Daily Papers

The potential of Multimodal Large Language Models (MLLMs) in domain of medical imaging raise the demands of systematic and rigorous evaluation frameworks that are aligned with the real-world medical imaging practice. Existing practices that report single or coarse-grained metrics are lack the granularity required for specialized clinical support and fail to assess the reliability of reasoning mechanisms. To address this, we propose a paradigm shift toward multidimensional, fine-grained and in-depth evaluation. Based on a two-stage systematic construction pipeline designed for this paradigm, we instantiate it with MedRCube. We benchmark 33 MLLMs, Lingshu-32B achieve top-tier performance. Crucially, MedRCube exposes a series of pronounced insights inaccessible under prior evaluation settings. Furthermore, we introduce a credibility evaluation subset to quantify reasoning credibility, uncover a highly significant positive association between shortcut behavior and diagnostic task performance, raising concerns for clinically trustworthy deployment. The resources of this work can be found at https://github.com/F1mc/MedRCube.

The non-invasive assessment of increasingly incidentally discovered renal masses is a critical challenge in urologic oncology, where diagnostic uncertainty frequently leads to the overtreatment of benign or indolent tumors. In this study, we developed and validated RenalCLIP using a dataset of 27,866 CT scans from 8,809 patients across nine Chinese medical centers and the public TCIA cohort, a visual-language foundation model for characterization, diagnosis and prognosis of renal mass. The model was developed via a two-stage pre-training strategy that first enhances the image and text encoders with domain-specific knowledge before aligning them through a contrastive learning objective, to create robust representations for superior generalization and diagnostic precision. RenalCLIP achieved better performance and superior generalizability across 10 core tasks spanning the full clinical workflow of kidney cancer, including anatomical assessment, diagnostic classification, and survival prediction, compared with other state-of-the-art general-purpose CT foundation models. Especially, for complicated task like recurrence-free survival prediction in the TCIA cohort, RenalCLIP achieved a C-index of 0.726, representing a substantial improvement of approximately 20% over the leading baselines. Furthermore, RenalCLIP's pre-training imparted remarkable data efficiency; in the diagnostic classification task, it only needs 20% training data to achieve the peak performance of all baseline models even after they were fully fine-tuned on 100% of the data. Additionally, it achieved superior performance in report generation, image-text retrieval and zero-shot diagnosis tasks. Our findings establish that RenalCLIP provides a robust tool with the potential to enhance diagnostic accuracy, refine prognostic stratification, and personalize the management of patients with kidney cancer.

Although large multimodal models (LMMs) have demonstrated remarkable capabilities in visual scene interpretation and reasoning, their capacity for complex and precise 3-dimensional spatial reasoning remains uncertain. Existing benchmarks focus predominantly on 2D spatial understanding and lack a framework to comprehensively evaluate 6D spatial reasoning across varying complexities. To address this limitation, we present PulseCheck457, a scalable and unbiased synthetic dataset designed with 4 key capability for spatial reasoning: multi-object recognition, 2D location, 3D location, and 3D orientation. We develop a cascading evaluation structure, constructing 7 question types across 5 difficulty levels that range from basic single object recognition to our new proposed complex 6D spatial reasoning tasks. We evaluated various large multimodal models (LMMs) on PulseCheck457, observing a general decline in performance as task complexity increases, particularly in 3D reasoning and 6D spatial tasks. To quantify these challenges, we introduce the Relative Performance Dropping Rate (RPDR), highlighting key weaknesses in 3D reasoning capabilities. Leveraging the unbiased attribute design of our dataset, we also uncover prediction biases across different attributes, with similar patterns observed in real-world image settings.

The recent success of natural language understanding (NLU) systems has been troubled by results highlighting the failure of these models to generalize in a systematic and robust way. In this work, we introduce a diagnostic benchmark suite, named CLUTRR, to clarify some key issues related to the robustness and systematicity of NLU systems. Motivated by classic work on inductive logic programming, CLUTRR requires that an NLU system infer kinship relations between characters in short stories. Successful performance on this task requires both extracting relationships between entities, as well as inferring the logical rules governing these relationships. CLUTRR allows us to precisely measure a model's ability for systematic generalization by evaluating on held-out combinations of logical rules, and it allows us to evaluate a model's robustness by adding curated noise facts. Our empirical results highlight a substantial performance gap between state-of-the-art NLU models (e.g., BERT and MAC) and a graph neural network model that works directly with symbolic inputs---with the graph-based model exhibiting both stronger generalization and greater robustness.

Recent advances in autonomous LLM agents demonstrate their ability to improve performance through iterative interaction with the environment. We define this paradigm as Test-Time Improvement (TTI). However, the mechanisms under how and why TTI succeed or fail remain poorly understood, and existing evaluation metrics fail to capture their task optimization efficiency, behavior adaptation after erroneous actions, and the specific utility of working memory for task completion. To address these gaps, we propose Test-time Improvement Diagnostic Evaluation (TIDE), an agent-agnostic and environment-agnostic framework that decomposes TTI into three comprehensive and interconnected dimensions. The framework measures (1) the overall temporal dynamics of task completion and (2) identifies whether performance is primarily constrained by recursive looping behaviors or (3) by burdensome accumulated memory. Through extensive experiments across diverse agents and environments, TIDE highlights that improving agent performance requires more than scaling internal reasoning, calling for explicitly optimizing the interaction dynamics between the agent and the environment.

Large Language Models (LLMs), such as ChatGPT, are becoming increasingly sophisticated, demonstrating capabilities that closely resemble those of humans. These AI models are playing an essential role in assisting humans with a wide array of tasks in daily life. A significant application of AI is its use as a chat agent, responding to human inquiries across various domains. Current LLMs have shown proficiency in answering general questions. However, basic question-answering dialogue often falls short in complex diagnostic scenarios, such as legal or medical consultations. These scenarios typically necessitate Task-Oriented Dialogue (TOD), wherein an AI chat agent needs to proactively pose questions and guide users towards specific task completion. Previous fine-tuning models have underperformed in TOD, and current LLMs do not inherently possess this capability. In this paper, we introduce DiagGPT (Dialogue in Diagnosis GPT), an innovative method that extends LLMs to TOD scenarios. Our experiments reveal that DiagGPT exhibits outstanding performance in conducting TOD with users, demonstrating its potential for practical applications.

Large language models frequently rely on both contextual input and parametric knowledge to perform tasks. However, these sources can come into conflict, especially when retrieved documents contradict the model's parametric knowledge. We propose a diagnostic framework to systematically evaluate LLM behavior under context-memory conflict, where the contextual information diverges from their parametric beliefs. We construct diagnostic data that elicit these conflicts and analyze model performance across multiple task types. Our findings reveal that (1) knowledge conflict has minimal impact on tasks that do not require knowledge utilization, (2) model performance is consistently higher when contextual and parametric knowledge are aligned, (3) models are unable to fully suppress their internal knowledge even when instructed, and (4) providing rationales that explain the conflict increases reliance on contexts. These insights raise concerns about the validity of model-based evaluation and underscore the need to account for knowledge conflict in the deployment of LLMs.

We present a new dataset for machine comprehension in the medical domain. Our dataset uses clinical case reports with around 100,000 gap-filling queries about these cases. We apply several baselines and state-of-the-art neural readers to the dataset, and observe a considerable gap in performance (20% F1) between the best human and machine readers. We analyze the skills required for successful answering and show how reader performance varies depending on the applicable skills. We find that inferences using domain knowledge and object tracking are the most frequently required skills, and that recognizing omitted information and spatio-temporal reasoning are the most difficult for the machines.

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.

Finding relevant literature underpins the practice of evidence-based medicine. From 2014 to 2016, TREC conducted a clinical decision support track, wherein participants were tasked with finding articles relevant to clinical questions posed by physicians. In total, 87 teams have participated over the past three years, generating 395 runs. During this period, each team has trialled a variety of methods. While there was significant overlap in the methods employed by different teams, the results were varied. Due to the diversity of the platforms used, the results arising from the different techniques are not directly comparable, reducing the ability to build on previous work. By using a stable platform, we have been able to compare different document and query processing techniques, allowing us to experiment with different search parameters. We have used our system to reproduce leading teams runs, and compare the results obtained. By benchmarking our indexing and search techniques, we can statistically test a variety of hypotheses, paving the way for further research.

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

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

Current medical retrieval benchmarks primarily emphasize lexical or shallow semantic similarity, overlooking the reasoning-intensive demands that are central to clinical decision-making. In practice, physicians often retrieve authoritative medical evidence to support diagnostic hypotheses. Such evidence typically aligns with an inferred diagnosis rather than the surface form of a patient's symptoms, leading to low lexical or semantic overlap between queries and relevant documents. To address this gap, we introduce R2MED, the first benchmark explicitly designed for reasoning-driven medical retrieval. It comprises 876 queries spanning three tasks: Q&A reference retrieval, clinical evidence retrieval, and clinical case retrieval. These tasks are drawn from five representative medical scenarios and twelve body systems, capturing the complexity and diversity of real-world medical information needs. We evaluate 15 widely-used retrieval systems on R2MED and find that even the best model achieves only 31.4 nDCG@10, demonstrating the benchmark's difficulty. Classical re-ranking and generation-augmented retrieval methods offer only modest improvements. Although large reasoning models improve performance via intermediate inference generation, the best results still peak at 41.4 nDCG@10. These findings underscore a substantial gap between current retrieval techniques and the reasoning demands of real clinical tasks. We release R2MED as a challenging benchmark to foster the development of next-generation medical retrieval systems with enhanced reasoning capabilities. Data and code are available at https://github.com/R2MED/R2MED

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.

Large Language Models (LLMs) changed the way we design and interact with software systems. Their ability to process and extract information from text has drastically improved productivity in a number of routine tasks. Developers that want to include these models in their software stack, however, face a dreadful challenge: debugging LLMs' inconsistent behavior across minor variations of the prompt. We therefore introduce two metrics for classification tasks, namely sensitivity and consistency, which are complementary to task performance. First, sensitivity measures changes of predictions across rephrasings of the prompt, and does not require access to ground truth labels. Instead, consistency measures how predictions vary across rephrasings for elements of the same class. We perform an empirical comparison of these metrics on text classification tasks, using them as guideline for understanding failure modes of the LLM. Our hope is that sensitivity and consistency will be helpful to guide prompt engineering and obtain LLMs that balance robustness with performance.

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

Prompt sensitivity, referring to the phenomenon where paraphrasing (i.e., repeating something written or spoken using different words) leads to significant changes in large language model (LLM) performance, has been widely accepted as a core limitation of LLMs. In this work, we revisit this issue and ask: Is the widely reported high prompt sensitivity truly an inherent weakness of LLMs, or is it largely an artifact of evaluation processes? To answer this question, we systematically evaluate 7 LLMs (e.g., GPT and Gemini family) across 6 benchmarks, including both multiple-choice and open-ended tasks on 12 diverse prompt templates. We find that much of the prompt sensitivity stems from heuristic evaluation methods, including log-likelihood scoring and rigid answer matching, which often overlook semantically correct responses expressed through alternative phrasings, such as synonyms or paraphrases. When we adopt LLM-as-a-Judge evaluations, we observe a substantial reduction in performance variance and a consistently higher correlation in model rankings across prompts. Our findings suggest that modern LLMs are more robust to prompt templates than previously believed, and that prompt sensitivity may be more an artifact of evaluation than a flaw in the models.

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.

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

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.

Medical imaging is widely used in clinical practice for diagnosis and treatment. Report-writing can be error-prone for unexperienced physicians, and time- consuming and tedious for experienced physicians. To address these issues, we study the automatic generation of medical imaging reports. This task presents several challenges. First, a complete report contains multiple heterogeneous forms of information, including findings and tags. Second, abnormal regions in medical images are difficult to identify. Third, the re- ports are typically long, containing multiple sentences. To cope with these challenges, we (1) build a multi-task learning framework which jointly performs the pre- diction of tags and the generation of para- graphs, (2) propose a co-attention mechanism to localize regions containing abnormalities and generate narrations for them, (3) develop a hierarchical LSTM model to generate long paragraphs. We demonstrate the effectiveness of the proposed methods on two publicly available datasets.

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.

We present HEAD-QA, a multi-choice question answering testbed to encourage research on complex reasoning. The questions come from exams to access a specialized position in the Spanish healthcare system, and are challenging even for highly specialized humans. We then consider monolingual (Spanish) and cross-lingual (to English) experiments with information retrieval and neural techniques. We show that: (i) HEAD-QA challenges current methods, and (ii) the results lag well behind human performance, demonstrating its usefulness as a benchmark for future work.

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

Medical systematic reviews typically require assessing all the documents retrieved by a search. The reason is two-fold: the task aims for ``total recall''; and documents retrieved using Boolean search are an unordered set, and thus it is unclear how an assessor could examine only a subset. Screening prioritisation is the process of ranking the (unordered) set of retrieved documents, allowing assessors to begin the downstream processes of the systematic review creation earlier, leading to earlier completion of the review, or even avoiding screening documents ranked least relevant. Screening prioritisation requires highly effective ranking methods. Pre-trained language models are state-of-the-art on many IR tasks but have yet to be applied to systematic review screening prioritisation. In this paper, we apply several pre-trained language models to the systematic review document ranking task, both directly and fine-tuned. An empirical analysis compares how effective neural methods compare to traditional methods for this task. We also investigate different types of document representations for neural methods and their impact on ranking performance. Our results show that BERT-based rankers outperform the current state-of-the-art screening prioritisation methods. However, BERT rankers and existing methods can actually be complementary, and thus, further improvements may be achieved if used in conjunction.

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.

This paper describes the results of SemEval 2023 task 7 -- Multi-Evidence Natural Language Inference for Clinical Trial Data (NLI4CT) -- consisting of 2 tasks, a Natural Language Inference (NLI) task, and an evidence selection task on clinical trial data. The proposed challenges require multi-hop biomedical and numerical reasoning, which are of significant importance to the development of systems capable of large-scale interpretation and retrieval of medical evidence, to provide personalized evidence-based care. Task 1, the entailment task, received 643 submissions from 40 participants, and Task 2, the evidence selection task, received 364 submissions from 23 participants. The tasks are challenging, with the majority of submitted systems failing to significantly outperform the majority class baseline on the entailment task, and we observe significantly better performance on the evidence selection task than on the entailment task. Increasing the number of model parameters leads to a direct increase in performance, far more significant than the effect of biomedical pre-training. Future works could explore the limitations of large models for generalization and numerical inference, and investigate methods to augment clinical datasets to allow for more rigorous testing and to facilitate fine-tuning. We envisage that the dataset, models, and results of this task will be useful to the biomedical NLI and evidence retrieval communities. The dataset, competition leaderboard, and website are publicly available.

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.

This is the fifth year of the TREC Deep Learning track. As in previous years, we leverage the MS MARCO datasets that made hundreds of thousands of human-annotated training labels available for both passage and document ranking tasks. We mostly repeated last year's design, to get another matching test set, based on the larger, cleaner, less-biased v2 passage and document set, with passage ranking as primary and document ranking as a secondary task (using labels inferred from passage). As we did last year, we sample from MS MARCO queries that were completely held out, unused in corpus construction, unlike the test queries in the first three years. This approach yields a more difficult test with more headroom for improvement. Alongside the usual MS MARCO (human) queries from MS MARCO, this year we generated synthetic queries using a fine-tuned T5 model and using a GPT-4 prompt. The new headline result this year is that runs using Large Language Model (LLM) prompting in some way outperformed runs that use the "nnlm" approach, which was the best approach in the previous four years. Since this is the last year of the track, future iterations of prompt-based ranking can happen in other tracks. Human relevance assessments were applied to all query types, not just human MS MARCO queries. Evaluation using synthetic queries gave similar results to human queries, with system ordering agreement of τ=0.8487. However, human effort was needed to select a subset of the synthetic queries that were usable. We did not see clear evidence of bias, where runs using GPT-4 were favored when evaluated using synthetic GPT-4 queries, or where runs using T5 were favored when evaluated on synthetic T5 queries.

We present a large-scale dataset, ReCoRD, for machine reading comprehension requiring commonsense reasoning. Experiments on this dataset demonstrate that the performance of state-of-the-art MRC systems fall far behind human performance. ReCoRD represents a challenge for future research to bridge the gap between human and machine commonsense reading comprehension. ReCoRD is available at http://nlp.jhu.edu/record.

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

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

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

In the information retrieval (IR) domain, evaluation plays a crucial role in optimizing search experiences and supporting diverse user intents. In the recent LLM era, research has been conducted to automate document relevance labels, as these labels have traditionally been assigned by crowd-sourced workers - a process that is both time and consuming and costly. This study focuses on LLM-generated usefulness labels, a crucial evaluation metric that considers the user's search intents and task objectives, an aspect where relevance falls short. Our experiment utilizes task-level, query-level, and document-level features along with user search behavior signals, which are essential in defining the usefulness of a document. Our research finds that (i) pre-trained LLMs can generate moderate usefulness labels by understanding the comprehensive search task session, (ii) pre-trained LLMs perform better judgement in short search sessions when provided with search session contexts. Additionally, we investigated whether LLMs can capture the unique divergence between relevance and usefulness, along with conducting an ablation study to identify the most critical metrics for accurate usefulness label generation. In conclusion, this work explores LLM-generated usefulness labels by evaluating critical metrics and optimizing for practicality in real-world settings.

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

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

This paper presents a systematic review of benchmarks and approaches for explainability in Machine Reading Comprehension (MRC). We present how the representation and inference challenges evolved and the steps which were taken to tackle these challenges. We also present the evaluation methodologies to assess the performance of explainable systems. In addition, we identify persisting open research questions and highlight critical directions for future work.

This article presents the Cogni-CISMeF project, which aims at improving medical information search in the CISMeF system (Catalog and Index of French-language health resources) by including a conversational agent to interact with the user in natural language. To study the cognitive processes involved during the information search, a bottom-up methodology was adopted. Experimentation has been set up to obtain human dialogs between a user (playing the role of patient) dealing with medical information search and a CISMeF expert refining the request. The analysis of these dialogs underlined the use of discursive evidence: vocabulary, reformulation, implicit or explicit expression of user intentions, conversational sequences, etc. A model of artificial agent is proposed. It leads the user in its information search by proposing to him examples, assistance and choices. This model was implemented and integrated in the CISMeF system. ---- Cet article d\'ecrit le projet Cogni-CISMeF qui propose un module de dialogue Homme-Machine \`a int\'egrer dans le syst\`eme d'indexation de connaissances m\'edicales CISMeF (Catalogue et Index des Sites M\'edicaux Francophones). Nous avons adopt\'e une d\'emarche de mod\'elisation cognitive en proc\'edant \`a un recueil de corpus de dialogues entre un utilisateur (jouant le r\^ole d'un patient) d\'esirant une information m\'edicale et un expert CISMeF af inant cette demande pour construire la requ\^ete. Nous avons analys\'e la structure des dialogues ainsi obtenus et avons \'etudi\'e un certain nombre d'indices discursifs : vocabulaire employ\'e, marques de reformulation, commentaires m\'eta et \'epilinguistiques, expression implicite ou explicite des intentions de l'utilisateur, encha\^inement conversationnel, etc. De cette analyse, nous avons construit un mod\`ele d'agent artificiel dot\'e de capacit\'es cognitives capables d'aider l'utilisateur dans sa t\^ache de recherche d'information. Ce mod\`ele a \'et\'e impl\'ement\'e et int\'egr\'e dans le syst\`eme CISMeF.

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

Readers of academic research papers often read with the goal of answering specific questions. Question Answering systems that can answer those questions can make consumption of the content much more efficient. However, building such tools requires data that reflect the difficulty of the task arising from complex reasoning about claims made in multiple parts of a paper. In contrast, existing information-seeking question answering datasets usually contain questions about generic factoid-type information. We therefore present QASPER, a dataset of 5,049 questions over 1,585 Natural Language Processing papers. Each question is written by an NLP practitioner who read only the title and abstract of the corresponding paper, and the question seeks information present in the full text. The questions are then answered by a separate set of NLP practitioners who also provide supporting evidence to answers. We find that existing models that do well on other QA tasks do not perform well on answering these questions, underperforming humans by at least 27 F1 points when answering them from entire papers, motivating further research in document-grounded, information-seeking QA, which our dataset is designed to facilitate.

Search-augmented large language models (LLMs) excel at knowledge-intensive tasks by integrating external retrieval. However, they often over-search -- unnecessarily invoking search tool even when it does not improve response quality, which leads to computational inefficiency and hallucinations by incorporating irrelevant context. In this work, we conduct a systematic evaluation of over-searching across multiple dimensions, including query types, model categories, retrieval conditions, and multi-turn conversations. Our finding shows: (i) search generally improves answer accuracy on answerable queries but harms abstention on unanswerable ones; (ii) over-searching is more pronounced in complex reasoning models and deep research systems, is exacerbated by noisy retrieval, and compounds across turns in multi-turn conversations; and (iii) the composition of retrieved evidence is crucial, as the presence of negative evidence improves abstention. To quantify over-searching, we introduce Tokens Per Correctness (TPC), an evaluation metric that captures the performance-cost trade-off for search-augmented LLMs. Lastly, we investigate mitigation approaches at both the query and retrieval levels and release the OverSearchQA to foster continued research into efficient search-augmented LLMs.

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.

While LLMs have shown great success in understanding and generating text in traditional conversational settings, their potential for performing ill-defined complex tasks is largely under-studied. Indeed, we are yet to conduct comprehensive benchmarking studies with multiple LLMs that are exclusively focused on a complex task. However, conducting such benchmarking studies is challenging because of the large variations in LLMs' performance when different prompt types/styles are used and different degrees of detail are provided in the prompts. To address this issue, the paper proposes a general taxonomy that can be used to design prompts with specific properties in order to perform a wide range of complex tasks. This taxonomy will allow future benchmarking studies to report the specific categories of prompts used as part of the study, enabling meaningful comparisons across different studies. Also, by establishing a common standard through this taxonomy, researchers will be able to draw more accurate conclusions about LLMs' performance on a specific complex task.

A promising application of AI to healthcare is the retrieval of information from electronic health records (EHRs), e.g. to aid clinicians in finding relevant information for a consultation or to recruit suitable patients for a study. This requires search capabilities far beyond simple string matching, including the retrieval of concepts (diagnoses, symptoms, medications, etc.) related to the one in question. The suitability of AI methods for such applications is tested by predicting the relatedness of concepts with known relatedness scores. However, all existing biomedical concept relatedness datasets are notoriously small and consist of hand-picked concept pairs. We open-source a novel concept relatedness benchmark overcoming these issues: it is six times larger than existing datasets and concept pairs are chosen based on co-occurrence in EHRs, ensuring their relevance for the application of interest. We present an in-depth analysis of our new dataset and compare it to existing ones, highlighting that it is not only larger but also complements existing datasets in terms of the types of concepts included. Initial experiments with state-of-the-art embedding methods show that our dataset is a challenging new benchmark for testing concept relatedness models.

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

Recent work finds that retrieval-augmented generation with large language models is prone to be influenced by the order of retrieved documents in the context. However, the lack of in-depth analysis limits the use of this phenomenon for prompt engineering in practice. In this study, we posit that likelihoods serve as an effective gauge for language model performance. Through experiments on two question-answering datasets with a variety of state-of-the-art language models, we reveal correlations between answer accuracy and the likelihood of the question at both the corpus level and the instance level. In addition, we find that question likelihood can also indicate the position of the task-relevant information in the context. Based on these findings, we propose two methods that use question likelihood as a gauge for selecting and constructing prompts that lead to better performance. We demonstrate their effectiveness with experiments. In addition, our likelihood-based methods are efficient, as they only need to compute the likelihood of the input, requiring much fewer language model passes than heuristic prompt engineering methods that require generating responses. Our analysis deepens our understanding of how input prompts affect model performance and provides a promising direction for efficient prompt optimization.

Automatically summarizing patients' main problems from daily progress notes using natural language processing methods helps to battle against information and cognitive overload in hospital settings and potentially assists providers with computerized diagnostic decision support. Problem list summarization requires a model to understand, abstract, and generate clinical documentation. In this work, we propose a new NLP task that aims to generate a list of problems in a patient's daily care plan using input from the provider's progress notes during hospitalization. We investigate the performance of T5 and BART, two state-of-the-art seq2seq transformer architectures, in solving this problem. We provide a corpus built on top of progress notes from publicly available electronic health record progress notes in the Medical Information Mart for Intensive Care (MIMIC)-III. T5 and BART are trained on general domain text, and we experiment with a data augmentation method and a domain adaptation pre-training method to increase exposure to medical vocabulary and knowledge. Evaluation methods include ROUGE, BERTScore, cosine similarity on sentence embedding, and F-score on medical concepts. Results show that T5 with domain adaptive pre-training achieves significant performance gains compared to a rule-based system and general domain pre-trained language models, indicating a promising direction for tackling the problem summarization task.

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

Keeping track of scientific challenges, advances and emerging directions is a fundamental part of research. However, researchers face a flood of papers that hinders discovery of important knowledge. In biomedicine, this directly impacts human lives. To address this problem, we present a novel task of extraction and search of scientific challenges and directions, to facilitate rapid knowledge discovery. We construct and release an expert-annotated corpus of texts sampled from full-length papers, labeled with novel semantic categories that generalize across many types of challenges and directions. We focus on a large corpus of interdisciplinary work relating to the COVID-19 pandemic, ranging from biomedicine to areas such as AI and economics. We apply a model trained on our data to identify challenges and directions across the corpus and build a dedicated search engine. In experiments with 19 researchers and clinicians using our system, we outperform a popular scientific search engine in assisting knowledge discovery. Finally, we show that models trained on our resource generalize to the wider biomedical domain and to AI papers, highlighting its broad utility. We make our data, model and search engine publicly available. https://challenges.apps.allenai.org/

How do we most effectively treat a disease or condition? Ideally, we could consult a database of evidence gleaned from clinical trials to answer such questions. Unfortunately, no such database exists; clinical trial results are instead disseminated primarily via lengthy natural language articles. Perusing all such articles would be prohibitively time-consuming for healthcare practitioners; they instead tend to depend on manually compiled systematic reviews of medical literature to inform care. NLP may speed this process up, and eventually facilitate immediate consult of published evidence. The Evidence Inference dataset was recently released to facilitate research toward this end. This task entails inferring the comparative performance of two treatments, with respect to a given outcome, from a particular article (describing a clinical trial) and identifying supporting evidence. For instance: Does this article report that chemotherapy performed better than surgery for five-year survival rates of operable cancers? In this paper, we collect additional annotations to expand the Evidence Inference dataset by 25\%, provide stronger baseline models, systematically inspect the errors that these make, and probe dataset quality. We also release an abstract only (as opposed to full-texts) version of the task for rapid model prototyping. The updated corpus, documentation, and code for new baselines and evaluations are available at http://evidence-inference.ebm-nlp.com/.

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

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.

When asked, current large language models (LLMs) like ChatGPT claim that they can assist us with relevance judgments. Many researchers think this would not lead to credible IR research. In this perspective paper, we discuss possible ways for LLMs to assist human experts along with concerns and issues that arise. We devise a human-machine collaboration spectrum that allows categorizing different relevance judgment strategies, based on how much the human relies on the machine. For the extreme point of "fully automated assessment", we further include a pilot experiment on whether LLM-based relevance judgments correlate with judgments from trained human assessors. We conclude the paper by providing two opposing perspectives - for and against the use of LLMs for automatic relevance judgments - and a compromise perspective, informed by our analyses of the literature, our preliminary experimental evidence, and our experience as IR researchers. We hope to start a constructive discussion within the community to avoid a stale-mate during review, where work is dammed if is uses LLMs for evaluation and dammed if it doesn't.

We present the Stanford Question Answering Dataset (SQuAD), a new reading comprehension dataset consisting of 100,000+ questions posed by crowdworkers on a set of Wikipedia articles, where the answer to each question is a segment of text from the corresponding reading passage. We analyze the dataset to understand the types of reasoning required to answer the questions, leaning heavily on dependency and constituency trees. We build a strong logistic regression model, which achieves an F1 score of 51.0%, a significant improvement over a simple baseline (20%). However, human performance (86.8%) is much higher, indicating that the dataset presents a good challenge problem for future research. The dataset is freely available at https://stanford-qa.com

The latest generation of LLMs can be prompted to achieve impressive zero-shot or few-shot performance in many NLP tasks. However, since performance is highly sensitive to the choice of prompts, considerable effort has been devoted to crowd-sourcing prompts or designing methods for prompt optimisation. Yet, we still lack a systematic understanding of how linguistic properties of prompts correlate with task performance. In this work, we investigate how LLMs of different sizes, pre-trained and instruction-tuned, perform on prompts that are semantically equivalent, but vary in linguistic structure. We investigate both grammatical properties such as mood, tense, aspect and modality, as well as lexico-semantic variation through the use of synonyms. Our findings contradict the common assumption that LLMs achieve optimal performance on lower perplexity prompts that reflect language use in pretraining or instruction-tuning data. Prompts transfer poorly between datasets or models, and performance cannot generally be explained by perplexity, word frequency, ambiguity or prompt length. Based on our results, we put forward a proposal for a more robust and comprehensive evaluation standard for prompting research.

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

The proliferation of Large Language Models (LLMs) highlights the critical importance of conducting thorough evaluations to discern their comparative advantages, limitations, and optimal use cases. Particularly important is assessing their capacity to accurately retrieve information included in a given prompt. A model's ability to do this significantly influences how effectively it can utilize contextual details, thus impacting its practical efficacy and dependability in real-world applications. Our research analyzes the in-context recall performance of various LLMs using the needle-in-a-haystack method. In this approach, a factoid (the "needle") is embedded within a block of filler text (the "haystack"), which the model is asked to retrieve. We assess the recall performance of each model across various haystack lengths and with varying needle placements to identify performance patterns. This study demonstrates that an LLM's recall capability is not only contingent upon the prompt's content but also may be compromised by biases in its training data. Conversely, adjustments to model architecture, training strategy, or fine-tuning can improve performance. Our analysis provides insight into LLM behavior, offering direction for the development of more effective applications of LLMs.

Evaluation efforts such as TREC, CLEF, NTCIR and FIRE, alongside public leaderboard such as MS MARCO, are intended to encourage research and track our progress, addressing big questions in our field. However, the goal is not simply to identify which run is "best", achieving the top score. The goal is to move the field forward by developing new robust techniques, that work in many different settings, and are adopted in research and practice. This paper uses the MS MARCO and TREC Deep Learning Track as our case study, comparing it to the case of TREC ad hoc ranking in the 1990s. We show how the design of the evaluation effort can encourage or discourage certain outcomes, and raising questions about internal and external validity of results. We provide some analysis of certain pitfalls, and a statement of best practices for avoiding such pitfalls. We summarize the progress of the effort so far, and describe our desired end state of "robust usefulness", along with steps that might be required to get us there.

We introduce a new problem KTRL+F, a knowledge-augmented in-document search task that necessitates real-time identification of all semantic targets within a document with the awareness of external sources through a single natural query. This task addresses following unique challenges for in-document search: 1) utilizing knowledge outside the document for extended use of additional information about targets to bridge the semantic gap between the query and the targets, and 2) balancing between real-time applicability with the performance. We analyze various baselines in KTRL+F and find there are limitations of existing models, such as hallucinations, low latency, or difficulties in leveraging external knowledge. Therefore we propose a Knowledge-Augmented Phrase Retrieval model that shows a promising balance between speed and performance by simply augmenting external knowledge embedding in phrase embedding. Additionally, we conduct a user study to verify whether solving KTRL+F can enhance search experience of users. It demonstrates that even with our simple model users can reduce the time for searching with less queries and reduced extra visits to other sources for collecting evidence. We encourage the research community to work on KTRL+F to enhance more efficient in-document information access.

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

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

Recent advancements in large language models (LLM) capable of processing extremely long texts highlight the need for a dedicated evaluation benchmark to assess their long-context capabilities. However, existing methods, like the needle-in-a-haystack test, do not effectively assess whether these models fully utilize contextual information, raising concerns about the reliability of current evaluation techniques. To thoroughly examine the effectiveness of existing benchmarks, we introduce a new metric called information coverage (IC), which quantifies the proportion of the input context necessary for answering queries. Our findings indicate that current benchmarks exhibit low IC; although the input context may be extensive, the actual usable context is often limited. To address this, we present ETHIC, a novel benchmark designed to assess LLMs' ability to leverage the entire context. Our benchmark comprises 2,648 test instances spanning four long-context tasks with high IC scores in the domains of books, debates, medicine, and law. Our evaluations reveal significant performance drops in contemporary LLMs, highlighting a critical challenge in managing long contexts. Our benchmark is available at https://github.com/dmis-lab/ETHIC.

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.

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

Neural networks -- especially those that use large, pre-trained language models -- have improved search engines in various ways. Most prominently, they can estimate the relevance of a passage or document to a user's query. In this work, we depart from this direction by exploring whether neural networks can effectively predict which of a document's passages are unlikely to be relevant to any query submitted to the search engine. We refer to this query-agnostic estimation of passage relevance as a passage's quality. We find that our novel methods for estimating passage quality allow passage corpora to be pruned considerably while maintaining statistically equivalent effectiveness; our best methods can consistently prune >25% of passages in a corpora, across various retrieval pipelines. Such substantial pruning reduces the operating costs of neural search engines in terms of computing resources, power usage, and carbon footprint -- both when processing queries (thanks to a smaller index size) and when indexing (lightweight models can prune low-quality passages prior to the costly dense or learned sparse encoding step). This work sets the stage for developing more advanced neural "learning-what-to-index" methods.

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

A unique aspect of ColBERT is its use of [MASK] tokens in queries to score documents (query augmentation). Prior work shows [MASK] tokens weighting non-[MASK] query terms, emphasizing certain tokens over others , rather than introducing whole new terms as initially proposed. We begin by demonstrating that a term weighting behavior previously reported for [MASK] tokens in ColBERTv1 holds for ColBERTv2. We then examine the effect of changing the number of [MASK] tokens from zero to up to four times past the query input length used in training, both for first stage retrieval, and for scoring candidates, observing an initial decrease in performance with few [MASK]s, a large increase when enough [MASK]s are added to pad queries to an average length of 32, then a plateau in performance afterwards. Additionally, we compare baseline performance to performance when the query length is extended to 128 tokens, and find that differences are small (e.g., within 1% on various metrics) and generally statistically insignificant, indicating performance does not collapse if ColBERT is presented with more [MASK] tokens than expected.

Passage ranking involves two stages: passage retrieval and passage re-ranking, which are important and challenging topics for both academics and industries in the area of Information Retrieval (IR). However, the commonly-used datasets for passage ranking usually focus on the English language. For non-English scenarios, such as Chinese, the existing datasets are limited in terms of data scale, fine-grained relevance annotation and false negative issues. To address this problem, we introduce T2Ranking, a large-scale Chinese benchmark for passage ranking. T2Ranking comprises more than 300K queries and over 2M unique passages from real-world search engines. Expert annotators are recruited to provide 4-level graded relevance scores (fine-grained) for query-passage pairs instead of binary relevance judgments (coarse-grained). To ease the false negative issues, more passages with higher diversities are considered when performing relevance annotations, especially in the test set, to ensure a more accurate evaluation. Apart from the textual query and passage data, other auxiliary resources are also provided, such as query types and XML files of documents which passages are generated from, to facilitate further studies. To evaluate the dataset, commonly used ranking models are implemented and tested on T2Ranking as baselines. The experimental results show that T2Ranking is challenging and there is still scope for improvement. The full data and all codes are available at https://github.com/THUIR/T2Ranking/

Although LLMs are increasing the productivity of professional programmers, existing work shows that beginners struggle to prompt LLMs to solve text-to-code tasks. Why is this the case? This paper explores two competing hypotheses about the cause of student-LLM miscommunication: (1) students simply lack the technical vocabulary needed to write good prompts, and (2) students do not understand the extent of information that LLMs need to solve code generation tasks. We study (1) with a causal intervention experiment on technical vocabulary and (2) by analyzing graphs that abstract how students edit prompts and the different failures that they encounter. We find that substance beats style: a poor grasp of technical vocabulary is merely correlated with prompt failure; that the information content of prompts predicts success; that students get stuck making trivial edits; and more. Our findings have implications for the use of LLMs in programming education, and for efforts to make computing more accessible with LLMs.

Discharge summaries in Electronic Health Records (EHRs) are crucial for clinical decision-making, but their length and complexity make information extraction challenging, especially when dealing with accumulated summaries across multiple patient admissions. Large Language Models (LLMs) show promise in addressing this challenge by efficiently analyzing vast and complex data. Existing benchmarks, however, fall short in properly evaluating LLMs' capabilities in this context, as they typically focus on single-note information or limited topics, failing to reflect the real-world inquiries required by clinicians. To bridge this gap, we introduce EHRNoteQA, a novel benchmark built on the MIMIC-IV EHR, comprising 962 different QA pairs each linked to distinct patients' discharge summaries. Every QA pair is initially generated using GPT-4 and then manually reviewed and refined by three clinicians to ensure clinical relevance. EHRNoteQA includes questions that require information across multiple discharge summaries and covers eight diverse topics, mirroring the complexity and diversity of real clinical inquiries. We offer EHRNoteQA in two formats: open-ended and multi-choice question answering, and propose a reliable evaluation method for each. We evaluate 27 LLMs using EHRNoteQA and examine various factors affecting the model performance (e.g., the length and number of discharge summaries). Furthermore, to validate EHRNoteQA as a reliable proxy for expert evaluations in clinical practice, we measure the correlation between the LLM performance on EHRNoteQA, and the LLM performance manually evaluated by clinicians. Results show that LLM performance on EHRNoteQA have higher correlation with clinician-evaluated performance (Spearman: 0.78, Kendall: 0.62) compared to other benchmarks, demonstrating its practical relevance in evaluating LLMs in clinical settings.

Recent advances in reasoning with large language models (LLMs)has shown remarkable reasoning capabilities in domains such as mathematics and coding, yet their application to clinical diagnosis remains underexplored. Here, we introduce ClinicalGPT-R1, a reasoning enhanced generalist large language model for disease diagnosis. Trained on a dataset of 20,000 real-world clinical records, ClinicalGPT-R1 leverages diverse training strategies to enhance diagnostic reasoning. To benchmark performance, we curated MedBench-Hard, a challenging dataset spanning seven major medical specialties and representative diseases. Experimental results demonstrate that ClinicalGPT-R1 outperforms GPT-4o in Chinese diagnostic tasks and achieves comparable performance to GPT-4 in English settings. This comparative study effectively validates the superior performance of ClinicalGPT-R1 in disease diagnosis tasks. Resources are available at https://github.com/medfound/medfound.

In this paper, we critically evaluate the capabilities of the state-of-the-art multimodal large language model, i.e., GPT-4 with Vision (GPT-4V), on Visual Question Answering (VQA) task. Our experiments thoroughly assess GPT-4V's proficiency in answering questions paired with images using both pathology and radiology datasets from 11 modalities (e.g. Microscopy, Dermoscopy, X-ray, CT, etc.) and fifteen objects of interests (brain, liver, lung, etc.). Our datasets encompass a comprehensive range of medical inquiries, including sixteen distinct question types. Throughout our evaluations, we devised textual prompts for GPT-4V, directing it to synergize visual and textual information. The experiments with accuracy score conclude that the current version of GPT-4V is not recommended for real-world diagnostics due to its unreliable and suboptimal accuracy in responding to diagnostic medical questions. In addition, we delineate seven unique facets of GPT-4V's behavior in medical VQA, highlighting its constraints within this complex arena. The complete details of our evaluation cases are accessible at https://github.com/ZhilingYan/GPT4V-Medical-Report.

This large scale study focuses on quantifying what X-rays diagnostic prediction tasks generalize well across multiple different datasets. We present evidence that the issue of generalization is not due to a shift in the images but instead a shift in the labels. We study the cross-domain performance, agreement between models, and model representations. We find interesting discrepancies between performance and agreement where models which both achieve good performance disagree in their predictions as well as models which agree yet achieve poor performance. We also test for concept similarity by regularizing a network to group tasks across multiple datasets together and observe variation across the tasks. All code is made available online and data is publicly available: https://github.com/mlmed/torchxrayvision

We introduce HEAD-QA v2, an expanded and updated version of a Spanish/English healthcare multiple-choice reasoning dataset originally released by Vilares and Gómez-Rodríguez (2019). The update responds to the growing need for high-quality datasets that capture the linguistic and conceptual complexity of healthcare reasoning. We extend the dataset to over 12,000 questions from ten years of Spanish professional exams, benchmark several open-source LLMs using prompting, RAG, and probability-based answer selection, and provide additional multilingual versions to support future work. Results indicate that performance is mainly driven by model scale and intrinsic reasoning ability, with complex inference strategies obtaining limited gains. Together, these results establish HEAD-QA v2 as a reliable resource for advancing research on biomedical reasoning and model improvement.

We describe the SemEval task of extracting keyphrases and relations between them from scientific documents, which is crucial for understanding which publications describe which processes, tasks and materials. Although this was a new task, we had a total of 26 submissions across 3 evaluation scenarios. We expect the task and the findings reported in this paper to be relevant for researchers working on understanding scientific content, as well as the broader knowledge base population and information extraction communities.

Large language models (LLMs) are widely used as zero-shot and few-shot classifiers, where task behaviour is largely controlled through prompting. A growing number of works have observed that LLMs are sensitive to prompt variations, with small changes leading to large changes in performance. However, in many cases, the investigation of sensitivity is performed using underspecified prompts that provide minimal task instructions and weakly constrain the model's output space. In this work, we argue that a significant portion of the observed prompt sensitivity can be attributed to prompt underspecification. We systematically study and compare the sensitivity of underspecified prompts and prompts that provide specific instructions. Utilising performance analysis, logit analysis, and linear probing, we find that underspecified prompts exhibit higher performance variance and lower logit values for relevant tokens, while instruction-prompts suffer less from such problems. However, linear probing analysis suggests that the effects of prompt underspecification have only a marginal impact on the internal LLM representations, instead emerging in the final layers. Overall, our findings highlight the need for more rigour when investigating and mitigating prompt sensitivity.

We present and evaluate a suite of proof-of-concept (PoC), structured workflow prompts designed to elicit human-like hierarchical reasoning while guiding Large Language Models (LLMs) in the high-level semantic and linguistic analysis of scholarly manuscripts. The prompts target two non-trivial analytical tasks within academic summaries (abstracts and conclusions): identifying unsubstantiated claims (informational integrity) and flagging semantically confusing ambiguous pronoun references (linguistic clarity). We conducted a systematic, multi-run evaluation on two frontier models (Gemini Pro 2.5 Pro and ChatGPT Plus o3) under varied context conditions. Our results for the informational integrity task reveal a significant divergence in model performance: while both models successfully identified an unsubstantiated head of a noun phrase (95% success), ChatGPT consistently failed (0% success) to identify an unsubstantiated adjectival modifier that Gemini correctly flagged (95% success), raising a question regarding the potential influence of the target's syntactic role. For the linguistic analysis task, both models performed well (80-90% success) with full manuscript context. Surprisingly, in a summary-only setting, Gemini's performance was substantially degraded, while ChatGPT achieved a perfect (100%) success rate. Our findings suggest that while structured prompting is a viable methodology for complex textual analysis, prompt performance may be highly dependent on the interplay between the model, task type, and context, highlighting the need for rigorous, model-specific testing.

Citations in scientific papers not only help us trace the intellectual lineage but also are a useful indicator of the scientific significance of the work. Citation intents prove beneficial as they specify the role of the citation in a given context. In this paper, we present CitePrompt, a framework which uses the hitherto unexplored approach of prompt-based learning for citation intent classification. We argue that with the proper choice of the pretrained language model, the prompt template, and the prompt verbalizer, we can not only get results that are better than or comparable to those obtained with the state-of-the-art methods but also do it with much less exterior information about the scientific document. We report state-of-the-art results on the ACL-ARC dataset, and also show significant improvement on the SciCite dataset over all baseline models except one. As suitably large labelled datasets for citation intent classification can be quite hard to find, in a first, we propose the conversion of this task to the few-shot and zero-shot settings. For the ACL-ARC dataset, we report a 53.86% F1 score for the zero-shot setting, which improves to 63.61% and 66.99% for the 5-shot and 10-shot settings, respectively.

Information tasks such as writing surveys or analytical reports require complex search and reasoning, and have recently been grouped under the umbrella of deep research -- a term also adopted by recent models targeting these capabilities. Despite growing interest, the scope of the deep research task remains underdefined and its distinction from other reasoning-intensive problems is poorly understood. In this paper, we propose a formal characterization of the deep research (DR) task and introduce a benchmark to evaluate the performance of DR systems. We argue that the core defining feature of deep research is not the production of lengthy report-style outputs, but rather the high fan-out over concepts required during the search process, i.e., broad and reasoning-intensive exploration. To enable objective evaluation, we define DR using an intermediate output representation that encodes key claims uncovered during search-separating the reasoning challenge from surface-level report generation. Based on this formulation, we propose a diverse, challenging benchmark LiveDRBench with 100 challenging tasks over scientific topics (e.g., datasets, materials discovery, prior art search) and public interest events (e.g., flight incidents, movie awards). Across state-of-the-art DR systems, F1 score ranges between 0.02 and 0.72 for any sub-category. OpenAI's model performs the best with an overall F1 score of 0.55. Analysis of reasoning traces reveals the distribution over the number of referenced sources, branching, and backtracking events executed by current DR systems, motivating future directions for improving their search mechanisms and grounding capabilities. The benchmark is available at https://github.com/microsoft/LiveDRBench.

Offline evaluation of search systems depends on test collections. These benchmarks provide the researchers with a corpus of documents, topics and relevance judgements indicating which documents are relevant for each topic. While test collections are an integral part of Information Retrieval (IR) research, their creation involves significant efforts in manual annotation. Large language models (LLMs) are gaining much attention as tools for automatic relevance assessment. Recent research has shown that LLM-based assessments yield high systems ranking correlation with human-made judgements. These correlations are helpful in large-scale experiments but less informative if we want to focus on top-performing systems. Moreover, these correlations ignore whether and how LLM-based judgements impact the statistically significant differences among systems with respect to human assessments. In this work, we look at how LLM-generated judgements preserve ranking differences among top-performing systems and also how they preserve pairwise significance evaluation as human judgements. Our results show that LLM-based judgements are unfair at ranking top-performing systems. Moreover, we observe an exceedingly high rate of false positives regarding statistical differences. Our work represents a step forward in the evaluation of the reliability of using LLMs-based judgements for IR evaluation. We hope this will serve as a basis for other researchers to develop more reliable models for automatic relevance assessment.

Large language models (LLMs) have shown promise in medical question answering, yet they often overlook the domain-specific expertise that professionals depend on, such as the clinical subject areas (e.g., trauma, airway) and the certification level (e.g., EMT, Paramedic). Existing approaches typically apply general-purpose prompting or retrieval strategies without leveraging this structured context, limiting performance in high-stakes settings. We address this gap with EMSQA, an 24.3K-question multiple-choice dataset spanning 10 clinical subject areas and 4 certification levels, accompanied by curated, subject area-aligned knowledge bases (40K documents and 2M tokens). Building on EMSQA, we introduce (i) Expert-CoT, a prompting strategy that conditions chain-of-thought (CoT) reasoning on specific clinical subject area and certification level, and (ii) ExpertRAG, a retrieval-augmented generation pipeline that grounds responses in subject area-aligned documents and real-world patient data. Experiments on 4 LLMs show that Expert-CoT improves up to 2.05% over vanilla CoT prompting. Additionally, combining Expert-CoT with ExpertRAG yields up to a 4.59% accuracy gain over standard RAG baselines. Notably, the 32B expertise-augmented LLMs pass all the computer-adaptive EMS certification simulation exams.

The exponential growth of scientific literature necessitates advanced tools for effective knowledge exploration. We present Knowledge Navigator, a system designed to enhance exploratory search abilities by organizing and structuring the retrieved documents from broad topical queries into a navigable, two-level hierarchy of named and descriptive scientific topics and subtopics. This structured organization provides an overall view of the research themes in a domain, while also enabling iterative search and deeper knowledge discovery within specific subtopics by allowing users to refine their focus and retrieve additional relevant documents. Knowledge Navigator combines LLM capabilities with cluster-based methods to enable an effective browsing method. We demonstrate our approach's effectiveness through automatic and manual evaluations on two novel benchmarks, CLUSTREC-COVID and SCITOC. Our code, prompts, and benchmarks are made publicly available.

Recent advancements in reasoning-enhanced large language models (LLMs), such as DeepSeek-R1 and OpenAI-o3, have demonstrated significant progress. However, their application in professional medical contexts remains underexplored, particularly in evaluating the quality of their reasoning processes alongside final outputs. Here, we introduce MedR-Bench, a benchmarking dataset of 1,453 structured patient cases, annotated with reasoning references derived from clinical case reports. Spanning 13 body systems and 10 specialties, it includes both common and rare diseases. To comprehensively evaluate LLM performance, we propose a framework encompassing three critical examination recommendation, diagnostic decision-making, and treatment planning, simulating the entire patient care journey. To assess reasoning quality, we present the Reasoning Evaluator, a novel automated system that objectively scores free-text reasoning responses based on efficiency, actuality, and completeness using dynamic cross-referencing and evidence checks. Using this benchmark, we evaluate five state-of-the-art reasoning LLMs, including DeepSeek-R1, OpenAI-o3-mini, and Gemini-2.0-Flash Thinking, etc. Our results show that current LLMs achieve over 85% accuracy in relatively simple diagnostic tasks when provided with sufficient examination results. However, performance declines in more complex tasks, such as examination recommendation and treatment planning. While reasoning outputs are generally reliable, with factuality scores exceeding 90%, critical reasoning steps are frequently missed. These findings underscore both the progress and limitations of clinical LLMs. Notably, open-source models like DeepSeek-R1 are narrowing the gap with proprietary systems, highlighting their potential to drive accessible and equitable advancements in healthcare.

We introduce MURA, a large dataset of musculoskeletal radiographs containing 40,561 images from 14,863 studies, where each study is manually labeled by radiologists as either normal or abnormal. To evaluate models robustly and to get an estimate of radiologist performance, we collect additional labels from six board-certified Stanford radiologists on the test set, consisting of 207 musculoskeletal studies. On this test set, the majority vote of a group of three radiologists serves as gold standard. We train a 169-layer DenseNet baseline model to detect and localize abnormalities. Our model achieves an AUROC of 0.929, with an operating point of 0.815 sensitivity and 0.887 specificity. We compare our model and radiologists on the Cohen's kappa statistic, which expresses the agreement of our model and of each radiologist with the gold standard. Model performance is comparable to the best radiologist performance in detecting abnormalities on finger and wrist studies. However, model performance is lower than best radiologist performance in detecting abnormalities on elbow, forearm, hand, humerus, and shoulder studies. We believe that the task is a good challenge for future research. To encourage advances, we have made our dataset freely available at https://stanfordmlgroup.github.io/competitions/mura .

Recent work has shown that prompting language models with code-like representations of natural language leads to performance improvements on structured reasoning tasks. However, such tasks comprise only a small subset of all natural language tasks. In our work, we seek to answer whether or not code-prompting is the preferred way of interacting with language models in general. We compare code and text prompts across three popular GPT models (davinci, code-davinci-002, and text-davinci-002) on a broader selection of tasks (e.g., QA, sentiment, summarization) and find that with few exceptions, code prompts do not consistently outperform text prompts. Furthermore, we show that the style of code prompt has a large effect on performance for some but not all tasks and that fine-tuning on text instructions leads to better relative performance of code prompts.

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.

It is desirable to coarsely classify short scientific texts, such as grant or publication abstracts, for strategic insight or research portfolio management. These texts efficiently transmit dense information to experts possessing a rich body of knowledge to aid interpretation. Yet this task is remarkably difficult to automate because of brevity and the absence of context. To address this gap, we have developed a novel approach to generate and appropriately assign coarse domain-specific labels. We show that a Large Language Model (LLM) can provide metadata essential to the task, in a process akin to the augmentation of supplemental knowledge representing human intuition, and propose a workflow. As a pilot study, we use a corpus of award abstracts from the National Aeronautics and Space Administration (NASA). We develop new assessment tools in concert with established performance metrics.

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

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

Medical benchmark datasets significantly contribute to developing Large Language Models (LLMs) for medical knowledge extraction, diagnosis, summarization, and other uses. Yet, current benchmarks are mainly derived from exam questions given to medical students or cases described in the medical literature, lacking the complexity of real-world patient cases that deviate from classic textbook abstractions. These include rare diseases, uncommon presentations of common diseases, and unexpected treatment responses. Here, we construct Clinically Uncommon Patient Cases and Diagnosis Dataset (CUPCase) based on 3,562 real-world case reports from BMC, including diagnoses in open-ended textual format and as multiple-choice options with distractors. Using this dataset, we evaluate the ability of state-of-the-art LLMs, including both general-purpose and Clinical LLMs, to identify and correctly diagnose a patient case, and test models' performance when only partial information about cases is available. Our findings show that general-purpose GPT-4o attains the best performance in both the multiple-choice task (average accuracy of 87.9%) and the open-ended task (BERTScore F1 of 0.764), outperforming several LLMs with a focus on the medical domain such as Meditron-70B and MedLM-Large. Moreover, GPT-4o was able to maintain 87% and 88% of its performance with only the first 20% of tokens of the case presentation in multiple-choice and free text, respectively, highlighting the potential of LLMs to aid in early diagnosis in real-world cases. CUPCase expands our ability to evaluate LLMs for clinical decision support in an open and reproducible manner.

To enable building and testing models on long-document comprehension, we introduce QuALITY, a multiple-choice QA dataset with context passages in English that have an average length of about 5,000 tokens, much longer than typical current models can process. Unlike in prior work with passages, our questions are written and validated by contributors who have read the entire passage, rather than relying on summaries or excerpts. In addition, only half of the questions are answerable by annotators working under tight time constraints, indicating that skimming and simple search are not enough to consistently perform well. Our baseline models perform poorly on this task (55.4%) and significantly lag behind human performance (93.5%).

Large language models (LLMs) have the potential to transform medicine, but real-world clinical scenarios contain extraneous information that can hinder performance. The rise of assistive technologies like ambient dictation, which automatically generates draft notes from live patient encounters, has the potential to introduce additional noise making it crucial to assess the ability of LLM's to filter relevant data. To investigate this, we developed MedDistractQA, a benchmark using USMLE-style questions embedded with simulated real-world distractions. Our findings show that distracting statements (polysemous words with clinical meanings used in a non-clinical context or references to unrelated health conditions) can reduce LLM accuracy by up to 17.9%. Commonly proposed solutions to improve model performance such as retrieval-augmented generation (RAG) and medical fine-tuning did not change this effect and in some cases introduced their own confounders and further degraded performance. Our findings suggest that LLMs natively lack the logical mechanisms necessary to distinguish relevant from irrelevant clinical information, posing challenges for real-world applications. MedDistractQA and our results highlights the need for robust mitigation strategies to enhance LLM resilience to extraneous information.

The recent success of general-domain large language models (LLMs) has significantly changed the natural language processing paradigm towards a unified foundation model across domains and applications. In this paper, we focus on assessing the performance of GPT-4, the most capable LLM so far, on the text-based applications for radiology reports, comparing against state-of-the-art (SOTA) radiology-specific models. Exploring various prompting strategies, we evaluated GPT-4 on a diverse range of common radiology tasks and we found GPT-4 either outperforms or is on par with current SOTA radiology models. With zero-shot prompting, GPT-4 already obtains substantial gains (approx 10% absolute improvement) over radiology models in temporal sentence similarity classification (accuracy) and natural language inference (F_1). For tasks that require learning dataset-specific style or schema (e.g. findings summarisation), GPT-4 improves with example-based prompting and matches supervised SOTA. Our extensive error analysis with a board-certified radiologist shows GPT-4 has a sufficient level of radiology knowledge with only occasional errors in complex context that require nuanced domain knowledge. For findings summarisation, GPT-4 outputs are found to be overall comparable with existing manually-written impressions.

Recently, rapid advancements in Multi-Modal In-Context Learning (MM-ICL) have achieved notable success, which is capable of achieving superior performance across various tasks without requiring additional parameter tuning. However, the underlying rules for the effectiveness of MM-ICL remain under-explored. To fill this gap, this work aims to investigate the research question: "What factors affect the performance of MM-ICL?'' To this end, we investigate extensive experiments on the three core steps of MM-ICL including demonstration retrieval, demonstration ordering, and prompt construction using 6 vision large language models and 20 strategies. Our findings highlight (1) the necessity of a multi-modal retriever for demonstration retrieval, (2) the importance of intra-demonstration ordering over inter-demonstration ordering, and (3) the enhancement of task comprehension through introductory instructions in prompts. We hope this study can serve as a foundational guide for optimizing MM-ICL strategies in future research.

Dense retrieval has become a prominent method to obtain relevant context or world knowledge in open-domain NLP tasks. When we use a learned dense retriever on a retrieval corpus at inference time, an often-overlooked design choice is the retrieval unit in which the corpus is indexed, e.g. document, passage, or sentence. We discover that the retrieval unit choice significantly impacts the performance of both retrieval and downstream tasks. Distinct from the typical approach of using passages or sentences, we introduce a novel retrieval unit, proposition, for dense retrieval. Propositions are defined as atomic expressions within text, each encapsulating a distinct factoid and presented in a concise, self-contained natural language format. We conduct an empirical comparison of different retrieval granularity. Our results reveal that proposition-based retrieval significantly outperforms traditional passage or sentence-based methods in dense retrieval. Moreover, retrieval by proposition also enhances the performance of downstream QA tasks, since the retrieved texts are more condensed with question-relevant information, reducing the need for lengthy input tokens and minimizing the inclusion of extraneous, irrelevant information.

Teachers and students are increasingly relying on online learning resources to supplement the ones provided in school. This increase in the breadth and depth of available resources is a great thing for students, but only provided they are able to find answers to their queries. Question-answering and information retrieval systems have benefited from public datasets to train and evaluate their algorithms, but most of these datasets have been in English text written by and for adults. We introduce a new public French question-answering dataset collected from Alloprof, a Quebec-based primary and high-school help website, containing 29 349 questions and their explanations in a variety of school subjects from 10 368 students, with more than half of the explanations containing links to other questions or some of the 2 596 reference pages on the website. We also present a case study of this dataset in an information retrieval task. This dataset was collected on the Alloprof public forum, with all questions verified for their appropriateness and the explanations verified both for their appropriateness and their relevance to the question. To predict relevant documents, architectures using pre-trained BERT models were fine-tuned and evaluated. This dataset will allow researchers to develop question-answering, information retrieval and other algorithms specifically for the French speaking education context. Furthermore, the range of language proficiency, images, mathematical symbols and spelling mistakes will necessitate algorithms based on a multimodal comprehension. The case study we present as a baseline shows an approach that relies on recent techniques provides an acceptable performance level, but more work is necessary before it can reliably be used and trusted in a production setting.

Using Large Language Models (LLMs) for relevance assessments offers promising opportunities to improve Information Retrieval (IR), Natural Language Processing (NLP), and related fields. Indeed, LLMs hold the promise of allowing IR experimenters to build evaluation collections with a fraction of the manual human labor currently required. This could help with fresh topics on which there is still limited knowledge and could mitigate the challenges of evaluating ranking systems in low-resource scenarios, where it is challenging to find human annotators. Given the fast-paced recent developments in the domain, many questions concerning LLMs as assessors are yet to be answered. Among the aspects that require further investigation, we can list the impact of various components in a relevance judgment generation pipeline, such as the prompt used or the LLM chosen. This paper benchmarks and reports on the results of a large-scale automatic relevance judgment evaluation, the LLMJudge challenge at SIGIR 2024, where different relevance assessment approaches were proposed. In detail, we release and benchmark 42 LLM-generated labels of the TREC 2023 Deep Learning track relevance judgments produced by eight international teams who participated in the challenge. Given their diverse nature, these automatically generated relevance judgments can help the community not only investigate systematic biases caused by LLMs but also explore the effectiveness of ensemble models, analyze the trade-offs between different models and human assessors, and advance methodologies for improving automated evaluation techniques. The released resource is available at the following link: https://llm4eval.github.io/LLMJudge-benchmark/

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

Test-time scaling has emerged as a powerful technique for enhancing the reasoning capabilities of large language models. However, its effectiveness in medical reasoning remains uncertain, as the medical domain fundamentally differs from mathematical tasks in terms of knowledge representation and decision-making processes. In this paper, we provide the first comprehensive investigation of test-time scaling for medical reasoning and present m1, a simple yet effective approach that increases a model's medical reasoning capability at inference. Our evaluation across diverse medical tasks demonstrates that test-time scaling consistently enhances medical reasoning, enabling lightweight fine-tuned models under 10B parameters to establish new state-of-the-art performance, while our 32B model rivals previous 70B-scale medical LLMs. However, we identify an optimal reasoning token budget of approximately 4K, beyond which performance may degrade due to overthinking. Budget forcing, which extends test-time computation through iterative prompts, helps models double-check answers but does not necessarily improve the overall medical QA performance and, in some cases, even introduces errors into previously correct responses. Our case-by-case analysis identifies insufficient medical knowledge as a key bottleneck that prevents further performance gains through test-time scaling. We find that increasing data scale, improving data quality, and expanding model capacity consistently enhance medical knowledge grounding, enabling continued performance improvements, particularly on challenging medical benchmarks where smaller models reach saturation. These findings underscore fundamental differences between medical and mathematical reasoning in LLMs, highlighting that enriched medical knowledge, other than increased reasoning depth alone, is essential for realizing the benefits of test-time scaling.

Enabling a computer to understand a document so that it can answer comprehension questions is a central, yet unsolved goal of NLP. A key factor impeding its solution by machine learned systems is the limited availability of human-annotated data. Hermann et al. (2015) seek to solve this problem by creating over a million training examples by pairing CNN and Daily Mail news articles with their summarized bullet points, and show that a neural network can then be trained to give good performance on this task. In this paper, we conduct a thorough examination of this new reading comprehension task. Our primary aim is to understand what depth of language understanding is required to do well on this task. We approach this from one side by doing a careful hand-analysis of a small subset of the problems and from the other by showing that simple, carefully designed systems can obtain accuracies of 73.6% and 76.6% on these two datasets, exceeding current state-of-the-art results by 7-10% and approaching what we believe is the ceiling for performance on this task.

Large language models (LLMs) are transforming the landscape of medicine, yet two fundamental challenges persist: keeping up with rapidly evolving medical knowledge and providing verifiable, evidence-grounded reasoning. Retrieval-augmented generation (RAG) has been widely adopted to address these limitations by supplementing model outputs with retrieved evidence. However, whether RAG reliably achieves these goals remains unclear. Here, we present the most comprehensive expert evaluation of RAG in medicine to date. Eighteen medical experts contributed a total of 80,502 annotations, assessing 800 model outputs generated by GPT-4o and Llama-3.1-8B across 200 real-world patient and USMLE-style queries. We systematically decomposed the RAG pipeline into three components: (i) evidence retrieval (relevance of retrieved passages), (ii) evidence selection (accuracy of evidence usage), and (iii) response generation (factuality and completeness of outputs). Contrary to expectation, standard RAG often degraded performance: only 22% of top-16 passages were relevant, evidence selection remained weak (precision 41-43%, recall 27-49%), and factuality and completeness dropped by up to 6% and 5%, respectively, compared with non-RAG variants. Retrieval and evidence selection remain key failure points for the model, contributing to the overall performance drop. We further show that simple yet effective strategies, including evidence filtering and query reformulation, substantially mitigate these issues, improving performance on MedMCQA and MedXpertQA by up to 12% and 8.2%, respectively. These findings call for re-examining RAG's role in medicine and highlight the importance of stage-aware evaluation and deliberate system design for reliable medical LLM applications.

LLM test-time compute (or LLM inference) via search has emerged as a promising research area with rapid developments. However, current frameworks often adopt distinct perspectives on three key aspects (task definition, LLM profiling, and search procedures), making direct comparisons challenging. Moreover, the search algorithms employed often diverge from standard implementations, and their specific characteristics are not thoroughly specified. In this survey, we provide a comprehensive technical review that unifies task definitions and provides modular definitions of LLM profiling and search procedures. The definitions enable precise comparisons of various LLM inference frameworks while highlighting their departures from conventional search algorithms. We also discuss the applicability, performance, and efficiency of these methods. For further details and ongoing updates, please refer to our GitHub repository: https://github.com/xinzhel/LLM-Agent-Survey/blob/main/search.md

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.

We present our submission to the Task 5 of SemEval-2025 that aims to aid librarians in assigning subject tags to the library records by producing a list of likely relevant tags for a given document. We frame the task as an information retrieval problem, where the document content is used to retrieve subject tags from a large subject taxonomy. We leverage two types of encoder models to build a two-stage information retrieval system -- a bi-encoder for coarse-grained candidate extraction at the first stage, and a cross-encoder for fine-grained re-ranking at the second stage. This approach proved effective, demonstrating significant improvements in recall compared to single-stage methods and showing competitive results according to qualitative evaluation.

The ability of Large Language Models (LLMs) to use external tools unlocks powerful real-world interactions, making rigorous evaluation essential. However, current benchmarks primarily report final accuracy, revealing what models can do but obscuring the cognitive bottlenecks that define their true capability boundaries. To move from simple performance scoring to a diagnostic tool, we introduce a framework grounded in Cognitive Load Theory. Our framework deconstructs task complexity into two quantifiable components: Intrinsic Load, the inherent structural complexity of the solution path, formalized with a novel Tool Interaction Graph; and Extraneous Load, the difficulty arising from ambiguous task presentation. To enable controlled experiments, we construct ToolLoad-Bench, the first benchmark with parametrically adjustable cognitive load. Our evaluation reveals distinct performance cliffs as cognitive load increases, allowing us to precisely map each model's capability boundary. We validate that our framework's predictions are highly calibrated with empirical results, establishing a principled methodology for understanding an agent's limits and a practical foundation for building more efficient systems.

Background: General-purpose large language models that utilize both text and images have not been evaluated on a diverse array of challenging medical cases. Methods: Using 934 cases from the NEJM Image Challenge published between 2005 and 2023, we evaluated the accuracy of the recently released Generative Pre-trained Transformer 4 with Vision model (GPT-4V) compared to human respondents overall and stratified by question difficulty, image type, and skin tone. We further conducted a physician evaluation of GPT-4V on 69 NEJM clinicopathological conferences (CPCs). Analyses were conducted for models utilizing text alone, images alone, and both text and images. Results: GPT-4V achieved an overall accuracy of 61% (95% CI, 58 to 64%) compared to 49% (95% CI, 49 to 50%) for humans. GPT-4V outperformed humans at all levels of difficulty and disagreement, skin tones, and image types; the exception was radiographic images, where performance was equivalent between GPT-4V and human respondents. Longer, more informative captions were associated with improved performance for GPT-4V but similar performance for human respondents. GPT-4V included the correct diagnosis in its differential for 80% (95% CI, 68 to 88%) of CPCs when using text alone, compared to 58% (95% CI, 45 to 70%) of CPCs when using both images and text. Conclusions: GPT-4V outperformed human respondents on challenging medical cases and was able to synthesize information from both images and text, but performance deteriorated when images were added to highly informative text. Overall, our results suggest that multimodal AI models may be useful in medical diagnostic reasoning but that their accuracy may depend heavily on context.

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

Humanities scholars commonly provide evidence for claims that they make about a work of literature (e.g., a novel) in the form of quotations from the work. We collect a large-scale dataset (RELiC) of 78K literary quotations and surrounding critical analysis and use it to formulate the novel task of literary evidence retrieval, in which models are given an excerpt of literary analysis surrounding a masked quotation and asked to retrieve the quoted passage from the set of all passages in the work. Solving this retrieval task requires a deep understanding of complex literary and linguistic phenomena, which proves challenging to methods that overwhelmingly rely on lexical and semantic similarity matching. We implement a RoBERTa-based dense passage retriever for this task that outperforms existing pretrained information retrieval baselines; however, experiments and analysis by human domain experts indicate that there is substantial room for improvement over our dense retriever.

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

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

Objective: Data unavailability has been one of the biggest barriers in clinical natural language processing. This paper is aimed at providing a large-scale and publicly available patient note dataset, named PMC-Patients, with relevant articles and similar patients annotations. The ultimate goal of PMC-Patients is to facilitate the development of retrieval-based clinical decision support systems. Materials and Methods: To collect PMC-Patients, we extract patient notes from case reports in PubMed Central by recognizing certain section patterns. Patient-article relevance and patient-patient similarity are annotated by citation relationships in PubMed. In addition, we perform three tasks with PMC-Patients to demonstrate its utility in providing clinical decision support for a given patient, including (1) classifying whether another patient is similar, (2) retrieving similar patients in PMC-Patients, and (3) retrieving relevant articles in PubMed. Results: We collect and release PMC-Patients under the CC BY-NC-SA license, which becomes the largest publicly available patient note dataset so far. PMC-Patients contains 167k patient notes that are annotated with 3.1M relevant articles and 293k similar patients. Qualitative and quantitative analyses reveal the high quality and richness of our dataset. Experiments show that classifying the similarity of patient pairs is relatively easy, but it is hard to retrieve similar patients or relevant articles for a given patient from a large set of candidates. Conclusion: We present PMC-Patients, a large-scale dataset of patient notes with high quality, easy access, diverse conditions, and rich annotations. The proposed dataset can also serve as a hard benchmark for evaluating retrieval-based clinical decision support systems.

In recent years, the application of Large Language Models (LLMs) in healthcare has shown significant promise in improving the accessibility and dissemination of medical knowledge. This paper presents a detailed study of various LLMs trained on the MedQuAD medical question-answering dataset, with a focus on identifying the most effective model for providing accurate medical information. Among the models tested, the Sentence-t5 combined with Mistral 7B demonstrated superior performance, achieving a precision score of 0.762. This model's enhanced capabilities are attributed to its advanced pretraining techniques, robust architecture, and effective prompt construction methodologies. By leveraging these strengths, the Sentence-t5 + Mistral 7B model excels in understanding and generating precise medical answers. Our findings highlight the potential of integrating sophisticated LLMs in medical contexts to facilitate efficient and accurate medical knowledge retrieval, thus significantly enhancing patient education and support.

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

We present BLANC, a new approach to the automatic estimation of document summary quality. Our goal is to measure the functional performance of a summary with an objective, reproducible, and fully automated method. Our approach achieves this by measuring the performance boost gained by a pre-trained language model with access to a document summary while carrying out its language understanding task on the document's text. We present evidence that BLANC scores have as good correlation with human evaluations as do the ROUGE family of summary quality measurements. And unlike ROUGE, the BLANC method does not require human-written reference summaries, allowing for fully human-free summary quality estimation.

Melanoma is the most lethal subtype of skin cancer, and early and accurate detection of this disease can greatly improve patients' outcomes. Although machine learning models, especially convolutional neural networks (CNNs), have shown great potential in automating melanoma classification, their diagnostic reliability still suffers due to inconsistent focus on lesion areas. In this study, we analyze the relationship between lesion attention and diagnostic performance, involving masked images, bounding box detection, and transfer learning. We used multiple explainability and sensitivity analysis approaches to investigate how well models aligned their attention with lesion areas and how this alignment correlated with precision, recall, and F1-score. Results showed that models with a higher focus on lesion areas achieved better diagnostic performance, suggesting the potential of interpretable AI in medical diagnostics. This study provides a foundation for developing more accurate and trustworthy melanoma classification models in the future.

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.

Reading comprehension (RC)---in contrast to information retrieval---requires integrating information and reasoning about events, entities, and their relations across a full document. Question answering is conventionally used to assess RC ability, in both artificial agents and children learning to read. However, existing RC datasets and tasks are dominated by questions that can be solved by selecting answers using superficial information (e.g., local context similarity or global term frequency); they thus fail to test for the essential integrative aspect of RC. To encourage progress on deeper comprehension of language, we present a new dataset and set of tasks in which the reader must answer questions about stories by reading entire books or movie scripts. These tasks are designed so that successfully answering their questions requires understanding the underlying narrative rather than relying on shallow pattern matching or salience. We show that although humans solve the tasks easily, standard RC models struggle on the tasks presented here. We provide an analysis of the dataset and the challenges it presents.

Open-world embodied agents must solve long-horizon tasks where the main bottleneck is not single-step planning quality but how interaction experience is organized and evolved. To this end, we present Steve-Evolving, a non-parametric self-evolving framework that tightly couples fine-grained execution diagnosis with dual-track knowledge distillation in a closed loop. The method follows three phases: Experience Anchoring, Experience Distillation, and Knowledge-Driven Closed-Loop Control. In detail, Experience Anchoring solidifies each subgoal attempt into a structured experience tuple with a fixed schema (pre-state, action, diagnosis-result, and post-state) and organizes it in a three-tier experience space with multi-dimensional indices (e.g., condition signatures, spatial hashing, and semantic tags) plus rolling summarization for efficient and auditable recall. To ensure sufficient information density for attribution, the execution layer provides compositional diagnosis signals beyond binary outcomes, including state-difference summaries, enumerated failure causes, continuous indicators, and stagnation/loop detection. Moreover, successful trajectories of Experience Distillation are generalized into reusable skills with explicit preconditions and verification criteria, while failures are distilled into executable guardrails that capture root causes and forbid risky operations at both subgoal and task granularities. Besides, Knowledge-Driven Closed-Loop Control retrieved skills and guardrails are injected into an LLM planner, and diagnosis-triggered local replanning updates the active constraints online, forming a continual evolution process without any model parameter updates. Experiments on the long-horizon suite of Minecraft MCU demonstrate consistent improvements over static-retrieval baselines.

This paper introduces a new tool, OccCANINE, to automatically transform occupational descriptions into the HISCO classification system. The manual work involved in processing and classifying occupational descriptions is error-prone, tedious, and time-consuming. We finetune a preexisting language model (CANINE) to do this automatically thereby performing in seconds and minutes what previously took days and weeks. The model is trained on 14 million pairs of occupational descriptions and HISCO codes in 13 different languages contributed by 22 different sources. Our approach is shown to have accuracy, recall and precision above 90 percent. Our tool breaks the metaphorical HISCO barrier and makes this data readily available for analysis of occupational structures with broad applicability in economics, economic history and various related disciplines.

We assessed the performance of commercial Large Language Models (LLMs) GPT-3.5-Turbo and GPT-4 on tasks from the 2023 BioASQ challenge. In Task 11b Phase B, which is focused on answer generation, both models demonstrated competitive abilities with leading systems. Remarkably, they achieved this with simple zero-shot learning, grounded with relevant snippets. Even without relevant snippets, their performance was decent, though not on par with the best systems. Interestingly, the older and cheaper GPT-3.5-Turbo system was able to compete with GPT-4 in the grounded Q&A setting on factoid and list answers. In Task 11b Phase A, focusing on retrieval, query expansion through zero-shot learning improved performance, but the models fell short compared to other systems. The code needed to rerun these experiments is available through GitHub.