Yu Heng Kwan

Kabilan Elangovan, Jasmine Chiat Ling Ong, Liyuan Jin et al.

Large Language Models (LLMs) have emerged as a potential solution to assist digital health development with patient education, commonly medication-related enquires. We trained and validated Med-Pal, a medication domain-specific LLM-chatbot fine-tuned with a fine-grained and expert curated dataset from a selection of five light-weighted open-source LLMs of smaller parameter size (7 billion or less) regarding computational constraints and prioritizing operational efficiency. A multi-disciplinary team performed a clinical evaluation of LLMs responses using the SCORE criteria, focusing on safety, accuracy, bias, reproducibility, and ease of understanding. Best performing light-weighted LLM was chosen as Med-Pal for further engineering with guard-railing using adversarial prompting. Med-Pal and existing light-weighted LLMs, including pretrained Biomistral and finetuned Meerkat, were validated on an independent dataset on a broad range of medication-related questions (231 in total), 12 different question types across 14 different medication classes. Mistral-7b emerged as the top performer among selected lightweight LLMs, achieving the highest median score of 14 and 71.9% high-quality responses in accuracy and safety domains, hence chosen as the backbone LLM for Med-Pal. When compared against Biomistral, Med-pal outperformed in generating responses appropriate for patient communication, with significant reductions bias and errors typical of general LLMs. Comparable performance was observed when comparing Med-Pal with Meerkat. Med-Pal showcases the feasibility of developing and employing fine-tuned light-weighted LLMs to enhance digital health communications.

Yang Zhou, Zhenting Sheng, Mingrui Tan et al.

Effective clinical history taking is a foundational yet underexplored component of clinical reasoning. While large language models (LLMs) have shown promise on static benchmarks, they often fall short in dynamic, multi-turn diagnostic settings that require iterative questioning and hypothesis refinement. To address this gap, we propose \method{}, a note-driven framework that trains LLMs to conduct structured history taking and diagnosis by learning from widely available medical notes. Instead of relying on scarce and sensitive dialogue data, we convert real-world medical notes into high-quality doctor-patient dialogues using a decision tree-guided generation and refinement pipeline. We then propose a three-stage fine-tuning strategy combining supervised learning, simulated data augmentation, and preference learning. Furthermore, we propose a novel single-turn reasoning paradigm that reframes history taking as a sequence of single-turn reasoning problems. This design enhances interpretability and enables local supervision, dynamic adaptation, and greater sample efficiency. Experimental results show that our method substantially improves clinical reasoning, achieving gains of +16.9 F1 and +21.0 Top-1 diagnostic accuracy over GPT-4o. Our code and dataset can be found at https://github.com/zhentingsheng/Note2Chat.