, an agent must decompose goals, select tools, reason over constraints, and decide when a task is infeasible. Yet existing agent evaluations often report only end-to-end success, making it difficult to determine whether failures stem from planning or execution. We introduce Agent Planning Benchmark (APB), a planning-specific diagnostic benchmark with 4,209 multimodal cases across 22 domains and five settings, covering holistic planning, feedback-conditioned step-wise planning, and robustness under extraneous tools, broken tools, and unsolvable tasks. Across 12 MLLMs, APB reveals systematic weaknesses in long-horizon planning, tool-noise robustness, calibrated refusal, and inference-time refinement. We further validate APB on 200 ToolSandbox tasks and 200 τ^2-bench tasks, where APB-guided refinement consistently improves plan correctness, plan grade, and downstream execution metrics across three representative models. APB thus serves as an upstream diagnostic complement to execution benchmarks. The APB benchmark and code are available in https://github.com/Mikivishy/AgentPlanningBenchmark{this URL}.

Automatically evaluating the quality of language generation is critical. Although recent learned metrics show high correlation with human judgement, these metrics can not explain their verdict or associate the scores with defects in generated text. To address this limitation, we present InstructScore, an explainable evaluation metric for text generation. By harnessing both explicit human instruction and the implicit knowledge of GPT-4, we fine-tune a text evaluation metric based on LLaMA, producing both a score for generated text and a human readable diagnostic report. We evaluate InstructScore on a variety of generation tasks, including translation, captioning, data-to-text and commonsense generation. Experiments show that our 7B model surpasses all other unsupervised metrics, including those based on 175B GPT-3 and GPT-4. Surprisingly, our InstructScore, even without direct supervision from human-rated data, achieves performance levels on par with state-of-the-art metrics like COMET22, which were fine-tuned on human ratings.

Accurate diagnosis with medical large language models is hindered by knowledge gaps and hallucinations. Retrieval and tool-augmented methods help, but their impact is limited by weak use of external knowledge and poor feedback-reasoning traceability. To address these challenges, We introduce Deep-DxSearch, an agentic RAG system trained end-to-end with reinforcement learning (RL) that enables steer tracebale retrieval-augmented reasoning for medical diagnosis. In Deep-DxSearch, we first construct a large-scale medical retrieval corpus comprising patient records and reliable medical knowledge sources to support retrieval-aware reasoning across diagnostic scenarios. More crutially, we frame the LLM as the core agent and the retrieval corpus as its environment, using tailored rewards on format, retrieval, reasoning structure, and diagnostic accuracy, thereby evolving the agentic RAG policy from large-scale data through RL. Experiments demonstrate that our end-to-end agentic RL training framework consistently outperforms prompt-engineering and training-free RAG approaches across multiple data centers. After training, Deep-DxSearch achieves substantial gains in diagnostic accuracy, surpassing strong diagnostic baselines such as GPT-4o, DeepSeek-R1, and other medical-specific frameworks for both common and rare disease diagnosis under in-distribution and out-of-distribution settings. Moreover, ablation studies on reward design and retrieval corpus components confirm their critical roles, underscoring the uniqueness and effectiveness of our approach compared with traditional implementations. Finally, case studies and interpretability analyses highlight improvements in Deep-DxSearch's diagnostic policy, providing deeper insight into its performance gains and supporting clinicians in delivering more reliable and precise preliminary diagnoses. See https://github.com/MAGIC-AI4Med/Deep-DxSearch.

Large language model agents are commonly trained through reinforcement learning with sparse trajectory-level rewards, which offer limited guidance on how strongly individual tokens should be updated. On-Policy Self-Distillation (OPSD) addresses this by re-scoring generated tokens under a privileged replay view to obtain dense, token-level supervision. However, we identify a confounding issue: the resulting support may reflect both the privileged information contained in the replay view and score shifts induced by the replay scaffold, making it difficult to attribute the support specifically to that information. This issue is especially pronounced when future environment observations serve as privileged information, since replaying them requires reconstructing an extended scaffold that itself perturbs token scores. To resolve this confounding, we propose Observation-Calibrated Self-Distillation (OCSD), which contrasts two structurally matched replay views, Full and Observation-Ablated, differing only in whether the actual future observation is present, to derive an observation residual that discounts score changes shared by the replay scaffold. OCSD then applies this residual to modulate token-level GRPO updates at high-uncertainty steps, while preserving the trajectory-level update direction. Experiments on ALFWorld, WebShop, and Search-QA across three Qwen3 model scales show that OCSD consistently outperforms strong baselines. Diagnostic analyses further confirm that the calibrated residual aligns better with local environment feedback. Our code is publicly available at https://github.com/yiy1x/OCSD.

An agent system's execution traces record how it fails, and procedures that improve such a system without changing model weights (trajectory selection, prompt and workflow optimization, runtime monitoring) read these traces for feedback. Yet raw traces are a poor medium for accumulating that feedback: long, instance-specific, and lacking a stable vocabulary for recurring failures. We argue that an agent system should instead maintain an explicit representation of how it fails, induced from its own behavior and reusable wherever failure feedback is needed. AdaMAST builds this representation by converting a target system's traces into a compact, evidence-grounded failure taxonomy: named failure codes organized along three fixed axes (system-level, role-specific, and domain-specific), with every name, definition, and evidence pattern induced from the traces; no code is hand-authored, no trace human-annotated. The taxonomy is not merely a post-hoc diagnostic but a shared feedback interface, improving agents in three ways. In agent-system search, taxonomy-coded diagnoses of failed candidates outperform free-form reflection on all five benchmarks we test. At runtime, taxonomy feedback raises SWE-agent's resolution on SWE-bench Verified Mini from 60% with free-text reflection to 70%, and improves Claude Code from 64.0% to 70.7% as a runtime skill. In trajectory selection, AdaMAST-Judge, a verifier built on the induced codes, improves best-of-5 accuracy on Terminal-Bench 2.0 by 8-15 points over Pass@1. The vocabulary itself is compact (an order-of-magnitude compression that preserves trace distinctions), human-faithful (matching expert failure annotations more closely than a hand-crafted reference vocabulary), and adaptive (taxonomies induced for different domains share few codes). Adaptive failure taxonomies close the loop between the traces agents produce and the procedures that improve them.

We explore the potential of Large Language Models (LLMs) to assist and potentially correct physicians in medical decision-making tasks. We evaluate several LLMs, including Meditron, Llama2, and Mistral, to analyze the ability of these models to interact effectively with physicians across different scenarios. We consider questions from PubMedQA and several tasks, ranging from binary (yes/no) responses to long answer generation, where the answer of the model is produced after an interaction with a physician. Our findings suggest that prompt design significantly influences the downstream accuracy of LLMs and that LLMs can provide valuable feedback to physicians, challenging incorrect diagnoses and contributing to more accurate decision-making. For example, when the physician is accurate 38% of the time, Mistral can produce the correct answer, improving accuracy up to 74% depending on the prompt being used, while Llama2 and Meditron models exhibit greater sensitivity to prompt choice. Our analysis also uncovers the challenges of ensuring that LLM-generated suggestions are pertinent and useful, emphasizing the need for further research in this area.

Large language models increasingly expose reasoning traces, yet their underlying cognitive structure and steps remain difficult to identify and analyze beyond surface-level statistics. We adopt Schoenfeld's Episode Theory as an inductive, intermediate-scale lens and introduce ThinkARM (Anatomy of Reasoning in Models), a scalable framework that explicitly abstracts reasoning traces into functional reasoning steps such as Analysis, Explore, Implement, Verify, etc. When applied to mathematical problem solving by diverse models, this abstraction reveals reproducible thinking dynamics and structural differences between reasoning and non-reasoning models, which are not apparent from token-level views. We further present two diagnostic case studies showing that exploration functions as a critical branching step associated with correctness, and that efficiency-oriented methods selectively suppress evaluative feedback steps rather than uniformly shortening responses. Together, our results demonstrate that episode-level representations make reasoning steps explicit, enabling systematic analysis of how reasoning is structured, stabilized, and altered in modern language models.

Code agents can autonomously resolve GitHub issues, yet when they fail, current evaluation provides no visibility into where or why. Metrics such as Pass@1 collapse an entire execution into a single binary outcome, making it difficult to identify where and why the agent went wrong. To address this limitation, we introduce TRAJEVAL, a diagnostic framework that decomposes agent trajectories into three interpretable stages: search (file localization), read (function comprehension), and edit (modification targeting). For each stage, we compute precision and recall by comparing against reference patches. Analyzing 16,758 trajectories across three agent architectures and seven models, we find universal inefficiencies (all agents examine approximately 22x more functions than necessary) yet distinct failure modes: GPT-5 locates relevant code but targets edits incorrectly, while Qwen-32B fails at file discovery entirely. We validate that these diagnostics are predictive, achieving model-level Pass@1 prediction within 0.87-2.1% MAE, and actionable: real-time feedback based on trajectory signals improves two state-of-the-art models by 2.2-4.6 percentage points while reducing costs by 20-31%. These results demonstrate that our framework not only provides a more fine-grained analysis of agent behavior, but also translates diagnostic signals into tangible performance gains. More broadly, TRAJEVAL transforms agent evaluation beyond outcome-based benchmarking toward mechanism-driven diagnosis of agent success and failure.

Traditional frameworks of political communication operate under linear, event-driven assumptions that treat voter persuasion as a static, transactional function. This paper introduces Dynamic Consent Engineering (DCE), a novel interdisciplinary paradigm that synthesizes Edward Bernays' foundational principles of public relations with the S-E-E-D (Snowball, Equilibrium, Elasticity, Dominance) framework of system dynamics. By expanding Bernaysian operational constraints into a four-dimensional resource matrix (incorporating algorithmic media infrastructure alongside manpower, mindpower, and capital), we mathematically formalize how democratic institutions construct, optimize, and sustain political dominance. We map Bernays' classic eight-step engineering workflow directly onto non-linear feedback loops, information time lags, and demographic carrying capacities. Through rigorous modeling of systemic feedback structures, we isolate the dynamic root causes of political elasticity, policy resistance plateaus, and threshold-triggered trust collapses. Finally, we establish a four-step diagnostic pipeline and validate the framework via historical reference mode verification, demonstrating that long-term political stability depends not on ephemeral rhetoric, but on the structural synchronization of policy execution and dynamic feedback calibration.

Repository-level software engineering (SWE) is a challenging long-horizon setting: agents must reason over extended interactions, use tools, and adapt to stateful environments. Recent work trains SWE agents with reinforcement learning methods such as Group Relative Policy Optimization (GRPO), which independently sample multiple trajectories per issue, test the resulting patches, and compare terminal rewards within a fixed group. However, this training setup does not reuse verifier feedback from failed patches as context for subsequent attempts, even though this feedback contains valuable diagnostic information about what went wrong. Training on recovery trajectories is challenging because the preceding outcome determines whether the next trajectory is generated, while the failed execution determines its conditioning context. We introduce FC-SWE, a failure-conditioned RL framework that incorporates recovery attempts into policy training. After a patch fails verification, FC-SWE restores the repository to its original task state and uses the failed patch and verifier feedback as context for a recovery trajectory. FC-SWE adapts GRPO to these chains of complete, multi-turn tool-use trajectories through two mechanisms. Trajectory-local rewards preserve each attempt's verifier outcome, preventing recovery success from rewarding an earlier failed patch. Active-set advantage estimation forms a comparison group from all initial and recovery trajectories actually executed for the same issue, so failed attempts remain in the group while unexecuted attempts are excluded. On all 500 SWE-bench Verified tasks under a verifier-assisted protocol, FC-SWE with Qwen3.5-4B and SWE-agent achieves 41.7% Resolved@1 and 52.8% Resolved@2, compared with 38.9% and 48.5% for GRPO. Although trained with at most two attempts per chain, FC-SWE reaches 70.7% Resolved@11 under an eleven-attempt test-time budget.

While multimodal large language models have advanced across text, image, and audio, personalization research has remained primarily vision-language, with unified omnimodal benchmarking that jointly covers text, image, and audio still limited, and lacking the methodological rigor to account for absent-persona scenarios or systematic grounding studies. We introduce Omni-Persona, the first comprehensive benchmark for omnimodal personalization. We formalize the task as cross-modal routing over the Persona Modality Graph, encompassing 4 task groups and 18 fine-grained tasks across {sim}750 items. To rigorously diagnose grounding behavior, we propose Calibrated Accuracy (mathrm{Cal)}, which jointly rewards correct grounding and appropriate abstention, incorporating absent-persona queries within a unified evaluation framework. On our dedicated experiments, three diagnostic findings emerge: (i) open-source models show a consistent audio-vs-visual grounding gap that RLVR partially narrows via dense rule-based supervision; (ii) answerable recall and parameter scale are incomplete diagnostics, since strong recall can coexist with absent-persona hallucination and larger models do not always achieve higher Cal, exposing calibration as a separate evaluation axis; and (iii) SFT is bounded by the difficulty of constructing annotated ground-truth supervision at scale, while RLVR generalizes more consistently through outcome-level verifiable feedback yet drifts toward conservative behavior and lower generation quality under our reward design. Omni-Persona thus serves as a diagnostic framework that surfaces the pitfalls of omnimodal personalization, guiding future post-training and reward design.

The rapid progress of text-to-image (T2I) models has unlocked unprecedented creative potential, yet their ability to faithfully render complex prompts involving multiple objects, attributes, and spatial relationships remains a significant bottleneck. Progress is hampered by a lack of adequate evaluation methods; current benchmarks are often restricted to closed-set vocabularies, lack fine-grained diagnostic capabilities, and fail to provide the interpretable feedback necessary to diagnose and remedy specific compositional failures. We solve these challenges by introducing SANEval (Spatial, Attribute, and Numeracy Evaluation), a comprehensive benchmark that establishes a scalable new pipeline for open-vocabulary compositional evaluation. SANEval combines a large language model (LLM) for deep prompt understanding with an LLM-enhanced, open-vocabulary object detector to robustly evaluate compositional adherence, unconstrained by a fixed vocabulary. Through extensive experiments on six state-of-the-art T2I models, we demonstrate that SANEval's automated evaluations provide a more faithful proxy for human assessment; our metric achieves a Spearman's rank correlation with statistically different results than those of existing benchmarks across tasks of attribute binding, spatial relations, and numeracy. To facilitate future research in compositional T2I generation and evaluation, we will release the SANEval dataset and our open-source evaluation pipeline.

Proof auto-formalization translates natural-language (NL) theorems and proofs into a formal language (FL) such as Lean, enabling mechanical verification. Despite rapid progress, research-level proofs often depend on concepts missing from leading proof assistant libraries (e.g., Lean's Mathlib), and successful compilation does not guarantee that a translation preserves the theorem's meaning or the proof's reasoning. Furthermore, aligned NL-FL training data are scarce, and leading agents often rely on costly frontier models and manually engineered harnesses. To address the above issues, we present AIProver, an agentic framework for autonomous proof auto-formalization and proof synthesis (AFPS) that jointly post-trains a 119B open-weight language model and evolves its agentic, tool-calling harness with HarnessEvolve. Verifiers assess type correctness, proof completeness, and semantic correctness, returning rewards and diagnostic certificates that drive model fine-tuning and alternating reinforcement learning via symbolic feedback and HarnessEvolve, a certificate-driven evolutionary search over the whole harness control flow that re-tailors the harness to the updated model. For research-level training and evaluation, we introduce LoCoBench, 58.9k instances from Mathlib, CSLib, Mizar Math Library, and a bounded-arithmetic textbook, with a 771-instance validation split whose theorem-proof pairs have no public Lean formalization. Against 39 frameworks spanning AFPS agents, frontier LLMs, and coding agents, AIProver lifts pass@4 semantic correctness over its Leanstral-1.5 base from 15.7% to 36.7% and outperforms every other open-weight system and Aristotle. As a Claude Code and Codex skill, it lifts their semantic correctness from 41.9% and 34.1% to 79.8% and 62.4%, respectively. Further, it is also 24% cheaper than Numina-Lean-Agent, pushing the accuracy-cost frontier of research-level AFPS.

This study investigates GPT-4's assessment of its performance in healthcare applications. A simple prompting technique was used to prompt the LLM with questions taken from the United States Medical Licensing Examination (USMLE) questionnaire and it was tasked to evaluate its confidence score before posing the question and after asking the question. The questionnaire was categorized into two groups-questions with feedback (WF) and questions with no feedback(NF) post-question. The model was asked to provide absolute and relative confidence scores before and after each question. The experimental findings were analyzed using statistical tools to study the variability of confidence in WF and NF groups. Additionally, a sequential analysis was conducted to observe the performance variation for the WF and NF groups. Results indicate that feedback influences relative confidence but doesn't consistently increase or decrease it. Understanding the performance of LLM is paramount in exploring its utility in sensitive areas like healthcare. This study contributes to the ongoing discourse on the reliability of AI, particularly of LLMs like GPT-4, within healthcare, offering insights into how feedback mechanisms might be optimized to enhance AI-assisted medical education and decision support.

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.

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.

There has been a rapidly growing interest in Automatic Symptom Detection (ASD) and Automatic Diagnosis (AD) systems in the machine learning research literature, aiming to assist doctors in telemedicine services. These systems are designed to interact with patients, collect evidence about their symptoms and relevant antecedents, and possibly make predictions about the underlying diseases. Doctors would review the interactions, including the evidence and the predictions, collect if necessary additional information from patients, before deciding on next steps. Despite recent progress in this area, an important piece of doctors' interactions with patients is missing in the design of these systems, namely the differential diagnosis. Its absence is largely due to the lack of datasets that include such information for models to train on. In this work, we present a large-scale synthetic dataset of roughly 1.3 million patients that includes a differential diagnosis, along with the ground truth pathology, symptoms and antecedents for each patient. Unlike existing datasets which only contain binary symptoms and antecedents, this dataset also contains categorical and multi-choice symptoms and antecedents useful for efficient data collection. Moreover, some symptoms are organized in a hierarchy, making it possible to design systems able to interact with patients in a logical way. As a proof-of-concept, we extend two existing AD and ASD systems to incorporate the differential diagnosis, and provide empirical evidence that using differentials as training signals is essential for the efficiency of such systems or for helping doctors better understand the reasoning of those systems.

Automated research systems support literature synthesis, ideation, experiments, writing, and peer review, but their evaluation is dispersed across tasks, benchmarks, and studies that are difficult to compare directly. We review this literature from the perspective of evaluation design and evidence, covering six targets: literature synthesis, research ideation, executable workflows, scholarly writing and communication, automatic peer review, and end-to-end research. We compare task construction, evidence sources, evaluators, and scoring procedures to explain the capabilities assessed by different designs. Our synthesis highlights three recurring lessons: output checks, process checks, and human studies provide complementary information; evaluator calibration is specific to the property being assessed; and resource budgets and attempt selection are integral to interpreting performance comparisons. We identify diagnostic evaluation designs and documented gaps in supporting evidence, and translate these comparisons into reporting and audit recommendations for specific evaluation settings. The survey helps readers navigate existing evaluations, select appropriate benchmarks, and design subsequent studies.

The growing capabilities of large language models (LLMs) have led to their use as substitutes for human feedback for training and assessing other LLMs. These methods often rely on `constitutions', written guidelines which a critic model uses to provide feedback and improve generations. We investigate how the choice of constitution affects feedback quality by using four different constitutions to improve patient-centered communication in medical interviews. In pairwise comparisons conducted by 215 human raters, we found that detailed constitutions led to better results regarding emotive qualities. However, none of the constitutions outperformed the baseline in learning more practically-oriented skills related to information gathering and provision. Our findings indicate that while detailed constitutions should be prioritised, there are possible limitations to the effectiveness of AI feedback as a reward signal in certain areas.

Reality may establish that an outcome occurred without identifying which evolving procedure produced it or why. This distinction matters in production ML systems whose code, configuration, and artifacts change while external feedback accumulates. We examine it in a human-directed, agent-engineered quantitative trading system, using oracle to mean an external source of realized outcomes rather than a complete correctness specification. Across one year, the account gained and outperformed a broad market index, while annual alpha was not statistically distinguishable from zero under the main retrospective specification. Retrospectively selected subperiods include adverse relative performance and conditional candidate-level weakness under declared approximate references. Engineering records document changes during the episode, and complete recommendation-to-runtime binding is unavailable. The archive does not establish a common frozen instance or a unique cause. The case motivates an outcome--diagnosis gap: outcome evidence, evaluated-object identity, and causal explanation support distinct claims. We distinguish frozen instances, pre-specified adaptive procedures, and ad-hoc development; organize archive-relative claim identifiability and an evidence hierarchy; and propose a prospective production-binding protocol. An illustrative compatible-history example shows how factual binding can resolve a recommendation's referent without supplying its counterfactual effect. The protocol is proposed rather than prospectively validated. External feedback constrains outcome claims, while provenance and additional identification structure determine the resolution of diagnosis.

During surgical training, real-time feedback from trainers to trainees is important for preventing errors and enhancing long-term skill acquisition. Accurately predicting the effectiveness of this feedback, specifically whether it leads to a change in trainee behavior, is crucial for developing methods for improving surgical training and education. However, relying on human annotations to assess feedback effectiveness is laborious and prone to biases, underscoring the need for an automated, scalable, and objective method. Creating such an automated system poses challenges, as it requires an understanding of both the verbal feedback delivered by the trainer and the visual context of the real-time surgical scene. To address this, we propose a method that integrates information from transcribed verbal feedback and corresponding surgical video to predict feedback effectiveness. Our findings show that both transcribed feedback and surgical video are individually predictive of trainee behavior changes, and their combination achieves an AUROC of 0.70+/-0.02, improving prediction accuracy by up to 6.6%. Additionally, we introduce self-supervised fine-tuning as a strategy for enhancing surgical video representation learning, which is scalable and further enhances prediction performance. Our results demonstrate the potential of multi-modal learning to advance the automated assessment of surgical feedback.

Traditionally, AI research in medical diagnosis has largely centered on image analysis. While this has led to notable advancements, the absence of patient-reported symptoms continues to hinder diagnostic accuracy. To address this, we propose a Pre-Consultation Dialogue Framework (PCDF) that mimics real-world diagnostic procedures, where doctors iteratively query patients before reaching a conclusion. Specifically, we simulate diagnostic dialogues between two vision-language models (VLMs): a DocVLM, which generates follow-up questions based on the image and dialogue history, and a PatientVLM, which responds using a symptom profile derived from the ground-truth diagnosis. We additionally conducted a small-scale clinical validation of the synthetic symptoms generated by our framework, with licensed clinicians confirming their clinical relevance, symptom coverage, and overall realism. These findings indicate that the resulting DocVLM-PatientVLM interactions form coherent, multi-turn consultations paired with images and diagnoses, which we then use to fine-tune the DocVLM. This dialogue-based supervision leads to substantial gains over image-only training, highlighting the value of realistic symptom elicitation for diagnosis.

Realistic practice and tailored feedback are key processes for training peer counselors with clinical skills. However, existing mechanisms of providing feedback largely rely on human supervision. Peer counselors often lack mechanisms to receive detailed feedback from experienced mentors, making it difficult for them to support the large number of people with mental health issues who use peer counseling. Our work aims to leverage large language models to provide contextualized and multi-level feedback to empower peer counselors, especially novices, at scale. To achieve this, we co-design with a group of senior psychotherapy supervisors to develop a multi-level feedback taxonomy, and then construct a publicly available dataset with comprehensive feedback annotations of 400 emotional support conversations. We further design a self-improvement method on top of large language models to enhance the automatic generation of feedback. Via qualitative and quantitative evaluation with domain experts, we demonstrate that our method minimizes the risk of potentially harmful and low-quality feedback generation which is desirable in such high-stakes scenarios.

Quantification of real-time informal feedback delivered by an experienced surgeon to a trainee during surgery is important for skill improvements in surgical training. Such feedback in the live operating room is inherently multimodal, consisting of verbal conversations (e.g., questions and answers) as well as non-verbal elements (e.g., through visual cues like pointing to anatomic elements). In this work, we leverage a clinically-validated five-category classification of surgical feedback: "Anatomic", "Technical", "Procedural", "Praise" and "Visual Aid". We then develop a multi-label machine learning model to classify these five categories of surgical feedback from inputs of text, audio, and video modalities. The ultimate goal of our work is to help automate the annotation of real-time contextual surgical feedback at scale. Our automated classification of surgical feedback achieves AUCs ranging from 71.5 to 77.6 with the fusion improving performance by 3.1%. We also show that high-quality manual transcriptions of feedback audio from experts improve AUCs to between 76.5 and 96.2, which demonstrates a clear path toward future improvements. Empirically, we find that the Staged training strategy, with first pre-training each modality separately and then training them jointly, is more effective than training different modalities altogether. We also present intuitive findings on the importance of modalities for different feedback categories. This work offers an important first look at the feasibility of automated classification of real-world live surgical feedback based on text, audio, and video modalities.

The MEDIQA-CORR 2024 shared task aims to assess the ability of Large Language Models (LLMs) to identify and correct medical errors in clinical notes. In this study, we evaluate the capability of general LLMs, specifically GPT-3.5 and GPT-4, to identify and correct medical errors with multiple prompting strategies. Recognising the limitation of LLMs in generating accurate corrections only via prompting strategies, we propose incorporating error-span predictions from a smaller, fine-tuned model in two ways: 1) by presenting it as a hint in the prompt and 2) by framing it as multiple-choice questions from which the LLM can choose the best correction. We found that our proposed prompting strategies significantly improve the LLM's ability to generate corrections. Our best-performing solution with 8-shot + CoT + hints ranked sixth in the shared task leaderboard. Additionally, our comprehensive analyses show the impact of the location of the error sentence, the prompted role, and the position of the multiple-choice option on the accuracy of the LLM. This prompts further questions about the readiness of LLM to be implemented in real-world clinical settings.

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.

Large language models (LLMs) are increasingly explored for clinical decision support, yet most evaluations are conducted in English, leaving their reliability in other languages uncertain. Here we evaluate the impact of prompting language on diagnostic reasoning and final diagnosis accuracy by comparing English and French performance across five LLMs (o3, DeepSeek-R1, GPT-4-Turbo, Llama-3.1-405B-Instruct, and BioMistral-7B). A total of 180 clinical vignettes covering 16 medical specialties were assessed by two physicians using an 18-point scale evaluating both diagnosis accuracy and reasoning quality. Four of the five models performed better in English (mean difference 0.37-0.91, adjusted p < 0.05), with the gap spanning multiple aspects of reasoning, including differential diagnosis, logical structure, and internal validity. o3 was the only model showing no overall language effect. These findings demonstrate that prompting language remains a critical determinant of LLM clinical performance, with implications for equitable linguistico-cultural deployment worldwide.

Most clinical benchmarks evaluate language models (LMs) on diagnosis using complete case descriptions. In clinical practice, however, patients present information in different ways, and clinicians must obtain relevant history and determine which examinations are needed before reaching a diagnosis. Diagnostic accuracy alone therefore cannot establish whether an agent gathered essential information or conducted an appropriate clinical assessment. Furthermore, existing benchmarks lack professional clinicians' verification. To address this gap, we introduce KlinikeBench, a benchmark of 333 clinician-authored tasks, each providing an isolated sandbox environment with a virtual patient, clinical tools, and task-specific success criteria. More than 35 clinicians contributed to case authoring and benchmark evaluation. In an empirical study, clinicians gave simulated dialogues higher mean quality ratings than reference conversations, which is adapted from real conversation. In each task, an LM has a fixed budget of turns to communicate with the patient, ask about relevant history, request examinations, follow action constraints, and record a final diagnosis. We score these steps separately as well as together. Across 31 models and seven model families, the best-performing models (e.g., GPT-6-astra and Claude Opus 5) succeed on less than 30% of tasks, even though their diagnosis accuracy reaches 90.7%. Some models benefit from talking with the patient; others diagnose well from a complete chart but perform much worse in conversation. Overall, KlinikeBench provides a testbed for evaluating the full clinical encounter and reveals a substantial gap between diagnostic accuracy and performance in interactive clinical assessment.

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.

Unstructured clinical notes contain essential patient information but are challenging for physicians to search and interpret efficiently. Although large language models (LLMs) have shown promise in question answering (QA), most existing systems lack transparency, usability, and alignment with clinical workflows. This work introduces an interactive QA system that enables physicians to query clinical notes via text or voice and receive extractive answers highlighted directly in the note for traceability. The system was built using OpenAI models with zero-shot prompting and evaluated across multiple metrics, including exact string match, word overlap, SentenceTransformer similarity, and BERTScore. Results show that while exact match scores ranged from 47 to 62 percent, semantic similarity scores exceeded 87 percent, indicating strong contextual alignment even when wording varied. To assess usability, the system was also evaluated using simulated clinical personas. Seven diverse physician and nurse personas interacted with the system across scenario-based tasks and provided structured feedback. The evaluations highlighted strengths in intuitive design and answer accessibility, alongside opportunities for enhancing explanation clarity.

Large language models have the potential to be valuable in the healthcare industry, but it's crucial to verify their safety and effectiveness through rigorous evaluation. For this purpose, we comprehensively evaluated both open-source LLMs and Google's new multimodal LLM called Gemini across Medical reasoning, hallucination detection, and Medical Visual Question Answering tasks. While Gemini showed competence, it lagged behind state-of-the-art models like MedPaLM 2 and GPT-4 in diagnostic accuracy. Additionally, Gemini achieved an accuracy of 61.45\% on the medical VQA dataset, significantly lower than GPT-4V's score of 88\%. Our analysis revealed that Gemini is highly susceptible to hallucinations, overconfidence, and knowledge gaps, which indicate risks if deployed uncritically. We also performed a detailed analysis by medical subject and test type, providing actionable feedback for developers and clinicians. To mitigate risks, we applied prompting strategies that improved performance. Additionally, we facilitated future research and development by releasing a Python module for medical LLM evaluation and establishing a dedicated leaderboard on Hugging Face for medical domain LLMs. Python module can be found at https://github.com/promptslab/RosettaEval

Objective: Question answering (QA) systems have the potential to improve the quality of clinical care by providing health professionals with the latest and most relevant evidence. However, QA systems have not been widely adopted. This systematic review aims to characterize current medical QA systems, assess their suitability for healthcare, and identify areas of improvement. Materials and methods: We searched PubMed, IEEE Xplore, ACM Digital Library, ACL Anthology and forward and backward citations on 7th February 2023. We included peer-reviewed journal and conference papers describing the design and evaluation of biomedical QA systems. Two reviewers screened titles, abstracts, and full-text articles. We conducted a narrative synthesis and risk of bias assessment for each study. We assessed the utility of biomedical QA systems. Results: We included 79 studies and identified themes, including question realism, answer reliability, answer utility, clinical specialism, systems, usability, and evaluation methods. Clinicians' questions used to train and evaluate QA systems were restricted to certain sources, types and complexity levels. No system communicated confidence levels in the answers or sources. Many studies suffered from high risks of bias and applicability concerns. Only 8 studies completely satisfied any criterion for clinical utility, and only 7 reported user evaluations. Most systems were built with limited input from clinicians. Discussion: While machine learning methods have led to increased accuracy, most studies imperfectly reflected real-world healthcare information needs. Key research priorities include developing more realistic healthcare QA datasets and considering the reliability of answer sources, rather than merely focusing on accuracy.

Accurate diagnostic coding of medical notes is crucial for enhancing patient care, medical research, and error-free billing in healthcare organizations. Manual coding is a time-consuming task for providers, and diagnostic codes often exhibit low sensitivity and specificity, whereas the free text in medical notes can be a more precise description of a patients status. Thus, accurate automated diagnostic coding of medical notes has become critical for a learning healthcare system. Recent developments in long-document transformer architectures have enabled attention-based deep-learning models to adjudicate medical notes. In addition, contrastive loss functions have been used to jointly pre-train large language and image models with noisy labels. To further improve the automated adjudication of medical notes, we developed an approach based on i) models for ICD-10 diagnostic code sequences using a large real-world data set, ii) large language models for medical notes, and iii) contrastive pre-training to build an integrated model of both ICD-10 diagnostic codes and corresponding medical text. We demonstrate that a contrastive approach for pre-training improves performance over prior state-of-the-art models for the MIMIC-III-50, MIMIC-III-rare50, and MIMIC-III-full diagnostic coding tasks.

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.

Clinical decision-making in emergency medicine demands rapid, accurate diagnoses under uncertainty. Despite benchmark progress, evidence for LLMs as interactive aids in live physician workflows remains sparse. MedSyn lets physicians iteratively query an LLM provided with the full clinical record while initially viewing only the chief complaint. Seven physicians (three seniors, four residents) completed baseline and AI-assisted sessions across 52 MIMIC-IV cases stratified by difficulty. Blinded evaluation showed residents' Hard-case correctness rose from 0.589 to 0.734; difficulty-standardised completely-correct rates confirmed a medium effect (Δ = 0.092; p = 0.071; d = 0.47). Automated metrics corroborated these gains: standardised any-match accuracy improved by 0.156 (p < 0.0001), and residents showed the largest F1 gain (Δ = 0.138; p < 0.0001). Dialogue analysis revealed expertise-dependent strategies (seniors asked targeted, hypothesis-driven questions; residents relied on broader queries) and cross-expertise concordance increased (Δ = 0.145; p < 0.0001). Interactive LLM support meaningfully enhances diagnostic reasoning.

This study explores the proactive ability of LLMs to seek user support. We propose metrics to evaluate the trade-off between performance improvements and user burden, and investigate whether LLMs can determine when to request help under varying information availability. Our experiments show that without external feedback, many LLMs struggle to recognize their need for user support. The findings highlight the importance of external signals and provide insights for future research on improving support-seeking strategies. Source code: https://github.com/appier-research/i-need-help

Doctors and patients alike increasingly use Large Language Models (LLMs) to diagnose clinical cases. However, unlike domains such as math or coding, where correctness can be objectively defined by the final answer, medical diagnosis requires both the outcome and the reasoning process to be accurate. Currently, widely used medical benchmarks like MedQA and MMLU assess only accuracy in the final answer, overlooking the quality and faithfulness of the clinical reasoning process. To address this limitation, we introduce MedCaseReasoning, the first open-access dataset for evaluating LLMs on their ability to align with clinician-authored diagnostic reasoning. The dataset includes 14,489 diagnostic question-and-answer cases, each paired with detailed reasoning statements derived from open-access medical case reports. We evaluate state-of-the-art reasoning LLMs on MedCaseReasoning and find significant shortcomings in their diagnoses and reasoning: for instance, the top-performing open-source model, DeepSeek-R1, achieves only 48% 10-shot diagnostic accuracy and mentions only 64% of the clinician reasoning statements (recall). However, we demonstrate that fine-tuning LLMs on the reasoning traces derived from MedCaseReasoning significantly improves diagnostic accuracy and clinical reasoning recall by an average relative gain of 29% and 41%, respectively. The open-source dataset, code, and models are available at https://github.com/kevinwu23/Stanford-MedCaseReasoning.

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.

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.

Radiologists play a crucial role by translating medical images into medical reports. However, the field faces staffing shortages and increasing workloads. While automated approaches using vision-language models (VLMs) show promise as assistants, they require exceptionally high accuracy. Most current VLMs in radiology rely solely on supervised fine-tuning (SFT). Meanwhile, in the general domain, additional preference fine-tuning has become standard practice. The challenge in radiology lies in the prohibitive cost of obtaining radiologist feedback. We propose a scalable automated preference alignment technique for VLMs in radiology, focusing on chest X-ray (CXR) report generation. Our method leverages publicly available datasets with an LLM-as-a-Judge mechanism, eliminating the need for additional expert radiologist feedback. We evaluate and benchmark five direct alignment algorithms (DAAs). Our results show up to a 57.4% improvement in average GREEN scores, a LLM-based metric for evaluating CXR reports, and a 9.2% increase in an average across six metrics (domain specific and general), compared to the SFT baseline. We study reward overoptimization via length exploitation, with reports lengthening by up to 3.2x. To assess a potential alignment tax, we benchmark on six additional diverse tasks, finding no significant degradations. A reader study involving four board-certified radiologists indicates win rates of up to 0.62 over the SFT baseline, while significantly penalizing verbosity. Our analysis provides actionable insights for the development of VLMs in high-stakes fields like radiology.

To build a French national electronic injury surveillance system based on emergency room visits, we aim to develop a coding system to classify their causes from clinical notes in free-text. Supervised learning techniques have shown good results in this area but require a large amount of expert annotated dataset which is time consuming and costly to obtain. We hypothesize that the Natural Language Processing Transformer model incorporating a generative self-supervised pre-training step can significantly reduce the required number of annotated samples for supervised fine-tuning. In this preliminary study, we test our hypothesis in the simplified problem of predicting whether a visit is the consequence of a traumatic event or not from free-text clinical notes. Using fully re-trained GPT-2 models (without OpenAI pre-trained weights), we assess the gain of applying a self-supervised pre-training phase with unlabeled notes prior to the supervised learning task. Results show that the number of data required to achieve a ginve level of performance (AUC>0.95) was reduced by a factor of 10 when applying pre-training. Namely, for 16 times more data, the fully-supervised model achieved an improvement <1% in AUC. To conclude, it is possible to adapt a multi-purpose neural language model such as the GPT-2 to create a powerful tool for classification of free-text notes with only a small number of labeled samples.

As LLMs are increasingly used for pre-submission self-review, there is growing demand for feedback that not only identifies weaknesses but also guides authors toward concrete revisions. We study this as Actionable Peer-review Generation and decompose it into two subtasks: diagnostic claim generation and revision suggestion generation. We introduce ActReview, a rebuttal-guided post-training framework that connects paper-specific diagnoses to concrete, grounded revision plans. Our central insight is that author rebuttals reveal plausible actions for addressing reviewer concerns and can therefore provide latent supervision for revision-oriented feedback. From real review-rebuttal threads on OpenReview, we construct ActReview-40K by aligning reviewer weaknesses with author responses and grounding the resulting feedback in localized paper evidence. We post-train Qwen3-8B-Base with multi-task supervised fine-tuning followed by GRPO using candidate-aware, weakness-specific rubric rewards. We also introduce ActReview-Bench, a human-curated benchmark of 1,000 instances for evaluating diagnostic quality and revision usefulness. Experiments show that ActReview outperforms prior specialized review-generation models on actionability and grounding while remaining competitive with strong prompt-based LLMs. Human evaluation confirms improved revision usefulness while revealing a remaining gap in technical accuracy, and additional analyses support generalization to held-out papers and robustness across independent judges.

In this work, we introduce MedAgentSim, an open-source simulated clinical environment with doctor, patient, and measurement agents designed to evaluate and enhance LLM performance in dynamic diagnostic settings. Unlike prior approaches, our framework requires doctor agents to actively engage with patients through multi-turn conversations, requesting relevant medical examinations (e.g., temperature, blood pressure, ECG) and imaging results (e.g., MRI, X-ray) from a measurement agent to mimic the real-world diagnostic process. Additionally, we incorporate self improvement mechanisms that allow models to iteratively refine their diagnostic strategies. We enhance LLM performance in our simulated setting by integrating multi-agent discussions, chain-of-thought reasoning, and experience-based knowledge retrieval, facilitating progressive learning as doctor agents interact with more patients. We also introduce an evaluation benchmark for assessing the LLM's ability to engage in dynamic, context-aware diagnostic interactions. While MedAgentSim is fully automated, it also supports a user-controlled mode, enabling human interaction with either the doctor or patient agent. Comprehensive evaluations in various simulated diagnostic scenarios demonstrate the effectiveness of our approach. Our code, simulation tool, and benchmark are available at https://medagentsim.netlify.app/.

The effectiveness of feedback in enhancing learning outcomes is well documented within Educational Data Mining (EDM). Various prior research has explored methodologies to enhance the effectiveness of feedback. Recent developments in Large Language Models (LLMs) have extended their utility in enhancing automated feedback systems. This study aims to explore the potential of LLMs in facilitating automated feedback in math education. We examine the effectiveness of LLMs in evaluating student responses by comparing 3 different models: Llama, SBERT-Canberra, and GPT4 model. The evaluation requires the model to provide both a quantitative score and qualitative feedback on the student's responses to open-ended math problems. We employ Mistral, a version of Llama catered to math, and fine-tune this model for evaluating student responses by leveraging a dataset of student responses and teacher-written feedback for middle-school math problems. A similar approach was taken for training the SBERT model as well, while the GPT4 model used a zero-shot learning approach. We evaluate the model's performance in scoring accuracy and the quality of feedback by utilizing judgments from 2 teachers. The teachers utilized a shared rubric in assessing the accuracy and relevance of the generated feedback. We conduct both quantitative and qualitative analyses of the model performance. By offering a detailed comparison of these methods, this study aims to further the ongoing development of automated feedback systems and outlines potential future directions for leveraging generative LLMs to create more personalized learning experiences.

Language models excel at diagnostic assessments on currated medical case-studies and vignettes, performing on par with, or better than, clinical professionals. However, existing studies focus on complex scenarios with rich context making it difficult to draw conclusions about how these systems perform for patients reporting symptoms in everyday life. We deployed SymptomAI, a set of conversational AI agents for end-to-end patient interviewing and differential diagnosis (DDx), via the Fitbit app in a study that randomized participants (N=13,917) to interact with five AI agents. This corpus captures diverse communication and a realistic distribution of illnesses from a real world population. A subset of 1,228 participants reported a clinician-provided diagnosis, and 517 of these were further evaluated by a panel of clinicians during over 250 hours of annotation. SymptomAI DDx were significantly more accurate (OR = 2.47, p < 0.001) than those from independent clinicians given the same dialogue in a blinded randomized comparison. Moreover, agentic strategies which conduct a dedicated symptom interview that elicit additional symptom information before providing a diagnosis, perform substantially better than baseline, user-guided conversations (p < 0.001). An auxiliary analysis on 1,509 conversations from a general US population panel validated that these results generalize beyond wearable device users. We used SymptomAI diagnoses as labels for all 13,917 participants to analyze over 500,000 days of wearable metrics across nearly 400 unique conditions. We identified strong associations between acute infections and physiological shifts (e.g., OR > 7 for influenza). While limited by self-reported ground truth, these results demonstrate the benefits of a dedicated and complete symptom interview compared to a user-guided symptom discussion, which is the default of most consumer LLMs.

Lectures are a learning experience for both students and teachers. Students learn from teachers about the subject material, while teachers learn from students about how to refine their instruction. However, online student feedback is unstructured and abundant, making it challenging for teachers to learn and improve. We take a step towards tackling this challenge. First, we contribute a dataset for studying this problem: SIGHT is a large dataset of 288 math lecture transcripts and 15,784 comments collected from the Massachusetts Institute of Technology OpenCourseWare (MIT OCW) YouTube channel. Second, we develop a rubric for categorizing feedback types using qualitative analysis. Qualitative analysis methods are powerful in uncovering domain-specific insights, however they are costly to apply to large data sources. To overcome this challenge, we propose a set of best practices for using large language models (LLMs) to cheaply classify the comments at scale. We observe a striking correlation between the model's and humans' annotation: Categories with consistent human annotations (>0.9 inter-rater reliability, IRR) also display higher human-model agreement (>0.7), while categories with less consistent human annotations (0.7-0.8 IRR) correspondingly demonstrate lower human-model agreement (0.3-0.5). These techniques uncover useful student feedback from thousands of comments, costing around 0.002$ per comment. We conclude by discussing exciting future directions on using online student feedback and improving automated annotation techniques for qualitative research.

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.

Despite growing interest in using large language models (LLMs) in healthcare, current explorations do not assess the real-world utility and safety of LLMs in clinical settings. Our objective was to determine whether two LLMs can serve information needs submitted by physicians as questions to an informatics consultation service in a safe and concordant manner. Sixty six questions from an informatics consult service were submitted to GPT-3.5 and GPT-4 via simple prompts. 12 physicians assessed the LLM responses' possibility of patient harm and concordance with existing reports from an informatics consultation service. Physician assessments were summarized based on majority vote. For no questions did a majority of physicians deem either LLM response as harmful. For GPT-3.5, responses to 8 questions were concordant with the informatics consult report, 20 discordant, and 9 were unable to be assessed. There were 29 responses with no majority on "Agree", "Disagree", and "Unable to assess". For GPT-4, responses to 13 questions were concordant, 15 discordant, and 3 were unable to be assessed. There were 35 responses with no majority. Responses from both LLMs were largely devoid of overt harm, but less than 20% of the responses agreed with an answer from an informatics consultation service, responses contained hallucinated references, and physicians were divided on what constitutes harm. These results suggest that while general purpose LLMs are able to provide safe and credible responses, they often do not meet the specific information need of a given question. A definitive evaluation of the usefulness of LLMs in healthcare settings will likely require additional research on prompt engineering, calibration, and custom-tailoring of general purpose models.

Several studies showed that Large Language Models (LLMs) can answer medical questions correctly, even outperforming the average human score in some medical exams. However, to our knowledge, no study has been conducted to assess the ability of language models to validate existing or generated medical text for correctness and consistency. In this paper, we introduce MEDEC (https://github.com/abachaa/MEDEC), the first publicly available benchmark for medical error detection and correction in clinical notes, covering five types of errors (Diagnosis, Management, Treatment, Pharmacotherapy, and Causal Organism). MEDEC consists of 3,848 clinical texts, including 488 clinical notes from three US hospital systems that were not previously seen by any LLM. The dataset has been used for the MEDIQA-CORR shared task to evaluate seventeen participating systems [Ben Abacha et al., 2024]. In this paper, we describe the data creation methods and we evaluate recent LLMs (e.g., o1-preview, GPT-4, Claude 3.5 Sonnet, and Gemini 2.0 Flash) for the tasks of detecting and correcting medical errors requiring both medical knowledge and reasoning capabilities. We also conducted a comparative study where two medical doctors performed the same task on the MEDEC test set. The results showed that MEDEC is a sufficiently challenging benchmark to assess the ability of models to validate existing or generated notes and to correct medical errors. We also found that although recent LLMs have a good performance in error detection and correction, they are still outperformed by medical doctors in these tasks. We discuss the potential factors behind this gap, the insights from our experiments, the limitations of current evaluation metrics, and share potential pointers for future research.

The rapid increase of computed tomography (CT) scans and their time-consuming manual analysis have created an urgent need for robust automated analysis techniques in clinical settings. These aim to assist radiologists and help them managing their growing workload. Existing methods typically generate entire reports directly from 3D CT images, without explicitly focusing on observed abnormalities. This unguided approach often results in repetitive content or incomplete reports, failing to prioritize anomaly-specific descriptions. We propose a new anomaly-guided report generation model, which first predicts abnormalities and then generates targeted descriptions for each. Evaluation on a public dataset demonstrates significant improvements in report quality and clinical relevance. We extend our work by conducting an ablation study to demonstrate its effectiveness.

People increasingly search online for answers to their medical questions but the rate at which medical questions are asked online significantly exceeds the capacity of qualified people to answer them. This leaves many questions unanswered or inadequately answered. Many of these questions are not unique, and reliable identification of similar questions would enable more efficient and effective question answering schema. COVID-19 has only exacerbated this problem. Almost every government agency and healthcare organization has tried to meet the informational need of users by building online FAQs, but there is no way for people to ask their question and know if it is answered on one of these pages. While many research efforts have focused on the problem of general question similarity, these approaches do not generalize well to domains that require expert knowledge to determine semantic similarity, such as the medical domain. In this paper, we show how a double fine-tuning approach of pretraining a neural network on medical question-answer pairs followed by fine-tuning on medical question-question pairs is a particularly useful intermediate task for the ultimate goal of determining medical question similarity. While other pretraining tasks yield an accuracy below 78.7% on this task, our model achieves an accuracy of 82.6% with the same number of training examples, an accuracy of 80.0% with a much smaller training set, and an accuracy of 84.5% when the full corpus of medical question-answer data is used. We also describe a currently live system that uses the trained model to match user questions to COVID-related FAQs.

This work introduces the first framework for reconstructing surgical dialogue from unstructured real-world recordings, which is crucial for characterizing teaching tasks. In surgical training, the formative verbal feedback that trainers provide to trainees during live surgeries is crucial for ensuring safety, correcting behavior immediately, and facilitating long-term skill acquisition. However, analyzing and quantifying this feedback is challenging due to its unstructured and specialized nature. Automated systems are essential to manage these complexities at scale, allowing for the creation of structured datasets that enhance feedback analysis and improve surgical education. Our framework integrates voice activity detection, speaker diarization, and automated speech recaognition, with a novel enhancement that 1) removes hallucinations (non-existent utterances generated during speech recognition fueled by noise in the operating room) and 2) separates speech from trainers and trainees using few-shot voice samples. These aspects are vital for reconstructing accurate surgical dialogues and understanding the roles of operating room participants. Using data from 33 real-world surgeries, we demonstrated the system's capability to reconstruct surgical teaching dialogues and detect feedback instances effectively (F1 score of 0.79+/-0.07). Moreover, our hallucination removal step improves feedback detection performance by ~14%. Evaluation on downstream clinically relevant tasks of predicting Behavioral Adjustment of trainees and classifying Technical feedback, showed performances comparable to manual annotations with F1 scores of 0.82+/0.03 and 0.81+/0.03 respectively. These results highlight the effectiveness of our framework in supporting clinically relevant tasks and improving over manual methods.

Recent studies have shown LLMs possess some ability to improve their responses when given external feedback. However, it remains unclear how effectively and thoroughly these models can incorporate extrinsic feedback. In an ideal scenario, if LLMs receive near-perfect and complete feedback, we would expect them to fully integrate the feedback and change their incorrect answers to correct ones. In this paper, we systematically investigate LLMs' ability to incorporate feedback by designing a controlled experimental environment. For each problem, a solver model attempts a solution, then a feedback generator with access to near-complete ground-truth answers produces targeted feedback, after which the solver tries again. We evaluate this pipeline across a diverse range of tasks, including math reasoning, knowledge reasoning, scientific reasoning, and general multi-domain evaluations with state-of-the-art language models including Claude 3.7 (with and without extended thinking). Surprisingly, even under these near-ideal conditions, solver models consistently show resistance to feedback, a limitation that we term FEEDBACK FRICTION. To mitigate this limitation, we experiment with sampling-based strategies like progressive temperature increases and explicit rejection of previously attempted incorrect answers, which yield improvements but still fail to help models achieve target performance. We also perform a rigorous exploration of potential causes of FEEDBACK FRICTION, ruling out factors such as model overconfidence and data familiarity. We hope that highlighting this issue in LLMs and ruling out several apparent causes will help future research in self-improvement.

Many recent advances in natural language generation have been fueled by training large language models on internet-scale data. However, this paradigm can lead to models that generate toxic, inaccurate, and unhelpful content, and automatic evaluation metrics often fail to identify these behaviors. As models become more capable, human feedback is an invaluable signal for evaluating and improving models. This survey aims to provide an overview of the recent research that has leveraged human feedback to improve natural language generation. First, we introduce an encompassing formalization of feedback, and identify and organize existing research into a taxonomy following this formalization. Next, we discuss how feedback can be described by its format and objective, and cover the two approaches proposed to use feedback (either for training or decoding): directly using the feedback or training feedback models. We also discuss existing datasets for human-feedback data collection, and concerns surrounding feedback collection. Finally, we provide an overview of the nascent field of AI feedback, which exploits large language models to make judgments based on a set of principles and minimize the need for human intervention.

Retrieval-enhanced methods have become a primary approach in fact verification (FV); it requires reasoning over multiple retrieved pieces of evidence to verify the integrity of a claim. To retrieve evidence, existing work often employs off-the-shelf retrieval models whose design is based on the probability ranking principle. We argue that, rather than relevance, for FV we need to focus on the utility that a claim verifier derives from the retrieved evidence. We introduce the feedback-based evidence retriever(FER) that optimizes the evidence retrieval process by incorporating feedback from the claim verifier. As a feedback signal we use the divergence in utility between how effectively the verifier utilizes the retrieved evidence and the ground-truth evidence to produce the final claim label. Empirical studies demonstrate the superiority of FER over prevailing baselines.

Autoresearch agents are reshaping the research ecosystem, but they can also let flawed claims enter the literature at scale. Human advisors catch such issues in drafts through careful, traceable feedback, yet advisor-style assessment requires extensive manual effort and does not scale. To shift automated paper assessment from a judge to a diagnostician, we introduce PaperDoctor, an agent framework for pre-submission feedback with three key innovations. First, a holistic hierarchical framework evaluates writing, layout, references, code, theory, prior work, and experiments through three layers: L1 surface screening, L2 typed verifiers that route each claim to the appropriate evidence, and L3 reproducers that rerun experiments by priority. Second, each finding contains an observation, a pointer to specific evidence such as a sentence, equation, or code line, and a revision suggestion, making critiques auditable and actionable. Third, PaperDoctor selectively rebuilds and reruns experiments based on claim importance and compute budget, surfacing reproducibility gaps and quantitative limitations that are invisible from the manuscript alone. We evaluate PaperDoctor on 30 in-progress papers, yielding 70.6% agreement and all positive holistic scores, and on 40 manuscripts across machine learning, natural science, and social science, covering human- and AI-authored papers with code. Overall, PaperDoctor produces more auditable feedback than human and other agentic reviewers, pairs critiques with concrete suggestions by design, and complements dimensions often overlooked by human reviewers. We also develop an interactive interface that lets authors browse findings grounded in their paper. PaperDoctor reframes automated paper assessment as diagnosis rather than verdict, taking a concrete step toward AI advisors for more rigorous AI-assisted scientific discovery.

Natural language (NL) feedback contains rich information about the user experience. Existing studies focus on an instance-level approach, where feedback is used to refine specific examples, disregarding its system-wide application. This paper proposes a general framework for unlocking the system-level use of NL feedback. We show how to use feedback to formalize system-level design decisions in a human-in-the-loop-process -- in order to produce better models. In particular this is done through: (i) metric design for tasks; and (ii) language model prompt design for refining model responses. We conduct two case studies of this approach for improving search query generation and dialog response generation, demonstrating the effectiveness of the use of system-level feedback. We show the combination of system-level feedback and instance-level feedback brings further gains, and that human written instance-level feedback results in more grounded refinements than GPT-3.5 written ones, underlying the importance of human feedback for building systems.

Future short or long-term space missions require a new generation of monitoring and diagnostic systems due to communication impasses as well as limitations in specialized crew and equipment. Machine learning supported diagnostic systems present a viable solution for medical and technical applications. We discuss challenges and applicability of such systems in light of upcoming missions and outline an example use case for a next-generation medical diagnostic system for future space operations. Additionally, we present approach recommendations and constraints for the successful generation and use of machine learning models aboard a spacecraft.

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.

Expert feedback lays the foundation of rigorous research. However, the rapid growth of scholarly production and intricate knowledge specialization challenge the conventional scientific feedback mechanisms. High-quality peer reviews are increasingly difficult to obtain. Researchers who are more junior or from under-resourced settings have especially hard times getting timely feedback. With the breakthrough of large language models (LLM) such as GPT-4, there is growing interest in using LLMs to generate scientific feedback on research manuscripts. However, the utility of LLM-generated feedback has not been systematically studied. To address this gap, we created an automated pipeline using GPT-4 to provide comments on the full PDFs of scientific papers. We evaluated the quality of GPT-4's feedback through two large-scale studies. We first quantitatively compared GPT-4's generated feedback with human peer reviewer feedback in 15 Nature family journals (3,096 papers in total) and the ICLR machine learning conference (1,709 papers). The overlap in the points raised by GPT-4 and by human reviewers (average overlap 30.85% for Nature journals, 39.23% for ICLR) is comparable to the overlap between two human reviewers (average overlap 28.58% for Nature journals, 35.25% for ICLR). The overlap between GPT-4 and human reviewers is larger for the weaker papers. We then conducted a prospective user study with 308 researchers from 110 US institutions in the field of AI and computational biology to understand how researchers perceive feedback generated by our GPT-4 system on their own papers. Overall, more than half (57.4%) of the users found GPT-4 generated feedback helpful/very helpful and 82.4% found it more beneficial than feedback from at least some human reviewers. While our findings show that LLM-generated feedback can help researchers, we also identify several limitations.

We develop and evaluate a data-driven approach for detecting unusual (anomalous) patient-management decisions using past patient cases stored in electronic health records (EHRs). Our hypothesis is that a patient-management decision that is unusual with respect to past patient care may be due to an error and that it is worthwhile to generate an alert if such a decision is encountered. We evaluate this hypothesis using data obtained from EHRs of 4486 post-cardiac surgical patients and a subset of 222 alerts generated from the data. We base the evaluation on the opinions of a panel of experts. The results of the study support our hypothesis that the outlier-based alerting can lead to promising true alert rates. We observed true alert rates that ranged from 25\% to 66\% for a variety of patient-management actions, with 66\% corresponding to the strongest outliers.

Generalist foundation models such as GPT-4 have displayed surprising capabilities in a wide variety of domains and tasks. Yet, there is a prevalent assumption that they cannot match specialist capabilities of fine-tuned models. For example, most explorations to date on medical competency benchmarks have leveraged domain-specific training, as exemplified by efforts on BioGPT and Med-PaLM. We build on a prior study of GPT-4's capabilities on medical challenge benchmarks in the absence of special training. Rather than using simple prompting to highlight the model's out-of-the-box capabilities, we perform a systematic exploration of prompt engineering. We find that prompting innovation can unlock deeper specialist capabilities and show that GPT-4 easily tops prior leading results for medical benchmarks. The prompting methods we explore are general purpose, and make no specific use of domain expertise, removing the need for expert-curated content. Our experimental design carefully controls for overfitting during the prompt engineering process. We introduce Medprompt, based on a composition of several prompting strategies. With Medprompt, GPT-4 achieves state-of-the-art results on all nine of the benchmark datasets in the MultiMedQA suite. The method outperforms leading specialist models such as Med-PaLM 2 by a significant margin with an order of magnitude fewer calls to the model. Steering GPT-4 with Medprompt achieves a 27% reduction in error rate on the MedQA dataset over the best methods to date achieved with specialist models and surpasses a score of 90% for the first time. Beyond medical problems, we show the power of Medprompt to generalize to other domains and provide evidence for the broad applicability of the approach via studies of the strategy on exams in electrical engineering, machine learning, philosophy, accounting, law, nursing, and clinical psychology.

Throughout the course of my Ph.D., I have been designing the user experience (UX) of various machine learning (ML) systems. In this workshop, I share two projects as case studies in which people engage with ML in much more complicated and nuanced ways than the technical HCML work might assume. The first case study describes how cardiology teams in three hospitals used a clinical decision-support system that helps them decide whether and when to implant an artificial heart to a heart failure patient. I demonstrate that physicians cannot draw on their decision-making experience by seeing only patient data on paper. They are also confused by some fundamental premises upon which ML operates. For example, physicians asked: Are ML predictions made based on clinicians' best efforts? Is it ethical to make decisions based on previous patients' collective outcomes? In the second case study, my collaborators and I designed an intelligent text editor, with the goal of improving authors' writing experience with NLP (Natural Language Processing) technologies. We prototyped a number of generative functionalities where the system provides phrase-or-sentence-level writing suggestions upon user request. When writing with the prototype, however, authors shared that they need to "see where the sentence is going two paragraphs later" in order to decide whether the suggestion aligns with their writing; Some even considered adopting machine suggestions as plagiarism, therefore "is simply wrong". By sharing these unexpected and intriguing responses from these real-world ML users, I hope to start a discussion about such previously-unknown complexities and nuances of -- as the workshop proposal states -- "putting ML at the service of people in a way that is accessible, useful, and trustworthy to all".

Global healthcare providers are exploring use of large language models (LLMs) to provide medical advice to the public. LLMs now achieve nearly perfect scores on medical licensing exams, but this does not necessarily translate to accurate performance in real-world settings. We tested if LLMs can assist members of the public in identifying underlying conditions and choosing a course of action (disposition) in ten medical scenarios in a controlled study with 1,298 participants. Participants were randomly assigned to receive assistance from an LLM (GPT-4o, Llama 3, Command R+) or a source of their choice (control). Tested alone, LLMs complete the scenarios accurately, correctly identifying conditions in 94.9% of cases and disposition in 56.3% on average. However, participants using the same LLMs identified relevant conditions in less than 34.5% of cases and disposition in less than 44.2%, both no better than the control group. We identify user interactions as a challenge to the deployment of LLMs for medical advice. Standard benchmarks for medical knowledge and simulated patient interactions do not predict the failures we find with human participants. Moving forward, we recommend systematic human user testing to evaluate interactive capabilities prior to public deployments in healthcare.

We introduce RJUA-QA, a novel medical dataset for question answering (QA) and reasoning with clinical evidence, contributing to bridge the gap between general large language models (LLMs) and medical-specific LLM applications. RJUA-QA is derived from realistic clinical scenarios and aims to facilitate LLMs in generating reliable diagnostic and advice. The dataset contains 2,132 curated Question-Context-Answer pairs, corresponding about 25,000 diagnostic records and clinical cases. The dataset covers 67 common urological disease categories, where the disease coverage exceeds 97.6\% of the population seeking medical services in urology. Each data instance in RJUA-QA comprises: (1) a question mirroring real patient to inquiry about clinical symptoms and medical conditions, (2) a context including comprehensive expert knowledge, serving as a reference for medical examination and diagnosis, (3) a doctor response offering the diagnostic conclusion and suggested examination guidance, (4) a diagnosed clinical disease as the recommended diagnostic outcome, and (5) clinical advice providing recommendations for medical examination. RJUA-QA is the first medical QA dataset for clinical reasoning over the patient inquiries, where expert-level knowledge and experience are required for yielding diagnostic conclusions and medical examination advice. A comprehensive evaluation is conducted to evaluate the performance of both medical-specific and general LLMs on the RJUA-QA dataset.

Clinical diagnosis is a highly specialized discipline requiring both domain expertise and strict adherence to rigorous guidelines. While current AI-driven medical research predominantly focuses on knowledge graphs or natural text pretraining paradigms to incorporate medical knowledge, these approaches primarily rely on implicitly encoded knowledge within model parameters, neglecting task-specific knowledge required by diverse downstream tasks. To address this limitation, we propose Retrieval-Augmented Diagnosis (RAD), a novel framework that explicitly injects external knowledge into multimodal models directly on downstream tasks. Specifically, RAD operates through three key mechanisms: retrieval and refinement of disease-centered knowledge from multiple medical sources, a guideline-enhanced contrastive loss that constrains the latent distance between multi-modal features and guideline knowledge, and the dual transformer decoder that employs guidelines as queries to steer cross-modal fusion, aligning the models with clinical diagnostic workflows from guideline acquisition to feature extraction and decision-making. Moreover, recognizing the lack of quantitative evaluation of interpretability for multimodal diagnostic models, we introduce a set of criteria to assess the interpretability from both image and text perspectives. Extensive evaluations across four datasets with different anatomies demonstrate RAD's generalizability, achieving state-of-the-art performance. Furthermore, RAD enables the model to concentrate more precisely on abnormal regions and critical indicators, ensuring evidence-based, trustworthy diagnosis. Our code is available at https://github.com/tdlhl/RAD.

Large language models (LLMs) show promise in medical diagnosis, but real-world deployment remains challenging due to high-stakes clinical decisions and imperfect reasoning reliability. As a result, careful inspection of model behavior is essential for assessing whether diagnostic reasoning is reliable and clinically grounded. However, debugging medical LLMs remains difficult. First, developers often lack sufficient medical domain expertise to interpret model errors in clinically meaningful terms. Second, models can fail across a large and diverse set of instances involving different input types, tasks, and reasoning steps, making it challenging for developers to prioritize which errors deserve focused inspection. Third, developers struggle to identify recurring error patterns across cases, as existing debugging practices are largely instance-centric and rely on manual inspection of isolated failures. To address these challenges, we present VeriLLMed, a visual analytics system that integrates external biomedical knowledge to audit and debug medical LLM diagnostic reasoning. VeriLLMed transforms model outputs into comparable reasoning paths, constructs knowledge graph-grounded reference paths, and identifies three recurring classes of diagnosis errors: relation errors, branch errors, and missing errors. Case studies and expert evaluation demonstrate that VeriLLMed helps developers identify clinically implausible reasoning and generate actionable insights that can inform the improvement of medical LLMs.

Diagnostic consultation is an online sequential decision-making process in which clinicians gather evidence through patient interaction until a diagnosis is sufficiently supported. Automating this process requires adaptive inquiry and interpretable decisions. Bayesian networks offer a natural foundation by updating diagnostic posteriors as evidence accumulates, but their use in open-ended consultation raises two challenges: linking diagnostic hypotheses to potential inquiries and translating evolving posteriors into consultation decisions. We introduce AutoDisym, an automated pipeline that integrates diagnostic knowledge with heterogeneous diagnosis-labeled clinical narratives to construct a Disorder--Symptom Bayesian Network (DSBN). Building on the DSBN, we propose ConsultMind, an uncertainty-aware framework that updates disorder posteriors after each response and uses posterior uncertainty to guide inquiry and diagnosis. We evaluate both methods across psychiatry, respiratory medicine, fever clinics, and three public datasets. The results show that AutoDisym can automatically construct high-quality DSBNs and that ConsultMind consistently improves diagnostic performance and explanation soundness. For example, AutoDisym achieves macro-averaged F1 scores of 81.37 for canonical symptoms and 72.19 for manifestations using GPT-5.6-Sol. ConsultMind improves Top-1 and Top-3 diagnostic accuracy by up to 22.15 and 37.89 percentage points, respectively. Physician evaluation further shows that ConsultMind improves the quality of ranking explanations, differential diagnoses, and diagnosis rationales across LLMs of different scales. This work offers a promising approach to automatic diagnostic consultation.

Large language models (LLMs) have recently showcased remarkable capabilities, spanning a wide range of tasks and applications, including those in the medical domain. Models like GPT-4 excel in medical question answering but may face challenges in the lack of interpretability when handling complex tasks in real clinical settings. We thus introduce the diagnostic reasoning dataset for clinical notes (DiReCT), aiming at evaluating the reasoning ability and interpretability of LLMs compared to human doctors. It contains 511 clinical notes, each meticulously annotated by physicians, detailing the diagnostic reasoning process from observations in a clinical note to the final diagnosis. Additionally, a diagnostic knowledge graph is provided to offer essential knowledge for reasoning, which may not be covered in the training data of existing LLMs. Evaluations of leading LLMs on DiReCT bring out a significant gap between their reasoning ability and that of human doctors, highlighting the critical need for models that can reason effectively in real-world clinical scenarios.

Automatic medical report generation (MRG) is of great research value as it has the potential to relieve radiologists from the heavy burden of report writing. Despite recent advancements, accurate MRG remains challenging due to the need for precise clinical understanding and the identification of clinical findings. Moreover, the imbalanced distribution of diseases makes the challenge even more pronounced, as rare diseases are underrepresented in training data, making their diagnostic performance unreliable. To address these challenges, we propose diagnosis-driven prompts for medical report generation (PromptMRG), a novel framework that aims to improve the diagnostic accuracy of MRG with the guidance of diagnosis-aware prompts. Specifically, PromptMRG is based on encoder-decoder architecture with an extra disease classification branch. When generating reports, the diagnostic results from the classification branch are converted into token prompts to explicitly guide the generation process. To further improve the diagnostic accuracy, we design cross-modal feature enhancement, which retrieves similar reports from the database to assist the diagnosis of a query image by leveraging the knowledge from a pre-trained CLIP. Moreover, the disease imbalanced issue is addressed by applying an adaptive logit-adjusted loss to the classification branch based on the individual learning status of each disease, which overcomes the barrier of text decoder's inability to manipulate disease distributions. Experiments on two MRG benchmarks show the effectiveness of the proposed method, where it obtains state-of-the-art clinical efficacy performance on both datasets.

Daily progress notes are common types in the electronic health record (EHR) where healthcare providers document the patient's daily progress and treatment plans. The EHR is designed to document all the care provided to patients, but it also enables note bloat with extraneous information that distracts from the diagnoses and treatment plans. Applications of natural language processing (NLP) in the EHR is a growing field with the majority of methods in information extraction. Few tasks use NLP methods for downstream diagnostic decision support. We introduced the 2022 National NLP Clinical Challenge (N2C2) Track 3: Progress Note Understanding - Assessment and Plan Reasoning as one step towards a new suite of tasks. The Assessment and Plan Reasoning task focuses on the most critical components of progress notes, Assessment and Plan subsections where health problems and diagnoses are contained. The goal of the task was to develop and evaluate NLP systems that automatically predict causal relations between the overall status of the patient contained in the Assessment section and its relation to each component of the Plan section which contains the diagnoses and treatment plans. The goal of the task was to identify and prioritize diagnoses as the first steps in diagnostic decision support to find the most relevant information in long documents like daily progress notes. We present the results of 2022 n2c2 Track 3 and provide a description of the data, evaluation, participation and system performance.

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.

Interactive dialogue games test a capability that static benchmarks largely leave implicit: a model must carry state across turns, interpret feedback, and choose valid actions under changing constraints. We study this setting in the LM Playschool Challenge with a 2B open-weight model, and find that many failures are not only broad knowledge failures but also local decision failures: repeated guesses, malformed actions, and violations of feedback that the model has just seen. These diagnostics motivate a training recipe organized around three steps: acquire broad game participation through supervised fine-tuning, repair mechanically verifiable failures within one targeted dialogue-game family using turn-local preference pairs, and preserve general capabilities beyond these dialogue games. In the official final evaluation, our submission improves public clemscore from 10.67 to 38.92 and closed in-domain score from 13.41 to 41.17, while approximately preserving aggregate static performance (44.14 vs. 44.24 for the baseline). Out-of-domain clemscore remains low at 7.88, with the largest gains concentrated in unseen variants of the targeted family. Our results suggest that broad SFT brings most of the model's capability improvement; turn-local supervision can be effective when failure detection is precise, with observed transfer concentrated primarily within-family.

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.

Objectives: While Large Language Models (LLMs) have been widely used to assist clinicians and support patients, no existing work has explored dialogue systems for standard diagnostic interviews and assessments. This study aims to bridge the gap in mental healthcare accessibility by developing an LLM-powered dialogue system that replicates clinician behavior. Materials and Methods: We introduce TRUST, a framework of cooperative LLM modules capable of conducting formal diagnostic interviews and assessments for Post-Traumatic Stress Disorder (PTSD). To guide the generation of appropriate clinical responses, we propose a Dialogue Acts schema specifically designed for clinical interviews. Additionally, we develop a patient simulation approach based on real-life interview transcripts to replace time-consuming and costly manual testing by clinicians. Results: A comprehensive set of evaluation metrics is designed to assess the dialogue system from both the agent and patient simulation perspectives. Expert evaluations by conversation and clinical specialists show that TRUST performs comparably to real-life clinical interviews. Discussion: Our system performs at the level of average clinicians, with room for future enhancements in communication styles and response appropriateness. Conclusions: Our TRUST framework shows its potential to facilitate mental healthcare availability.

We develop an algorithm which exceeds the performance of board certified cardiologists in detecting a wide range of heart arrhythmias from electrocardiograms recorded with a single-lead wearable monitor. We build a dataset with more than 500 times the number of unique patients than previously studied corpora. On this dataset, we train a 34-layer convolutional neural network which maps a sequence of ECG samples to a sequence of rhythm classes. Committees of board-certified cardiologists annotate a gold standard test set on which we compare the performance of our model to that of 6 other individual cardiologists. We exceed the average cardiologist performance in both recall (sensitivity) and precision (positive predictive value).

We develop and evaluate a data-driven approach for detecting unusual (anomalous) patient-management actions using past patient cases stored in an electronic health record (EHR) system. Our hypothesis is that patient-management actions that are unusual with respect to past patients may be due to a potential error and that it is worthwhile to raise an alert if such a condition is encountered. We evaluate this hypothesis using data obtained from the electronic health records of 4,486 post-cardiac surgical patients. We base the evaluation on the opinions of a panel of experts. The results support that anomaly-based alerting can have reasonably low false alert rates and that stronger anomalies are correlated with higher alert rates.

Radiology report evaluation is essential for advancing automated report generation. Natural language generation metrics have limited clinical relevance. Clinical efficacy (CE) metrics evaluate important medical findings, but focus mainly on presence and cover only a limited set of entities. Due to heavy reliance on manual annotations, it is difficult for CE metrics to extend clinical entities or attributes. In clinical practice, radiology reports serve as a medium for information transfer. Clinicians use them to perform downstream diagnostic tasks without directly inspecting images. Based on this insight, we propose ReportQA, a clinical-related and flexible radiology report evaluation framework, supporting detailed quantitative analysis of radiology report generation systems. We first collect datasets covering multiple imaging modalities and anatomical regions. We then construct knowledge trees of clinical entities and attributes with radiologist guidance, and use large language models (LLMs) to extract structured information from raw reports. Next, we generate QA pairs from predefined templates and apply quality control through self-filtering and report-based filtering. During evaluation, the report is treated as context, and an LLM acts as a judge model to answer the QA pairs. Based on the resulting QA accuracy, we introduce QAScore metric. Compared with existing metrics, QAScore shows better alignment with radiologist judgments. Experiments on multiple state-of-the-art vision-language models reveal that current report-based inference paradigms struggle to learn fine-grained clinical representations and exhibit strong negative prior biases. In contrast, question-driven inference provides a more effective alternative. For reproducibility and extensibility, we release the knowledge trees, structured reports, and QA pairs, along with the pipeline code for QA construction and evaluation.

Users typically engage with LLMs interactively, yet most existing benchmarks evaluate them in a static, single-turn format, posing reliability concerns in interactive scenarios. We identify a key obstacle towards reliability: LLMs are trained to answer any question, even with incomplete context or insufficient knowledge. In this paper, we propose to change the static paradigm to an interactive one, develop systems that proactively ask questions to gather more information and respond reliably, and introduce an benchmark - MediQ - to evaluate question-asking ability in LLMs. MediQ simulates clinical interactions consisting of a Patient System and an adaptive Expert System; with potentially incomplete initial information, the Expert refrains from making diagnostic decisions when unconfident, and instead elicits missing details via follow-up questions. We provide a pipeline to convert single-turn medical benchmarks into an interactive format. Our results show that directly prompting state-of-the-art LLMs to ask questions degrades performance, indicating that adapting LLMs to proactive information-seeking settings is nontrivial. We experiment with abstention strategies to better estimate model confidence and decide when to ask questions, improving diagnostic accuracy by 22.3%; however, performance still lags compared to an (unrealistic in practice) upper bound with complete information upfront. Further analyses show improved interactive performance with filtering irrelevant contexts and reformatting conversations. Overall, we introduce a novel problem towards LLM reliability, an interactive MediQ benchmark and a novel question-asking system, and highlight directions to extend LLMs' information-seeking abilities in critical domains.

Diagnosing a patient from video requires more than recognizing the sign: a vision-language model must turn what it sees into hypotheses, questions and tests. DynamicDx evaluates each step in 71 neurological consultations across 11 sign categories, linking authentic patient videos to confirmed diagnoses and fixed charts built from the same case reports, so that every model queries the same evidence. Across five such models, video improves accuracy by 9.9-22.5 percentage points over blind input, but neither recognition alone nor temporal order explains the gain: the cause is usually missing from the model's video-only differential diagnosis even when the sign is recognized, and shuffling the frames produces no reliable accuracy loss. Instead, a trajectory replay traces most of the gain to the investigation results the video prompts. Evidence acquisition is the bottleneck: supplying the decisive investigations raises accuracy to 73.2-93.0%. Two interventions act on it. A post-trained 4B video describer improves sign descriptions, especially from a short, densely sampled segment, and source-clean literature retrieval expands initial hypotheses; both bring the tests a model orders closer to those the treating clinicians documented and, through them, raise accuracy. For video-based diagnosis, seeing better helps when it leads to asking better.

Recent advancements in Large Language Models (LLMs) have demonstrated significant promise in clinical diagnosis. However, current models struggle to emulate the iterative, diagnostic hypothesis-driven reasoning of real clinical scenarios. Specifically, current LLMs suffer from three critical limitations: (1) generating hallucinated medical content due to weak grounding in verified knowledge, (2) asking redundant or inefficient questions rather than discriminative ones that hinder diagnostic progress, and (3) losing coherence over multi-turn dialogues, leading to contradictory or inconsistent conclusions. To address these challenges, we propose MedKGI, a diagnostic framework grounded in clinical practices. MedKGI integrates a medical knowledge graph (KG) to constrain reasoning to validated medical ontologies, selects questions based on information gain to maximize diagnostic efficiency, and adopts an OSCE-format structured state to maintain consistent evidence tracking across turns. Experiments on clinical benchmarks show that MedKGI outperforms strong LLM baselines in both diagnostic accuracy and inquiry efficiency, improving dialogue efficiency by 30% on average while maintaining state-of-the-art accuracy.

Generating clinical reports from raw recordings such as X-rays and electroencephalogram (EEG) is an essential and routine task for doctors. However, it is often time-consuming to write accurate and detailed reports. Most existing methods try to generate the whole reports from the raw input with limited success because 1) generated reports often contain errors that need manual review and correction, 2) it does not save time when doctors want to write additional information into the report, and 3) the generated reports are not customized based on individual doctors' preference. We propose {\it CL}inic{\it A}l {\it R}eport {\it A}uto-completion (CLARA), an interactive method that generates reports in a sentence by sentence fashion based on doctors' anchor words and partially completed sentences. CLARA searches for most relevant sentences from existing reports as the template for the current report. The retrieved sentences are sequentially modified by combining with the input feature representations to create the final report. In our experimental evaluation, CLARA achieved 0.393 CIDEr and 0.248 BLEU-4 on X-ray reports and 0.482 CIDEr and 0.491 BLEU-4 for EEG reports for sentence-level generation, which is up to 35% improvement over the best baseline. Also via our qualitative evaluation, CLARA is shown to produce reports which have a significantly higher level of approval by doctors in a user study (3.74 out of 5 for CLARA vs 2.52 out of 5 for the baseline).

Objective. Clinical AI documentation systems require evaluation methodologies that are clinically valid, economically viable, and sensitive to iterative changes. Methods requiring expert review per scoring instance are too slow and expensive for safe, iterative deployment. We present a case-specific, clinician-authored rubric methodology for clinical AI evaluation and examine whether LLM-generated rubrics can approximate clinician agreement. Materials and Methods. Twenty clinicians authored 1,646 rubrics for 823 clinical cases (736 real-world, 87 synthetic) across primary care, psychiatry, oncology, and behavioral health. Each rubric was validated by confirming that an LLM-based scoring agent consistently scored clinician-preferred outputs higher than rejected ones. Seven versions of an EHR-embedded AI agent for clinicians were evaluated across all cases. Results. Clinician-authored rubrics discriminated effectively between high- and low-quality outputs (median score gap: 82.9%) with high scoring stability (median range: 0.00%). Median scores improved from 84% to 95%. In later experiments, clinician-LLM ranking agreement (tau: 0.42-0.46) matched or exceeded clinician-clinician agreement (tau: 0.38-0.43), attributable to both ceiling compression and LLM rubric improvement. Discussion. This convergence supports incorporating LLM rubrics alongside clinician-authored ones. At roughly 1,000 times lower cost, LLM rubrics enable substantially greater evaluation coverage, while continued clinical authorship grounds evaluation in expert judgment. Ceiling compression poses a methodological challenge for future inter-rater agreement studies. Conclusion. Case-specific rubrics offer a path for clinical AI evaluation that preserves expert judgment while enabling automation at three orders lower cost. Clinician-authored rubrics establish the baseline against which LLM rubrics are validated.

Recent advances in large language models have led to renewed interest in natural language processing in healthcare using the free text of clinical notes. One distinguishing characteristic of clinical notes is their long time span over multiple long documents. The unique structure of clinical notes creates a new design choice: when the context length for a language model predictor is limited, which part of clinical notes should we choose as the input? Existing studies either choose the inputs with domain knowledge or simply truncate them. We propose a framework to analyze the sections with high predictive power. Using MIMIC-III, we show that: 1) predictive power distribution is different between nursing notes and discharge notes and 2) combining different types of notes could improve performance when the context length is large. Our findings suggest that a carefully selected sampling function could enable more efficient information extraction from clinical notes.

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.

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.

Ambient AI scribes draft clinical notes under the reassurance that a clinician signs every note. We audited three commercial AI scribes on the same 142 consultations: 565 notes from recorded UK primary-care and US ambulatory encounters plus authored scenarios. Twelve discovery passes proposed 13,678 candidate errors; the 5,898 clearing an importance filter went to an adversarial panel of two models from different families, each told to refute what it could, and 618 survived. One note in three (31.3% [27.0, 35.6]) carries a verified failure, concentrated in allergy and medication information, invented patient identity, and history written up as examination on telephone consultations that can contain none. No product was given a patient record; setting aside the two classes a record would have prefilled, invented identity and dates, the rate is 24.8% [20.8, 29.0]. One failure mode did not fit our scheme, drawn from published scribe-error taxonomies: a treatment the clinician retracts, recorded as delivered care. Two clinicians adjudicated blind, disjoint samples: a physician author upheld 20 of 21 findings (95.2% [77.3, 99.2]) and an independent clinician, not an author, 12 of 12 ([75.8, 100]); both judged every sampled refusal genuine. A failure rate depends on the instrument as much as the scribes. With model, evidence and settings fixed, the review instruction alone moves the share of candidates verified from 9.3% to 79.0%, and the reviewing family moves it too: alone at that instruction the gentler flags 54.8% of notes against 27.8%. Between 28% and 97% of sampled notes carry a failure depending on the standard. Published audits disagree among themselves by a margin instrument differences alone can produce: omission is 54-86% of their errors against our 23.1%. We release all 618 findings with transcript-side evidence, every prompt and model version, and the re-runnable pipeline.

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).

AI assistance continues to help advance applications in education, from language learning to intelligent tutoring systems, yet current methods for providing students feedback are still quite limited. Most automatic feedback systems either provide binary correctness feedback, which may not help a student understand how to improve, or require hand-coding feedback templates, which may not generalize to new domains. This can be particularly challenging for physical control tasks, where the rich diversity in student behavior and specialized domains make it challenging to leverage general-purpose assistive tools for providing feedback. We design and build CORGI, a model trained to generate language corrections for physical control tasks, such as learning to ride a bike. CORGI takes in as input a pair of student and expert trajectories, and then generates natural language corrections to help the student improve. We collect and train CORGI over data from three diverse physical control tasks (drawing, steering, and joint movement). Through both automatic and human evaluations, we show that CORGI can (i) generate valid feedback for novel student trajectories, (ii) outperform baselines on domains with novel control dynamics, and (iii) improve student learning in an interactive drawing task.

Given the dominance of dense retrievers that do not generalize well beyond their training dataset distributions, domain-specific test sets are essential in evaluating retrieval. There are few test datasets for retrieval systems intended for use by healthcare providers in a point-of-care setting. To fill this gap we have collaborated with medical professionals to create CURE, an ad-hoc retrieval test dataset for passage ranking with 2000 queries spanning 10 medical domains with a monolingual (English) and two cross-lingual (French/Spanish -> English) conditions. In this paper, we describe how CURE was constructed and provide baseline results to showcase its effectiveness as an evaluation tool. CURE is published with a Creative Commons Attribution Non Commercial 4.0 license and can be accessed on Hugging Face.

Real-world clinical diagnosis is a complex process in which the doctor is required to obtain information from both interaction with the patient and conducting medical exams. Additionally, the doctor needs to adapt to different patient personas, as well as noisy and incomplete information that can happen at any time during the process. However, existing benchmarks for medical LLMs and methods for automatic diagnosis largely simplify this process by reducing it to single-turn question answering, noise-free conversations, or sequential exam making, etc., ignoring the interactive and uncertain nature of clinical diagnosis. In this paper, we aim to address this gap by formalizing clinical diagnosis as a Partially Observable Markov Decision Process (POMDP) with three action types: questioning the patient, ordering medical exams as tool calls, and issuing a diagnosis. We also introduce a systematic noise model comprising seven patient noise types and three exam noise types. Using our proposed environment, we train an effective diagnosis agent, MedExAgent, through a two-stage pipeline that first performs supervised finetuning on synthetic conversations structured after the Calgary-Cambridge model for clinical interviews, and then applies DAPO to optimize a composite reward capturing diagnostic accuracy, tool call quality, and exam cost including financial cost and patient discomfort. Through extensive experiments and ablation studies, we demonstrate that MedExAgent achieves diagnostic performance comparable to larger models while maintaining cost-efficient examination strategies.

We here summarize our experience running a challenge with open data for musical genre recognition. Those notes motivate the task and the challenge design, show some statistics about the submissions, and present the results.

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.

Lung cancer is the deadliest type of cancer worldwide and late detection is the major factor for the low survival rate of patients. Low dose computed tomography has been suggested as a potential screening tool but manual screening is costly, time-consuming and prone to variability. This has fueled the development of automatic methods for the detection, segmentation and characterisation of pulmonary nodules but its application to clinical routine is challenging. In this study, a new database for the development and testing of pulmonary nodule computer-aided strategies is presented which intends to complement current databases by giving additional focus to radiologist variability and local clinical reality. State-of-the-art nodule detection, segmentation and characterization methods are tested and compared to manual annotations as well as collaborative strategies combining multiple radiologists and radiologists and computer-aided systems. It is shown that state-of-the-art methodologies can determine a patient's follow-up recommendation as accurately as a radiologist, though the nodule detection method used shows decreased performance in this database.

This paper presents our team's participation in the MEDIQA-ClinicalNLP2024 shared task B. We present a novel approach to diagnosing clinical dermatology cases by integrating large multimodal models, specifically leveraging the capabilities of GPT-4V under a retriever and a re-ranker framework. Our investigation reveals that GPT-4V, when used as a retrieval agent, can accurately retrieve the correct skin condition 85% of the time using dermatological images and brief patient histories. Additionally, we empirically show that Naive Chain-of-Thought (CoT) works well for retrieval while Medical Guidelines Grounded CoT is required for accurate dermatological diagnosis. Further, we introduce a Multi-Agent Conversation (MAC) framework and show its superior performance and potential over the best CoT strategy. The experiments suggest that using naive CoT for retrieval and multi-agent conversation for critique-based diagnosis, GPT-4V can lead to an early and accurate diagnosis of dermatological conditions. The implications of this work extend to improving diagnostic workflows, supporting dermatological education, and enhancing patient care by providing a scalable, accessible, and accurate diagnostic tool.

Prior work uses linear probes on benchmark prompts as evidence of evaluation awareness in large language models. Because evaluation context is typically entangled with benchmark format and genre, it is unclear whether probe-based signals reflect context or surface structure. We test whether these signals persist under partial control of prompt format using a controlled 2x2 dataset and diagnostic rewrites. We find that probes primarily track benchmark-canonical structure and fail to generalize to free-form prompts independent of linguistic style. Thus, standard probe-based methodologies do not reliably disentangle evaluation context from structural artifacts, limiting the evidential strength of existing results.