Daily Papers

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.

Large language models (LLMs) often fail to ask effective questions under uncertainty, making them unreliable in domains where proactive information-gathering is essential for decisionmaking. We present ALFA, a framework that improves LLM question-asking by (i) decomposing the notion of a "good" question into a set of theory-grounded attributes (e.g., clarity, relevance), (ii) controllably synthesizing attribute-specific question variations, and (iii) aligning models via preference-based optimization to explicitly learn to ask better questions along these fine-grained attributes. Focusing on clinical reasoning as a case study, we introduce the MediQ-AskDocs dataset, composed of 17k real-world clinical interactions augmented with 80k attribute-specific preference pairs of follow-up questions, as well as a novel expert-annotated interactive healthcare QA task to evaluate question-asking abilities. Models aligned with ALFA reduce diagnostic errors by 56.6% on MediQ-AskDocs compared to SOTA instruction-tuned LLMs, with a question-level win-rate of 64.4% and strong generalizability. Our findings suggest that explicitly guiding question-asking with structured, fine-grained attributes offers a scalable path to improve LLMs, especially in expert application domains.

There are two main barriers to using large language models (LLMs) in clinical reasoning. Firstly, while LLMs exhibit significant promise in Natural Language Processing (NLP) tasks, their performance in complex reasoning and planning falls short of expectations. Secondly, LLMs use uninterpretable methods to make clinical decisions that are fundamentally different from the clinician's cognitive processes. This leads to user distrust. In this paper, we present a multi-agent framework called ArgMed-Agents, which aims to enable LLM-based agents to make explainable clinical decision reasoning through interaction. ArgMed-Agents performs self-argumentation iterations via Argumentation Scheme for Clinical Discussion (a reasoning mechanism for modeling cognitive processes in clinical reasoning), and then constructs the argumentation process as a directed graph representing conflicting relationships. Ultimately, use symbolic solver to identify a series of rational and coherent arguments to support decision. We construct a formal model of ArgMed-Agents and present conjectures for theoretical guarantees. ArgMed-Agents enables LLMs to mimic the process of clinical argumentative reasoning by generating explanations of reasoning in a self-directed manner. The setup experiments show that ArgMed-Agents not only improves accuracy in complex clinical decision reasoning problems compared to other prompt methods, but more importantly, it provides users with decision explanations that increase their confidence.

Vision-Language Models (VLM) can support clinicians by analyzing medical images and engaging in natural language interactions to assist in diagnostic and treatment tasks. However, VLMs often exhibit "hallucinogenic" behavior, generating textual outputs not grounded in contextual multimodal information. This challenge is particularly pronounced in the medical domain, where we do not only require VLM outputs to be accurate in single interactions but also to be consistent with clinical reasoning and diagnostic pathways throughout multi-turn conversations. For this purpose, we propose a new alignment algorithm that uses symbolic representations of clinical reasoning to ground VLMs in medical knowledge. These representations are utilized to (i) generate GPT-4-guided visual instruction tuning data at scale, simulating clinician-VLM conversations with demonstrations of clinical reasoning, and (ii) create an automatic reward function that evaluates the clinical validity of VLM generations throughout clinician-VLM interactions. Our algorithm eliminates the need for human involvement in training data generation or reward model construction, reducing costs compared to standard reinforcement learning with human feedback (RLHF). We apply our alignment algorithm to develop Dr-LLaVA, a conversational VLM finetuned for analyzing bone marrow pathology slides, demonstrating strong performance in multi-turn medical conversations.

Building upon our previous investigations of O1 replication (Part 1: Journey Learning [Qin et al., 2024] and Part 2: Distillation [Huang et al., 2024]), this work explores the potential of inference-time scaling in large language models (LLMs) for medical reasoning tasks, ranging from diagnostic decision-making to treatment planning. Through extensive experiments on medical benchmarks of varying complexity (MedQA, Medbullets, and JAMA Clinical Challenges), our investigation reveals several key insights: (1) Increasing inference time does lead to improved performance. With a modest training set of 500 samples, our model yields substantial performance improvements of 6%-11%. (2) Task complexity directly correlates with the required length of reasoning chains, confirming the necessity of extended thought processes for challenging problems. (3) The differential diagnoses generated by our model adhere to the principles of the hypothetico-deductive method, producing a list of potential conditions that may explain a patient's symptoms and systematically narrowing these possibilities by evaluating the evidence. These findings demonstrate the promising synergy between inference-time scaling and journey learning in advancing LLMs' real-world clinical reasoning capabilities.

Large Language Models (LLMs) have shown impressive performance on existing medical question-answering benchmarks. This high performance makes it increasingly difficult to meaningfully evaluate and differentiate advanced methods. We present MedAgentsBench, a benchmark that focuses on challenging medical questions requiring multi-step clinical reasoning, diagnosis formulation, and treatment planning-scenarios where current models still struggle despite their strong performance on standard tests. Drawing from seven established medical datasets, our benchmark addresses three key limitations in existing evaluations: (1) the prevalence of straightforward questions where even base models achieve high performance, (2) inconsistent sampling and evaluation protocols across studies, and (3) lack of systematic analysis of the interplay between performance, cost, and inference time. Through experiments with various base models and reasoning methods, we demonstrate that the latest thinking models, DeepSeek R1 and OpenAI o3, exhibit exceptional performance in complex medical reasoning tasks. Additionally, advanced search-based agent methods offer promising performance-to-cost ratios compared to traditional approaches. Our analysis reveals substantial performance gaps between model families on complex questions and identifies optimal model selections for different computational constraints. Our benchmark and evaluation framework are publicly available at https://github.com/gersteinlab/medagents-benchmark.

Large Language Models (LLMs) hold great promise to revolutionize current clinical systems for their superior capacities on medical text processing tasks and medical licensing exams. Meanwhile, traditional ML models such as SVM and XGBoost have still been mainly adopted in clinical prediction tasks. An emerging question is Can LLMs beat traditional ML models in clinical prediction? Thus, we build a new benchmark ClinicalBench to comprehensively study the clinical predictive modeling capacities of both general-purpose and medical LLMs, and compare them with traditional ML models. ClinicalBench embraces three common clinical prediction tasks, two databases, 14 general-purpose LLMs, 8 medical LLMs, and 11 traditional ML models. Through extensive empirical investigation, we discover that both general-purpose and medical LLMs, even with different model scales, diverse prompting or fine-tuning strategies, still cannot beat traditional ML models in clinical prediction yet, shedding light on their potential deficiency in clinical reasoning and decision-making. We call for caution when practitioners adopt LLMs in clinical applications. ClinicalBench can be utilized to bridge the gap between LLMs' development for healthcare and real-world clinical practice.

We introduce RJUA-QA, a novel medical dataset for question answering (QA) and reasoning with clinical evidence, contributing to bridge the gap between general large language models (LLMs) and medical-specific LLM applications. RJUA-QA is derived from realistic clinical scenarios and aims to facilitate LLMs in generating reliable diagnostic and advice. The dataset contains 2,132 curated Question-Context-Answer pairs, corresponding about 25,000 diagnostic records and clinical cases. The dataset covers 67 common urological disease categories, where the disease coverage exceeds 97.6\% of the population seeking medical services in urology. Each data instance in RJUA-QA comprises: (1) a question mirroring real patient to inquiry about clinical symptoms and medical conditions, (2) a context including comprehensive expert knowledge, serving as a reference for medical examination and diagnosis, (3) a doctor response offering the diagnostic conclusion and suggested examination guidance, (4) a diagnosed clinical disease as the recommended diagnostic outcome, and (5) clinical advice providing recommendations for medical examination. RJUA-QA is the first medical QA dataset for clinical reasoning over the patient inquiries, where expert-level knowledge and experience are required for yielding diagnostic conclusions and medical examination advice. A comprehensive evaluation is conducted to evaluate the performance of both medical-specific and general LLMs on the RJUA-QA dataset.

With the rapid development of artificial intelligence, large language models (LLMs) have shown promising capabilities in mimicking human-level language comprehension and reasoning. This has sparked significant interest in applying LLMs to enhance various aspects of healthcare, ranging from medical education to clinical decision support. However, medicine involves multifaceted data modalities and nuanced reasoning skills, presenting challenges for integrating LLMs. This paper provides a comprehensive review on the applications and implications of LLMs in medicine. It begins by examining the fundamental applications of general-purpose and specialized LLMs, demonstrating their utilities in knowledge retrieval, research support, clinical workflow automation, and diagnostic assistance. Recognizing the inherent multimodality of medicine, the review then focuses on multimodal LLMs, investigating their ability to process diverse data types like medical imaging and EHRs to augment diagnostic accuracy. To address LLMs' limitations regarding personalization and complex clinical reasoning, the paper explores the emerging development of LLM-powered autonomous agents for healthcare. Furthermore, it summarizes the evaluation methodologies for assessing LLMs' reliability and safety in medical contexts. Overall, this review offers an extensive analysis on the transformative potential of LLMs in modern medicine. It also highlights the pivotal need for continuous optimizations and ethical oversight before these models can be effectively integrated into clinical practice. Visit https://github.com/mingze-yuan/Awesome-LLM-Healthcare for an accompanying GitHub repository containing latest papers.

Large language models (LLMs) have shown remarkable progress in encoding clinical knowledge and responding to complex medical queries with appropriate clinical reasoning. However, their applicability in subspecialist or complex medical settings remains underexplored. In this work, we probe the performance of AMIE, a research conversational diagnostic AI system, in the subspecialist domain of breast oncology care without specific fine-tuning to this challenging domain. To perform this evaluation, we curated a set of 50 synthetic breast cancer vignettes representing a range of treatment-naive and treatment-refractory cases and mirroring the key information available to a multidisciplinary tumor board for decision-making (openly released with this work). We developed a detailed clinical rubric for evaluating management plans, including axes such as the quality of case summarization, safety of the proposed care plan, and recommendations for chemotherapy, radiotherapy, surgery and hormonal therapy. To improve performance, we enhanced AMIE with the inference-time ability to perform web search retrieval to gather relevant and up-to-date clinical knowledge and refine its responses with a multi-stage self-critique pipeline. We compare response quality of AMIE with internal medicine trainees, oncology fellows, and general oncology attendings under both automated and specialist clinician evaluations. In our evaluations, AMIE outperformed trainees and fellows demonstrating the potential of the system in this challenging and important domain. We further demonstrate through qualitative examples, how systems such as AMIE might facilitate conversational interactions to assist clinicians in their decision making. However, AMIE's performance was overall inferior to attending oncologists suggesting that further research is needed prior to consideration of prospective uses.

The meaningful use of electronic health records (EHR) continues to progress in the digital era with clinical decision support systems augmented by artificial intelligence. A priority in improving provider experience is to overcome information overload and reduce the cognitive burden so fewer medical errors and cognitive biases are introduced during patient care. One major type of medical error is diagnostic error due to systematic or predictable errors in judgment that rely on heuristics. The potential for clinical natural language processing (cNLP) to model diagnostic reasoning in humans with forward reasoning from data to diagnosis and potentially reduce the cognitive burden and medical error has not been investigated. Existing tasks to advance the science in cNLP have largely focused on information extraction and named entity recognition through classification tasks. We introduce a novel suite of tasks coined as Diagnostic Reasoning Benchmarks, DR.BENCH, as a new benchmark for developing and evaluating cNLP models with clinical diagnostic reasoning ability. The suite includes six tasks from ten publicly available datasets addressing clinical text understanding, medical knowledge reasoning, and diagnosis generation. DR.BENCH is the first clinical suite of tasks designed to be a natural language generation framework to evaluate pre-trained language models. Experiments with state-of-the-art pre-trained generative language models using large general domain models and models that were continually trained on a medical corpus demonstrate opportunities for improvement when evaluated in DR. BENCH. We share DR. BENCH as a publicly available GitLab repository with a systematic approach to load and evaluate models for the cNLP community.

The rapid development of Large Language Models (LLMs) for healthcare applications has spurred calls for holistic evaluation beyond frequently-cited benchmarks like USMLE, to better reflect real-world performance. While real-world assessments are valuable indicators of utility, they often lag behind the pace of LLM evolution, likely rendering findings obsolete upon deployment. This temporal disconnect necessitates a comprehensive upfront evaluation that can guide model selection for specific clinical applications. We introduce MEDIC, a framework assessing LLMs across five critical dimensions of clinical competence: medical reasoning, ethics and bias, data and language understanding, in-context learning, and clinical safety. MEDIC features a novel cross-examination framework quantifying LLM performance across areas like coverage and hallucination detection, without requiring reference outputs. We apply MEDIC to evaluate LLMs on medical question-answering, safety, summarization, note generation, and other tasks. Our results show performance disparities across model sizes, baseline vs medically finetuned models, and have implications on model selection for applications requiring specific model strengths, such as low hallucination or lower cost of inference. MEDIC's multifaceted evaluation reveals these performance trade-offs, bridging the gap between theoretical capabilities and practical implementation in healthcare settings, ensuring that the most promising models are identified and adapted for diverse healthcare applications.

Large Language Models (LLMs) like ChatGPT demonstrate significant potential in the medical field, often evaluated using multiple-choice questions (MCQs) similar to those found on the USMLE. Despite their prevalence in medical education, MCQs have limitations that might be exacerbated when assessing LLMs. To evaluate the effectiveness of MCQs in assessing the performance of LLMs, we developed a fictional medical benchmark focused on a non-existent gland, the Glianorex. This approach allowed us to isolate the knowledge of the LLM from its test-taking abilities. We used GPT-4 to generate a comprehensive textbook on the Glianorex in both English and French and developed corresponding multiple-choice questions in both languages. We evaluated various open-source, proprietary, and domain-specific LLMs using these questions in a zero-shot setting. The models achieved average scores around 67%, with minor performance differences between larger and smaller models. Performance was slightly higher in English than in French. Fine-tuned medical models showed some improvement over their base versions in English but not in French. The uniformly high performance across models suggests that traditional MCQ-based benchmarks may not accurately measure LLMs' clinical knowledge and reasoning abilities, instead highlighting their pattern recognition skills. This study underscores the need for more robust evaluation methods to better assess the true capabilities of LLMs in medical contexts.

Medical language models (MLMs) have become pivotal in advancing medical natural language processing. However, prior models that rely on pre-training or supervised fine-tuning often exhibit low data efficiency and limited practicality in real-world clinical applications. While OpenAIs O1 highlights test-time scaling in mathematics, attempts to replicate this approach in medicine typically distill responses from GPT-series models to open-source models, focusing primarily on multiple-choice tasks. This strategy, though straightforward, neglects critical concerns like data privacy and realistic deployment in clinical settings. In this work, we present a deployable, small-scale medical language model, \mone, designed for long-chain reasoning in clinical tasks using a self-evolution paradigm. Starting with a seed dataset of around 8,000 instances spanning five domains and 16 datasets, we prompt a base policy model to perform Monte Carlo Tree Search (MCTS) to construct verifiable reasoning chains. Each reasoning step is assigned an evolution rollout value, allowing verified trajectories to train the policy model and the reward model. During inference, the policy model generates multiple responses, and the reward model selects the one with the highest reward score. Experiments on eleven evaluation datasets demonstrate that \mone outperforms prior open-source models by 2 points, with the addition of the reward model further boosting performance (sim13 points), surpassing GPT-4o-mini. Code and data are available at https://github.com/pixas/MedSSS.

Large Language Models (LLMs) and multi-agent systems have shown impressive capabilities in natural language tasks but face challenges in clinical trial applications, primarily due to limited access to external knowledge. Recognizing the potential of advanced clinical trial tools that aggregate and predict based on the latest medical data, we propose an integrated solution to enhance their accessibility and utility. We introduce Clinical Agent System (ClinicalAgent), a clinical multi-agent system designed for clinical trial tasks, leveraging GPT-4, multi-agent architectures, LEAST-TO-MOST, and ReAct reasoning technology. This integration not only boosts LLM performance in clinical contexts but also introduces novel functionalities. The proposed method achieves competitive predictive performance in clinical trial outcome prediction (0.7908 PR-AUC), obtaining a 0.3326 improvement over the standard prompt Method. Publicly available code can be found at https://anonymous.4open.science/r/ClinicalAgent-6671.

Passively collected behavioral health data from ubiquitous sensors holds significant promise to provide mental health professionals insights from patient's daily lives; however, developing analysis tools to use this data in clinical practice requires addressing challenges of generalization across devices and weak or ambiguous correlations between the measured signals and an individual's mental health. To address these challenges, we take a novel approach that leverages large language models (LLMs) to synthesize clinically useful insights from multi-sensor data. We develop chain of thought prompting methods that use LLMs to generate reasoning about how trends in data such as step count and sleep relate to conditions like depression and anxiety. We first demonstrate binary depression classification with LLMs achieving accuracies of 61.1% which exceed the state of the art. While it is not robust for clinical use, this leads us to our key finding: even more impactful and valued than classification is a new human-AI collaboration approach in which clinician experts interactively query these tools and combine their domain expertise and context about the patient with AI generated reasoning to support clinical decision-making. We find models like GPT-4 correctly reference numerical data 75% of the time, and clinician participants express strong interest in using this approach to interpret self-tracking data.

Large language models (LLMs) have demonstrated impressive capabilities in natural language understanding and generation, but the quality bar for medical and clinical applications is high. Today, attempts to assess models' clinical knowledge typically rely on automated evaluations on limited benchmarks. There is no standard to evaluate model predictions and reasoning across a breadth of tasks. To address this, we present MultiMedQA, a benchmark combining six existing open question answering datasets spanning professional medical exams, research, and consumer queries; and HealthSearchQA, a new free-response dataset of medical questions searched online. We propose a framework for human evaluation of model answers along multiple axes including factuality, precision, possible harm, and bias. In addition, we evaluate PaLM (a 540-billion parameter LLM) and its instruction-tuned variant, Flan-PaLM, on MultiMedQA. Using a combination of prompting strategies, Flan-PaLM achieves state-of-the-art accuracy on every MultiMedQA multiple-choice dataset (MedQA, MedMCQA, PubMedQA, MMLU clinical topics), including 67.6% accuracy on MedQA (US Medical License Exam questions), surpassing prior state-of-the-art by over 17%. However, human evaluation reveals key gaps in Flan-PaLM responses. To resolve this we introduce instruction prompt tuning, a parameter-efficient approach for aligning LLMs to new domains using a few exemplars. The resulting model, Med-PaLM, performs encouragingly, but remains inferior to clinicians. We show that comprehension, recall of knowledge, and medical reasoning improve with model scale and instruction prompt tuning, suggesting the potential utility of LLMs in medicine. Our human evaluations reveal important limitations of today's models, reinforcing the importance of both evaluation frameworks and method development in creating safe, helpful LLM models for clinical applications.

Daily progress notes are common types in the electronic health record (EHR) where healthcare providers document the patient's daily progress and treatment plans. The EHR is designed to document all the care provided to patients, but it also enables note bloat with extraneous information that distracts from the diagnoses and treatment plans. Applications of natural language processing (NLP) in the EHR is a growing field with the majority of methods in information extraction. Few tasks use NLP methods for downstream diagnostic decision support. We introduced the 2022 National NLP Clinical Challenge (N2C2) Track 3: Progress Note Understanding - Assessment and Plan Reasoning as one step towards a new suite of tasks. The Assessment and Plan Reasoning task focuses on the most critical components of progress notes, Assessment and Plan subsections where health problems and diagnoses are contained. The goal of the task was to develop and evaluate NLP systems that automatically predict causal relations between the overall status of the patient contained in the Assessment section and its relation to each component of the Plan section which contains the diagnoses and treatment plans. The goal of the task was to identify and prioritize diagnoses as the first steps in diagnostic decision support to find the most relevant information in long documents like daily progress notes. We present the results of 2022 n2c2 Track 3 and provide a description of the data, evaluation, participation and system performance.

Language models (LMs) have demonstrated expert-level reasoning and recall abilities in medicine. However, computational costs and privacy concerns are mounting barriers to wide-scale implementation. We introduce a parsimonious adaptation of phi-3-mini, MedMobile, a 3.8 billion parameter LM capable of running on a mobile device, for medical applications. We demonstrate that MedMobile scores 75.7% on the MedQA (USMLE), surpassing the passing mark for physicians (~60%), and approaching the scores of models 100 times its size. We subsequently perform a careful set of ablations, and demonstrate that chain of thought, ensembling, and fine-tuning lead to the greatest performance gains, while unexpectedly retrieval augmented generation fails to demonstrate significant improvements

Recent proprietary large language models (LLMs), such as GPT-4, have achieved a milestone in tackling diverse challenges in the biomedical domain, ranging from multiple-choice questions to long-form generations. To address challenges that still cannot be handled with the encoded knowledge of LLMs, various retrieval-augmented generation (RAG) methods have been developed by searching documents from the knowledge corpus and appending them unconditionally or selectively to the input of LLMs for generation. However, when applying existing methods to different domain-specific problems, poor generalization becomes apparent, leading to fetching incorrect documents or making inaccurate judgments. In this paper, we introduce Self-BioRAG, a framework reliable for biomedical text that specializes in generating explanations, retrieving domain-specific documents, and self-reflecting generated responses. We utilize 84k filtered biomedical instruction sets to train Self-BioRAG that can assess its generated explanations with customized reflective tokens. Our work proves that domain-specific components, such as a retriever, domain-related document corpus, and instruction sets are necessary for adhering to domain-related instructions. Using three major medical question-answering benchmark datasets, experimental results of Self-BioRAG demonstrate significant performance gains by achieving a 7.2% absolute improvement on average over the state-of-the-art open-foundation model with a parameter size of 7B or less. Overall, we analyze that Self-BioRAG finds the clues in the question, retrieves relevant documents if needed, and understands how to answer with information from retrieved documents and encoded knowledge as a medical expert does. We release our data and code for training our framework components and model weights (7B and 13B) to enhance capabilities in biomedical and clinical domains.

Recent advancements in large language models (LLMs) have shown promise in medical applications such as disease diagnosis and treatment planning. However, most existing medical LLMs struggle with the advanced reasoning required for complex clinical scenarios, such as differential diagnosis or personalized treatment suggestions. We proposed FineMedLM-o1, which leverages high-quality synthetic medical data and long-form reasoning data for Supervised Fine-Tuning (SFT) and Direct Preference Optimization (DPO), enabling advanced dialogue and deep reasoning capabilities. Additionally, we introduced Test-Time Training (TTT) in the medical domain for the first time, facilitating domain adaptation and ensuring reliable, accurate reasoning. Experimental results demonstrate that FineMedLM-o1 achieves a 23% average performance improvement over prior models on key medical benchmarks. Furthermore, the introduction of TTT provides an additional 14% performance boost, highlighting its effectiveness in enhancing medical reasoning capabilities. To support this process, we also proposed a novel method for synthesizing medical dialogue. Compared to other open-source datasets, our dataset stands out as superior in both quality and complexity. The project and data will be released on GitHub.

We introduce MedXpertQA, a highly challenging and comprehensive benchmark to evaluate expert-level medical knowledge and advanced reasoning. MedXpertQA includes 4,460 questions spanning 17 specialties and 11 body systems. It includes two subsets, Text for text evaluation and MM for multimodal evaluation. Notably, MM introduces expert-level exam questions with diverse images and rich clinical information, including patient records and examination results, setting it apart from traditional medical multimodal benchmarks with simple QA pairs generated from image captions. MedXpertQA applies rigorous filtering and augmentation to address the insufficient difficulty of existing benchmarks like MedQA, and incorporates specialty board questions to improve clinical relevance and comprehensiveness. We perform data synthesis to mitigate data leakage risk and conduct multiple rounds of expert reviews to ensure accuracy and reliability. We evaluate 16 leading models on MedXpertQA. Moreover, medicine is deeply connected to real-world decision-making, providing a rich and representative setting for assessing reasoning abilities beyond mathematics and code. To this end, we develop a reasoning-oriented subset to facilitate the assessment of o1-like models.

While recent advancements in commercial large language models (LM) have shown promising results in medical tasks, their closed-source nature poses significant privacy and security concerns, hindering their widespread use in the medical field. Despite efforts to create open-source models, their limited parameters often result in insufficient multi-step reasoning capabilities required for solving complex medical problems. To address this, we introduce Meerkat-7B, a novel medical AI system with 7 billion parameters. Meerkat-7B was trained using our new synthetic dataset consisting of high-quality chain-of-thought reasoning paths sourced from 18 medical textbooks, along with diverse instruction-following datasets. Our system achieved remarkable accuracy across seven medical benchmarks, surpassing GPT-3.5 by 13.1%, as well as outperforming the previous best 7B models such as MediTron-7B and BioMistral-7B by 13.4% and 9.8%, respectively. Notably, it surpassed the passing threshold of the United States Medical Licensing Examination (USMLE) for the first time for a 7B-parameter model. Additionally, our system offered more detailed free-form responses to clinical queries compared to existing 7B and 13B models, approaching the performance level of GPT-3.5. This significantly narrows the performance gap with large LMs, showcasing its effectiveness in addressing complex medical challenges.

Chest X-rays (CXRs) play an integral role in driving critical decisions in disease management and patient care. While recent innovations have led to specialized models for various CXR interpretation tasks, these solutions often operate in isolation, limiting their practical utility in clinical practice. We present MedRAX, the first versatile AI agent that seamlessly integrates state-of-the-art CXR analysis tools and multimodal large language models into a unified framework. MedRAX dynamically leverages these models to address complex medical queries without requiring additional training. To rigorously evaluate its capabilities, we introduce ChestAgentBench, a comprehensive benchmark containing 2,500 complex medical queries across 7 diverse categories. Our experiments demonstrate that MedRAX achieves state-of-the-art performance compared to both open-source and proprietary models, representing a significant step toward the practical deployment of automated CXR interpretation systems. Data and code have been publicly available at https://github.com/bowang-lab/MedRAX

Reasoning is a critical frontier for advancing medical image analysis, where transparency and trustworthiness play a central role in both clinician trust and regulatory approval. Although Medical Visual Language Models (VLMs) show promise for radiological tasks, most existing VLMs merely produce final answers without revealing the underlying reasoning. To address this gap, we introduce MedVLM-R1, a medical VLM that explicitly generates natural language reasoning to enhance transparency and trustworthiness. Instead of relying on supervised fine-tuning (SFT), which often suffers from overfitting to training distributions and fails to foster genuine reasoning, MedVLM-R1 employs a reinforcement learning framework that incentivizes the model to discover human-interpretable reasoning paths without using any reasoning references. Despite limited training data (600 visual question answering samples) and model parameters (2B), MedVLM-R1 boosts accuracy from 55.11% to 78.22% across MRI, CT, and X-ray benchmarks, outperforming larger models trained on over a million samples. It also demonstrates robust domain generalization under out-of-distribution tasks. By unifying medical image analysis with explicit reasoning, MedVLM-R1 marks a pivotal step toward trustworthy and interpretable AI in clinical practice.

Med42-v2 introduces a suite of clinical large language models (LLMs) designed to address the limitations of generic models in healthcare settings. These models are built on Llama3 architecture and fine-tuned using specialized clinical data. They underwent multi-stage preference alignment to effectively respond to natural prompts. While generic models are often preference-aligned to avoid answering clinical queries as a precaution, Med42-v2 is specifically trained to overcome this limitation, enabling its use in clinical settings. Med42-v2 models demonstrate superior performance compared to the original Llama3 models in both 8B and 70B parameter configurations and GPT-4 across various medical benchmarks. These LLMs are developed to understand clinical queries, perform reasoning tasks, and provide valuable assistance in clinical environments. The models are now publicly available at https://huggingface.co/m42-health{https://huggingface.co/m42-health}.

The in-vivo identification of the kidney stone types during an ureteroscopy would be a major medical advance in urology, as it could reduce the time of the tedious renal calculi extraction process, while diminishing infection risks. Furthermore, such an automated procedure would make possible to prescribe anti-recurrence treatments immediately. Nowadays, only few experienced urologists are able to recognize the kidney stone types in the images of the videos displayed on a screen during the endoscopy. Thus, several deep learning (DL) models have recently been proposed to automatically recognize the kidney stone types using ureteroscopic images. However, these DL models are of black box nature whicl limits their applicability in clinical settings. This contribution proposes a case-based reasoning DL model which uses prototypical parts (PPs) and generates local and global descriptors. The PPs encode for each class (i.e., kidney stone type) visual feature information (hue, saturation, intensity and textures) similar to that used by biologists. The PPs are optimally generated due a new loss function used during the model training. Moreover, the local and global descriptors of PPs allow to explain the decisions ("what" information, "where in the images") in an understandable way for biologists and urologists. The proposed DL model has been tested on a database including images of the six most widespread kidney stone types. The overall average classification accuracy was 90.37. When comparing this results with that of the eight other DL models of the kidney stone state-of-the-art, it can be seen that the valuable gain in explanability was not reached at the expense of accuracy which was even slightly increased with respect to that (88.2) of the best method of the literature. These promising and interpretable results also encourage urologists to put their trust in AI-based solutions.

This paper explores the task of radiology report generation, which aims at generating free-text descriptions for a set of radiographs. One significant challenge of this task is how to correctly maintain the consistency between the images and the lengthy report. Previous research explored solving this issue through planning-based methods, which generate reports only based on high-level plans. However, these plans usually only contain the major observations from the radiographs (e.g., lung opacity), lacking much necessary information, such as the observation characteristics and preliminary clinical diagnoses. To address this problem, the system should also take the image information into account together with the textual plan and perform stronger reasoning during the generation process. In this paper, we propose an observation-guided radiology report generation framework (ORGAN). It first produces an observation plan and then feeds both the plan and radiographs for report generation, where an observation graph and a tree reasoning mechanism are adopted to precisely enrich the plan information by capturing the multi-formats of each observation. Experimental results demonstrate that our framework outperforms previous state-of-the-art methods regarding text quality and clinical efficacy

We present a new dataset for machine comprehension in the medical domain. Our dataset uses clinical case reports with around 100,000 gap-filling queries about these cases. We apply several baselines and state-of-the-art neural readers to the dataset, and observe a considerable gap in performance (20% F1) between the best human and machine readers. We analyze the skills required for successful answering and show how reader performance varies depending on the applicable skills. We find that inferences using domain knowledge and object tracking are the most frequently required skills, and that recognizing omitted information and spatio-temporal reasoning are the most difficult for the machines.

Several studies showed that Large Language Models (LLMs) can answer medical questions correctly, even outperforming the average human score in some medical exams. However, to our knowledge, no study has been conducted to assess the ability of language models to validate existing or generated medical text for correctness and consistency. In this paper, we introduce MEDEC (https://github.com/abachaa/MEDEC), the first publicly available benchmark for medical error detection and correction in clinical notes, covering five types of errors (Diagnosis, Management, Treatment, Pharmacotherapy, and Causal Organism). MEDEC consists of 3,848 clinical texts, including 488 clinical notes from three US hospital systems that were not previously seen by any LLM. The dataset has been used for the MEDIQA-CORR shared task to evaluate seventeen participating systems [Ben Abacha et al., 2024]. In this paper, we describe the data creation methods and we evaluate recent LLMs (e.g., o1-preview, GPT-4, Claude 3.5 Sonnet, and Gemini 2.0 Flash) for the tasks of detecting and correcting medical errors requiring both medical knowledge and reasoning capabilities. We also conducted a comparative study where two medical doctors performed the same task on the MEDEC test set. The results showed that MEDEC is a sufficiently challenging benchmark to assess the ability of models to validate existing or generated notes and to correct medical errors. We also found that although recent LLMs have a good performance in error detection and correction, they are still outperformed by medical doctors in these tasks. We discuss the potential factors behind this gap, the insights from our experiments, the limitations of current evaluation metrics, and share potential pointers for future research.

Large language models (LLMs) have exhibited remarkable capabilities across various domains and tasks, pushing the boundaries of our knowledge in learning and cognition. The latest model, OpenAI's o1, stands out as the first LLM with an internalized chain-of-thought technique using reinforcement learning strategies. While it has demonstrated surprisingly strong capabilities on various general language tasks, its performance in specialized fields such as medicine remains unknown. To this end, this report provides a comprehensive exploration of o1 on different medical scenarios, examining 3 key aspects: understanding, reasoning, and multilinguality. Specifically, our evaluation encompasses 6 tasks using data from 37 medical datasets, including two newly constructed and more challenging question-answering (QA) tasks based on professional medical quizzes from the New England Journal of Medicine (NEJM) and The Lancet. These datasets offer greater clinical relevance compared to standard medical QA benchmarks such as MedQA, translating more effectively into real-world clinical utility. Our analysis of o1 suggests that the enhanced reasoning ability of LLMs may (significantly) benefit their capability to understand various medical instructions and reason through complex clinical scenarios. Notably, o1 surpasses the previous GPT-4 in accuracy by an average of 6.2% and 6.6% across 19 datasets and two newly created complex QA scenarios. But meanwhile, we identify several weaknesses in both the model capability and the existing evaluation protocols, including hallucination, inconsistent multilingual ability, and discrepant metrics for evaluation. We release our raw data and model outputs at https://ucsc-vlaa.github.io/o1_medicine/ for future research.

We develop Polaris, the first safety-focused LLM constellation for real-time patient-AI healthcare conversations. Unlike prior LLM works in healthcare focusing on tasks like question answering, our work specifically focuses on long multi-turn voice conversations. Our one-trillion parameter constellation system is composed of several multibillion parameter LLMs as co-operative agents: a stateful primary agent that focuses on driving an engaging conversation and several specialist support agents focused on healthcare tasks performed by nurses to increase safety and reduce hallucinations. We develop a sophisticated training protocol for iterative co-training of the agents that optimize for diverse objectives. We train our models on proprietary data, clinical care plans, healthcare regulatory documents, medical manuals, and other medical reasoning documents. We align our models to speak like medical professionals, using organic healthcare conversations and simulated ones between patient actors and experienced nurses. This allows our system to express unique capabilities such as rapport building, trust building, empathy and bedside manner. Finally, we present the first comprehensive clinician evaluation of an LLM system for healthcare. We recruited over 1100 U.S. licensed nurses and over 130 U.S. licensed physicians to perform end-to-end conversational evaluations of our system by posing as patients and rating the system on several measures. We demonstrate Polaris performs on par with human nurses on aggregate across dimensions such as medical safety, clinical readiness, conversational quality, and bedside manner. Additionally, we conduct a challenging task-based evaluation of the individual specialist support agents, where we demonstrate our LLM agents significantly outperform a much larger general-purpose LLM (GPT-4) as well as from its own medium-size class (LLaMA-2 70B).

As opposed to evaluating computation and logic-based reasoning, current benchmarks for evaluating large language models (LLMs) in medicine are primarily focused on question-answering involving domain knowledge and descriptive reasoning. While such qualitative capabilities are vital to medical diagnosis, in real-world scenarios, doctors frequently use clinical calculators that follow quantitative equations and rule-based reasoning paradigms for evidence-based decision support. To this end, we propose MedCalc-Bench, a first-of-its-kind dataset focused on evaluating the medical calculation capability of LLMs. MedCalc-Bench contains an evaluation set of over 1000 manually reviewed instances from 55 different medical calculation tasks. Each instance in MedCalc-Bench consists of a patient note, a question requesting to compute a specific medical value, a ground truth answer, and a step-by-step explanation showing how the answer is obtained. While our evaluation results show the potential of LLMs in this area, none of them are effective enough for clinical settings. Common issues include extracting the incorrect entities, not using the correct equation or rules for a calculation task, or incorrectly performing the arithmetic for the computation. We hope our study highlights the quantitative knowledge and reasoning gaps in LLMs within medical settings, encouraging future improvements of LLMs for various clinical calculation tasks.

Predicting in-hospital mortality for intensive care unit (ICU) patients is key to final clinical outcomes. AI has shown advantaged accuracy but suffers from the lack of explainability. To address this issue, this paper proposes an eXplainable Multimodal Mortality Predictor (X-MMP) approaching an efficient, explainable AI solution for predicting in-hospital mortality via multimodal ICU data. We employ multimodal learning in our framework, which can receive heterogeneous inputs from clinical data and make decisions. Furthermore, we introduce an explainable method, namely Layer-Wise Propagation to Transformer, as a proper extension of the LRP method to Transformers, producing explanations over multimodal inputs and revealing the salient features attributed to prediction. Moreover, the contribution of each modality to clinical outcomes can be visualized, assisting clinicians in understanding the reasoning behind decision-making. We construct a multimodal dataset based on MIMIC-III and MIMIC-III Waveform Database Matched Subset. Comprehensive experiments on benchmark datasets demonstrate that our proposed framework can achieve reasonable interpretation with competitive prediction accuracy. In particular, our framework can be easily transferred to other clinical tasks, which facilitates the discovery of crucial factors in healthcare research.

Multimodal large language models (MLLMs) have made significant strides, yet they face challenges in the medical domain due to limited specialized knowledge. While recent medical MLLMs demonstrate strong performance in lab settings, they often struggle in real-world applications, highlighting a substantial gap between research and practice. In this paper, we seek to address this gap at various stages of the end-to-end learning pipeline, including data collection, model fine-tuning, and evaluation. At the data collection stage, we introduce SemiHVision, a dataset that combines human annotations with automated augmentation techniques to improve both medical knowledge representation and diagnostic reasoning. For model fine-tuning, we trained PMC-Cambrian-8B-AN over 2400 H100 GPU hours, resulting in performance that surpasses public medical models like HuatuoGPT-Vision-34B (79.0% vs. 66.7%) and private general models like Claude3-Opus (55.7%) on traditional benchmarks such as SLAKE and VQA-RAD. In the evaluation phase, we observed that traditional benchmarks cannot accurately reflect realistic clinical task capabilities. To overcome this limitation and provide more targeted guidance for model evaluation, we introduce the JAMA Clinical Challenge, a novel benchmark specifically designed to evaluate diagnostic reasoning. On this benchmark, PMC-Cambrian-AN achieves state-of-the-art performance with a GPT-4 score of 1.29, significantly outperforming HuatuoGPT-Vision-34B (1.13) and Claude3-Opus (1.17), demonstrating its superior diagnostic reasoning abilities.

Large language models (LLMs), particularly those with reasoning capabilities, have rapidly advanced in recent years, demonstrating significant potential across a wide range of applications. However, their deployment in healthcare, especially in disease reasoning tasks, is hindered by the challenge of acquiring expert-level cognitive data. In this paper, we introduce Citrus, a medical language model that bridges the gap between clinical expertise and AI reasoning by emulating the cognitive processes of medical experts. The model is trained on a large corpus of simulated expert disease reasoning data, synthesized using a novel approach that accurately captures the decision-making pathways of clinicians. This approach enables Citrus to better simulate the complex reasoning processes involved in diagnosing and treating medical conditions.To further address the lack of publicly available datasets for medical reasoning tasks, we release the last-stage training data, including a custom-built medical diagnostic dialogue dataset. This open-source contribution aims to support further research and development in the field. Evaluations using authoritative benchmarks such as MedQA, covering tasks in medical reasoning and language understanding, show that Citrus achieves superior performance compared to other models of similar size. These results highlight Citrus potential to significantly enhance medical decision support systems, providing a more accurate and efficient tool for clinical decision-making.

Artificial intelligence has advanced in Medical Visual Question Answering (Med-VQA), but prevalent research tends to focus on the accuracy of the answers, often overlooking the reasoning paths and interpretability, which are crucial in clinical settings. Besides, current Med-VQA algorithms, typically reliant on singular models, lack the robustness needed for real-world medical diagnostics which usually require collaborative expert evaluation. To address these shortcomings, this paper presents MedCoT, a novel hierarchical expert verification reasoning chain method designed to enhance interpretability and accuracy in biomedical imaging inquiries. MedCoT is predicated on two principles: The necessity for explicit reasoning paths in Med-VQA and the requirement for multi-expert review to formulate accurate conclusions. The methodology involves an Initial Specialist proposing diagnostic rationales, followed by a Follow-up Specialist who validates these rationales, and finally, a consensus is reached through a vote among a sparse Mixture of Experts within the locally deployed Diagnostic Specialist, which then provides the definitive diagnosis. Experimental evaluations on four standard Med-VQA datasets demonstrate that MedCoT surpasses existing state-of-the-art approaches, providing significant improvements in performance and interpretability.

Large Multimodal Models (LMMs) have shown remarkable progress in the field of medical Visual Question Answering (Med-VQA), achieving high accuracy on existing benchmarks. However, their reliability under robust evaluation is questionable. This study reveals that state-of-the-art models, when subjected to simple probing evaluation, perform worse than random guessing on medical diagnosis questions. To address this critical evaluation problem, we introduce the Probing Evaluation for Medical Diagnosis (ProbMed) dataset to rigorously assess LMM performance in medical imaging through probing evaluation and procedural diagnosis. Particularly, probing evaluation features pairing original questions with negation questions with hallucinated attributes, while procedural diagnosis requires reasoning across various diagnostic dimensions for each image, including modality recognition, organ identification, clinical findings, abnormalities, and positional grounding. Our evaluation reveals that top-performing models like GPT-4V and Gemini Pro perform worse than random guessing on specialized diagnostic questions, indicating significant limitations in handling fine-grained medical inquiries. Besides, models like LLaVA-Med struggle even with more general questions, and results from CheXagent demonstrate the transferability of expertise across different modalities of the same organ, showing that specialized domain knowledge is still crucial for improving performance. This study underscores the urgent need for more robust evaluation to ensure the reliability of LMMs in critical fields like medical diagnosis, and current LMMs are still far from applicable to those fields.

This study reveals an unexpected parallel between instructible vision-language models (VLMs) and human cognitive disorders, specifically constructive apraxia. We tested 25 state-of-the-art VLMs, including GPT-4 Vision, DALL-E 3, and Midjourney v5, on their ability to generate images of the Ponzo illusion, a task that requires basic spatial reasoning and is often used in clinical assessments of constructive apraxia. Remarkably, 24 out of 25 models failed to correctly render two horizontal lines against a perspective background, mirroring the deficits seen in patients with parietal lobe damage. The models consistently misinterpreted spatial instructions, producing tilted or misaligned lines that followed the perspective of the background rather than remaining horizontal. This behavior is strikingly similar to how apraxia patients struggle to copy or construct simple figures despite intact visual perception and motor skills. Our findings suggest that current VLMs, despite their advanced capabilities in other domains, lack fundamental spatial reasoning abilities akin to those impaired in constructive apraxia. This limitation in AI systems provides a novel computational model for studying spatial cognition deficits and highlights a critical area for improvement in VLM architecture and training methodologies.

Reasoning, as an essential ability for complex problem-solving, can provide back-end support for various real-world applications, such as medical diagnosis, negotiation, etc. This paper provides a comprehensive survey of cutting-edge research on reasoning with language model prompting. We introduce research works with comparisons and summaries and provide systematic resources to help beginners. We also discuss the potential reasons for emerging such reasoning abilities and highlight future research directions. Resources are available at https://github.com/zjunlp/Prompt4ReasoningPapers (updated periodically).

Explaining Artificial Intelligence (AI) decisions is a major challenge nowadays in AI, in particular when applied to sensitive scenarios like medicine and law. However, the need to explain the rationale behind decisions is a main issue also for human-based deliberation as it is important to justify why a certain decision has been taken. Resident medical doctors for instance are required not only to provide a (possibly correct) diagnosis, but also to explain how they reached a certain conclusion. Developing new tools to aid residents to train their explanation skills is therefore a central objective of AI in education. In this paper, we follow this direction, and we present, to the best of our knowledge, the first multilingual dataset for Medical Question Answering where correct and incorrect diagnoses for a clinical case are enriched with a natural language explanation written by doctors. These explanations have been manually annotated with argument components (i.e., premise, claim) and argument relations (i.e., attack, support), resulting in the Multilingual CasiMedicos-Arg dataset which consists of 558 clinical cases in four languages (English, Spanish, French, Italian) with explanations, where we annotated 5021 claims, 2313 premises, 2431 support relations, and 1106 attack relations. We conclude by showing how competitive baselines perform over this challenging dataset for the argument mining task.

The breakthrough of OpenAI o1 highlights the potential of enhancing reasoning to improve LLM. Yet, most research in reasoning has focused on mathematical tasks, leaving domains like medicine underexplored. The medical domain, though distinct from mathematics, also demands robust reasoning to provide reliable answers, given the high standards of healthcare. However, verifying medical reasoning is challenging, unlike those in mathematics. To address this, we propose verifiable medical problems with a medical verifier to check the correctness of model outputs. This verifiable nature enables advancements in medical reasoning through a two-stage approach: (1) using the verifier to guide the search for a complex reasoning trajectory for fine-tuning LLMs, (2) applying reinforcement learning (RL) with verifier-based rewards to enhance complex reasoning further. Finally, we introduce HuatuoGPT-o1, a medical LLM capable of complex reasoning, which outperforms general and medical-specific baselines using only 40K verifiable problems. Experiments show complex reasoning improves medical problem-solving and benefits more from RL. We hope our approach inspires advancements in reasoning across medical and other specialized domains.

Reasoning is a fundamental aspect of human intelligence that plays a crucial role in activities such as problem solving, decision making, and critical thinking. In recent years, large language models (LLMs) have made significant progress in natural language processing, and there is observation that these models may exhibit reasoning abilities when they are sufficiently large. However, it is not yet clear to what extent LLMs are capable of reasoning. This paper provides a comprehensive overview of the current state of knowledge on reasoning in LLMs, including techniques for improving and eliciting reasoning in these models, methods and benchmarks for evaluating reasoning abilities, findings and implications of previous research in this field, and suggestions on future directions. Our aim is to provide a detailed and up-to-date review of this topic and stimulate meaningful discussion and future work.

LLMs have demonstrated impressive performance in answering medical questions, such as passing scores on medical licensing examinations. However, medical board exam questions or general clinical questions do not capture the complexity of realistic clinical cases. Moreover, the lack of reference explanations means we cannot easily evaluate the reasoning of model decisions, a crucial component of supporting doctors in making complex medical decisions. To address these challenges, we construct two new datasets: JAMA Clinical Challenge and Medbullets. JAMA Clinical Challenge consists of questions based on challenging clinical cases, while Medbullets comprises USMLE Step 2&3 style clinical questions. Both datasets are structured as multiple-choice question-answering tasks, where each question is accompanied by an expert-written explanation. We evaluate four LLMs on the two datasets using various prompts. Experiments demonstrate that our datasets are harder than previous benchmarks. The inconsistency between automatic and human evaluations of model-generated explanations highlights the need to develop new metrics to support future research on explainable medical QA.

Reinforcement learning from verifiable rewards (RLVR) has recently gained attention for its ability to elicit self-evolved reasoning capabilitie from base language models without explicit reasoning supervisions, as demonstrated by DeepSeek-R1. While prior work on RLVR has primarily focused on mathematical and coding domains, its applicability to other tasks and domains remains unexplored. In this work, we investigate whether medical reasoning can emerge from RLVR. We introduce Med-RLVR as an initial study of RLVR in the medical domain leveraging medical multiple-choice question answering (MCQA) data as verifiable labels. Our results demonstrate that RLVR is not only effective for math and coding but also extends successfully to medical question answering. Notably, Med-RLVR achieves performance comparable to traditional supervised fine-tuning (SFT) on in-distribution tasks while significantly improving out-of-distribution generalization, with an 8-point accuracy gain. Further analysis of training dynamics reveals that, with no explicit reasoning supervision, reasoning emerges from the 3B-parameter base model. These findings underscore the potential of RLVR in domains beyond math and coding, opening new avenues for its application in knowledge-intensive fields such as medicine.

Recent advancements in the field of large language models, particularly through the Chain of Thought (CoT) approach, have demonstrated significant improvements in solving complex problems. However, existing models either tend to sacrifice detailed reasoning for brevity due to user preferences, or require extensive and expensive training data to learn complicated reasoning ability, limiting their potential in solving complex tasks. To bridge this gap, following the concept of scaling test-time, we propose a simple method by encouraging models to adopt a more patient reasoning style without the need of introducing new knowledge or skills. To employ a preference optimization approach, we generate detailed reasoning processes as positive examples and simple answers as negative examples, thereby training the model to favor thoroughness in its responses. Our results demonstrate a performance increase of up to 6.7% on GSM8k with training just on a lightweight dataset.

Large language models (LLMs) have demonstrated remarkable capabilities in natural language understanding and generation across various domains, including medicine. We present a comprehensive evaluation of GPT-4, a state-of-the-art LLM, on medical competency examinations and benchmark datasets. GPT-4 is a general-purpose model that is not specialized for medical problems through training or engineered to solve clinical tasks. Our analysis covers two sets of official practice materials for the USMLE, a three-step examination program used to assess clinical competency and grant licensure in the United States. We also evaluate performance on the MultiMedQA suite of benchmark datasets. Beyond measuring model performance, experiments were conducted to investigate the influence of test questions containing both text and images on model performance, probe for memorization of content during training, and study probability calibration, which is of critical importance in high-stakes applications like medicine. Our results show that GPT-4, without any specialized prompt crafting, exceeds the passing score on USMLE by over 20 points and outperforms earlier general-purpose models (GPT-3.5) as well as models specifically fine-tuned on medical knowledge (Med-PaLM, a prompt-tuned version of Flan-PaLM 540B). In addition, GPT-4 is significantly better calibrated than GPT-3.5, demonstrating a much-improved ability to predict the likelihood that its answers are correct. We also explore the behavior of the model qualitatively through a case study that shows the ability of GPT-4 to explain medical reasoning, personalize explanations to students, and interactively craft new counterfactual scenarios around a medical case. Implications of the findings are discussed for potential uses of GPT-4 in medical education, assessment, and clinical practice, with appropriate attention to challenges of accuracy and safety.

An accurate differential diagnosis (DDx) is a cornerstone of medical care, often reached through an iterative process of interpretation that combines clinical history, physical examination, investigations and procedures. Interactive interfaces powered by Large Language Models (LLMs) present new opportunities to both assist and automate aspects of this process. In this study, we introduce an LLM optimized for diagnostic reasoning, and evaluate its ability to generate a DDx alone or as an aid to clinicians. 20 clinicians evaluated 302 challenging, real-world medical cases sourced from the New England Journal of Medicine (NEJM) case reports. Each case report was read by two clinicians, who were randomized to one of two assistive conditions: either assistance from search engines and standard medical resources, or LLM assistance in addition to these tools. All clinicians provided a baseline, unassisted DDx prior to using the respective assistive tools. Our LLM for DDx exhibited standalone performance that exceeded that of unassisted clinicians (top-10 accuracy 59.1% vs 33.6%, [p = 0.04]). Comparing the two assisted study arms, the DDx quality score was higher for clinicians assisted by our LLM (top-10 accuracy 51.7%) compared to clinicians without its assistance (36.1%) (McNemar's Test: 45.7, p < 0.01) and clinicians with search (44.4%) (4.75, p = 0.03). Further, clinicians assisted by our LLM arrived at more comprehensive differential lists than those without its assistance. Our study suggests that our LLM for DDx has potential to improve clinicians' diagnostic reasoning and accuracy in challenging cases, meriting further real-world evaluation for its ability to empower physicians and widen patients' access to specialist-level expertise.

Large language models have exhibited exceptional performance on various Natural Language Processing (NLP) tasks, leveraging techniques such as the pre-training, and instruction fine-tuning. Despite these advances, their effectiveness in medical applications is limited, due to challenges such as factual inaccuracies, reasoning abilities, and lack grounding in real-world experience. In this study, we present ClinicalGPT, a language model explicitly designed and optimized for clinical scenarios. By incorporating extensive and diverse real-world data, such as medical records, domain-specific knowledge, and multi-round dialogue consultations in the training process, ClinicalGPT is better prepared to handle multiple clinical task. Furthermore, we introduce a comprehensive evaluation framework that includes medical knowledge question-answering, medical exams, patient consultations, and diagnostic analysis of medical records. Our results demonstrate that ClinicalGPT significantly outperforms other models in these tasks, highlighting the effectiveness of our approach in adapting large language models to the critical domain of healthcare.

In response to the pressing need for advanced clinical problem-solving tools in healthcare, we introduce BooksMed, a novel framework based on a Large Language Model (LLM). BooksMed uniquely emulates human cognitive processes to deliver evidence-based and reliable responses, utilizing the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework to effectively quantify evidence strength. For clinical decision-making to be appropriately assessed, an evaluation metric that is clinically aligned and validated is required. As a solution, we present ExpertMedQA, a multispecialty clinical benchmark comprised of open-ended, expert-level clinical questions, and validated by a diverse group of medical professionals. By demanding an in-depth understanding and critical appraisal of up-to-date clinical literature, ExpertMedQA rigorously evaluates LLM performance. BooksMed outperforms existing state-of-the-art models Med-PaLM 2, Almanac, and ChatGPT in a variety of medical scenarios. Therefore, a framework that mimics human cognitive stages could be a useful tool for providing reliable and evidence-based responses to clinical inquiries.

Several recent works seek to develop foundation models specifically for medical applications, adapting general-purpose large language models (LLMs) and vision-language models (VLMs) via continued pretraining on publicly available biomedical corpora. These works typically claim that such domain-adaptive pretraining (DAPT) improves performance on downstream medical tasks, such as answering medical licensing exam questions. In this paper, we compare seven public "medical" LLMs and two VLMs against their corresponding base models, arriving at a different conclusion: all medical VLMs and nearly all medical LLMs fail to consistently improve over their base models in the zero-/few-shot prompting regime for medical question-answering (QA) tasks. For instance, across the tasks and model pairs we consider in the 3-shot setting, medical LLMs only outperform their base models in 12.1% of cases, reach a (statistical) tie in 49.8% of cases, and are significantly worse than their base models in the remaining 38.2% of cases. Our conclusions are based on (i) comparing each medical model head-to-head, directly against the corresponding base model; (ii) optimizing the prompts for each model separately; and (iii) accounting for statistical uncertainty in comparisons. While these basic practices are not consistently adopted in the literature, our ablations show that they substantially impact conclusions. Our findings suggest that state-of-the-art general-domain models may already exhibit strong medical knowledge and reasoning capabilities, and offer recommendations to strengthen the conclusions of future studies.

How do we most effectively treat a disease or condition? Ideally, we could consult a database of evidence gleaned from clinical trials to answer such questions. Unfortunately, no such database exists; clinical trial results are instead disseminated primarily via lengthy natural language articles. Perusing all such articles would be prohibitively time-consuming for healthcare practitioners; they instead tend to depend on manually compiled systematic reviews of medical literature to inform care. NLP may speed this process up, and eventually facilitate immediate consult of published evidence. The Evidence Inference dataset was recently released to facilitate research toward this end. This task entails inferring the comparative performance of two treatments, with respect to a given outcome, from a particular article (describing a clinical trial) and identifying supporting evidence. For instance: Does this article report that chemotherapy performed better than surgery for five-year survival rates of operable cancers? In this paper, we collect additional annotations to expand the Evidence Inference dataset by 25\%, provide stronger baseline models, systematically inspect the errors that these make, and probe dataset quality. We also release an abstract only (as opposed to full-texts) version of the task for rapid model prototyping. The updated corpus, documentation, and code for new baselines and evaluations are available at http://evidence-inference.ebm-nlp.com/.

Clinical diagnosis is critical in medical practice, typically requiring a continuous and evolving process that includes primary diagnosis, differential diagnosis, and final diagnosis. However, most existing clinical diagnostic tasks are single-step processes, which does not align with the complex multi-step diagnostic procedures found in real-world clinical settings. In this paper, we propose a multi-step diagnostic task and annotate a clinical diagnostic dataset (MSDiagnosis). This dataset includes primary diagnosis, differential diagnosis, and final diagnosis questions. Additionally, we propose a novel and effective framework. This framework combines forward inference, backward inference, reflection, and refinement, enabling the LLM to self-evaluate and adjust its diagnostic results. To assess the effectiveness of our proposed method, we design and conduct extensive experiments. The experimental results demonstrate the effectiveness of the proposed method. We also provide a comprehensive experimental analysis and suggest future research directions for this task.

Large Language Models (LLMs) have shown the potential to significantly contribute to patient care, diagnostics, and administrative processes. Emerging biomedical LLMs address healthcare-specific challenges, including privacy demands and computational constraints. However, evaluation of these models has primarily been limited to non-clinical tasks, which do not reflect the complexity of practical clinical applications. Additionally, there has been no thorough comparison between biomedical and general-domain LLMs for clinical tasks. To fill this gap, we present the Clinical Language Understanding Evaluation (CLUE), a benchmark tailored to evaluate LLMs on real-world clinical tasks. CLUE includes two novel datasets derived from MIMIC IV discharge letters and four existing tasks designed to test the practical applicability of LLMs in healthcare settings. Our evaluation covers several biomedical and general domain LLMs, providing insights into their clinical performance and applicability. CLUE represents a step towards a standardized approach to evaluating and developing LLMs in healthcare to align future model development with the real-world needs of clinical application. We publish our evaluation and data generation scripts: https://github.com/dadaamin/CLUE

Reasoning is an essential component of human intelligence as it plays a fundamental role in our ability to think critically, support responsible decisions, and solve challenging problems. Traditionally, AI has addressed reasoning in the context of logic-based representations of knowledge. However, the recent leap forward in natural language processing, with the emergence of language models based on transformers, is hinting at the possibility that these models exhibit reasoning abilities, particularly as they grow in size and are trained on more data. Despite ongoing discussions about what reasoning is in language models, it is still not easy to pin down to what extent these models are actually capable of reasoning. The goal of this workshop is to create a platform for researchers from different disciplines and/or AI perspectives, to explore approaches and techniques with the aim to reconcile reasoning between language models using transformers and using logic-based representations. The specific objectives include analyzing the reasoning abilities of language models measured alongside KR methods, injecting KR-style reasoning abilities into language models (including by neuro-symbolic means), and formalizing the kind of reasoning language models carry out. This exploration aims to uncover how language models can effectively integrate and leverage knowledge and reasoning with it, thus improving their application and utility in areas where precision and reliability are a key requirement.

Commonsense causality reasoning (CCR) aims at identifying plausible causes and effects in natural language descriptions that are deemed reasonable by an average person. Although being of great academic and practical interest, this problem is still shadowed by the lack of a well-posed theoretical framework; existing work usually relies on deep language models wholeheartedly, and is potentially susceptible to confounding co-occurrences. Motivated by classical causal principles, we articulate the central question of CCR and draw parallels between human subjects in observational studies and natural languages to adopt CCR to the potential-outcomes framework, which is the first such attempt for commonsense tasks. We propose a novel framework, ROCK, to Reason O(A)bout Commonsense K(C)ausality, which utilizes temporal signals as incidental supervision, and balances confounding effects using temporal propensities that are analogous to propensity scores. The ROCK implementation is modular and zero-shot, and demonstrates good CCR capabilities.

Large-language models have recently demonstrated impressive zero-shot capabilities in a variety of natural language tasks such as summarization, dialogue generation, and question-answering. Despite many promising applications in clinical medicine, adoption of these models in real-world settings has been largely limited by their tendency to generate incorrect and sometimes even toxic statements. In this study, we develop Almanac, a large language model framework augmented with retrieval capabilities for medical guideline and treatment recommendations. Performance on a novel dataset of clinical scenarios (n = 130) evaluated by a panel of 5 board-certified and resident physicians demonstrates significant increases in factuality (mean of 18% at p-value < 0.05) across all specialties, with improvements in completeness and safety. Our results demonstrate the potential for large language models to be effective tools in the clinical decision-making process, while also emphasizing the importance of careful testing and deployment to mitigate their shortcomings.

Reasoning is a cognitive process of using evidence to reach a sound conclusion. The reasoning capability is essential for large language models (LLMs) to serve as the brain of the artificial general intelligence agent. Recent studies reveal that fine-tuning LLMs on data with the chain of thought (COT) reasoning process can significantly enhance their reasoning capabilities. However, we find that the fine-tuned LLMs suffer from an Assessment Misalignment problem, i.e., they frequently assign higher scores to subpar COTs, leading to potential limitations in their reasoning abilities. To address this problem, we introduce an Alignment Fine-Tuning (AFT) paradigm, which involves three steps: 1) fine-tuning LLMs with COT training data; 2) generating multiple COT responses for each question, and categorizing them into positive and negative ones based on whether they achieve the correct answer; 3) calibrating the scores of positive and negative responses given by LLMs with a novel constraint alignment loss. Specifically, the constraint alignment loss has two objectives: a) Alignment, which guarantees that positive scores surpass negative scores to encourage answers with high-quality COTs; b) Constraint, which keeps the negative scores confined to a reasonable range to prevent the model degradation. Beyond just the binary positive and negative feedback, the constraint alignment loss can be seamlessly adapted to the ranking situations when ranking feedback is accessible. Furthermore, we also delve deeply into recent ranking-based alignment methods, such as DPO, RRHF, and PRO, and discover that the constraint, which has been overlooked by these approaches, is also crucial for their performance. Extensive experiments on four reasoning benchmarks with both binary and ranking feedback demonstrate the effectiveness of AFT.

Several recent works seek to develop foundation models specifically for medical applications, adapting general-purpose large language models (LLMs) and vision-language models (VLMs) via continued pretraining on publicly available biomedical corpora. These works typically claim that such domain-adaptive pretraining (DAPT) improves performance on downstream medical tasks, such as answering medical licensing exam questions. In this paper, we compare ten public "medical" LLMs and two VLMs against their corresponding base models, arriving at a different conclusion: all medical VLMs and nearly all medical LLMs fail to consistently improve over their base models in the zero-/few-shot prompting and supervised fine-tuning regimes for medical question-answering (QA). For instance, across all tasks and model pairs we consider in the 3-shot setting, medical LLMs only outperform their base models in 22.7% of cases, reach a (statistical) tie in 36.8% of cases, and are significantly worse than their base models in the remaining 40.5% of cases. Our conclusions are based on (i) comparing each medical model head-to-head, directly against the corresponding base model; (ii) optimizing the prompts for each model separately in zero-/few-shot prompting; and (iii) accounting for statistical uncertainty in comparisons. While these basic practices are not consistently adopted in the literature, our ablations show that they substantially impact conclusions. Meanwhile, we find that after fine-tuning on specific QA tasks, medical LLMs can show performance improvements, but the benefits do not carry over to tasks based on clinical notes. Our findings suggest that state-of-the-art general-domain models may already exhibit strong medical knowledge and reasoning capabilities, and offer recommendations to strengthen the conclusions of future studies.

Clinical notes contain information about patients that goes beyond structured data like lab values and medications. However, clinical notes have been underused relative to structured data, because notes are high-dimensional and sparse. This work develops and evaluates representations of clinical notes using bidirectional transformers (ClinicalBERT). ClinicalBERT uncovers high-quality relationships between medical concepts as judged by humans. ClinicalBert outperforms baselines on 30-day hospital readmission prediction using both discharge summaries and the first few days of notes in the intensive care unit. Code and model parameters are available.

Biomedical knowledge is uniquely complex and structured, requiring distinct reasoning strategies compared to other scientific disciplines like physics or chemistry. Biomedical scientists do not rely on a single approach to reasoning; instead, they use various strategies, including rule-based, prototype-based, and case-based reasoning. This diversity calls for flexible approaches that accommodate multiple reasoning strategies while leveraging in-domain knowledge. We introduce KGARevion, a knowledge graph (KG) based agent designed to address the complexity of knowledge-intensive medical queries. Upon receiving a query, KGARevion generates relevant triplets by using the knowledge base of the LLM. These triplets are then verified against a grounded KG to filter out erroneous information and ensure that only accurate, relevant data contribute to the final answer. Unlike RAG-based models, this multi-step process ensures robustness in reasoning while adapting to different models of medical reasoning. Evaluations on four gold-standard medical QA datasets show that KGARevion improves accuracy by over 5.2%, outperforming 15 models in handling complex medical questions. To test its capabilities, we curated three new medical QA datasets with varying levels of semantic complexity, where KGARevion achieved a 10.4% improvement in accuracy.

Deductive reasoning plays a pivotal role in the formulation of sound and cohesive arguments. It allows individuals to draw conclusions that logically follow, given the truth value of the information provided. Recent progress in the domain of large language models (LLMs) has showcased their capability in executing deductive reasoning tasks. Nonetheless, a significant portion of research primarily assesses the accuracy of LLMs in solving such tasks, often overlooking a deeper analysis of their reasoning behavior. In this study, we draw upon principles from cognitive psychology to examine inferential strategies employed by LLMs, through a detailed evaluation of their responses to propositional logic problems. Our findings indicate that LLMs display reasoning patterns akin to those observed in humans, including strategies like supposition following or chain construction. Moreover, our research demonstrates that the architecture and scale of the model significantly affect its preferred method of reasoning, with more advanced models tending to adopt strategies more frequently than less sophisticated ones. Importantly, we assert that a model's accuracy, that is the correctness of its final conclusion, does not necessarily reflect the validity of its reasoning process. This distinction underscores the necessity for more nuanced evaluation procedures in the field.

This paper introduces MedMCQA, a new large-scale, Multiple-Choice Question Answering (MCQA) dataset designed to address real-world medical entrance exam questions. More than 194k high-quality AIIMS \& NEET PG entrance exam MCQs covering 2.4k healthcare topics and 21 medical subjects are collected with an average token length of 12.77 and high topical diversity. Each sample contains a question, correct answer(s), and other options which requires a deeper language understanding as it tests the 10+ reasoning abilities of a model across a wide range of medical subjects \& topics. A detailed explanation of the solution, along with the above information, is provided in this study.

Clinical diagnosis prediction models, when provided with a patient's medical history, aim to detect potential diseases early, facilitating timely intervention and improving prognostic outcomes. However, the inherent scarcity of patient data and large disease candidate space often pose challenges in developing satisfactory models for this intricate task. The exploration of leveraging Large Language Models (LLMs) for encapsulating clinical decision processes has been limited. We introduce MERA, a clinical diagnosis prediction model that bridges pertaining natural language knowledge with medical practice. We apply hierarchical contrastive learning on a disease candidate ranking list to alleviate the large decision space issue. With concept memorization through fine-tuning, we bridge the natural language clinical knowledge with medical codes. Experimental results on MIMIC-III and IV datasets show that MERA achieves the state-of-the-art diagnosis prediction performance and dramatically elevates the diagnosis prediction capabilities of generative LMs.

Synthesizing clinical evidence largely relies on systematic reviews of clinical trials and retrospective analyses from medical literature. However, the rapid expansion of publications presents challenges in efficiently identifying, summarizing, and updating clinical evidence. Here, we introduce TrialMind, a generative artificial intelligence (AI) pipeline for facilitating human-AI collaboration in three crucial tasks for evidence synthesis: study search, screening, and data extraction. To assess its performance, we chose published systematic reviews to build the benchmark dataset, named TrialReviewBench, which contains 100 systematic reviews and the associated 2,220 clinical studies. Our results show that TrialMind excels across all three tasks. In study search, it generates diverse and comprehensive search queries to achieve high recall rates (Ours 0.711-0.834 v.s. Human baseline 0.138-0.232). For study screening, TrialMind surpasses traditional embedding-based methods by 30% to 160%. In data extraction, it outperforms a GPT-4 baseline by 29.6% to 61.5%. We further conducted user studies to confirm its practical utility. Compared to manual efforts, human-AI collaboration using TrialMind yielded a 71.4% recall lift and 44.2% time savings in study screening and a 23.5% accuracy lift and 63.4% time savings in data extraction. Additionally, when comparing synthesized clinical evidence presented in forest plots, medical experts favored TrialMind's outputs over GPT-4's outputs in 62.5% to 100% of cases. These findings show the promise of LLM-based approaches like TrialMind to accelerate clinical evidence synthesis via streamlining study search, screening, and data extraction from medical literature, with exceptional performance improvement when working with human experts.

Cognitive textual and visual reasoning tasks, such as puzzles, series, and analogies, demand the ability to quickly reason, decipher, and evaluate patterns both textually and spatially. While LLMs and VLMs, through extensive training on large amounts of human-curated data, have attained a high level of pseudo-human intelligence in some common sense reasoning tasks, they still struggle with more complex reasoning tasks that require cognitive understanding. In this work, we introduce a new dataset, NTSEBench, designed to evaluate the cognitive multi-modal reasoning and problem-solving skills of large models. The dataset comprises 2,728 multiple-choice questions comprising of a total of 4,642 images across 26 categories sampled from the NTSE examination conducted nationwide in India, featuring both visual and textual general aptitude questions that do not rely on rote learning. We establish baselines on the dataset using state-of-the-art LLMs and VLMs. To facilitate a comparison between open source and propriety models, we propose four distinct modeling strategies to handle different modalities (text and images) in the dataset instances.

Clinical natural language processing requires methods that can address domain-specific challenges, such as complex medical terminology and clinical contexts. Recently, large language models (LLMs) have shown promise in this domain. Yet, their direct deployment can lead to privacy issues and are constrained by resources. To address this challenge, we delve into synthetic clinical text generation using LLMs for clinical NLP tasks. We propose an innovative, resource-efficient approach, ClinGen, which infuses knowledge into the process. Our model involves clinical knowledge extraction and context-informed LLM prompting. Both clinical topics and writing styles are drawn from external domain-specific knowledge graphs and LLMs to guide data generation. Our extensive empirical study across 7 clinical NLP tasks and 16 datasets reveals that ClinGen consistently enhances performance across various tasks, effectively aligning the distribution of real datasets and significantly enriching the diversity of generated training instances. We will publish our code and all the generated data in https://github.com/ritaranx/ClinGen.

Clinical question answering systems have the potential to provide clinicians with relevant and timely answers to their questions. Nonetheless, despite the advances that have been made, adoption of these systems in clinical settings has been slow. One issue is a lack of question-answering datasets which reflect the real-world needs of health professionals. In this work, we present RealMedQA, a dataset of realistic clinical questions generated by humans and an LLM. We describe the process for generating and verifying the QA pairs and assess several QA models on BioASQ and RealMedQA to assess the relative difficulty of matching answers to questions. We show that the LLM is more cost-efficient for generating "ideal" QA pairs. Additionally, we achieve a lower lexical similarity between questions and answers than BioASQ which provides an additional challenge to the top two QA models, as per the results. We release our code and our dataset publicly to encourage further research.

Although large language models (LLMs) have been assessed for general medical knowledge using medical licensing exams, their ability to effectively support clinical decision-making tasks, such as selecting and using medical calculators, remains uncertain. Here, we evaluate the capability of both medical trainees and LLMs to recommend medical calculators in response to various multiple-choice clinical scenarios such as risk stratification, prognosis, and disease diagnosis. We assessed eight LLMs, including open-source, proprietary, and domain-specific models, with 1,009 question-answer pairs across 35 clinical calculators and measured human performance on a subset of 100 questions. While the highest-performing LLM, GPT-4o, provided an answer accuracy of 74.3% (CI: 71.5-76.9%), human annotators, on average, outperformed LLMs with an accuracy of 79.5% (CI: 73.5-85.0%). With error analysis showing that the highest-performing LLMs continue to make mistakes in comprehension (56.6%) and calculator knowledge (8.1%), our findings emphasize that humans continue to surpass LLMs on complex clinical tasks such as calculator recommendation.

Artificial intelligence (AI) and large language models (LLMs) in healthcare require advanced clinical skills (CS), yet current benchmarks fail to evaluate these comprehensively. We introduce MedQA-CS, an AI-SCE framework inspired by medical education's Objective Structured Clinical Examinations (OSCEs), to address this gap. MedQA-CS evaluates LLMs through two instruction-following tasks, LLM-as-medical-student and LLM-as-CS-examiner, designed to reflect real clinical scenarios. Our contributions include developing MedQA-CS, a comprehensive evaluation framework with publicly available data and expert annotations, and providing the quantitative and qualitative assessment of LLMs as reliable judges in CS evaluation. Our experiments show that MedQA-CS is a more challenging benchmark for evaluating clinical skills than traditional multiple-choice QA benchmarks (e.g., MedQA). Combined with existing benchmarks, MedQA-CS enables a more comprehensive evaluation of LLMs' clinical capabilities for both open- and closed-source LLMs.

Exploiting large language models (LLMs) to tackle deductive reasoning has garnered growing attention. It still remains highly challenging to achieve satisfactory results in complex deductive problems, characterized by plenty of premises (i.e., facts or rules) entailing intricate relationships among entities and requiring multi-hop reasoning. One intuitive solution is to decompose the original task into smaller sub-tasks, and then chain the multiple casual reasoning steps together in a forward (e.g., Selection-Inference) or backward (e.g., LAMBADA) direction. However, these techniques inevitably necessitate a large number of overall stages, leading to computationally expensive operations and a higher possibility of making misleading steps. In addition to stage-by-stage decomposition, we draw inspiration from another aspect of human problem-solving. Humans tend to distill the most relevant information and organize their thoughts systematically (e.g., creating mind maps), which assists them in answering questions or drawing conclusions precisely and quickly. In light of this, we propose a novel reasoning approach named Concise and Organized Perception (COP). COP carefully analyzes the given statements to efficiently identify the most pertinent information while eliminating redundancy. It then prompts the LLMs in a more organized form that adapts to the model's inference process. By perceiving concise and organized proofs, the deductive reasoning abilities of LLMs can be better elicited, and the risk of acquiring errors caused by excessive reasoning stages is mitigated. Furthermore, our approach can be combined with the aforementioned ones to further boost their performance. Extensive experimental results on three popular deductive benchmarks (i.e., ProofWriter, PrOntoQA and PrOntoQA-OOD) show that COP significantly outperforms previous state-of-the-art methods.

Reasoning is a fundamental capability for solving complex multi-step problems, particularly in visual contexts where sequential step-wise understanding is essential. Existing approaches lack a comprehensive framework for evaluating visual reasoning and do not emphasize step-wise problem-solving. To this end, we propose a comprehensive framework for advancing step-by-step visual reasoning in large language models (LMMs) through three key contributions. First, we introduce a visual reasoning benchmark specifically designed to evaluate multi-step reasoning tasks. The benchmark presents a diverse set of challenges with eight different categories ranging from complex visual perception to scientific reasoning with over 4k reasoning steps in total, enabling robust evaluation of LLMs' abilities to perform accurate and interpretable visual reasoning across multiple steps. Second, we propose a novel metric that assesses visual reasoning quality at the granularity of individual steps, emphasizing both correctness and logical coherence. The proposed metric offers deeper insights into reasoning performance compared to traditional end-task accuracy metrics. Third, we present a new multimodal visual reasoning model, named LlamaV-o1, trained using a multi-step curriculum learning approach, where tasks are progressively organized to facilitate incremental skill acquisition and problem-solving. The proposed LlamaV-o1 is designed for multi-step reasoning and learns step-by-step through a structured training paradigm. Extensive experiments show that our LlamaV-o1 outperforms existing open-source models and performs favorably against close-source proprietary models. Compared to the recent Llava-CoT, our LlamaV-o1 achieves an average score of 67.3 with an absolute gain of 3.8\% across six benchmarks while being 5 times faster during inference scaling. Our benchmark, model, and code are publicly available.

Statutory reasoning refers to the application of legislative provisions to a series of case facts described in natural language. We re-frame statutory reasoning as an analogy task, where each instance of the analogy task involves a combination of two instances of statutory reasoning. This increases the dataset size by two orders of magnitude, and introduces an element of interpretability. We show that this task is roughly as difficult to Natural Language Processing models as the original task. Finally, we come back to statutory reasoning, solving it with a combination of a retrieval mechanism and analogy models, and showing some progress on prior comparable work.

Mathematical reasoning is a fundamental aspect of human intelligence and is applicable in various fields, including science, engineering, finance, and everyday life. The development of artificial intelligence (AI) systems capable of solving math problems and proving theorems has garnered significant interest in the fields of machine learning and natural language processing. For example, mathematics serves as a testbed for aspects of reasoning that are challenging for powerful deep learning models, driving new algorithmic and modeling advances. On the other hand, recent advances in large-scale neural language models have opened up new benchmarks and opportunities to use deep learning for mathematical reasoning. In this survey paper, we review the key tasks, datasets, and methods at the intersection of mathematical reasoning and deep learning over the past decade. We also evaluate existing benchmarks and methods, and discuss future research directions in this domain.

Mathematical reasoning, a core ability of human intelligence, presents unique challenges for machines in abstract thinking and logical reasoning. Recent large pre-trained language models such as GPT-3 have achieved remarkable progress on mathematical reasoning tasks written in text form, such as math word problems (MWP). However, it is unknown if the models can handle more complex problems that involve math reasoning over heterogeneous information, such as tabular data. To fill the gap, we present Tabular Math Word Problems (TabMWP), a new dataset containing 38,431 open-domain grade-level problems that require mathematical reasoning on both textual and tabular data. Each question in TabMWP is aligned with a tabular context, which is presented as an image, semi-structured text, and a structured table. There are two types of questions: free-text and multi-choice, and each problem is annotated with gold solutions to reveal the multi-step reasoning process. We evaluate different pre-trained models on TabMWP, including the GPT-3 model in a few-shot setting. As earlier studies suggest, since few-shot GPT-3 relies on the selection of in-context examples, its performance is unstable and can degrade to near chance. The unstable issue is more severe when handling complex problems like TabMWP. To mitigate this, we further propose a novel approach, PromptPG, which utilizes policy gradient to learn to select in-context examples from a small amount of training data and then constructs the corresponding prompt for the test example. Experimental results show that our method outperforms the best baseline by 5.31% on the accuracy metric and reduces the prediction variance significantly compared to random selection, which verifies its effectiveness in selecting in-context examples.

Reasoning is a distinctive human capacity, enabling us to address complex problems by breaking them down into a series of manageable cognitive steps. Yet, complex logical reasoning is still cumbersome for language models. Based on the dual process theory in cognitive science, we are the first to unravel the cognitive reasoning abilities of language models. Our framework employs an iterative methodology to construct a Cognitive Tree (CogTree). The root node of this tree represents the initial query, while the leaf nodes consist of straightforward questions that can be answered directly. This construction involves two main components: the implicit extraction module (referred to as the intuitive system) and the explicit reasoning module (referred to as the reflective system). The intuitive system rapidly generates multiple responses by utilizing in-context examples, while the reflective system scores these responses using comparative learning. The scores guide the intuitive system in its subsequent generation step. Our experimental results on two popular and challenging reasoning tasks indicate that it is possible to achieve a performance level comparable to that of GPT-3.5 (with 175B parameters), using a significantly smaller language model that contains fewer parameters (<=7B) than 5% of GPT-3.5.

Logical reasoning, i.e., deductively inferring the truth value of a conclusion from a set of premises, is an important task for artificial intelligence with wide potential impacts on science, mathematics, and society. While many prompting-based strategies have been proposed to enable Large Language Models (LLMs) to do such reasoning more effectively, they still appear unsatisfactory, often failing in subtle and unpredictable ways. In this work, we investigate the validity of instead reformulating such tasks as modular neurosymbolic programming, which we call LINC: Logical Inference via Neurosymbolic Computation. In LINC, the LLM acts as a semantic parser, translating premises and conclusions from natural language to expressions in first-order logic. These expressions are then offloaded to an external theorem prover, which symbolically performs deductive inference. Leveraging this approach, we observe significant performance gains on FOLIO and a balanced subset of ProofWriter for three different models in nearly all experimental conditions we evaluate. On ProofWriter, augmenting the comparatively small open-source StarCoder+ (15.5B parameters) with LINC even outperforms GPT-3.5 and GPT-4 with Chain-of-Thought (CoT) prompting by an absolute 38% and 10%, respectively. When used with GPT-4, LINC scores 26% higher than CoT on ProofWriter while performing comparatively on FOLIO. Further analysis reveals that although both methods on average succeed roughly equally often on this dataset, they exhibit distinct and complementary failure modes. We thus provide promising evidence for how logical reasoning over natural language can be tackled through jointly leveraging LLMs alongside symbolic provers. All corresponding code is publicly available at https://github.com/benlipkin/linc

Medical Visual Question Answering (MedVQA), which offers language responses to image-based medical inquiries, represents a challenging task and significant advancement in healthcare. It assists medical experts to swiftly interpret medical images, thereby enabling faster and more accurate diagnoses. However, the model interpretability and transparency of existing MedVQA solutions are often limited, posing challenges in understanding their decision-making processes. To address this issue, we devise a semi-automated annotation process to streamline data preparation and build new benchmark MedVQA datasets R-RAD, R-SLAKE and R-Path. These datasets provide intermediate medical decision-making rationales generated by multimodal large language models and human annotations for question-answering pairs in existing MedVQA datasets, i.e., VQA-RAD, SLAKE and PathVQA. Moreover, we design a novel framework, MedThink, which finetunes lightweight pretrained generative models by incorporating medical decision-making rationales. MedThink includes three distinct strategies to generate decision outcomes and corresponding rationales, thereby clearly showcasing the medical decision-making process during reasoning. Our comprehensive experiments show that our method achieves an accuracy of 83.5% on R-RAD, 86.3% on R-SLAKE and 87.2% on R-Path. These results significantly exceed those of existing state-of-the-art models with comparable parameters. Datasets and code will be released.

Medical visual question answering (VQA) aims to answer clinically relevant questions regarding input medical images. This technique has the potential to improve the efficiency of medical professionals while relieving the burden on the public health system, particularly in resource-poor countries. Existing medical VQA methods tend to encode medical images and learn the correspondence between visual features and questions without exploiting the spatial, semantic, or medical knowledge behind them. This is partially because of the small size of the current medical VQA dataset, which often includes simple questions. Therefore, we first collected a comprehensive and large-scale medical VQA dataset, focusing on chest X-ray images. The questions involved detailed relationships, such as disease names, locations, levels, and types in our dataset. Based on this dataset, we also propose a novel baseline method by constructing three different relationship graphs: spatial relationship, semantic relationship, and implicit relationship graphs on the image regions, questions, and semantic labels. The answer and graph reasoning paths are learned for different questions.

When building artificial intelligence systems that can reason and answer questions about visual data, we need diagnostic tests to analyze our progress and discover shortcomings. Existing benchmarks for visual question answering can help, but have strong biases that models can exploit to correctly answer questions without reasoning. They also conflate multiple sources of error, making it hard to pinpoint model weaknesses. We present a diagnostic dataset that tests a range of visual reasoning abilities. It contains minimal biases and has detailed annotations describing the kind of reasoning each question requires. We use this dataset to analyze a variety of modern visual reasoning systems, providing novel insights into their abilities and limitations.

Math reasoning is a highly active area of Large Language Model (LLM) research because it is a hallmark of artificial intelligence. However, few works have explored how math reasoning is encoded within LLM parameters and if it is a skill that can be isolated within a model. Doing so could allow targeted intervention to improve math performance without altering non-math behavior and foster understanding of how models encode math reasoning. We introduce Math Neurosurgery (MathNeuro), a method for isolating math-specific parameters in LLMs using only forward passes. MathNeuro builds on existing work by using weights and activations to calculate parameter importance, but isolates math-specific parameters by removing those important for general language tasks. Pruning parameters MathNeuro identifies deletes a LLM's math reasoning ability without destroying its general language ability. Scaling these parameters by a small constant improves a pretrained or instruction-tuned LLM's performance by 4-17% on GSM8K while leaving non-math behavior unaltered. MathNeuro is also data efficient: most of its effectiveness holds when identifying math-specific parameters using a single sample. MathNeuro highlights the potential for future work to intervene on math-specific parameters.

Large Language Models (LLMs) have succeeded remarkably in various natural language processing (NLP) tasks, yet their reasoning capabilities remain a fundamental challenge. While LLMs exhibit impressive fluency and factual recall, their ability to perform complex reasoning-spanning logical deduction, mathematical problem-solving, commonsense inference, and multi-step reasoning-often falls short of human expectations. This survey provides a comprehensive review of emerging techniques enhancing reasoning in LLMs. We categorize existing methods into key approaches, including prompting strategies (e.g., Chain-of-Thought reasoning, Self-Consistency, and Tree-of-Thought reasoning), architectural innovations (e.g., retrieval-augmented models, modular reasoning networks, and neuro-symbolic integration), and learning paradigms (e.g., fine-tuning with reasoning-specific datasets, reinforcement learning, and self-supervised reasoning objectives). Additionally, we explore evaluation frameworks used to assess reasoning in LLMs and highlight open challenges, such as hallucinations, robustness, and reasoning generalization across diverse tasks. By synthesizing recent advancements, this survey aims to provide insights into promising directions for future research and practical applications of reasoning-augmented LLMs.

Online medical consultation (OMC) restricts doctors to gathering patient information solely through inquiries, making the already complex sequential decision-making process of diagnosis even more challenging. Recently, the rapid advancement of large language models has demonstrated a significant potential to transform OMC. However, most studies have primarily focused on improving diagnostic accuracy under conditions of relatively sufficient information, while paying limited attention to the "inquiry" phase of the consultation process. This lack of focus has left the relationship between "inquiry" and "diagnosis" insufficiently explored. In this paper, we first extract real patient interaction strategies from authentic doctor-patient conversations and use these strategies to guide the training of a patient simulator that closely mirrors real-world behavior. By inputting medical records into our patient simulator to simulate patient responses, we conduct extensive experiments to explore the relationship between "inquiry" and "diagnosis" in the consultation process. Experimental results demonstrate that inquiry and diagnosis adhere to the Liebig's law: poor inquiry quality limits the effectiveness of diagnosis, regardless of diagnostic capability, and vice versa. Furthermore, the experiments reveal significant differences in the inquiry performance of various models. To investigate this phenomenon, we categorize the inquiry process into four types: (1) chief complaint inquiry; (2) specification of known symptoms; (3) inquiry about accompanying symptoms; and (4) gathering family or medical history. We analyze the distribution of inquiries across the four types for different models to explore the reasons behind their significant performance differences. We plan to open-source the weights and related code of our patient simulator at https://github.com/LIO-H-ZEN/PatientSimulator.

In recent years, there have been significant breakthroughs in the field of natural language processing, particularly with the development of large language models (LLMs). These LLMs have showcased remarkable capabilities on various benchmarks. In the healthcare field, the exact role LLMs and other future AI models will play remains unclear. There is a potential for these models in the future to be used as part of adaptive physician training, medical co-pilot applications, and digital patient interaction scenarios. The ability of AI models to participate in medical training and patient care will depend in part on their mastery of the knowledge content of specific medical fields. This study investigated the medical knowledge capability of LLMs, specifically in the context of internal medicine subspecialty multiple-choice test-taking ability. We compared the performance of several open-source LLMs (Koala 7B, Falcon 7B, Stable-Vicuna 13B, and Orca Mini 13B), to GPT-4 and Claude 2 on multiple-choice questions in the field of Nephrology. Nephrology was chosen as an example of a particularly conceptually complex subspecialty field within internal medicine. The study was conducted to evaluate the ability of LLM models to provide correct answers to nephSAP (Nephrology Self-Assessment Program) multiple-choice questions. The overall success of open-sourced LLMs in answering the 858 nephSAP multiple-choice questions correctly was 17.1% - 25.5%. In contrast, Claude 2 answered 54.4% of the questions correctly, whereas GPT-4 achieved a score of 73.3%. We show that current widely used open-sourced LLMs do poorly in their ability for zero-shot reasoning when compared to GPT-4 and Claude 2. The findings of this study potentially have significant implications for the future of subspecialty medical training and patient care.

We present MedConceptsQA, a dedicated open source benchmark for medical concepts question answering. The benchmark comprises of questions of various medical concepts across different vocabularies: diagnoses, procedures, and drugs. The questions are categorized into three levels of difficulty: easy, medium, and hard. We conducted evaluations of the benchmark using various Large Language Models. Our findings show that pre-trained clinical Large Language Models achieved accuracy levels close to random guessing on this benchmark, despite being pre-trained on medical data. However, GPT-4 achieves an absolute average improvement of nearly 27%-37% (27% for zero-shot learning and 37% for few-shot learning) when compared to clinical Large Language Models. Our benchmark serves as a valuable resource for evaluating the understanding and reasoning of medical concepts by Large Language Models. Our benchmark is available at https://huggingface.co/datasets/ofir408/MedConceptsQA

Reasoning is central to a wide range of intellectual activities, and while the capabilities of large language models (LLMs) continue to advance, their performance in reasoning tasks remains limited. The processes and mechanisms underlying reasoning are not yet fully understood, but key elements include path exploration, selection of relevant knowledge, and multi-step inference. Problems are solved through the synthesis of these components. In this paper, we propose a benchmark that focuses on a specific aspect of reasoning ability: the direct evaluation of multi-step inference. To this end, we design a special reasoning task where multi-step inference is specifically focused by largely eliminating path exploration and implicit knowledge utilization. Our dataset comprises pairs of explicit instructions and corresponding questions, where the procedures necessary for solving the questions are entirely detailed within the instructions. This setup allows models to solve problems solely by following the provided directives. By constructing problems that require varying numbers of steps to solve and evaluating responses at each step, we enable a thorough assessment of state-of-the-art LLMs' ability to follow instructions. To ensure the robustness of our evaluation, we include multiple distinct tasks. Furthermore, by comparing accuracy across tasks, utilizing step-aware metrics, and applying separately defined measures of complexity, we conduct experiments that offer insights into the capabilities and limitations of LLMs in reasoning tasks. Our findings have significant implications for the development of LLMs and highlight areas for future research in advancing their reasoning abilities. Our dataset is available at https://huggingface.co/datasets/ifujisawa/procbench and code at https://github.com/ifujisawa/proc-bench.

Large Language Models, such as Generative Pre-trained Transformer 3 (aka. GPT-3), have been developed to understand language through the analysis of extensive text data, allowing them to identify patterns and connections between words. While LLMs have demonstrated impressive performance across various text-related tasks, they encounter challenges in tasks associated with reasoning. To address this challenge, Chain of Thought(CoT) prompting method has been proposed as a means to enhance LLMs' proficiency in complex reasoning tasks like solving math word problems and answering questions based on logical argumentative reasoning. The primary aim of this research is to assess how well four language models can grade reflective essays of third-year medical students. The assessment will specifically target the evaluation of critical thinking skills using CoT prompting. The research will provide the following contributions; to introduce and educate on the process of instructing models to evaluate reflective essays from a dataset they have not been previously trained on; to illustrate the use of CoT prompting as an instructional approach for training large models to carry out particular tasks. Our results suggest that among all the models, Llama-7b performs the least effectively, displaying the highest mean squared error. Conversely, ChatGPT emerges as the superior model, boasting a higher Cohen kappa score value of 0.53. Lastly, it's important to note that the selected models do prioritise user privacy by allowing users to delete their own conducted conversations.

Logical reasoning is fundamental for humans yet presents a substantial challenge in the domain of Artificial Intelligence. Initially, researchers used Knowledge Representation and Reasoning (KR) systems that did not scale and required non trivial manual effort. Recently, the emergence of large language models (LLMs) has demonstrated the ability to overcome various limitations of formal Knowledge Representation (KR) systems. Consequently, there is a growing interest in using LLMs for logical reasoning via natural language. This work strives to understand the proficiency of LLMs in logical reasoning by offering a brief review of the latest progress in this area; with a focus on the logical reasoning datasets, tasks, and the methods adopted to utilize LLMs for reasoning. To offer a thorough analysis, we have compiled a benchmark titled LogiGLUE. This includes 24 varied datasets encompassing deductive, abductive, and inductive reasoning. We have standardized these datasets into Seq2Seq tasks to facilitate straightforward training and evaluation for future research. Utilizing LogiGLUE as a foundation, we have trained an instruction fine tuned language model, resulting in LogiT5. We study single task training, multi task training, and a chain of thought knowledge distillation fine tuning technique to assess the performance of model across the different logical reasoning categories. By this comprehensive process, we aim to shed light on the capabilities and potential pathways for enhancing logical reasoning proficiency in LLMs, paving the way for more advanced and nuanced developments in this critical field.

Providing high quality explanations for AI predictions based on machine learning is a challenging and complex task. To work well it requires, among other factors: selecting a proper level of generality/specificity of the explanation; considering assumptions about the familiarity of the explanation beneficiary with the AI task under consideration; referring to specific elements that have contributed to the decision; making use of additional knowledge (e.g. expert evidence) which might not be part of the prediction process; and providing evidence supporting negative hypothesis. Finally, the system needs to formulate the explanation in a clearly interpretable, and possibly convincing, way. Given these considerations, ANTIDOTE fosters an integrated vision of explainable AI, where low-level characteristics of the deep learning process are combined with higher level schemes proper of the human argumentation capacity. ANTIDOTE will exploit cross-disciplinary competences in deep learning and argumentation to support a broader and innovative view of explainable AI, where the need for high-quality explanations for clinical cases deliberation is critical. As a first result of the project, we publish the Antidote CasiMedicos dataset to facilitate research on explainable AI in general, and argumentation in the medical domain in particular.

Large language models have shown impressive results for multi-hop mathematical reasoning when the input question is only textual. Many mathematical reasoning problems, however, contain both text and image. With the ever-increasing adoption of vision language models (VLMs), understanding their reasoning abilities for such problems is crucial. In this paper, we evaluate the reasoning capabilities of VLMs along various axes through the lens of geometry problems. We procedurally create a synthetic dataset of geometry questions with controllable difficulty levels along multiple axes, thus enabling a systematic evaluation. The empirical results obtained using our benchmark for state-of-the-art VLMs indicate that these models are not as capable in subjects like geometry (and, by generalization, other topics requiring similar reasoning) as suggested by previous benchmarks. This is made especially clear by the construction of our benchmark at various depth levels, since solving higher-depth problems requires long chains of reasoning rather than additional memorized knowledge. We release the dataset for further research in this area.

This study focuses on improving the performance of lightweight Large Language Models (LLMs) in mathematical reasoning tasks. We introduce a novel method for measuring mathematical logic similarity and design an automatic screening mechanism to construct a set of reference problems that integrate both semantic and logical similarity. By employing carefully crafted positive and negative example prompts, we guide the model towards adopting sound reasoning logic. To the best of our knowledge, this is the first attempt to utilize retrieval-enhanced generation for mathematical problem-solving. Experimental results demonstrate that our method achieves a 15.8% improvement over the Chain of Thought approach on the SVAMP dataset and a 21.5 % improvement on the GSM8K dataset. Further application of this method to a large-scale model with 175 billion parameters yields performance comparable to the best results on both aforementioned datasets. Finally, we conduct an analysis of errors during the reasoning process, providing valuable insights and directions for future research on reasoning tasks using large language models.

Objective: To transform heterogeneous clinical data from electronic health records into clinically meaningful constructed features using data driven method that rely, in part, on temporal relations among data. Materials and Methods: The clinically meaningful representations of medical concepts and patients are the key for health analytic applications. Most of existing approaches directly construct features mapped to raw data (e.g., ICD or CPT codes), or utilize some ontology mapping such as SNOMED codes. However, none of the existing approaches leverage EHR data directly for learning such concept representation. We propose a new way to represent heterogeneous medical concepts (e.g., diagnoses, medications and procedures) based on co-occurrence patterns in longitudinal electronic health records. The intuition behind the method is to map medical concepts that are co-occuring closely in time to similar concept vectors so that their distance will be small. We also derive a simple method to construct patient vectors from the related medical concept vectors. Results: For qualitative evaluation, we study similar medical concepts across diagnosis, medication and procedure. In quantitative evaluation, our proposed representation significantly improves the predictive modeling performance for onset of heart failure (HF), where classification methods (e.g. logistic regression, neural network, support vector machine and K-nearest neighbors) achieve up to 23% improvement in area under the ROC curve (AUC) using this proposed representation. Conclusion: We proposed an effective method for patient and medical concept representation learning. The resulting representation can map relevant concepts together and also improves predictive modeling performance.

Recent advances in large language models have led to renewed interest in natural language processing in healthcare using the free text of clinical notes. One distinguishing characteristic of clinical notes is their long time span over multiple long documents. The unique structure of clinical notes creates a new design choice: when the context length for a language model predictor is limited, which part of clinical notes should we choose as the input? Existing studies either choose the inputs with domain knowledge or simply truncate them. We propose a framework to analyze the sections with high predictive power. Using MIMIC-III, we show that: 1) predictive power distribution is different between nursing notes and discharge notes and 2) combining different types of notes could improve performance when the context length is large. Our findings suggest that a carefully selected sampling function could enable more efficient information extraction from clinical notes.

We present Eir Thai Medical LLM, a large language model with 8 billion parameters, specifically designed to enhance the accuracy of handling medical tasks in the Thai language. This model focuses on providing clear and easy-to-understand answers for both healthcare professionals and patients, thereby improving the efficiency of diagnosis and treatment processes. Human evaluation was conducted to ensure that the model adheres to care standards and provides unbiased answers. To prioritize data security, the model is deployed within the hospital's internal network, ensuring both high security and faster processing speeds. The internal API connection is secured with encryption and strict authentication measures to prevent data leaks and unauthorized access. We evaluated several open-source large language models with 8 billion parameters on four medical benchmarks: MedQA, MedMCQA, PubMedQA, and the medical subset of MMLU. The best-performing baselines were used to develop Eir Thai Medical LLM. Our evaluation employed multiple questioning strategies, including zero-shot, few-shot, chain-of-thought reasoning, and ensemble/self-consistency voting methods. Our model outperformed commercially available Thai-language large language models by more than 10%. In addition, we developed enhanced model testing tailored for clinical use in Thai across 18 clinical tasks, where our model exceeded GPT-4o performance by more than 11%

Recently, slow-thinking reasoning systems, such as o1, have demonstrated remarkable capabilities in solving complex reasoning tasks. These systems typically engage in an extended thinking process before responding to a query, allowing them to generate more thorough, accurate, and well-reasoned solutions. These systems are primarily developed and maintained by industry, with their core techniques not publicly disclosed. In response, an increasing number of studies from the research community aim to explore the technical foundations underlying these powerful reasoning systems. Building on these prior efforts, this paper presents a reproduction report on implementing o1-like reasoning systems. We introduce an "imitate, explore, and self-improve" framework as our primary technical approach to train the reasoning model. In the initial phase, we use distilled long-form thought data to fine-tune the reasoning model, enabling it to invoke a slow-thinking mode. The model is then encouraged to explore challenging problems by generating multiple rollouts, which can result in increasingly more high-quality trajectories that lead to correct answers. Furthermore, the model undergoes self-improvement by iteratively refining its training dataset. To verify the effectiveness of this approach, we conduct extensive experiments on three challenging benchmarks. The experimental results demonstrate that our approach achieves competitive performance compared to industry-level reasoning systems on these benchmarks.

Large Language Models (LLMs) significantly benefit from Chain-of-Thought (CoT) prompting in performing various reasoning tasks. While CoT allows models to produce more comprehensive reasoning processes, its emphasis on intermediate reasoning steps can inadvertently introduce hallucinations and accumulated errors, thereby limiting models' ability to solve complex reasoning tasks. Inspired by how humans engage in careful and meticulous deductive logical reasoning processes to solve tasks, we seek to enable language models to perform explicit and rigorous deductive reasoning, and also ensure the trustworthiness of their reasoning process through self-verification. However, directly verifying the validity of an entire deductive reasoning process is challenging, even with advanced models like ChatGPT. In light of this, we propose to decompose a reasoning verification process into a series of step-by-step subprocesses, each only receiving their necessary context and premises. To facilitate this procedure, we propose Natural Program, a natural language-based deductive reasoning format. Our approach enables models to generate precise reasoning steps where subsequent steps are more rigorously grounded on prior steps. It also empowers language models to carry out reasoning self-verification in a step-by-step manner. By integrating this verification process into each deductive reasoning stage, we significantly enhance the rigor and trustfulness of generated reasoning steps. Along this process, we also improve the answer correctness on complex reasoning tasks. Code will be released at https://github.com/lz1oceani/verify_cot.

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.

This study evaluates the performance of OpenAI's o1-preview model in higher-order cognitive domains, including critical thinking, systematic thinking, computational thinking, data literacy, creative thinking, logical reasoning, and scientific reasoning. Using established benchmarks, we compared the o1-preview models's performance to human participants from diverse educational levels. o1-preview achieved a mean score of 24.33 on the Ennis-Weir Critical Thinking Essay Test (EWCTET), surpassing undergraduate (13.8) and postgraduate (18.39) participants (z = 1.60 and 0.90, respectively). In systematic thinking, it scored 46.1, SD = 4.12 on the Lake Urmia Vignette, significantly outperforming the human mean (20.08, SD = 8.13, z = 3.20). For data literacy, o1-preview scored 8.60, SD = 0.70 on Merk et al.'s "Use Data" dimension, compared to the human post-test mean of 4.17, SD = 2.02 (z = 2.19). On creative thinking tasks, the model achieved originality scores of 2.98, SD = 0.73, higher than the human mean of 1.74 (z = 0.71). In logical reasoning (LogiQA), it outperformed humans with average 90%, SD = 10% accuracy versus 86%, SD = 6.5% (z = 0.62). For scientific reasoning, it achieved near-perfect performance (mean = 0.99, SD = 0.12) on the TOSLS,, exceeding the highest human scores of 0.85, SD = 0.13 (z = 1.78). While o1-preview excelled in structured tasks, it showed limitations in problem-solving and adaptive reasoning. These results demonstrate the potential of AI to complement education in structured assessments but highlight the need for ethical oversight and refinement for broader applications.

Mathematical reasoning---a core ability within human intelligence---presents some unique challenges as a domain: we do not come to understand and solve mathematical problems primarily on the back of experience and evidence, but on the basis of inferring, learning, and exploiting laws, axioms, and symbol manipulation rules. In this paper, we present a new challenge for the evaluation (and eventually the design) of neural architectures and similar system, developing a task suite of mathematics problems involving sequential questions and answers in a free-form textual input/output format. The structured nature of the mathematics domain, covering arithmetic, algebra, probability and calculus, enables the construction of training and test splits designed to clearly illuminate the capabilities and failure-modes of different architectures, as well as evaluate their ability to compose and relate knowledge and learned processes. Having described the data generation process and its potential future expansions, we conduct a comprehensive analysis of models from two broad classes of the most powerful sequence-to-sequence architectures and find notable differences in their ability to resolve mathematical problems and generalize their knowledge.

Analogical reasoning is a unique ability of humans to address unfamiliar challenges by transferring strategies from relevant past experiences. One key finding in psychology is that compared with irrelevant past experiences, recalling relevant ones can help humans better handle new tasks. Coincidentally, the NLP community has also recently found that self-generating relevant examples in the context can help large language models (LLMs) better solve a given problem than hand-crafted prompts. However, it is yet not clear whether relevance is the key factor eliciting such capability, i.e., can LLMs benefit more from self-generated relevant examples than irrelevant ones? In this work, we systematically explore whether LLMs can truly perform analogical reasoning on a diverse set of reasoning tasks. With extensive experiments and analysis, we show that self-generated random examples can surprisingly achieve comparable or even better performance, e.g., 4% performance boost on GSM8K with random biological examples. We find that the accuracy of self-generated examples is the key factor and subsequently design two improved methods with significantly reduced inference costs. Overall, we aim to advance a deeper understanding of LLM analogical reasoning and hope this work stimulates further research in the design of self-generated contexts.

Large language models (LLMs) have demonstrated impressive reasoning abilities in complex tasks. However, they lack up-to-date knowledge and experience hallucinations during reasoning, which can lead to incorrect reasoning processes and diminish their performance and trustworthiness. Knowledge graphs (KGs), which capture vast amounts of facts in a structured format, offer a reliable source of knowledge for reasoning. Nevertheless, existing KG-based LLM reasoning methods only treat KGs as factual knowledge bases and overlook the importance of their structural information for reasoning. In this paper, we propose a novel method called reasoning on graphs (RoG) that synergizes LLMs with KGs to enable faithful and interpretable reasoning. Specifically, we present a planning-retrieval-reasoning framework, where RoG first generates relation paths grounded by KGs as faithful plans. These plans are then used to retrieve valid reasoning paths from the KGs for LLMs to conduct faithful reasoning. Furthermore, RoG not only distills knowledge from KGs to improve the reasoning ability of LLMs through training but also allows seamless integration with any arbitrary LLMs during inference. Extensive experiments on two benchmark KGQA datasets demonstrate that RoG achieves state-of-the-art performance on KG reasoning tasks and generates faithful and interpretable reasoning results.

The integration of Artificial Intelligence (AI), especially Large Language Models (LLMs), into the clinical diagnosis process offers significant potential to improve the efficiency and accessibility of medical care. While LLMs have shown some promise in the medical domain, their application in clinical diagnosis remains underexplored, especially in real-world clinical practice, where highly sophisticated, patient-specific decisions need to be made. Current evaluations of LLMs in this field are often narrow in scope, focusing on specific diseases or specialties and employing simplified diagnostic tasks. To bridge this gap, we introduce CliBench, a novel benchmark developed from the MIMIC IV dataset, offering a comprehensive and realistic assessment of LLMs' capabilities in clinical diagnosis. This benchmark not only covers diagnoses from a diverse range of medical cases across various specialties but also incorporates tasks of clinical significance: treatment procedure identification, lab test ordering and medication prescriptions. Supported by structured output ontologies, CliBench enables a precise and multi-granular evaluation, offering an in-depth understanding of LLM's capability on diverse clinical tasks of desired granularity. We conduct a zero-shot evaluation of leading LLMs to assess their proficiency in clinical decision-making. Our preliminary results shed light on the potential and limitations of current LLMs in clinical settings, providing valuable insights for future advancements in LLM-powered healthcare.

Studies have underscored how, regardless of the recent breakthrough and swift advances in AI research, even state-of-the-art Large Language models (LLMs) continue to struggle when performing logical and mathematical reasoning. The results seem to suggest that LLMs still work as (highly advanced) data pattern identifiers, scoring poorly when attempting to generalise and solve reasoning problems the models have never previously seen or that are not close to samples presented in their training data. To address this compelling concern, this paper makes use of the notion of critical questions from the literature on argumentation theory, focusing in particular on Toulmin's model of argumentation. We show that employing these critical questions can improve the reasoning capabilities of LLMs. By probing the rationale behind the models' reasoning process, the LLM can assess whether some logical mistake is occurring and correct it before providing the final reply to the user prompt. The underlying idea is drawn from the gold standard of any valid argumentative procedure: the conclusion is valid if it is entailed by accepted premises. Or, to paraphrase such Aristotelian principle in a real-world approximation, characterised by incomplete information and presumptive logic, the conclusion is valid if not proved otherwise. This approach successfully steers the models' output through a reasoning pipeline, resulting in better performance against the baseline and its Chain-of-Thought (CoT) implementation. To this end, an extensive evaluation of the proposed approach on the MT-Bench Reasoning and Math tasks across a range of LLMs is provided.

The absence of transparency and explainability hinders the clinical adoption of Machine learning (ML) algorithms. Although various methods of explainable artificial intelligence (XAI) have been suggested, there is a lack of literature that delves into their practicality and assesses them based on criteria that could foster trust in clinical environments. To address this gap this study evaluates two popular XAI methods used for explaining predictive models in the healthcare context in terms of whether they (i) generate domain-appropriate representation, i.e. coherent with respect to the application task, (ii) impact clinical workflow and (iii) are consistent. To that end, explanations generated at the cohort and patient levels were analysed. The paper reports the first benchmarking of the XAI methods applied to risk prediction models obtained by evaluating the concordance between generated explanations and the trigger of a future clinical deterioration episode recorded by the data collection system. We carried out an analysis using two Electronic Medical Records (EMR) datasets sourced from Australian major hospitals. The findings underscore the limitations of state-of-the-art XAI methods in the clinical context and their potential benefits. We discuss these limitations and contribute to the theoretical development of trustworthy XAI solutions where clinical decision support guides the choice of intervention by suggesting the pattern or drivers for clinical deterioration in the future.

Multimodal reasoning is a challenging task that requires models to reason across multiple modalities to answer questions. Existing approaches have made progress by incorporating language and visual modalities into a two-stage reasoning framework, separating rationale generation from answer inference. However, these approaches often fall short due to the inadequate quality of the generated rationales. In this work, we delve into the importance of rationales in model reasoning. We observe that when rationales are completely accurate, the model's accuracy significantly improves, highlighting the need for high-quality rationale generation. Motivated by this, we propose MC-CoT, a self-consistency training strategy that generates multiple rationales and answers, subsequently selecting the most accurate through a voting process. This approach not only enhances the quality of generated rationales but also leads to more accurate and robust answers. Through extensive experiments, we demonstrate that our approach significantly improves model performance across various benchmarks. Remarkably, we show that even smaller base models, when equipped with our proposed approach, can achieve results comparable to those of larger models, illustrating the potential of our approach in harnessing the power of rationales for improved multimodal reasoning. The code is available at https://github.com/chengtan9907/mc-cot.

Recent advancements in large language models (LLMs) have transformed the field of question answering (QA). However, evaluating LLMs in the medical field is challenging due to the lack of standardized and comprehensive datasets. To address this gap, we introduce CMExam, sourced from the Chinese National Medical Licensing Examination. CMExam consists of 60K+ multiple-choice questions for standardized and objective evaluations, as well as solution explanations for model reasoning evaluation in an open-ended manner. For in-depth analyses of LLMs, we invited medical professionals to label five additional question-wise annotations, including disease groups, clinical departments, medical disciplines, areas of competency, and question difficulty levels. Alongside the dataset, we further conducted thorough experiments with representative LLMs and QA algorithms on CMExam. The results show that GPT-4 had the best accuracy of 61.6% and a weighted F1 score of 0.617. These results highlight a great disparity when compared to human accuracy, which stood at 71.6%. For explanation tasks, while LLMs could generate relevant reasoning and demonstrate improved performance after finetuning, they fall short of a desired standard, indicating ample room for improvement. To the best of our knowledge, CMExam is the first Chinese medical exam dataset to provide comprehensive medical annotations. The experiments and findings of LLM evaluation also provide valuable insights into the challenges and potential solutions in developing Chinese medical QA systems and LLM evaluation pipelines. The dataset and relevant code are available at https://github.com/williamliujl/CMExam.

Although recent advances in scaling large language models (LLMs) have resulted in improvements on many NLP tasks, it remains unclear whether these models trained primarily with general web text are the right tool in highly specialized, safety critical domains such as clinical text. Recent results have suggested that LLMs encode a surprising amount of medical knowledge. This raises an important question regarding the utility of smaller domain-specific language models. With the success of general-domain LLMs, is there still a need for specialized clinical models? To investigate this question, we conduct an extensive empirical analysis of 12 language models, ranging from 220M to 175B parameters, measuring their performance on 3 different clinical tasks that test their ability to parse and reason over electronic health records. As part of our experiments, we train T5-Base and T5-Large models from scratch on clinical notes from MIMIC III and IV to directly investigate the efficiency of clinical tokens. We show that relatively small specialized clinical models substantially outperform all in-context learning approaches, even when finetuned on limited annotated data. Further, we find that pretraining on clinical tokens allows for smaller, more parameter-efficient models that either match or outperform much larger language models trained on general text. We release the code and the models used under the PhysioNet Credentialed Health Data license and data use agreement.

With the emergence of advanced reasoning models like OpenAI o3 and DeepSeek-R1, large language models (LLMs) have demonstrated remarkable reasoning capabilities. However, their ability to perform rigorous logical reasoning remains an open question. This survey synthesizes recent advancements in logical reasoning within LLMs, a critical area of AI research. It outlines the scope of logical reasoning in LLMs, its theoretical foundations, and the benchmarks used to evaluate reasoning proficiency. We analyze existing capabilities across different reasoning paradigms - deductive, inductive, abductive, and analogical - and assess strategies to enhance reasoning performance, including data-centric tuning, reinforcement learning, decoding strategies, and neuro-symbolic approaches. The review concludes with future directions, emphasizing the need for further exploration to strengthen logical reasoning in AI systems.

Although large language models (LLMs) often produce impressive outputs, it remains unclear how they perform in real-world scenarios requiring strong reasoning skills and expert domain knowledge. We set out to investigate whether close- and open-source models (GPT-3.5, LLama-2, etc.) can be applied to answer and reason about difficult real-world-based questions. We focus on three popular medical benchmarks (MedQA-USMLE, MedMCQA, and PubMedQA) and multiple prompting scenarios: Chain-of-Thought (CoT, think step-by-step), few-shot and retrieval augmentation. Based on an expert annotation of the generated CoTs, we found that InstructGPT can often read, reason and recall expert knowledge. Last, by leveraging advances in prompt engineering (few-shot and ensemble methods), we demonstrated that GPT-3.5 not only yields calibrated predictive distributions, but also reaches the passing score on three datasets: MedQA-USMLE 60.2%, MedMCQA 62.7% and PubMedQA 78.2%. Open-source models are closing the gap: Llama-2 70B also passed the MedQA-USMLE with 62.5% accuracy.

Run-time steering strategies like Medprompt are valuable for guiding large language models (LLMs) to top performance on challenging tasks. Medprompt demonstrates that a general LLM can be focused to deliver state-of-the-art performance on specialized domains like medicine by using a prompt to elicit a run-time strategy involving chain of thought reasoning and ensembling. OpenAI's o1-preview model represents a new paradigm, where a model is designed to do run-time reasoning before generating final responses. We seek to understand the behavior of o1-preview on a diverse set of medical challenge problem benchmarks. Following on the Medprompt study with GPT-4, we systematically evaluate the o1-preview model across various medical benchmarks. Notably, even without prompting techniques, o1-preview largely outperforms the GPT-4 series with Medprompt. We further systematically study the efficacy of classic prompt engineering strategies, as represented by Medprompt, within the new paradigm of reasoning models. We found that few-shot prompting hinders o1's performance, suggesting that in-context learning may no longer be an effective steering approach for reasoning-native models. While ensembling remains viable, it is resource-intensive and requires careful cost-performance optimization. Our cost and accuracy analysis across run-time strategies reveals a Pareto frontier, with GPT-4o representing a more affordable option and o1-preview achieving state-of-the-art performance at higher cost. Although o1-preview offers top performance, GPT-4o with steering strategies like Medprompt retains value in specific contexts. Moreover, we note that the o1-preview model has reached near-saturation on many existing medical benchmarks, underscoring the need for new, challenging benchmarks. We close with reflections on general directions for inference-time computation with LLMs.

Generalist foundation models such as GPT-4 have displayed surprising capabilities in a wide variety of domains and tasks. Yet, there is a prevalent assumption that they cannot match specialist capabilities of fine-tuned models. For example, most explorations to date on medical competency benchmarks have leveraged domain-specific training, as exemplified by efforts on BioGPT and Med-PaLM. We build on a prior study of GPT-4's capabilities on medical challenge benchmarks in the absence of special training. Rather than using simple prompting to highlight the model's out-of-the-box capabilities, we perform a systematic exploration of prompt engineering. We find that prompting innovation can unlock deeper specialist capabilities and show that GPT-4 easily tops prior leading results for medical benchmarks. The prompting methods we explore are general purpose, and make no specific use of domain expertise, removing the need for expert-curated content. Our experimental design carefully controls for overfitting during the prompt engineering process. We introduce Medprompt, based on a composition of several prompting strategies. With Medprompt, GPT-4 achieves state-of-the-art results on all nine of the benchmark datasets in the MultiMedQA suite. The method outperforms leading specialist models such as Med-PaLM 2 by a significant margin with an order of magnitude fewer calls to the model. Steering GPT-4 with Medprompt achieves a 27% reduction in error rate on the MedQA dataset over the best methods to date achieved with specialist models and surpasses a score of 90% for the first time. Beyond medical problems, we show the power of Medprompt to generalize to other domains and provide evidence for the broad applicability of the approach via studies of the strategy on exams in electrical engineering, machine learning, philosophy, accounting, law, nursing, and clinical psychology.

Recent advancements in large language models have showcased their remarkable generalizability across various domains. However, their reasoning abilities still have significant room for improvement, especially when confronted with scenarios requiring multi-step reasoning. Although large language models possess extensive knowledge, their behavior, particularly in terms of reasoning, often fails to effectively utilize this knowledge to establish a coherent thinking paradigm. Generative language models sometimes show hallucinations as their reasoning procedures are unconstrained by logical principles. Aiming to improve the zero-shot chain-of-thought reasoning ability of large language models, we propose Logical Chain-of-Thought (LogiCoT), a neurosymbolic framework that leverages principles from symbolic logic to verify and revise the reasoning processes accordingly. Experimental evaluations conducted on language tasks in diverse domains, including arithmetic, commonsense, symbolic, causal inference, and social problems, demonstrate the efficacy of the enhanced reasoning paradigm by logic.

Throughout the course of my Ph.D., I have been designing the user experience (UX) of various machine learning (ML) systems. In this workshop, I share two projects as case studies in which people engage with ML in much more complicated and nuanced ways than the technical HCML work might assume. The first case study describes how cardiology teams in three hospitals used a clinical decision-support system that helps them decide whether and when to implant an artificial heart to a heart failure patient. I demonstrate that physicians cannot draw on their decision-making experience by seeing only patient data on paper. They are also confused by some fundamental premises upon which ML operates. For example, physicians asked: Are ML predictions made based on clinicians' best efforts? Is it ethical to make decisions based on previous patients' collective outcomes? In the second case study, my collaborators and I designed an intelligent text editor, with the goal of improving authors' writing experience with NLP (Natural Language Processing) technologies. We prototyped a number of generative functionalities where the system provides phrase-or-sentence-level writing suggestions upon user request. When writing with the prototype, however, authors shared that they need to "see where the sentence is going two paragraphs later" in order to decide whether the suggestion aligns with their writing; Some even considered adopting machine suggestions as plagiarism, therefore "is simply wrong". By sharing these unexpected and intriguing responses from these real-world ML users, I hope to start a discussion about such previously-unknown complexities and nuances of -- as the workshop proposal states -- "putting ML at the service of people in a way that is accessible, useful, and trustworthy to all".

Logical reasoning is a critical component of Large Language Models (LLMs), and substantial research efforts in recent years have aimed to enhance their deductive reasoning capabilities. However, existing deductive reasoning benchmarks, which are crucial for evaluating and advancing LLMs, are inadequate due to their lack of task complexity, presence of prior knowledge as a confounder, and superficial error analysis. To address these deficiencies, we introduce JustLogic, a synthetically generated deductive reasoning benchmark designed for rigorous evaluation of LLMs. JustLogic is (i) highly complex, capable of generating a diverse range of linguistic patterns, vocabulary, and argument structures; (ii) prior knowledge independent, eliminating the advantage of models possessing prior knowledge and ensuring that only deductive reasoning is used to answer questions; and (iii) capable of in-depth error analysis on the heterogeneous effects of reasoning depth and argument form on model accuracy. Our experimental results on JustLogic reveal that most state-of-the-art (SOTA) LLMs perform significantly worse than the human average, demonstrating substantial room for model improvement. All code and data are available at https://github.com/michaelchen-lab/JustLogic

Clinical Question Answering (QA) systems enable doctors to quickly access patient information from electronic health records (EHRs). However, training these systems requires significant annotated data, which is limited due to the expertise needed and the privacy concerns associated with clinical data. This paper explores generating Clinical QA data using large language models (LLMs) in a zero-shot setting. We find that naive prompting often results in easy questions that do not reflect the complexity of clinical scenarios. To address this, we propose two prompting strategies: 1) instructing the model to generate questions that do not overlap with the input context, and 2) summarizing the input record using a predefined schema to scaffold question generation. Experiments on two Clinical QA datasets demonstrate that our method generates more challenging questions, significantly improving fine-tuning performance over baselines. We compare synthetic and gold data and find a gap between their training efficacy resulting from the quality of synthetically generated answers.

This paper introduces Typhoon T1, an open effort to develop an open Thai reasoning model. A reasoning model is a relatively new type of generative model built on top of large language models (LLMs). A reasoning model generates a long chain of thought before arriving at a final answer, an approach found to improve performance on complex tasks. However, details on developing such a model are limited, especially for reasoning models that can generate traces in a low-resource language. Typhoon T1 presents an open effort that dives into the details of developing a reasoning model in a more cost-effective way by leveraging supervised fine-tuning using open datasets, instead of reinforcement learning. This paper shares the details about synthetic data generation and training, as well as our dataset and model weights. Additionally, we provide insights gained from developing a reasoning model that generalizes across domains and is capable of generating reasoning traces in a low-resource language, using Thai as an example. We hope this open effort provides a foundation for further research in this field.

Developing the required technology to assist medical experts in their everyday activities is currently a hot topic in the Artificial Intelligence research field. Thus, a number of large language models (LLMs) and automated benchmarks have recently been proposed with the aim of facilitating information extraction in Evidence-Based Medicine (EBM) using natural language as a tool for mediating in human-AI interaction. The most representative benchmarks are limited to either multiple-choice or long-form answers and are available only in English. In order to address these shortcomings, in this paper we present a new dataset which, unlike previous work: (i) includes not only explanatory arguments for the correct answer, but also arguments to reason why the incorrect answers are not correct; (ii) the explanations are written originally by medical doctors to answer questions from the Spanish Residency Medical Exams. Furthermore, this new benchmark allows us to setup a novel extractive task which consists of identifying the explanation of the correct answer written by medical doctors. An additional benefit of our setting is that we can leverage the extractive QA paradigm to automatically evaluate performance of LLMs without resorting to costly manual evaluation by medical experts. Comprehensive experimentation with language models for Spanish shows that sometimes multilingual models fare better than monolingual ones, even outperforming models which have been adapted to the medical domain. Furthermore, results across the monolingual models are mixed, with supposedly smaller and inferior models performing competitively. In any case, the obtained results show that our novel dataset and approach can be an effective technique to help medical practitioners in identifying relevant evidence-based explanations for medical questions.

This research tests the role of Large Language Models (LLMs) as formal second opinion tools in professional decision-making, particularly focusing on complex medical cases where even experienced physicians seek peer consultation. The work analyzed 183 challenging medical cases from Medscape over a 20-month period, testing multiple LLMs' performance against crowd-sourced physician responses. A key finding was the high overall score possible in the latest foundational models (>80% accuracy compared to consensus opinion), which exceeds most human metrics reported on the same clinical cases (450 pages of patient profiles, test results). The study rates the LLMs' performance disparity between straightforward cases (>81% accuracy) and complex scenarios (43% accuracy), particularly in these cases generating substantial debate among human physicians. The research demonstrates that LLMs may be valuable as generators of comprehensive differential diagnoses rather than as primary diagnostic tools, potentially helping to counter cognitive biases in clinical decision-making, reduce cognitive loads, and thus remove some sources of medical error. The inclusion of a second comparative legal dataset (Supreme Court cases, N=21) provides added empirical context to the AI use to foster second opinions, though these legal challenges proved considerably easier for LLMs to analyze. In addition to the original contributions of empirical evidence for LLM accuracy, the research aggregated a novel benchmark for others to score highly contested question and answer reliability between both LLMs and disagreeing human practitioners. These results suggest that the optimal deployment of LLMs in professional settings may differ substantially from current approaches that emphasize automation of routine tasks.

Large language models (LLMs) have gained enormous attention from both academia and industry, due to their exceptional ability in language generation and extremely powerful generalization. However, current LLMs still output unreliable content in practical reasoning tasks due to their inherent issues (e.g., hallucination). To better disentangle this problem, in this paper, we conduct an in-depth investigation to systematically explore the capability of LLMs in logical reasoning. More in detail, we first investigate the deficiency of LLMs in logical reasoning on different tasks, including event relation extraction and deductive reasoning. Our study demonstrates that LLMs are not good reasoners in solving tasks with rigorous reasoning and will produce counterfactual answers, which require us to iteratively refine. Therefore, we comprehensively explore different strategies to endow LLMs with logical reasoning ability, and thus enable them to generate more logically consistent answers across different scenarios. Based on our approach, we also contribute a synthesized dataset (LLM-LR) involving multi-hop reasoning for evaluation and pre-training. Extensive quantitative and qualitative analyses on different tasks also validate the effectiveness and necessity of teaching LLMs with logic and provide insights for solving practical tasks with LLMs in future work.

Recent artificial intelligence (AI) systems have reached milestones in "grand challenges" ranging from Go to protein-folding. The capability to retrieve medical knowledge, reason over it, and answer medical questions comparably to physicians has long been viewed as one such grand challenge. Large language models (LLMs) have catalyzed significant progress in medical question answering; Med-PaLM was the first model to exceed a "passing" score in US Medical Licensing Examination (USMLE) style questions with a score of 67.2% on the MedQA dataset. However, this and other prior work suggested significant room for improvement, especially when models' answers were compared to clinicians' answers. Here we present Med-PaLM 2, which bridges these gaps by leveraging a combination of base LLM improvements (PaLM 2), medical domain finetuning, and prompting strategies including a novel ensemble refinement approach. Med-PaLM 2 scored up to 86.5% on the MedQA dataset, improving upon Med-PaLM by over 19% and setting a new state-of-the-art. We also observed performance approaching or exceeding state-of-the-art across MedMCQA, PubMedQA, and MMLU clinical topics datasets. We performed detailed human evaluations on long-form questions along multiple axes relevant to clinical applications. In pairwise comparative ranking of 1066 consumer medical questions, physicians preferred Med-PaLM 2 answers to those produced by physicians on eight of nine axes pertaining to clinical utility (p < 0.001). We also observed significant improvements compared to Med-PaLM on every evaluation axis (p < 0.001) on newly introduced datasets of 240 long-form "adversarial" questions to probe LLM limitations. While further studies are necessary to validate the efficacy of these models in real-world settings, these results highlight rapid progress towards physician-level performance in medical question answering.

Excellence in a wide variety of medical applications poses considerable challenges for AI, requiring advanced reasoning, access to up-to-date medical knowledge and understanding of complex multimodal data. Gemini models, with strong general capabilities in multimodal and long-context reasoning, offer exciting possibilities in medicine. Building on these core strengths of Gemini, we introduce Med-Gemini, a family of highly capable multimodal models that are specialized in medicine with the ability to seamlessly use web search, and that can be efficiently tailored to novel modalities using custom encoders. We evaluate Med-Gemini on 14 medical benchmarks, establishing new state-of-the-art (SoTA) performance on 10 of them, and surpass the GPT-4 model family on every benchmark where a direct comparison is viable, often by a wide margin. On the popular MedQA (USMLE) benchmark, our best-performing Med-Gemini model achieves SoTA performance of 91.1% accuracy, using a novel uncertainty-guided search strategy. On 7 multimodal benchmarks including NEJM Image Challenges and MMMU (health & medicine), Med-Gemini improves over GPT-4V by an average relative margin of 44.5%. We demonstrate the effectiveness of Med-Gemini's long-context capabilities through SoTA performance on a needle-in-a-haystack retrieval task from long de-identified health records and medical video question answering, surpassing prior bespoke methods using only in-context learning. Finally, Med-Gemini's performance suggests real-world utility by surpassing human experts on tasks such as medical text summarization, alongside demonstrations of promising potential for multimodal medical dialogue, medical research and education. Taken together, our results offer compelling evidence for Med-Gemini's potential, although further rigorous evaluation will be crucial before real-world deployment in this safety-critical domain.

Large Language Models (LLMs) have demonstrated significant potential in handling complex reasoning tasks through step-by-step rationale generation. However, recent studies have raised concerns regarding the hallucination and flaws in their reasoning process. Substantial efforts are being made to improve the reliability and faithfulness of the generated rationales. Some approaches model reasoning as planning, while others focus on annotating for process supervision. Nevertheless, the planning-based search process often results in high latency due to the frequent assessment of intermediate reasoning states and the extensive exploration space. Additionally, supervising the reasoning process with human annotation is costly and challenging to scale for LLM training. To address these issues, in this paper, we propose a framework to learn planning-based reasoning through direct preference optimization (DPO) on collected trajectories, which are ranked according to synthesized process rewards. Our results on challenging logical reasoning benchmarks demonstrate the effectiveness of our learning framework, showing that our 7B model can surpass the strong counterparts like GPT-3.5-Turbo.

When presented with questions involving visual thinking, humans naturally switch reasoning modalities, often forming mental images or drawing visual aids. Large language models have shown promising results in arithmetic and symbolic reasoning by expressing intermediate reasoning in text as a chain of thought, yet struggle to extend this capability to answer text queries that are easily solved by visual reasoning, even with extensive multimodal pretraining. We introduce a simple method, whiteboard-of-thought prompting, to unlock the visual reasoning capabilities of multimodal large language models across modalities. Whiteboard-of-thought prompting provides multimodal large language models with a metaphorical `whiteboard' to draw out reasoning steps as images, then returns these images back to the model for further processing. We find this can be accomplished with no demonstrations or specialized modules, instead leveraging models' existing ability to write code with libraries such as Matplotlib and Turtle. This simple approach shows state-of-the-art results on four difficult natural language tasks that involve visual and spatial reasoning. We identify multiple settings where GPT-4o using chain-of-thought fails dramatically, including more than one where it achieves 0% accuracy, while whiteboard-of-thought enables up to 92% accuracy in these same settings. We present a detailed exploration of where the technique succeeds as well as its sources of error.

This paper introduces MedExQA, a novel benchmark in medical question-answering, to evaluate large language models' (LLMs) understanding of medical knowledge through explanations. By constructing datasets across five distinct medical specialties that are underrepresented in current datasets and further incorporating multiple explanations for each question-answer pair, we address a major gap in current medical QA benchmarks which is the absence of comprehensive assessments of LLMs' ability to generate nuanced medical explanations. Our work highlights the importance of explainability in medical LLMs, proposes an effective methodology for evaluating models beyond classification accuracy, and sheds light on one specific domain, speech language pathology, where current LLMs including GPT4 lack good understanding. Our results show generation evaluation with multiple explanations aligns better with human assessment, highlighting an opportunity for a more robust automated comprehension assessment for LLMs. To diversify open-source medical LLMs (currently mostly based on Llama2), this work also proposes a new medical model, MedPhi-2, based on Phi-2 (2.7B). The model outperformed medical LLMs based on Llama2-70B in generating explanations, showing its effectiveness in the resource-constrained medical domain. We will share our benchmark datasets and the trained model.

Mathematical reasoning serves as a cornerstone for assessing the fundamental cognitive capabilities of human intelligence. In recent times, there has been a notable surge in the development of Large Language Models (LLMs) geared towards the automated resolution of mathematical problems. However, the landscape of mathematical problem types is vast and varied, with LLM-oriented techniques undergoing evaluation across diverse datasets and settings. This diversity makes it challenging to discern the true advancements and obstacles within this burgeoning field. This survey endeavors to address four pivotal dimensions: i) a comprehensive exploration of the various mathematical problems and their corresponding datasets that have been investigated; ii) an examination of the spectrum of LLM-oriented techniques that have been proposed for mathematical problem-solving; iii) an overview of factors and concerns affecting LLMs in solving math; and iv) an elucidation of the persisting challenges within this domain. To the best of our knowledge, this survey stands as one of the first extensive examinations of the landscape of LLMs in the realm of mathematics, providing a holistic perspective on the current state, accomplishments, and future challenges in this rapidly evolving field.

Large language models (LLMs) have shown remarkable reasoning capabilities given chain-of-thought prompts (examples with intermediate reasoning steps). Existing benchmarks measure reasoning ability indirectly, by evaluating accuracy on downstream tasks such as mathematical reasoning. However, it is unclear how these models obtain the answers and whether they rely on simple heuristics rather than the generated chain-of-thought. To enable systematic exploration of the reasoning ability of LLMs, we present a new synthetic question-answering dataset called PrOntoQA, where each example is generated from a synthetic world model represented in first-order logic. This allows us to parse the generated chain-of-thought into symbolic proofs for formal analysis. Our analysis on InstructGPT and GPT-3 shows that LLMs are quite capable of making correct individual deduction steps, and so are generally capable of reasoning, even in fictional contexts. However, they have difficulty with proof planning: When multiple valid deduction steps are available, they are not able to systematically explore the different options.

Logical reasoning consistently plays a fundamental and significant role in the domains of knowledge engineering and artificial intelligence. Recently, Large Language Models (LLMs) have emerged as a noteworthy innovation in natural language processing (NLP), exhibiting impressive achievements across various classic NLP tasks. However, the question of whether LLMs can effectively address the task of logical reasoning, which requires gradual cognitive inference similar to human intelligence, remains unanswered. To this end, we aim to bridge this gap and provide comprehensive evaluations in this paper. Firstly, to offer systematic evaluations, we select fifteen typical logical reasoning datasets and organize them into deductive, inductive, abductive and mixed-form reasoning settings. Considering the comprehensiveness of evaluations, we include three representative LLMs (i.e., text-davinci-003, ChatGPT and BARD) and evaluate them on all selected datasets under zero-shot, one-shot and three-shot settings. Secondly, different from previous evaluations relying only on simple metrics (e.g., accuracy), we propose fine-level evaluations from objective and subjective manners, covering both answers and explanations. Additionally, to uncover the logical flaws of LLMs, problematic cases will be attributed to five error types from two dimensions, i.e., evidence selection process and reasoning process. Thirdly, to avoid the influences of knowledge bias and purely focus on benchmarking the logical reasoning capability of LLMs, we propose a new dataset with neutral content. It contains 3,000 samples and covers deductive, inductive and abductive settings. Based on the in-depth evaluations, this paper finally forms a general evaluation scheme of logical reasoning capability from six dimensions. It reflects the pros and cons of LLMs and gives guiding directions for future works.

Emergent chain-of-thought (CoT) reasoning capabilities promise to improve performance and explainability of large language models (LLMs). However, uncertainties remain about how reasoning strategies formulated for previous model generations generalize to new model generations and different datasets. In this small-scale study, we compare different reasoning strategies induced by zero-shot prompting across six recently released LLMs (davinci-002, davinci-003, GPT-3.5-turbo, GPT-4, Flan-T5-xxl and Cohere command-xlarge) on a mixture of six question-answering datasets, including datasets from scientific and medical domains. Our findings demonstrate that while some variations in effectiveness occur, gains from CoT reasoning strategies remain robust across different models and datasets. GPT-4 has the most benefit from current state-of-the-art reasoning strategies and exhibits the best performance by applying a prompt previously discovered through automated discovery.

Analytical reasoning is an essential and challenging task that requires a system to analyze a scenario involving a set of particular circumstances and perform reasoning over it to make conclusions. In this paper, we study the challenge of analytical reasoning of text and introduce a new dataset consisting of questions from the Law School Admission Test from 1991 to 2016. We analyze what knowledge understanding and reasoning abilities are required to do well on this task. Furthermore, to address this reasoning challenge, we design two different baselines: (1) a Transformer-based method which leverages the state-of-the-art pre-trained language models and (2) Analytical Reasoning Machine (ARM), a logical-level reasoning framework extracting symbolic knowledge (e.g, participants, facts, logical functions) to deduce legitimate solutions. In our experiments, we find that the Transformer-based models struggle to solve this task as their performance is close to random guess and ARM achieves better performance by leveraging symbolic knowledge and interpretable reasoning steps. Results show that both methods still lag far behind human performance, which leave further space for future research.

The lack of transparency and explainability hinders the clinical adoption of Machine learning (ML) algorithms. While explainable artificial intelligence (XAI) methods have been proposed, little research has focused on the agreement between these methods and expert clinical knowledge. This study applies current state-of-the-art explainability methods to clinical decision support algorithms developed for Electronic Medical Records (EMR) data to analyse the concordance between these factors and discusses causes for identified discrepancies from a clinical and technical perspective. Important factors for achieving trustworthy XAI solutions for clinical decision support are also discussed.

Brief hospital course (BHC) summaries are common clinical documents generated by summarizing clinical notes. While large language models (LLMs) depict remarkable capabilities in automating real-world tasks, their capabilities for healthcare applications such as BHC synthesis have not been shown. To enable the adaptation of LLMs for BHC synthesis, we introduce a novel benchmark consisting of a pre-processed dataset extracted from MIMIC-IV notes, encapsulating clinical note, and brief hospital course (BHC) pairs. We assess the performance of two general-purpose LLMs and three healthcare-adapted LLMs to improve BHC synthesis from clinical notes. Using clinical notes as input for generating BHCs, we apply prompting-based (using in-context learning) and fine-tuning-based adaptation strategies to three open-source LLMs (Clinical-T5-Large, Llama2-13B, FLAN-UL2) and two proprietary LLMs (GPT-3.5, GPT-4). We quantitatively evaluate the performance of these LLMs across varying context-length inputs using conventional natural language similarity metrics. We further perform a qualitative study where five diverse clinicians blindly compare clinician-written BHCs and two LLM-generated BHCs for 30 samples across metrics of comprehensiveness, conciseness, factual correctness, and fluency. Overall, we present a new benchmark and pre-processed dataset for using LLMs in BHC synthesis from clinical notes. We observe high-quality summarization performance for both in-context proprietary and fine-tuned open-source LLMs using both quantitative metrics and a qualitative clinical reader study. We propose our work as a benchmark to motivate future works to adapt and assess the performance of LLMs in BHC synthesis.

Language has long been conceived as an essential tool for human reasoning. The breakthrough of Large Language Models (LLMs) has sparked significant research interest in leveraging these models to tackle complex reasoning tasks. Researchers have moved beyond simple autoregressive token generation by introducing the concept of "thought" -- a sequence of tokens representing intermediate steps in the reasoning process. This innovative paradigm enables LLMs' to mimic complex human reasoning processes, such as tree search and reflective thinking. Recently, an emerging trend of learning to reason has applied reinforcement learning (RL) to train LLMs to master reasoning processes. This approach enables the automatic generation of high-quality reasoning trajectories through trial-and-error search algorithms, significantly expanding LLMs' reasoning capacity by providing substantially more training data. Furthermore, recent studies demonstrate that encouraging LLMs to "think" with more tokens during test-time inference can further significantly boost reasoning accuracy. Therefore, the train-time and test-time scaling combined to show a new research frontier -- a path toward Large Reasoning Model. The introduction of OpenAI's o1 series marks a significant milestone in this research direction. In this survey, we present a comprehensive review of recent progress in LLM reasoning. We begin by introducing the foundational background of LLMs and then explore the key technical components driving the development of large reasoning models, with a focus on automated data construction, learning-to-reason techniques, and test-time scaling. We also analyze popular open-source projects at building large reasoning models, and conclude with open challenges and future research directions.

One of the most widely used methods to evaluate LLMs are Multiple Choice Question (MCQ) tests. MCQ benchmarks enable the testing of LLM knowledge on almost any topic at scale as the results can be processed automatically. To help the LLM answer, a few examples called few shots can be included in the prompt. Moreover, the LLM can be asked to answer the question directly with the selected option or to first provide the reasoning and then the selected answer, which is known as chain of thought. In addition to checking whether the selected answer is correct, the evaluation can look at the LLM-estimated probability of its response as an indication of the confidence of the LLM in the response. In this paper, we study how the LLM confidence in its answer depends on whether the model has been asked to answer directly or to provide the reasoning before answering. The results of the evaluation of questions on a wide range of topics in seven different models show that LLMs are more confident in their answers when they provide reasoning before the answer. This occurs regardless of whether the selected answer is correct. Our hypothesis is that this behavior is due to the reasoning that modifies the probability of the selected answer, as the LLM predicts the answer based on the input question and the reasoning that supports the selection made. Therefore, LLM estimated probabilities seem to have intrinsic limitations that should be understood in order to use them in evaluation procedures. Interestingly, the same behavior has been observed in humans, for whom explaining an answer increases confidence in its correctness.

Large language models (LLMs) have accomplished remarkable reasoning performance in various domains. However, in the domain of reasoning tasks, we discover a frailty: LLMs are surprisingly brittle to the ordering of the premises, despite the fact that such ordering does not alter the underlying task. In particular, we observe that LLMs achieve the best performance when the premise order aligns with the context required in intermediate reasoning steps. For example, in deductive reasoning tasks, presenting the premises in the same order as the ground truth proof in the prompt (as opposed to random ordering) drastically increases the model's accuracy. We first examine the effect of premise ordering on deductive reasoning on a variety of LLMs, and our evaluation shows that permuting the premise order can cause a performance drop of over 30%. In addition, we release the benchmark R-GSM, based on GSM8K, to examine the ordering effect for mathematical problem-solving, and we again observe a significant drop in accuracy, relative to the original GSM8K benchmark.

Recent research on large language models (LLMs) has primarily focused on their adaptation and application in specialized domains. The application of LLMs in the medical field is mainly concentrated on tasks such as the automation of medical report generation, summarization, diagnostic reasoning, and question-and-answer interactions between doctors and patients. The challenge of becoming a good teacher is more formidable than that of becoming a good student, and this study pioneers the application of LLMs in the field of medical education. In this work, we investigate the extent to which LLMs can generate medical qualification exam questions and corresponding answers based on few-shot prompts. Utilizing a real-world Chinese dataset of elderly chronic diseases, we tasked the LLMs with generating open-ended questions and answers based on a subset of sampled admission reports across eight widely used LLMs, including ERNIE 4, ChatGLM 4, Doubao, Hunyuan, Spark 4, Qwen, Llama 3, and Mistral. Furthermore, we engaged medical experts to manually evaluate these open-ended questions and answers across multiple dimensions. The study found that LLMs, after using few-shot prompts, can effectively mimic real-world medical qualification exam questions, whereas there is room for improvement in the correctness, evidence-based statements, and professionalism of the generated answers. Moreover, LLMs also demonstrate a decent level of ability to correct and rectify reference answers. Given the immense potential of artificial intelligence in the medical field, the task of generating questions and answers for medical qualification exams aimed at medical students, interns and residents can be a significant focus of future research.

It is a common practice for recent works in vision language cross-modal reasoning to adopt a binary or multi-choice classification formulation taking as input a set of source image(s) and textual query. In this work, we take a sober look at such an unconditional formulation in the sense that no prior knowledge is specified with respect to the source image(s). Inspired by the designs of both visual commonsense reasoning and natural language inference tasks, we propose a new task termed Premise-based Multi-modal Reasoning(PMR) where a textual premise is the background presumption on each source image. The PMR dataset contains 15,360 manually annotated samples which are created by a multi-phase crowd-sourcing process. With selected high-quality movie screenshots and human-curated premise templates from 6 pre-defined categories, we ask crowd-source workers to write one true hypothesis and three distractors (4 choices) given the premise and image through a cross-check procedure. Besides, we generate adversarial samples to alleviate the annotation artifacts and double the size of PMR. We benchmark various state-of-the-art (pretrained) multi-modal inference models on PMR and conduct comprehensive experimental analyses to showcase the utility of our dataset.

The capabilities and limitations of Large Language Models have been sketched out in great detail in recent years, providing an intriguing yet conflicting picture. On the one hand, LLMs demonstrate a general ability to solve problems. On the other hand, they show surprising reasoning gaps when compared to humans, casting doubt on the robustness of their generalisation strategies. The sheer volume of data used in the design of LLMs has precluded us from applying the method traditionally used to measure generalisation: train-test set separation. To overcome this, we study what kind of generalisation strategies LLMs employ when performing reasoning tasks by investigating the pretraining data they rely on. For two models of different sizes (7B and 35B) and 2.5B of their pretraining tokens, we identify what documents influence the model outputs for three simple mathematical reasoning tasks and contrast this to the data that are influential for answering factual questions. We find that, while the models rely on mostly distinct sets of data for each factual question, a document often has a similar influence across different reasoning questions within the same task, indicating the presence of procedural knowledge. We further find that the answers to factual questions often show up in the most influential data. However, for reasoning questions the answers usually do not show up as highly influential, nor do the answers to the intermediate reasoning steps. When we characterise the top ranked documents for the reasoning questions qualitatively, we confirm that the influential documents often contain procedural knowledge, like demonstrating how to obtain a solution using formulae or code. Our findings indicate that the approach to reasoning the models use is unlike retrieval, and more like a generalisable strategy that synthesises procedural knowledge from documents doing a similar form of reasoning.

Recent advances in generative models, including large language models (LLMs), vision language models (VLMs), and diffusion models, have accelerated the field of natural language and image processing in medicine and marked a significant paradigm shift in how biomedical models can be developed and deployed. While these models are highly adaptable to new tasks, scaling and evaluating their usage presents new challenges not addressed in previous frameworks. In particular, the ability of these models to produce useful outputs with little to no specialized training data ("zero-" or "few-shot" approaches), as well as the open-ended nature of their outputs, necessitate the development of new guidelines for robust reporting of clinical generative model research. In response to gaps in standards and best practices for the development of clinical AI tools identified by US Executive Order 141103 and several emerging national networks for clinical AI evaluation, we begin to formalize some of these guidelines by building on the original MI-CLAIM checklist. The new checklist, MI-CLAIM-GEN (Table 1), aims to address differences in training, evaluation, interpretability, and reproducibility of new generative models compared to non-generative ("predictive") AI models. This MI-CLAIM-GEN checklist also seeks to clarify cohort selection reporting with unstructured clinical data and adds additional items on alignment with ethical standards for clinical AI research.

Factuality can play an important role when automatically processing clinical text, as it makes a difference if particular symptoms are explicitly not present, possibly present, not mentioned, or affirmed. In most cases, a sufficient number of examples is necessary to handle such phenomena in a supervised machine learning setting. However, as clinical text might contain sensitive information, data cannot be easily shared. In the context of factuality detection, this work presents a simple solution using machine translation to translate English data to German to train a transformer-based factuality detection model.

Logical reading comprehension is a challenging task that entails grasping the underlying semantics of text and applying reasoning to deduce the correct answer. Prior researches have primarily focused on enhancing logical reasoning capabilities through Chain-of-Thought (CoT) or data augmentation. However, previous work constructing chain-of-thought rationales concentrates solely on analyzing correct options, neglecting the incorrect alternatives. Addtionally, earlier efforts on data augmentation by altering contexts rely on rule-based methods, which result in generated contexts that lack diversity and coherence. To address these issues, we propose a Premise-Oriented Data Augmentation (PODA) framework. This framework can generate CoT rationales including analyses for both correct and incorrect options, while constructing diverse and high-quality counterfactual contexts from incorrect candidate options. We integrate summarizing premises and identifying premises for each option into rationales. Subsequently, we employ multi-step prompts with identified premises to construct counterfactual context. To facilitate the model's capabilities to better differentiate the reasoning process associated with each option, we introduce a novel thought-path contrastive learning method that compares reasoning paths between the original and counterfactual samples. Experimental results on three representative LLMs demonstrate that our method can improve the baselines substantially across two challenging logical reasoning benchmarks (ReClor and LogiQA 2.0). The data and code are released at https://github.com/lalalamdbf/TPReasoner.

Large language models (LLMs) have shown increasing capability in problem-solving and decision-making, largely based on the step-by-step chain-of-thought reasoning processes. However, it has been increasingly challenging to evaluate the reasoning capability of LLMs. Concretely, existing outcome-based benchmarks begin to saturate and become less sufficient to monitor the progress. To this end, we present a process-based benchmark MR-BEN that demands a meta reasoning skill, where LMs are asked to locate and analyse potential errors in automatically generated reasoning steps. MR-BEN is a comprehensive benchmark comprising 5,975 questions collected from human experts, covering various subjects such as physics, chemistry, logic, coding, and more. Through our designed metrics for assessing meta-reasoning on this benchmark, we identify interesting limitations and weaknesses of current LLMs (open-source and closed-source models). For example, open-source models are seemingly comparable to GPT-4 on outcome-based benchmarks, but they lag far behind on our benchmark, revealing the underlying reasoning capability gap between them. Our dataset and codes are available on https://randolph-zeng.github.io/Mr-Ben.github.io/.

Large language models (LLMs) represent a transformative class of AI tools capable of revolutionizing various aspects of healthcare by generating human-like responses across diverse contexts and adapting to novel tasks following human instructions. Their potential application spans a broad range of medical tasks, such as clinical documentation, matching patients to clinical trials, and answering medical questions. In this primer paper, we propose an actionable guideline to help healthcare professionals more efficiently utilize LLMs in their work, along with a set of best practices. This approach consists of several main phases, including formulating the task, choosing LLMs, prompt engineering, fine-tuning, and deployment. We start with the discussion of critical considerations in identifying healthcare tasks that align with the core capabilities of LLMs and selecting models based on the selected task and data, performance requirements, and model interface. We then review the strategies, such as prompt engineering and fine-tuning, to adapt standard LLMs to specialized medical tasks. Deployment considerations, including regulatory compliance, ethical guidelines, and continuous monitoring for fairness and bias, are also discussed. By providing a structured step-by-step methodology, this tutorial aims to equip healthcare professionals with the tools necessary to effectively integrate LLMs into clinical practice, ensuring that these powerful technologies are applied in a safe, reliable, and impactful manner.

Recently, with the chain of thought (CoT) prompting, large language models (LLMs), e.g., GPT-3, have shown strong reasoning ability in several natural language processing tasks such as arithmetic, commonsense, and logical reasoning. However, LLMs with CoT require multi-step prompting and multi-token prediction, which is highly sensitive to individual mistakes and vulnerable to error accumulation. The above issues make the LLMs need the ability to verify the answers. In fact, after inferring conclusions in some thinking decision tasks, people often check them by re-verifying steps to avoid some mistakes. In this paper, we propose and prove that LLMs also have similar self-verification abilities. We take the conclusion obtained by CoT as one of the conditions for solving the original problem. By taking turns masking the original conditions and predicting their results, we calculate an explainable answer verification score based on whether the re-predicted conditions are correct. Experimental results demonstrate that the proposed method can improve the reasoning performance on various arithmetic, commonsense, and logical reasoning datasets. Our code is publicly available at: https://github.com/WENGSYX/Self-Verification.

In recent advancements, multimodal large language models (MLLMs) have been fine-tuned on specific medical image datasets to address medical visual question answering (Med-VQA) tasks. However, this common approach of task-specific fine-tuning is costly and necessitates separate models for each downstream task, limiting the exploration of zero-shot capabilities. In this paper, we introduce MC-CoT, a modular cross-modal collaboration Chain-of-Thought (CoT) framework designed to enhance the zero-shot performance of MLLMs in Med-VQA by leveraging large language models (LLMs). MC-CoT improves reasoning and information extraction by integrating medical knowledge and task-specific guidance, where LLM provides various complex medical reasoning chains and MLLM provides various observations of medical images based on instructions of the LLM. Our experiments on datasets such as SLAKE, VQA-RAD, and PATH-VQA show that MC-CoT surpasses standalone MLLMs and various multimodality CoT frameworks in recall rate and accuracy. These findings highlight the importance of incorporating background information and detailed guidance in addressing complex zero-shot Med-VQA tasks.

Abstract reasoning is a key ability for an intelligent system. Large language models achieve above-chance performance on abstract reasoning tasks, but exhibit many imperfections. However, human abstract reasoning is also imperfect, and depends on our knowledge and beliefs about the content of the reasoning problem. For example, humans reason much more reliably about logical rules that are grounded in everyday situations than arbitrary rules about abstract attributes. The training experiences of language models similarly endow them with prior expectations that reflect human knowledge and beliefs. We therefore hypothesized that language models would show human-like content effects on abstract reasoning problems. We explored this hypothesis across three logical reasoning tasks: natural language inference, judging the logical validity of syllogisms, and the Wason selection task (Wason, 1968). We find that state of the art large language models (with 7 or 70 billion parameters; Hoffman et al., 2022) reflect many of the same patterns observed in humans across these tasks -- like humans, models reason more effectively about believable situations than unrealistic or abstract ones. Our findings have implications for understanding both these cognitive effects, and the factors that contribute to language model performance.

Recent scholarship on reasoning in LLMs has supplied evidence of impressive performance and flexible adaptation to machine generated or human feedback. Nonmonotonic reasoning, crucial to human cognition for navigating the real world, remains a challenging, yet understudied task. In this work, we study nonmonotonic reasoning capabilities of seven state-of-the-art LLMs in one abstract and one commonsense reasoning task featuring generics, such as 'Birds fly', and exceptions, 'Penguins don't fly' (see Fig. 1). While LLMs exhibit reasoning patterns in accordance with human nonmonotonic reasoning abilities, they fail to maintain stable beliefs on truth conditions of generics at the addition of supporting examples ('Owls fly') or unrelated information ('Lions have manes'). Our findings highlight pitfalls in attributing human reasoning behaviours to LLMs, as well as assessing general capabilities, while consistent reasoning remains elusive.

Logical reasoning is central to human cognition and intelligence. Past research of logical reasoning within AI uses formal language as knowledge representation~(and symbolic reasoners). However, reasoning with formal language has proved challenging~(e.g., brittleness and knowledge-acquisition bottleneck). This paper provides a comprehensive overview on a new paradigm of logical reasoning, which uses natural language as knowledge representation~(and pretrained language models as reasoners), including philosophical definition and categorization of logical reasoning, advantages of the new paradigm, benchmarks and methods, challenges of the new paradigm, desirable tasks & methods in the future, and relation to related NLP fields. This new paradigm is promising since it not only alleviates many challenges of formal representation but also has advantages over end-to-end neural methods.

Logical reasoning remains a challenge for natural language processing, but it can be improved by training language models to mimic theorem provers on procedurally generated problems. Previous work used domain-specific proof generation algorithms, which biases reasoning toward specific proof traces and limits auditability and extensibility. We present a simpler and more general declarative framework with flexible context-sensitive rules binding multiple languages (specifically, simplified English and the TPTP theorem-proving language). We construct first-order logic problems by selecting up to 32 premises and one hypothesis. We demonstrate that using semantic constraints during generation and careful English verbalization of predicates enhances logical reasoning without hurting natural English tasks. We use relatively small DeBERTa-v3 models to achieve state-of-the-art accuracy on the FOLIO human-authored logic dataset, surpassing GPT-4 in accuracy with or without an external solver by 12%.

The advancement of natural language processing (NLP) systems in healthcare hinges on language model ability to interpret the intricate information contained within clinical notes. This process often requires integrating information from various time points in a patient's medical history. However, most earlier clinical language models were pretrained with a context length limited to roughly one clinical document. In this study, We introduce ClinicalMamba, a specialized version of the Mamba language model, pretrained on a vast corpus of longitudinal clinical notes to address the unique linguistic characteristics and information processing needs of the medical domain. ClinicalMamba, with 130 million and 2.8 billion parameters, demonstrates a superior performance in modeling clinical language across extended text lengths compared to Mamba and clinical Llama. With few-shot learning, ClinicalMamba achieves notable benchmarks in speed and accuracy, outperforming existing clinical language models and general domain large models like GPT-4 in longitudinal clinical notes information extraction tasks.

Recently, large language model (LLM) based artificial intelligence (AI) systems have demonstrated remarkable capabilities in natural language understanding and generation. However, these models face a significant challenge when it comes to sensitive applications, such as reasoning over medical knowledge and answering medical questions in a physician-like manner. Prior studies attempted to overcome this challenge by increasing the model size (>100B) to learn more general medical knowledge, while there is still room for improvement in LLMs with smaller-scale model sizes (<100B). In this work, we start from a pre-trained general LLM model (AntGLM-10B) and fine-tune it from a medical beginner towards a medical expert (called AntGLM-Med-10B), which leverages a 3-stage optimization procedure, i.e., general medical knowledge injection, medical domain instruction tuning, and specific medical task adaptation. Our contributions are threefold: (1) We specifically investigate how to adapt a pre-trained general LLM in medical domain, especially for a specific medical task. (2) We collect and construct large-scale medical datasets for each stage of the optimization process. These datasets encompass various data types and tasks, such as question-answering, medical reasoning, multi-choice questions, and medical conversations. (3) Specifically for multi-choice questions in the medical domain, we propose a novel Verification-of-Choice approach for prompting engineering, which significantly enhances the reasoning ability of LLMs. Remarkably, by combining the above approaches, our AntGLM-Med-10B model can outperform the most of LLMs on PubMedQA, including both general and medical LLMs, even when these LLMs have larger model size.

Multi-modal Large Language Models (MLLMs) are increasingly prominent in the field of artificial intelligence. These models not only excel in traditional vision-language tasks but also demonstrate impressive performance in contemporary multi-modal benchmarks. Although many of these benchmarks attempt to holistically evaluate MLLMs, they typically concentrate on basic reasoning tasks, often yielding only simple yes/no or multi-choice responses. These methods naturally lead to confusion and difficulties in conclusively determining the reasoning capabilities of MLLMs. To mitigate this issue, we manually curate a benchmark dataset specifically designed for MLLMs, with a focus on complex reasoning tasks. Our benchmark comprises three key reasoning categories: deductive, abductive, and analogical reasoning. The queries in our dataset are intentionally constructed to engage the reasoning capabilities of MLLMs in the process of generating answers. For a fair comparison across various MLLMs, we incorporate intermediate reasoning steps into our evaluation criteria. In instances where an MLLM is unable to produce a definitive answer, its reasoning ability is evaluated by requesting intermediate reasoning steps. If these steps align with our manual annotations, appropriate scores are assigned. This evaluation scheme resembles methods commonly used in human assessments, such as exams or assignments, and represents what we consider a more effective assessment technique compared with existing benchmarks. We evaluate a selection of representative MLLMs using this rigorously developed open-ended multi-step elaborate reasoning benchmark, designed to challenge and accurately measure their reasoning capabilities. The code and data will be released at https://core-mm.github.io/

Clinicians spend a significant amount of time reviewing medical images and transcribing their findings regarding patient diagnosis, referral and treatment in text form. Vision-language models (VLMs), which automatically interpret images and summarize their findings as text, have enormous potential to alleviate clinical workloads and increase patient access to high-quality medical care. While foundational models have stirred considerable interest in the medical community, it is unclear whether their general capabilities translate to real-world clinical utility. In this work, we show that foundation VLMs markedly underperform compared to practicing ophthalmologists on specialist tasks crucial to the care of patients with age-related macular degeneration (AMD). To address this, we initially identified the essential capabilities required for image-based clinical decision-making, and then developed a curriculum to selectively train VLMs in these skills. The resulting model, RetinaVLM, can be instructed to write reports that significantly outperform those written by leading foundation medical VLMs in disease staging (F1 score of 0.63 vs. 0.11) and patient referral (0.67 vs. 0.39), and approaches the diagnostic performance of junior ophthalmologists (who achieve 0.77 and 0.78 on the respective tasks). Furthermore, in a reader study involving two senior ophthalmologists with up to 32 years of experience, RetinaVLM's reports were found to be similarly correct (78.6% vs. 82.1%) and complete (both 78.6%) as reports written by junior ophthalmologists with up to 10 years of experience. These results demonstrate that our curriculum-based approach provides a blueprint for specializing generalist foundation medical VLMs to handle real-world clinical tasks.

Logical reasoning is a fundamental aspect of human intelligence and a key component of tasks like problem-solving and decision-making. Recent advancements have enabled Large Language Models (LLMs) to potentially exhibit reasoning capabilities, but complex logical reasoning remains a challenge. The state-of-the-art, solver-augmented language models, use LLMs to parse natural language logical questions into symbolic representations first and then adopt external logical solvers to take in the symbolic representations and output the answers. Despite their impressive performance, any parsing errors will inevitably result in the failure of the execution of the external logical solver and no answer to the logical questions. In this paper, we introduce LoGiPT, a novel language model that directly emulates the reasoning processes of logical solvers and bypasses the parsing errors by learning to strict adherence to solver syntax and grammar. LoGiPT is fine-tuned on a newly constructed instruction-tuning dataset derived from revealing and refining the invisible reasoning process of deductive solvers. Experimental results on two public deductive reasoning datasets demonstrate that LoGiPT outperforms state-of-the-art solver-augmented LMs and few-shot prompting methods on competitive LLMs like ChatGPT or GPT-4.

Recent literature uses language to build foundation models for audio. These Audio-Language Models (ALMs) are trained on a vast number of audio-text pairs and show remarkable performance in tasks including Text-to-Audio Retrieval, Captioning, and Question Answering. However, their ability to engage in more complex open-ended tasks, like Interactive Question-Answering, requires proficiency in logical reasoning -- a skill not yet benchmarked. We introduce the novel task of Audio Entailment to evaluate an ALM's deductive reasoning ability. This task assesses whether a text description (hypothesis) of audio content can be deduced from an audio recording (premise), with potential conclusions being entailment, neutral, or contradiction, depending on the sufficiency of the evidence. We create two datasets for this task with audio recordings sourced from two audio captioning datasets -- AudioCaps and Clotho -- and hypotheses generated using Large Language Models (LLMs). We benchmark state-of-the-art ALMs and find deficiencies in logical reasoning with both zero-shot and linear probe evaluations. Finally, we propose "caption-before-reason", an intermediate step of captioning that improves the zero-shot and linear-probe performance of ALMs by an absolute 6% and 3%, respectively.

Summarization of clinical narratives is a long-standing research problem. Here, we introduce the task of hospital-course summarization. Given the documentation authored throughout a patient's hospitalization, generate a paragraph that tells the story of the patient admission. We construct an English, text-to-text dataset of 109,000 hospitalizations (2M source notes) and their corresponding summary proxy: the clinician-authored "Brief Hospital Course" paragraph written as part of a discharge note. Exploratory analyses reveal that the BHC paragraphs are highly abstractive with some long extracted fragments; are concise yet comprehensive; differ in style and content organization from the source notes; exhibit minimal lexical cohesion; and represent silver-standard references. Our analysis identifies multiple implications for modeling this complex, multi-document summarization task.

Although contemporary large language models (LMs) demonstrate impressive question-answering capabilities, their answers are typically the product of a single call to the model. This entails an unwelcome degree of opacity and compromises performance, especially on problems that are inherently multi-step. To address these limitations, we show how LMs can be made to perform faithful multi-step reasoning via a process whose causal structure mirrors the underlying logical structure of the problem. Our approach works by chaining together reasoning steps, where each step results from calls to two fine-tuned LMs, one for selection and one for inference, to produce a valid reasoning trace. Our method carries out a beam search through the space of reasoning traces to improve reasoning quality. We demonstrate the effectiveness of our model on multi-step logical deduction and scientific question-answering, showing that it outperforms baselines on final answer accuracy, and generates humanly interpretable reasoning traces whose validity can be checked by the user.

This article reports the results of a study examining the ability of legal and non-legal Large Language Models to perform legal analysis using the Issue-Rule-Application-Conclusion framework. LLMs were tested on legal reasoning tasks involving rule analysis and analogical reasoning. The results show that LLMs can conduct basic IRAC analysis, but are limited by brief responses lacking detail, an inability to commit to answers, false confidence, and hallucinations. The study compares legal and nonlegal LLMs, identifies shortcomings, and explores traits that may hinder their ability to think like a lawyer. It also discusses the implications for legal education and practice, highlighting the need for critical thinking skills in future lawyers and the potential pitfalls of overreliance on artificial intelligence AI resulting in a loss of logic, reasoning, and critical thinking skills.

Large Language Models (LLMs) have the potential of facilitating the development of Artificial Intelligence technology to assist medical experts for interactive decision support, which has been demonstrated by their competitive performances in Medical QA. However, while impressive, the required quality bar for medical applications remains far from being achieved. Currently, LLMs remain challenged by outdated knowledge and by their tendency to generate hallucinated content. Furthermore, most benchmarks to assess medical knowledge lack reference gold explanations which means that it is not possible to evaluate the reasoning of LLMs predictions. Finally, the situation is particularly grim if we consider benchmarking LLMs for languages other than English which remains, as far as we know, a totally neglected topic. In order to address these shortcomings, in this paper we present MedExpQA, the first multilingual benchmark based on medical exams to evaluate LLMs in Medical Question Answering. To the best of our knowledge, MedExpQA includes for the first time reference gold explanations written by medical doctors which can be leveraged to establish various gold-based upper-bounds for comparison with LLMs performance. Comprehensive multilingual experimentation using both the gold reference explanations and Retrieval Augmented Generation (RAG) approaches show that performance of LLMs still has large room for improvement, especially for languages other than English. Furthermore, and despite using state-of-the-art RAG methods, our results also demonstrate the difficulty of obtaining and integrating readily available medical knowledge that may positively impact results on downstream evaluations for Medical Question Answering. So far the benchmark is available in four languages, but we hope that this work may encourage further development to other languages.

Mathematical reasoning is regarded as a necessary ability for Language Models (LMs). Recent works demonstrate large LMs' impressive performance in solving math problems. The success is attributed to their Chain-of-Thought (CoT) reasoning abilities, i.e., the ability to decompose complex questions into step-by-step reasoning chains, but such ability seems only to emerge from models with abundant parameters. This work investigates how to incorporate relatively small LMs with the capabilities of multi-step reasoning. We propose to inject such abilities by continually pre-training LMs on a synthetic dataset MsAT which is composed of Multi-step Arithmetic Tasks. Our experiments on four math word problem datasets show the effectiveness of the proposed method in enhancing LMs' math reasoning abilities.

Vision-Language Models (VLMs) such as GPT-4V have recently demonstrated incredible strides on diverse vision language tasks. We dig into vision-based deductive reasoning, a more sophisticated but less explored realm, and find previously unexposed blindspots in the current SOTA VLMs. Specifically, we leverage Raven's Progressive Matrices (RPMs), to assess VLMs' abilities to perform multi-hop relational and deductive reasoning relying solely on visual clues. We perform comprehensive evaluations of several popular VLMs employing standard strategies such as in-context learning, self-consistency, and Chain-of-thoughts (CoT) on three diverse datasets, including the Mensa IQ test, IntelligenceTest, and RAVEN. The results reveal that despite the impressive capabilities of LLMs in text-based reasoning, we are still far from achieving comparable proficiency in visual deductive reasoning. We found that certain standard strategies that are effective when applied to LLMs do not seamlessly translate to the challenges presented by visual reasoning tasks. Moreover, a detailed analysis reveals that VLMs struggle to solve these tasks mainly because they are unable to perceive and comprehend multiple, confounding abstract patterns in RPM examples.

Extracting causal relationships from observed correlations is a growing area in probabilistic reasoning, originating with the seminal work of Pearl and others from the early 1990s. This paper develops a new, categorically oriented view based on a clear distinction between syntax (string diagrams) and semantics (stochastic matrices), connected via interpretations as structure-preserving functors. A key notion in the identification of causal effects is that of an intervention, whereby a variable is forcefully set to a particular value independent of any prior propensities. We represent the effect of such an intervention as an endofunctor which performs `string diagram surgery' within the syntactic category of string diagrams. This diagram surgery in turn yields a new, interventional distribution via the interpretation functor. While in general there is no way to compute interventional distributions purely from observed data, we show that this is possible in certain special cases using a calculational tool called comb disintegration. We demonstrate the use of this technique on a well-known toy example, where we predict the causal effect of smoking on cancer in the presence of a confounding common cause. After developing this specific example, we show this technique provides simple sufficient conditions for computing interventions which apply to a wide variety of situations considered in the causal inference literature.

This study presents a novel learning approach designed to enhance both mathematical reasoning and problem-solving abilities of Large Language Models (LLMs). We focus on integrating the Chain-of-Thought (CoT) and the Program-of-Thought (PoT) learning, hypothesizing that prioritizing the learning of mathematical reasoning ability is helpful for the amplification of problem-solving ability. Thus, the initial learning with CoT is essential for solving challenging mathematical problems. To this end, we propose a sequential learning approach, named SAAS (Solving Ability Amplification Strategy), which strategically transitions from CoT learning to PoT learning. Our empirical study, involving an extensive performance comparison using several benchmarks, demonstrates that our SAAS achieves state-of-the-art (SOTA) performance. The results underscore the effectiveness of our sequential learning approach, marking a significant advancement in the field of mathematical reasoning in LLMs.

Large-scale pre-trained language models (PLMs) bring new opportunities to challenging problems, especially those that need high-level intelligence, such as the math word problem (MWPs). However, directly applying existing PLMs to MWPs can fail as the generation process lacks sufficient supervision and thus lacks fast adaptivity as humans. We notice that human reasoning has a dual reasoning framework that consists of an immediate reaction system (system 1) and a delicate reasoning system (system 2), where the entire reasoning is determined by their interaction. This inspires us to develop a cooperative reasoning-induced PLM for solving MWPs, called Cooperative Reasoning (CoRe), resulting in a human-like reasoning architecture with system 1 as the generator and system 2 as the verifier. In our approach, the generator is responsible for generating reasoning paths, and the verifiers are used to supervise the evaluation in order to obtain reliable feedback for the generator. We evaluate our CoRe framework on several mathematical reasoning datasets and achieve decent improvement over state-of-the-art methods, up to 9.6% increase over best baselines. Our codes are available at https://github.com/TianHongZXY/CoRe

Reasoning encompasses two typical types: deductive reasoning and inductive reasoning. Despite extensive research into the reasoning capabilities of Large Language Models (LLMs), most studies have failed to rigorously differentiate between inductive and deductive reasoning, leading to a blending of the two. This raises an essential question: In LLM reasoning, which poses a greater challenge - deductive or inductive reasoning? While the deductive reasoning capabilities of LLMs, (i.e. their capacity to follow instructions in reasoning tasks), have received considerable attention, their abilities in true inductive reasoning remain largely unexplored. To investigate into the true inductive reasoning capabilities of LLMs, we propose a novel framework, SolverLearner. This framework enables LLMs to learn the underlying function (i.e., y = f_w(x)), that maps input data points (x) to their corresponding output values (y), using only in-context examples. By focusing on inductive reasoning and separating it from LLM-based deductive reasoning, we can isolate and investigate inductive reasoning of LLMs in its pure form via SolverLearner. Our observations reveal that LLMs demonstrate remarkable inductive reasoning capabilities through SolverLearner, achieving near-perfect performance with ACC of 1 in most cases. Surprisingly, despite their strong inductive reasoning abilities, LLMs tend to relatively lack deductive reasoning capabilities, particularly in tasks involving ``counterfactual'' reasoning.

Visual mathematical reasoning, as a fundamental visual reasoning ability, has received widespread attention from the Large Multimodal Models (LMMs) community. Existing benchmarks, such as MathVista and MathVerse, focus more on the result-oriented performance but neglect the underlying principles in knowledge acquisition and generalization. Inspired by human-like mathematical reasoning, we introduce WE-MATH, the first benchmark specifically designed to explore the problem-solving principles beyond end-to-end performance. We meticulously collect and categorize 6.5K visual math problems, spanning 67 hierarchical knowledge concepts and five layers of knowledge granularity. We decompose composite problems into sub-problems according to the required knowledge concepts and introduce a novel four-dimensional metric, namely Insufficient Knowledge (IK), Inadequate Generalization (IG), Complete Mastery (CM), and Rote Memorization (RM), to hierarchically assess inherent issues in LMMs' reasoning process. With WE-MATH, we conduct a thorough evaluation of existing LMMs in visual mathematical reasoning and reveal a negative correlation between solving steps and problem-specific performance. We confirm the IK issue of LMMs can be effectively improved via knowledge augmentation strategies. More notably, the primary challenge of GPT-4o has significantly transitioned from IK to IG, establishing it as the first LMM advancing towards the knowledge generalization stage. In contrast, other LMMs exhibit a marked inclination towards Rote Memorization - they correctly solve composite problems involving multiple knowledge concepts yet fail to answer sub-problems. We anticipate that WE-MATH will open new pathways for advancements in visual mathematical reasoning for LMMs. The WE-MATH data and evaluation code are available at https://github.com/We-Math/We-Math.

As mental health care systems worldwide struggle to meet demand, there is increasing focus on using language models to infer neuropsychiatric conditions or psychopathological traits from language production. Yet, so far, this research has only delivered solutions with limited clinical applicability, due to insufficient consideration of ethical questions crucial to ensuring the synergy between possible applications and model design. To accelerate progress towards clinically applicable models, our paper charts the ethical landscape of research on language-based inference of psychopathology and provides a practical tool for researchers to navigate it. We identify seven core ethical principles that should guide model development and deployment in this domain, translate them into ELLIPS, an ethical toolkit operationalizing these principles into questions that can guide researchers' choices with respect to data selection, architectures, evaluation, and model deployment, and provide a case study exemplifying its use. With this, we aim to facilitate the emergence of model technology with concrete potential for real-world applicability.

Like other fields of Traditional Medicines, Unani Medicines have been found as an effective medical practice for ages. It is still widely used in the subcontinent, particularly in Pakistan and India. However, Unani Medicines Practitioners are lacking modern IT applications in their everyday clinical practices. An Online Clinical Decision Support System may address this challenge to assist apprentice Unani Medicines practitioners in their diagnostic processes. The proposed system provides a web-based interface to enter the patient's symptoms, which are then automatically analyzed by our system to generate a list of probable diseases. The system allows practitioners to choose the most likely disease and inform patients about the associated treatment options remotely. The system consists of three modules: an Online Clinical Decision Support System, an Artificial Intelligence Inference Engine, and a comprehensive Unani Medicines Database. The system employs advanced AI techniques such as Decision Trees, Deep Learning, and Natural Language Processing. For system development, the project team used a technology stack that includes React, FastAPI, and MySQL. Data and functionality of the application is exposed using APIs for integration and extension with similar domain applications. The novelty of the project is that it addresses the challenge of diagnosing diseases accurately and efficiently in the context of Unani Medicines principles. By leveraging the power of technology, the proposed Clinical Decision Support System has the potential to ease access to healthcare services and information, reduce cost, boost practitioner and patient satisfaction, improve speed and accuracy of the diagnostic process, and provide effective treatments remotely. The application will be useful for Unani Medicines Practitioners, Patients, Government Drug Regulators, Software Developers, and Medical Researchers.

Hallucinations (i.e., generating plausible but inaccurate content) and laziness (i.e. excessive refusals or defaulting to "I don't know") persist as major challenges in LLM reasoning. Current efforts to reduce hallucinations primarily focus on factual errors in knowledge-grounded tasks, often neglecting hallucinations related to faulty reasoning. Meanwhile, some approaches render LLMs overly conservative, limiting their problem-solving capabilities. To mitigate hallucination and laziness in reasoning tasks, we propose Automatic Curriculum Expert Iteration (Auto-CEI) to enhance LLM reasoning and align responses to the model's capabilities--assertively answering within its limits and declining when tasks exceed them. In our method, Expert Iteration explores the reasoning trajectories near the LLM policy, guiding incorrect paths back on track to reduce compounding errors and improve robustness; it also promotes appropriate "I don't know" responses after sufficient reasoning attempts. The curriculum automatically adjusts rewards, incentivizing extended reasoning before acknowledging incapability, thereby pushing the limits of LLM reasoning and aligning its behaviour with these limits. We compare Auto-CEI with various SOTA baselines across logical reasoning, mathematics, and planning tasks, where Auto-CEI achieves superior alignment by effectively balancing assertiveness and conservativeness.

Large Language Models (LLMs) exhibit impressive performance across various domains but still struggle with arithmetic reasoning tasks. Recent work shows the effectiveness of prompt design methods in enhancing reasoning capabilities. However, these approaches overlook crucial requirements for prior knowledge of specific concepts, theorems, and tricks to tackle most arithmetic reasoning problems successfully. To address this issue, we propose a novel and effective Teaching-Inspired Integrated Framework, which emulates the instructional process of a teacher guiding students. This method equips LLMs with essential concepts, relevant theorems, and similar problems with analogous solution approaches, facilitating the enhancement of reasoning abilities. Additionally, we introduce two new Chinese datasets, MathMC and MathToF, both with detailed explanations and answers. Experiments are conducted on nine benchmarks which demonstrates that our approach improves the reasoning accuracy of LLMs. With GPT-4 and our framework, we achieve new state-of-the-art performance on four math benchmarks (AddSub, SVAMP, Math23K and AQuA) with accuracies of 98.2% (+3.3%), 93.9% (+0.2%), 94.3% (+7.2%) and 81.1% (+1.2%). Our data and code are available at https://github.com/SallyTan13/Teaching-Inspired-Prompting.

Reasoning is a fundamental component for achieving language understanding. Among the multiple types of reasoning, conditional reasoning, the ability to draw different conclusions depending on some condition, has been understudied in large language models (LLMs). Recent prompting methods, such as chain of thought, have significantly improved LLMs on reasoning tasks. Nevertheless, there is still little understanding of what triggers reasoning abilities in LLMs. We hypothesize that code prompts can trigger conditional reasoning in LLMs trained on text and code. We propose a chain of prompts that transforms a natural language problem into code and prompts the LLM with the generated code. Our experiments find that code prompts exhibit a performance boost between 2.6 and 7.7 points on GPT 3.5 across multiple datasets requiring conditional reasoning. We then conduct experiments to discover how code prompts elicit conditional reasoning abilities and through which features. We observe that prompts need to contain natural language text accompanied by high-quality code that closely represents the semantics of the instance text. Furthermore, we show that code prompts are more efficient, requiring fewer demonstrations, and that they trigger superior state tracking of variables or key entities.

The evolution of Artificial Intelligence (AI) has been significantly accelerated by advancements in Large Language Models (LLMs) and Large Multimodal Models (LMMs), gradually showcasing potential cognitive reasoning abilities in problem-solving and scientific discovery (i.e., AI4Science) once exclusive to human intellect. To comprehensively evaluate current models' performance in cognitive reasoning abilities, we introduce OlympicArena, which includes 11,163 bilingual problems across both text-only and interleaved text-image modalities. These challenges encompass a wide range of disciplines spanning seven fields and 62 international Olympic competitions, rigorously examined for data leakage. We argue that the challenges in Olympic competition problems are ideal for evaluating AI's cognitive reasoning due to their complexity and interdisciplinary nature, which are essential for tackling complex scientific challenges and facilitating discoveries. Beyond evaluating performance across various disciplines using answer-only criteria, we conduct detailed experiments and analyses from multiple perspectives. We delve into the models' cognitive reasoning abilities, their performance across different modalities, and their outcomes in process-level evaluations, which are vital for tasks requiring complex reasoning with lengthy solutions. Our extensive evaluations reveal that even advanced models like GPT-4o only achieve a 39.97% overall accuracy, illustrating current AI limitations in complex reasoning and multimodal integration. Through the OlympicArena, we aim to advance AI towards superintelligence, equipping it to address more complex challenges in science and beyond. We also provide a comprehensive set of resources to support AI research, including a benchmark dataset, an open-source annotation platform, a detailed evaluation tool, and a leaderboard with automatic submission features.

Rule-based reasoning, a fundamental type of legal reasoning, enables us to draw conclusions by accurately applying a rule to a set of facts. We explore causal language models as rule-based reasoners, specifically with respect to compositional rules - rules consisting of multiple elements which form a complex logical expression. Reasoning about compositional rules is challenging because it requires multiple reasoning steps, and attending to the logical relationships between elements. We introduce a new prompting method, Chain of Logic, which elicits rule-based reasoning through decomposition (solving elements as independent threads of logic), and recomposition (recombining these sub-answers to resolve the underlying logical expression). This method was inspired by the IRAC (Issue, Rule, Application, Conclusion) framework, a sequential reasoning approach used by lawyers. We evaluate chain of logic across eight rule-based reasoning tasks involving three distinct compositional rules from the LegalBench benchmark and demonstrate it consistently outperforms other prompting methods, including chain of thought and self-ask, using open-source and commercial language models.

Recent large language models (LLMs) have shown indications of mathematical reasoning ability. However it has not been clear how they would fare on more challenging competition-level problems. And while self-generated verbalizations of intermediate reasoning steps (i.e., chain-of-thought prompting) have been shown to be helpful, whether LLMs can make use of helpful side information such as problem-specific hints has not been investigated before. In this paper, we propose a challenging benchmark dataset for enabling such analyses. The Concept and Hint-Annotated Math Problems (CHAMP) consists of high school math competition problems, annotated with concepts, or general math facts, and hints, or problem-specific tricks. These annotations allow us to explore the effects of additional information, such as relevant hints, misleading concepts, or related problems. This benchmark is difficult, with the best model only scoring 58.1% in standard settings. With concepts and hints, performance sometimes improves, indicating that some models can make use of such side information. We further annotate model-generated solutions for their correctness. Using this corpus, we find that models often arrive at the correct final answer through wrong reasoning steps. In addition, we test whether models are able to verify these solutions, and find that most models struggle. The dataset and code are available on the project website.

The reasoning steps generated by LLMs might be incomplete, as they mimic logical leaps common in everyday communication found in their pre-training data: underlying rationales are frequently left implicit (unstated). To address this challenge, we introduce RATIONALYST, a model for process-supervision of reasoning based on pre-training on a vast collection of rationale annotations extracted from unlabeled data. We extract 79k rationales from web-scale unlabelled dataset (the Pile) and a combination of reasoning datasets with minimal human intervention. This web-scale pre-training for reasoning allows RATIONALYST to consistently generalize across diverse reasoning tasks, including mathematical, commonsense, scientific, and logical reasoning. Fine-tuned from LLaMa-3-8B, RATIONALYST improves the accuracy of reasoning by an average of 3.9% on 7 representative reasoning benchmarks. It also demonstrates superior performance compared to significantly larger verifiers like GPT-4 and similarly sized models fine-tuned on matching training sets.

We introduce a new task, Video-and-Language Inference, for joint multimodal understanding of video and text. Given a video clip with aligned subtitles as premise, paired with a natural language hypothesis based on the video content, a model needs to infer whether the hypothesis is entailed or contradicted by the given video clip. A new large-scale dataset, named Violin (VIdeO-and-Language INference), is introduced for this task, which consists of 95,322 video-hypothesis pairs from 15,887 video clips, spanning over 582 hours of video. These video clips contain rich content with diverse temporal dynamics, event shifts, and people interactions, collected from two sources: (i) popular TV shows, and (ii) movie clips from YouTube channels. In order to address our new multimodal inference task, a model is required to possess sophisticated reasoning skills, from surface-level grounding (e.g., identifying objects and characters in the video) to in-depth commonsense reasoning (e.g., inferring causal relations of events in the video). We present a detailed analysis of the dataset and an extensive evaluation over many strong baselines, providing valuable insights on the challenges of this new task.

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.

In recent years, the application of Large Language Models (LLMs) in healthcare has shown significant promise in improving the accessibility and dissemination of medical knowledge. This paper presents a detailed study of various LLMs trained on the MedQuAD medical question-answering dataset, with a focus on identifying the most effective model for providing accurate medical information. Among the models tested, the Sentence-t5 combined with Mistral 7B demonstrated superior performance, achieving a precision score of 0.762. This model's enhanced capabilities are attributed to its advanced pretraining techniques, robust architecture, and effective prompt construction methodologies. By leveraging these strengths, the Sentence-t5 + Mistral 7B model excels in understanding and generating precise medical answers. Our findings highlight the potential of integrating sophisticated LLMs in medical contexts to facilitate efficient and accurate medical knowledge retrieval, thus significantly enhancing patient education and support.

Mathematical understanding and reasoning are crucial tasks for assessing the capabilities of artificial intelligence (AI). However, existing benchmarks either require just a few steps of reasoning, or only contain a small amount of data in one specific topic, making it hard to analyse AI's behaviour with reference to different problems within a specific topic in detail. In this work, we propose Conic10K, a challenging math problem dataset on conic sections in Chinese senior high school education. Our dataset contains various problems with different reasoning depths, while only the knowledge from conic sections is required. Since the dataset only involves a narrow range of knowledge, it is easy to separately analyse the knowledge a model possesses and the reasoning ability it has. For each problem, we provide a high-quality formal representation, the reasoning steps, and the final solution. Experiments show that existing large language models, including GPT-4, exhibit weak performance on complex reasoning. We hope that our findings could inspire more advanced techniques for precise natural language understanding and reasoning. Our dataset and codes are available at https://github.com/whyNLP/Conic10K.

Algorithmic reasoning refers to the ability to understand the complex patterns behind the problem and decompose them into a sequence of reasoning steps towards the solution. Such nature of algorithmic reasoning makes it a challenge for large language models (LLMs), even though they have demonstrated promising performance in other reasoning tasks. Within this context, some recent studies use programming languages (e.g., Python) to express the necessary logic for solving a given instance/question (e.g., Program-of-Thought) as inspired by their strict and precise syntaxes. However, it is non-trivial to write an executable code that expresses the correct logic on the fly within a single inference call. Also, the code generated specifically for an instance cannot be reused for others, even if they are from the same task and might require identical logic to solve. This paper presents Think-and-Execute, a novel framework that decomposes the reasoning process of language models into two steps. (1) In Think, we discover a task-level logic that is shared across all instances for solving a given task and then express the logic with pseudocode; (2) In Execute, we further tailor the generated pseudocode to each instance and simulate the execution of the code. With extensive experiments on seven algorithmic reasoning tasks, we demonstrate the effectiveness of Think-and-Execute. Our approach better improves LMs' reasoning compared to several strong baselines performing instance-specific reasoning (e.g., CoT and PoT), suggesting the helpfulness of discovering task-level logic. Also, we show that compared to natural language, pseudocode can better guide the reasoning of LMs, even though they are trained to follow natural language instructions.

As large language models (LLMs) perform more difficult tasks, it becomes harder to verify the correctness and safety of their behavior. One approach to help with this issue is to prompt LLMs to externalize their reasoning, e.g., by having them generate step-by-step reasoning as they answer a question (Chain-of-Thought; CoT). The reasoning may enable us to check the process that models use to perform tasks. However, this approach relies on the stated reasoning faithfully reflecting the model's actual reasoning, which is not always the case. To improve over the faithfulness of CoT reasoning, we have models generate reasoning by decomposing questions into subquestions. Decomposition-based methods achieve strong performance on question-answering tasks, sometimes approaching that of CoT while improving the faithfulness of the model's stated reasoning on several recently-proposed metrics. By forcing the model to answer simpler subquestions in separate contexts, we greatly increase the faithfulness of model-generated reasoning over CoT, while still achieving some of the performance gains of CoT. Our results show it is possible to improve the faithfulness of model-generated reasoning; continued improvements may lead to reasoning that enables us to verify the correctness and safety of LLM behavior.

Reasoning has long been viewed as an emergent property of large language models (LLMs), appearing at or above a certain scale (sim100B parameters). However, recent studies challenge this assumption, showing that small language models (SLMs) can also achieve competitive reasoning performance. SLMs are increasingly favored for their efficiency and deployability. However, there is a lack of systematic study on the reasoning abilities of diverse SLMs, including those trained from scratch or derived from LLMs through quantization, pruning, and distillation. This raises a critical question: Can SLMs achieve reasoning abilities comparable to LLMs? In this work, we systematically survey, benchmark, and analyze 72 SLMs from six model families across 14 reasoning benchmarks. For reliable evaluation, we examine four evaluation methods and compare four LLM judges against human evaluations on 800 data points. We repeat all experiments three times to ensure a robust performance assessment. Additionally, we analyze the impact of different prompting strategies in small models. Beyond accuracy, we also evaluate model robustness under adversarial conditions and intermediate reasoning steps. Our findings challenge the assumption that scaling is the only way to achieve strong reasoning. Instead, we foresee a future where SLMs with strong reasoning capabilities can be developed through structured training or post-training compression. They can serve as efficient alternatives to LLMs for reasoning-intensive tasks.