Advancing Conversational Diagnostic AI with Multimodal Reasoning

Large Language Models (LLMs) have demonstrated great potential for conducting diagnostic conversations but evaluation has been largely limited to language-only interactions, deviating from the real-world requirements of remote care delivery. Instant messaging platforms permit clinicians and patients to upload and discuss multimodal medical artifacts seamlessly in medical consultation, but the ability of LLMs to reason over such data while preserving other attributes of competent diagnostic conversation remains unknown. Here we advance the conversational diagnosis and management performance of the Articulate Medical Intelligence Explorer (AMIE) through a new capability to gather and interpret multimodal data, and reason about this precisely during consultations. Leveraging Gemini 2.0 Flash, our system implements a state-aware dialogue framework, where conversation flow is dynamically controlled by intermediate model outputs reflecting patient states and evolving diagnoses. Follow-up questions are strategically directed by uncertainty in such patient states, leading to a more structured multimodal history-taking process that emulates experienced clinicians. We compared AMIE to primary care physicians (PCPs) in a randomized, blinded, OSCE-style study of chat-based consultations with patient actors. We constructed 105 evaluation scenarios using artifacts like smartphone skin photos, ECGs, and PDFs of clinical documents across diverse conditions and demographics. Our rubric assessed multimodal capabilities and other clinically meaningful axes like history-taking, diagnostic accuracy, management reasoning, communication, and empathy. Specialist evaluation showed AMIE to be superior to PCPs on 7/9 multimodal and 29/32 non-multimodal axes (including diagnostic accuracy). The results show clear progress in multimodal conversational diagnostic AI, but real-world translation needs further research.

LLM-based Text Simplification and its Effect on User Comprehension and Cognitive Load

Information on the web, such as scientific publications and Wikipedia, often surpasses users' reading level. To help address this, we used a self-refinement approach to develop a LLM capability for minimally lossy text simplification. To validate our approach, we conducted a randomized study involving 4563 participants and 31 texts spanning 6 broad subject areas: PubMed (biomedical scientific articles), biology, law, finance, literature/philosophy, and aerospace/computer science. Participants were randomized to viewing original or simplified texts in a subject area, and answered multiple-choice questions (MCQs) that tested their comprehension of the text. The participants were also asked to provide qualitative feedback such as task difficulty. Our results indicate that participants who read the simplified text answered more MCQs correctly than their counterparts who read the original text (3.9% absolute increase, p<0.05). This gain was most striking with PubMed (14.6%), while more moderate gains were observed for finance (5.5%), aerospace/computer science (3.8%) domains, and legal (3.5%). Notably, the results were robust to whether participants could refer back to the text while answering MCQs. The absolute accuracy decreased by up to ~9% for both original and simplified setups where participants could not refer back to the text, but the ~4% overall improvement persisted. Finally, participants' self-reported perceived ease based on a simplified NASA Task Load Index was greater for those who read the simplified text (absolute change on a 5-point scale 0.33, p<0.05). This randomized study, involving an order of magnitude more participants than prior works, demonstrates the potential of LLMs to make complex information easier to understand. Our work aims to enable a broader audience to better learn and make use of expert knowledge available on the web, improving information accessibility.

Towards Conversational AI for Disease Management

While large language models (LLMs) have shown promise in diagnostic dialogue, their capabilities for effective management reasoning - including disease progression, therapeutic response, and safe medication prescription - remain under-explored. We advance the previously demonstrated diagnostic capabilities of the Articulate Medical Intelligence Explorer (AMIE) through a new LLM-based agentic system optimised for clinical management and dialogue, incorporating reasoning over the evolution of disease and multiple patient visit encounters, response to therapy, and professional competence in medication prescription. To ground its reasoning in authoritative clinical knowledge, AMIE leverages Gemini's long-context capabilities, combining in-context retrieval with structured reasoning to align its output with relevant and up-to-date clinical practice guidelines and drug formularies. In a randomized, blinded virtual Objective Structured Clinical Examination (OSCE) study, AMIE was compared to 21 primary care physicians (PCPs) across 100 multi-visit case scenarios designed to reflect UK NICE Guidance and BMJ Best Practice guidelines. AMIE was non-inferior to PCPs in management reasoning as assessed by specialist physicians and scored better in both preciseness of treatments and investigations, and in its alignment with and grounding of management plans in clinical guidelines. To benchmark medication reasoning, we developed RxQA, a multiple-choice question benchmark derived from two national drug formularies (US, UK) and validated by board-certified pharmacists. While AMIE and PCPs both benefited from the ability to access external drug information, AMIE outperformed PCPs on higher difficulty questions. While further research would be needed before real-world translation, AMIE's strong performance across evaluations marks a significant step towards conversational AI as a tool in disease management.

ECLeKTic: a Novel Challenge Set for Evaluation of Cross-Lingual Knowledge Transfer

To achieve equitable performance across languages, multilingual large language models (LLMs) must be able to abstract knowledge beyond the language in which it was acquired. However, the current literature lacks reliable ways to measure LLMs' capability of cross-lingual knowledge transfer. To that end, we present ECLeKTic, a multilingual closed-book QA (CBQA) dataset that Evaluates Cross-Lingual Knowledge Transfer in a simple, black-box manner. We detected information with uneven coverage across languages by controlling for presence and absence of Wikipedia articles in 12 languages. We generated knowledge-seeking questions in a source language, for which the answer appears in a relevant Wikipedia article and translated them to all other 11 languages, for which the respective Wikipedias lack equivalent articles. Assuming that Wikipedia reflects the prominent knowledge in the LLM's training data, to solve ECLeKTic's CBQA task the model is required to transfer knowledge between languages. Experimenting with 8 LLMs, we show that SOTA models struggle to effectively share knowledge across, languages even if they can predict the answer well for queries in the same language the knowledge was acquired in.

CoCa-CXR: Contrastive Captioners Learn Strong Temporal Structures for Chest X-Ray Vision-Language Understanding

Vision-language models have proven to be of great benefit for medical image analysis since they learn rich semantics from both images and reports. Prior efforts have focused on better alignment of image and text representations to enhance image understanding. However, though explicit reference to a prior image is common in Chest X-Ray (CXR) reports, aligning progression descriptions with the semantics differences in image pairs remains under-explored. In this work, we propose two components to address this issue. (1) A CXR report processing pipeline to extract temporal structure. It processes reports with a large language model (LLM) to separate the description and comparison contexts, and extracts fine-grained annotations from reports. (2) A contrastive captioner model for CXR, namely CoCa-CXR, to learn how to both describe images and their temporal progressions. CoCa-CXR incorporates a novel regional cross-attention module to identify local differences between paired CXR images. Extensive experiments show the superiority of CoCa-CXR on both progression analysis and report generation compared to previous methods. Notably, on MS-CXR-T progression classification, CoCa-CXR obtains 65.0% average testing accuracy on five pulmonary conditions, outperforming the previous state-of-the-art (SOTA) model BioViL-T by 4.8%. It also achieves a RadGraph F1 of 24.2% on MIMIC-CXR, which is comparable to the Med-Gemini foundation model.

Towards an AI co-scientist

Scientific discovery relies on scientists generating novel hypotheses that undergo rigorous experimental validation. To augment this process, we introduce an AI co-scientist, a multi-agent system built on Gemini 2.0. The AI co-scientist is intended to help uncover new, original knowledge and to formulate demonstrably novel research hypotheses and proposals, building upon prior evidence and aligned to scientist-provided research objectives and guidance. The system's design incorporates a generate, debate, and evolve approach to hypothesis generation, inspired by the scientific method and accelerated by scaling test-time compute. Key contributions include: (1) a multi-agent architecture with an asynchronous task execution framework for flexible compute scaling; (2) a tournament evolution process for self-improving hypotheses generation. Automated evaluations show continued benefits of test-time compute, improving hypothesis quality. While general purpose, we focus development and validation in three biomedical areas: drug repurposing, novel target discovery, and explaining mechanisms of bacterial evolution and anti-microbial resistance. For drug repurposing, the system proposes candidates with promising validation findings, including candidates for acute myeloid leukemia that show tumor inhibition in vitro at clinically applicable concentrations. For novel target discovery, the AI co-scientist proposed new epigenetic targets for liver fibrosis, validated by anti-fibrotic activity and liver cell regeneration in human hepatic organoids. Finally, the AI co-scientist recapitulated unpublished experimental results via a parallel in silico discovery of a novel gene transfer mechanism in bacterial evolution. These results, detailed in separate, co-timed reports, demonstrate the potential to augment biomedical and scientific discovery and usher an era of AI empowered scientists.

Health AI Developer Foundations

Robust medical Machine Learning (ML) models have the potential to revolutionize healthcare by accelerating clinical research, improving workflows and outcomes, and producing novel insights or capabilities. Developing such ML models from scratch is cost prohibitive and requires substantial compute, data, and time (e.g., expert labeling). To address these challenges, we introduce Health AI Developer Foundations (HAI-DEF), a suite of pre-trained, domain-specific foundation models, tools, and recipes to accelerate building ML for health applications. The models cover various modalities and domains, including radiology (X-rays and computed tomography), histopathology, dermatological imaging, and audio. These models provide domain specific embeddings that facilitate AI development with less labeled data, shorter training times, and reduced computational costs compared to traditional approaches. In addition, we utilize a common interface and style across these models, and prioritize usability to enable developers to integrate HAI-DEF efficiently. We present model evaluations across various tasks and conclude with a discussion of their application and evaluation, covering the importance of ensuring efficacy, fairness, and equity. Finally, while HAI-DEF and specifically the foundation models lower the barrier to entry for ML in healthcare, we emphasize the importance of validation with problem- and population-specific data for each desired usage setting. This technical report will be updated over time as more modalities and features are added.

Can Few-shot Work in Long-Context? Recycling the Context to Generate Demonstrations

Despite recent advancements in Large Language Models (LLMs), their performance on tasks involving long contexts remains sub-optimal. In-Context Learning (ICL) with few-shot examples may be an appealing solution to enhance LLM performance in this scenario; However, naively adding ICL examples with long context introduces challenges, including substantial token overhead added for each few-shot example and context mismatch between the demonstrations and the target query. In this work, we propose to automatically generate few-shot examples for long context QA tasks by recycling contexts. Specifically, given a long input context (1-3k tokens) and a query, we generate additional query-output pairs from the given context as few-shot examples, while introducing the context only once. This ensures that the demonstrations are leveraging the same context as the target query while only adding a small number of tokens to the prompt. We further enhance each demonstration by instructing the model to explicitly identify the relevant paragraphs before the answer, which improves performance while providing fine-grained attribution to the answer source. We apply our method on multiple LLMs and obtain substantial improvements on various QA datasets with long context, especially when the answer lies within the middle of the context. Surprisingly, despite introducing only single-hop ICL examples, LLMs also successfully generalize to multi-hop long-context QA using our approach.

Multi-turn Reinforcement Learning from Preference Human Feedback

Reinforcement Learning from Human Feedback (RLHF) has become the standard approach for aligning Large Language Models (LLMs) with human preferences, allowing LLMs to demonstrate remarkable abilities in various tasks. Existing methods work by emulating the preferences at the single decision (turn) level, limiting their capabilities in settings that require planning or multi-turn interactions to achieve a long-term goal. In this paper, we address this issue by developing novel methods for Reinforcement Learning (RL) from preference feedback between two full multi-turn conversations. In the tabular setting, we present a novel mirror-descent-based policy optimization algorithm for the general multi-turn preference-based RL problem, and prove its convergence to Nash equilibrium. To evaluate performance, we create a new environment, Education Dialogue, where a teacher agent guides a student in learning a random topic, and show that a deep RL variant of our algorithm outperforms RLHF baselines. Finally, we show that in an environment with explicit rewards, our algorithm recovers the same performance as a reward-based RL baseline, despite relying solely on a weaker preference signal.

The Temporal Structure of Language Processing in the Human Brain Corresponds to The Layered Hierarchy of Deep Language Models

Deep Language Models (DLMs) provide a novel computational paradigm for understanding the mechanisms of natural language processing in the human brain. Unlike traditional psycholinguistic models, DLMs use layered sequences of continuous numerical vectors to represent words and context, allowing a plethora of emerging applications such as human-like text generation. In this paper we show evidence that the layered hierarchy of DLMs may be used to model the temporal dynamics of language comprehension in the brain by demonstrating a strong correlation between DLM layer depth and the time at which layers are most predictive of the human brain. Our ability to temporally resolve individual layers benefits from our use of electrocorticography (ECoG) data, which has a much higher temporal resolution than noninvasive methods like fMRI. Using ECoG, we record neural activity from participants listening to a 30-minute narrative while also feeding the same narrative to a high-performing DLM (GPT2-XL). We then extract contextual embeddings from the different layers of the DLM and use linear encoding models to predict neural activity. We first focus on the Inferior Frontal Gyrus (IFG, or Broca's area) and then extend our model to track the increasing temporal receptive window along the linguistic processing hierarchy from auditory to syntactic and semantic areas. Our results reveal a connection between human language processing and DLMs, with the DLM's layer-by-layer accumulation of contextual information mirroring the timing of neural activity in high-order language areas.