General surgery vision transformer: A video pre-trained foundation model for general surgery

The absence of openly accessible data and specialized foundation models is a major barrier for computational research in surgery. Toward this, (i) we open-source the largest dataset of general surgery videos to-date, consisting of 680 hours of surgical videos, including data from robotic and laparoscopic techniques across 28 procedures; (ii) we propose a technique for video pre-training a general surgery vision transformer (GSViT) on surgical videos based on forward video prediction that can run in real-time for surgical applications, toward which we open-source the code and weights of GSViT; (iii) we also release code and weights for procedure-specific fine-tuned versions of GSViT across 10 procedures; (iv) we demonstrate the performance of GSViT on the Cholec80 phase annotation task, displaying improved performance over state-of-the-art single frame predictors.

Addressing cognitive bias in medical language models

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.

General-purpose foundation models for increased autonomy in robot-assisted surgery

The dominant paradigm for end-to-end robot learning focuses on optimizing task-specific objectives that solve a single robotic problem such as picking up an object or reaching a target position. However, recent work on high-capacity models in robotics has shown promise toward being trained on large collections of diverse and task-agnostic datasets of video demonstrations. These models have shown impressive levels of generalization to unseen circumstances, especially as the amount of data and the model complexity scale. Surgical robot systems that learn from data have struggled to advance as quickly as other fields of robot learning for a few reasons: (1) there is a lack of existing large-scale open-source data to train models, (2) it is challenging to model the soft-body deformations that these robots work with during surgery because simulation cannot match the physical and visual complexity of biological tissue, and (3) surgical robots risk harming patients when tested in clinical trials and require more extensive safety measures. This perspective article aims to provide a path toward increasing robot autonomy in robot-assisted surgery through the development of a multi-modal, multi-task, vision-language-action model for surgical robots. Ultimately, we argue that surgical robots are uniquely positioned to benefit from general-purpose models and provide three guiding actions toward increased autonomy in robot-assisted surgery.

Surgical Gym: A high-performance GPU-based platform for reinforcement learning with surgical robots

Recent advances in robot-assisted surgery have resulted in progressively more precise, efficient, and minimally invasive procedures, sparking a new era of robotic surgical intervention. This enables doctors, in collaborative interaction with robots, to perform traditional or minimally invasive surgeries with improved outcomes through smaller incisions. Recent efforts are working toward making robotic surgery more autonomous which has the potential to reduce variability of surgical outcomes and reduce complication rates. Deep reinforcement learning methodologies offer scalable solutions for surgical automation, but their effectiveness relies on extensive data acquisition due to the absence of prior knowledge in successfully accomplishing tasks. Due to the intensive nature of simulated data collection, previous works have focused on making existing algorithms more efficient. In this work, we focus on making the simulator more efficient, making training data much more accessible than previously possible. We introduce Surgical Gym, an open-source high performance platform for surgical robot learning where both the physics simulation and reinforcement learning occur directly on the GPU. We demonstrate between 100-5000x faster training times compared with previous surgical learning platforms. The code is available at: https://github.com/SamuelSchmidgall/SurgicalGym.

Language models are susceptible to incorrect patient self-diagnosis in medical applications

Large language models (LLMs) are becoming increasingly relevant as a potential tool for healthcare, aiding communication between clinicians, researchers, and patients. However, traditional evaluations of LLMs on medical exam questions do not reflect the complexity of real patient-doctor interactions. An example of this complexity is the introduction of patient self-diagnosis, where a patient attempts to diagnose their own medical conditions from various sources. While the patient sometimes arrives at an accurate conclusion, they more often are led toward misdiagnosis due to the patient's over-emphasis on bias validating information. In this work we present a variety of LLMs with multiple-choice questions from United States medical board exams which are modified to include self-diagnostic reports from patients. Our findings highlight that when a patient proposes incorrect bias-validating information, the diagnostic accuracy of LLMs drop dramatically, revealing a high susceptibility to errors in self-diagnosis.

Synaptic motor adaptation: A three-factor learning rule for adaptive robotic control in spiking neural networks

Legged robots operating in real-world environments must possess the ability to rapidly adapt to unexpected conditions, such as changing terrains and varying payloads. This paper introduces the Synaptic Motor Adaptation (SMA) algorithm, a novel approach to achieving real-time online adaptation in quadruped robots through the utilization of neuroscience-derived rules of synaptic plasticity with three-factor learning. To facilitate rapid adaptation, we meta-optimize a three-factor learning rule via gradient descent to adapt to uncertainty by approximating an embedding produced by privileged information using only locally accessible onboard sensing data. Our algorithm performs similarly to state-of-the-art motor adaptation algorithms and presents a clear path toward achieving adaptive robotics with neuromorphic hardware.

Brain-inspired learning in artificial neural networks: a review

Artificial neural networks (ANNs) have emerged as an essential tool in machine learning, achieving remarkable success across diverse domains, including image and speech generation, game playing, and robotics. However, there exist fundamental differences between ANNs' operating mechanisms and those of the biological brain, particularly concerning learning processes. This paper presents a comprehensive review of current brain-inspired learning representations in artificial neural networks. We investigate the integration of more biologically plausible mechanisms, such as synaptic plasticity, to enhance these networks' capabilities. Moreover, we delve into the potential advantages and challenges accompanying this approach. Ultimately, we pinpoint promising avenues for future research in this rapidly advancing field, which could bring us closer to understanding the essence of intelligence.

Biological connectomes as a representation for the architecture of artificial neural networks

Grand efforts in neuroscience are working toward mapping the connectomes of many new species, including the near completion of the Drosophila melanogaster. It is important to ask whether these models could benefit artificial intelligence. In this work we ask two fundamental questions: (1) where and when biological connectomes can provide use in machine learning, (2) which design principles are necessary for extracting a good representation of the connectome. Toward this end, we translate the motor circuit of the C. Elegans nematode into artificial neural networks at varying levels of biophysical realism and evaluate the outcome of training these networks on motor and non-motor behavioral tasks. We demonstrate that biophysical realism need not be upheld to attain the advantages of using biological circuits. We also establish that, even if the exact wiring diagram is not retained, the architectural statistics provide a valuable prior. Finally, we show that while the C. Elegans locomotion circuit provides a powerful inductive bias on locomotion problems, its structure may hinder performance on tasks unrelated to locomotion such as visual classification problems.