Daily Papers

As large language models (LLMs) become increasingly integrated into daily applications, it is essential to ensure they operate fairly across diverse user demographics. In this work, we show that LLMs suffer from personalization bias, where their performance is impacted when they are personalized to a user's identity. We quantify personalization bias by evaluating the performance of LLMs along two axes - safety and utility. We measure safety by examining how benign LLM responses are to unsafe prompts with and without personalization. We measure utility by evaluating the LLM's performance on various tasks, including general knowledge, mathematical abilities, programming, and reasoning skills. We find that various LLMs, ranging from open-source models like Llama (Touvron et al., 2023) and Mistral (Jiang et al., 2023) to API-based ones like GPT-3.5 and GPT-4o (Ouyang et al., 2022), exhibit significant variance in performance in terms of safety-utility trade-offs depending on the user's identity. Finally, we discuss several strategies to mitigate personalization bias using preference tuning and prompt-based defenses.

Large Language Models (LLMs) are increasingly deployed in various applications. As their usage grows, concerns regarding their safety are rising, especially in maintaining harmless responses when faced with malicious instructions. Many defense strategies have been developed to enhance the safety of LLMs. However, our research finds that existing defense strategies lead LLMs to predominantly adopt a rejection-oriented stance, thereby diminishing the usability of their responses to benign instructions. To solve this problem, we introduce the MoGU framework, designed to enhance LLMs' safety while preserving their usability. Our MoGU framework transforms the base LLM into two variants: the usable LLM and the safe LLM, and further employs dynamic routing to balance their contribution. When encountering malicious instructions, the router will assign a higher weight to the safe LLM to ensure that responses are harmless. Conversely, for benign instructions, the router prioritizes the usable LLM, facilitating usable and helpful responses. On various open-sourced LLMs, we compare multiple defense strategies to verify the superiority of our MoGU framework. Besides, our analysis provides key insights into the effectiveness of MoGU and verifies that our designed routing mechanism can effectively balance the contribution of each variant by assigning weights. Our work released the safer Llama2, Vicuna, Falcon, Dolphin, and Baichuan2.

Despite growing interest in using large language models (LLMs) in healthcare, current explorations do not assess the real-world utility and safety of LLMs in clinical settings. Our objective was to determine whether two LLMs can serve information needs submitted by physicians as questions to an informatics consultation service in a safe and concordant manner. Sixty six questions from an informatics consult service were submitted to GPT-3.5 and GPT-4 via simple prompts. 12 physicians assessed the LLM responses' possibility of patient harm and concordance with existing reports from an informatics consultation service. Physician assessments were summarized based on majority vote. For no questions did a majority of physicians deem either LLM response as harmful. For GPT-3.5, responses to 8 questions were concordant with the informatics consult report, 20 discordant, and 9 were unable to be assessed. There were 29 responses with no majority on "Agree", "Disagree", and "Unable to assess". For GPT-4, responses to 13 questions were concordant, 15 discordant, and 3 were unable to be assessed. There were 35 responses with no majority. Responses from both LLMs were largely devoid of overt harm, but less than 20% of the responses agreed with an answer from an informatics consultation service, responses contained hallucinated references, and physicians were divided on what constitutes harm. These results suggest that while general purpose LLMs are able to provide safe and credible responses, they often do not meet the specific information need of a given question. A definitive evaluation of the usefulness of LLMs in healthcare settings will likely require additional research on prompt engineering, calibration, and custom-tailoring of general purpose models.

Large Language Models (LLMs) require careful safety alignment to prevent malicious outputs. While significant research focuses on mitigating harmful content generation, the enhanced safety often come with the side effect of over-refusal, where LLMs may reject innocuous prompts and become less helpful. Although the issue of over-refusal has been empirically observed, a systematic measurement is challenging due to the difficulty of crafting prompts that appear harmful but are benign. This study proposes a novel method for automatically generating large-scale sets of "seemingly toxic prompts" (benign prompts likely rejected by LLMs). Leveraging this technique, we introduce OR-Bench, the first large-scale over-refusal benchmark. OR-Bench comprises 80,000 seemingly toxic prompts across 10 common rejection categories, a subset of around 1,000 hard prompts that are challenging even for state-of-the-art LLMs, and an additional 600 toxic prompts to prevent indiscriminate responses. We then conduct a comprehensive study to measure the over-refusal of 25 popular LLMs across 8 model families. Our datasets are available at https://huggingface.co/datasets/bench-llm/or-bench and the demo can be found at https://huggingface.co/spaces/bench-llm/or-bench. We hope this benchmark can help the community develop better safety aligned models.

Large language models (LLMs), such as ChatGPT, are able to generate human-like, fluent responses for many downstream tasks, e.g., task-oriented dialog and question answering. However, applying LLMs to real-world, mission-critical applications remains challenging mainly due to their tendency to generate hallucinations and their inability to use external knowledge. This paper proposes a LLM-Augmenter system, which augments a black-box LLM with a set of plug-and-play modules. Our system makes the LLM generate responses grounded in external knowledge, e.g., stored in task-specific databases. It also iteratively revises LLM prompts to improve model responses using feedback generated by utility functions, e.g., the factuality score of a LLM-generated response. The effectiveness of LLM-Augmenter is empirically validated on two types of scenarios, task-oriented dialog and open-domain question answering. LLM-Augmenter significantly reduces ChatGPT's hallucinations without sacrificing the fluency and informativeness of its responses. We make the source code and models publicly available.

Large-scale language models (LLMs), such as ChatGPT, are capable of generating human-like responses for various downstream tasks, such as task-oriented dialogues and question answering. However, applying LLMs to medical domains remains challenging due to their inability to leverage domain-specific knowledge. In this study, we present the Large-scale Language Models Augmented with Medical Textbooks (LLM-AMT), which integrates authoritative medical textbooks as the cornerstone of its design, enhancing its proficiency in the specialized domain through plug-and-play modules, comprised of a Hybrid Textbook Retriever, supplemented by the Query Augmenter and the LLM Reader. Experimental evaluation on three open-domain medical question-answering tasks reveals a substantial enhancement in both the professionalism and accuracy of the LLM responses when utilizing LLM-AMT, exhibiting an improvement ranging from 11.4% to 13.2%. Despite being 100 times smaller, we found that medical textbooks as the retrieval corpus serves as a more valuable external knowledge source than Wikipedia in the medical domain. Our experiments show that textbook augmentation results in a performance improvement ranging from 9.7% to 12.2% over Wikipedia augmentation.

We investigate the phenomenon of an LLM's untruthful response using a large set of 220 handcrafted linguistic features. We focus on GPT-3 models and find that the linguistic profiles of responses are similar across model sizes. That is, how varying-sized LLMs respond to given prompts stays similar on the linguistic properties level. We expand upon this finding by training support vector machines that rely only upon the stylistic components of model responses to classify the truthfulness of statements. Though the dataset size limits our current findings, we present promising evidence that truthfulness detection is possible without evaluating the content itself.

In the medical domain, numerous scenarios necessitate the long-form generation ability of large language models (LLMs). Specifically, when addressing patients' questions, it is essential that the model's response conveys factual claims, highlighting the need for an automated method to evaluate those claims. Thus, we introduce MedLFQA, a benchmark dataset reconstructed using long-form question-answering datasets related to the biomedical domain. We use MedLFQA to facilitate the automatic evaluations of factuality. We also propose OLAPH, a simple and novel framework that enables the improvement of factuality through automatic evaluations. The OLAPH framework iteratively trains LLMs to mitigate hallucinations using sampling predictions and preference optimization. In other words, we iteratively set the highest-scoring response as a preferred response derived from sampling predictions and train LLMs to align with the preferred response that improves factuality. We highlight that, even on evaluation metrics not used during training, LLMs trained with our OLAPH framework demonstrate significant performance improvement in factuality. Our findings reveal that a 7B LLM trained with our OLAPH framework can provide long answers comparable to the medical experts' answers in terms of factuality. We believe that our work could shed light on gauging the long-text generation ability of LLMs in the medical domain. Our code and datasets are available at https://github.com/dmis-lab/OLAPH}{https://github.com/dmis-lab/OLAPH.

There is a lack of benchmarks for evaluating large language models (LLMs) in long-form medical question answering (QA). Most existing medical QA evaluation benchmarks focus on automatic metrics and multiple-choice questions. While valuable, these benchmarks fail to fully capture or assess the complexities of real-world clinical applications where LLMs are being deployed. Furthermore, existing studies on evaluating long-form answer generation in medical QA are primarily closed-source, lacking access to human medical expert annotations, which makes it difficult to reproduce results and enhance existing baselines. In this work, we introduce a new publicly available benchmark featuring real-world consumer medical questions with long-form answer evaluations annotated by medical doctors. We performed pairwise comparisons of responses from various open and closed-source medical and general-purpose LLMs based on criteria such as correctness, helpfulness, harmfulness, and bias. Additionally, we performed a comprehensive LLM-as-a-judge analysis to study the alignment between human judgments and LLMs. Our preliminary results highlight the strong potential of open LLMs in medical QA compared to leading closed models. Code & Data: https://github.com/lavita-ai/medical-eval-sphere

Humans are prone to cognitive distortions -- biased thinking patterns that lead to exaggerated responses to specific stimuli, albeit in very different contexts. This paper demonstrates that advanced Multimodal Large Language Models (MLLMs) exhibit similar tendencies. While these models are designed to respond queries under safety mechanism, they sometimes reject harmless queries in the presence of certain visual stimuli, disregarding the benign nature of their contexts. As the initial step in investigating this behavior, we identify three types of stimuli that trigger the oversensitivity of existing MLLMs: Exaggerated Risk, Negated Harm, and Counterintuitive Interpretation. To systematically evaluate MLLMs' oversensitivity to these stimuli, we propose the Multimodal OverSenSitivity Benchmark (MOSSBench). This toolkit consists of 300 manually collected benign multimodal queries, cross-verified by third-party reviewers (AMT). Empirical studies using MOSSBench on 20 MLLMs reveal several insights: (1). Oversensitivity is prevalent among SOTA MLLMs, with refusal rates reaching up to 76% for harmless queries. (2). Safer models are more oversensitive: increasing safety may inadvertently raise caution and conservatism in the model's responses. (3). Different types of stimuli tend to cause errors at specific stages -- perception, intent reasoning, and safety judgement -- in the response process of MLLMs. These findings highlight the need for refined safety mechanisms that balance caution with contextually appropriate responses, improving the reliability of MLLMs in real-world applications. We make our project available at https://turningpoint-ai.github.io/MOSSBench/.

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.

Large Language Models (LLMs) have demonstrated remarkable success in diverse natural language processing (NLP) tasks in general domains. However, LLMs sometimes generate responses with the hallucination about medical facts due to limited domain knowledge. Such shortcomings pose potential risks in the utilization of LLMs within medical contexts. To address this challenge, we propose knowledge-tuning, which leverages structured medical knowledge bases for the LLMs to grasp domain knowledge efficiently and facilitate reliable response generation. We also release cMedKnowQA, a Chinese medical knowledge question-answering dataset constructed from medical knowledge bases to assess the medical knowledge proficiency of LLMs. Experimental results show that the LLMs which are knowledge-tuned with cMedKnowQA, can exhibit higher levels of accuracy in response generation compared with vanilla instruction-tuning and offer a new reliable way for the domain adaptation of LLMs.

Accurate and efficient question-answering systems are essential for delivering high-quality patient care in the medical field. While Large Language Models (LLMs) have made remarkable strides across various domains, they continue to face significant challenges in medical question answering, particularly in understanding domain-specific terminologies and performing complex reasoning. These limitations undermine their effectiveness in critical medical applications. To address these issues, we propose a novel approach incorporating similar case generation within a multi-agent medical question-answering (MedQA) system. Specifically, we leverage the Llama3.1:70B model, a state-of-the-art LLM, in a multi-agent architecture to enhance performance on the MedQA dataset using zero-shot learning. Our method capitalizes on the model's inherent medical knowledge and reasoning capabilities, eliminating the need for additional training data. Experimental results show substantial performance gains over existing benchmark models, with improvements of 7% in both accuracy and F1-score across various medical QA tasks. Furthermore, we examine the model's interpretability and reliability in addressing complex medical queries. This research not only offers a robust solution for medical question answering but also establishes a foundation for broader applications of LLMs in the medical domain.

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.

Despite the potential of Large Language Models (LLMs) in medicine, they may generate responses lacking supporting evidence or based on hallucinated evidence. While Retrieval Augment Generation (RAG) is popular to address this issue, few studies implemented and evaluated RAG in downstream domain-specific applications. We developed a RAG pipeline with 70,000 ophthalmology-specific documents that retrieve relevant documents to augment LLMs during inference time. In a case study on long-form consumer health questions, we systematically evaluated the responses including over 500 references of LLMs with and without RAG on 100 questions with 10 healthcare professionals. The evaluation focuses on factuality of evidence, selection and ranking of evidence, attribution of evidence, and answer accuracy and completeness. LLMs without RAG provided 252 references in total. Of which, 45.3% hallucinated, 34.1% consisted of minor errors, and 20.6% were correct. In contrast, LLMs with RAG significantly improved accuracy (54.5% being correct) and reduced error rates (18.8% with minor hallucinations and 26.7% with errors). 62.5% of the top 10 documents retrieved by RAG were selected as the top references in the LLM response, with an average ranking of 4.9. The use of RAG also improved evidence attribution (increasing from 1.85 to 2.49 on a 5-point scale, P<0.001), albeit with slight decreases in accuracy (from 3.52 to 3.23, P=0.03) and completeness (from 3.47 to 3.27, P=0.17). The results demonstrate that LLMs frequently exhibited hallucinated and erroneous evidence in the responses, raising concerns for downstream applications in the medical domain. RAG substantially reduced the proportion of such evidence but encountered challenges.

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.

Automatic disease diagnosis has become increasingly valuable in clinical practice. The advent of large language models (LLMs) has catalyzed a paradigm shift in artificial intelligence, with growing evidence supporting the efficacy of LLMs in diagnostic tasks. Despite the increasing attention in this field, a holistic view is still lacking. Many critical aspects remain unclear, such as the diseases and clinical data to which LLMs have been applied, the LLM techniques employed, and the evaluation methods used. In this article, we perform a comprehensive review of LLM-based methods for disease diagnosis. Our review examines the existing literature across various dimensions, including disease types and associated clinical specialties, clinical data, LLM techniques, and evaluation methods. Additionally, we offer recommendations for applying and evaluating LLMs for diagnostic tasks. Furthermore, we assess the limitations of current research and discuss future directions. To our knowledge, this is the first comprehensive review for LLM-based disease diagnosis.

In this study, we tackle a growing concern around the safety and ethical use of large language models (LLMs). Despite their potential, these models can be tricked into producing harmful or unethical content through various sophisticated methods, including 'jailbreaking' techniques and targeted manipulation. Our work zeroes in on a specific issue: to what extent LLMs can be led astray by asking them to generate responses that are instruction-centric such as a pseudocode, a program or a software snippet as opposed to vanilla text. To investigate this question, we introduce TechHazardQA, a dataset containing complex queries which should be answered in both text and instruction-centric formats (e.g., pseudocodes), aimed at identifying triggers for unethical responses. We query a series of LLMs -- Llama-2-13b, Llama-2-7b, Mistral-V2 and Mistral 8X7B -- and ask them to generate both text and instruction-centric responses. For evaluation we report the harmfulness score metric as well as judgements from GPT-4 and humans. Overall, we observe that asking LLMs to produce instruction-centric responses enhances the unethical response generation by ~2-38% across the models. As an additional objective, we investigate the impact of model editing using the ROME technique, which further increases the propensity for generating undesirable content. In particular, asking edited LLMs to generate instruction-centric responses further increases the unethical response generation by ~3-16% across the different models.

Large language models (LLM) have achieved impressive performance on medical question-answering benchmarks. However, high benchmark accuracy does not imply that the performance generalizes to real-world clinical settings. Medical question-answering benchmarks rely on assumptions consistent with quantifying LLM performance but that may not hold in the open world of the clinic. Yet LLMs learn broad knowledge that can help the LLM generalize to practical conditions regardless of unrealistic assumptions in celebrated benchmarks. We seek to quantify how well LLM medical question-answering benchmark performance generalizes when benchmark assumptions are violated. Specifically, we present an adversarial method that we call MedFuzz (for medical fuzzing). MedFuzz attempts to modify benchmark questions in ways aimed at confounding the LLM. We demonstrate the approach by targeting strong assumptions about patient characteristics presented in the MedQA benchmark. Successful "attacks" modify a benchmark item in ways that would be unlikely to fool a medical expert but nonetheless "trick" the LLM into changing from a correct to an incorrect answer. Further, we present a permutation test technique that can ensure a successful attack is statistically significant. We show how to use performance on a "MedFuzzed" benchmark, as well as individual successful attacks. The methods show promise at providing insights into the ability of an LLM to operate robustly in more realistic settings.

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.

Large language models (LLMs), such as ChatGPT, have received substantial attention due to their impressive human language understanding and generation capabilities. Therefore, the application of LLMs in medicine to assist physicians and patient care emerges as a promising research direction in both artificial intelligence and clinical medicine. To reflect this trend, this survey provides a comprehensive overview of the principles, applications, and challenges faced by LLMs in medicine. Specifically, we aim to address the following questions: 1) How can medical LLMs be built? 2) What are the downstream performances of medical LLMs? 3) How can medical LLMs be utilized in real-world clinical practice? 4) What challenges arise from the use of medical LLMs? and 5) How can we better construct and utilize medical LLMs? As a result, this survey aims to provide insights into the opportunities and challenges of LLMs in medicine and serve as a valuable resource for constructing practical and effective medical LLMs. A regularly updated list of practical guides on medical LLMs can be found at https://github.com/AI-in-Health/MedLLMsPracticalGuide.

Large Language Models (LLMs) have made significant strides in natural language processing but face challenges in terms of computational expense and inefficiency as they grow in size, especially in domain-specific tasks. Small Language Models (SLMs), on the other hand, often struggle in these tasks due to limited capacity and training data. In this paper, we introduce Dr. LLaMA, a method for improving SLMs through generative data augmentation using LLMs, focusing on medical question-answering tasks and the PubMedQA dataset. Our findings indicate that LLMs effectively refine and diversify existing question-answer pairs, resulting in improved performance of a much smaller model on domain-specific QA datasets after fine-tuning. This study highlights the challenges of using LLMs for domain-specific question answering and suggests potential research directions to address these limitations, ultimately aiming to create more efficient and capable models for specialized applications. We have also made our code available for interested researchers

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.

As Large Language Models (LLMs) gain wider adoption in various contexts, it becomes crucial to ensure they are reasonably safe, consistent, and reliable for an application at hand. This may require probing or auditing them. Probing LLMs with varied iterations of a single question could reveal potential inconsistencies in their knowledge or functionality. However, a tool for performing such audits with simple workflow and low technical threshold is lacking. In this demo, we introduce "AuditLLM," a novel tool designed to evaluate the performance of various LLMs in a methodical way. AuditLLM's core functionality lies in its ability to test a given LLM by auditing it using multiple probes generated from a single question, thereby identifying any inconsistencies in the model's understanding or operation. A reasonably robust, reliable, and consistent LLM should output semantically similar responses for a question asked differently or by different people. Based on this assumption, AuditLLM produces easily interpretable results regarding the LLM's consistencies from a single question that the user enters. A certain level of inconsistency has been shown to be an indicator of potential bias, hallucinations, and other issues. One could then use the output of AuditLLM to further investigate issues with the aforementioned LLM. To facilitate demonstration and practical uses, AuditLLM offers two key modes: (1) Live mode which allows instant auditing of LLMs by analyzing responses to real-time queries; (2) Batch mode which facilitates comprehensive LLM auditing by processing multiple queries at once for in-depth analysis. This tool is beneficial for both researchers and general users, as it enhances our understanding of LLMs' capabilities in generating responses, using a standardized auditing platform.

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.

Retrieval-augmented language models are being increasingly tasked with subjective, contentious, and conflicting queries such as "is aspartame linked to cancer". To resolve these ambiguous queries, one must search through a large range of websites and consider "which, if any, of this evidence do I find convincing?". In this work, we study how LLMs answer this question. In particular, we construct ConflictingQA, a dataset that pairs controversial queries with a series of real-world evidence documents that contain different facts (e.g., quantitative results), argument styles (e.g., appeals to authority), and answers (Yes or No). We use this dataset to perform sensitivity and counterfactual analyses to explore which text features most affect LLM predictions. Overall, we find that current models rely heavily on the relevance of a website to the query, while largely ignoring stylistic features that humans find important such as whether a text contains scientific references or is written with a neutral tone. Taken together, these results highlight the importance of RAG corpus quality (e.g., the need to filter misinformation), and possibly even a shift in how LLMs are trained to better align with human judgements.

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.

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.

Recent advancements in large language model(LLM) performance on medical multiple choice question (MCQ) benchmarks have stimulated interest from healthcare providers and patients globally. Particularly in low-and middle-income countries (LMICs) facing acute physician shortages and lack of specialists, LLMs offer a potentially scalable pathway to enhance healthcare access and reduce costs. However, their effectiveness in the Global South, especially across the African continent, remains to be established. In this work, we introduce AfriMed-QA, the first large scale Pan-African English multi-specialty medical Question-Answering (QA) dataset, 15,000 questions (open and closed-ended) sourced from over 60 medical schools across 16 countries, covering 32 medical specialties. We further evaluate 30 LLMs across multiple axes including correctness and demographic bias. Our findings show significant performance variation across specialties and geographies, MCQ performance clearly lags USMLE (MedQA). We find that biomedical LLMs underperform general models and smaller edge-friendly LLMs struggle to achieve a passing score. Interestingly, human evaluations show a consistent consumer preference for LLM answers and explanations when compared with clinician answers.

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.

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.

Large Language Models (LLMs) have shown great potential in Natural Language Processing (NLP) tasks. However, recent literature reveals that LLMs generate nonfactual responses intermittently, which impedes the LLMs' reliability for further utilization. In this paper, we propose a novel self-detection method to detect which questions that a LLM does not know that are prone to generate nonfactual results. Specifically, we first diversify the textual expressions for a given question and collect the corresponding answers. Then we examine the divergencies between the generated answers to identify the questions that the model may generate falsehoods. All of the above steps can be accomplished by prompting the LLMs themselves without referring to any other external resources. We conduct comprehensive experiments and demonstrate the effectiveness of our method on recently released LLMs, e.g., Vicuna, ChatGPT, and GPT-4.

Large Language Models (LLMs), although powerful in general domains, often perform poorly on domain-specific tasks like medical question answering (QA). Moreover, they tend to function as "black-boxes," making it challenging to modify their behavior. Addressing this, our study delves into model editing utilizing in-context learning, aiming to improve LLM responses without the need for fine-tuning or retraining. Specifically, we propose a comprehensive retrieval strategy to extract medical facts from an external knowledge base, and then we incorporate them into the query prompt for the LLM. Focusing on medical QA using the MedQA-SMILE dataset, we evaluate the impact of different retrieval models and the number of facts provided to the LLM. Notably, our edited Vicuna model exhibited an accuracy improvement from 44.46% to 48.54%. This work underscores the potential of model editing to enhance LLM performance, offering a practical approach to mitigate the challenges of black-box LLMs.

LLM safety and ethical alignment are widely discussed, but the impact of content moderation on user satisfaction remains underexplored. To address this, we analyze nearly 50,000 Chatbot Arena response-pairs using a novel fine-tuned RoBERTa model, that we trained on hand-labeled data to disentangle refusals due to ethical concerns from other refusals due to technical disabilities or lack of information. Our findings reveal a significant refusal penalty on content moderation, with users choosing ethical-based refusals roughly one-fourth as often as their preferred LLM response compared to standard responses. However, the context and phrasing play critical roles: refusals on highly sensitive prompts, such as illegal content, achieve higher win rates than less sensitive ethical concerns, and longer responses closely aligned with the prompt perform better. These results emphasize the need for nuanced moderation strategies that balance ethical safeguards with user satisfaction. Moreover, we find that the refusal penalty is notably lower in evaluations using the LLM-as-a-Judge method, highlighting discrepancies between user and automated assessments.

Large language models (LLMs) hold great potential for many natural language applications but risk generating incorrect or toxic content. To probe when an LLM generates unwanted content, the current paradigm is to recruit a red team of human testers to design input prompts (i.e., test cases) that elicit undesirable responses from LLMs. However, relying solely on human testers is expensive and time-consuming. Recent works automate red teaming by training a separate red team LLM with reinforcement learning (RL) to generate test cases that maximize the chance of eliciting undesirable responses from the target LLM. However, current RL methods are only able to generate a small number of effective test cases resulting in a low coverage of the span of prompts that elicit undesirable responses from the target LLM. To overcome this limitation, we draw a connection between the problem of increasing the coverage of generated test cases and the well-studied approach of curiosity-driven exploration that optimizes for novelty. Our method of curiosity-driven red teaming (CRT) achieves greater coverage of test cases while mantaining or increasing their effectiveness compared to existing methods. Our method, CRT successfully provokes toxic responses from LLaMA2 model that has been heavily fine-tuned using human preferences to avoid toxic outputs. Code is available at https://github.com/Improbable-AI/curiosity_redteam

Large Language Models (LLMs) have demonstrated remarkable capabilities in natural language processing, and yet, their factual inaccuracies and hallucinations limits their application, particularly in critical domains like healthcare. Context retrieval methods, by introducing relevant information as input, have emerged as a crucial approach for enhancing LLM factuality and reliability. This study explores the boundaries of context retrieval methods within the healthcare domain, optimizing their components and benchmarking their performance against open and closed alternatives. Our findings reveal how open LLMs, when augmented with an optimized retrieval system, can achieve performance comparable to the biggest private solutions on established healthcare benchmarks (multiple-choice question answering). Recognizing the lack of realism of including the possible answers within the question (a setup only found in medical exams), and after assessing a strong LLM performance degradation in the absence of those options, we extend the context retrieval system in that direction. In particular, we propose OpenMedPrompt a pipeline that improves the generation of more reliable open-ended answers, moving this technology closer to practical application.

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.

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.

Large language models (LLMs) have recently become the leading source of answers for users' questions online. Despite their ability to offer eloquent answers, their accuracy and reliability can pose a significant challenge. This is especially true for sensitive domains such as biomedicine, where there is a higher need for factually correct answers. This paper introduces a biomedical retrieval-augmented generation (RAG) system designed to enhance the reliability of generated responses. The system is based on a fine-tuned LLM for the referenced question-answering, where retrieved relevant abstracts from PubMed are passed to LLM's context as input through a prompt. Its output is an answer based on PubMed abstracts, where each statement is referenced accordingly, allowing the users to verify the answer. Our retrieval system achieves an absolute improvement of 23% compared to the PubMed search engine. Based on the manual evaluation on a small sample, our fine-tuned LLM component achieves comparable results to GPT-4 Turbo in referencing relevant abstracts. We make the dataset used to fine-tune the models and the fine-tuned models based on Mistral-7B-instruct-v0.1 and v0.2 publicly available.

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).

While the rise of large language models (LLMs) has created rich new opportunities to learn about digital technology, many on the margins of this technology struggle to gain and maintain competency due to lexical or conceptual barriers that prevent them from asking appropriate questions. Although there have been many efforts to understand factuality of LLM-created content and ability of LLMs to answer questions, it is not well understood how unclear or nonstandard language queries affect the model outputs. We propose the creation of a dataset that captures questions of digital newcomers and outsiders, utilizing data we have compiled from a decade's worth of one-on-one tutoring. In this paper we lay out our planned efforts and some potential uses of this dataset.

Large language models (LLMs) are capable of generating multiple responses to a single prompt, yet little effort has been expended to help end-users or system designers make use of this capability. In this paper, we explore how to present many LLM responses at once. We design five features, which include both pre-existing and novel methods for computing similarities and differences across textual documents, as well as how to render their outputs. We report on a controlled user study (n=24) and eight case studies evaluating these features and how they support users in different tasks. We find that the features support a wide variety of sensemaking tasks and even make tasks previously considered to be too difficult by our participants now tractable. Finally, we present design guidelines to inform future explorations of new LLM interfaces.

Tumor documentation in Germany is largely done manually, requiring reading patient records and entering data into structured databases. Large language models (LLMs) could potentially enhance this process by improving efficiency and reliability. This evaluation tests eleven different open source LLMs with sizes ranging from 1-70 billion model parameters on three basic tasks of the tumor documentation process: identifying tumor diagnoses, assigning ICD-10 codes, and extracting the date of first diagnosis. For evaluating the LLMs on these tasks, a dataset of annotated text snippets based on anonymized doctors' notes from urology was prepared. Different prompting strategies were used to investigate the effect of the number of examples in few-shot prompting and to explore the capabilities of the LLMs in general. The models Llama 3.1 8B, Mistral 7B, and Mistral NeMo 12 B performed comparably well in the tasks. Models with less extensive training data or having fewer than 7 billion parameters showed notably lower performance, while larger models did not display performance gains. Examples from a different medical domain than urology could also improve the outcome in few-shot prompting, which demonstrates the ability of LLMs to handle tasks needed for tumor documentation. Open source LLMs show a strong potential for automating tumor documentation. Models from 7-12 billion parameters could offer an optimal balance between performance and resource efficiency. With tailored fine-tuning and well-designed prompting, these models might become important tools for clinical documentation in the future. The code for the evaluation is available from https://github.com/stefan-m-lenz/UroLlmEval. We also release the dataset as a new valuable resource that addresses the shortage of authentic and easily accessible benchmarks in German-language medical NLP.

Large language models (LLMs) have been applied to tasks in healthcare, ranging from medical exam questions to responding to patient questions. With increasing institutional partnerships between companies producing LLMs and healthcare systems, real world clinical application is coming closer to reality. As these models gain traction, it is essential for healthcare practitioners to understand what LLMs are, their development, their current and potential applications, and the associated pitfalls when utilized in medicine. This review and accompanying tutorial aim to give an overview of these topics to aid healthcare practitioners in understanding the rapidly changing landscape of LLMs as applied to medicine.

In this paper, we investigate Extractive Question Answering (EQA) with Large Language Models (LLMs) under domain drift, i.e., can LLMs generalize to domains that require specific knowledge such as medicine and law in a zero-shot fashion without additional in-domain training? To this end, we devise a series of experiments to explain the performance gap empirically. Our findings suggest that: (a) LLMs struggle with dataset demands of closed domains such as retrieving long answer spans; (b) Certain LLMs, despite showing strong overall performance, display weaknesses in meeting basic requirements as discriminating between domain-specific senses of words which we link to pre-processing decisions; (c) Scaling model parameters is not always effective for cross domain generalization; and (d) Closed-domain datasets are quantitatively much different than open-domain EQA datasets and current LLMs struggle to deal with them. Our findings point out important directions for improving existing LLMs.

Large language models (LLMs) introduce new security risks, but there are few comprehensive evaluation suites to measure and reduce these risks. We present BenchmarkName, a novel benchmark to quantify LLM security risks and capabilities. We introduce two new areas for testing: prompt injection and code interpreter abuse. We evaluated multiple state-of-the-art (SOTA) LLMs, including GPT-4, Mistral, Meta Llama 3 70B-Instruct, and Code Llama. Our results show that conditioning away risk of attack remains an unsolved problem; for example, all tested models showed between 26% and 41% successful prompt injection tests. We further introduce the safety-utility tradeoff: conditioning an LLM to reject unsafe prompts can cause the LLM to falsely reject answering benign prompts, which lowers utility. We propose quantifying this tradeoff using False Refusal Rate (FRR). As an illustration, we introduce a novel test set to quantify FRR for cyberattack helpfulness risk. We find many LLMs able to successfully comply with "borderline" benign requests while still rejecting most unsafe requests. Finally, we quantify the utility of LLMs for automating a core cybersecurity task, that of exploiting software vulnerabilities. This is important because the offensive capabilities of LLMs are of intense interest; we quantify this by creating novel test sets for four representative problems. We find that models with coding capabilities perform better than those without, but that further work is needed for LLMs to become proficient at exploit generation. Our code is open source and can be used to evaluate other LLMs.

Large language models (LLMs) need to serve everyone, including a global majority of non-English speakers. However, most LLMs today, and open LLMs in particular, are often intended for use in just English (e.g. Llama2, Mistral) or a small handful of high-resource languages (e.g. Mixtral, Qwen). Recent research shows that, despite limits in their intended use, people prompt LLMs in many different languages. Therefore, in this paper, we investigate the basic multilingual capabilities of state-of-the-art open LLMs beyond their intended use. For this purpose, we introduce MultiQ, a new silver standard benchmark for basic open-ended question answering with 27.4k test questions across a typologically diverse set of 137 languages. With MultiQ, we evaluate language fidelity, i.e. whether models respond in the prompted language, and question answering accuracy. All LLMs we test respond faithfully and/or accurately for at least some languages beyond their intended use. Most models are more accurate when they respond faithfully. However, differences across models are large, and there is a long tail of languages where models are neither accurate nor faithful. We explore differences in tokenization as a potential explanation for our findings, identifying possible correlations that warrant further investigation.

Large language models (LLMs) can produce erroneous responses that sound fluent and convincing, raising the risk that users will rely on these responses as if they were correct. Mitigating such overreliance is a key challenge. Through a think-aloud study in which participants use an LLM-infused application to answer objective questions, we identify several features of LLM responses that shape users' reliance: explanations (supporting details for answers), inconsistencies in explanations, and sources. Through a large-scale, pre-registered, controlled experiment (N=308), we isolate and study the effects of these features on users' reliance, accuracy, and other measures. We find that the presence of explanations increases reliance on both correct and incorrect responses. However, we observe less reliance on incorrect responses when sources are provided or when explanations exhibit inconsistencies. We discuss the implications of these findings for fostering appropriate reliance on LLMs.

Large language models (LLMs) have the potential to transform the practice of law, but this potential is threatened by the presence of legal hallucinations -- responses from these models that are not consistent with legal facts. We investigate the extent of these hallucinations using an original suite of legal queries, comparing LLMs' responses to structured legal metadata and examining their consistency. Our work makes four key contributions: (1) We develop a typology of legal hallucinations, providing a conceptual framework for future research in this area. (2) We find that legal hallucinations are alarmingly prevalent, occurring between 69% of the time with ChatGPT 3.5 and 88% with Llama 2, when these models are asked specific, verifiable questions about random federal court cases. (3) We illustrate that LLMs often fail to correct a user's incorrect legal assumptions in a contra-factual question setup. (4) We provide evidence that LLMs cannot always predict, or do not always know, when they are producing legal hallucinations. Taken together, these findings caution against the rapid and unsupervised integration of popular LLMs into legal tasks. Even experienced lawyers must remain wary of legal hallucinations, and the risks are highest for those who stand to benefit from LLMs the most -- pro se litigants or those without access to traditional legal resources.

This study investigates GPT-4's assessment of its performance in healthcare applications. A simple prompting technique was used to prompt the LLM with questions taken from the United States Medical Licensing Examination (USMLE) questionnaire and it was tasked to evaluate its confidence score before posing the question and after asking the question. The questionnaire was categorized into two groups-questions with feedback (WF) and questions with no feedback(NF) post-question. The model was asked to provide absolute and relative confidence scores before and after each question. The experimental findings were analyzed using statistical tools to study the variability of confidence in WF and NF groups. Additionally, a sequential analysis was conducted to observe the performance variation for the WF and NF groups. Results indicate that feedback influences relative confidence but doesn't consistently increase or decrease it. Understanding the performance of LLM is paramount in exploring its utility in sensitive areas like healthcare. This study contributes to the ongoing discourse on the reliability of AI, particularly of LLMs like GPT-4, within healthcare, offering insights into how feedback mechanisms might be optimized to enhance AI-assisted medical education and decision support.

Large Language Models (LLMs) generate responses to questions; however, their effectiveness is often hindered by sub-optimal quality of answers and occasional failures to provide accurate responses to questions. To address these challenges, a fine-tuning process is employed, involving feedback and examples to refine models. The objective is to enhance AI models through continuous feedback loops, utilizing metrics such as cosine similarity, LLM evaluation and Rouge-L scores to evaluate the models. Leveraging LLMs like GPT-3.5, GPT4ALL, and LLaMA2, and Claude, this approach is benchmarked on financial datasets, including the FinanceBench and RAG Instruct Benchmark Tester Dataset, illustrating the necessity of fine-tuning. The results showcase the capability of fine-tuned models to surpass the accuracy of zero-shot LLMs, providing superior question and answering capabilities. Notably, the combination of fine-tuning the LLM with a process known as Retrieval Augmented Generation (RAG) proves to generate responses with improved accuracy.

Large language models (LLMs) have demonstrated remarkable performance by following natural language instructions without fine-tuning them on domain-specific tasks and data. However, leveraging LLMs for domain-specific question answering suffers from severe limitations. The generated answer tends to hallucinate due to the training data collection time (when using off-the-shelf), complex user utterance and wrong retrieval (in retrieval-augmented generation). Furthermore, due to the lack of awareness about the domain and expected output, such LLMs may generate unexpected and unsafe answers that are not tailored to the target domain. In this paper, we propose CarExpert, an in-car retrieval-augmented conversational question-answering system leveraging LLMs for different tasks. Specifically, CarExpert employs LLMs to control the input, provide domain-specific documents to the extractive and generative answering components, and controls the output to ensure safe and domain-specific answers. A comprehensive empirical evaluation exhibits that CarExpert outperforms state-of-the-art LLMs in generating natural, safe and car-specific answers.

Large Language Models (LLMs), such as the LLaMA model, have demonstrated their effectiveness in various general-domain natural language processing (NLP) tasks. Nevertheless, LLMs have not yet performed optimally in biomedical domain tasks due to the need for medical expertise in the responses. In response to this challenge, we propose HuaTuo, a LLaMA-based model that has been supervised-fine-tuned with generated QA (Question-Answer) instances. The experimental results demonstrate that HuaTuo generates responses that possess more reliable medical knowledge. Our proposed HuaTuo model is accessible at https://github.com/SCIR-HI/Huatuo-Llama-Med-Chinese.

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.

As large language models (LLMs) gain popularity among speakers of diverse languages, we believe that it is crucial to benchmark them to better understand model behaviors, failures, and limitations in languages beyond English. In this work, we evaluate LLM APIs (ChatGPT, GPT-3, and GPT-4) on the Japanese national medical licensing examinations from the past five years, including the current year. Our team comprises native Japanese-speaking NLP researchers and a practicing cardiologist based in Japan. Our experiments show that GPT-4 outperforms ChatGPT and GPT-3 and passes all six years of the exams, highlighting LLMs' potential in a language that is typologically distant from English. However, our evaluation also exposes critical limitations of the current LLM APIs. First, LLMs sometimes select prohibited choices that should be strictly avoided in medical practice in Japan, such as suggesting euthanasia. Further, our analysis shows that the API costs are generally higher and the maximum context size is smaller for Japanese because of the way non-Latin scripts are currently tokenized in the pipeline. We release our benchmark as Igaku QA as well as all model outputs and exam metadata. We hope that our results and benchmark will spur progress on more diverse applications of LLMs. Our benchmark is available at https://github.com/jungokasai/IgakuQA.

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.

Large language models (LLMs) are becoming increasingly important for machine learning applications. However, it can be challenging to align LLMs with our intent, particularly when we want to generate content that is preferable over others or when we want the LLM to respond in a certain style or tone that is hard to describe. To address this challenge, we propose an approach that uses contrastive examples to better describe our intent. This involves providing positive examples that illustrate the true intent, along with negative examples that show what characteristics we want LLMs to avoid. The negative examples can be retrieved from labeled data, written by a human, or generated by the LLM itself. Before generating an answer, we ask the model to analyze the examples to teach itself what to avoid. This reasoning step provides the model with the appropriate articulation of the user's need and guides it towards generting a better answer. We tested our approach on both synthesized and real-world datasets, including StackExchange and Reddit, and found that it significantly improves performance compared to standard few-shot prompting

Large language models have the potential to be valuable in the healthcare industry, but it's crucial to verify their safety and effectiveness through rigorous evaluation. For this purpose, we comprehensively evaluated both open-source LLMs and Google's new multimodal LLM called Gemini across Medical reasoning, hallucination detection, and Medical Visual Question Answering tasks. While Gemini showed competence, it lagged behind state-of-the-art models like MedPaLM 2 and GPT-4 in diagnostic accuracy. Additionally, Gemini achieved an accuracy of 61.45\% on the medical VQA dataset, significantly lower than GPT-4V's score of 88\%. Our analysis revealed that Gemini is highly susceptible to hallucinations, overconfidence, and knowledge gaps, which indicate risks if deployed uncritically. We also performed a detailed analysis by medical subject and test type, providing actionable feedback for developers and clinicians. To mitigate risks, we applied prompting strategies that improved performance. Additionally, we facilitated future research and development by releasing a Python module for medical LLM evaluation and establishing a dedicated leaderboard on Hugging Face for medical domain LLMs. Python module can be found at https://github.com/promptslab/RosettaEval

The remarkable capabilities of large language models (LLMs) in language understanding and generation have not rendered them immune to hallucinations. LLMs can still generate plausible-sounding but factually incorrect or fabricated information. As LLM-empowered chatbots become popular, laypeople may frequently ask health-related queries and risk falling victim to these LLM hallucinations, resulting in various societal and healthcare implications. In this work, we conduct a pioneering study of hallucinations in LLM-generated responses to real-world healthcare queries from patients. We propose MedHalu, a carefully crafted first-of-its-kind medical hallucination dataset with a diverse range of health-related topics and the corresponding hallucinated responses from LLMs with labeled hallucination types and hallucinated text spans. We also introduce MedHaluDetect framework to evaluate capabilities of various LLMs in detecting hallucinations. We also employ three groups of evaluators -- medical experts, LLMs, and laypeople -- to study who are more vulnerable to these medical hallucinations. We find that LLMs are much worse than the experts. They also perform no better than laypeople and even worse in few cases in detecting hallucinations. To fill this gap, we propose expert-in-the-loop approach to improve hallucination detection through LLMs by infusing expert reasoning. We observe significant performance gains for all the LLMs with an average macro-F1 improvement of 6.3 percentage points for GPT-4.

When unsure about an answer, humans often respond with more words than necessary, hoping that part of the response will be correct. We observe a similar behavior in large language models (LLMs), which we term "Verbosity Compensation" (VC). VC is harmful because it confuses the user understanding, leading to low efficiency, and influences the LLM services by increasing the latency and cost of generating useless tokens. In this paper, we present the first work that defines and analyzes Verbosity Compensation, explores its causes, and proposes a simple mitigating approach. We define Verbosity Compensation as the behavior of generating responses that can be compressed without information loss when prompted to write concisely. Our experiments, conducted on five datasets of knowledge and reasoning-based QA tasks with 14 newly developed LLMs, reveal three conclusions. 1) We reveal a pervasive presence of verbosity compensation across all models and all datasets. Notably, GPT-4 exhibits a VC frequency of 50.40%. 2) We reveal the large performance gap between verbose and concise responses, with a notable difference of 27.61% on the Qasper dataset. We also demonstrate that this difference does not naturally diminish as LLM capability increases. Both 1) and 2) highlight the urgent need to mitigate the frequency of VC behavior and disentangle verbosity with veracity. We propose a simple yet effective cascade algorithm that replaces the verbose responses with the other model-generated responses. The results show that our approach effectively alleviates the VC of the Mistral model from 63.81% to 16.16% on the Qasper dataset. 3) We also find that verbose responses exhibit higher uncertainty across all five datasets, suggesting a strong connection between verbosity and model uncertainty. Our dataset and code are available at https://github.com/psunlpgroup/VerbosityLLM.

Safety guard models that detect malicious queries aimed at large language models (LLMs) are essential for ensuring the secure and responsible deployment of LLMs in real-world applications. However, deploying existing safety guard models with billions of parameters alongside LLMs on mobile devices is impractical due to substantial memory requirements and latency. To reduce this cost, we distill a large teacher safety guard model into a smaller one using a labeled dataset of instruction-response pairs with binary harmfulness labels. Due to the limited diversity of harmful instructions in the existing labeled dataset, naively distilled models tend to underperform compared to larger models. To bridge the gap between small and large models, we propose HarmAug, a simple yet effective data augmentation method that involves jailbreaking an LLM and prompting it to generate harmful instructions. Given a prompt such as, "Make a single harmful instruction prompt that would elicit offensive content", we add an affirmative prefix (e.g., "I have an idea for a prompt:") to the LLM's response. This encourages the LLM to continue generating the rest of the response, leading to sampling harmful instructions. Another LLM generates a response to the harmful instruction, and the teacher model labels the instruction-response pair. We empirically show that our HarmAug outperforms other relevant baselines. Moreover, a 435-million-parameter safety guard model trained with HarmAug achieves an F1 score comparable to larger models with over 7 billion parameters, and even outperforms them in AUPRC, while operating at less than 25% of their computational cost.

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.

Since the rise of large language models (LLMs), the domain adaptation has been one of the hot topics in various domains. Many medical LLMs trained with English medical dataset have made public recently. However, Japanese LLMs in medical domain still lack its research. Here we utilize multiple 70B-parameter LLMs for the first time and show that instruction tuning using Japanese medical question-answering dataset significantly improves the ability of Japanese LLMs to solve Japanese medical license exams, surpassing 50\% in accuracy. In particular, the Japanese-centric models exhibit a more significant leap in improvement through instruction tuning compared to their English-centric counterparts. This underscores the importance of continual pretraining and the adjustment of the tokenizer in our local language. We also examine two slightly different prompt formats, resulting in non-negligible performance improvement.

Background: Large language models (LLMs) are trained to follow directions, but this introduces a vulnerability to blindly comply with user requests even if they generate wrong information. In medicine, this could accelerate the generation of misinformation that impacts human well-being. Objectives/Methods: We analyzed compliance to requests to generate misleading content about medications in settings where models know the request is illogical. We investigated whether in-context directions and instruction-tuning of LLMs to prioritize logical reasoning over compliance reduced misinformation risk. Results: While all frontier LLMs complied with misinformation requests, both prompt-based and parameter-based approaches can improve the detection of logic flaws in requests and prevent the dissemination of medical misinformation. Conclusion: Shifting LLMs to prioritize logic over compliance could reduce risks of exploitation for medical misinformation.

Misunderstandings arise not only in interpersonal communication but also between humans and Large Language Models (LLMs). Such discrepancies can make LLMs interpret seemingly unambiguous questions in unexpected ways, yielding incorrect responses. While it is widely acknowledged that the quality of a prompt, such as a question, significantly impacts the quality of the response provided by LLMs, a systematic method for crafting questions that LLMs can better comprehend is still underdeveloped. In this paper, we present a method named `Rephrase and Respond' (RaR), which allows LLMs to rephrase and expand questions posed by humans and provide responses in a single prompt. This approach serves as a simple yet effective prompting method for improving performance. We also introduce a two-step variant of RaR, where a rephrasing LLM first rephrases the question and then passes the original and rephrased questions together to a different responding LLM. This facilitates the effective utilization of rephrased questions generated by one LLM with another. Our experiments demonstrate that our methods significantly improve the performance of different models across a wide range to tasks. We further provide a comprehensive comparison between RaR and the popular Chain-of-Thought (CoT) methods, both theoretically and empirically. We show that RaR is complementary to CoT and can be combined with CoT to achieve even better performance. Our work not only contributes to enhancing LLM performance efficiently and effectively but also sheds light on a fair evaluation of LLM capabilities. Data and codes are available at https://github.com/uclaml/Rephrase-and-Respond.

Recent large language models (LLMs) in the general domain, such as ChatGPT, have shown remarkable success in following instructions and producing human-like responses. However, such language models have not been learned individually and carefully for the medical domain, resulting in poor diagnostic accuracy and inability to give correct recommendations for medical diagnosis, medications, etc. To address this issue, we collected more than 700 diseases and their corresponding symptoms, recommended medications, and required medical tests, and then generated 5K doctor-patient conversations. By fine-tuning models of doctor-patient conversations, these models emerge with great potential to understand patients' needs, provide informed advice, and offer valuable assistance in a variety of medical-related fields. The integration of these advanced language models into healthcare can revolutionize the way healthcare professionals and patients communicate, ultimately improving the overall quality of care and patient outcomes. In addition, we will open all source code, datasets and model weights to advance the further development of dialogue models in the medical field. In addition, the training data, code, and weights of this project are available at: https://github.com/Kent0n-Li/ChatDoctor.

The emergent abilities of large language models (LLMs) have demonstrated great potential in solving medical questions. They can possess considerable medical knowledge, but may still hallucinate and are inflexible in the knowledge updates. While Retrieval-Augmented Generation (RAG) has been proposed to enhance the medical question-answering capabilities of LLMs with external knowledge bases, it may still fail in complex cases where multiple rounds of information-seeking are required. To address such an issue, we propose iterative RAG for medicine (i-MedRAG), where LLMs can iteratively ask follow-up queries based on previous information-seeking attempts. In each iteration of i-MedRAG, the follow-up queries will be answered by a vanilla RAG system and they will be further used to guide the query generation in the next iteration. Our experiments show the improved performance of various LLMs brought by i-MedRAG compared with vanilla RAG on complex questions from clinical vignettes in the United States Medical Licensing Examination (USMLE), as well as various knowledge tests in the Massive Multitask Language Understanding (MMLU) dataset. Notably, our zero-shot i-MedRAG outperforms all existing prompt engineering and fine-tuning methods on GPT-3.5, achieving an accuracy of 69.68\% on the MedQA dataset. In addition, we characterize the scaling properties of i-MedRAG with different iterations of follow-up queries and different numbers of queries per iteration. Our case studies show that i-MedRAG can flexibly ask follow-up queries to form reasoning chains, providing an in-depth analysis of medical questions. To the best of our knowledge, this is the first-of-its-kind study on incorporating follow-up queries into medical RAG.

An Achilles heel of Large Language Models (LLMs) is their tendency to hallucinate non-factual statements. A response mixed of factual and non-factual statements poses a challenge for humans to verify and accurately base their decisions on. To combat this problem, we propose Highlighted Chain-of-Thought Prompting (HoT), a technique for prompting LLMs to generate responses with XML tags that ground facts to those provided in the query. That is, given an input question, LLMs would first re-format the question to add XML tags highlighting key facts, and then, generate a response with highlights over the facts referenced from the input. Interestingly, in few-shot settings, HoT outperforms vanilla chain of thought prompting (CoT) on a wide range of 17 tasks from arithmetic, reading comprehension to logical reasoning. When asking humans to verify LLM responses, highlights help time-limited participants to more accurately and efficiently recognize when LLMs are correct. Yet, surprisingly, when LLMs are wrong, HoTs tend to make users believe that an answer is correct.

We propose DISC-MedLLM, a comprehensive solution that leverages Large Language Models (LLMs) to provide accurate and truthful medical response in end-to-end conversational healthcare services. To construct high-quality Supervised Fine-Tuning (SFT) datasets, we employ three strategies: utilizing medical knowledge-graphs, reconstructing real-world dialogues, and incorporating human-guided preference rephrasing. These datasets are instrumental in training DISC-MedLLM, surpassing existing medical LLMs in both single-turn and multi-turn consultation scenarios. Extensive experimental results demonstrate the effectiveness of the proposed model in bridging the gap between general language models and real-world medical consultation. Additionally, we release the constructed dataset and model weights to further contribute to research and development. Further details and resources can be found at https://github.com/FudanDISC/DISC-MedLLM

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.

Widely deployed large language models (LLMs) can produce convincing yet incorrect outputs, potentially misleading users who may rely on them as if they were correct. To reduce such overreliance, there have been calls for LLMs to communicate their uncertainty to end users. However, there has been little empirical work examining how users perceive and act upon LLMs' expressions of uncertainty. We explore this question through a large-scale, pre-registered, human-subject experiment (N=404) in which participants answer medical questions with or without access to responses from a fictional LLM-infused search engine. Using both behavioral and self-reported measures, we examine how different natural language expressions of uncertainty impact participants' reliance, trust, and overall task performance. We find that first-person expressions (e.g., "I'm not sure, but...") decrease participants' confidence in the system and tendency to agree with the system's answers, while increasing participants' accuracy. An exploratory analysis suggests that this increase can be attributed to reduced (but not fully eliminated) overreliance on incorrect answers. While we observe similar effects for uncertainty expressed from a general perspective (e.g., "It's not clear, but..."), these effects are weaker and not statistically significant. Our findings suggest that using natural language expressions of uncertainty may be an effective approach for reducing overreliance on LLMs, but that the precise language used matters. This highlights the importance of user testing before deploying LLMs at scale.

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.

Ensuring the accuracy of responses provided by large language models (LLMs) is crucial, particularly in clinical settings where incorrect information may directly impact patient health. To address this challenge, we construct K-QA, a dataset containing 1,212 patient questions originating from real-world conversations held on K Health (an AI-driven clinical platform). We employ a panel of in-house physicians to answer and manually decompose a subset of K-QA into self-contained statements. Additionally, we formulate two NLI-based evaluation metrics approximating recall and precision: (1) comprehensiveness, measuring the percentage of essential clinical information in the generated answer and (2) hallucination rate, measuring the number of statements from the physician-curated response contradicted by the LLM answer. Finally, we use K-QA along with these metrics to evaluate several state-of-the-art models, as well as the effect of in-context learning and medically-oriented augmented retrieval schemes developed by the authors. Our findings indicate that in-context learning improves the comprehensiveness of the models, and augmented retrieval is effective in reducing hallucinations. We make K-QA available to to the community to spur research into medically accurate NLP applications.

The evaluation of the problem-solving capability under incomplete information scenarios of Large Language Models (LLMs) is increasingly important, encompassing capabilities such as questioning, knowledge search, error detection, and path planning. Current research mainly focus on LLMs' problem-solving capability such as ``Twenty Questions''. However, these kinds of games do not require recognizing misleading cues which are necessary in the incomplete information scenario. Moreover, the existing game such as ``Who is undercover'' are highly subjective, making it challenging for evaluation. Therefore, in this paper, we introduce a novel game named BrainKing based on the ``Who is undercover'' and ``Twenty Questions'' for evaluating LLM capabilities under incomplete information scenarios. It requires LLMs to identify target entities with limited yes-or-no questions and potential misleading answers. By setting up easy, medium, and hard difficulty modes, we comprehensively assess the performance of LLMs across various aspects. Our results reveal the capabilities and limitations of LLMs in BrainKing, providing significant insights of LLM problem-solving levels.

Recent researches of large language models(LLM), which is pre-trained on massive general-purpose corpora, have achieved breakthroughs in responding human queries. However, these methods face challenges including limited data insufficiency to support extensive pre-training and can not align responses with users' instructions. To address these issues, we introduce a medical instruction dataset, CMedINS, containing six medical instructions derived from actual medical tasks, which effectively fine-tunes LLM in conjunction with other data. Subsequently, We launch our medical model, IIMedGPT, employing an efficient preference alignment method, Direct preference Optimization(DPO). The results show that our final model outperforms existing medical models in medical dialogue.Datsets, Code and model checkpoints will be released upon acceptance.

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.

Large language models (LLMs) have demonstrated impressive capabilities in disease diagnosis. However, their effectiveness in identifying rarer diseases, which are inherently more challenging to diagnose, remains an open question. Rare disease performance is critical with the increasing use of LLMs in healthcare settings. This is especially true if a primary care physician needs to make a rarer prognosis from only a patient conversation so that they can take the appropriate next step. To that end, several clinical decision support systems are designed to support providers in rare disease identification. Yet their utility is limited due to their lack of knowledge of common disorders and difficulty of use. In this paper, we propose RareScale to combine the knowledge LLMs with expert systems. We use jointly use an expert system and LLM to simulate rare disease chats. This data is used to train a rare disease candidate predictor model. Candidates from this smaller model are then used as additional inputs to black-box LLM to make the final differential diagnosis. Thus, RareScale allows for a balance between rare and common diagnoses. We present results on over 575 rare diseases, beginning with Abdominal Actinomycosis and ending with Wilson's Disease. Our approach significantly improves the baseline performance of black-box LLMs by over 17% in Top-5 accuracy. We also find that our candidate generation performance is high (e.g. 88.8% on gpt-4o generated chats).

Large-scale language models (LLMs) have achieved remarkable success across various language tasks but suffer from hallucinations and temporal misalignment. To mitigate these shortcomings, Retrieval-augmented generation (RAG) has been utilized to provide external knowledge to facilitate the answer generation. However, applying such models to the medical domain faces several challenges due to the lack of domain-specific knowledge and the intricacy of real-world scenarios. In this study, we explore LLMs with RAG framework for knowledge-intensive tasks in the medical field. To evaluate the capabilities of LLMs, we introduce MedicineQA, a multi-round dialogue benchmark that simulates the real-world medication consultation scenario and requires LLMs to answer with retrieved evidence from the medicine database. MedicineQA contains 300 multi-round question-answering pairs, each embedded within a detailed dialogue history, highlighting the challenge posed by this knowledge-intensive task to current LLMs. We further propose a new Distill-Retrieve-Read framework instead of the previous Retrieve-then-Read. Specifically, the distillation and retrieval process utilizes a tool calling mechanism to formulate search queries that emulate the keyword-based inquiries used by search engines. With experimental results, we show that our framework brings notable performance improvements and surpasses the previous counterparts in the evidence retrieval process in terms of evidence retrieval accuracy. This advancement sheds light on applying RAG to the medical domain.

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

The increased use of large language models (LLMs) across a variety of real-world applications calls for mechanisms to verify the factual accuracy of their outputs. In this work, we present a holistic end-to-end solution for annotating the factuality of LLM-generated responses, which encompasses a multi-stage annotation scheme designed to yield detailed labels concerning the verifiability and factual inconsistencies found in LLM outputs. We design and build an annotation tool to speed up the labelling procedure and ease the workload of raters. It allows flexible incorporation of automatic results in any stage, e.g. automatically-retrieved evidence. We further construct an open-domain document-level factuality benchmark in three-level granularity: claim, sentence and document. Preliminary experiments show that FacTool, FactScore and Perplexity.ai are struggling to identify false claims with the best F1=0.53. Annotation tool, benchmark and code are available at https://github.com/yuxiaw/Factcheck-GPT.

Recent advancements in Retrieval-Augmented Generation (RAG) have shown remarkable performance in enhancing response accuracy and relevance by integrating external knowledge into generative models. However, existing RAG methods primarily focus on providing text-only answers, even in multimodal retrieval-augmented generation scenarios. In this work, we introduce the Multimodal Retrieval-Augmented Multimodal Generation (MRAMG) task, which aims to generate answers that combine both text and images, fully leveraging the multimodal data within a corpus. Despite the importance of this task, there is a notable absence of a comprehensive benchmark to effectively evaluate MRAMG performance. To bridge this gap, we introduce the MRAMG-Bench, a carefully curated, human-annotated dataset comprising 4,346 documents, 14,190 images, and 4,800 QA pairs, sourced from three categories: Web Data, Academic Papers, and Lifestyle. The dataset incorporates diverse difficulty levels and complex multi-image scenarios, providing a robust foundation for evaluating multimodal generation tasks. To facilitate rigorous evaluation, our MRAMG-Bench incorporates a comprehensive suite of both statistical and LLM-based metrics, enabling a thorough analysis of the performance of popular generative models in the MRAMG task. Besides, we propose an efficient multimodal answer generation framework that leverages both LLMs and MLLMs to generate multimodal responses. Our datasets are available at: https://huggingface.co/MRAMG.

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.

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.

Large language models (LLMs) have shown promise for generative and knowledge-intensive tasks including question-answering (QA) tasks. However, the practical deployment still faces challenges, notably the issue of "hallucination", where models generate plausible-sounding but unfaithful or nonsensical information. This issue becomes particularly critical in the medical domain due to the uncommon professional concepts and potential social risks involved. This paper analyses the phenomenon of hallucination in medical generative QA systems using widely adopted LLMs and datasets. Our investigation centers on the identification and comprehension of common problematic answers, with a specific emphasis on hallucination. To tackle this challenge, we present an interactive self-reflection methodology that incorporates knowledge acquisition and answer generation. Through this feedback process, our approach steadily enhances the factuality, consistency, and entailment of the generated answers. Consequently, we harness the interactivity and multitasking ability of LLMs and produce progressively more precise and accurate answers. Experimental results on both automatic and human evaluation demonstrate the superiority of our approach in hallucination reduction compared to baselines.

Large language models (LLMs) are transforming the ways the general public accesses and consumes information. Their influence is particularly pronounced in pivotal sectors like healthcare, where lay individuals are increasingly appropriating LLMs as conversational agents for everyday queries. While LLMs demonstrate impressive language understanding and generation proficiencies, concerns regarding their safety remain paramount in these high-stake domains. Moreover, the development of LLMs is disproportionately focused on English. It remains unclear how these LLMs perform in the context of non-English languages, a gap that is critical for ensuring equity in the real-world use of these systems.This paper provides a framework to investigate the effectiveness of LLMs as multi-lingual dialogue systems for healthcare queries. Our empirically-derived framework XlingEval focuses on three fundamental criteria for evaluating LLM responses to naturalistic human-authored health-related questions: correctness, consistency, and verifiability. Through extensive experiments on four major global languages, including English, Spanish, Chinese, and Hindi, spanning three expert-annotated large health Q&A datasets, and through an amalgamation of algorithmic and human-evaluation strategies, we found a pronounced disparity in LLM responses across these languages, indicating a need for enhanced cross-lingual capabilities. We further propose XlingHealth, a cross-lingual benchmark for examining the multilingual capabilities of LLMs in the healthcare context. Our findings underscore the pressing need to bolster the cross-lingual capacities of these models, and to provide an equitable information ecosystem accessible to all.

The rise of large language models (LLMs) has significantly influenced the quality of information in decision-making systems, leading to the prevalence of AI-generated content and challenges in detecting misinformation and managing conflicting information, or "inter-evidence conflicts." This study introduces a method for generating diverse, validated evidence conflicts to simulate real-world misinformation scenarios. We evaluate conflict detection methods, including Natural Language Inference (NLI) models, factual consistency (FC) models, and LLMs, on these conflicts (RQ1) and analyze LLMs' conflict resolution behaviors (RQ2). Our key findings include: (1) NLI and LLM models exhibit high precision in detecting answer conflicts, though weaker models suffer from low recall; (2) FC models struggle with lexically similar answer conflicts, while NLI and LLM models handle these better; and (3) stronger models like GPT-4 show robust performance, especially with nuanced conflicts. For conflict resolution, LLMs often favor one piece of conflicting evidence without justification and rely on internal knowledge if they have prior beliefs.

Scientific literature is typically dense, requiring significant background knowledge and deep comprehension for effective engagement. We introduce SciDQA, a new dataset for reading comprehension that challenges LLMs for a deep understanding of scientific articles, consisting of 2,937 QA pairs. Unlike other scientific QA datasets, SciDQA sources questions from peer reviews by domain experts and answers by paper authors, ensuring a thorough examination of the literature. We enhance the dataset's quality through a process that carefully filters out lower quality questions, decontextualizes the content, tracks the source document across different versions, and incorporates a bibliography for multi-document question-answering. Questions in SciDQA necessitate reasoning across figures, tables, equations, appendices, and supplementary materials, and require multi-document reasoning. We evaluate several open-source and proprietary LLMs across various configurations to explore their capabilities in generating relevant and factual responses. Our comprehensive evaluation, based on metrics for surface-level similarity and LLM judgements, highlights notable performance discrepancies. SciDQA represents a rigorously curated, naturally derived scientific QA dataset, designed to facilitate research on complex scientific text understanding.

The ability of large language models (LLMs) to follow natural language instructions with human-level fluency suggests many opportunities in healthcare to reduce administrative burden and improve quality of care. However, evaluating LLMs on realistic text generation tasks for healthcare remains challenging. Existing question answering datasets for electronic health record (EHR) data fail to capture the complexity of information needs and documentation burdens experienced by clinicians. To address these challenges, we introduce MedAlign, a benchmark dataset of 983 natural language instructions for EHR data. MedAlign is curated by 15 clinicians (7 specialities), includes clinician-written reference responses for 303 instructions, and provides 276 longitudinal EHRs for grounding instruction-response pairs. We used MedAlign to evaluate 6 general domain LLMs, having clinicians rank the accuracy and quality of each LLM response. We found high error rates, ranging from 35% (GPT-4) to 68% (MPT-7B-Instruct), and an 8.3% drop in accuracy moving from 32k to 2k context lengths for GPT-4. Finally, we report correlations between clinician rankings and automated natural language generation metrics as a way to rank LLMs without human review. We make MedAlign available under a research data use agreement to enable LLM evaluations on tasks aligned with clinician needs and preferences.

Knowledge-intensive tasks (e.g., open-domain question answering (QA)) require a substantial amount of factual knowledge and often rely on external information for assistance. Recently, large language models (LLMs) (e.g., ChatGPT), have demonstrated impressive prowess in solving a wide range of tasks with world knowledge, including knowledge-intensive tasks. However, it remains unclear how well LLMs are able to perceive their factual knowledge boundaries, particularly how they behave when incorporating retrieval augmentation. In this study, we present an initial analysis of the factual knowledge boundaries of LLMs and how retrieval augmentation affects LLMs on open-domain QA. Specially, we focus on three primary research questions and analyze them by examining QA performance, priori judgement and posteriori judgement of LLMs. We show evidence that LLMs possess unwavering confidence in their capabilities to respond to questions and the accuracy of their responses. Furthermore, retrieval augmentation proves to be an effective approach in enhancing LLMs' awareness of knowledge boundaries, thereby improving their judgemental abilities. Additionally, we also find that LLMs have a propensity to rely on the provided retrieval results when formulating answers, while the quality of these results significantly impacts their reliance. The code to reproduce this work is available at https://github.com/RUCAIBox/LLM-Knowledge-Boundary.

Large language models (LLMs) have demonstrated remarkable capabilities across various tasks but still face challenges such as hallucinations. One potential reason for hallucinations is the lack of relevant knowledge or context. Thus, a promising solution to mitigate this issue involves instructing LLMs to respond with "I do not know" when a question falls outside their knowledge domain or the provided context. However, in this work, we observed that LLMs struggle to admit their lack of knowledge, primarily due to existing instruction datasets designed to encourage specific answers. To improve large language models' capability to recognize the boundaries of their knowledge, we propose a novel approach called uncertainty-sensitive tuning. This method involves two-stage training designed for uncertainty recognition and prompt-sensitive activation. In the first stage, we guide the LLM to reject unknown questions. In the second stage, we recover the decreased performance in QA tasks by incorporating designed causal instructions. By leveraging this method, we aim to enhance the model's ability to identify areas of uncertainty. The experimental results demonstrate that our proposed uncertainty-sensitive tuning method significantly improves the performance of the Llama2-chat-7B model. Specifically, it achieves a substantial 34.7% improvement in handling questions involving knowledge gaps compared to the original model. Moreover, our approach outperforms GPT-4, exhibiting a 9.4% increase in overall performance. We open-source the model and code on GitHub.

Multiple choice question answering (MCQA) is popular for LLM evaluation due to its simplicity and human-like testing, but we argue for its reform. We first reveal flaws in MCQA's format, as it struggles to: 1) test generation/subjectivity; 2) match LLM use cases; and 3) fully test knowledge. We instead advocate for generative formats based on human testing-where LLMs construct and explain answers-better capturing user needs and knowledge while remaining easy to score. We then show even when MCQA is a useful format, its datasets suffer from: leakage; unanswerability; shortcuts; and saturation. In each issue, we give fixes from education, like rubrics to guide MCQ writing; scoring methods to bridle guessing; and Item Response Theory to build harder MCQs. Lastly, we discuss LLM errors in MCQA-robustness, biases, and unfaithful explanations-showing how our prior solutions better measure or address these issues. While we do not need to desert MCQA, we encourage more efforts in refining the task based on educational testing, advancing evaluations.

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.

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.

LLM-as-a-Judge is a framework that uses an LLM (large language model) to evaluate the quality of natural language text - typically text that is also generated by an LLM. This framework holds great promise due to its relative low-cost, ease of use, and strong correlations with human stylistic preferences. However, LLM Judges have been shown to exhibit biases that can distort their judgments. We evaluate how well LLM Judges can grade whether a given response to a conversational question is correct, an ability crucial to soundly estimating the overall response quality. To do so, we create and publicly release a human-annotated dataset with labels of correctness for 1,200 LLM responses. We source questions from a combination of existing datasets and a novel, challenging benchmark (BFF-Bench) created for this analysis. We demonstrate a strong connection between an LLM's ability to correctly answer a question and grade responses to that question. Although aggregate level statistics might imply a judge has high agreement with human annotators, it will struggle on the subset of questions it could not answer. To address this issue, we recommend a simple solution: provide the judge with a correct, human-written reference answer. We perform an in-depth analysis on how reference quality can affect the performance of an LLM Judge. We show that providing a weaker judge (e.g. Qwen 2.5 7B) with higher quality references reaches better agreement with human annotators than a stronger judge (e.g. GPT-4o) with synthetic references.

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.

Large Language Models (LLMs) have shown the impressive capability of answering questions in a wide range of scenarios. However, when LLMs face different types of questions, it is worth exploring whether LLMs are aware that some questions have limited answers and need to respond more deterministically but some do not. We refer to this as question awareness of LLMs. The lack of question awareness in LLMs leads to two phenomena that LLMs are: (1) too casual to answer non-open-ended questions or (2) too boring to answer open-ended questions. In this paper, we first evaluate the question awareness in LLMs. The experimental results show that LLMs have the issues of lacking awareness of questions in certain domains, e.g. factual knowledge, resulting in hallucinations during the generation. To mitigate these, we propose a method called Question Awareness Temperature Sampling (QuATS). This method enhances the question awareness of LLMs by adaptively adjusting the output distributions based on question features. The automatic adjustment in QuATS eliminates the need for manual temperature tuning in text generation and consistently improves model performance in various benchmarks.

Large Language Models (LLMs) have demonstrated remarkable capabilities, revolutionizing the integration of AI in daily life applications. However, they are prone to hallucinations, generating claims that contradict established facts, deviating from prompts, and producing inconsistent responses when the same prompt is presented multiple times. Addressing these issues is challenging due to the lack of comprehensive and easily assessable benchmark datasets. Most existing datasets are small and rely on multiple-choice questions, which are inadequate for evaluating the generative prowess of LLMs. To measure hallucination in LLMs, this paper introduces a comprehensive benchmark dataset comprising over 75,000 prompts across eight domains. These prompts are designed to elicit definitive, concise, and informative answers. The dataset is divided into two segments: one publicly available for testing and assessing LLM performance and a hidden segment for benchmarking various LLMs. In our experiments, we tested six LLMs-GPT-3.5, LLama 2, LLama 3, Gemini, Mixtral, and Zephyr-revealing that overall factual hallucination ranges from 59% to 82% on the public dataset and 57% to 76% in the hidden benchmark. Prompt misalignment hallucination ranges from 6% to 95% in the public dataset and 17% to 94% in the hidden counterpart. Average consistency ranges from 21% to 61% and 22% to 63%, respectively. Domain-wise analysis shows that LLM performance significantly deteriorates when asked for specific numeric information while performing moderately with person, location, and date queries. Our dataset demonstrates its efficacy and serves as a comprehensive benchmark for LLM performance evaluation. Our dataset and LLMs responses are available at https://github.com/ashikiut/DefAn{https://github.com/ashikiut/DefAn}.

Existing methods for controlling language models, such as RLHF and Constitutional AI, involve determining which LLM behaviors are desirable and training them into a language model. However, in many cases, it is desirable for LLMs to be controllable at inference time, so that they can be used in multiple contexts with diverse needs. We illustrate this with the Pink Elephant Problem: instructing an LLM to avoid discussing a certain entity (a ``Pink Elephant''), and instead discuss a preferred entity (``Grey Elephant''). We apply a novel simplification of Constitutional AI, Direct Principle Feedback, which skips the ranking of responses and uses DPO directly on critiques and revisions. Our results show that after DPF fine-tuning on our synthetic Pink Elephants dataset, our 13B fine-tuned LLaMA 2 model significantly outperforms Llama-2-13B-Chat and a prompted baseline, and performs as well as GPT-4 in on our curated test set assessing the Pink Elephant Problem.

While holding great promise for improving and facilitating healthcare, large language models (LLMs) struggle to produce up-to-date responses on evolving topics due to outdated knowledge or hallucination. Retrieval-augmented generation (RAG) is a pivotal innovation that improves the accuracy and relevance of LLM responses by integrating LLMs with a search engine and external sources of knowledge. However, the quality of RAG responses can be largely impacted by the rank and density of key information in the retrieval results, such as the "lost-in-the-middle" problem. In this work, we aim to improve the robustness and reliability of the RAG workflow in the medical domain. Specifically, we propose a map-reduce strategy, BriefContext, to combat the "lost-in-the-middle" issue without modifying the model weights. We demonstrated the advantage of the workflow with various LLM backbones and on multiple QA datasets. This method promises to improve the safety and reliability of LLMs deployed in healthcare domains.

The adoption of large language models (LLMs) in many applications, from customer service chat bots and software development assistants to more capable agentic systems necessitates research into how to secure these systems. Attacks like prompt injection and jailbreaking attempt to elicit responses and actions from these models that are not compliant with the safety, privacy, or content policies of organizations using the model in their application. In order to counter abuse of LLMs for generating potentially harmful replies or taking undesirable actions, LLM owners must apply safeguards during training and integrate additional tools to block the LLM from generating text that abuses the model. Jailbreaking prompts play a vital role in convincing an LLM to generate potentially harmful content, making it important to identify jailbreaking attempts to block any further steps. In this work, we propose a novel approach to detect jailbreak prompts based on pairing text embeddings well-suited for retrieval with traditional machine learning classification algorithms. Our approach outperforms all publicly available methods from open source LLM security applications.

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.

With Large Language Models (LLMs) being widely used across various tasks, detecting errors in their responses is increasingly crucial. However, little research has been conducted on error detection of LLM responses. Collecting error annotations on LLM responses is challenging due to the subjective nature of many NLP tasks, and thus previous research focuses on tasks of little practical value (e.g., word sorting) or limited error types (e.g., faithfulness in summarization). This work introduces ReaLMistake, the first error detection benchmark consisting of objective, realistic, and diverse errors made by LLMs. ReaLMistake contains three challenging and meaningful tasks that introduce objectively assessable errors in four categories (reasoning correctness, instruction-following, context-faithfulness, and parameterized knowledge), eliciting naturally observed and diverse errors in responses of GPT-4 and Llama 2 70B annotated by experts. We use ReaLMistake to evaluate error detectors based on 12 LLMs. Our findings show: 1) Top LLMs like GPT-4 and Claude 3 detect errors made by LLMs at very low recall, and all LLM-based error detectors perform much worse than humans. 2) Explanations by LLM-based error detectors lack reliability. 3) LLMs-based error detection is sensitive to small changes in prompts but remains challenging to improve. 4) Popular approaches to improving LLMs, including self-consistency and majority vote, do not improve the error detection performance. Our benchmark and code are provided at https://github.com/psunlpgroup/ReaLMistake.

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.

Recently, Large Language Models (LLMs) have showcased remarkable capabilities in natural language understanding. While demonstrating proficiency in everyday conversations and question-answering situations, these models frequently struggle in domains that require precision, such as medical applications, due to their lack of domain-specific knowledge. In this paper, we describe the procedure for building a powerful, open-source language model specifically designed for medicine applications, termed as PMC-LLaMA. Our contributions are threefold: (i) we systematically investigate the process of adapting a general-purpose foundation language model towards medical domain, this involves data-centric knowledge injection through the integration of 4.8M biomedical academic papers and 30K medical textbooks, as well as comprehensive fine-tuning for alignment with domain-specific instructions; (ii) we contribute a large-scale, comprehensive dataset for instruction tuning. This dataset encompasses medical question-answering (QA), rationale for reasoning, and conversational dialogues, comprising a total of 202M tokens; (iii) we conduct thorough ablation studies to demonstrate the effectiveness of each proposed component. While evaluating on various public medical question-answering benchmarks, our lightweight PMCLLaMA, which consists of only 13 billion parameters, exhibits superior performance, even surpassing ChatGPT. All models, codes, datasets can be found in https://github.com/chaoyi-wu/PMC-LLaMA.

Multimodal Large Language Models (MLLMs) demonstrate a strong understanding of the real world and can even handle complex tasks. However, they still fail on some straightforward visual question-answering (VQA) problems. This paper dives deeper into this issue, revealing that models tend to err when answering easy questions (e.g. Yes/No questions) about an image, even though they can correctly describe it. We refer to this model behavior discrepancy between difficult and simple questions as model laziness. To systematically investigate model laziness, we manually construct LazyBench, a benchmark that includes Yes/No, multiple choice, short answer questions, and image description tasks that are related to the same subjects in the images. Based on LazyBench, we observe that laziness widely exists in current advanced MLLMs (e.g. GPT-4o, Gemini-1.5-pro, Claude 3 and LLaVA-v1.5-13B), and it is more pronounced on stronger models. We also analyze the VQA v2 (LLaVA-v1.5-13B) benchmark and find that about half of its failure cases are caused by model laziness, which further highlights the importance of ensuring that the model fully utilizes its capability. To this end, we conduct preliminary exploration on how to mitigate laziness and find that chain of thought (CoT) can effectively address this issue.

This study presents a comprehensive analysis and comparison of two predominant fine-tuning methodologies - full-parameter fine-tuning and parameter-efficient tuning - within the context of medical Large Language Models (LLMs). We developed and refined a series of LLMs, based on the Llama-2 architecture, specifically designed to enhance medical knowledge retrieval, reasoning, and question-answering capabilities. Our experiments systematically evaluate the effectiveness of these tuning strategies across various well-known medical benchmarks. Notably, our medical LLM Med42 showed an accuracy level of 72% on the US Medical Licensing Examination (USMLE) datasets, setting a new standard in performance for openly available medical LLMs. Through this comparative analysis, we aim to identify the most effective and efficient method for fine-tuning LLMs in the medical domain, thereby contributing significantly to the advancement of AI-driven healthcare applications.

Recent Large Language Models (LLMs) have shown remarkable capabilities in mimicking fictional characters or real humans in conversational settings. However, the realism and consistency of these responses can be further enhanced by providing richer information of the agent being mimicked. In this paper, we propose a novel approach to generate more realistic and consistent responses from LLMs, leveraging five senses, attributes, emotional states, relationship with the interlocutor, and memories. By incorporating these factors, we aim to increase the LLM's capacity for generating natural and realistic reactions in conversational exchanges. Through our research, we expect to contribute to the development of LLMs that demonstrate improved capabilities in mimicking fictional characters. We release a new benchmark dataset and all our codes, prompts, and sample results on our Github: https://github.com/srafsasm/InfoRichBot

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.

Retrieval-augmented generation (RAG) has emerged as a promising approach to enhance the performance of large language models (LLMs) in knowledge-intensive tasks such as those from medical domain. However, the sensitive nature of the medical domain necessitates a completely accurate and trustworthy system. While existing RAG benchmarks primarily focus on the standard retrieve-answer setting, they overlook many practical scenarios that measure crucial aspects of a reliable medical system. This paper addresses this gap by providing a comprehensive evaluation framework for medical question-answering (QA) systems in a RAG setting for these situations, including sufficiency, integration, and robustness. We introduce Medical Retrieval-Augmented Generation Benchmark (MedRGB) that provides various supplementary elements to four medical QA datasets for testing LLMs' ability to handle these specific scenarios. Utilizing MedRGB, we conduct extensive evaluations of both state-of-the-art commercial LLMs and open-source models across multiple retrieval conditions. Our experimental results reveals current models' limited ability to handle noise and misinformation in the retrieved documents. We further analyze the LLMs' reasoning processes to provides valuable insights and future directions for developing RAG systems in this critical medical domain.

The effectiveness of Large Language Models (LLMs) in generating accurate responses relies heavily on the quality of input provided, particularly when employing Retrieval Augmented Generation (RAG) techniques. RAG enhances LLMs by sourcing the most relevant text chunk(s) to base queries upon. Despite the significant advancements in LLMs' response quality in recent years, users may still encounter inaccuracies or irrelevant answers; these issues often stem from suboptimal text chunk retrieval by RAG rather than the inherent capabilities of LLMs. To augment the efficacy of LLMs, it is crucial to refine the RAG process. This paper explores the existing constraints of RAG pipelines and introduces methodologies for enhancing text retrieval. It delves into strategies such as sophisticated chunking techniques, query expansion, the incorporation of metadata annotations, the application of re-ranking algorithms, and the fine-tuning of embedding algorithms. Implementing these approaches can substantially improve the retrieval quality, thereby elevating the overall performance and reliability of LLMs in processing and responding to queries.

Large Language Models (LLMs) have recently gained attention due to their ability to understand and generate sophisticated human-like content. However, ensuring their safety is paramount as they might provide harmful and unsafe responses. Existing LLM testing frameworks address various safety-related concerns (e.g., drugs, terrorism, animal abuse) but often face challenges due to unbalanced and obsolete datasets. In this paper, we present ASTRAL, a tool that automates the generation and execution of test cases (i.e., prompts) for testing the safety of LLMs. First, we introduce a novel black-box coverage criterion to generate balanced and diverse unsafe test inputs across a diverse set of safety categories as well as linguistic writing characteristics (i.e., different style and persuasive writing techniques). Second, we propose an LLM-based approach that leverages Retrieval Augmented Generation (RAG), few-shot prompting strategies and web browsing to generate up-to-date test inputs. Lastly, similar to current LLM test automation techniques, we leverage LLMs as test oracles to distinguish between safe and unsafe test outputs, allowing a fully automated testing approach. We conduct an extensive evaluation on well-known LLMs, revealing the following key findings: i) GPT3.5 outperforms other LLMs when acting as the test oracle, accurately detecting unsafe responses, and even surpassing more recent LLMs (e.g., GPT-4), as well as LLMs that are specifically tailored to detect unsafe LLM outputs (e.g., LlamaGuard); ii) the results confirm that our approach can uncover nearly twice as many unsafe LLM behaviors with the same number of test inputs compared to currently used static datasets; and iii) our black-box coverage criterion combined with web browsing can effectively guide the LLM on generating up-to-date unsafe test inputs, significantly increasing the number of unsafe LLM behaviors.

Large Language Models (LLMs) are revolutionizing information retrieval, with chatbots becoming an important source for answering user queries. As by their design, LLMs prioritize generating correct answers, the value of highly plausible yet incorrect answers (candidate answers) tends to be overlooked. However, such answers can still prove useful, for example, they can play a crucial role in tasks like Multiple-Choice Question Answering (MCQA) and QA Robustness Assessment (QARA). Existing QA datasets primarily focus on correct answers without explicit consideration of the plausibility of other candidate answers, limiting opportunity for more nuanced evaluations of models. To address this gap, we introduce PlausibleQA, a large-scale dataset comprising 10,000 questions and 100,000 candidate answers, each annotated with plausibility scores and justifications for their selection. Additionally, the dataset includes 900,000 justifications for pairwise comparisons between candidate answers, further refining plausibility assessments. We evaluate PlausibleQA through human assessments and empirical experiments, demonstrating its utility in MCQA and QARA analysis. Our findings show that plausibility-aware approaches are effective for MCQA distractor generation and QARA. We release PlausibleQA as a resource for advancing QA research and enhancing LLM performance in distinguishing plausible distractors from correct answers.

Assessing student's answers and in particular natural language answers is a crucial challenge in the field of education. Advances in machine learning, including transformer-based models such as Large Language Models(LLMs), have led to significant progress in various natural language tasks. Nevertheless, amidst the growing trend of evaluating LLMs across diverse tasks, evaluating LLMs in the realm of automated answer assesment has not received much attention. To address this gap, we explore the potential of using LLMs for automated assessment of student's short and open-ended answer. Particularly, we use LLMs to compare students' explanations with expert explanations in the context of line-by-line explanations of computer programs. For comparison purposes, we assess both Large Language Models (LLMs) and encoder-based Semantic Textual Similarity (STS) models in the context of assessing the correctness of students' explanation of computer code. Our findings indicate that LLMs, when prompted in few-shot and chain-of-thought setting perform comparable to fine-tuned encoder-based models in evaluating students' short answers in programming domain.

With the rapid evolution of large language models (LLMs), new and hard-to-predict harmful capabilities are emerging. This requires developers to be able to identify risks through the evaluation of "dangerous capabilities" in order to responsibly deploy LLMs. In this work, we collect the first open-source dataset to evaluate safeguards in LLMs, and deploy safer open-source LLMs at a low cost. Our dataset is curated and filtered to consist only of instructions that responsible language models should not follow. We annotate and assess the responses of six popular LLMs to these instructions. Based on our annotation, we proceed to train several BERT-like classifiers, and find that these small classifiers can achieve results that are comparable with GPT-4 on automatic safety evaluation. Warning: this paper contains example data that may be offensive, harmful, or biased.

This survey addresses the crucial issue of factuality in Large Language Models (LLMs). As LLMs find applications across diverse domains, the reliability and accuracy of their outputs become vital. We define the Factuality Issue as the probability of LLMs to produce content inconsistent with established facts. We first delve into the implications of these inaccuracies, highlighting the potential consequences and challenges posed by factual errors in LLM outputs. Subsequently, we analyze the mechanisms through which LLMs store and process facts, seeking the primary causes of factual errors. Our discussion then transitions to methodologies for evaluating LLM factuality, emphasizing key metrics, benchmarks, and studies. We further explore strategies for enhancing LLM factuality, including approaches tailored for specific domains. We focus two primary LLM configurations standalone LLMs and Retrieval-Augmented LLMs that utilizes external data, we detail their unique challenges and potential enhancements. Our survey offers a structured guide for researchers aiming to fortify the factual reliability of LLMs.

Uncovering latent values and opinions in large language models (LLMs) can help identify biases and mitigate potential harm. Recently, this has been approached by presenting LLMs with survey questions and quantifying their stances towards morally and politically charged statements. However, the stances generated by LLMs can vary greatly depending on how they are prompted, and there are many ways to argue for or against a given position. In this work, we propose to address this by analysing a large and robust dataset of 156k LLM responses to the 62 propositions of the Political Compass Test (PCT) generated by 6 LLMs using 420 prompt variations. We perform coarse-grained analysis of their generated stances and fine-grained analysis of the plain text justifications for those stances. For fine-grained analysis, we propose to identify tropes in the responses: semantically similar phrases that are recurrent and consistent across different prompts, revealing patterns in the text that a given LLM is prone to produce. We find that demographic features added to prompts significantly affect outcomes on the PCT, reflecting bias, as well as disparities between the results of tests when eliciting closed-form vs. open domain responses. Additionally, patterns in the plain text rationales via tropes show that similar justifications are repeatedly generated across models and prompts even with disparate stances.

Multimodal Large Language Models (MLLMs) have tremendous potential to improve the accuracy, availability, and cost-effectiveness of healthcare by providing automated solutions or serving as aids to medical professionals. Despite promising first steps in developing medical MLLMs in the past few years, their capabilities and limitations are not well-understood. Recently, many benchmark datasets have been proposed that test the general medical knowledge of such models across a variety of medical areas. However, the systematic failure modes and vulnerabilities of such models are severely underexplored with most medical benchmarks failing to expose the shortcomings of existing models in this safety-critical domain. In this paper, we introduce MediConfusion, a challenging medical Visual Question Answering (VQA) benchmark dataset, that probes the failure modes of medical MLLMs from a vision perspective. We reveal that state-of-the-art models are easily confused by image pairs that are otherwise visually dissimilar and clearly distinct for medical experts. Strikingly, all available models (open-source or proprietary) achieve performance below random guessing on MediConfusion, raising serious concerns about the reliability of existing medical MLLMs for healthcare deployment. We also extract common patterns of model failure that may help the design of a new generation of more trustworthy and reliable MLLMs in healthcare.

There exist challenges in learning and understanding religions as the presence of complexity and depth of religious doctrines and teachings. Chatbots as question-answering systems can help in solving these challenges. LLM chatbots use NLP techniques to establish connections between topics and accurately respond to complex questions. These capabilities make it perfect to be used in enlightenment on religion as a question answering chatbot. However, LLMs also have a tendency to generate false information, known as hallucination. The responses of the chatbots can include content that insults personal religious beliefs, interfaith conflicts, and controversial or sensitive topics. It needs to avoid such cases without promoting hate speech or offending certain groups of people or their beliefs. This study uses a vector database-based Retrieval Augmented Generation (RAG) approach to enhance the accuracy and transparency of LLMs. Our question-answering system is called as "MufassirQAS". We created a vector database with several open-access books that include Turkish context. These are Turkish translations, and interpretations on Islam. We worked on creating system prompts with care, ensuring they provide instructions that prevent harmful, offensive, or disrespectful responses. We also tested the MufassirQAS and ChatGPT with sensitive questions. We got better performance with our system. Study and enhancements are still in progress. Results and future works are given.

Large language models (LLMs) are prone to hallucinations in question-answering (QA) tasks when faced with ambiguous questions. Users often assume that LLMs share their cognitive alignment, a mutual understanding of context, intent, and implicit details, leading them to omit critical information in the queries. However, LLMs generate responses based on assumptions that can misalign with user intent, which may be perceived as hallucinations if they misalign with the user's intent. Therefore, identifying those implicit assumptions is crucial to resolve ambiguities in QA. Prior work, such as AmbigQA, reduces ambiguity in queries via human-annotated clarifications, which is not feasible in real application. Meanwhile, ASQA compiles AmbigQA's short answers into long-form responses but inherits human biases and fails capture explicit logical distinctions that differentiates the answers. We introduce Conditional Ambiguous Question-Answering (CondAmbigQA), a benchmark with 200 ambiguous queries and condition-aware evaluation metrics. Our study pioneers the concept of ``conditions'' in ambiguous QA tasks, where conditions stand for contextual constraints or assumptions that resolve ambiguities. The retrieval-based annotation strategy uses retrieved Wikipedia fragments to identify possible interpretations for a given query as its conditions and annotate the answers through those conditions. Such a strategy minimizes human bias introduced by different knowledge levels among annotators. By fixing retrieval results, CondAmbigQA evaluates how RAG systems leverage conditions to resolve ambiguities. Experiments show that models considering conditions before answering improve performance by 20%, with an additional 5% gain when conditions are explicitly provided. These results underscore the value of conditional reasoning in QA, offering researchers tools to rigorously evaluate ambiguity resolution.

Large Language Models (LLMs) have fast become an essential tools to many conversational chatbots due to their ability to provide coherent answers for varied queries. Datasets used to train these LLMs are often a mix of generic and synthetic samples, thus lacking the verification needed to provide correct and verifiable answers for T.V. News. We collect and share a large collection of QA pairs extracted from transcripts of news recordings from various news-channels across the United States. Resultant QA pairs are then used to fine-tune an off-the-shelf LLM model. Our model surpasses base models of similar size on several open LLM benchmarks. We further integrate and propose a RAG method to improve contextualization of our answers and also point it to a verifiable news recording.

Large Language Models (LLMs) constitute a breakthrough state-of-the-art Artificial Intelligence (AI) technology which is rapidly evolving and promises to aid in medical diagnosis either by assisting doctors or by simulating a doctor's workflow in more advanced and complex implementations. In this technical paper, we outline Cognitive Network Evaluation Toolkit for Medical Domains (COGNET-MD), which constitutes a novel benchmark for LLM evaluation in the medical domain. Specifically, we propose a scoring-framework with increased difficulty to assess the ability of LLMs in interpreting medical text. The proposed framework is accompanied with a database of Multiple Choice Quizzes (MCQs). To ensure alignment with current medical trends and enhance safety, usefulness, and applicability, these MCQs have been constructed in collaboration with several associated medical experts in various medical domains and are characterized by varying degrees of difficulty. The current (first) version of the database includes the medical domains of Psychiatry, Dentistry, Pulmonology, Dermatology and Endocrinology, but it will be continuously extended and expanded to include additional medical domains.

This paper investigates whether large language models (LLMs) are state-of-the-art quality estimators for machine translation of user-generated content (UGC) that contains emotional expressions, without the use of reference translations. To achieve this, we employ an existing emotion-related dataset with human-annotated errors and calculate quality evaluation scores based on the Multi-dimensional Quality Metrics. We compare the accuracy of several LLMs with that of our fine-tuned baseline models, under in-context learning and parameter-efficient fine-tuning (PEFT) scenarios. We find that PEFT of LLMs leads to better performance in score prediction with human interpretable explanations than fine-tuned models. However, a manual analysis of LLM outputs reveals that they still have problems such as refusal to reply to a prompt and unstable output while evaluating machine translation of UGC.

We investigate the usefulness of generative Large Language Models (LLMs) in generating training data for cross-encoder re-rankers in a novel direction: generating synthetic documents instead of synthetic queries. We introduce a new dataset, ChatGPT-RetrievalQA, and compare the effectiveness of models fine-tuned on LLM-generated and human-generated data. Data generated with generative LLMs can be used to augment training data, especially in domains with smaller amounts of labeled data. We build ChatGPT-RetrievalQA based on an existing dataset, human ChatGPT Comparison Corpus (HC3), consisting of public question collections with human responses and answers from ChatGPT. We fine-tune a range of cross-encoder re-rankers on either human-generated or ChatGPT-generated data. Our evaluation on MS MARCO DEV, TREC DL'19, and TREC DL'20 demonstrates that cross-encoder re-ranking models trained on ChatGPT responses are statistically significantly more effective zero-shot re-rankers than those trained on human responses. In a supervised setting, the human-trained re-rankers outperform the LLM-trained re-rankers. Our novel findings suggest that generative LLMs have high potential in generating training data for neural retrieval models. Further work is needed to determine the effect of factually wrong information in the generated responses and test our findings' generalizability with open-source LLMs. We release our data, code, and cross-encoders checkpoints for future work.

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.

Large language models (LLMs) have shown potential in biomedical applications, leading to efforts to fine-tune them on domain-specific data. However, the effectiveness of this approach remains unclear. This study evaluates the performance of biomedically fine-tuned LLMs against their general-purpose counterparts on a variety of clinical tasks. We evaluated their performance on clinical case challenges from the New England Journal of Medicine (NEJM) and the Journal of the American Medical Association (JAMA) and on several clinical tasks (e.g., information extraction, document summarization, and clinical coding). Using benchmarks specifically chosen to be likely outside the fine-tuning datasets of biomedical models, we found that biomedical LLMs mostly perform inferior to their general-purpose counterparts, especially on tasks not focused on medical knowledge. While larger models showed similar performance on case tasks (e.g., OpenBioLLM-70B: 66.4% vs. Llama-3-70B-Instruct: 65% on JAMA cases), smaller biomedical models showed more pronounced underperformance (e.g., OpenBioLLM-8B: 30% vs. Llama-3-8B-Instruct: 64.3% on NEJM cases). Similar trends were observed across the CLUE (Clinical Language Understanding Evaluation) benchmark tasks, with general-purpose models often performing better on text generation, question answering, and coding tasks. Our results suggest that fine-tuning LLMs to biomedical data may not provide the expected benefits and may potentially lead to reduced performance, challenging prevailing assumptions about domain-specific adaptation of LLMs and highlighting the need for more rigorous evaluation frameworks in healthcare AI. Alternative approaches, such as retrieval-augmented generation, may be more effective in enhancing the biomedical capabilities of LLMs without compromising their general knowledge.

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%

Medical multiple-choice question answering (MCQA) is particularly difficult. Questions may describe patient symptoms and ask for the correct diagnosis, which requires domain knowledge and complex reasoning. Standard language modeling pretraining alone is not sufficient to achieve the best results. jin2020disease showed that focusing masked language modeling on disease name prediction when using medical encyclopedic paragraphs as input leads to considerable MCQA accuracy improvement. In this work, we show that (1) fine-tuning on generated MCQA dataset outperforms the masked language modeling based objective and (2) correctly masking the cues to the answers is critical for good performance. We release new pretraining datasets and achieve state-of-the-art results on 4 MCQA datasets, notably +5.7\% with base-size model on MedQA-USMLE.

Large language models (LLMs) are increasingly being integrated into search engines to provide natural language responses tailored to user queries. Customers and end-users are also becoming more dependent on these models for quick and easy purchase decisions. In this work, we investigate whether recommendations from LLMs can be manipulated to enhance a product's visibility. We demonstrate that adding a strategic text sequence (STS) -- a carefully crafted message -- to a product's information page can significantly increase its likelihood of being listed as the LLM's top recommendation. To understand the impact of STS, we use a catalog of fictitious coffee machines and analyze its effect on two target products: one that seldom appears in the LLM's recommendations and another that usually ranks second. We observe that the strategic text sequence significantly enhances the visibility of both products by increasing their chances of appearing as the top recommendation. This ability to manipulate LLM-generated search responses provides vendors with a considerable competitive advantage and has the potential to disrupt fair market competition. Just as search engine optimization (SEO) revolutionized how webpages are customized to rank higher in search engine results, influencing LLM recommendations could profoundly impact content optimization for AI-driven search services. Code for our experiments is available at https://github.com/aounon/llm-rank-optimizer.

Although Large Language Models (LLMs) have demonstrated extraordinary capabilities in many domains, they still have a tendency to hallucinate and generate fictitious responses to user requests. This problem can be alleviated by augmenting LLMs with information retrieval (IR) systems (also known as retrieval-augmented LLMs). Applying this strategy, LLMs can generate more factual texts in response to user input according to the relevant content retrieved by IR systems from external corpora as references. In addition, by incorporating external knowledge, retrieval-augmented LLMs can answer in-domain questions that cannot be answered by solely relying on the world knowledge stored in parameters. To support research in this area and facilitate the development of retrieval-augmented LLM systems, we develop RETA-LLM, a {RET}reival-{A}ugmented LLM toolkit. In RETA-LLM, we create a complete pipeline to help researchers and users build their customized in-domain LLM-based systems. Compared with previous retrieval-augmented LLM systems, RETA-LLM provides more plug-and-play modules to support better interaction between IR systems and LLMs, including {request rewriting, document retrieval, passage extraction, answer generation, and fact checking} modules. Our toolkit is publicly available at https://github.com/RUC-GSAI/YuLan-IR/tree/main/RETA-LLM.

Despite the considerable advancements in English LLMs, the progress in building comparable models for other languages has been hindered due to the scarcity of tailored resources. Our work aims to bridge this divide by introducing an expansive suite of resources specifically designed for the development of Indic LLMs, covering 22 languages, containing a total of 251B tokens and 74.8M instruction-response pairs. Recognizing the importance of both data quality and quantity, our approach combines highly curated manually verified data, unverified yet valuable data, and synthetic data. We build a clean, open-source pipeline for curating pre-training data from diverse sources, including websites, PDFs, and videos, incorporating best practices for crawling, cleaning, flagging, and deduplication. For instruction-fine tuning, we amalgamate existing Indic datasets, translate/transliterate English datasets into Indian languages, and utilize LLaMa2 and Mixtral models to create conversations grounded in articles from Indian Wikipedia and Wikihow. Additionally, we address toxicity alignment by generating toxic prompts for multiple scenarios and then generate non-toxic responses by feeding these toxic prompts to an aligned LLaMa2 model. We hope that the datasets, tools, and resources released as a part of this work will not only propel the research and development of Indic LLMs but also establish an open-source blueprint for extending such efforts to other languages. The data and other artifacts created as part of this work are released with permissive licenses.

When asked, current large language models (LLMs) like ChatGPT claim that they can assist us with relevance judgments. Many researchers think this would not lead to credible IR research. In this perspective paper, we discuss possible ways for LLMs to assist human experts along with concerns and issues that arise. We devise a human-machine collaboration spectrum that allows categorizing different relevance judgment strategies, based on how much the human relies on the machine. For the extreme point of "fully automated assessment", we further include a pilot experiment on whether LLM-based relevance judgments correlate with judgments from trained human assessors. We conclude the paper by providing two opposing perspectives - for and against the use of LLMs for automatic relevance judgments - and a compromise perspective, informed by our analyses of the literature, our preliminary experimental evidence, and our experience as IR researchers. We hope to start a constructive discussion within the community to avoid a stale-mate during review, where work is dammed if is uses LLMs for evaluation and dammed if it doesn't.

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.

The deployment of large language models (LLMs) within the healthcare sector has sparked both enthusiasm and apprehension. These models exhibit the remarkable capability to provide proficient responses to free-text queries, demonstrating a nuanced understanding of professional medical knowledge. This comprehensive survey delves into the functionalities of existing LLMs designed for healthcare applications, elucidating the trajectory of their development, starting from traditional Pretrained Language Models (PLMs) to the present state of LLMs in healthcare sector. First, we explore the potential of LLMs to amplify the efficiency and effectiveness of diverse healthcare applications, particularly focusing on clinical language understanding tasks. These tasks encompass a wide spectrum, ranging from named entity recognition and relation extraction to natural language inference, multi-modal medical applications, document classification, and question-answering. Additionally, we conduct an extensive comparison of the most recent state-of-the-art LLMs in the healthcare domain, while also assessing the utilization of various open-source LLMs and highlighting their significance in healthcare applications. Furthermore, we present the essential performance metrics employed to evaluate LLMs in the biomedical domain, shedding light on their effectiveness and limitations. Finally, we summarize the prominent challenges and constraints faced by large language models in the healthcare sector, offering a holistic perspective on their potential benefits and shortcomings. This review provides a comprehensive exploration of the current landscape of LLMs in healthcare, addressing their role in transforming medical applications and the areas that warrant further research and development.

Retrieval Augmented Generation (RAG) is widely used to enable Large Language Models (LLMs) perform Question Answering (QA) tasks in various domains. However, RAG based on open-source LLM for specialized domains has challenges of evaluating generated responses. A popular framework in the literature is the RAG Assessment (RAGAS), a publicly available library which uses LLMs for evaluation. One disadvantage of RAGAS is the lack of details of derivation of numerical value of the evaluation metrics. One of the outcomes of this work is a modified version of this package for few metrics (faithfulness, context relevance, answer relevance, answer correctness, answer similarity and factual correctness) through which we provide the intermediate outputs of the prompts by using any LLMs. Next, we analyse the expert evaluations of the output of the modified RAGAS package and observe the challenges of using it in the telecom domain. We also study the effect of the metrics under correct vs. wrong retrieval and observe that few of the metrics have higher values for correct retrieval. We also study for differences in metrics between base embeddings and those domain adapted via pre-training and fine-tuning. Finally, we comment on the suitability and challenges of using these metrics for in-the-wild telecom QA task.

As Large Language Models (LLMs) become more pervasive across various users and scenarios, identifying potential issues when using these models becomes essential. Examples of such issues include: bias, inconsistencies, and hallucination. Although auditing the LLM for these problems is often warranted, such a process is neither easy nor accessible for most. An effective method is to probe the LLM using different versions of the same question. This could expose inconsistencies in its knowledge or operation, indicating potential for bias or hallucination. However, to operationalize this auditing method at scale, we need an approach to create those probes reliably and automatically. In this paper we propose the LLMAuditor framework which is an automatic, and scalable solution, where one uses a different LLM along with human-in-the-loop (HIL). This approach offers verifiability and transparency, while avoiding circular reliance on the same LLM, and increasing scientific rigor and generalizability. Specifically, LLMAuditor includes two phases of verification using humans: standardized evaluation criteria to verify responses, and a structured prompt template to generate desired probes. A case study using questions from the TruthfulQA dataset demonstrates that we can generate a reliable set of probes from one LLM that can be used to audit inconsistencies in a different LLM. This process is enhanced by our structured prompt template with HIL, which not only boosts the reliability of our approach in auditing but also yields the delivery of less hallucinated results. The novelty of our research stems from the development of a comprehensive, general-purpose framework that includes a HIL verified prompt template for auditing responses generated by LLMs.

The Retrieval-Augmented Language Model (RALM) has shown remarkable performance on knowledge-intensive tasks by incorporating external knowledge during inference, which mitigates the factual hallucinations inherited in large language models (LLMs). Despite these advancements, challenges persist in the implementation of RALMs, particularly concerning their reliability and traceability. To be specific, the irrelevant document retrieval may result in unhelpful response generation or even deteriorate the performance of LLMs, while the lack of proper citations in generated outputs complicates efforts to verify the trustworthiness of the models. To this end, we propose a novel self-reasoning framework aimed at improving the reliability and traceability of RALMs, whose core idea is to leverage reasoning trajectories generated by the LLM itself. The framework involves constructing self-reason trajectories with three processes: a relevance-aware process, an evidence-aware selective process, and a trajectory analysis process. We have evaluated our framework across four public datasets (two short-form QA datasets, one long-form QA dataset, and one fact verification dataset) to demonstrate the superiority of our method, which can outperform existing state-of-art models and can achieve comparable performance with GPT-4, while only using 2,000 training samples.

Recent breakthroughs in large language models (LLMs) offer unprecedented natural language understanding and generation capabilities. However, existing surveys on LLMs in biomedicine often focus on specific applications or model architectures, lacking a comprehensive analysis that integrates the latest advancements across various biomedical domains. This review, based on an analysis of 484 publications sourced from databases including PubMed, Web of Science, and arXiv, provides an in-depth examination of the current landscape, applications, challenges, and prospects of LLMs in biomedicine, distinguishing itself by focusing on the practical implications of these models in real-world biomedical contexts. Firstly, we explore the capabilities of LLMs in zero-shot learning across a broad spectrum of biomedical tasks, including diagnostic assistance, drug discovery, and personalized medicine, among others, with insights drawn from 137 key studies. Then, we discuss adaptation strategies of LLMs, including fine-tuning methods for both uni-modal and multi-modal LLMs to enhance their performance in specialized biomedical contexts where zero-shot fails to achieve, such as medical question answering and efficient processing of biomedical literature. Finally, we discuss the challenges that LLMs face in the biomedicine domain including data privacy concerns, limited model interpretability, issues with dataset quality, and ethics due to the sensitive nature of biomedical data, the need for highly reliable model outputs, and the ethical implications of deploying AI in healthcare. To address these challenges, we also identify future research directions of LLM in biomedicine including federated learning methods to preserve data privacy and integrating explainable AI methodologies to enhance the transparency of LLMs.

Hallucination is a well-known phenomenon in text generated by large language models (LLMs). The existence of hallucinatory responses is found in almost all application scenarios e.g., summarization, question-answering (QA) etc. For applications requiring high reliability (e.g., customer-facing assistants), the potential existence of hallucination in LLM-generated text is a critical problem. The amount of hallucination can be reduced by leveraging information retrieval to provide relevant background information to the LLM. However, LLMs can still generate hallucinatory content for various reasons (e.g., prioritizing its parametric knowledge over the context, failure to capture the relevant information from the context, etc.). Detecting hallucinations through automated methods is thus paramount. To facilitate research in this direction, we introduce a sophisticated dataset, DelucionQA, that captures hallucinations made by retrieval-augmented LLMs for a domain-specific QA task. Furthermore, we propose a set of hallucination detection methods to serve as baselines for future works from the research community. Analysis and case study are also provided to share valuable insights on hallucination phenomena in the target scenario.

Large language models (LLMs) are gaining increasing popularity in both academia and industry, owing to their unprecedented performance in various applications. As LLMs continue to play a vital role in both research and daily use, their evaluation becomes increasingly critical, not only at the task level, but also at the society level for better understanding of their potential risks. Over the past years, significant efforts have been made to examine LLMs from various perspectives. This paper presents a comprehensive review of these evaluation methods for LLMs, focusing on three key dimensions: what to evaluate, where to evaluate, and how to evaluate. Firstly, we provide an overview from the perspective of evaluation tasks, encompassing general natural language processing tasks, reasoning, medical usage, ethics, educations, natural and social sciences, agent applications, and other areas. Secondly, we answer the `where' and `how' questions by diving into the evaluation methods and benchmarks, which serve as crucial components in assessing performance of LLMs. Then, we summarize the success and failure cases of LLMs in different tasks. Finally, we shed light on several future challenges that lie ahead in LLMs evaluation. Our aim is to offer invaluable insights to researchers in the realm of LLMs evaluation, thereby aiding the development of more proficient LLMs. Our key point is that evaluation should be treated as an essential discipline to better assist the development of LLMs. We consistently maintain the related open-source materials at: https://github.com/MLGroupJLU/LLM-eval-survey.

The development of robust safety benchmarks for large language models requires open, reproducible datasets that can measure both appropriate refusal of harmful content and potential over-restriction of legitimate scientific discourse. We present an open-source dataset and testing framework for evaluating LLM safety mechanisms across mainly controlled substance queries, analyzing four major models' responses to systematically varied prompts. Our results reveal distinct safety profiles: Claude-3.5-sonnet demonstrated the most conservative approach with 73% refusals and 27% allowances, while Mistral attempted to answer 100% of queries. GPT-3.5-turbo showed moderate restriction with 10% refusals and 90% allowances, and Grok-2 registered 20% refusals and 80% allowances. Testing prompt variation strategies revealed decreasing response consistency, from 85% with single prompts to 65% with five variations. This publicly available benchmark enables systematic evaluation of the critical balance between necessary safety restrictions and potential over-censorship of legitimate scientific inquiry, while providing a foundation for measuring progress in AI safety implementation. Chain-of-thought analysis reveals potential vulnerabilities in safety mechanisms, highlighting the complexity of implementing robust safeguards without unduly restricting desirable and valid scientific discourse.

Assessing the capabilities and limitations of large language models (LLMs) has garnered significant interest, yet the evaluation of multiple models in real-world scenarios remains rare. Multilingual evaluation often relies on translated benchmarks, which typically do not capture linguistic and cultural nuances present in the source language. This study provides an extensive assessment of 24 LLMs on real world data collected from Indian patients interacting with a medical chatbot in Indian English and 4 other Indic languages. We employ a uniform Retrieval Augmented Generation framework to generate responses, which are evaluated using both automated techniques and human evaluators on four specific metrics relevant to our application. We find that models vary significantly in their performance and that instruction tuned Indic models do not always perform well on Indic language queries. Further, we empirically show that factual correctness is generally lower for responses to Indic queries compared to English queries. Finally, our qualitative work shows that code-mixed and culturally relevant queries in our dataset pose challenges to evaluated models.

We introduce BSDetector, a method for detecting bad and speculative answers from a pretrained Large Language Model by estimating a numeric confidence score for any output it generated. Our uncertainty quantification technique works for any LLM accessible only via a black-box API, whose training data remains unknown. By expending a bit of extra computation, users of any LLM API can now get the same response as they would ordinarily, as well as a confidence estimate that cautions when not to trust this response. Experiments on both closed and open-form Question-Answer benchmarks reveal that BSDetector more accurately identifies incorrect LLM responses than alternative uncertainty estimation procedures (for both GPT-3 and ChatGPT). By sampling multiple responses from the LLM and considering the one with the highest confidence score, we can additionally obtain more accurate responses from the same LLM, without any extra training steps. In applications involving automated evaluation with LLMs, accounting for our confidence scores leads to more reliable evaluation in both human-in-the-loop and fully-automated settings (across both GPT 3.5 and 4).

Large language models (LLMs) have shown remarkable performance in various tasks but often fail to handle queries that exceed their knowledge and capabilities, leading to incorrect or fabricated responses. This paper addresses the need for LLMs to recognize and refuse infeasible tasks due to the required skills surpassing their capabilities. We first systematically conceptualize infeasible tasks for LLMs, providing formal definitions and categorizations that cover a spectrum of related hallucinations. We develop and benchmark a new dataset comprising diverse infeasible and feasible tasks to test multiple LLMs' abilities on task feasibility. Furthermore, we explore the potential of training enhancements to increase LLMs' refusal capabilities with fine-tuning. Experiments validate the effectiveness of our methods, offering promising directions for refining the operational boundaries of LLMs in real applications.

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.

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.

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 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.

Large Language Models(LLMs)have become effective tools for natural language processing and have been used in many different fields. This essay offers a succinct summary of various LLM subcategories. The survey emphasizes recent developments and efforts made for various LLM kinds, including task-based financial LLMs, multilingual language LLMs, biomedical and clinical LLMs, vision language LLMs, and code language models. The survey gives a general summary of the methods, attributes, datasets, transformer models, and comparison metrics applied in each category of LLMs. Furthermore, it highlights unresolved problems in the field of developing chatbots and virtual assistants, such as boosting natural language processing, enhancing chatbot intelligence, and resolving moral and legal dilemmas. The purpose of this study is to provide readers, developers, academics, and users interested in LLM-based chatbots and virtual intelligent assistant technologies with useful information and future directions.

Retrieval augmented generation (RAG) is often used to fix hallucinations and provide up-to-date knowledge for large language models (LLMs). However, in cases when the LLM alone incorrectly answers a question, does providing the correct retrieved content always fix the error? Conversely, in cases where the retrieved content is incorrect, does the LLM know to ignore the wrong information, or does it recapitulate the error? To answer these questions, we systematically analyze the tug-of-war between a LLM's internal knowledge (i.e. its prior) and the retrieved information in settings when they disagree. We test GPT-4 and other LLMs on question-answering abilities across datasets with and without reference documents. As expected, providing the correct retrieved information fixes most model mistakes (94% accuracy). However, when the reference document is perturbed with increasing levels of wrong values, the LLM is more likely to recite the incorrect, modified information when its internal prior is weaker but is more resistant when its prior is stronger. Similarly, we also find that the more the modified information deviates from the model's prior, the less likely the model is to prefer it. These results highlight an underlying tension between a model's prior knowledge and the information presented in reference documents.

Evaluation and ranking of large language models (LLMs) has become an important problem with the proliferation of these models and their impact. Evaluation methods either require human responses which are expensive to acquire or use pairs of LLMs to evaluate each other which can be unreliable. In this paper, we provide a novel perspective where, given a dataset of prompts (viz. questions, instructions, etc.) and a set of LLMs, we rank them without access to any ground truth or reference responses. Inspired by real life where both an expert and a knowledgeable person can identify a novice our main idea is to consider triplets of models, where each one of them evaluates the other two, correctly identifying the worst model in the triplet with high probability. We also analyze our idea and provide sufficient conditions for it to succeed. Applying this idea repeatedly, we propose two methods to rank LLMs. In experiments on different generative tasks (summarization, multiple-choice, and dialog), our methods reliably recover close to true rankings without reference data. This points to a viable low-resource mechanism for practical use.

Hate speech is a harmful form of online expression, often manifesting as derogatory posts. It is a significant risk in digital environments. With the rise of Large Language Models (LLMs), there is concern about their potential to replicate hate speech patterns, given their training on vast amounts of unmoderated internet data. Understanding how LLMs respond to hate speech is crucial for their responsible deployment. However, the behaviour of LLMs towards hate speech has been limited compared. This paper investigates the reactions of seven state-of-the-art LLMs (LLaMA 2, Vicuna, LLaMA 3, Mistral, GPT-3.5, GPT-4, and Gemini Pro) to hate speech. Through qualitative analysis, we aim to reveal the spectrum of responses these models produce, highlighting their capacity to handle hate speech inputs. We also discuss strategies to mitigate hate speech generation by LLMs, particularly through fine-tuning and guideline guardrailing. Finally, we explore the models' responses to hate speech framed in politically correct language.

Recent advancements in Large Language Models (LLMs) have demonstrated their potential in delivering accurate answers to questions about world knowledge. Despite this, existing benchmarks for evaluating LLMs in healthcare predominantly focus on medical doctors, leaving other critical healthcare professions underrepresented. To fill this research gap, we introduce the Examinations for Medical Personnel in Chinese (EMPEC), a pioneering large-scale healthcare knowledge benchmark in traditional Chinese. EMPEC consists of 157,803 exam questions across 124 subjects and 20 healthcare professions, including underrepresented occupations like Optometrists and Audiologists. Each question is tagged with its release time and source, ensuring relevance and authenticity. We conducted extensive experiments on 17 LLMs, including proprietary, open-source models, general domain models and medical specific models, evaluating their performance under various settings. Our findings reveal that while leading models like GPT-4 achieve over 75\% accuracy, they still struggle with specialized fields and alternative medicine. Surprisingly, general-purpose LLMs outperformed medical-specific models, and incorporating EMPEC's training data significantly enhanced performance. Additionally, the results on questions released after the models' training cutoff date were consistent with overall performance trends, suggesting that the models' performance on the test set can predict their effectiveness in addressing unseen healthcare-related queries. The transition from traditional to simplified Chinese characters had a negligible impact on model performance, indicating robust linguistic versatility. Our study underscores the importance of expanding benchmarks to cover a broader range of healthcare professions to better assess the applicability of LLMs in real-world healthcare scenarios.

This paper examines the zero-shot ability of Large Language Models (LLMs) to detect multiple-choice questions with no correct answer, a crucial aspect of educational assessment quality. We explore this ability not only as a measure of subject matter knowledge but also as an indicator of critical thinking within LLMs. Our experiments, utilizing a range of LLMs on diverse questions, highlight the significant performance gap between questions with a single correct answer and those without. Llama-3.1-405B stands out by successfully identifying the lack of a valid answer in many instances. These findings suggest that LLMs should prioritize critical thinking over blind instruction following and caution against their use in educational settings where questions with incorrect answers might lead to inaccurate evaluations. This research sets a benchmark for assessing critical thinking in LLMs and emphasizes the need for ongoing model alignment to ensure genuine user comprehension and assistance.

Since the recent prosperity of Large Language Models (LLMs), there have been interleaved discussions regarding how to reduce hallucinations from LLM responses, how to increase the factuality of LLMs, and whether Knowledge Graphs (KGs), which store the world knowledge in a symbolic form, will be replaced with LLMs. In this paper, we try to answer these questions from a new angle: How knowledgeable are LLMs? To answer this question, we constructed Head-to-Tail, a benchmark that consists of 18K question-answer (QA) pairs regarding head, torso, and tail facts in terms of popularity. We designed an automated evaluation method and a set of metrics that closely approximate the knowledge an LLM confidently internalizes. Through a comprehensive evaluation of 14 publicly available LLMs, we show that existing LLMs are still far from being perfect in terms of their grasp of factual knowledge, especially for facts of torso-to-tail entities.

Augmenting LLMs with context leads to improved performance across many applications. Despite much research on Retrieval Augmented Generation (RAG) systems, an open question is whether errors arise because LLMs fail to utilize the context from retrieval or the context itself is insufficient to answer the query. To shed light on this, we develop a new notion of sufficient context, along with a way to classify instances that have enough information to answer the query. We then use sufficient context to analyze several models and datasets. By stratifying errors based on context sufficiency, we find that proprietary LLMs (Gemini, GPT, Claude) excel at answering queries when the context is sufficient, but often output incorrect answers instead of abstaining when the context is not. On the other hand, open-source LLMs (Llama, Mistral, Gemma) hallucinate or abstain often, even with sufficient context. We further categorize cases when the context is useful, and improves accuracy, even though it does not fully answer the query and the model errs without the context. Building on our findings, we explore ways to reduce hallucinations in RAG systems, including a new selective generation method that leverages sufficient context information for guided abstention. Our method improves the fraction of correct answers among times where the model responds by 2-10% for Gemini, GPT, and Gemma.

Large language models (LLMs) have performed well in providing general and extensive health suggestions in single-turn conversations, exemplified by systems such as ChatGPT, ChatGLM, ChatDoctor, DoctorGLM, and etc. However, the limited information provided by users during single turn results in inadequate personalization and targeting of the generated suggestions, which requires users to independently select the useful part. It is mainly caused by the missing ability to engage in multi-turn questioning. In real-world medical consultations, doctors usually employ a series of iterative inquiries to comprehend the patient's condition thoroughly, enabling them to provide effective and personalized suggestions subsequently, which can be defined as chain of questioning (CoQ) for LLMs. To improve the CoQ of LLMs, we propose BianQue, a ChatGLM-based LLM finetuned with the self-constructed health conversation dataset BianQueCorpus that is consist of multiple turns of questioning and health suggestions polished by ChatGPT. Experimental results demonstrate that the proposed BianQue can simultaneously balance the capabilities of both questioning and health suggestions, which will help promote the research and application of LLMs in the field of proactive health.

Grounded generation aims to equip language models (LMs) with the ability to produce more credible and accountable responses by accurately citing verifiable sources. However, existing methods, by either feeding LMs with raw or preprocessed materials, remain prone to errors. To address this, we introduce CaLM, a novel verification framework. CaLM leverages the insight that a robust grounded response should be consistent with information derived solely from its cited sources. Our framework empowers smaller LMs, which rely less on parametric memory and excel at processing relevant information given a query, to validate the output of larger LMs. Larger LM responses that closely align with the smaller LMs' output, which relies exclusively on cited documents, are verified. Responses showing discrepancies are iteratively refined through a feedback loop. Experiments on three open-domain question-answering datasets demonstrate significant performance gains of 1.5% to 7% absolute average without any required model fine-tuning.

Large language models (LLMs) have demonstrated remarkable capabilities out of box for a wide range of applications, yet accuracy still remains a major growth area, especially in mission-critical domains such as biomedicine. An effective method to calibrate the confidence level on LLM responses is essential to automatically detect errors and facilitate human-in-the-loop verification. An important source of calibration signals stems from expert-stipulated programmatic supervision, which is often available at low cost but has its own limitations such as noise and coverage. In this paper, we introduce a Pareto optimal self-supervision framework that can leverage available programmatic supervision to systematically calibrate LLM responses by producing a risk score for every response, without any additional manual efforts. This is accomplished by learning a harmonizer model to align LLM output with other available supervision sources, which would assign higher risk scores to more uncertain LLM responses and facilitate error correction. Experiments on standard relation extraction tasks in biomedical and general domains demonstrate the promise of this approach, with our proposed risk scores highly correlated with the real error rate of LLMs. For the most uncertain test instances, dynamic prompting based on our proposed risk scores results in significant accuracy improvement for off-the-shelf LLMs, boosting GPT-3 results past state-of-the-art (SOTA) weak supervision and GPT-4 results past SOTA supervised results on challenging evaluation datasets.

Much recent work seeks to evaluate values and opinions in large language models (LLMs) using multiple-choice surveys and questionnaires. Most of this work is motivated by concerns around real-world LLM applications. For example, politically-biased LLMs may subtly influence society when they are used by millions of people. Such real-world concerns, however, stand in stark contrast to the artificiality of current evaluations: real users do not typically ask LLMs survey questions. Motivated by this discrepancy, we challenge the prevailing constrained evaluation paradigm for values and opinions in LLMs and explore more realistic unconstrained evaluations. As a case study, we focus on the popular Political Compass Test (PCT). In a systematic review, we find that most prior work using the PCT forces models to comply with the PCT's multiple-choice format. We show that models give substantively different answers when not forced; that answers change depending on how models are forced; and that answers lack paraphrase robustness. Then, we demonstrate that models give different answers yet again in a more realistic open-ended answer setting. We distill these findings into recommendations and open challenges in evaluating values and opinions in LLMs.

Large language models (LLM) have demonstrated emergent abilities in text generation, question answering, and reasoning, facilitating various tasks and domains. Despite their proficiency in various tasks, LLMs like LaPM 540B and Llama-3.1 405B face limitations due to large parameter sizes and computational demands, often requiring cloud API use which raises privacy concerns, limits real-time applications on edge devices, and increases fine-tuning costs. Additionally, LLMs often underperform in specialized domains such as healthcare and law due to insufficient domain-specific knowledge, necessitating specialized models. Therefore, Small Language Models (SLMs) are increasingly favored for their low inference latency, cost-effectiveness, efficient development, and easy customization and adaptability. These models are particularly well-suited for resource-limited environments and domain knowledge acquisition, addressing LLMs' challenges and proving ideal for applications that require localized data handling for privacy, minimal inference latency for efficiency, and domain knowledge acquisition through lightweight fine-tuning. The rising demand for SLMs has spurred extensive research and development. However, a comprehensive survey investigating issues related to the definition, acquisition, application, enhancement, and reliability of SLM remains lacking, prompting us to conduct a detailed survey on these topics. The definition of SLMs varies widely, thus to standardize, we propose defining SLMs by their capability to perform specialized tasks and suitability for resource-constrained settings, setting boundaries based on the minimal size for emergent abilities and the maximum size sustainable under resource constraints. For other aspects, we provide a taxonomy of relevant models/methods and develop general frameworks for each category to enhance and utilize SLMs effectively.

Large language models (LLMs) like ChatGPT have revealed amazing intelligence. How to evaluate the question-solving abilities of LLMs and their degrees of intelligence is a hot-spot but challenging issue. First, the question-solving abilities are interlaced with different ability branches like understanding and massive knowledge categories like mathematics. Second, the inputs of questions are multimodal that may involve text and images. Third, the response format of LLMs is diverse and thus poses great challenges for result extraction and evaluation. In this paper, we propose AGIBench -- a multi-granularity, multimodal, human-referenced, and auto-scoring benchmarking methodology for LLMs. Instead of a collection of blended questions, AGIBench focuses on three typical ability branches and adopts a four-tuple <ability branch, knowledge, difficulty, modal> to label the attributes of each question. First, it supports multi-granularity benchmarking, e.g., per-question, per-ability branch, per-knowledge, per-modal, per-dataset, and per-difficulty level granularities. Second, it contains multimodal input, including text and images. Third, it classifies all the questions into five degrees of difficulty according to the average accuracy rate of abundant educated humans (human-referenced). Fourth, it adopts zero-shot learning to avoid introducing additional unpredictability and provides an auto-scoring method to extract and judge the result. Finally, it defines multi-dimensional metrics, including accuracy under the average, worst, best, and majority voting cases, and repeatability. AGIBench is publically available from https://www.benchcouncil.org/agibench.

Advancements in Large Language Models (LLMs) and their increasing use in medical question-answering necessitate rigorous evaluation of their reliability. A critical challenge lies in hallucination, where models generate plausible yet factually incorrect outputs. In the medical domain, this poses serious risks to patient safety and clinical decision-making. To address this, we introduce MedHallu, the first benchmark specifically designed for medical hallucination detection. MedHallu comprises 10,000 high-quality question-answer pairs derived from PubMedQA, with hallucinated answers systematically generated through a controlled pipeline. Our experiments show that state-of-the-art LLMs, including GPT-4o, Llama-3.1, and the medically fine-tuned UltraMedical, struggle with this binary hallucination detection task, with the best model achieving an F1 score as low as 0.625 for detecting "hard" category hallucinations. Using bidirectional entailment clustering, we show that harder-to-detect hallucinations are semantically closer to ground truth. Through experiments, we also show incorporating domain-specific knowledge and introducing a "not sure" category as one of the answer categories improves the precision and F1 scores by up to 38% relative to baselines.