Rojin Ziaei

Rojin Ziaei, Samuel Schmidgall

Large language models (LLMs) are becoming increasingly relevant as a potential tool for healthcare, aiding communication between clinicians, researchers, and patients. However, traditional evaluations of LLMs on medical exam questions do not reflect the complexity of real patient-doctor interactions. An example of this complexity is the introduction of patient self-diagnosis, where a patient attempts to diagnose their own medical conditions from various sources. While the patient sometimes arrives at an accurate conclusion, they more often are led toward misdiagnosis due to the patient's over-emphasis on bias validating information. In this work we present a variety of LLMs with multiple-choice questions from United States medical board exams which are modified to include self-diagnostic reports from patients. Our findings highlight that when a patient proposes incorrect bias-validating information, the diagnostic accuracy of LLMs drop dramatically, revealing a high susceptibility to errors in self-diagnosis.

Samuel Schmidgall, Rojin Ziaei, Carl Harris et al.

Evaluating large language models (LLM) in clinical scenarios is crucial to assessing their potential clinical utility. Existing benchmarks rely heavily on static question-answering, which does not accurately depict the complex, sequential nature of clinical decision-making. Here, we introduce AgentClinic, a multimodal agent benchmark for evaluating LLMs in simulated clinical environments that include patient interactions, multimodal data collection under incomplete information, and the usage of various tools, resulting in an in-depth evaluation across nine medical specialties and seven languages. We find that solving MedQA problems in the sequential decision-making format of AgentClinic is considerably more challenging, resulting in diagnostic accuracies that can drop to below a tenth of the original accuracy. Overall, we observe that agents sourced from Claude-3.5 outperform other LLM backbones in most settings. Nevertheless, we see stark differences in the LLMs' ability to make use of tools, such as experiential learning, adaptive retrieval, and reflection cycles. Strikingly, Llama-3 shows up to 92% relative improvements with the notebook tool that allows for writing and editing notes that persist across cases. To further scrutinize our clinical simulations, we leverage real-world electronic health records, perform a clinical reader study, perturb agents with biases, and explore novel patient-centric metrics that this interactive environment firstly enables.

Samuel Schmidgall, Carl Harris, Ime Essien et al.

There is increasing interest in the application large language models (LLMs) to the medical field, in part because of their impressive performance on medical exam questions. While promising, exam questions do not reflect the complexity of real patient-doctor interactions. In reality, physicians' decisions are shaped by many complex factors, such as patient compliance, personal experience, ethical beliefs, and cognitive bias. Taking a step toward understanding this, our hypothesis posits that when LLMs are confronted with clinical questions containing cognitive biases, they will yield significantly less accurate responses compared to the same questions presented without such biases. In this study, we developed BiasMedQA, a benchmark for evaluating cognitive biases in LLMs applied to medical tasks. Using BiasMedQA we evaluated six LLMs, namely GPT-4, Mixtral-8x70B, GPT-3.5, PaLM-2, Llama 2 70B-chat, and the medically specialized PMC Llama 13B. We tested these models on 1,273 questions from the US Medical Licensing Exam (USMLE) Steps 1, 2, and 3, modified to replicate common clinically-relevant cognitive biases. Our analysis revealed varying effects for biases on these LLMs, with GPT-4 standing out for its resilience to bias, in contrast to Llama 2 70B-chat and PMC Llama 13B, which were disproportionately affected by cognitive bias. Our findings highlight the critical need for bias mitigation in the development of medical LLMs, pointing towards safer and more reliable applications in healthcare.

Samuel Schmidgall, Jascha Achterberg, Thomas Miconi et al.

Artificial neural networks (ANNs) have emerged as an essential tool in machine learning, achieving remarkable success across diverse domains, including image and speech generation, game playing, and robotics. However, there exist fundamental differences between ANNs' operating mechanisms and those of the biological brain, particularly concerning learning processes. This paper presents a comprehensive review of current brain-inspired learning representations in artificial neural networks. We investigate the integration of more biologically plausible mechanisms, such as synaptic plasticity, to enhance these networks' capabilities. Moreover, we delve into the potential advantages and challenges accompanying this approach. Ultimately, we pinpoint promising avenues for future research in this rapidly advancing field, which could bring us closer to understanding the essence of intelligence.