Daily Papers

Listening to heart and lung sounds - auscultation - is one of the first and most fundamental steps in a clinical examination. Despite being fast and non-invasive, it demands years of experience to interpret subtle audio cues. Recent deep learning methods have made progress in automating cardiopulmonary sound analysis, yet most are restricted to simple classification and offer little clinical interpretability or decision support. We present StethoLM, the first audio-language model specialized for cardiopulmonary auscultation, capable of performing instruction-driven clinical tasks across the full spectrum of auscultation analysis. StethoLM integrates audio encoding with a medical language model backbone and is trained on StethoBench, a comprehensive benchmark comprising 77,027 instruction-response pairs synthesized from 16,125 labeled cardiopulmonary recordings spanning seven clinical task categories: binary classification, detection, reporting, reasoning, differential diagnosis, comparison, and location-based analysis. Through multi-stage training that combines supervised fine-tuning and direct preference optimization, StethoLM achieves substantial gains in performance and robustness on out-of-distribution data. Our work establishes a foundation for instruction-following AI systems in clinical auscultation.

High computation costs and latency of large language models such as GPT-4 have limited their deployment in clinical settings. Small language models (SLMs) offer a cost-effective alternative, but their limited capacity requires biomedical domain adaptation, which remains challenging. An additional bottleneck is the unavailability and high sensitivity of clinical data. To address these challenges, we propose a novel framework for adapting SLMs into high-performing clinical models. We introduce the MediPhi collection of 3.8B-parameter SLMs developed with our novel framework: pre-instruction tuning of experts on relevant medical and clinical corpora (PMC, Medical Guideline, MedWiki, etc.), model merging, and clinical-tasks alignment. To cover most clinical tasks, we extended the CLUE benchmark to CLUE+, doubling its size. Our expert models deliver relative improvements on this benchmark over the base model without any task-specific fine-tuning: 64.3% on medical entities, 49.5% on radiology reports, and 44% on ICD-10 coding (outperforming GPT-4-0125 by 14%). We unify the expert models into MediPhi via model merging, preserving gains across benchmarks. Furthermore, we built the MediFlow collection, a synthetic dataset of 2.5 million high-quality instructions on 14 medical NLP tasks, 98 fine-grained document types, and JSON format support. Alignment of MediPhi using supervised fine-tuning and direct preference optimization achieves further gains of 18.9% on average.

Large language models (LLMs) represent a transformative class of AI tools capable of revolutionizing various aspects of healthcare by generating human-like responses across diverse contexts and adapting to novel tasks following human instructions. Their potential application spans a broad range of medical tasks, such as clinical documentation, matching patients to clinical trials, and answering medical questions. In this primer paper, we propose an actionable guideline to help healthcare professionals more efficiently utilize LLMs in their work, along with a set of best practices. This approach consists of several main phases, including formulating the task, choosing LLMs, prompt engineering, fine-tuning, and deployment. We start with the discussion of critical considerations in identifying healthcare tasks that align with the core capabilities of LLMs and selecting models based on the selected task and data, performance requirements, and model interface. We then review the strategies, such as prompt engineering and fine-tuning, to adapt standard LLMs to specialized medical tasks. Deployment considerations, including regulatory compliance, ethical guidelines, and continuous monitoring for fairness and bias, are also discussed. By providing a structured step-by-step methodology, this tutorial aims to equip healthcare professionals with the tools necessary to effectively integrate LLMs into clinical practice, ensuring that these powerful technologies are applied in a safe, reliable, and impactful manner.

Single-task models have proven pivotal in solving specific tasks; however, they have limitations in real-world applications where multi-tasking is necessary and domain shifts are exhibited. Recently, instructional prompts have shown significant improvement towards multi-task generalization; however, the effect of instructional prompts and Multi-Task Learning (MTL) has not been systematically studied in the biomedical domain. Motivated by this, this paper explores the impact of instructional prompts for biomedical MTL. We introduce the BoX, a collection of 32 instruction tasks for Biomedical NLP across (X) various categories. Using this meta-dataset, we propose a unified model termed In-BoXBART, that can jointly learn all tasks of the BoX without any task-specific modules. To the best of our knowledge, this is the first attempt to propose a unified model in the biomedical domain and use instructions to achieve generalization across several biomedical tasks. Experimental results indicate that the proposed model: 1) outperforms the single-task baseline by ~3% and multi-task (without instruction) baseline by ~18% on an average, and 2) shows ~23% improvement compared to the single-task baseline in few-shot learning (i.e., 32 instances per task) on an average. Our analysis indicates that there is significant room for improvement across tasks in the BoX, implying the scope for future research direction.

Task semantics can be expressed by a set of input-to-output examples or a piece of textual instruction. Conventional machine learning approaches for natural language processing (NLP) mainly rely on the availability of large-scale sets of task-specific examples. Two issues arise: first, collecting task-specific labeled examples does not apply to scenarios where tasks may be too complicated or costly to annotate, or the system is required to handle a new task immediately; second, this is not user-friendly since end-users are probably more willing to provide task description rather than a set of examples before using the system. Therefore, the community is paying increasing interest in a new supervision-seeking paradigm for NLP: learning from task instructions. Despite its impressive progress, there are some common issues that the community struggles with. This survey paper tries to summarize and provide insights into the current research on instruction learning, particularly by answering the following questions: (i) What is task instruction, and what instruction types exist? (ii) How to model instructions? (iii) What factors influence and explain the instructions' performance? (iv) What challenges remain in instruction learning? To our knowledge, this is the first comprehensive survey about textual instructions.

Large language models (LLMs) excel at text generation, but their ability to handle clinical classification tasks involving structured data, such as time series, remains underexplored. In this work, we adapt instruction-tuned LLMs using DSPy-based prompt optimization to process clinical notes and structured EHR inputs jointly. Our results show that this approach achieves performance on par with specialized multimodal systems while requiring less complexity and offering greater adaptability across tasks.

Large Language Models (LLMs) have demonstrated significant enhancements in instruction-following abilities through instruction tuning, achieving notable performances across various tasks. Previous research has focused on fine-tuning medical domain-specific LLMs using an extensive array of medical-specific data, incorporating millions of pieces of biomedical literature to augment their medical capabilities. However, existing medical instruction-tuned LLMs have been constrained by the limited scope of tasks and instructions available, restricting the efficacy of instruction tuning and adversely affecting performance in the general domain. In this paper, we fine-tune LLaMA-series models using 52k diverse, machine-generated, medical instruction-following data, MedInstruct-52k, resulting in the model AlpaCare. Comprehensive experimental results on both general and medical-specific domain free-form instruction evaluations showcase AlpaCare's strong medical proficiency and generalizability compared to previous instruction-tuned models in both medical and general domains. We provide public access to our MedInstruct-52k dataset and a clinician-crafted free-form instruction test set, MedInstruct-test, along with our codebase, to foster further research and development. Our project page is available at https://github.com/XZhang97666/AlpaCare.

Despite the critical need to align search targets with users' intention, retrievers often only prioritize query information without delving into the users' intended search context. Enhancing the capability of retrievers to understand intentions and preferences of users, akin to language model instructions, has the potential to yield more aligned search targets. Prior studies restrict the application of instructions in information retrieval to a task description format, neglecting the broader context of diverse and evolving search scenarios. Furthermore, the prevailing benchmarks utilized for evaluation lack explicit tailoring to assess instruction-following ability, thereby hindering progress in this field. In response to these limitations, we propose a novel benchmark,INSTRUCTIR, specifically designed to evaluate instruction-following ability in information retrieval tasks. Our approach focuses on user-aligned instructions tailored to each query instance, reflecting the diverse characteristics inherent in real-world search scenarios. Through experimental analysis, we observe that retrievers fine-tuned to follow task-style instructions, such as INSTRUCTOR, can underperform compared to their non-instruction-tuned counterparts. This underscores potential overfitting issues inherent in constructing retrievers trained on existing instruction-aware retrieval datasets.

Despite widespread deployment of Large Language Models, systematic evaluation of instruction-following capabilities remains challenging. While comprehensive benchmarks exist, focused assessments that quickly diagnose specific instruction adherence patterns are valuable. As newer models may be trained on existing benchmarks, novel evaluation approaches are needed to assess genuine capabilities rather than memorized performance. This paper presents a streamlined evaluation framework using twenty carefully designed prompts to assess LLM instruction-following across diverse task categories. We demonstrate this framework through a large-scale empirical study conducted on October 14, 2025, testing 256 verified working models from 331 available via OpenRouter. To ensure methodological rigor and prevent selection bias, we first verified each model's basic functionality before inclusion. Unlike large-scale benchmarks requiring extensive computational resources, our approach offers a practical diagnostic tool researchers and practitioners can readily apply. Our methodology builds upon verifiable instructions while introducing a compact test suite balancing comprehensiveness with efficiency. Each prompt targets distinct aspects of instruction following, including format compliance, content constraints, logical sequencing, and multi-step task execution. We evaluate models from major providers (OpenAI, Anthropic, Google, Meta, Mistral) and emerging implementations (Qwen, DeepSeek, community models), providing comparative performance analysis. Our findings reveal consistent failure modes and identify specific instruction types posing particular challenges. This work contributes both a practical evaluation tool and one of the most comprehensive empirical analyses of instruction-following capabilities across the contemporary LLM landscape.

Open-source, multilingual medical large language models (LLMs) have the potential to serve linguistically diverse populations across different regions. Adapting generic LLMs for healthcare often requires continual pretraining, but this approach is computationally expensive and sometimes impractical. Instruction fine-tuning on a specific task may not always guarantee optimal performance due to the lack of broader domain knowledge that the model needs to understand and reason effectively in diverse scenarios. To address these challenges, we introduce two multilingual instruction fine-tuning datasets, MMed-IFT and MMed-IFT-MC, containing over 200k high-quality medical samples in six languages. We propose a two-stage training paradigm: the first stage injects general medical knowledge using MMed-IFT, while the second stage fine-tunes task-specific multiple-choice questions with MMed-IFT-MC. Our method achieves competitive results on both English and multilingual benchmarks, striking a balance between computational efficiency and performance. We plan to make our dataset and model weights public at https://github.com/SpassMed/Med-Llama3 in the future.

Clinical trials are fundamental in developing new drugs, medical devices, and treatments. However, they are often time-consuming and have low success rates. Although there have been initial attempts to create large language models (LLMs) for clinical trial design and patient-trial matching, these models remain task-specific and not adaptable to diverse clinical trial tasks. To address this challenge, we propose a clinical trial foundation model named Panacea, designed to handle multiple tasks, including trial search, trial summarization, trial design, and patient-trial matching. We also assemble a large-scale dataset, named TrialAlign, of 793,279 trial documents and 1,113,207 trial-related scientific papers, to infuse clinical knowledge into the model by pre-training. We further curate TrialInstruct, which has 200,866 of instruction data for fine-tuning. These resources enable Panacea to be widely applicable for a range of clinical trial tasks based on user requirements. We evaluated Panacea on a new benchmark, named TrialPanorama, which covers eight clinical trial tasks. Our method performed the best on seven of the eight tasks compared to six cutting-edge generic or medicine-specific LLMs. Specifically, Panacea showed great potential to collaborate with human experts in crafting the design of eligibility criteria, study arms, and outcome measures, in multi-round conversations. In addition, Panacea achieved 14.42% improvement in patient-trial matching, 41.78% to 52.02% improvement in trial search, and consistently ranked at the top for five aspects of trial summarization. Our approach demonstrates the effectiveness of Panacea in clinical trials and establishes a comprehensive resource, including training data, model, and benchmark, for developing clinical trial foundation models, paving the path for AI-based clinical trial development.

Experts in various fields routinely perform methodical writing tasks to plan, organize, and report their work. From a clinician writing a differential diagnosis for a patient, to a teacher writing a lesson plan for students, these tasks are pervasive, requiring to methodically generate structured long-form output for a given input. We develop a typology of methodical tasks structured in the form of a task objective, procedure, input, and output, and introduce DoLoMiTes, a novel benchmark with specifications for 519 such tasks elicited from hundreds of experts from across 25 fields. Our benchmark further contains specific instantiations of methodical tasks with concrete input and output examples (1,857 in total) which we obtain by collecting expert revisions of up to 10 model-generated examples of each task. We use these examples to evaluate contemporary language models highlighting that automating methodical tasks is a challenging long-form generation problem, as it requires performing complex inferences, while drawing upon the given context as well as domain knowledge.

Recent researches of large language models(LLM), which is pre-trained on massive general-purpose corpora, have achieved breakthroughs in responding human queries. However, these methods face challenges including limited data insufficiency to support extensive pre-training and can not align responses with users' instructions. To address these issues, we introduce a medical instruction dataset, CMedINS, containing six medical instructions derived from actual medical tasks, which effectively fine-tunes LLM in conjunction with other data. Subsequently, We launch our medical model, IIMedGPT, employing an efficient preference alignment method, Direct preference Optimization(DPO). The results show that our final model outperforms existing medical models in medical dialogue.Datsets, Code and model checkpoints will be released upon acceptance.

In this study, we present MedS-Bench, a comprehensive benchmark designed to evaluate the performance of large language models (LLMs) in clinical contexts. Unlike existing benchmarks that focus on multiple-choice question answering, MedS-Bench spans 11 high-level clinical tasks, including clinical report summarization, treatment recommendations, diagnosis, named entity recognition, and medical concept explanation, among others. We evaluated six leading LLMs, e.g., MEDITRON, Mistral, InternLM 2, Llama 3, GPT-4, and Claude-3.5 using few-shot prompting, and found that even the most sophisticated models struggle with these complex tasks. To address these limitations, we developed MedS-Ins, a large-scale instruction tuning dataset for medicine. MedS-Ins comprises 58 medically oriented language corpora, totaling 13.5 million samples across 122 tasks. To demonstrate the dataset's utility, we conducted a proof-of-concept experiment by performing instruction tuning on a lightweight, open-source medical language model. The resulting model, MMedIns-Llama 3, significantly outperformed existing models across nearly all clinical tasks. To promote further advancements in the application of LLMs to clinical challenges, we have made the MedS-Ins dataset fully accessible and invite the research community to contribute to its expansion.Additionally, we have launched a dynamic leaderboard for MedS-Bench, which we plan to regularly update the test set to track progress and enhance the adaptation of general LLMs to the medical domain. Leaderboard: https://henrychur.github.io/MedS-Bench/. Github: https://github.com/MAGIC-AI4Med/MedS-Ins.

Large language models (LLMs) have shown impressive performance in following natural language instructions to solve unseen tasks. However, it remains unclear whether models truly understand task definitions and whether the human-written definitions are optimal. In this paper, we systematically study the role of task definitions in instruction learning. We first conduct an ablation analysis informed by human annotations to understand which parts of a task definition are most important, and find that model performance only drops substantially when removing contents describing the task output, in particular label information. Next, we propose an automatic algorithm to compress task definitions to a minimal supporting set of tokens, and find that 60\% of tokens can be removed while maintaining or even improving model performance. Based on these results, we propose two strategies to help models better leverage task instructions: (1) providing only key information for tasks in a common structured format, and (2) adding a meta-tuning stage to help the model better understand the definitions. With these two strategies, we achieve a 4.2 Rouge-L improvement over 119 unseen test tasks.

The integration of large language model (LLM) techniques in the field of medical analysis has brought about significant advancements, yet the scarcity of large, diverse, and well-annotated datasets remains a major challenge. Medical data and tasks, which vary in format, size, and other parameters, require extensive preprocessing and standardization for effective use in training LLMs. To address these challenges, we introduce MedINST, the Meta Dataset of Biomedical Instructions, a novel multi-domain, multi-task instructional meta-dataset. MedINST comprises 133 biomedical NLP tasks and over 7 million training samples, making it the most comprehensive biomedical instruction dataset to date. Using MedINST as the meta dataset, we curate MedINST32, a challenging benchmark with different task difficulties aiming to evaluate LLMs' generalization ability. We fine-tune several LLMs on MedINST and evaluate on MedINST32, showcasing enhanced cross-task generalization.

The emergence of advanced reasoning capabilities in Large Language Models (LLMs) marks a transformative development in healthcare applications. Beyond merely expanding functional capabilities, these reasoning mechanisms enhance decision transparency and explainability-critical requirements in medical contexts. This survey examines the transformation of medical LLMs from basic information retrieval tools to sophisticated clinical reasoning systems capable of supporting complex healthcare decisions. We provide a thorough analysis of the enabling technological foundations, with a particular focus on specialized prompting techniques like Chain-of-Thought and recent breakthroughs in Reinforcement Learning exemplified by DeepSeek-R1. Our investigation evaluates purpose-built medical frameworks while also examining emerging paradigms such as multi-agent collaborative systems and innovative prompting architectures. The survey critically assesses current evaluation methodologies for medical validation and addresses persistent challenges in field interpretation limitations, bias mitigation strategies, patient safety frameworks, and integration of multimodal clinical data. Through this survey, we seek to establish a roadmap for developing reliable LLMs that can serve as effective partners in clinical practice and medical research.

In many real-world applications, users rely on natural language instructions to guide large language models (LLMs) across a wide range of tasks. These instructions are often complex, diverse, and subject to frequent change. However, LLMs do not always attend to these instructions reliably, and users lack simple mechanisms to emphasize their importance beyond modifying prompt wording or structure. To address this, we present an inference-time method that enables users to emphasize specific parts of their prompt by steering the model's attention toward them, aligning the model's perceived importance of different prompt tokens with user intent. Unlike prior approaches that are limited to static instructions, require significant offline profiling, or rely on fixed biases, we dynamically update the proportion of model attention given to the user-specified parts--ensuring improved instruction following without performance degradation. We demonstrate that our approach improves instruction following across a variety of tasks involving multiple instructions and generalizes across models of varying scales.

Diverse instruction data is vital for effective instruction tuning of large language models, as it enables the model to generalize across different types of inputs . Building such diversified instruction dataset is an essential step in this process. Existing approaches often leverage large language models to automatically explore and generate diverse instructions, ensuring both data diversity and quality. However, they tend to overlook an important factor in real-world applications: on-task relevance. In practice, only a few real-world applications require a truly general-purpose model; most benefit from task-specific knowledge tailored to their particular use case. Therefore, it is vital to develop instruction augmentation methods that not only maintain diversity but are also optimized for specific, real-world scenarios. We thus introduce Task Centric Instruction Augmentation (TCIA), a framework that systematically expands instructions while preserving both diversity and task alignment. By representing instructions in a discrete query-constraints space, TCIA creates a rich set of task-relevant instructions and enables models to generalize to these task-specific instructions without sacrificing overall performance. Experiments show that TCIA improves open-source LLMs' performance by an average of 8.7% across four real-world, task-specific applications, and in some cases outperforming leading closed-source models. These improvements do not compromise general instruction-following ability, making TCIA a scalable and efficient solution for adapting LLMs to real-world, task-focused applications.

Multi-Modal Large Language Models (MLLMs), despite being successful, exhibit limited generality and often fall short when compared to specialized models. Recently, LLM-based agents have been developed to address these challenges by selecting appropriate specialized models as tools based on user inputs. However, such advancements have not been extensively explored within the medical domain. To bridge this gap, this paper introduces the first agent explicitly designed for the medical field, named Multi-modal Medical Agent (MMedAgent). We curate an instruction-tuning dataset comprising six medical tools solving seven tasks across five modalities, enabling the agent to choose the most suitable tools for a given task. Comprehensive experiments demonstrate that MMedAgent achieves superior performance across a variety of medical tasks compared to state-of-the-art open-source methods and even the closed-source model, GPT-4o. Furthermore, MMedAgent exhibits efficiency in updating and integrating new medical tools. Codes and models are all available.

Instruction tuning is an emergent paradigm in NLP wherein natural language instructions are leveraged with language models to induce zero-shot performance on unseen tasks. Instructions have been shown to enable good performance on unseen tasks and datasets in both large and small language models. Dialogue is an especially interesting area to explore instruction tuning because dialogue systems perform multiple kinds of tasks related to language (e.g., natural language understanding and generation, domain-specific interaction), yet instruction tuning has not been systematically explored for dialogue-related tasks. We introduce InstructDial, an instruction tuning framework for dialogue, which consists of a repository of 48 diverse dialogue tasks in a unified text-to-text format created from 59 openly available dialogue datasets. Next, we explore cross-task generalization ability on models tuned on InstructDial across diverse dialogue tasks. Our analysis reveals that InstructDial enables good zero-shot performance on unseen datasets and tasks such as dialogue evaluation and intent detection, and even better performance in a few-shot setting. To ensure that models adhere to instructions, we introduce novel meta-tasks. We establish benchmark zero-shot and few-shot performance of models trained using the proposed framework on multiple dialogue tasks.

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

By conditioning on natural language instructions, large language models (LLMs) have displayed impressive capabilities as general-purpose computers. However, task performance depends significantly on the quality of the prompt used to steer the model, and most effective prompts have been handcrafted by humans. Inspired by classical program synthesis and the human approach to prompt engineering, we propose Automatic Prompt Engineer (APE) for automatic instruction generation and selection. In our method, we treat the instruction as the "program," optimized by searching over a pool of instruction candidates proposed by an LLM in order to maximize a chosen score function. To evaluate the quality of the selected instruction, we evaluate the zero-shot performance of another LLM following the selected instruction. Experiments on 24 NLP tasks show that our automatically generated instructions outperform the prior LLM baseline by a large margin and achieve better or comparable performance to the instructions generated by human annotators on 19/24 tasks. We conduct extensive qualitative and quantitative analyses to explore the performance of APE. We show that APE-engineered prompts can be applied to steer models toward truthfulness and/or informativeness, as well as to improve few-shot learning performance by simply prepending them to standard in-context learning prompts. Please check out our webpage at https://sites.google.com/view/automatic-prompt-engineer.

Multimodal in-context learning (ICL) remains underexplored despite significant potential for domains such as medicine. Clinicians routinely encounter diverse, specialized tasks requiring adaptation from limited examples, such as drawing insights from a few relevant prior cases or considering a constrained set of differential diagnoses. While multimodal large language models (MLLMs) have shown advances in medical visual question answering (VQA), their ability to learn multimodal tasks from context is largely unknown. We introduce SMMILE, the first expert-driven multimodal ICL benchmark for medical tasks. Eleven medical experts curated problems, each including a multimodal query and multimodal in-context examples as task demonstrations. SMMILE encompasses 111 problems (517 question-image-answer triplets) covering 6 medical specialties and 13 imaging modalities. We further introduce SMMILE++, an augmented variant with 1038 permuted problems. A comprehensive evaluation of 15 MLLMs demonstrates that most models exhibit moderate to poor multimodal ICL ability in medical tasks. In open-ended evaluations, ICL contributes only 8% average improvement over zero-shot on SMMILE and 9.4% on SMMILE++. We observe a susceptibility for irrelevant in-context examples: even a single noisy or irrelevant example can degrade performance by up to 9.5%. Moreover, example ordering exhibits a recency bias, i.e., placing the most relevant example last can lead to substantial performance improvements by up to 71%. Our findings highlight critical limitations and biases in current MLLMs when learning multimodal medical tasks from context.

Large language models (LLMs) struggle to follow a sequence of instructions in a single query as they may ignore or misinterpret part of it. This impairs their performance in complex problems whose solution requires multiple intermediate steps, such as multilingual (translate then answer) and multimodal (caption then answer) tasks. We empirically verify this with open-source LLMs as large as LLaMA-2 70B and Mixtral-8x7B. Targeting the scarcity of sequential instructions in present-day data, we propose sequential instruction tuning, a simple yet effective strategy to automatically augment instruction tuning data and equip LLMs with the ability to execute multiple sequential instructions. After exploring interleaving instructions in existing datasets, such as Alpaca, with a wide range of intermediate tasks, we find that sequential instruction-tuned models consistently outperform the conventional instruction-tuned baselines in downstream tasks involving reasoning, multilingual, and multimodal abilities. To shed further light on our technique, we analyse how adversarial intermediate texts, unseen tasks, prompt verbalization, number of tasks, and prompt length affect SIT. We hope that this method will open new research avenues on instruction tuning for complex tasks.

Large Language Models (LLMs), particularly those similar to ChatGPT, have significantly influenced the field of Natural Language Processing (NLP). While these models excel in general language tasks, their performance in domain-specific downstream tasks such as biomedical and clinical Named Entity Recognition (NER), Relation Extraction (RE), and Medical Natural Language Inference (NLI) is still evolving. In this context, our study investigates the potential of instruction tuning for biomedical language processing, applying this technique to two general LLMs of substantial scale. We present a comprehensive, instruction-based model trained on a dataset that consists of approximately 200,000 instruction-focused samples. This dataset represents a carefully curated compilation of existing data, meticulously adapted and reformatted to align with the specific requirements of our instruction-based tasks. This initiative represents an important step in utilising such models to achieve results on par with specialised encoder-only models like BioBERT and BioClinicalBERT for various classical biomedical NLP tasks. Our work includes an analysis of the dataset's composition and its impact on model performance, providing insights into the intricacies of instruction tuning. By sharing our codes, models, and the distinctively assembled instruction-based dataset, we seek to encourage ongoing research and development in this area.

The ability of large language models (LLMs) to follow natural language instructions with human-level fluency suggests many opportunities in healthcare to reduce administrative burden and improve quality of care. However, evaluating LLMs on realistic text generation tasks for healthcare remains challenging. Existing question answering datasets for electronic health record (EHR) data fail to capture the complexity of information needs and documentation burdens experienced by clinicians. To address these challenges, we introduce MedAlign, a benchmark dataset of 983 natural language instructions for EHR data. MedAlign is curated by 15 clinicians (7 specialities), includes clinician-written reference responses for 303 instructions, and provides 276 longitudinal EHRs for grounding instruction-response pairs. We used MedAlign to evaluate 6 general domain LLMs, having clinicians rank the accuracy and quality of each LLM response. We found high error rates, ranging from 35% (GPT-4) to 68% (MPT-7B-Instruct), and an 8.3% drop in accuracy moving from 32k to 2k context lengths for GPT-4. Finally, we report correlations between clinician rankings and automated natural language generation metrics as a way to rank LLMs without human review. We make MedAlign available under a research data use agreement to enable LLM evaluations on tasks aligned with clinician needs and preferences.

We introduce SoftTiger, a clinical large language model (CLaM) designed as a foundation model for healthcare workflows. The narrative and unstructured nature of clinical notes is a major obstacle for healthcare intelligentization. We address a critical problem of structuring clinical notes into clinical data, according to international interoperability standards. We collect and annotate data for three subtasks, namely, international patient summary, clinical impression and medical encounter. We then supervised fine-tuned a state-of-the-art LLM using public and credentialed clinical data. The training is orchestrated in a way that the target model can first support basic clinical tasks such as abbreviation expansion and temporal information extraction, and then learn to perform more complex downstream clinical tasks. Moreover, we address several modeling challenges in the healthcare context, e.g., extra long context window. Our blind pairwise evaluation shows that SoftTiger outperforms other popular open-source models and GPT-3.5, comparable to Gemini-pro, with a mild gap from GPT-4. We believe that LLMs may become a step-stone towards healthcare digitalization and democratization. Therefore, we publicly release SoftTiger models at scales of 13 billion and 70 billion parameters, as well as datasets and code for our innovative scalable evaluation, hopefully, making a significant contribution to the healthcare industry.

Data science plays a critical role in clinical research, but it requires professionals with expertise in coding and medical data analysis. Large language models (LLMs) have shown great potential in supporting medical tasks and performing well in general coding tests. However, these tests do not assess LLMs' ability to handle data science tasks in medicine, nor do they explore their practical utility in clinical research. To address this, we developed a dataset consisting of 293 real-world data science coding tasks, based on 39 published clinical studies, covering 128 tasks in Python and 165 tasks in R. This dataset simulates realistic clinical research scenarios using patient data. Our findings reveal that cutting-edge LLMs struggle to generate perfect solutions, frequently failing to follow input instructions, understand target data, and adhere to standard analysis practices. Consequently, LLMs are not yet ready to fully automate data science tasks. We benchmarked advanced adaptation methods and found two to be particularly effective: chain-of-thought prompting, which provides a step-by-step plan for data analysis, which led to a 60% improvement in code accuracy; and self-reflection, enabling LLMs to iteratively refine their code, yielding a 38% accuracy improvement. Building on these insights, we developed a platform that integrates LLMs into the data science workflow for medical professionals. In a user study with five medical doctors, we found that while LLMs cannot fully automate coding tasks, they significantly streamline the programming process. We found that 80% of their submitted code solutions were incorporated from LLM-generated code, with up to 96% reuse in some cases. Our analysis highlights the potential of LLMs, when integrated into expert workflows, to enhance data science efficiency in clinical research.

We present SciRIFF (Scientific Resource for Instruction-Following and Finetuning), a dataset of 137K instruction-following demonstrations for 54 tasks covering five essential scientific literature understanding capabilities: information extraction, summarization, question answering, claim verification, and classification. SciRIFF demonstrations are notable for their long input contexts, detailed task specifications, and complex structured outputs. While instruction-following resources are available in specific domains such as clinical medicine and chemistry, SciRIFF is the first dataset focused on extracting and synthesizing information from research literature across a wide range of scientific fields. To demonstrate the utility of SciRIFF, we develop a sample-efficient strategy to adapt a general instruction-following model for science by performing additional finetuning on a mix of general-domain and SciRIFF demonstrations. In evaluations on nine held-out scientific tasks, our model -- called SciTulu -- improves over a strong LLM baseline by 28.1% and 6.5% at the 7B and 70B scales respectively, while maintaining general instruction-following performance within 2% of the baseline. We are optimistic that SciRIFF will facilitate the development and evaluation of LLMs to help researchers navigate the ever-growing body of scientific literature. We release our dataset, model checkpoints, and data processing and evaluation code to enable further research.

Traditional computer vision generally solves each single task independently by a dedicated model with the task instruction implicitly designed in the model architecture, arising two limitations: (1) it leads to task-specific models, which require multiple models for different tasks and restrict the potential synergies from diverse tasks; (2) it leads to a pre-defined and fixed model interface that has limited interactivity and adaptability in following user' task instructions. To address them, Visual Instruction Tuning (VIT) has been intensively studied recently, which finetunes a large vision model with language as task instructions, aiming to learn from a wide range of vision tasks described by language instructions a general-purpose multimodal model that can follow arbitrary instructions and thus solve arbitrary tasks specified by the user. This work aims to provide a systematic review of visual instruction tuning, covering (1) the background that presents computer vision task paradigms and the development of VIT; (2) the foundations of VIT that introduce commonly used network architectures, visual instruction tuning frameworks and objectives, and evaluation setups and tasks; (3) the commonly used datasets in visual instruction tuning and evaluation; (4) the review of existing VIT methods that categorizes them with a taxonomy according to both the studied vision task and the method design and highlights the major contributions, strengths, and shortcomings of them; (5) the comparison and discussion of VIT methods over various instruction-following benchmarks; (6) several challenges, open directions and possible future works in visual instruction tuning research.

The widespread use of chest X-rays (CXRs), coupled with a shortage of radiologists, has driven growing interest in automated CXR analysis and AI-assisted reporting. While existing vision-language models (VLMs) show promise in specific tasks such as report generation or abnormality detection, they often lack support for interactive diagnostic capabilities. In this work we present RadVLM, a compact, multitask conversational foundation model designed for CXR interpretation. To this end, we curate a large-scale instruction dataset comprising over 1 million image-instruction pairs containing both single-turn tasks -- such as report generation, abnormality classification, and visual grounding -- and multi-turn, multi-task conversational interactions. After fine-tuning RadVLM on this instruction dataset, we evaluate it across different tasks along with re-implemented baseline VLMs. Our results show that RadVLM achieves state-of-the-art performance in conversational capabilities and visual grounding while remaining competitive in other radiology tasks. Ablation studies further highlight the benefit of joint training across multiple tasks, particularly for scenarios with limited annotated data. Together, these findings highlight the potential of RadVLM as a clinically relevant AI assistant, providing structured CXR interpretation and conversational capabilities to support more effective and accessible diagnostic workflows.

To enhance the performance of large language models (LLMs) in biomedical natural language processing (BioNLP) by introducing a domain-specific instruction dataset and examining its impact when combined with multi-task learning principles. We created the BioInstruct, comprising 25,005 instructions to instruction-tune LLMs(LLaMA 1 & 2, 7B & 13B version). The instructions were created by prompting the GPT-4 language model with three-seed samples randomly drawn from an 80 human curated instructions. We employed Low-Rank Adaptation(LoRA) for parameter-efficient fine-tuning. We then evaluated these instruction-tuned LLMs on several BioNLP tasks, which can be grouped into three major categories: question answering(QA), information extraction(IE), and text generation(GEN). We also examined whether categories(e.g., QA, IE, and generation) of instructions impact model performance. Comparing with LLMs without instruction-tuned, our instruction-tuned LLMs demonstrated marked performance gains: 17.3% in QA, 5.7% in IE, and 96% in Generation tasks. Our 7B-parameter instruction-tuned LLaMA 1 model was competitive or even surpassed other LLMs in the biomedical domain that were also fine-tuned from LLaMA 1 with vast domain-specific data or a variety of tasks. Our results also show that the performance gain is significantly higher when instruction fine-tuning is conducted with closely related tasks. Our findings align with the observations of multi-task learning, suggesting the synergies between two tasks. The BioInstruct dataset serves as a valuable resource and instruction tuned LLMs lead to the best performing BioNLP applications.

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.

Recent advances in large language models (LLMs) have demonstrated exceptional performance in various natural language processing (NLP) tasks. However, their effective application in the medical domain is hampered by a lack of medical domain knowledge. In this study, we present SA-MDKIF, a scalable and adaptable framework that aims to inject medical knowledge into general-purpose LLMs through instruction tuning, thereby enabling adaptability for various downstream tasks. SA-MDKIF consists of two stages: skill training and skill adaptation. In the first stage, we define 12 basic medical skills and use AdaLoRA to train these skills based on uniformly formatted instructional datasets that we have constructed. In the next stage, we train the skill router using task-specific downstream data and use this router to integrate the acquired skills with LLMs during inference. Experimental results on 9 different medical tasks show that SA-MDKIF improves performance by 10-20% compared to the original LLMs. Notably, this improvement is particularly pronounced for unseen medical tasks, showing an improvement of up to 30%.

Charts provide visual representations of data and are widely used for analyzing information, addressing queries, and conveying insights to others. Various chart-related downstream tasks have emerged recently, such as question-answering and summarization. A common strategy to solve these tasks is to fine-tune various models originally trained on vision tasks language. However, such task-specific models are not capable of solving a wide range of chart-related tasks, constraining their real-world applicability. To overcome these challenges, we introduce ChartInstruct: a novel chart-specific vision-language Instruction-following dataset comprising 191K instructions generated with 71K charts. We then present two distinct systems for instruction tuning on such datasets: (1) an end-to-end model that connects a vision encoder for chart understanding with a LLM; and (2) a pipeline model that employs a two-step approach to extract chart data tables and input them into the LLM. In experiments on four downstream tasks, we first show the effectiveness of our model--achieving a new set of state-of-the-art results. Further evaluation shows that our instruction-tuning approach supports a wide array of real-world chart comprehension and reasoning scenarios, thereby expanding the scope and applicability of our models to new kinds of tasks.

We present a corpus of 5,000 richly annotated abstracts of medical articles describing clinical randomized controlled trials. Annotations include demarcations of text spans that describe the Patient population enrolled, the Interventions studied and to what they were Compared, and the Outcomes measured (the `PICO' elements). These spans are further annotated at a more granular level, e.g., individual interventions within them are marked and mapped onto a structured medical vocabulary. We acquired annotations from a diverse set of workers with varying levels of expertise and cost. We describe our data collection process and the corpus itself in detail. We then outline a set of challenging NLP tasks that would aid searching of the medical literature and the practice of evidence-based medicine.

Recent advancements in instruction-based image editing and subject-driven generation have garnered significant attention, yet both tasks still face limitations in meeting practical user needs. Instruction-based editing relies solely on language instructions, which often fail to capture specific editing details, making reference images necessary. Meanwhile, subject-driven generation is limited to combining concrete objects or people, overlooking broader, abstract concepts. To address these challenges, we propose two novel tasks: multimodal instruction-based editing and generation. These tasks support both text and image instructions and extend the scope to include both concrete and abstract concepts, greatly enhancing their practical applications. We introduce DreamOmni2, tackling two primary challenges: data creation and model framework design. Our data synthesis pipeline consists of three steps: (1) using a feature mixing method to create extraction data for both abstract and concrete concepts, (2) generating multimodal instruction-based editing training data using the editing and extraction models, and (3) further applying the extraction model to create training data for multimodal instruction-based editing. For the framework, to handle multi-image input, we propose an index encoding and position encoding shift scheme, which helps the model distinguish images and avoid pixel confusion. Additionally, we introduce joint training with the VLM and our generation/editing model to better process complex instructions. In addition, we have proposed comprehensive benchmarks for these two new tasks to drive their development. Experiments show that DreamOmni2 has achieved impressive results. Models and codes will be released.

The proliferation of Large Language Models (LLMs) in medicine has enabled impressive capabilities, yet a critical gap remains in their ability to perform systematic, transparent, and verifiable reasoning, a cornerstone of clinical practice. This has catalyzed a shift from single-step answer generation to the development of LLMs explicitly designed for medical reasoning. This paper provides the first systematic review of this emerging field. We propose a taxonomy of reasoning enhancement techniques, categorized into training-time strategies (e.g., supervised fine-tuning, reinforcement learning) and test-time mechanisms (e.g., prompt engineering, multi-agent systems). We analyze how these techniques are applied across different data modalities (text, image, code) and in key clinical applications such as diagnosis, education, and treatment planning. Furthermore, we survey the evolution of evaluation benchmarks from simple accuracy metrics to sophisticated assessments of reasoning quality and visual interpretability. Based on an analysis of 60 seminal studies from 2022-2025, we conclude by identifying critical challenges, including the faithfulness-plausibility gap and the need for native multimodal reasoning, and outlining future directions toward building efficient, robust, and sociotechnically responsible medical AI.

What kinds of instructional prompts are easier to follow for Language Models (LMs)? We study this question by conducting extensive empirical analysis that shed light on important features of successful instructional prompts. Specifically, we study several classes of reframing techniques for manual reformulation of prompts into more effective ones. Some examples include decomposing a complex task instruction into multiple simpler tasks or itemizing instructions into sequential steps. Our experiments compare the zero-shot and few-shot performance of LMs prompted with reframed instructions on 12 NLP tasks across 6 categories. Compared with original instructions, our reframed instructions lead to significant improvements across LMs with different sizes. For example, the same reframed prompts boost few-shot performance of GPT3-series and GPT2-series by 12.5% and 6.7% respectively averaged over all tasks. Furthermore, reframed instructions reduce the number of examples required to prompt LMs in the few-shot setting. We hope these empirically-driven techniques will pave the way towards more effective future prompting algorithms.

Advances in large language models (LLMs) have empowered a variety of applications. However, there is still a significant gap in research when it comes to understanding and enhancing the capabilities of LLMs in the field of mental health. In this work, we present the first comprehensive evaluation of multiple LLMs, including Alpaca, Alpaca-LoRA, FLAN-T5, GPT-3.5, and GPT-4, on various mental health prediction tasks via online text data. We conduct a broad range of experiments, covering zero-shot prompting, few-shot prompting, and instruction fine-tuning. The results indicate a promising yet limited performance of LLMs with zero-shot and few-shot prompt designs for the mental health tasks. More importantly, our experiments show that instruction finetuning can significantly boost the performance of LLMs for all tasks simultaneously. Our best-finetuned models, Mental-Alpaca and Mental-FLAN-T5, outperform the best prompt design of GPT-3.5 (25 and 15 times bigger) by 10.9% on balanced accuracy and the best of GPT-4 (250 and 150 times bigger) by 4.8%. They further perform on par with the state-of-the-art task-specific language model. We also conduct an exploratory case study on LLMs' capability on the mental health reasoning tasks, illustrating the promising capability of certain models such as GPT-4. We summarize our findings into a set of action guidelines for potential methods to enhance LLMs' capability for mental health tasks. Meanwhile, we also emphasize the important limitations before achieving deployability in real-world mental health settings, such as known racial and gender bias. We highlight the important ethical risks accompanying this line of research.

In recent years, instruction tuning has gained increasing attention and emerged as a crucial technique to enhance the capabilities of Large Language Models (LLMs). To construct high-quality instruction datasets, many instruction processing approaches have been proposed, aiming to achieve a delicate balance between data quantity and data quality. Nevertheless, due to inconsistencies that persist among various instruction processing methods, there is no standard open-source instruction processing implementation framework available for the community, which hinders practitioners from further developing and advancing. To facilitate instruction processing research and development, we present EasyInstruct, an easy-to-use instruction processing framework for LLMs, which modularizes instruction generation, selection, and prompting, while also considering their combination and interaction. EasyInstruct is publicly released and actively maintained at https://github.com/zjunlp/EasyInstruct, along with a running demo App at https://huggingface.co/spaces/zjunlp/EasyInstruct for quick-start, calling for broader research centered on instruction data.

Large Language Models (LLMs) have shown the potential to significantly contribute to patient care, diagnostics, and administrative processes. Emerging biomedical LLMs address healthcare-specific challenges, including privacy demands and computational constraints. However, evaluation of these models has primarily been limited to non-clinical tasks, which do not reflect the complexity of practical clinical applications. Additionally, there has been no thorough comparison between biomedical and general-domain LLMs for clinical tasks. To fill this gap, we present the Clinical Language Understanding Evaluation (CLUE), a benchmark tailored to evaluate LLMs on real-world clinical tasks. CLUE includes two novel datasets derived from MIMIC IV discharge letters and four existing tasks designed to test the practical applicability of LLMs in healthcare settings. Our evaluation covers several biomedical and general domain LLMs, providing insights into their clinical performance and applicability. CLUE represents a step towards a standardized approach to evaluating and developing LLMs in healthcare to align future model development with the real-world needs of clinical application. We publish our evaluation and data generation scripts: https://github.com/dadaamin/CLUE

Vision-language foundation models (VLMs) show promise for diverse imaging tasks but often underperform on medical benchmarks. Prior efforts to improve performance include model finetuning, which requires large domain-specific datasets and significant compute, or manual prompt engineering, which is hard to generalize and often inaccessible to medical institutions seeking to deploy these tools. These challenges motivate interest in approaches that draw on a model's embedded knowledge while abstracting away dependence on human-designed prompts to enable scalable, weight-agnostic performance improvements. To explore this, we adapt the Declarative Self-improving Python (DSPy) framework for structured automated prompt optimization in medical vision-language systems through a comprehensive, formal evaluation. We implement prompting pipelines for five medical imaging tasks across radiology, gastroenterology, and dermatology, evaluating 10 open-source VLMs with four prompt optimization techniques. Optimized pipelines achieved a median relative improvement of 53% over zero-shot prompting baselines, with the largest gains ranging from 300% to 3,400% on tasks where zero-shot performance is low. These results highlight the substantial potential of applying automated prompt optimization to medical AI systems, demonstrating significant gains for vision-based applications requiring accurate clinical image interpretation. By reducing dependence on prompt design to elicit intended outputs, these techniques allow clinicians to focus on patient care and clinical decision-making. Furthermore, our experiments offer scalability and preserve data privacy, demonstrating performance improvement on open-source VLMs. We publicly release our evaluation pipelines to support reproducible research on specialized medical tasks, available at https://github.com/DaneshjouLab/prompt-triage-lab.

A long-running goal of the clinical NLP community is the extraction of important variables trapped in clinical notes. However, roadblocks have included dataset shift from the general domain and a lack of public clinical corpora and annotations. In this work, we show that large language models, such as InstructGPT, perform well at zero- and few-shot information extraction from clinical text despite not being trained specifically for the clinical domain. Whereas text classification and generation performance have already been studied extensively in such models, here we additionally demonstrate how to leverage them to tackle a diverse set of NLP tasks which require more structured outputs, including span identification, token-level sequence classification, and relation extraction. Further, due to the dearth of available data to evaluate these systems, we introduce new datasets for benchmarking few-shot clinical information extraction based on a manual re-annotation of the CASI dataset for new tasks. On the clinical extraction tasks we studied, the GPT-3 systems significantly outperform existing zero- and few-shot baselines.

Knowledge editing for large language models can offer an efficient solution to alter a model's behavior without negatively impacting the overall performance. However, the current approach encounters issues with limited generalizability across tasks, necessitating one distinct editor for each task, which significantly hinders the broader applications. To address this, we take the first step to analyze the multi-task generalization issue in knowledge editing. Specifically, we develop an instruction-based editing technique, termed InstructEdit, which facilitates the editor's adaptation to various task performances simultaneously using simple instructions. With only one unified editor for each LLM, we empirically demonstrate that InstructEdit can improve the editor's control, leading to an average 14.86% increase in Reliability in multi-task editing setting. Furthermore, experiments involving holdout unseen task illustrate that InstructEdit consistently surpass previous strong baselines. To further investigate the underlying mechanisms of instruction-based knowledge editing, we analyze the principal components of the editing gradient directions, which unveils that instructions can help control optimization direction with stronger OOD generalization. Code and datasets will be available in https://github.com/zjunlp/EasyEdit.

Instruction tuning, a new learning paradigm that fine-tunes pre-trained language models on tasks specified through instructions, has shown promising zero-shot performance on various natural language processing tasks. However, it has yet to be explored for vision and multimodal tasks. In this work, we introduce MUL-TIINSTRUCT, the first multimodal instruction tuning benchmark dataset that consists of 62 diverse multimodal tasks in a unified seq-to-seq format covering 10 broad categories. The tasks are derived from 21 existing open-source datasets and each task is equipped with 5 expert-written instructions. We take OFA as the base pre-trained model for multimodal instruction tuning, and to further improve its zero-shot performance, we explore multiple transfer learning strategies to leverage the large-scale NATURAL INSTRUCTIONS dataset. Experimental results demonstrate strong zero-shot performance on various unseen multimodal tasks and the benefit of transfer learning from a text-only instruction dataset. We also design a new evaluation metric - Sensitivity, to evaluate how sensitive the model is to the variety of instructions. Our results indicate that fine-tuning the model on a diverse set of tasks and instructions leads to a reduced sensitivity to variations in instructions for each task.

There are substantial instructional videos on the Internet, which provide us tutorials for completing various tasks. Existing instructional video datasets only focus on specific steps at the video level, lacking experiential guidelines at the task level, which can lead to beginners struggling to learn new tasks due to the lack of relevant experience. Moreover, the specific steps without guidelines are trivial and unsystematic, making it difficult to provide a clear tutorial. To address these problems, we present the GUIDE (Guideline-Guided) dataset, which contains 3.5K videos of 560 instructional tasks in 8 domains related to our daily life. Specifically, we annotate each instructional task with a guideline, representing a common pattern shared by all task-related videos. On this basis, we annotate systematic specific steps, including their associated guideline steps, specific step descriptions and timestamps. Our proposed benchmark consists of three sub-tasks to evaluate comprehension ability of models: (1) Step Captioning: models have to generate captions for specific steps from videos. (2) Guideline Summarization: models have to mine the common pattern in task-related videos and summarize a guideline from them. (3) Guideline-Guided Captioning: models have to generate captions for specific steps under the guide of guideline. We evaluate plenty of foundation models with GUIDE and perform in-depth analysis. Given the diversity and practicality of GUIDE, we believe that it can be used as a better benchmark for instructional video comprehension.

Although large language models (LLMs) demonstrate expert-level medical knowledge, aligning their open-ended outputs with fine-grained clinician preferences remains challenging. Existing methods often rely on coarse objectives or unreliable automated judges that are weakly grounded in professional guidelines. We propose a two-stage framework to address this gap. First, we introduce HealthRubrics, a dataset of 7,034 physician-verified preference examples in which clinicians refine LLM-drafted rubrics to meet rigorous medical standards. Second, we distill these rubrics into HealthPrinciples: 119 broadly reusable, clinically grounded principles organized by clinical dimensions, enabling scalable supervision beyond manual annotation. We use HealthPrinciples for (1) offline alignment by synthesizing rubrics for unlabeled queries and (2) an inference-time tool for guided self-revision. A 30B parameter model that activates only 3B parameters at inference trained with our framework achieves 33.4% on HealthBench-Hard, outperforming much larger models including Deepseek-R1 and o3, establishing a resource-efficient baseline for clinical alignment.

We investigate fine-tuning Vision-Language Models (VLMs) for multi-task medical image understanding, focusing on detection, localization, and counting of findings in medical images. Our objective is to evaluate whether instruction-tuned VLMs can simultaneously improve these tasks, with the goal of enhancing diagnostic accuracy and efficiency. Using MedMultiPoints, a multimodal dataset with annotations from endoscopy (polyps and instruments) and microscopy (sperm cells), we reformulate each task into instruction-based prompts suitable for vision-language reasoning. We fine-tune Qwen2.5-VL-7B-Instruct using Low-Rank Adaptation (LoRA) across multiple task combinations. Results show that multi-task training improves robustness and accuracy. For example, it reduces the Count Mean Absolute Error (MAE) and increases Matching Accuracy in the Counting + Pointing task. However, trade-offs emerge, such as more zero-case point predictions, indicating reduced reliability in edge cases despite overall performance gains. Our study highlights the potential of adapting general-purpose VLMs to specialized medical tasks via prompt-driven fine-tuning. This approach mirrors clinical workflows, where radiologists simultaneously localize, count, and describe findings - demonstrating how VLMs can learn composite diagnostic reasoning patterns. The model produces interpretable, structured outputs, offering a promising step toward explainable and versatile medical AI. Code, model weights, and scripts will be released for reproducibility at https://github.com/simula/PointDetectCount.

Large language models (LLMs) integrated into agent-driven workflows hold immense promise for healthcare, yet a significant gap exists between their potential and practical implementation within clinical settings. To address this, we present a practitioner-oriented field manual for deploying generative agents that use electronic health record (EHR) data. This guide is informed by our experience deploying the "irAE-Agent", an automated system to detect immune-related adverse events from clinical notes at Mass General Brigham, and by structured interviews with 21 clinicians, engineers, and informatics leaders involved in the project. Our analysis reveals a critical misalignment in clinical AI development: less than 20% of our effort was dedicated to prompt engineering and model development, while over 80% was consumed by the sociotechnical work of implementation. We distill this effort into five "heavy lifts": data integration, model validation, ensuring economic value, managing system drift, and governance. By providing actionable solutions for each of these challenges, this field manual shifts the focus from algorithmic development to the essential infrastructure and implementation work required to bridge the "valley of death" and successfully translate generative AI from pilot projects into routine clinical care.

Vision-Language Models (VLM) can support clinicians by analyzing medical images and engaging in natural language interactions to assist in diagnostic and treatment tasks. However, VLMs often exhibit "hallucinogenic" behavior, generating textual outputs not grounded in contextual multimodal information. This challenge is particularly pronounced in the medical domain, where we do not only require VLM outputs to be accurate in single interactions but also to be consistent with clinical reasoning and diagnostic pathways throughout multi-turn conversations. For this purpose, we propose a new alignment algorithm that uses symbolic representations of clinical reasoning to ground VLMs in medical knowledge. These representations are utilized to (i) generate GPT-4-guided visual instruction tuning data at scale, simulating clinician-VLM conversations with demonstrations of clinical reasoning, and (ii) create an automatic reward function that evaluates the clinical validity of VLM generations throughout clinician-VLM interactions. Our algorithm eliminates the need for human involvement in training data generation or reward model construction, reducing costs compared to standard reinforcement learning with human feedback (RLHF). We apply our alignment algorithm to develop Dr-LLaVA, a conversational VLM finetuned for analyzing bone marrow pathology slides, demonstrating strong performance in multi-turn medical conversations.

Instruction tuning has become essential for adapting large language models (LLMs) to follow domain-specific prompts. Yet, in specialized fields such as medicine, the scarcity of high-quality French instruction data limits effective supervision. To address this gap, we introduce MedInjection-FR, a large-scale French biomedical instruction dataset comprising 571K instruction-response pairs drawn from three complementary sources: native, synthetic, and translated data. We design a controlled experimental framework to systematically assess how data provenance affects instruction tuning, using Qwen-4B-Instruct fine-tuned across seven configurations combining these sources. Results show that native data yield the strongest performance, while mixed setups, particularly native and translated, provide complementary benefits. Synthetic data alone remains less effective but contributes positively when balanced with native supervision. Evaluation on open-ended QA combines automatic metrics, LLM-as-a-judge assessment, and human expert review; although LLM-based judgments correlate best with human ratings, they show sensitivity to verbosity. These findings highlight that data authenticity and diversity jointly shape downstream adaptation and that heterogeneous supervision can mitigate the scarcity of native French medical instructions.

Clinical natural language processing requires methods that can address domain-specific challenges, such as complex medical terminology and clinical contexts. Recently, large language models (LLMs) have shown promise in this domain. Yet, their direct deployment can lead to privacy issues and are constrained by resources. To address this challenge, we delve into synthetic clinical text generation using LLMs for clinical NLP tasks. We propose an innovative, resource-efficient approach, ClinGen, which infuses knowledge into the process. Our model involves clinical knowledge extraction and context-informed LLM prompting. Both clinical topics and writing styles are drawn from external domain-specific knowledge graphs and LLMs to guide data generation. Our extensive empirical study across 7 clinical NLP tasks and 16 datasets reveals that ClinGen consistently enhances performance across various tasks, effectively aligning the distribution of real datasets and significantly enriching the diversity of generated training instances. We will publish our code and all the generated data in https://github.com/ritaranx/ClinGen.

Extracting patient information from unstructured text is a critical task in health decision-support and clinical research. Large language models (LLMs) have shown the potential to accelerate clinical curation via few-shot in-context learning, in contrast to supervised learning which requires much more costly human annotations. However, despite drastic advances in modern LLMs such as GPT-4, they still struggle with issues regarding accuracy and interpretability, especially in mission-critical domains such as health. Here, we explore a general mitigation framework using self-verification, which leverages the LLM to provide provenance for its own extraction and check its own outputs. This is made possible by the asymmetry between verification and generation, where the latter is often much easier than the former. Experimental results show that our method consistently improves accuracy for various LLMs in standard clinical information extraction tasks. Additionally, self-verification yields interpretations in the form of a short text span corresponding to each output, which makes it very efficient for human experts to audit the results, paving the way towards trustworthy extraction of clinical information in resource-constrained scenarios. To facilitate future research in this direction, we release our code and prompts.

Background: Large language models (LLMs) are trained to follow directions, but this introduces a vulnerability to blindly comply with user requests even if they generate wrong information. In medicine, this could accelerate the generation of misinformation that impacts human well-being. Objectives/Methods: We analyzed compliance to requests to generate misleading content about medications in settings where models know the request is illogical. We investigated whether in-context directions and instruction-tuning of LLMs to prioritize logical reasoning over compliance reduced misinformation risk. Results: While all frontier LLMs complied with misinformation requests, both prompt-based and parameter-based approaches can improve the detection of logic flaws in requests and prevent the dissemination of medical misinformation. Conclusion: Shifting LLMs to prioritize logic over compliance could reduce risks of exploitation for medical misinformation.

The instruction learning paradigm -- where a model learns to perform new tasks from task descriptions alone -- has become popular in general-purpose model research. The capabilities of large transformer models as instruction learners, however, remain poorly understood. We use a controlled synthetic environment to characterize such capabilities. Specifically, we use the task of deciding whether a given string matches a regular expression (viewed as an instruction) to identify properties of tasks, instructions, and instances that make instruction learning challenging. For instance, we find that our model, a fine-tuned T5-based text2text transformer, struggles with large regular languages, suggesting that less precise instructions are challenging for models. Additionally, instruction executions that require tracking longer contexts of prior steps are also more difficult. We use our findings to systematically construct a challenging instruction learning dataset, which we call Hard RegSet. Fine-tuning on Hard RegSet, our large transformer learns to correctly interpret only 65.6% of test instructions (with at least 90% accuracy), and 11%-24% of the instructions in out-of-distribution generalization settings. We propose Hard RegSet as a challenging instruction learning task, and a controlled environment for studying instruction learning.

Objective: Using natural language processing (NLP) to find sentences that state treatment plans in a clinical note, would automate plan extraction and would further enable their use in tools that help providers and care managers. However, as in the most NLP tasks on clinical text, creating gold standard to train and test NLP models is tedious and expensive. Fortuitously, sometimes but not always clinical notes contain sections with a heading that identifies the section as a plan. Leveraging contents of such labeled sections as a noisy training data, we assessed accuracy of NLP models trained with the data. Methods: We used common variations of plan headings and rule-based heuristics to find plan sections with headings in clinical notes, and we extracted sentences from them and formed a noisy training data of plan sentences. We trained Support Vector Machine (SVM) and Convolutional Neural Network (CNN) models with the data. We measured accuracy of the trained models on the noisy dataset using ten-fold cross validation and separately on a set-aside manually annotated dataset. Results: About 13% of 117,730 clinical notes contained treatment plans sections with recognizable headings in the 1001 longitudinal patient records that were obtained from Cleveland Clinic under an IRB approval. We were able to extract and create a noisy training data of 13,492 plan sentences from the clinical notes. CNN achieved best F measures, 0.91 and 0.97 in the cross-validation and set-aside evaluation experiments respectively. SVM slightly underperformed with F measures of 0.89 and 0.96 in the same experiments. Conclusion: Our study showed that the training supervised learning models using noisy plan sentences was effective in identifying them in all clinical notes. More broadly, sections with informal headings in clinical notes can be a good source for generating effective training data.

Fine-tuning large language models (LLMs) with a collection of large and diverse instructions has improved the model's generalization to different tasks, even for unseen tasks. However, most existing instruction datasets include only single instructions, and they struggle to follow complex instructions composed of multiple subtasks (Wang et al., 2023a). In this work, we propose a novel concept of compositional instructions called chain-of-instructions (CoI), where the output of one instruction becomes an input for the next like a chain. Unlike the conventional practice of solving single instruction tasks, our proposed method encourages a model to solve each subtask step by step until the final answer is reached. CoI-tuning (i.e., fine-tuning with CoI instructions) improves the model's ability to handle instructions composed of multiple subtasks. CoI-tuned models also outperformed baseline models on multilingual summarization, demonstrating the generalizability of CoI models on unseen composite downstream tasks.

Large language models (LLMs) such as GPT-4o and o1 have demonstrated strong performance on clinical natural language processing (NLP) tasks across multiple medical benchmarks. Nonetheless, two high-impact NLP tasks - structured tabular reporting from nurse dictations and medical order extraction from doctor-patient consultations - remain underexplored due to data scarcity and sensitivity, despite active industry efforts. Practical solutions to these real-world clinical tasks can significantly reduce the documentation burden on healthcare providers, allowing greater focus on patient care. In this paper, we investigate these two challenging tasks using private and open-source clinical datasets, evaluating the performance of both open- and closed-weight LLMs, and analyzing their respective strengths and limitations. Furthermore, we propose an agentic pipeline for generating realistic, non-sensitive nurse dictations, enabling structured extraction of clinical observations. To support further research in both areas, we release SYNUR and SIMORD, the first open-source datasets for nurse observation extraction and medical order extraction.

Large Language Models (LLMs) exhibit strong generalization capabilities to novel tasks when prompted with language instructions and in-context demos. Since this ability sensitively depends on the quality of prompts, various methods have been explored to automate the instruction design. While these methods demonstrated promising results, they also restricted the searched prompt to one instruction. Such simplification significantly limits their capacity, as a single demo-free instruction might not be able to cover the entire complex problem space of the targeted task. To alleviate this issue, we adopt the Mixture-of-Expert paradigm and divide the problem space into a set of sub-regions; Each sub-region is governed by a specialized expert, equipped with both an instruction and a set of demos. A two-phase process is developed to construct the specialized expert for each region: (1) demo assignment: Inspired by the theoretical connection between in-context learning and kernel regression, we group demos into experts based on their semantic similarity; (2) instruction assignment: A region-based joint search of an instruction per expert complements the demos assigned to it, yielding a synergistic effect. The resulting method, codenamed Mixture-of-Prompts (MoP), achieves an average win rate of 81% against prior arts across several major benchmarks.

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

Humans (e.g., crowdworkers) have a remarkable ability in solving different tasks, by simply reading textual instructions that define them and looking at a few examples. Despite the success of the conventional supervised learning on individual datasets, such models often struggle with generalization across tasks (e.g., a question-answering system cannot solve classification tasks). A long-standing challenge in AI is to build a model that learns a new task by understanding the human-readable instructions that define it. To study this, we introduce NATURAL INSTRUCTIONS, a dataset of 61 distinct tasks, their human-authored instructions, and 193k task instances (input-output pairs). The instructions are obtained from crowdsourcing instructions used to create existing NLP datasets and mapped to a unified schema. Using this meta-dataset, we measure cross-task generalization by training models on seen tasks and measuring generalization to the remaining unseen ones. We adopt generative pre-trained language models to encode task-specific instructions along with input and generate task output. Our results indicate that models benefit from instructions when evaluated in terms of generalization to unseen tasks (19% better for models utilizing instructions). These models, however, are far behind an estimated performance upperbound indicating significant room for more progress in this direction.

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.

The process of instruction tuning aligns pre-trained large language models (LLMs) with open-domain instructions and human-preferred responses. While several studies have explored autonomous approaches to distilling and annotating instructions from more powerful proprietary LLMs, such as ChatGPT, they often neglect the impact of task distributions and the varying difficulty of instructions of the training sets. This oversight can lead to imbalanced knowledge capabilities and poor generalization powers of small student LLMs. To address this challenge, we introduce Task-Aware Curriculum Planning for Instruction Refinement (TAPIR), a multi-round distillation framework with balanced task distributions and dynamic difficulty adjustment. This approach utilizes an oracle LLM to select instructions that are difficult for a student LLM to follow and distill instructions with balanced task distributions. By incorporating curriculum planning, our approach systematically escalates the difficulty levels, progressively enhancing the student LLM's capabilities. We rigorously evaluate TAPIR using two widely recognized benchmarks, including AlpacaEval 2.0 and MT-Bench. The empirical results demonstrate that the student LLMs, trained with our method and less training data, outperform larger instruction-tuned models and strong distillation baselines. The improvement is particularly notable in complex tasks, such as logical reasoning and code generation.

Large Language Models (LLMs) have demonstrated significant potential in transforming clinical applications. In this study, we investigate the efficacy of four techniques in adapting LLMs for clinical use-cases: continuous pretraining, instruct fine-tuning, NEFTune, and prompt engineering. We employ these methods on Mistral 7B and Mixtral 8x7B models, leveraging a large-scale clinical pretraining dataset of 50 billion tokens and an instruct fine-tuning dataset of 500 million tokens. Our evaluation across various clinical tasks reveals the impact of each technique. While continuous pretraining beyond 250 billion tokens yields marginal improvements on its own, it establishes a strong foundation for instruct fine-tuning. Notably, NEFTune, designed primarily to enhance generation quality, surprisingly demonstrates additional gains on our benchmark. Complex prompt engineering methods further enhance performance. These findings show the importance of tailoring fine-tuning strategies and exploring innovative techniques to optimize LLM performance in the clinical domain.

In response to the pressing need for advanced clinical problem-solving tools in healthcare, we introduce BooksMed, a novel framework based on a Large Language Model (LLM). BooksMed uniquely emulates human cognitive processes to deliver evidence-based and reliable responses, utilizing the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework to effectively quantify evidence strength. For clinical decision-making to be appropriately assessed, an evaluation metric that is clinically aligned and validated is required. As a solution, we present ExpertMedQA, a multispecialty clinical benchmark comprised of open-ended, expert-level clinical questions, and validated by a diverse group of medical professionals. By demanding an in-depth understanding and critical appraisal of up-to-date clinical literature, ExpertMedQA rigorously evaluates LLM performance. BooksMed outperforms existing state-of-the-art models Med-PaLM 2, Almanac, and ChatGPT in a variety of medical scenarios. Therefore, a framework that mimics human cognitive stages could be a useful tool for providing reliable and evidence-based responses to clinical inquiries.

Large language models excel at instruction-following in English, but their performance in low-resource languages like Thai remains underexplored. Existing benchmarks often rely on translations, missing cultural and domain-specific nuances needed for real-world use. We present WangchanThaiInstruct, a human-authored Thai dataset for evaluation and instruction tuning, covering four professional domains and seven task types. Created through a multi-stage quality control process with annotators, domain experts, and AI researchers, WangchanThaiInstruct supports two studies: (1) a zero-shot evaluation showing performance gaps on culturally and professionally specific tasks, and (2) an instruction tuning study with ablations isolating the effect of native supervision. Models fine-tuned on WangchanThaiInstruct outperform those using translated data in both in-domain and out-of-domain benchmarks. These findings underscore the need for culturally and professionally grounded instruction data to improve LLM alignment in low-resource, linguistically diverse settings.

Large language models have exhibited exceptional performance on various Natural Language Processing (NLP) tasks, leveraging techniques such as the pre-training, and instruction fine-tuning. Despite these advances, their effectiveness in medical applications is limited, due to challenges such as factual inaccuracies, reasoning abilities, and lack grounding in real-world experience. In this study, we present ClinicalGPT, a language model explicitly designed and optimized for clinical scenarios. By incorporating extensive and diverse real-world data, such as medical records, domain-specific knowledge, and multi-round dialogue consultations in the training process, ClinicalGPT is better prepared to handle multiple clinical task. Furthermore, we introduce a comprehensive evaluation framework that includes medical knowledge question-answering, medical exams, patient consultations, and diagnostic analysis of medical records. Our results demonstrate that ClinicalGPT significantly outperforms other models in these tasks, highlighting the effectiveness of our approach in adapting large language models to the critical domain of healthcare.

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.

Instruction-tuned large language models have revolutionized natural language processing and have shown great potential in applications such as conversational agents. These models, such as GPT-4, can not only master language but also solve complex tasks in areas like mathematics, coding, medicine, and law. Despite their impressive capabilities, there is still a lack of comprehensive understanding regarding their full potential, primarily due to the black-box nature of many models and the absence of holistic evaluation studies. To address these challenges, we present INSTRUCTEVAL, a more comprehensive evaluation suite designed specifically for instruction-tuned large language models. Unlike previous works, our evaluation involves a rigorous assessment of models based on problem-solving, writing ability, and alignment to human values. We take a holistic approach to analyze various factors affecting model performance, including the pretraining foundation, instruction-tuning data, and training methods. Our findings reveal that the quality of instruction data is the most crucial factor in scaling model performance. While open-source models demonstrate impressive writing abilities, there is substantial room for improvement in problem-solving and alignment. We are encouraged by the rapid development of models by the open-source community, but we also highlight the need for rigorous evaluation to support claims made about these models. Through INSTRUCTEVAL, we aim to foster a deeper understanding of instruction-tuned models and advancements in their capabilities. INSTRUCTEVAL is publicly available at https://github.com/declare-lab/instruct-eval.

Fine-tuning language models on tasks with instructions has demonstrated potential in facilitating zero-shot generalization to unseen tasks. In this paper, we introduce a straightforward yet effective method for enhancing instruction tuning by employing symbolic tasks. Compared to crowdsourced human tasks or model-generated tasks, symbolic tasks present a unique advantage as they can be easily generated in vast quantities, theoretically providing an infinite supply of high-quality training instances. To explore the potential of symbolic tasks, we carry out an extensive case study on the representative symbolic task of SQL execution. Empirical results on various benchmarks validate that the integration of SQL execution leads to significant improvements in zero-shot scenarios, particularly in table reasoning. Notably, our 3B model surpasses both the 175B GPT-3 and ChatGPT in zero-shot table reasoning across four benchmarks. Furthermore, experimental results on BBH (27 tasks) and MMLU (57 tasks) reveal that language models can be enhanced through symbolic tasks without compromising their generality. We hope that our paper serves as a catalyst, inspiring increased efforts to incorporate symbolic tasks in instruction tuning.

Large Language Models (LLMs) are at the forefront of NLP achievements but fall short in dealing with shortcut learning, factual inconsistency, and vulnerability to adversarial inputs.These shortcomings are especially critical in medical contexts, where they can misrepresent actual model capabilities. Addressing this, we present SemEval-2024 Task 2: Safe Biomedical Natural Language Inference for ClinicalTrials. Our contributions include the refined NLI4CT-P dataset (i.e., Natural Language Inference for Clinical Trials - Perturbed), designed to challenge LLMs with interventional and causal reasoning tasks, along with a comprehensive evaluation of methods and results for participant submissions. A total of 106 participants registered for the task contributing to over 1200 individual submissions and 25 system overview papers. This initiative aims to advance the robustness and applicability of NLI models in healthcare, ensuring safer and more dependable AI assistance in clinical decision-making. We anticipate that the dataset, models, and outcomes of this task can support future research in the field of biomedical NLI. The dataset, competition leaderboard, and website are publicly available.

Instruction tuning (IT) achieves impressive zero-shot generalization results by training large language models (LLMs) on a massive amount of diverse tasks with instructions. However, how to select new tasks to improve the performance and generalizability of IT models remains an open question. Training on all existing tasks is impractical due to prohibiting computation requirements, and randomly selecting tasks can lead to suboptimal performance. In this work, we propose active instruction tuning based on prompt uncertainty, a novel framework to identify informative tasks, and then actively tune the models on the selected tasks. We represent the informativeness of new tasks with the disagreement of the current model outputs over perturbed prompts. Our experiments on NIV2 and Self-Instruct datasets demonstrate that our method consistently outperforms other baseline strategies for task selection, achieving better out-of-distribution generalization with fewer training tasks. Additionally, we introduce a task map that categorizes and diagnoses tasks based on prompt uncertainty and prediction probability. We discover that training on ambiguous (prompt-uncertain) tasks improves generalization while training on difficult (prompt-certain and low-probability) tasks offers no benefit, underscoring the importance of task selection for instruction tuning.

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

We study the problem of retrieval with instructions, where users of a retrieval system explicitly describe their intent along with their queries. We aim to develop a general-purpose task-aware retrieval system using multi-task instruction tuning, which can follow human-written instructions to find the best documents for a given query. We introduce the first large-scale collection of approximately 40 retrieval datasets with instructions, BERRI, and present TART, a multi-task retrieval system trained on BERRI with instructions. TART shows strong capabilities to adapt to a new retrieval task via instructions and advances the state of the art on two zero-shot retrieval benchmarks, BEIR and LOTTE, outperforming models up to three times larger. We further introduce a new evaluation setup, X^2-Retrieval to better reflect real-world scenarios, where diverse domains and tasks are pooled and a system needs to find documents aligning users' intents. In this setup, TART significantly outperforms competitive baselines, further demonstrating the effectiveness of guiding retrieval with instructions.

The deployment of Large Language Models (LLMs) in high-stakes clinical settings demands rigorous and reliable evaluation. However, existing medical benchmarks remain static, suffering from two critical limitations: (1) data contamination, where test sets inadvertently leak into training corpora, leading to inflated performance estimates; and (2) temporal misalignment, failing to capture the rapid evolution of medical knowledge. Furthermore, current evaluation metrics for open-ended clinical reasoning often rely on either shallow lexical overlap (e.g., ROUGE) or subjective LLM-as-a-Judge scoring, both inadequate for verifying clinical correctness. To bridge these gaps, we introduce LiveMedBench, a continuously updated, contamination-free, and rubric-based benchmark that weekly harvests real-world clinical cases from online medical communities, ensuring strict temporal separation from model training data. We propose a Multi-Agent Clinical Curation Framework that filters raw data noise and validates clinical integrity against evidence-based medical principles. For evaluation, we develop an Automated Rubric-based Evaluation Framework that decomposes physician responses into granular, case-specific criteria, achieving substantially stronger alignment with expert physicians than LLM-as-a-Judge. To date, LiveMedBench comprises 2,756 real-world cases spanning 38 medical specialties and multiple languages, paired with 16,702 unique evaluation criteria. Extensive evaluation of 38 LLMs reveals that even the best-performing model achieves only 39.2%, and 84% of models exhibit performance degradation on post-cutoff cases, confirming pervasive data contamination risks. Error analysis further identifies contextual application-not factual knowledge-as the dominant bottleneck, with 35-48% of failures stemming from the inability to tailor medical knowledge to patient-specific constraints.

Learning to represent free text is a core task in many clinical machine learning (ML) applications, as clinical text contains observations and plans not otherwise available for inference. State-of-the-art methods use large language models developed with immense computational resources and training data; however, applying these models is challenging because of the highly varying syntax and vocabulary in clinical free text. Structured information such as International Classification of Disease (ICD) codes often succinctly abstracts the most important facts of a clinical encounter and yields good performance, but is often not as available as clinical text in real-world scenarios. We propose a multi-view learning framework that jointly learns from codes and text to combine the availability and forward-looking nature of text and better performance of ICD codes. The learned text embeddings can be used as inputs to predictive algorithms independent of the ICD codes during inference. Our approach uses a Graph Neural Network (GNN) to process ICD codes, and Bi-LSTM to process text. We apply Deep Canonical Correlation Analysis (DCCA) to enforce the two views to learn a similar representation of each patient. In experiments using planned surgical procedure text, our model outperforms BERT models fine-tuned to clinical data, and in experiments using diverse text in MIMIC-III, our model is competitive to a fine-tuned BERT at a tiny fraction of its computational effort.

Large language models are able to perform a task by conditioning on a few input-output demonstrations - a paradigm known as in-context learning. We show that language models can explicitly infer an underlying task from a few demonstrations by prompting them to generate a natural language instruction that fits the examples. To explore this ability, we introduce the instruction induction challenge, compile a dataset consisting of 24 tasks, and define a novel evaluation metric based on executing the generated instruction. We discover that, to a large extent, the ability to generate instructions does indeed emerge when using a model that is both large enough and aligned to follow instructions; InstructGPT achieves 65.7% of human performance in our execution-based metric, while the original GPT-3 model reaches only 9.8% of human performance. This surprising result suggests that instruction induction might be a viable learning paradigm in and of itself, where instead of fitting a set of latent continuous parameters to the data, one searches for the best description in the natural language hypothesis space.

The potential of large language models (LLMs) to simultaneously perform a wide range of natural language processing (NLP) tasks has been the subject of extensive research. Although instruction tuning has proven to be a data-efficient method for transforming LLMs into such generalist models, their performance still lags behind specialist models trained exclusively for specific tasks. In this paper, we investigate whether incorporating broad-coverage generalist instruction tuning can contribute to building a specialist model. We hypothesize that its efficacy depends on task specificity and skill requirements. Our experiments assess four target tasks with distinct coverage levels, revealing that integrating generalist instruction tuning consistently enhances model performance when the task coverage is broad. The effect is particularly pronounced when the amount of task-specific training data is limited. Further investigation into three target tasks focusing on different capabilities demonstrates that generalist instruction tuning improves understanding and reasoning abilities. However, for tasks requiring factual knowledge, generalist data containing hallucinatory information may negatively affect the model's performance. Overall, our work provides a systematic guide for developing specialist models with general instruction tuning. Our code and other related resources can be found at https://github.com/DavidFanzz/Generalist_or_Specialist.

With the rapid development of large language models in recent years, there has been an increasing demand for domain-specific Agents that can cater to the unique needs of enterprises and organizations. Unlike general models, which strive for broad coverage, these specialized Agents rely on focused datasets tailored to their intended applications. This research proposes a pipeline that leverages the power of LLMs and the Retrieval-Augmented Generation related framework to construct high-quality instruction datasets for fine-tuning on specific domains using custom document collections. By ingesting domain-specific documents, the pipeline generates relevant and contextually appropriate instructions, thus effectively creating a comprehensive dataset for fine-tuning LLMs on the target domain. This approach overcomes the limitations of traditional dataset creation methods, which often rely on manual curation or web-scraping techniques that may introduce noise and irrelevant data. Notably, our pipeline offers a dynamic solution that can quickly adapt to updates or modifications in the domain-specific document collection, eliminating the need for complete retraining. Additionally, it addresses the challenge of data scarcity by enabling the generation of instruction datasets from a limited set of initial documents, rendering it suitable for unpopular or specialized domains where comprehensive datasets are scarce. As a case study, we apply this approach to the domain of psychiatry, a field requiring specialized knowledge and sensitive handling of patient information. The resulting fine-tuned LLM demonstrates showcases the viability of the proposed approach and underscores its potential for widespread adoption across various industries and domains where tailored, accurate, and contextually relevant language models are indispensable.

Sifting through vast textual data and summarizing key information imposes a substantial burden on how clinicians allocate their time. Although large language models (LLMs) have shown immense promise in natural language processing (NLP) tasks, their efficacy across diverse clinical summarization tasks has not yet been rigorously examined. In this work, we employ domain adaptation methods on eight LLMs, spanning six datasets and four distinct summarization tasks: radiology reports, patient questions, progress notes, and doctor-patient dialogue. Our thorough quantitative assessment reveals trade-offs between models and adaptation methods in addition to instances where recent advances in LLMs may not lead to improved results. Further, in a clinical reader study with six physicians, we depict that summaries from the best adapted LLM are preferable to human summaries in terms of completeness and correctness. Our ensuing qualitative analysis delineates mutual challenges faced by both LLMs and human experts. Lastly, we correlate traditional quantitative NLP metrics with reader study scores to enhance our understanding of how these metrics align with physician preferences. Our research marks the first evidence of LLMs outperforming human experts in clinical text summarization across multiple tasks. This implies that integrating LLMs into clinical workflows could alleviate documentation burden, empowering clinicians to focus more on personalized patient care and other irreplaceable human aspects of medicine.

Large Language Models (LLMs) have shown remarkable capabilities in natural language understanding and generation, yet their deployment in enterprise environments reveals a critical limitation: inconsistent adherence to custom instructions. This study presents a comprehensive evaluation of 13 leading LLMs across instruction compliance, response accuracy, and performance metrics in realworld RAG (Retrieval-Augmented Generation) scenarios. Through systematic testing with samples and enterprise-grade evaluation protocols, we demonstrate that instruction following varies dramatically across models, with Claude-Sonnet-4 and GPT-5 achieving the highest results. Our findings reveal the "instruction gap" - a fundamental challenge where models excel at general tasks but struggle with precise instruction adherence required for enterprise deployment. This work provides practical insights for organizations deploying LLM-powered solutions and establishes benchmarks for instruction-following capabilities across major model families.

Curated datasets for healthcare are often limited due to the need of human annotations from experts. In this paper, we present MedEval, a multi-level, multi-task, and multi-domain medical benchmark to facilitate the development of language models for healthcare. MedEval is comprehensive and consists of data from several healthcare systems and spans 35 human body regions from 8 examination modalities. With 22,779 collected sentences and 21,228 reports, we provide expert annotations at multiple levels, offering a granular potential usage of the data and supporting a wide range of tasks. Moreover, we systematically evaluated 10 generic and domain-specific language models under zero-shot and finetuning settings, from domain-adapted baselines in healthcare to general-purposed state-of-the-art large language models (e.g., ChatGPT). Our evaluations reveal varying effectiveness of the two categories of language models across different tasks, from which we notice the importance of instruction tuning for few-shot usage of large language models. Our investigation paves the way toward benchmarking language models for healthcare and provides valuable insights into the strengths and limitations of adopting large language models in medical domains, informing their practical applications and future advancements.

Recent LLMs have shown remarkable success in following user instructions, yet handling instructions with multiple constraints remains a significant challenge. In this work, we introduce WildIFEval - a large-scale dataset of 12K real user instructions with diverse, multi-constraint conditions. Unlike prior datasets, our collection spans a broad lexical and topical spectrum of constraints, in natural user prompts. We categorize these constraints into eight high-level classes to capture their distribution and dynamics in real-world scenarios. Leveraging WildIFEval, we conduct extensive experiments to benchmark the instruction-following capabilities of leading LLMs. Our findings reveal that all evaluated models experience performance degradation with an increasing number of constraints. Thus, we show that all models have a large room for improvement on such tasks. Moreover, we observe that the specific type of constraint plays a critical role in model performance. We release our dataset to promote further research on instruction-following under complex, realistic conditions.

Artificial intelligence (AI) and large language models (LLMs) in healthcare require advanced clinical skills (CS), yet current benchmarks fail to evaluate these comprehensively. We introduce MedQA-CS, an AI-SCE framework inspired by medical education's Objective Structured Clinical Examinations (OSCEs), to address this gap. MedQA-CS evaluates LLMs through two instruction-following tasks, LLM-as-medical-student and LLM-as-CS-examiner, designed to reflect real clinical scenarios. Our contributions include developing MedQA-CS, a comprehensive evaluation framework with publicly available data and expert annotations, and providing the quantitative and qualitative assessment of LLMs as reliable judges in CS evaluation. Our experiments show that MedQA-CS is a more challenging benchmark for evaluating clinical skills than traditional multiple-choice QA benchmarks (e.g., MedQA). Combined with existing benchmarks, MedQA-CS enables a more comprehensive evaluation of LLMs' clinical capabilities for both open- and closed-source LLMs.

Instruction tuning is an important step in making language models useful for direct user interaction. However, many legal tasks remain out of reach for most open LLMs and there do not yet exist any large scale instruction datasets for the domain. This critically limits research in this application area. In this work, we curate LawInstruct, a large legal instruction dataset, covering 17 jurisdictions, 24 languages and a total of 12M examples. We present evidence that domain-specific pretraining and instruction tuning improve performance on LegalBench, including improving Flan-T5 XL by 8 points or 16\% over the baseline. However, the effect does not generalize across all tasks, training regimes, model sizes, and other factors. LawInstruct is a resource for accelerating the development of models with stronger information processing and decision making capabilities in the legal domain.

Hospitals and healthcare systems rely on operational decisions that determine patient flow, cost, and quality of care. Despite strong performance on medical knowledge and conversational benchmarks, foundation models trained on general text may lack the specialized knowledge required for these operational decisions. We introduce Lang1, a family of models (100M-7B parameters) pretrained on a specialized corpus blending 80B clinical tokens from NYU Langone Health's EHRs and 627B tokens from the internet. To rigorously evaluate Lang1 in real-world settings, we developed the REalistic Medical Evaluation (ReMedE), a benchmark derived from 668,331 EHR notes that evaluates five critical tasks: 30-day readmission prediction, 30-day mortality prediction, length of stay, comorbidity coding, and predicting insurance claims denial. In zero-shot settings, both general-purpose and specialized models underperform on four of five tasks (36.6%-71.7% AUROC), with mortality prediction being an exception. After finetuning, Lang1-1B outperforms finetuned generalist models up to 70x larger and zero-shot models up to 671x larger, improving AUROC by 3.64%-6.75% and 1.66%-23.66% respectively. We also observed cross-task scaling with joint finetuning on multiple tasks leading to improvement on other tasks. Lang1-1B effectively transfers to out-of-distribution settings, including other clinical tasks and an external health system. Our findings suggest that predictive capabilities for hospital operations require explicit supervised finetuning, and that this finetuning process is made more efficient by in-domain pretraining on EHR. Our findings support the emerging view that specialized LLMs can compete with generalist models in specialized tasks, and show that effective healthcare systems AI requires the combination of in-domain pretraining, supervised finetuning, and real-world evaluation beyond proxy benchmarks.

Access to the right evidence does not guarantee that large language models (LLMs) will reason with it correctly. This gap between retrieval and reasoning is especially concerning in clinical settings, where outputs must align with structured protocols. We study this gap using Written Exposure Therapy (WET) guidelines as a testbed. In evaluating model responses to curated clinician-vetted questions, we find that errors persist even when authoritative passages are provided. To address this, we propose an evaluation framework that measures accuracy, consistency, and fidelity of reasoning. Our results highlight both the potential and the risks: retrieval-augmented generation (RAG) can constrain outputs, but safe deployment requires assessing reasoning as rigorously as retrieval.

We introduce a new Information Extraction (IE) task dubbed Instruction-based IE, which aims to ask the system to follow specific instructions or guidelines to extract information. To facilitate research in this area, we construct a dataset called InstructIE, consisting of 270,000 weakly supervised data from Chinese Wikipedia and 1,000 high-quality crowdsourced annotated instances. We further evaluate the performance of various baseline models on the InstructIE dataset. The results reveal that although current models exhibit promising performance, there is still room for improvement. Furthermore, we conduct a comprehensive case study analysis, underlining the challenges inherent in the Instruction-based IE task. Code and dataset are available at https://github.com/zjunlp/DeepKE/tree/main/example/llm.

Generating diverse and sophisticated instructions for downstream tasks by Large Language Models (LLMs) is pivotal for advancing the effect. Current approaches leverage closed-source LLMs, employing in-context prompting for instruction generation. However, in this paper, we found that in-context prompting cannot generate complex instructions with length ge 100 for tasks like code completion. To solve this problem, we introduce Ada-Instruct, an adaptive instruction generator developed by fine-tuning open-source LLMs. Our pivotal finding illustrates that fine-tuning open-source LLMs with a mere ten samples generates long instructions that maintain distributional consistency for complex reasoning tasks. We empirically validated Ada-Instruct's efficacy across different applications, including code completion, mathematical reasoning, and commonsense reasoning. The results underscore Ada-Instruct's superiority, evidencing its improvements over its base models, current self-instruct methods, and other state-of-the-art models.

Clinical Question Answering (QA) systems enable doctors to quickly access patient information from electronic health records (EHRs). However, training these systems requires significant annotated data, which is limited due to the expertise needed and the privacy concerns associated with clinical data. This paper explores generating Clinical QA data using large language models (LLMs) in a zero-shot setting. We find that naive prompting often results in easy questions that do not reflect the complexity of clinical scenarios. To address this, we propose two prompting strategies: 1) instructing the model to generate questions that do not overlap with the input context, and 2) summarizing the input record using a predefined schema to scaffold question generation. Experiments on two Clinical QA datasets demonstrate that our method generates more challenging questions, significantly improving fine-tuning performance over baselines. We compare synthetic and gold data and find a gap between their training efficacy resulting from the quality of synthetically generated answers.

Although recent advances in scaling large language models (LLMs) have resulted in improvements on many NLP tasks, it remains unclear whether these models trained primarily with general web text are the right tool in highly specialized, safety critical domains such as clinical text. Recent results have suggested that LLMs encode a surprising amount of medical knowledge. This raises an important question regarding the utility of smaller domain-specific language models. With the success of general-domain LLMs, is there still a need for specialized clinical models? To investigate this question, we conduct an extensive empirical analysis of 12 language models, ranging from 220M to 175B parameters, measuring their performance on 3 different clinical tasks that test their ability to parse and reason over electronic health records. As part of our experiments, we train T5-Base and T5-Large models from scratch on clinical notes from MIMIC III and IV to directly investigate the efficiency of clinical tokens. We show that relatively small specialized clinical models substantially outperform all in-context learning approaches, even when finetuned on limited annotated data. Further, we find that pretraining on clinical tokens allows for smaller, more parameter-efficient models that either match or outperform much larger language models trained on general text. We release the code and the models used under the PhysioNet Credentialed Health Data license and data use agreement.

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

The pursuit of diverse, complex, and large-scale instruction data is crucial for automatically aligning large language models (LLMs). While there are methods capable of generating synthetic instructions at scale, they either suffer from limited grounding sources, leading to a narrow distribution, or rely on trivial extensions that fail to produce meaningful trajectories in terms of complexity. In contrast, instructions that benefit efficient alignment are typically crafted with cognitive insights and grounded in real-world use cases. In this paper, we synthesize such instructions using attributed grounding, which involves 1) a top-down attribution process that grounds a selective set of real instructions to situated users, and 2) a bottom-up synthesis process that leverages web documents to first generate a situation, then a meaningful instruction. This framework allows us to harvest diverse and complex instructions at scale, utilizing the vast range of web documents. Specifically, we construct a dataset of 1 million instructions, called SynthQuestions, and demonstrate that models trained on it achieve leading performance on several common benchmarks, with improvements that continually scale with more web corpora. Data, models and codes will be available at https://github.com/Ignoramus0817/SynthQuestions.

Large Language Models (LLMs) and Retrieval-Augmented Generation (RAG) systems are increasingly integrated into clinical workflows; however, prompt injection attacks can steer these systems toward clinically unsafe or misleading outputs. We introduce the Medical Prompt Injection Benchmark (MPIB), a dataset-and-benchmark suite for evaluating clinical safety under both direct prompt injection and indirect, RAG-mediated injection across clinically grounded tasks. MPIB emphasizes outcome-level risk via the Clinical Harm Event Rate (CHER), which measures high-severity clinical harm events under a clinically grounded taxonomy, and reports CHER alongside Attack Success Rate (ASR) to disentangle instruction compliance from downstream patient risk. The benchmark comprises 9,697 curated instances constructed through multi-stage quality gates and clinical safety linting. Evaluating MPIB across a diverse set of baseline LLMs and defense configurations, we find that ASR and CHER can diverge substantially, and that robustness depends critically on whether adversarial instructions appear in the user query or in retrieved context. We release MPIB with evaluation code, adversarial baselines, and comprehensive documentation to support reproducible and systematic research on clinical prompt injection. Code and data are available at GitHub (code) and Hugging Face (data).

A broad range of NLP tasks involve selecting relevant text spans from given source texts. Despite this shared objective, such content selection tasks have traditionally been studied in isolation, each with its own modeling approaches, datasets, and evaluation metrics. In this work, we propose instruction-guided content selection (IGCS) as a beneficial unified framework for such settings, where the task definition and any instance-specific request are encapsulated as instructions to a language model. To promote this framework, we introduce , the first unified benchmark covering diverse content selection tasks. Further, we create a large generic synthetic dataset that can be leveraged for diverse content selection tasks, and show that transfer learning with these datasets often boosts performance, whether dedicated training for the targeted task is available or not. Finally, we address generic inference time issues that arise in LLM-based modeling of content selection, assess a generic evaluation metric, and overall propose the utility of our resources and methods for future content selection models. Models and datasets available at https://github.com/shmuelamar/igcs.

Instruction tuning of language models has demonstrated the ability to enhance model generalization to unseen tasks via in-context learning using a few examples. However, typical supervised learning still requires a plethora of downstream training data for finetuning. Often in real-world situations, there is a scarcity of data available for finetuning, falling somewhere between few shot inference and fully supervised finetuning. In this work, we demonstrate the sample efficiency of instruction tuned models over various tasks by estimating the minimal downstream training data required by them to perform transfer learning and match the performance of state-of-the-art (SOTA) supervised models. We conduct experiments on 119 tasks from Super Natural Instructions (SuperNI) in both the single task learning (STL) and multi task learning (MTL) settings. Our findings reveal that, in the STL setting, instruction tuned models equipped with 25% of the downstream train data surpass the SOTA performance on the downstream tasks. In the MTL setting, an instruction tuned model trained on only 6% of downstream training data achieve SOTA, while using 100% of the training data results in a 3.69% points improvement (ROUGE-L 74.68) over the previous SOTA. We conduct an analysis on T5 vs Tk-Instruct by developing several baselines to demonstrate that instruction tuning aids in increasing both sample efficiency and transfer learning. Additionally, we observe a consistent ~4% performance increase in both settings when pre-finetuning is performed with instructions. Finally, we conduct a categorical study and find that contrary to previous results, tasks in the question rewriting and title generation categories suffer from instruction tuning.

Objective To solve major clinical natural language processing (NLP) tasks using a unified text-to-text learning architecture based on a generative large language model (LLM) via prompt tuning. Methods We formulated 7 key clinical NLP tasks as text-to-text learning and solved them using one unified generative clinical LLM, GatorTronGPT, developed using GPT-3 architecture and trained with up to 20 billion parameters. We adopted soft prompts (i.e., trainable vectors) with frozen LLM, where the LLM parameters were not updated (i.e., frozen) and only the vectors of soft prompts were updated, known as prompt tuning. We added additional soft prompts as a prefix to the input layer, which were optimized during the prompt tuning. We evaluated the proposed method using 7 clinical NLP tasks and compared them with previous task-specific solutions based on Transformer models. Results and Conclusion The proposed approach achieved state-of-the-art performance for 5 out of 7 major clinical NLP tasks using one unified generative LLM. Our approach outperformed previous task-specific transformer models by ~3% for concept extraction and 7% for relation extraction applied to social determinants of health, 3.4% for clinical concept normalization, 3.4~10% for clinical abbreviation disambiguation, and 5.5~9% for natural language inference. Our approach also outperformed a previously developed prompt-based machine reading comprehension (MRC) model, GatorTron-MRC, for clinical concept and relation extraction. The proposed approach can deliver the ``one model for all`` promise from training to deployment using a unified generative LLM.

Motivation: Patient-generated text contains critical information about patients' lived experiences, social circumstances, and engagement in care, including factors that strongly influence adherence, care coordination, and health equity. However, these patient voice signals are rarely available in structured form, limiting their use in patient-centered outcomes research and clinical quality improvement. Reliable extraction of such information is therefore essential for understanding and addressing non-clinical drivers of health outcomes at scale. Results: We introduce PVminer, a benchmark for structured extraction of patient voice, and propose PVminerLLM, a supervised fine-tuned large language model tailored to this task. Across multiple datasets and model sizes, PVminerLLM substantially outperforms prompt-based baselines, achieving up to 83.82% F1 for Code prediction, 80.74% F1 for Sub-code prediction, and 87.03% F1 for evidence Span extraction. Notably, strong performance is achieved even with smaller models, demonstrating that reliable patient voice extraction is feasible without extreme model scale. These results enable scalable analysis of social and experiential signals embedded in patient-generated text. Availability and Implementation: Code, evaluation scripts, and trained LLMs will be released publicly. Annotated datasets will be made available upon request for research use. Keywords: Large Language Models, Supervised Fine-Tuning, Medical Annotation, Patient-Generated Text, Clinical NLP

In this work, we address the problem of grounding abnormalities in medical images, where the goal is to localize clinical findings based on textual descriptions. While generalist Vision-Language Models (VLMs) excel in natural grounding tasks, they often struggle in the medical domain due to rare, compositional, and domain-specific terms that are poorly aligned with visual patterns. Specialized medical VLMs address this challenge via large-scale domain pretraining, but at the cost of substantial annotation and computational resources. To overcome these limitations, we propose Knowledge to Sight (K2Sight), a framework that introduces structured semantic supervision by decomposing clinical concepts into interpretable visual attributes, such as shape, density, and anatomical location. These attributes are distilled from domain ontologies and encoded into concise instruction-style prompts, which guide region-text alignment during training. Unlike conventional report-level supervision, our approach explicitly bridges domain knowledge and spatial structure, enabling data-efficient training of compact models. We train compact models with 0.23B and 2B parameters using only 1.5\% of the data required by state-of-the-art medical VLMs. Despite their small size and limited training data, these models achieve performance on par with or better than 7B+ medical VLMs, with up to 9.82\% improvement in mAP_{50}. Code and models: https://lijunrio.github.io/K2Sight/{SOTAPink{https://lijunrio.github.io/K2Sight/}}.

Prompting Large Language Models (LLMs), or providing context on the expected model of operation, is an effective way to steer the outputs of such models to satisfy human desiderata after they have been trained. But in rapidly evolving domains, there is often need to fine-tune LLMs to improve either the kind of knowledge in their memory or their abilities to perform open ended reasoning in new domains. When human's learn new concepts, we often do so by linking the new material that we are studying to concepts we have already learned before. To that end, we ask, "can prompting help us teach LLMs how to learn". In this work, we study a novel generalization of instruction tuning, called contextual fine-tuning, to fine-tune LLMs. Our method leverages instructional prompts designed to mimic human cognitive strategies in learning and problem-solving to guide the learning process during training, aiming to improve the model's interpretation and understanding of domain-specific knowledge. We empirically demonstrate that this simple yet effective modification improves the ability of LLMs to be fine-tuned rapidly on new datasets both within the medical and financial domains.

Clinical dialogue represents a complex duality requiring both the empathetic fluency of natural conversation and the rigorous precision of evidence-based medicine. While Large Language Models possess unprecedented linguistic capabilities, their architectural reliance on reactive and stateless processing often favors probabilistic plausibility over factual veracity. This structural limitation has catalyzed a paradigm shift in medical AI from generative text prediction to agentic autonomy, where the model functions as a central reasoning engine capable of deliberate planning and persistent memory. Moving beyond existing reviews that primarily catalog downstream applications, this survey provides a first-principles analysis of the cognitive architecture underpinning this shift. We introduce a novel taxonomy structured along the orthogonal axes of knowledge source and agency objective to delineate the provenance of clinical knowledge against the system's operational scope. This framework facilitates a systematic analysis of the intrinsic trade-offs between creativity and reliability by categorizing methods into four archetypes: Latent Space Clinicians, Emergent Planners, Grounded Synthesizers, and Verifiable Workflow Automators. For each paradigm, we deconstruct the technical realization across the entire cognitive pipeline, encompassing strategic planning, memory management, action execution, collaboration, and evolution to reveal how distinct architectural choices balance the tension between autonomy and safety.

Clinical trial matching is a key process in health delivery and discovery. In practice, it is plagued by overwhelming unstructured data and unscalable manual processing. In this paper, we conduct a systematic study on scaling clinical trial matching using large language models (LLMs), with oncology as the focus area. Our study is grounded in a clinical trial matching system currently in test deployment at a large U.S. health network. Initial findings are promising: out of box, cutting-edge LLMs, such as GPT-4, can already structure elaborate eligibility criteria of clinical trials and extract complex matching logic (e.g., nested AND/OR/NOT). While still far from perfect, LLMs substantially outperform prior strong baselines and may serve as a preliminary solution to help triage patient-trial candidates with humans in the loop. Our study also reveals a few significant growth areas for applying LLMs to end-to-end clinical trial matching, such as context limitation and accuracy, especially in structuring patient information from longitudinal medical records.

Instruction-tuning can be substantially optimized through enhanced diversity, resulting in models capable of handling a broader spectrum of tasks. However, existing data employed for such tuning often exhibit an inadequate coverage of individual domains, limiting the scope for nuanced comprehension and interactions within these areas. To address this deficiency, we propose Explore-Instruct, a novel approach to enhance the data coverage to be used in domain-specific instruction-tuning through active exploration via Large Language Models (LLMs). Built upon representative domain use cases, Explore-Instruct explores a multitude of variations or possibilities by implementing a search algorithm to obtain diversified and domain-focused instruction-tuning data. Our data-centric analysis validates the effectiveness of this proposed approach in improving domain-specific instruction coverage. Moreover, our model's performance demonstrates considerable advancements over multiple baselines, including those utilizing domain-specific data enhancement. Our findings offer a promising opportunity to improve instruction coverage, especially in domain-specific contexts, thereby advancing the development of adaptable language models. Our code, model weights, and data are public at https://github.com/fanqiwan/Explore-Instruct.

We study the problem of procedure planning in instructional videos, which aims to make a goal-oriented sequence of action steps given partial visual state observations. The motivation of this problem is to learn a structured and plannable state and action space. Recent works succeeded in sequence modeling of steps with only sequence-level annotations accessible during training, which overlooked the roles of states in the procedures. In this work, we point out that State CHangEs MAtter (SCHEMA) for procedure planning in instructional videos. We aim to establish a more structured state space by investigating the causal relations between steps and states in procedures. Specifically, we explicitly represent each step as state changes and track the state changes in procedures. For step representation, we leveraged the commonsense knowledge in large language models (LLMs) to describe the state changes of steps via our designed chain-of-thought prompting. For state change tracking, we align visual state observations with language state descriptions via cross-modal contrastive learning, and explicitly model the intermediate states of the procedure using LLM-generated state descriptions. Experiments on CrossTask, COIN, and NIV benchmark datasets demonstrate that our proposed SCHEMA model achieves state-of-the-art performance and obtains explainable visualizations.

Robotic instruction following tasks require seamless integration of visual perception, task planning, target localization, and motion execution. However, existing task planning methods for instruction following are either data-driven or underperform in zero-shot scenarios due to difficulties in grounding lengthy instructions into actionable plans under operational constraints. To address this, we propose FlowPlan, a structured multi-stage LLM workflow that elevates zero-shot pipeline and bridges the performance gap between zero-shot and data-driven in-context learning methods. By decomposing the planning process into modular stages--task information retrieval, language-level reasoning, symbolic-level planning, and logical evaluation--FlowPlan generates logically coherent action sequences while adhering to operational constraints and further extracts contextual guidance for precise instance-level target localization. Benchmarked on the ALFRED and validated in real-world applications, our method achieves competitive performance relative to data-driven in-context learning methods and demonstrates adaptability across diverse environments. This work advances zero-shot task planning in robotic systems without reliance on labeled data. Project website: https://instruction-following-project.github.io/.

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.

Instruction tuning is a pivotal technique for aligning large language models (LLMs) with human intentions, safety constraints, and domain-specific requirements. This survey provides a comprehensive overview of the full pipeline, encompassing (i) data collection methodologies, (ii) full-parameter and parameter-efficient fine-tuning strategies, and (iii) evaluation protocols. We categorized data construction into three major paradigms: expert annotation, distillation from larger models, and self-improvement mechanisms, each offering distinct trade-offs between quality, scalability, and resource cost. Fine-tuning techniques range from conventional supervised training to lightweight approaches, such as low-rank adaptation (LoRA) and prefix tuning, with a focus on computational efficiency and model reusability. We further examine the challenges of evaluating faithfulness, utility, and safety across multilingual and multimodal scenarios, highlighting the emergence of domain-specific benchmarks in healthcare, legal, and financial applications. Finally, we discuss promising directions for automated data generation, adaptive optimization, and robust evaluation frameworks, arguing that a closer integration of data, algorithms, and human feedback is essential for advancing instruction-tuned LLMs. This survey aims to serve as a practical reference for researchers and practitioners seeking to design LLMs that are both effective and reliably aligned with human intentions.

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) show promise in drafting responses to patient portal messages, yet their integration into clinical workflows raises various concerns, including whether they would actually save clinicians time and effort in their portal workload. We investigate LLM alignment with individual clinicians through a comprehensive evaluation of the patient message response drafting task. We develop a novel taxonomy of thematic elements in clinician responses and propose a novel evaluation framework for assessing clinician editing load of LLM-drafted responses at both content and theme levels. We release an expert-annotated dataset and conduct large-scale evaluations of local and commercial LLMs using various adaptation techniques including thematic prompting, retrieval-augmented generation, supervised fine-tuning, and direct preference optimization. Our results reveal substantial epistemic uncertainty in aligning LLM drafts with clinician responses. While LLMs demonstrate capability in drafting certain thematic elements, they struggle with clinician-aligned generation in other themes, particularly question asking to elicit further information from patients. Theme-driven adaptation strategies yield improvements across most themes. Our findings underscore the necessity of adapting LLMs to individual clinician preferences to enable reliable and responsible use in patient-clinician communication workflows.

While large language models (LLMs) have exhibited impressive instruction-following capabilities, it is still unclear whether and to what extent they can respond to explicit constraints that might be entailed in various instructions. As a significant aspect of LLM alignment, it is thus important to formulate such a specialized set of instructions as well as investigate the resulting behavior of LLMs. To address this vacancy, we propose a new benchmark CoDI-Eval to systematically and comprehensively evaluate LLMs' responses to instructions with various constraints. We construct a large collection of constraints-attributed instructions as a test suite focused on both generalization and coverage. Specifically, we advocate an instruction diversification process to synthesize diverse forms of constraint expression and also deliberate the candidate task taxonomy with even finer-grained sub-categories. Finally, we automate the entire evaluation process to facilitate further developments. Different from existing studies on controllable text generation, CoDI-Eval extends the scope to the prevalent instruction-following paradigm for the first time. We provide extensive evaluations of representative LLMs (e.g., ChatGPT, Vicuna) on CoDI-Eval, revealing their limitations in following instructions with specific constraints and there is still a significant gap between open-source and commercial closed-source LLMs. We believe this benchmark will facilitate research into improving the controllability of LLMs' responses to instructions. Our data and code are available at https://github.com/Xt-cyh/CoDI-Eval.

Large language models (LLMs) have demonstrated impressive capabilities in various natural language processing tasks. Despite this, their application to information retrieval (IR) tasks is still challenging due to the infrequent occurrence of many IR-specific concepts in natural language. While prompt-based methods can provide task descriptions to LLMs, they often fall short in facilitating comprehensive understanding and execution of IR tasks, thereby limiting LLMs' applicability. To address this gap, in this work, we explore the potential of instruction tuning to enhance LLMs' proficiency in IR tasks. We introduce a novel instruction tuning dataset, INTERS, encompassing 21 tasks across three fundamental IR categories: query understanding, document understanding, and query-document relationship understanding. The data are derived from 43 distinct datasets with manually written templates. Our empirical results reveal that INTERS significantly boosts the performance of various publicly available LLMs, such as LLaMA, Mistral, and Phi, in search-related tasks. Furthermore, we conduct a comprehensive analysis to ascertain the effects of base model selection, instruction design, volume of instructions, and task variety on performance. We make our dataset and the models fine-tuned on it publicly accessible at https://github.com/DaoD/INTERS.

Instruction-tuned language models (LM) are able to respond to imperative commands, providing a more natural user interface compared to their base counterparts. In this work, we present Promptriever, the first retrieval model able to be prompted like an LM. To train Promptriever, we curate and release a new instance-level instruction training set from MS MARCO, spanning nearly 500k instances. Promptriever not only achieves strong performance on standard retrieval tasks, but also follows instructions. We observe: (1) large gains (reaching SoTA) on following detailed relevance instructions (+14.3 p-MRR / +3.1 nDCG on FollowIR), (2) significantly increased robustness to lexical choices/phrasing in the query+instruction (+12.9 Robustness@10 on InstructIR), and (3) the ability to perform hyperparameter search via prompting to reliably improve retrieval performance (+1.4 average increase on BEIR). Promptriever demonstrates that retrieval models can be controlled with prompts on a per-query basis, setting the stage for future work aligning LM prompting techniques with information retrieval.

Medical Visual Language Models have shown great potential in various healthcare applications, including medical image captioning and diagnostic assistance. However, most existing models rely on text-based instructions, limiting their usability in real-world clinical environments especially in scenarios such as surgery, text-based interaction is often impractical for physicians. In addition, current medical image analysis models typically lack comprehensive reasoning behind their predictions, which reduces their reliability for clinical decision-making. Given that medical diagnosis errors can have life-changing consequences, there is a critical need for interpretable and rational medical assistance. To address these challenges, we introduce an end-to-end speech-driven medical VLM, SilVar-Med, a multimodal medical image assistant that integrates speech interaction with VLMs, pioneering the task of voice-based communication for medical image analysis. In addition, we focus on the interpretation of the reasoning behind each prediction of medical abnormalities with a proposed reasoning dataset. Through extensive experiments, we demonstrate a proof-of-concept study for reasoning-driven medical image interpretation with end-to-end speech interaction. We believe this work will advance the field of medical AI by fostering more transparent, interactive, and clinically viable diagnostic support systems. Our code and dataset are publicly available at SiVar-Med.

Instruction tuning unlocks the superior capability of Large Language Models (LLM) to interact with humans. Furthermore, recent instruction-following datasets include images as visual inputs, collecting responses for image-based instructions. However, visual instruction-tuned models cannot comprehend textual details within images well. This work enhances the current visual instruction tuning pipeline with text-rich images (e.g., movie posters, book covers, etc.). Specifically, we first use publicly available OCR tools to collect results on 422K text-rich images from the LAION dataset. Moreover, we prompt text-only GPT-4 with recognized texts and image captions to generate 16K conversations, each containing question-answer pairs for text-rich images. By combining our collected data with previous multi-modal instruction-following data, our model, LLaVAR, substantially improves the LLaVA model's capability on text-based VQA datasets (up to 20% accuracy improvement) while achieving an accuracy of 91.42% on ScienceQA. The GPT-4-based instruction-following evaluation also demonstrates the improvement of our model on both natural images and text-rich images. Through qualitative analysis, LLaVAR shows promising interaction (e.g., reasoning, writing, and elaboration) skills with humans based on the latest real-world online content that combines text and images. We make our code/data/models publicly available at https://llavar.github.io/.

We explore the potential of ChatGPT (3.5-turbo and 4) to generate conversations focused on self-care strategies for African-American heart failure patients -- a domain with limited specialized datasets. To simulate patient-health educator dialogues, we employed four prompting strategies: domain, African American Vernacular English (AAVE), Social Determinants of Health (SDOH), and SDOH-informed reasoning. Conversations were generated across key self-care domains of food, exercise, and fluid intake, with varying turn lengths (5, 10, 15) and incorporated patient-specific SDOH attributes such as age, gender, neighborhood, and socioeconomic status. Our findings show that effective prompt design is essential. While incorporating SDOH and reasoning improves dialogue quality, ChatGPT still lacks the empathy and engagement needed for meaningful healthcare communication.

A number of tasks have been proposed recently to facilitate easy access to charts such as chart QA and summarization. The dominant paradigm to solve these tasks has been to fine-tune a pretrained model on the task data. However, this approach is not only expensive but also not generalizable to unseen tasks. On the other hand, large language models (LLMs) have shown impressive generalization capabilities to unseen tasks with zero- or few-shot prompting. However, their application to chart-related tasks is not trivial as these tasks typically involve considering not only the underlying data but also the visual features in the chart image. We propose PromptChart, a multimodal few-shot prompting framework with LLMs for chart-related applications. By analyzing the tasks carefully, we have come up with a set of prompting guidelines for each task to elicit the best few-shot performance from LLMs. We further propose a strategy to inject visual information into the prompts. Our experiments on three different chart-related information consumption tasks show that with properly designed prompts LLMs can excel on the benchmarks, achieving state-of-the-art.

Instruction-following is essential for aligning large language models (LLMs) with user intent. While recent reasoning-oriented models exhibit impressive performance on complex mathematical problems, their ability to adhere to natural language instructions remains underexplored. In this work, we introduce MathIF, a dedicated benchmark for evaluating instruction-following in mathematical reasoning tasks. Our empirical analysis reveals a consistent tension between scaling up reasoning capacity and maintaining controllability, as models that reason more effectively often struggle to comply with user directives. We find that models tuned on distilled long chains-of-thought or trained with reasoning-oriented reinforcement learning often degrade in instruction adherence, especially when generation length increases. Furthermore, we show that even simple interventions can partially recover obedience, though at the cost of reasoning performance. These findings highlight a fundamental tension in current LLM training paradigms and motivate the need for more instruction-aware reasoning models. We release the code and data at https://github.com/TingchenFu/MathIF.

With the rapid development of artificial intelligence, large language models (LLMs) have shown promising capabilities in mimicking human-level language comprehension and reasoning. This has sparked significant interest in applying LLMs to enhance various aspects of healthcare, ranging from medical education to clinical decision support. However, medicine involves multifaceted data modalities and nuanced reasoning skills, presenting challenges for integrating LLMs. This paper provides a comprehensive review on the applications and implications of LLMs in medicine. It begins by examining the fundamental applications of general-purpose and specialized LLMs, demonstrating their utilities in knowledge retrieval, research support, clinical workflow automation, and diagnostic assistance. Recognizing the inherent multimodality of medicine, the review then focuses on multimodal LLMs, investigating their ability to process diverse data types like medical imaging and EHRs to augment diagnostic accuracy. To address LLMs' limitations regarding personalization and complex clinical reasoning, the paper explores the emerging development of LLM-powered autonomous agents for healthcare. Furthermore, it summarizes the evaluation methodologies for assessing LLMs' reliability and safety in medical contexts. Overall, this review offers an extensive analysis on the transformative potential of LLMs in modern medicine. It also highlights the pivotal need for continuous optimizations and ethical oversight before these models can be effectively integrated into clinical practice. Visit https://github.com/mingze-yuan/Awesome-LLM-Healthcare for an accompanying GitHub repository containing latest papers.