Han Yu

Anran Li, Yuanyuan Chen, Wenjun Long et al.

Large language models (LLMs) have demonstrated strong performance on medical benchmarks, including question answering and diagnosis. To enable their use in clinical settings, LLMs are typically further adapted through continued pretraining or post-training using clinical data. However, most medical LLMs are trained on data from a single institution, which faces limitations in generalizability and safety in heterogeneous systems. Federated learning (FL) is a promising solution for enabling collaborative model development across healthcare institutions. Yet applying FL to LLMs in medicine remains fundamentally limited. First, conventional FL requires transmitting the full model during each communication round, which becomes impractical for multi-billion-parameter LLMs given the limited computational resources. Second, many FL algorithms implicitly assume data homogeneity, whereas real-world clinical data are highly heterogeneous across patients, diseases, and institutional practices. We introduce the model-agnostic and parameter-efficient federated learning framework for adapting LLMs to medical applications. Fed-MedLoRA transmits only low-rank adapter parameters, reducing communication and computation overhead, while Fed-MedLoRA+ further incorporates adaptive, data-aware aggregation to improve convergence under cross-site heterogeneity. We apply the framework to clinical information extraction (IE), which transforms patient narratives into structured medical entities and relations. Accuracy was assessed across five patient cohorts through comparisons with BERT models, and LLaMA-3 and DeepSeek-R1, GPT-4o models. Evaluation settings included (1) in-domain training and testing, (2) external validation on independent cohorts, and (3) a low-resource new-site adaptation scenario using real-world clinical notes from the Yale New Haven Health System.

Minghui Chen, Wenlong Deng, James Zou et al.

Large language models (LLMs) are increasingly deployed as part of compound AI systems that coordinate multiple modules (e.g., retrievers, tools, verifiers) over long-horizon workflows. Recent approaches that propagate textual feedback globally (e.g., TextGrad) make it feasible to optimize such pipelines, but we find that performance degrades as system depth grows. In particular, long-horizon agentic workflows exhibit two depth-scaling failure modes: 1) exploding textual gradient, where textual feedback grows exponentially with depth, leading to prohibitively long message and amplifies evaluation biases; and 2) vanishing textual gradient, where limited long-context ability causes models overemphasize partial feedback and compression of lengthy feedback causes downstream messages to lose specificity gradually as they propagate many hops upstream. To mitigate these issues, we introduce Textual Equilibrium Propagation (TEP), a local learning principle inspired by Equilibrium Propagation in energy-based models. TEP includes two phases: 1) a free phase where a local LLM critics iteratively refine prompts until reaching equilibrium (no further improvements are suggested); and 2) a nudged phase which applies proximal prompt edits with bounded modification intensity, using task-level objectives that propagate via forward signaling rather than backward feedback chains. This design supports local prompt optimization followed by controlled adaptation toward global goals without the computational burden and signal degradation of global textual backpropagation. Across long-horizon QA benchmarks and multi-agent tool-use dataset, TEP consistently improves accuracy and efficiency over global propagation methods such as TextGrad. The gains grows with depth, while preserving the practicality of black-box LLM components in deep compound AI system.