Kie Shidara

Sonali Santhosh, Kelly Shuhong Yu, Eugene Chang et al.

Automated detection of interictal epileptiform discharges in scalp electroencephalography (EEG) is clinically important, but recent high-performing deep-learning models often trade interpretability for accuracy. We introduce EEG-SpikeAgent, a closed-loop program-synthesis framework that uses a large language model (LLM) agentic system to generate signal-processing features for spike detection in scalp EEG. The system iteratively proposes one deterministic EEG feature module at a time, executes the resulting code on EEG to generate tabular features, evaluates performance via a tabular classifier, summarizes run-level metrics, and feeds structured diagnostics back to the model for refinement. Across iterations, EEG-SpikeAgent proposes and refines candidate signal features and decision rules informed by model performance. We evaluated EEG-SpikeAgent on VEPISET, a public 29-channel dataset of 4-second epochs containing 2,516 discharge-containing and 22,933 non-discharge epochs. Across five-fold cross-validation with a gradient-boosted tree classifier, agent-generated features achieved an area under the receiver operating characteristic curve of 0.935, balanced accuracy of 0.699, F1 score of 0.557, sensitivity of 0.401, and specificity of 0.996 at the default operating point. At an operating point with sensitivity 0.80, mean precision was 0.470 and mean specificity was 0.900. Artifact-aware feature generation improved balanced accuracy and F1 score over spike-only feature search. These results indicate that LLM-based program synthesis can automate EEG feature engineering in auditable and inspectable code-driven manner for clinical and methodological review.

Jonathan Kim, Anna Podlasek, Kie Shidara et al.

Large Language Models (LLMs) have attained human-level accuracy on medical question-answer (QA) benchmarks. However, their limitations in navigating open-ended clinical scenarios have recently been shown, raising concerns about the robustness and generalizability of LLM reasoning across diverse, real-world medical tasks. To probe potential LLM failure modes in clinical problem-solving, we present the medical abstraction and reasoning corpus (M-ARC). M-ARC assesses clinical reasoning through scenarios designed to exploit the Einstellung effect -- the fixation of thought arising from prior experience, targeting LLM inductive biases toward inflexible pattern matching from their training data rather than engaging in flexible reasoning. We find that LLMs, including current state-of-the-art o1 and Gemini models, perform poorly compared to physicians on M-ARC, often demonstrating lack of commonsense medical reasoning and a propensity to hallucinate. In addition, uncertainty estimation analyses indicate that LLMs exhibit overconfidence in their answers, despite their limited accuracy. The failure modes revealed by M-ARC in LLM medical reasoning underscore the need to exercise caution when deploying these models in clinical settings.