Differential diagnosis (DDx) is vital for physicians and challenging due to the existence of numerous diseases and their complex symptoms. Model training for this task is generally hindered by limited data access due to privacy concerns. To address this, we present DDxGym, a specialized OpenAI Gym environment for clinical differential diagnosis. DDxGym formulates DDx as a natural-language-based reinforcement learning (RL) problem, where agents emulate medical professionals, selecting examinations and treatments for patients with randomly sampled diseases. This RL environment utilizes data labeled from online resources, evaluated by medical professionals for accuracy. Transformers, while effective for encoding text in DDxGym, are unstable in online RL. For that reason we propose a novel training method using an auxiliary masked language modeling objective for policy optimization, resulting in model stabilization and significant performance improvement over strong baselines. Following this approach, our agent effectively navigates large action spaces and identifies universally applicable actions. All data, environment details, and implementation, including experiment reproduction code, are made publicly available.

Training transformer language models requires vast amounts of text and computational resources. This drastically limits the usage of these models in niche domains for which they are not optimized, or where domain-specific training data is scarce. We focus here on the clinical domain because of its limited access to training data in common tasks, while structured ontological data is often readily available. Recent observations in model compression of transformer models show optimization potential in improving the representation capacity of attention heads. We propose KIMERA (Knowledge Injection via Mask Enforced Retraining of Attention) for detecting, retraining and instilling attention heads with complementary structured domain knowledge. Our novel multi-task training scheme effectively identifies and targets individual attention heads that are least useful for a given downstream task and optimizes their representation with information from structured data. KIMERA generalizes well, thereby building the basis for an efficient fine-tuning. KIMERA achieves significant performance boosts on seven datasets in the medical domain in Information Retrieval and Clinical Outcome Prediction settings. We apply KIMERA to BERT-base to evaluate the extent of the domain transfer and also improve on the already strong results of BioBERT in the clinical domain.

Universal embeddings, such as BERT or ELMo, are useful for a broad set of natural language processing tasks like text classification or sentiment analysis. Moreover, specialized embeddings also exist for tasks like topic modeling or named entity disambiguation. We study if we can complement these universal embeddings with specialized embeddings. We conduct an in-depth evaluation of nine well known natural language understanding tasks with SentEval. Also, we extend SentEval with two additional tasks to the medical domain. We present PubMedSection, a novel topic classification dataset focussed on the biomedical domain. Our comprehensive analysis covers 11 tasks and combinations of six embeddings. We report that combined embeddings outperform state of the art universal embeddings without any embedding fine-tuning. We observe that adding topic model based embeddings helps for most tasks and that differing pre-training tasks encode complementary features. Moreover, we present new state of the art results on the MPQA and SUBJ tasks in SentEval.

We demonstrate TrainX, a system for Named Entity Linking for medical experts. It combines state-of-the-art entity recognition and linking architectures, such as Flair and fine-tuned Bi-Encoders based on BERT, with an easy-to-use interface for healthcare professionals. We support medical experts in annotating training data by using active sampling strategies to forward informative samples to the annotator. We demonstrate that our model is capable of linking against large knowledge bases, such as UMLS (3.6 million entities), and supporting zero-shot cases, where the linker has never seen the entity before. Those zero-shot capabilities help to mitigate the problem of rare and expensive training data that is a common issue in the medical domain.