MedHELM: Holistic Evaluation of Large Language Models for Medical Tasks

While large language models (LLMs) achieve near-perfect scores on medical licensing exams, these evaluations inadequately reflect the complexity and diversity of real-world clinical practice. We introduce MedHELM, an extensible evaluation framework for assessing LLM performance for medical tasks with three key contributions. First, a clinician-validated taxonomy spanning 5 categories, 22 subcategories, and 121 tasks developed with 29 clinicians. Second, a comprehensive benchmark suite comprising 35 benchmarks (17 existing, 18 newly formulated) providing complete coverage of all categories and subcategories in the taxonomy. Third, a systematic comparison of LLMs with improved evaluation methods (using an LLM-jury) and a cost-performance analysis. Evaluation of 9 frontier LLMs, using the 35 benchmarks, revealed significant performance variation. Advanced reasoning models (DeepSeek R1: 66% win-rate; o3-mini: 64% win-rate) demonstrated superior performance, though Claude 3.5 Sonnet achieved comparable results at 40% lower estimated computational cost. On a normalized accuracy scale (0-1), most models performed strongly in Clinical Note Generation (0.73-0.85) and Patient Communication & Education (0.78-0.83), moderately in Medical Research Assistance (0.65-0.75), and generally lower in Clinical Decision Support (0.56-0.72) and Administration & Workflow (0.53-0.63). Our LLM-jury evaluation method achieved good agreement with clinician ratings (ICC = 0.47), surpassing both average clinician-clinician agreement (ICC = 0.43) and automated baselines including ROUGE-L (0.36) and BERTScore-F1 (0.44). Claude 3.5 Sonnet achieved comparable performance to top models at lower estimated cost. These findings highlight the importance of real-world, task-specific evaluation for medical use of LLMs and provides an open source framework to enable this.

BiasICL: In-Context Learning and Demographic Biases of Vision Language Models

Vision language models (VLMs) show promise in medical diagnosis, but their performance across demographic subgroups when using in-context learning (ICL) remains poorly understood. We examine how the demographic composition of demonstration examples affects VLM performance in two medical imaging tasks: skin lesion malignancy prediction and pneumothorax detection from chest radiographs. Our analysis reveals that ICL influences model predictions through multiple mechanisms: (1) ICL allows VLMs to learn subgroup-specific disease base rates from prompts and (2) ICL leads VLMs to make predictions that perform differently across demographic groups, even after controlling for subgroup-specific disease base rates. Our empirical results inform best-practices for prompting current VLMs (specifically examining demographic subgroup performance, and matching base rates of labels to target distribution at a bulk level and within subgroups), while also suggesting next steps for improving our theoretical understanding of these models.

SycEval: Evaluating LLM Sycophancy

Large language models (LLMs) are increasingly applied in educational, clinical, and professional settings, but their tendency for sycophancy -- prioritizing user agreement over independent reasoning -- poses risks to reliability. This study introduces a framework to evaluate sycophantic behavior in ChatGPT-4o, Claude-Sonnet, and Gemini-1.5-Pro across AMPS (mathematics) and MedQuad (medical advice) datasets. Sycophantic behavior was observed in 58.19% of cases, with Gemini exhibiting the highest rate (62.47%) and ChatGPT the lowest (56.71%). Progressive sycophancy, leading to correct answers, occurred in 43.52% of cases, while regressive sycophancy, leading to incorrect answers, was observed in 14.66%. Preemptive rebuttals demonstrated significantly higher sycophancy rates than in-context rebuttals (61.75% vs. 56.52%, $Z=5.87$, $p<0.001$), particularly in computational tasks, where regressive sycophancy increased significantly (preemptive: 8.13%, in-context: 3.54%, $p<0.001$). Simple rebuttals maximized progressive sycophancy ($Z=6.59$, $p<0.001$), while citation-based rebuttals exhibited the highest regressive rates ($Z=6.59$, $p<0.001$). Sycophantic behavior showed high persistence (78.5%, 95% CI: [77.2%, 79.8%]) regardless of context or model. These findings emphasize the risks and opportunities of deploying LLMs in structured and dynamic domains, offering insights into prompt programming and model optimization for safer AI applications.

Best Practices for Large Language Models in Radiology

At the heart of radiological practice is the challenge of integrating complex imaging data with clinical information to produce actionable insights. Nuanced application of language is key for various activities, including managing requests, describing and interpreting imaging findings in the context of clinical data, and concisely documenting and communicating the outcomes. The emergence of large language models (LLMs) offers an opportunity to improve the management and interpretation of the vast data in radiology. Despite being primarily general-purpose, these advanced computational models demonstrate impressive capabilities in specialized language-related tasks, even without specific training. Unlocking the potential of LLMs for radiology requires basic understanding of their foundations and a strategic approach to navigate their idiosyncrasies. This review, drawing from practical radiology and machine learning expertise and recent literature, provides readers insight into the potential of LLMs in radiology. It examines best practices that have so far stood the test of time in the rapidly evolving landscape of LLMs. This includes practical advice for optimizing LLM characteristics for radiology practices along with limitations, effective prompting, and fine-tuning strategies.

Almanac Copilot: Towards Autonomous Electronic Health Record Navigation

Clinicians spend large amounts of time on clinical documentation, and inefficiencies impact quality of care and increase clinician burnout. Despite the promise of electronic medical records (EMR), the transition from paper-based records has been negatively associated with clinician wellness, in part due to poor user experience, increased burden of documentation, and alert fatigue. In this study, we present Almanac Copilot, an autonomous agent capable of assisting clinicians with EMR-specific tasks such as information retrieval and order placement. On EHR-QA, a synthetic evaluation dataset of 300 common EHR queries based on real patient data, Almanac Copilot obtains a successful task completion rate of 74% (n = 221 tasks) with a mean score of 2.45 over 3 (95% CI:2.34-2.56). By automating routine tasks and streamlining the documentation process, our findings highlight the significant potential of autonomous agents to mitigate the cognitive load imposed on clinicians by current EMR systems.

Assessing The Potential Of Mid-Sized Language Models For Clinical QA

Large language models, such as GPT-4 and Med-PaLM, have shown impressive performance on clinical tasks; however, they require access to compute, are closed-source, and cannot be deployed on device. Mid-size models such as BioGPT-large, BioMedLM, LLaMA 2, and Mistral 7B avoid these drawbacks, but their capacity for clinical tasks has been understudied. To help assess their potential for clinical use and help researchers decide which model they should use, we compare their performance on two clinical question-answering (QA) tasks: MedQA and consumer query answering. We find that Mistral 7B is the best performing model, winning on all benchmarks and outperforming models trained specifically for the biomedical domain. While Mistral 7B's MedQA score of 63.0% approaches the original Med-PaLM, and it often can produce plausible responses to consumer health queries, room for improvement still exists. This study provides the first head-to-head assessment of open source mid-sized models on clinical tasks.

BioMedLM: A 2.7B Parameter Language Model Trained On Biomedical Text

Models such as GPT-4 and Med-PaLM 2 have demonstrated impressive performance on a wide variety of biomedical NLP tasks. However, these models have hundreds of billions of parameters, are computationally expensive to run, require users to send their input data over the internet, and are trained on unknown data sources. Can smaller, more targeted models compete? To address this question, we build and release BioMedLM, a 2.7 billion parameter GPT-style autoregressive model trained exclusively on PubMed abstracts and full articles. When fine-tuned, BioMedLM can produce strong multiple-choice biomedical question-answering results competitive with much larger models, such as achieving a score of 57.3% on MedMCQA (dev) and 69.0% on the MMLU Medical Genetics exam. BioMedLM can also be fine-tuned to produce useful answers to patient questions on medical topics. This demonstrates that smaller models can potentially serve as transparent, privacy-preserving, economical and environmentally friendly foundations for particular NLP applications, such as in biomedicine. The model is available on the Hugging Face Hub: https://huggingface.co/stanford-crfm/BioMedLM.

RIDGE: Reproducibility, Integrity, Dependability, Generalizability, and Efficiency Assessment of Medical Image Segmentation Models

Deep learning techniques, despite their potential, often suffer from a lack of reproducibility and generalizability, impeding their clinical adoption. Image segmentation is one of the critical tasks in medical image analysis, in which one or several regions/volumes of interest should be annotated. This paper introduces the RIDGE checklist, a framework for assessing the Reproducibility, Integrity, Dependability, Generalizability, and Efficiency of deep learning-based medical image segmentation models. The checklist serves as a guide for researchers to enhance the quality and transparency of their work, ensuring that segmentation models are not only scientifically sound but also clinically relevant.

Towards Reliable Dermatology Evaluation Benchmarks

Benchmark datasets for digital dermatology unwittingly contain inaccuracies that reduce trust in model performance estimates. We propose a resource-efficient data cleaning protocol to identify issues that escaped previous curation. The protocol leverages an existing algorithmic cleaning strategy and is followed by a confirmation process terminated by an intuitive stopping criterion. Based on confirmation by multiple dermatologists, we remove irrelevant samples and near duplicates and estimate the percentage of label errors in six dermatology image datasets for model evaluation promoted by the International Skin Imaging Collaboration. Along with this paper, we publish revised file lists for each dataset which should be used for model evaluation. Our work paves the way for more trustworthy performance assessment in digital dermatology.

Large language models in medicine: the potentials and pitfalls

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.