Daily Papers

AI-driven medical history-taking is an important component in symptom checking, automated patient intake, triage, and other AI virtual care applications. As history-taking is extremely varied, machine learning models require a significant amount of data to train. To overcome this challenge, existing systems are developed using indirect data or expert knowledge. This leads to a training-inference gap as models are trained on different kinds of data than what they observe at inference time. In this work, we present a two-stage re-ranking approach that helps close the training-inference gap by re-ranking the first-stage question candidates using a dialogue-contextualized model. For this, we propose a new model, global re-ranker, which cross-encodes the dialogue with all questions simultaneously, and compare it with several existing neural baselines. We test both transformer and S4-based language model backbones. We find that relative to the expert system, the best performance is achieved by our proposed global re-ranker with a transformer backbone, resulting in a 30% higher normalized discount cumulative gain (nDCG) and a 77% higher mean average precision (mAP).

At the heart of medicine lies the physician-patient dialogue, where skillful history-taking paves the way for accurate diagnosis, effective management, and enduring trust. Artificial Intelligence (AI) systems capable of diagnostic dialogue could increase accessibility, consistency, and quality of care. However, approximating clinicians' expertise is an outstanding grand challenge. Here, we introduce AMIE (Articulate Medical Intelligence Explorer), a Large Language Model (LLM) based AI system optimized for diagnostic dialogue. AMIE uses a novel self-play based simulated environment with automated feedback mechanisms for scaling learning across diverse disease conditions, specialties, and contexts. We designed a framework for evaluating clinically-meaningful axes of performance including history-taking, diagnostic accuracy, management reasoning, communication skills, and empathy. We compared AMIE's performance to that of primary care physicians (PCPs) in a randomized, double-blind crossover study of text-based consultations with validated patient actors in the style of an Objective Structured Clinical Examination (OSCE). The study included 149 case scenarios from clinical providers in Canada, the UK, and India, 20 PCPs for comparison with AMIE, and evaluations by specialist physicians and patient actors. AMIE demonstrated greater diagnostic accuracy and superior performance on 28 of 32 axes according to specialist physicians and 24 of 26 axes according to patient actors. Our research has several limitations and should be interpreted with appropriate caution. Clinicians were limited to unfamiliar synchronous text-chat which permits large-scale LLM-patient interactions but is not representative of usual clinical practice. While further research is required before AMIE could be translated to real-world settings, the results represent a milestone towards conversational diagnostic AI.

Large language models (LLMs) hold great promise for assisting clinical interviews due to their fluent interactive capabilities and extensive medical knowledge. However, the lack of high-quality interview dialogue data and widely accepted evaluation methods has significantly impeded this process. So we propose CliniChat, a framework that integrates multi-source knowledge to enable LLMs to simulate real-world clinical interviews. It consists of two modules: Clini-Recon and Clini-Eval, each responsible for reconstructing and evaluating interview dialogues, respectively. By incorporating three sources of knowledge, Clini-Recon transforms clinical notes into systematic, professional, and empathetic interview dialogues. Clini-Eval combines a comprehensive evaluation metric system with a two-phase automatic evaluation approach, enabling LLMs to assess interview performance like experts. We contribute MedQA-Dialog, a high-quality synthetic interview dialogue dataset, and CliniChatGLM, a model specialized for clinical interviews. Experimental results demonstrate that CliniChatGLM's interview capabilities undergo a comprehensive upgrade, particularly in history-taking, achieving state-of-the-art performance.

Differential Diagnosis (DDx) is a fundamental yet complex aspect of clinical decision-making, in which physicians iteratively refine a ranked list of possible diseases based on symptoms, antecedents, and medical knowledge. While recent advances in large language models (LLMs) have shown promise in supporting DDx, existing approaches face key limitations, including single-dataset evaluations, isolated optimization of components, unrealistic assumptions about complete patient profiles, and single-attempt diagnosis. We introduce a Modular Explainable DDx Agent (MEDDxAgent) framework designed for interactive DDx, where diagnostic reasoning evolves through iterative learning, rather than assuming a complete patient profile is accessible. MEDDxAgent integrates three modular components: (1) an orchestrator (DDxDriver), (2) a history taking simulator, and (3) two specialized agents for knowledge retrieval and diagnosis strategy. To ensure robust evaluation, we introduce a comprehensive DDx benchmark covering respiratory, skin, and rare diseases. We analyze single-turn diagnostic approaches and demonstrate the importance of iterative refinement when patient profiles are not available at the outset. Our broad evaluation demonstrates that MEDDxAgent achieves over 10% accuracy improvements in interactive DDx across both large and small LLMs, while offering critical explainability into its diagnostic reasoning process.

Many NLP researchers are experiencing an existential crisis triggered by the astonishing success of ChatGPT and other systems based on large language models (LLMs). After such a disruptive change to our understanding of the field, what is left to do? Taking a historical lens, we look for guidance from the first era of LLMs, which began in 2005 with large n-gram models for machine translation. We identify durable lessons from the first era, and more importantly, we identify evergreen problems where NLP researchers can continue to make meaningful contributions in areas where LLMs are ascendant. Among these lessons, we discuss the primacy of hardware advancement in shaping the availability and importance of scale, as well as the urgent challenge of quality evaluation, both automated and human. We argue that disparities in scale are transient and that researchers can work to reduce them; that data, rather than hardware, is still a bottleneck for many meaningful applications; that meaningful evaluation informed by actual use is still an open problem; and that there is still room for speculative approaches.

Recently, context-dependent text-to-SQL semantic parsing which translates natural language into SQL in an interaction process has attracted a lot of attention. Previous works leverage context-dependence information either from interaction history utterances or the previous predicted SQL queries but fail in taking advantage of both since of the mismatch between natural language and logic-form SQL. In this work, we propose a History Information Enhanced text-to-SQL model (HIE-SQL) to exploit context-dependence information from both history utterances and the last predicted SQL query. In view of the mismatch, we treat natural language and SQL as two modalities and propose a bimodal pre-trained model to bridge the gap between them. Besides, we design a schema-linking graph to enhance connections from utterances and the SQL query to the database schema. We show our history information enhanced methods improve the performance of HIE-SQL by a significant margin, which achieves new state-of-the-art results on the two context-dependent text-to-SQL benchmarks, the SparC and CoSQL datasets, at the writing time.

Agents navigating in 3D environments require some form of memory, which should hold a compact and actionable representation of the history of observations useful for decision taking and planning. In most end-to-end learning approaches the representation is latent and usually does not have a clearly defined interpretation, whereas classical robotics addresses this with scene reconstruction resulting in some form of map, usually estimated with geometry and sensor models and/or learning. In this work we propose to learn an actionable representation of the scene independently of the targeted downstream task and without explicitly optimizing reconstruction. The learned representation is optimized by a blind auxiliary agent trained to navigate with it on multiple short sub episodes branching out from a waypoint and, most importantly, without any direct visual observation. We argue and show that the blindness property is important and forces the (trained) latent representation to be the only means for planning. With probing experiments we show that the learned representation optimizes navigability and not reconstruction. On downstream tasks we show that it is robust to changes in distribution, in particular the sim2real gap, which we evaluate with a real physical robot in a real office building, significantly improving performance.