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

This work introduces RARE (Retrieval-Augmented Reasoning Enhancement), a versatile extension to the mutual reasoning framework (rStar), aimed at enhancing reasoning accuracy and factual integrity across large language models (LLMs) for complex, knowledge-intensive tasks such as medical and commonsense reasoning. RARE incorporates two innovative actions within the Monte Carlo Tree Search (MCTS) framework: (A6), which generates search queries based on the initial problem statement, performs information retrieval using those queries, and augments reasoning with the retrieved data to formulate the final answer; and (A7), which leverages information retrieval specifically for generated sub-questions and re-answers these sub-questions with the relevant contextual information. Additionally, a Retrieval-Augmented Factuality Scorer is proposed to replace the original discriminator, prioritizing reasoning paths that meet high standards of factuality. Experimental results with LLaMA 3.1 show that RARE enables open-source LLMs to achieve competitive performance with top closed-source models like GPT-4 and GPT-4o. This research establishes RARE as a scalable solution for improving LLMs in domains where logical coherence and factual integrity are critical.

Automatic question generation (QG) is essential for AI and NLP, particularly in intelligent tutoring, dialogue systems, and fact verification. Generating multiple-choice questions (MCQG) for professional exams, like the United States Medical Licensing Examination (USMLE), is particularly challenging, requiring domain expertise and complex multi-hop reasoning for high-quality questions. However, current large language models (LLMs) like GPT-4 struggle with professional MCQG due to outdated knowledge, hallucination issues, and prompt sensitivity, resulting in unsatisfactory quality and difficulty. To address these challenges, we propose MCQG-SRefine, an LLM self-refine-based (Critique and Correction) framework for converting medical cases into high-quality USMLE-style questions. By integrating expert-driven prompt engineering with iterative self-critique and self-correction feedback, MCQG-SRefine significantly enhances human expert satisfaction regarding both the quality and difficulty of the questions. Furthermore, we introduce an LLM-as-Judge-based automatic metric to replace the complex and costly expert evaluation process, ensuring reliable and expert-aligned assessments.

Social and behavioral determinants of health (SBDH) play a crucial role in health outcomes and are frequently documented in clinical text. Automatically extracting SBDH information from clinical text relies on publicly available good-quality datasets. However, existing SBDH datasets exhibit substantial limitations in their availability and coverage. In this study, we introduce Synth-SBDH, a novel synthetic dataset with detailed SBDH annotations, encompassing status, temporal information, and rationale across 15 SBDH categories. We showcase the utility of Synth-SBDH on three tasks using real-world clinical datasets from two distinct hospital settings, highlighting its versatility, generalizability, and distillation capabilities. Models trained on Synth-SBDH consistently outperform counterparts with no Synth-SBDH training, achieving up to 63.75% macro-F improvements. Additionally, Synth-SBDH proves effective for rare SBDH categories and under-resource constraints while being substantially cheaper than expert-annotated real-world data. Human evaluation reveals a 71.06% Human-LLM alignment and uncovers areas for future refinements.

In this work, we study in-context teaching(ICT), where a teacher provides in-context example rationales to teach a student to reasonover unseen cases. Human teachers are usually required to craft in-context demonstrations, which are costly and have high variance. We ask whether a large language model (LLM) can serve as a more effective in-context teacher for itself or otherLLMs, compared to humans. Inspired by the Encoding Specificity Hypothesis from human episodic memory, we hypothesize thatin-context exemplars crafted by the teacher should match the training data of the student. This hypothesis motivates us to propose Self-Explain where an LLM’s self-elicited explanations are used as in-context demonstrations for prompting it as they are generalized fromthe model’s training examples. Self-Explain is shown to significantly outperform using human-crafted exemplars and other baselines.Furthermore, we reveal that for ICT, rationales from different teacher LLMs or human experts that more resemble the student LLM’s self-explanations are better in-context demonstrations. This supports our encoding specificity hypothesis. We then propose Teach-Back that aligns a teacher LLM with the student to enhance the ICT performance. For example, Teach-Back enables a 7B model to teach the much larger GPT-3.5 in context, surpassing human teachers by around 5% in test accuracy on medical question answering.

We introduce NoteChat, a novel cooperative multi-agent framework leveraging Large Language Models (LLMs) to generate patient-physician dialogues. NoteChat embodies the principle that an ensemble of role-specific LLMs, through structured role-play and strategic prompting, can perform their assigned roles more effectively. The synergy among these role-playing LLMs results in a cohesive and efficient dialogue generation. Evaluation on MTS-dialogue, a benchmark dataset for patient-physician dialogues-note pairs, shows that models trained with the augmented synthetic patient-physician dialogues by NoteChat outperforms other state-of-the-art models for generating clinical notes. Our comprehensive automatic and human evaluation demonstrates that NoteChat substantially surpasses state-of-the-art models like ChatGPT and GPT-4 up to 22.78% by domain experts in generating superior synthetic patient-physician dialogues based on clinical notes. NoteChat has the potential to engage patients directly and help clinical documentation, a leading cause of physician burnout.

The advancement in healthcare has shifted focus toward patient-centric approaches, particularly in self-care and patient education, facilitated by access to Electronic Health Records (EHR). However, medical jargon in EHRs poses significant challenges in patient comprehension. To address this, we introduce a new task of automatically generating lay definitions, aiming to simplify complex medical terms into patient-friendly lay language. We first created the README dataset, an extensive collection of over 50,000 unique (medical term, lay definition) pairs and 300,000 mentions, each offering context-aware lay definitions manually annotated by domain experts. We have also engineered a data-centric Human-AI pipeline that synergizes data filtering, augmentation, and selection to improve data quality. We then used README as the training data for models and leveraged a Retrieval-Augmented Generation method to reduce hallucinations and improve the quality of model outputs. Our extensive automatic and human evaluations demonstrate that open-source mobile-friendly models, when fine-tuned with high-quality data, are capable of matching or even surpassing the performance of state-of-the-art closed-source large language models like ChatGPT. This research represents a significant stride in closing the knowledge gap in patient education and advancing patient-centric healthcare solutions.