A prospective clinical feasibility study of a conversational diagnostic AI in an ambulatory primary care clinic

Large language model (LLM)-based AI systems have shown promise for patient-facing diagnostic and management conversations in simulated settings. Translating these systems into clinical practice requires assessment in real-world workflows with rigorous safety oversight. We report a prospective, single-arm feasibility study of an LLM-based conversational AI, the Articulate Medical Intelligence Explorer (AMIE), conducting clinical history taking and presentation of potential diagnoses for patients to discuss with their provider at urgent care appointments at a leading academic medical center. 100 adult patients completed an AMIE text-chat interaction up to 5 days before their appointment. We sought to assess the conversational safety and quality, patient and clinician experience, and clinical reasoning capabilities compared to primary care providers (PCPs). Human safety supervisors monitored all patient-AMIE interactions in real time and did not need to intervene to stop any consultations based on pre-defined criteria. Patients reported high satisfaction and their attitudes towards AI improved after interacting with AMIE (p < 0.001). PCPs found AMIE's output useful with a positive impact on preparedness. AMIE's differential diagnosis (DDx) included the final diagnosis, per chart review 8 weeks post-encounter, in 90% of cases, with 75% top-3 accuracy. Blinded assessment of AMIE and PCP DDx and management (Mx) plans suggested similar overall DDx and Mx plan quality, without significant differences for DDx (p = 0.6) and appropriateness and safety of Mx (p = 0.1 and 1.0, respectively). PCPs outperformed AMIE in the practicality (p = 0.003) and cost effectiveness (p = 0.004) of Mx. While further research is needed, this study demonstrates the initial feasibility, safety, and user acceptance of conversational AI in a real-world setting, representing crucial steps towards clinical translation.

Evaluating Alignment of Behavioral Dispositions in LLMs

As LLMs integrate into our daily lives, understanding their behavior becomes essential. In this work, we focus on behavioral dispositions$-$the underlying tendencies that shape responses in social contexts$-$and introduce a framework to study how closely the dispositions expressed by LLMs align with those of humans. Our approach is grounded in established psychological questionnaires but adapts them for LLMs by transforming human self-report statements into Situational Judgment Tests (SJTs). These SJTs assess behavior by eliciting natural recommendations in realistic user-assistant scenarios. We generate 2,500 SJTs, each validated by three human annotators, and collect preferred actions from 10 annotators per SJT, from a large pool of 550 participants. In a comprehensive study involving 25 LLMs, we find that models often do not reflect the distribution of human preferences: (1) in scenarios with low human consensus, LLMs consistently exhibit overconfidence in a single response; (2) when human consensus is high, smaller models deviate significantly, and even some frontier models do not reflect the consensus in 15-20% of cases; (3) traits can exhibit cross-LLM patterns, e.g., LLMs may encourage emotion expression in contexts where human consensus favors composure. Lastly, mapping psychometric statements directly to behavioral scenarios presents a unique opportunity to evaluate the predictive validity of self-reports, revealing considerable gaps between LLMs' stated values and their revealed behavior.

WAXAL: A Large-Scale Multilingual African Language Speech Corpus

The advancement of speech technology has predominantly favored high-resource languages, creating a significant digital divide for speakers of most Sub-Saharan African languages. To address this gap, we introduce WAXAL, a large-scale, openly accessible speech dataset for 21 languages representing over 100 million speakers. The collection consists of two main components: an Automated Speech Recognition (ASR) dataset containing approximately 1,250 hours of transcribed, natural speech from a diverse range of speakers, and a Text-to-Speech (TTS) dataset with over 180 hours of high-quality, single-speaker recordings reading phonetically balanced scripts. This paper details our methodology for data collection, annotation, and quality control, which involved partnerships with four African academic and community organizations. We provide a detailed statistical overview of the dataset and discuss its potential limitations and ethical considerations. The WAXAL datasets are released at https://huggingface.co/datasets/google/WaxalNLP under the permissive CC-BY-4.0 license to catalyze research, enable the development of inclusive technologies, and serve as a vital resource for the digital preservation of these languages.

Prompt Repetition Improves Non-Reasoning LLMs

When not using reasoning, repeating the input prompt improves performance for popular models (Gemini, GPT, Claude, and Deepseek) without increasing the number of generated tokens or latency.

The FACTS Leaderboard: A Comprehensive Benchmark for Large Language Model Factuality

We introduce The FACTS Leaderboard, an online leaderboard suite and associated set of benchmarks that comprehensively evaluates the ability of language models to generate factually accurate text across diverse scenarios. The suite provides a holistic measure of factuality by aggregating the performance of models on four distinct sub-leaderboards: (1) FACTS Multimodal, which measures the factuality of responses to image-based questions; (2) FACTS Parametric, which assesses models' world knowledge by answering closed-book factoid questions from internal parameters; (3) FACTS Search, which evaluates factuality in information-seeking scenarios, where the model must use a search API; and (4) FACTS Grounding (v2), which evaluates whether long-form responses are grounded in provided documents, featuring significantly improved judge models. Each sub-leaderboard employs automated judge models to score model responses, and the final suite score is an average of the four components, designed to provide a robust and balanced assessment of a model's overall factuality. The FACTS Leaderboard Suite will be actively maintained, containing both public and private splits to allow for external participation while guarding its integrity. It can be found at https://www.kaggle.com/benchmarks/google/facts .

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.

TxGemma: Efficient and Agentic LLMs for Therapeutics

Therapeutic development is a costly and high-risk endeavor that is often plagued by high failure rates. To address this, we introduce TxGemma, a suite of efficient, generalist large language models (LLMs) capable of therapeutic property prediction as well as interactive reasoning and explainability. Unlike task-specific models, TxGemma synthesizes information from diverse sources, enabling broad application across the therapeutic development pipeline. The suite includes 2B, 9B, and 27B parameter models, fine-tuned from Gemma-2 on a comprehensive dataset of small molecules, proteins, nucleic acids, diseases, and cell lines. Across 66 therapeutic development tasks, TxGemma achieved superior or comparable performance to the state-of-the-art generalist model on 64 (superior on 45), and against state-of-the-art specialist models on 50 (superior on 26). Fine-tuning TxGemma models on therapeutic downstream tasks, such as clinical trial adverse event prediction, requires less training data than fine-tuning base LLMs, making TxGemma suitable for data-limited applications. Beyond these predictive capabilities, TxGemma features conversational models that bridge the gap between general LLMs and specialized property predictors. These allow scientists to interact in natural language, provide mechanistic reasoning for predictions based on molecular structure, and engage in scientific discussions. Building on this, we further introduce Agentic-Tx, a generalist therapeutic agentic system powered by Gemini 2.5 that reasons, acts, manages diverse workflows, and acquires external domain knowledge. Agentic-Tx surpasses prior leading models on the Humanity's Last Exam benchmark (Chemistry & Biology) with 52.3% relative improvement over o3-mini (high) and 26.7% over o3-mini (high) on GPQA (Chemistry) and excels with improvements of 6.3% (ChemBench-Preference) and 2.4% (ChemBench-Mini) over o3-mini (high).

Gemma 3 Technical Report

We introduce Gemma 3, a multimodal addition to the Gemma family of lightweight open models, ranging in scale from 1 to 27 billion parameters. This version introduces vision understanding abilities, a wider coverage of languages and longer context - at least 128K tokens. We also change the architecture of the model to reduce the KV-cache memory that tends to explode with long context. This is achieved by increasing the ratio of local to global attention layers, and keeping the span on local attention short. The Gemma 3 models are trained with distillation and achieve superior performance to Gemma 2 for both pre-trained and instruction finetuned versions. In particular, our novel post-training recipe significantly improves the math, chat, instruction-following and multilingual abilities, making Gemma3-4B-IT competitive with Gemma2-27B-IT and Gemma3-27B-IT comparable to Gemini-1.5-Pro across benchmarks. We release all our models to the community.

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.