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May 20

NurValues: Real-World Nursing Values Evaluation for Large Language Models in Clinical Context

This work introduces the first benchmark for nursing value alignment, consisting of five core value dimensions distilled from international nursing codes: Altruism, Human Dignity, Integrity, Justice, and Professionalism. The benchmark comprises 1,100 real-world nursing behavior instances collected through a five-month longitudinal field study across three hospitals of varying tiers. These instances are annotated by five clinical nurses and then augmented with LLM-generated counterfactuals with reversed ethic polarity. Each original case is paired with a value-aligned and a value-violating version, resulting in 2,200 labeled instances that constitute the Easy-Level dataset. To increase adversarial complexity, each instance is further transformed into a dialogue-based format that embeds contextual cues and subtle misleading signals, yielding a Hard-Level dataset. We evaluate 23 state-of-the-art (SoTA) LLMs on their alignment with nursing values. Our findings reveal three key insights: (1) DeepSeek-V3 achieves the highest performance on the Easy-Level dataset (94.55), where Claude 3.5 Sonnet outperforms other models on the Hard-Level dataset (89.43), significantly surpassing the medical LLMs; (2) Justice is consistently the most difficult nursing value dimension to evaluate; and (3) in-context learning significantly improves alignment. This work aims to provide a foundation for value-sensitive LLMs development in clinical settings. The dataset and the code are available at https://huggingface.co/datasets/Ben012345/NurValues.

  • 7 authors
·
May 13, 2025

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

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

  • 2 authors
·
Mar 21, 2024

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

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

  • 9 authors
·
Jun 5, 2024

MedSkillAudit: A Domain-Specific Audit Framework for Medical Research Agent Skills

Background: Agent skills are increasingly deployed as modular, reusable capability units in AI agent systems. Medical research agent skills require safeguards beyond general-purpose evaluation, including scientific integrity, methodological validity, reproducibility, and boundary safety. This study developed and preliminarily evaluated a domain-specific audit framework for medical research agent skills, with a focus on reliability against expert review. Methods: We developed MedSkillAudit (skill-auditor@1.0), a layered framework assessing skill release readiness before deployment. We evaluated 75 skills across five medical research categories (15 per category). Two experts independently assigned a quality score (0-100), an ordinal release disposition (Production Ready / Limited Release / Beta Only / Reject), and a high-risk failure flag. System-expert agreement was quantified using ICC(2,1) and linearly weighted Cohen's kappa, benchmarked against the human inter-rater baseline. Results: The mean consensus quality score was 72.4 (SD = 13.0); 57.3% of skills fell below the Limited Release threshold. MedSkillAudit achieved ICC(2,1) = 0.449 (95% CI: 0.250-0.610), exceeding the human inter-rater ICC of 0.300. System-consensus score divergence (SD = 9.5) was smaller than inter-expert divergence (SD = 12.4), with no directional bias (Wilcoxon p = 0.613). Protocol Design showed the strongest category-level agreement (ICC = 0.551); Academic Writing showed a negative ICC (-0.567), reflecting a structural rubric-expert mismatch. Conclusions: Domain-specific pre-deployment audit may provide a practical foundation for governing medical research agent skills, complementing general-purpose quality checks with structured audit workflows tailored to scientific use cases.

AIPOCH-AI AIPOCH
·
Apr 21 2

A Human-Centric Pipeline for Aligning Large Language Models with Chinese Medical Ethics

Recent advances in large language models have enabled their application to a range of healthcare tasks. However, aligning LLMs with the nuanced demands of medical ethics, especially under complex real world scenarios, remains underexplored. In this work, we present MedES, a dynamic, scenario-centric benchmark specifically constructed from 260 authoritative Chinese medical, ethical, and legal sources to reflect the challenges in clinical decision-making. To facilitate model alignment, we introduce a guardian-in-the-loop framework that leverages a dedicated automated evaluator (trained on expert-labeled data and achieving over 97% accuracy within our domain) to generate targeted prompts and provide structured ethical feedback. Using this pipeline, we align a 7B-parameter LLM through supervised fine-tuning and domain-specific preference optimization. Experimental results, conducted entirely within the Chinese medical ethics context, demonstrate that our aligned model outperforms notably larger baselines on core ethical tasks, with observed improvements in both quality and composite evaluation metrics. Our work offers a practical and adaptable framework for aligning LLMs with medical ethics in the Chinese healthcare domain, and suggests that similar alignment pipelines may be instantiated in other legal and cultural environments through modular replacement of the underlying normative corpus.

  • 5 authors
·
Jan 12

LabSafety Bench: Benchmarking LLMs on Safety Issues in Scientific Labs

Laboratory accidents pose significant risks to human life and property, underscoring the importance of robust safety protocols. Despite advancements in safety training, laboratory personnel may still unknowingly engage in unsafe practices. With the increasing reliance on large language models (LLMs) for guidance in various fields, including laboratory settings, there is a growing concern about their reliability in critical safety-related decision-making. Unlike trained human researchers, LLMs lack formal lab safety education, raising questions about their ability to provide safe and accurate guidance. Existing research on LLM trustworthiness primarily focuses on issues such as ethical compliance, truthfulness, and fairness but fails to fully cover safety-critical real-world applications, like lab safety. To address this gap, we propose the Laboratory Safety Benchmark (LabSafety Bench), a comprehensive evaluation framework based on a new taxonomy aligned with Occupational Safety and Health Administration (OSHA) protocols. This benchmark includes 765 multiple-choice questions verified by human experts, assessing LLMs and vision language models (VLMs) performance in lab safety contexts. Our evaluations demonstrate that while GPT-4o outperforms human participants, it is still prone to critical errors, highlighting the risks of relying on LLMs in safety-critical environments. Our findings emphasize the need for specialized benchmarks to accurately assess the trustworthiness of LLMs in real-world safety applications.

  • 9 authors
·
Oct 18, 2024 1

Question answering systems for health professionals at the point of care -- a systematic review

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

  • 9 authors
·
Jan 24, 2024

Demystifying Large Language Models for Medicine: A Primer

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

  • 23 authors
·
Oct 24, 2024

NurViD: A Large Expert-Level Video Database for Nursing Procedure Activity Understanding

The application of deep learning to nursing procedure activity understanding has the potential to greatly enhance the quality and safety of nurse-patient interactions. By utilizing the technique, we can facilitate training and education, improve quality control, and enable operational compliance monitoring. However, the development of automatic recognition systems in this field is currently hindered by the scarcity of appropriately labeled datasets. The existing video datasets pose several limitations: 1) these datasets are small-scale in size to support comprehensive investigations of nursing activity; 2) they primarily focus on single procedures, lacking expert-level annotations for various nursing procedures and action steps; and 3) they lack temporally localized annotations, which prevents the effective localization of targeted actions within longer video sequences. To mitigate these limitations, we propose NurViD, a large video dataset with expert-level annotation for nursing procedure activity understanding. NurViD consists of over 1.5k videos totaling 144 hours, making it approximately four times longer than the existing largest nursing activity datasets. Notably, it encompasses 51 distinct nursing procedures and 177 action steps, providing a much more comprehensive coverage compared to existing datasets that primarily focus on limited procedures. To evaluate the efficacy of current deep learning methods on nursing activity understanding, we establish three benchmarks on NurViD: procedure recognition on untrimmed videos, procedure and action recognition on trimmed videos, and action detection. Our benchmark and code will be available at https://github.com/minghu0830/NurViD-benchmark.

  • 10 authors
·
Oct 20, 2023

Two Case Studies of Experience Prototyping Machine Learning Systems in the Wild

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

  • 1 authors
·
Oct 20, 2019

Medical Hallucinations in Foundation Models and Their Impact on Healthcare

Foundation Models that are capable of processing and generating multi-modal data have transformed AI's role in medicine. However, a key limitation of their reliability is hallucination, where inaccurate or fabricated information can impact clinical decisions and patient safety. We define medical hallucination as any instance in which a model generates misleading medical content. This paper examines the unique characteristics, causes, and implications of medical hallucinations, with a particular focus on how these errors manifest themselves in real-world clinical scenarios. Our contributions include (1) a taxonomy for understanding and addressing medical hallucinations, (2) benchmarking models using medical hallucination dataset and physician-annotated LLM responses to real medical cases, providing direct insight into the clinical impact of hallucinations, and (3) a multi-national clinician survey on their experiences with medical hallucinations. Our results reveal that inference techniques such as Chain-of-Thought (CoT) and Search Augmented Generation can effectively reduce hallucination rates. However, despite these improvements, non-trivial levels of hallucination persist. These findings underscore the ethical and practical imperative for robust detection and mitigation strategies, establishing a foundation for regulatory policies that prioritize patient safety and maintain clinical integrity as AI becomes more integrated into healthcare. The feedback from clinicians highlights the urgent need for not only technical advances but also for clearer ethical and regulatory guidelines to ensure patient safety. A repository organizing the paper resources, summaries, and additional information is available at https://github.com/mitmedialab/medical hallucination.

  • 25 authors
·
Feb 25, 2025

BengaliMoralBench: A Benchmark for Auditing Moral Reasoning in Large Language Models within Bengali Language and Culture

As multilingual Large Language Models (LLMs) gain traction across South Asia, their alignment with local ethical norms, particularly for Bengali, which is spoken by over 285 million people and ranked 6th globally, remains underexplored. Existing ethics benchmarks are largely English-centric and shaped by Western frameworks, overlooking cultural nuances critical for real-world deployment. To address this, we introduce BengaliMoralBench, the first large-scale ethics benchmark for the Bengali language and socio-cultural contexts. It covers five moral domains, Daily Activities, Habits, Parenting, Family Relationships, and Religious Activities, subdivided into 50 culturally relevant subtopics. Each scenario is annotated via native-speaker consensus using three ethical lenses: Virtue, Commonsense, and Justice ethics. We conduct systematic zero-shot evaluation of prominent multilingual LLMs, including Llama, Gemma, Qwen, and DeepSeek, using a unified prompting protocol and standard metrics. Performance varies widely (50-91% accuracy), with qualitative analysis revealing consistent weaknesses in cultural grounding, commonsense reasoning, and moral fairness. BengaliMoralBench provides a foundation for responsible localization, enabling culturally aligned evaluation and supporting the deployment of ethically robust AI in diverse, low-resource multilingual settings such as Bangladesh.

  • 3 authors
·
Nov 4, 2025

HealthQA-BR: A System-Wide Benchmark Reveals Critical Knowledge Gaps in Large Language Models

The evaluation of Large Language Models (LLMs) in healthcare has been dominated by physician-centric, English-language benchmarks, creating a dangerous illusion of competence that ignores the interprofessional nature of patient care. To provide a more holistic and realistic assessment, we introduce HealthQA-BR, the first large-scale, system-wide benchmark for Portuguese-speaking healthcare. Comprising 5,632 questions from Brazil's national licensing and residency exams, it uniquely assesses knowledge not only in medicine and its specialties but also in nursing, dentistry, psychology, social work, and other allied health professions. We conducted a rigorous zero-shot evaluation of over 20 leading LLMs. Our results reveal that while state-of-the-art models like GPT 4.1 achieve high overall accuracy (86.6%), this top-line score masks alarming, previously unmeasured deficiencies. A granular analysis shows performance plummets from near-perfect in specialties like Ophthalmology (98.7%) to barely passing in Neurosurgery (60.0%) and, most notably, Social Work (68.4%). This "spiky" knowledge profile is a systemic issue observed across all models, demonstrating that high-level scores are insufficient for safety validation. By publicly releasing HealthQA-BR and our evaluation suite, we provide a crucial tool to move beyond single-score evaluations and toward a more honest, granular audit of AI readiness for the entire healthcare team.

  • 1 authors
·
Jun 16, 2025

Eir: Thai Medical Large Language Models

We present Eir Thai Medical LLM, a large language model with 8 billion parameters, specifically designed to enhance the accuracy of handling medical tasks in the Thai language. This model focuses on providing clear and easy-to-understand answers for both healthcare professionals and patients, thereby improving the efficiency of diagnosis and treatment processes. Human evaluation was conducted to ensure that the model adheres to care standards and provides unbiased answers. To prioritize data security, the model is deployed within the hospital's internal network, ensuring both high security and faster processing speeds. The internal API connection is secured with encryption and strict authentication measures to prevent data leaks and unauthorized access. We evaluated several open-source large language models with 8 billion parameters on four medical benchmarks: MedQA, MedMCQA, PubMedQA, and the medical subset of MMLU. The best-performing baselines were used to develop Eir Thai Medical LLM. Our evaluation employed multiple questioning strategies, including zero-shot, few-shot, chain-of-thought reasoning, and ensemble/self-consistency voting methods. Our model outperformed commercially available Thai-language large language models by more than 10%. In addition, we developed enhanced model testing tailored for clinical use in Thai across 18 clinical tasks, where our model exceeded GPT-4o performance by more than 11%

  • 3 authors
·
Sep 13, 2024

Leveraging LLMs for User Stories in AI Systems: UStAI Dataset

AI systems are gaining widespread adoption across various sectors and domains. Creating high-quality AI system requirements is crucial for aligning the AI system with business goals and consumer values and for social responsibility. However, with the uncertain nature of AI systems and the heavy reliance on sensitive data, more research is needed to address the elicitation and analysis of AI systems requirements. With the proprietary nature of many AI systems, there is a lack of open-source requirements artifacts and technical requirements documents for AI systems, limiting broader research and investigation. With Large Language Models (LLMs) emerging as a promising alternative to human-generated text, this paper investigates the potential use of LLMs to generate user stories for AI systems based on abstracts from scholarly papers. We conducted an empirical evaluation using three LLMs and generated 1260 user stories from 42 abstracts from 26 domains. We assess their quality using the Quality User Story (QUS) framework. Moreover, we identify relevant non-functional requirements (NFRs) and ethical principles. Our analysis demonstrates that the investigated LLMs can generate user stories inspired by the needs of various stakeholders, offering a promising approach for generating user stories for research purposes and for aiding in the early requirements elicitation phase of AI systems. We have compiled and curated a collection of stories generated by various LLMs into a dataset (UStAI), which is now publicly available for use.

  • 3 authors
·
Apr 1, 2025

Healthsheet: Development of a Transparency Artifact for Health Datasets

Machine learning (ML) approaches have demonstrated promising results in a wide range of healthcare applications. Data plays a crucial role in developing ML-based healthcare systems that directly affect people's lives. Many of the ethical issues surrounding the use of ML in healthcare stem from structural inequalities underlying the way we collect, use, and handle data. Developing guidelines to improve documentation practices regarding the creation, use, and maintenance of ML healthcare datasets is therefore of critical importance. In this work, we introduce Healthsheet, a contextualized adaptation of the original datasheet questionnaire ~gebru2018datasheets for health-specific applications. Through a series of semi-structured interviews, we adapt the datasheets for healthcare data documentation. As part of the Healthsheet development process and to understand the obstacles researchers face in creating datasheets, we worked with three publicly-available healthcare datasets as our case studies, each with different types of structured data: Electronic health Records (EHR), clinical trial study data, and smartphone-based performance outcome measures. Our findings from the interviewee study and case studies show 1) that datasheets should be contextualized for healthcare, 2) that despite incentives to adopt accountability practices such as datasheets, there is a lack of consistency in the broader use of these practices 3) how the ML for health community views datasheets and particularly Healthsheets as diagnostic tool to surface the limitations and strength of datasets and 4) the relative importance of different fields in the datasheet to healthcare concerns.

  • 10 authors
·
Feb 25, 2022

Qworld: Question-Specific Evaluation Criteria for LLMs

Evaluating large language models (LLMs) on open-ended questions is difficult because response quality depends on the question's context. Binary scores and static rubrics fail to capture these context-dependent requirements. Existing methods define criteria at the dataset level or generate them in a single pass, which limits their ability to explore the evaluation space implied by each question. We introduce One-Question-One-World (Qworld), a method that generates question-specific evaluation criteria using a recursive expansion tree. Given a question, Qworld decomposes it into scenarios, perspectives, and fine-grained binary criteria through structured hierarchical and horizontal expansion. The resulting criteria specify what a high-quality answer must address for that question. On HealthBench, Qworld covers 89% of expert-authored criteria and generates 79% novel criteria validated by human experts. Experts rate Qworld criteria higher in insight and granularity than those produced by prior methods. When applied to 11 frontier LLMs on HealthBench and Humanity's Last Exam, Qworld reveals capability differences in dimensions such as long-term impact, equity, error handling, and interdisciplinary reasoning that coarse rubrics do not distinguish. By formulating criteria generation as structured coverage of question-implied evaluation axes, Qworld enables evaluation that adapts to each question rather than relying on fixed task-level criteria.