Daily Papers

Large language models (LLMs) have demonstrated impressive capabilities in natural language understanding and generation, but the quality bar for medical and clinical applications is high. Today, attempts to assess models' clinical knowledge typically rely on automated evaluations on limited benchmarks. There is no standard to evaluate model predictions and reasoning across a breadth of tasks. To address this, we present MultiMedQA, a benchmark combining six existing open question answering datasets spanning professional medical exams, research, and consumer queries; and HealthSearchQA, a new free-response dataset of medical questions searched online. We propose a framework for human evaluation of model answers along multiple axes including factuality, precision, possible harm, and bias. In addition, we evaluate PaLM (a 540-billion parameter LLM) and its instruction-tuned variant, Flan-PaLM, on MultiMedQA. Using a combination of prompting strategies, Flan-PaLM achieves state-of-the-art accuracy on every MultiMedQA multiple-choice dataset (MedQA, MedMCQA, PubMedQA, MMLU clinical topics), including 67.6% accuracy on MedQA (US Medical License Exam questions), surpassing prior state-of-the-art by over 17%. However, human evaluation reveals key gaps in Flan-PaLM responses. To resolve this we introduce instruction prompt tuning, a parameter-efficient approach for aligning LLMs to new domains using a few exemplars. The resulting model, Med-PaLM, performs encouragingly, but remains inferior to clinicians. We show that comprehension, recall of knowledge, and medical reasoning improve with model scale and instruction prompt tuning, suggesting the potential utility of LLMs in medicine. Our human evaluations reveal important limitations of today's models, reinforcing the importance of both evaluation frameworks and method development in creating safe, helpful LLM models for clinical applications.

Recent artificial intelligence (AI) systems have reached milestones in "grand challenges" ranging from Go to protein-folding. The capability to retrieve medical knowledge, reason over it, and answer medical questions comparably to physicians has long been viewed as one such grand challenge. Large language models (LLMs) have catalyzed significant progress in medical question answering; Med-PaLM was the first model to exceed a "passing" score in US Medical Licensing Examination (USMLE) style questions with a score of 67.2% on the MedQA dataset. However, this and other prior work suggested significant room for improvement, especially when models' answers were compared to clinicians' answers. Here we present Med-PaLM 2, which bridges these gaps by leveraging a combination of base LLM improvements (PaLM 2), medical domain finetuning, and prompting strategies including a novel ensemble refinement approach. Med-PaLM 2 scored up to 86.5% on the MedQA dataset, improving upon Med-PaLM by over 19% and setting a new state-of-the-art. We also observed performance approaching or exceeding state-of-the-art across MedMCQA, PubMedQA, and MMLU clinical topics datasets. We performed detailed human evaluations on long-form questions along multiple axes relevant to clinical applications. In pairwise comparative ranking of 1066 consumer medical questions, physicians preferred Med-PaLM 2 answers to those produced by physicians on eight of nine axes pertaining to clinical utility (p < 0.001). We also observed significant improvements compared to Med-PaLM on every evaluation axis (p < 0.001) on newly introduced datasets of 240 long-form "adversarial" questions to probe LLM limitations. While further studies are necessary to validate the efficacy of these models in real-world settings, these results highlight rapid progress towards physician-level performance in medical question answering.

Maybe not. We identify and analyse errors in the popular Massive Multitask Language Understanding (MMLU) benchmark. Even though MMLU is widely adopted, our analysis demonstrates numerous ground truth errors that obscure the true capabilities of LLMs. For example, we find that 57% of the analysed questions in the Virology subset contain errors. To address this issue, we introduce a comprehensive framework for identifying dataset errors using a novel error taxonomy. Then, we create MMLU-Redux, which is a subset of 3,000 manually re-annotated questions across 30 MMLU subjects. Using MMLU-Redux, we demonstrate significant discrepancies with the model performance metrics that were originally reported. Our results strongly advocate for revising MMLU's error-ridden questions to enhance its future utility and reliability as a benchmark. Therefore, we open up MMLU-Redux for additional annotation https://huggingface.co/datasets/edinburgh-dawg/mmlu-redux.

Medical vision-and-language models (MVLMs) have attracted substantial interest due to their capability to offer a natural language interface for interpreting complex medical data. Their applications are versatile and have the potential to improve diagnostic accuracy and decision-making for individual patients while also contributing to enhanced public health monitoring, disease surveillance, and policy-making through more efficient analysis of large data sets. MVLMS integrate natural language processing with medical images to enable a more comprehensive and contextual understanding of medical images alongside their corresponding textual information. Unlike general vision-and-language models trained on diverse, non-specialized datasets, MVLMs are purpose-built for the medical domain, automatically extracting and interpreting critical information from medical images and textual reports to support clinical decision-making. Popular clinical applications of MVLMs include automated medical report generation, medical visual question answering, medical multimodal segmentation, diagnosis and prognosis and medical image-text retrieval. Here, we provide a comprehensive overview of MVLMs and the various medical tasks to which they have been applied. We conduct a detailed analysis of various vision-and-language model architectures, focusing on their distinct strategies for cross-modal integration/exploitation of medical visual and textual features. We also examine the datasets used for these tasks and compare the performance of different models based on standardized evaluation metrics. Furthermore, we highlight potential challenges and summarize future research trends and directions. The full collection of papers and codes is available at: https://github.com/YtongXie/Medical-Vision-and-Language-Tasks-and-Methodologies-A-Survey.

Medical image analysis is essential to clinical diagnosis and treatment, which is increasingly supported by multi-modal large language models (MLLMs). However, previous research has primarily focused on 2D medical images, leaving 3D images under-explored, despite their richer spatial information. This paper aims to advance 3D medical image analysis with MLLMs. To this end, we present a large-scale 3D multi-modal medical dataset, M3D-Data, comprising 120K image-text pairs and 662K instruction-response pairs specifically tailored for various 3D medical tasks, such as image-text retrieval, report generation, visual question answering, positioning, and segmentation. Additionally, we propose M3D-LaMed, a versatile multi-modal large language model for 3D medical image analysis. Furthermore, we introduce a new 3D multi-modal medical benchmark, M3D-Bench, which facilitates automatic evaluation across eight tasks. Through comprehensive evaluation, our method proves to be a robust model for 3D medical image analysis, outperforming existing solutions. All code, data, and models are publicly available at: https://github.com/BAAI-DCAI/M3D.

Large Vision-Language Models (LVLMs) are capable of handling diverse data types such as imaging, text, and physiological signals, and can be applied in various fields. In the medical field, LVLMs have a high potential to offer substantial assistance for diagnosis and treatment. Before that, it is crucial to develop benchmarks to evaluate LVLMs' effectiveness in various medical applications. Current benchmarks are often built upon specific academic literature, mainly focusing on a single domain, and lacking varying perceptual granularities. Thus, they face specific challenges, including limited clinical relevance, incomplete evaluations, and insufficient guidance for interactive LVLMs. To address these limitations, we developed the GMAI-MMBench, the most comprehensive general medical AI benchmark with well-categorized data structure and multi-perceptual granularity to date. It is constructed from 285 datasets across 39 medical image modalities, 18 clinical-related tasks, 18 departments, and 4 perceptual granularities in a Visual Question Answering (VQA) format. Additionally, we implemented a lexical tree structure that allows users to customize evaluation tasks, accommodating various assessment needs and substantially supporting medical AI research and applications. We evaluated 50 LVLMs, and the results show that even the advanced GPT-4o only achieves an accuracy of 52%, indicating significant room for improvement. Moreover, we identified five key insufficiencies in current cutting-edge LVLMs that need to be addressed to advance the development of better medical applications. We believe that GMAI-MMBench will stimulate the community to build the next generation of LVLMs toward GMAI. Project Page: https://uni-medical.github.io/GMAI-MMBench.github.io/

Mixture of Expert Tuning (MoE-Tuning) has effectively enhanced the performance of general MLLMs with fewer parameters, yet its application in resource-limited medical settings has not been fully explored. To address this gap, we developed MoE-TinyMed, a model tailored for medical applications that significantly lowers parameter demands. In evaluations on the VQA-RAD, SLAKE, and Path-VQA datasets, MoE-TinyMed outperformed LLaVA-Med in all Med-VQA closed settings with just 3.6B parameters. Additionally, a streamlined version with 2B parameters surpassed LLaVA-Med's performance in PathVQA, showcasing its effectiveness in resource-limited healthcare settings.

Multimodal Large Language Models (MLLMs) have tremendous potential to improve the accuracy, availability, and cost-effectiveness of healthcare by providing automated solutions or serving as aids to medical professionals. Despite promising first steps in developing medical MLLMs in the past few years, their capabilities and limitations are not well-understood. Recently, many benchmark datasets have been proposed that test the general medical knowledge of such models across a variety of medical areas. However, the systematic failure modes and vulnerabilities of such models are severely underexplored with most medical benchmarks failing to expose the shortcomings of existing models in this safety-critical domain. In this paper, we introduce MediConfusion, a challenging medical Visual Question Answering (VQA) benchmark dataset, that probes the failure modes of medical MLLMs from a vision perspective. We reveal that state-of-the-art models are easily confused by image pairs that are otherwise visually dissimilar and clearly distinct for medical experts. Strikingly, all available models (open-source or proprietary) achieve performance below random guessing on MediConfusion, raising serious concerns about the reliability of existing medical MLLMs for healthcare deployment. We also extract common patterns of model failure that may help the design of a new generation of more trustworthy and reliable MLLMs in healthcare.

Open-source, multilingual medical large language models (LLMs) have the potential to serve linguistically diverse populations across different regions. Adapting generic LLMs for healthcare often requires continual pretraining, but this approach is computationally expensive and sometimes impractical. Instruction fine-tuning on a specific task may not always guarantee optimal performance due to the lack of broader domain knowledge that the model needs to understand and reason effectively in diverse scenarios. To address these challenges, we introduce two multilingual instruction fine-tuning datasets, MMed-IFT and MMed-IFT-MC, containing over 200k high-quality medical samples in six languages. We propose a two-stage training paradigm: the first stage injects general medical knowledge using MMed-IFT, while the second stage fine-tunes task-specific multiple-choice questions with MMed-IFT-MC. Our method achieves competitive results on both English and multilingual benchmarks, striking a balance between computational efficiency and performance. We plan to make our dataset and model weights public at https://github.com/SpassMed/Med-Llama3 in the future.

Multimodal large language models (MLLMs) have made significant strides, yet they face challenges in the medical domain due to limited specialized knowledge. While recent medical MLLMs demonstrate strong performance in lab settings, they often struggle in real-world applications, highlighting a substantial gap between research and practice. In this paper, we seek to address this gap at various stages of the end-to-end learning pipeline, including data collection, model fine-tuning, and evaluation. At the data collection stage, we introduce SemiHVision, a dataset that combines human annotations with automated augmentation techniques to improve both medical knowledge representation and diagnostic reasoning. For model fine-tuning, we trained PMC-Cambrian-8B-AN over 2400 H100 GPU hours, resulting in performance that surpasses public medical models like HuatuoGPT-Vision-34B (79.0% vs. 66.7%) and private general models like Claude3-Opus (55.7%) on traditional benchmarks such as SLAKE and VQA-RAD. In the evaluation phase, we observed that traditional benchmarks cannot accurately reflect realistic clinical task capabilities. To overcome this limitation and provide more targeted guidance for model evaluation, we introduce the JAMA Clinical Challenge, a novel benchmark specifically designed to evaluate diagnostic reasoning. On this benchmark, PMC-Cambrian-AN achieves state-of-the-art performance with a GPT-4 score of 1.29, significantly outperforming HuatuoGPT-Vision-34B (1.13) and Claude3-Opus (1.17), demonstrating its superior diagnostic reasoning abilities.

Pathology plays a critical role in diagnosing a wide range of diseases, yet existing approaches often rely heavily on task-specific models trained on extensive, well-labeled datasets. These methods face sustainability challenges due to the diversity of pathologies and the labor-intensive nature of data collection. To address these limitations, we highlight the need for universal multimodal embeddings that can support multiple downstream tasks. Previous approaches often involve fine-tuning CLIP-based models, which handle images and text separately, limiting their ability to capture complex multimodal relationships. Additionally, these models are evaluated across diverse datasets without a unified benchmark for assessing multimodal embeddings in pathology. To address these challenges, we propose MLLM4PUE, a novel framework that leverages Multimodal Large Language Models (MLLMs) to generate Pathology Universal Embeddings. The MLLM4PUE framework not only facilitates robust integration of images and text but also enhances understanding and fusion capabilities across various tasks. We further introduce the Pathology Multimodal Embedding Benchmark (PMEB), a comprehensive benchmark designed to assess the quality of pathology multimodal embeddings. PMEB comprises 15 original tasks drawn from 14 datasets, organized into three meta-tasks: retrieval, classification, and composed retrieval. Experimental results demonstrate the superiority of MLLM4PUE, illustrating MLLM-based models can effectively support a wide range of downstream tasks and unify the research direction for foundation models in pathology.

Multiple-choice question (MCQ) datasets like Massive Multitask Language Understanding (MMLU) are widely used to evaluate the commonsense, understanding, and problem-solving abilities of large language models (LLMs). However, the open-source nature of these benchmarks and the broad sources of training data for LLMs have inevitably led to benchmark contamination, resulting in unreliable evaluation results. To alleviate this issue, we propose a contamination-free and more challenging MCQ benchmark called MMLU-CF. This benchmark reassesses LLMs' understanding of world knowledge by averting both unintentional and malicious data leakage. To avoid unintentional data leakage, we source data from a broader domain and design three decontamination rules. To prevent malicious data leakage, we divide the benchmark into validation and test sets with similar difficulty and subject distributions. The test set remains closed-source to ensure reliable results, while the validation set is publicly available to promote transparency and facilitate independent verification. Our evaluation of mainstream LLMs reveals that the powerful GPT-4o achieves merely a 5-shot score of 73.4% and a 0-shot score of 71.9% on the test set, which indicates the effectiveness of our approach in creating a more rigorous and contamination-free evaluation standard. The GitHub repository is available at https://github.com/microsoft/MMLU-CF and the dataset refers to https://huggingface.co/datasets/microsoft/MMLU-CF.

Large Language Models (LLMs) hold great promise to revolutionize current clinical systems for their superior capacities on medical text processing tasks and medical licensing exams. Meanwhile, traditional ML models such as SVM and XGBoost have still been mainly adopted in clinical prediction tasks. An emerging question is Can LLMs beat traditional ML models in clinical prediction? Thus, we build a new benchmark ClinicalBench to comprehensively study the clinical predictive modeling capacities of both general-purpose and medical LLMs, and compare them with traditional ML models. ClinicalBench embraces three common clinical prediction tasks, two databases, 14 general-purpose LLMs, 8 medical LLMs, and 11 traditional ML models. Through extensive empirical investigation, we discover that both general-purpose and medical LLMs, even with different model scales, diverse prompting or fine-tuning strategies, still cannot beat traditional ML models in clinical prediction yet, shedding light on their potential deficiency in clinical reasoning and decision-making. We call for caution when practitioners adopt LLMs in clinical applications. ClinicalBench can be utilized to bridge the gap between LLMs' development for healthcare and real-world clinical practice.

Several medical Multimodal Large Languange Models (MLLMs) have been developed to address tasks involving visual images with textual instructions across various medical modalities, achieving impressive results. Most current medical generalist models are region-agnostic, treating the entire image as a holistic representation. However, they struggle to identify which specific regions they are focusing on when generating a sentence. To mimic the behavior of doctors, who typically begin by reviewing the entire image before concentrating on specific regions for a thorough evaluation, we aim to enhance the capability of medical MLLMs in understanding anatomical regions within entire medical scans. To achieve it, we first formulate Region-Centric tasks and construct a large-scale dataset, MedRegInstruct, to incorporate regional information into training. Combining our collected dataset with other medical multimodal corpora for training, we propose a Region-Aware medical MLLM, MedRegA, which is the first bilingual generalist medical AI system to simultaneously handle image-level and region-level medical vision-language tasks across a broad range of modalities. Our MedRegA not only enables three region-centric tasks, but also achieves the best performance for visual question answering, report generation and medical image classification over 8 modalities, showcasing significant versatility. Experiments demonstrate that our model can not only accomplish powerful performance across various medical vision-language tasks in bilingual settings, but also recognize and detect structures in multimodal medical scans, boosting the interpretability and user interactivity of medical MLLMs. Our project page is https://medrega.github.io.

Cultural biases in multilingual datasets pose significant challenges for their effectiveness as global benchmarks. These biases stem not only from language but also from the cultural knowledge required to interpret questions, reducing the practical utility of translated datasets like MMLU. Furthermore, translation often introduces artifacts that can distort the meaning or clarity of questions in the target language. A common practice in multilingual evaluation is to rely on machine-translated evaluation sets, but simply translating a dataset is insufficient to address these challenges. In this work, we trace the impact of both of these issues on multilingual evaluations and ensuing model performances. Our large-scale evaluation of state-of-the-art open and proprietary models illustrates that progress on MMLU depends heavily on learning Western-centric concepts, with 28% of all questions requiring culturally sensitive knowledge. Moreover, for questions requiring geographic knowledge, an astounding 84.9% focus on either North American or European regions. Rankings of model evaluations change depending on whether they are evaluated on the full portion or the subset of questions annotated as culturally sensitive, showing the distortion to model rankings when blindly relying on translated MMLU. We release Global-MMLU, an improved MMLU with evaluation coverage across 42 languages -- with improved overall quality by engaging with compensated professional and community annotators to verify translation quality while also rigorously evaluating cultural biases present in the original dataset. This comprehensive Global-MMLU set also includes designated subsets labeled as culturally sensitive and culturally agnostic to allow for more holistic, complete evaluation.

Online shopping is a complex multi-task, few-shot learning problem with a wide and evolving range of entities, relations, and tasks. However, existing models and benchmarks are commonly tailored to specific tasks, falling short of capturing the full complexity of online shopping. Large Language Models (LLMs), with their multi-task and few-shot learning abilities, have the potential to profoundly transform online shopping by alleviating task-specific engineering efforts and by providing users with interactive conversations. Despite the potential, LLMs face unique challenges in online shopping, such as domain-specific concepts, implicit knowledge, and heterogeneous user behaviors. Motivated by the potential and challenges, we propose Shopping MMLU, a diverse multi-task online shopping benchmark derived from real-world Amazon data. Shopping MMLU consists of 57 tasks covering 4 major shopping skills: concept understanding, knowledge reasoning, user behavior alignment, and multi-linguality, and can thus comprehensively evaluate the abilities of LLMs as general shop assistants. With Shopping MMLU, we benchmark over 20 existing LLMs and uncover valuable insights about practices and prospects of building versatile LLM-based shop assistants. Shopping MMLU can be publicly accessed at https://github.com/KL4805/ShoppingMMLU. In addition, with Shopping MMLU, we host a competition in KDD Cup 2024 with over 500 participating teams. The winning solutions and the associated workshop can be accessed at our website https://amazon-kddcup24.github.io/.

Multimodal large language models (MLLMs) hold significant potential in the medical field, but their capabilities are often limited by insufficient data in certain medical domains, highlighting the need for understanding what kinds of images can be used by MLLMs for generalization. Current research suggests that multi-task training outperforms single-task as different tasks can benefit each other, but they often overlook the internal relationships within these tasks, providing limited guidance on selecting datasets to enhance specific tasks. To analyze this phenomenon, we attempted to employ compositional generalization (CG)-the ability of models to understand novel combinations by recombining learned elements-as a guiding framework. Since medical images can be precisely defined by Modality, Anatomical area, and Task, naturally providing an environment for exploring CG. Therefore, we assembled 106 medical datasets to create Med-MAT for comprehensive experiments. The experiments confirmed that MLLMs can use CG to understand unseen medical images and identified CG as one of the main drivers of the generalization observed in multi-task training. Additionally, further studies demonstrated that CG effectively supports datasets with limited data and delivers consistent performance across different backbones, highlighting its versatility and broad applicability. Med-MAT is publicly available at https://github.com/FreedomIntelligence/Med-MAT.

The rapid development of multimodal large language models (MLLMs), such as GPT-4V, has led to significant advancements. However, these models still face challenges in medical multimodal capabilities due to limitations in the quantity and quality of medical vision-text data, stemming from data privacy concerns and high annotation costs. While pioneering approaches utilize PubMed's large-scale, de-identified medical image-text pairs to address these limitations, they still fall short due to inherent data noise. To tackle this, we refined medical image-text pairs from PubMed and employed MLLMs (GPT-4V) in an 'unblinded' capacity to denoise and reformat the data, resulting in the creation of the PubMedVision dataset with 1.3 million medical VQA samples. Our validation demonstrates that: (1) PubMedVision can significantly enhance the medical multimodal capabilities of current MLLMs, showing significant improvement in benchmarks including the MMMU Health & Medicine track; (2) manual checks by medical experts and empirical results validate the superior data quality of our dataset compared to other data construction methods. Using PubMedVision, we train a 34B medical MLLM HuatuoGPT-Vision, which shows superior performance in medical multimodal scenarios among open-source MLLMs.

Objective: Data unavailability has been one of the biggest barriers in clinical natural language processing. This paper is aimed at providing a large-scale and publicly available patient note dataset, named PMC-Patients, with relevant articles and similar patients annotations. The ultimate goal of PMC-Patients is to facilitate the development of retrieval-based clinical decision support systems. Materials and Methods: To collect PMC-Patients, we extract patient notes from case reports in PubMed Central by recognizing certain section patterns. Patient-article relevance and patient-patient similarity are annotated by citation relationships in PubMed. In addition, we perform three tasks with PMC-Patients to demonstrate its utility in providing clinical decision support for a given patient, including (1) classifying whether another patient is similar, (2) retrieving similar patients in PMC-Patients, and (3) retrieving relevant articles in PubMed. Results: We collect and release PMC-Patients under the CC BY-NC-SA license, which becomes the largest publicly available patient note dataset so far. PMC-Patients contains 167k patient notes that are annotated with 3.1M relevant articles and 293k similar patients. Qualitative and quantitative analyses reveal the high quality and richness of our dataset. Experiments show that classifying the similarity of patient pairs is relatively easy, but it is hard to retrieve similar patients or relevant articles for a given patient from a large set of candidates. Conclusion: We present PMC-Patients, a large-scale dataset of patient notes with high quality, easy access, diverse conditions, and rich annotations. The proposed dataset can also serve as a hard benchmark for evaluating retrieval-based clinical decision support systems.

Guided by the belief of the scaling law, large language models (LLMs) have achieved impressive performance in recent years. However, scaling law only gives a qualitative estimation of loss, which is influenced by various factors such as model architectures, data distributions, tokenizers, and computation precision. Thus, estimating the real performance of LLMs with different training settings rather than loss may be quite useful in practical development. In this article, we present an empirical equation named "Performance Law" to directly predict the MMLU score of an LLM, which is a widely used metric to indicate the general capability of LLMs in real-world conversations and applications. Based on only a few key hyperparameters of the LLM architecture and the size of training data, we obtain a quite accurate MMLU prediction of various LLMs with diverse sizes and architectures developed by different organizations in different years. Performance law can be used to guide the choice of LLM architecture and the effective allocation of computational resources without extensive experiments.

Medical images and radiology reports are crucial for diagnosing medical conditions, highlighting the importance of quantitative analysis for clinical decision-making. However, the diversity and cross-source heterogeneity of these data challenge the generalizability of current data-mining methods. Multimodal large language models (MLLMs) have recently transformed many domains, significantly affecting the medical field. Notably, Gemini-Vision-series (Gemini) and GPT-4-series (GPT-4) models have epitomized a paradigm shift in Artificial General Intelligence (AGI) for computer vision, showcasing their potential in the biomedical domain. In this study, we evaluated the performance of the Gemini, GPT-4, and 4 popular large models for an exhaustive evaluation across 14 medical imaging datasets, including 5 medical imaging categories (dermatology, radiology, dentistry, ophthalmology, and endoscopy), and 3 radiology report datasets. The investigated tasks encompass disease classification, lesion segmentation, anatomical localization, disease diagnosis, report generation, and lesion detection. Our experimental results demonstrated that Gemini-series models excelled in report generation and lesion detection but faces challenges in disease classification and anatomical localization. Conversely, GPT-series models exhibited proficiency in lesion segmentation and anatomical localization but encountered difficulties in disease diagnosis and lesion detection. Additionally, both the Gemini series and GPT series contain models that have demonstrated commendable generation efficiency. While both models hold promise in reducing physician workload, alleviating pressure on limited healthcare resources, and fostering collaboration between clinical practitioners and artificial intelligence technologies, substantial enhancements and comprehensive validations remain imperative before clinical deployment.

Med42-v2 introduces a suite of clinical large language models (LLMs) designed to address the limitations of generic models in healthcare settings. These models are built on Llama3 architecture and fine-tuned using specialized clinical data. They underwent multi-stage preference alignment to effectively respond to natural prompts. While generic models are often preference-aligned to avoid answering clinical queries as a precaution, Med42-v2 is specifically trained to overcome this limitation, enabling its use in clinical settings. Med42-v2 models demonstrate superior performance compared to the original Llama3 models in both 8B and 70B parameter configurations and GPT-4 across various medical benchmarks. These LLMs are developed to understand clinical queries, perform reasoning tasks, and provide valuable assistance in clinical environments. The models are now publicly available at https://huggingface.co/m42-health{https://huggingface.co/m42-health}.

In this paper, we aim to develop an open-source, multilingual language model for medicine, that the benefits a wider, linguistically diverse audience from different regions. In general, we present the contribution from the following aspects: first, for multilingual medical-specific adaptation, we construct a new multilingual medical corpus, that contains approximately 25.5B tokens encompassing 6 main languages, termed as MMedC, that enables auto-regressive training for existing general LLMs. second, to monitor the development of multilingual LLMs in medicine, we propose a new multilingual medical multi-choice question-answering benchmark with rationale, termed as MMedBench; third, we have assessed a number of popular, opensource large language models (LLMs) on our benchmark, along with those further auto-regressive trained on MMedC, as a result, our final model, termed as MMedLM 2, with only 7B parameters, achieves superior performance compared to all other open-source models, even rivaling GPT-4 on MMedBench. We will make the resources publicly available, including code, model weights, and datasets.

Artificial Intelligence (AI) has demonstrated significant potential in healthcare, particularly in disease diagnosis and treatment planning. Recent progress in Medical Large Vision-Language Models (Med-LVLMs) has opened up new possibilities for interactive diagnostic tools. However, these models often suffer from factual hallucination, which can lead to incorrect diagnoses. Fine-tuning and retrieval-augmented generation (RAG) have emerged as methods to address these issues. However, the amount of high-quality data and distribution shifts between training data and deployment data limit the application of fine-tuning methods. Although RAG is lightweight and effective, existing RAG-based approaches are not sufficiently general to different medical domains and can potentially cause misalignment issues, both between modalities and between the model and the ground truth. In this paper, we propose a versatile multimodal RAG system, MMed-RAG, designed to enhance the factuality of Med-LVLMs. Our approach introduces a domain-aware retrieval mechanism, an adaptive retrieved contexts selection method, and a provable RAG-based preference fine-tuning strategy. These innovations make the RAG process sufficiently general and reliable, significantly improving alignment when introducing retrieved contexts. Experimental results across five medical datasets (involving radiology, ophthalmology, pathology) on medical VQA and report generation demonstrate that MMed-RAG can achieve an average improvement of 43.8% in the factual accuracy of Med-LVLMs. Our data and code are available in https://github.com/richard-peng-xia/MMed-RAG.

In the quest for artificial general intelligence, Multi-modal Large Language Models (MLLMs) have emerged as a focal point in recent advancements. However, the predominant focus remains on developing their capabilities in static image understanding. The potential of MLLMs in processing sequential visual data is still insufficiently explored, highlighting the absence of a comprehensive, high-quality assessment of their performance. In this paper, we introduce Video-MME, the first-ever full-spectrum, Multi-Modal Evaluation benchmark of MLLMs in Video analysis. Our work distinguishes from existing benchmarks through four key features: 1) Diversity in video types, spanning 6 primary visual domains with 30 subfields to ensure broad scenario generalizability; 2) Duration in temporal dimension, encompassing both short-, medium-, and long-term videos, ranging from 11 seconds to 1 hour, for robust contextual dynamics; 3) Breadth in data modalities, integrating multi-modal inputs besides video frames, including subtitles and audios, to unveil the all-round capabilities of MLLMs; 4) Quality in annotations, utilizing rigorous manual labeling by expert annotators to facilitate precise and reliable model assessment. 900 videos with a total of 256 hours are manually selected and annotated by repeatedly viewing all the video content, resulting in 2,700 question-answer pairs. With Video-MME, we extensively evaluate various state-of-the-art MLLMs, including GPT-4 series and Gemini 1.5 Pro, as well as open-source image models like InternVL-Chat-V1.5 and video models like LLaVA-NeXT-Video. Our experiments reveal that Gemini 1.5 Pro is the best-performing commercial model, significantly outperforming the open-source models. Our dataset along with these findings underscores the need for further improvements in handling longer sequences and multi-modal data. Project Page: https://video-mme.github.io

In recent years, Multimodal Large Language Models (MLLM) have achieved notable advancements, demonstrating the feasibility of developing an intelligent biomedical assistant. However, current biomedical MLLMs predominantly focus on image-level understanding and restrict interactions to textual commands, thus limiting their capability boundaries and the flexibility of usage. In this paper, we introduce a novel end-to-end multimodal large language model for the biomedical domain, named MedPLIB, which possesses pixel-level understanding. Excitingly, it supports visual question answering (VQA), arbitrary pixel-level prompts (points, bounding boxes, and free-form shapes), and pixel-level grounding. We propose a novel Mixture-of-Experts (MoE) multi-stage training strategy, which divides MoE into separate training phases for a visual-language expert model and a pixel-grounding expert model, followed by fine-tuning using MoE. This strategy effectively coordinates multitask learning while maintaining the computational cost at inference equivalent to that of a single expert model. To advance the research of biomedical MLLMs, we introduce the Medical Complex Vision Question Answering Dataset (MeCoVQA), which comprises an array of 8 modalities for complex medical imaging question answering and image region understanding. Experimental results indicate that MedPLIB has achieved state-of-the-art outcomes across multiple medical visual language tasks. More importantly, in zero-shot evaluations for the pixel grounding task, MedPLIB leads the best small and large models by margins of 19.7 and 15.6 respectively on the mDice metric. The codes, data, and model checkpoints will be made publicly available at https://github.com/ShawnHuang497/MedPLIB.

Large Language Models (LLMs) have shown remarkable performance across various tasks, yet significant disparities remain for non-English languages, and especially native African languages. This paper addresses these disparities by creating approximately 1 million human-translated words of new benchmark data in 8 low-resource African languages, covering a population of over 160 million speakers of: Amharic, Bambara, Igbo, Sepedi (Northern Sotho), Shona, Sesotho (Southern Sotho), Setswana, and Tsonga. Our benchmarks are translations of Winogrande and three sections of MMLU: college medicine, clinical knowledge, and virology. Using the translated benchmarks, we report previously unknown performance gaps between state-of-the-art (SOTA) LLMs in English and African languages. Finally, using results from over 400 fine-tuned models, we explore several methods to reduce the LLM performance gap, including high-quality dataset fine-tuning (using an LLM-as-an-Annotator), cross-lingual transfer, and cultural appropriateness adjustments. Key findings include average mono-lingual improvements of 5.6% with fine-tuning (with 5.4% average mono-lingual improvements when using high-quality data over low-quality data), 2.9% average gains from cross-lingual transfer, and a 3.0% out-of-the-box performance boost on culturally appropriate questions. The publicly available benchmarks, translations, and code from this study support further research and development aimed at creating more inclusive and effective language technologies.

Security concerns related to Large Language Models (LLMs) have been extensively explored, yet the safety implications for Multimodal Large Language Models (MLLMs), particularly in medical contexts (MedMLLMs), remain insufficiently studied. This paper delves into the underexplored security vulnerabilities of MedMLLMs, especially when deployed in clinical environments where the accuracy and relevance of question-and-answer interactions are critically tested against complex medical challenges. By combining existing clinical medical data with atypical natural phenomena, we redefine two types of attacks: mismatched malicious attack (2M-attack) and optimized mismatched malicious attack (O2M-attack). Using our own constructed voluminous 3MAD dataset, which covers a wide range of medical image modalities and harmful medical scenarios, we conduct a comprehensive analysis and propose the MCM optimization method, which significantly enhances the attack success rate on MedMLLMs. Evaluations with this dataset and novel attack methods, including white-box attacks on LLaVA-Med and transfer attacks on four other state-of-the-art models, indicate that even MedMLLMs designed with enhanced security features are vulnerable to security breaches. Our work underscores the urgent need for a concerted effort to implement robust security measures and enhance the safety and efficacy of open-source MedMLLMs, particularly given the potential severity of jailbreak attacks and other malicious or clinically significant exploits in medical settings. For further research and replication, anonymous access to our code is available at https://github.com/dirtycomputer/O2M_attack. Warning: Medical large model jailbreaking may generate content that includes unverified diagnoses and treatment recommendations. Always consult professional medical advice.

Large Language Model (LLM) leaderboards based on benchmark rankings are regularly used to guide practitioners in model selection. Often, the published leaderboard rankings are taken at face value - we show this is a (potentially costly) mistake. Under existing leaderboards, the relative performance of LLMs is highly sensitive to (often minute) details. We show that for popular multiple choice question benchmarks (e.g. MMLU) minor perturbations to the benchmark, such as changing the order of choices or the method of answer selection, result in changes in rankings up to 8 positions. We explain this phenomenon by conducting systematic experiments over three broad categories of benchmark perturbations and identifying the sources of this behavior. Our analysis results in several best-practice recommendations, including the advantage of a hybrid scoring method for answer selection. Our study highlights the dangers of relying on simple benchmark evaluations and charts the path for more robust evaluation schemes on the existing benchmarks.

In the age of large-scale language models, benchmarks like the Massive Multitask Language Understanding (MMLU) have been pivotal in pushing the boundaries of what AI can achieve in language comprehension and reasoning across diverse domains. However, as models continue to improve, their performance on these benchmarks has begun to plateau, making it increasingly difficult to discern differences in model capabilities. This paper introduces MMLU-Pro, an enhanced dataset designed to extend the mostly knowledge-driven MMLU benchmark by integrating more challenging, reasoning-focused questions and expanding the choice set from four to ten options. Additionally, MMLU-Pro eliminates the trivial and noisy questions in MMLU. Our experimental results show that MMLU-Pro not only raises the challenge, causing a significant drop in accuracy by 16% to 33% compared to MMLU but also demonstrates greater stability under varying prompts. With 24 different prompt styles tested, the sensitivity of model scores to prompt variations decreased from 4-5% in MMLU to just 2% in MMLU-Pro. Additionally, we found that models utilizing Chain of Thought (CoT) reasoning achieved better performance on MMLU-Pro compared to direct answering, which is in stark contrast to the findings on the original MMLU, indicating that MMLU-Pro includes more complex reasoning questions. Our assessments confirm that MMLU-Pro is a more discriminative benchmark to better track progress in the field.

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.

Multimodal large language models (MLLMs) have achieved significant success in the general field of image processing. Their emerging task generalization and freeform conversational capabilities can greatly facilitate medical diagnostic assistance, helping patients better understand their conditions and enhancing doctor-patient trust. Computed Tomography (CT) is a non-invasive imaging technique used to capture the internal mechanisms of a patient's condition and is widely utilized. However, in past research, the complex textural features of this imaging data have made accurate interpretation by algorithms challenging, impeding the performance of general LLMs in diagnostic assistance. To address this, we developed OrthoDoc, a MLLM designed for CT diagnostics. OrthoDoc is trained on 120,000 CT images and diagnostic reports and includes a Retrieval-Augmented Generation (RAG) module capable of effectively mitigating model hallucinations. This module is informed by extensive medical literature, textbooks, and explanatory data. Thus, OrthoDoc not only processes complex CT images but also stores, understands, and reasons over medical knowledge and language. In extensive experiments, OrthoDoc outperforms commercial models led by GPT-4, demonstrating superior diagnostic capabilities and accuracy. Specifically, OrthoDoc significantly surpasses existing models in the diagnosis of common orthopedic conditions such as fractures, arthritis, and tumors. Additionally, OrthoDoc exhibits robust generalization and stability when handling rare and complex cases.

We present MM1.5, a new family of multimodal large language models (MLLMs) designed to enhance capabilities in text-rich image understanding, visual referring and grounding, and multi-image reasoning. Building upon the MM1 architecture, MM1.5 adopts a data-centric approach to model training, systematically exploring the impact of diverse data mixtures across the entire model training lifecycle. This includes high-quality OCR data and synthetic captions for continual pre-training, as well as an optimized visual instruction-tuning data mixture for supervised fine-tuning. Our models range from 1B to 30B parameters, encompassing both dense and mixture-of-experts (MoE) variants, and demonstrate that careful data curation and training strategies can yield strong performance even at small scales (1B and 3B). Additionally, we introduce two specialized variants: MM1.5-Video, designed for video understanding, and MM1.5-UI, tailored for mobile UI understanding. Through extensive empirical studies and ablations, we provide detailed insights into the training processes and decisions that inform our final designs, offering valuable guidance for future research in MLLM development.

Multimodal Large Language Model (MLLM) relies on the powerful LLM to perform multimodal tasks, showing amazing emergent abilities in recent studies, such as writing poems based on an image. However, it is difficult for these case studies to fully reflect the performance of MLLM, lacking a comprehensive evaluation. In this paper, we fill in this blank, presenting the first MLLM Evaluation benchmark MME. It measures both perception and cognition abilities on a total of 14 subtasks. In order to avoid data leakage that may arise from direct use of public datasets for evaluation, the annotations of instruction-answer pairs are all manually designed. The concise instruction design allows us to fairly compare MLLMs, instead of struggling in prompt engineering. Besides, with such an instruction, we can also easily carry out quantitative statistics. A total of 12 advanced MLLMs are comprehensively evaluated on our MME, which not only suggests that existing MLLMs still have a large room for improvement, but also reveals the potential directions for the subsequent model optimization.

In the era of modern healthcare, swiftly generating medical question summaries is crucial for informed and timely patient care. Despite the increasing complexity and volume of medical data, existing studies have focused solely on text-based summarization, neglecting the integration of visual information. Recognizing the untapped potential of combining textual queries with visual representations of medical conditions, we introduce the Multimodal Medical Question Summarization (MMQS) Dataset. This dataset, a major contribution to our work, pairs medical queries with visual aids, facilitating a richer and more nuanced understanding of patient needs. We also propose a framework, utilizing the power of Contrastive Language Image Pretraining(CLIP) and Large Language Models(LLMs), consisting of four modules that identify medical disorders, generate relevant context, filter medical concepts, and craft visually aware summaries. Our comprehensive framework harnesses the power of CLIP, a multimodal foundation model, and various general-purpose LLMs, comprising four main modules: the medical disorder identification module, the relevant context generation module, the context filtration module for distilling relevant medical concepts and knowledge, and finally, a general-purpose LLM to generate visually aware medical question summaries. Leveraging our MMQS dataset, we showcase how visual cues from images enhance the generation of medically nuanced summaries. This multimodal approach not only enhances the decision-making process in healthcare but also fosters a more nuanced understanding of patient queries, laying the groundwork for future research in personalized and responsive medical care

The advancement of natural language processing (NLP) systems in healthcare hinges on language model ability to interpret the intricate information contained within clinical notes. This process often requires integrating information from various time points in a patient's medical history. However, most earlier clinical language models were pretrained with a context length limited to roughly one clinical document. In this study, We introduce ClinicalMamba, a specialized version of the Mamba language model, pretrained on a vast corpus of longitudinal clinical notes to address the unique linguistic characteristics and information processing needs of the medical domain. ClinicalMamba, with 130 million and 2.8 billion parameters, demonstrates a superior performance in modeling clinical language across extended text lengths compared to Mamba and clinical Llama. With few-shot learning, ClinicalMamba achieves notable benchmarks in speed and accuracy, outperforming existing clinical language models and general domain large models like GPT-4 in longitudinal clinical notes information extraction tasks.

The increasing interest in developing Artificial Intelligence applications in the medical domain, suffers from the lack of high-quality dataset, mainly due to privacy-related issues. Moreover, the recent rising of Multimodal Large Language Models (MLLM) leads to a need for multimodal medical datasets, where clinical reports and findings are attached to the corresponding CT or MR scans. This paper illustrates the entire workflow for building the data set MedPix 2.0. Starting from the well-known multimodal dataset MedPix\textregistered, mainly used by physicians, nurses and healthcare students for Continuing Medical Education purposes, a semi-automatic pipeline was developed to extract visual and textual data followed by a manual curing procedure where noisy samples were removed, thus creating a MongoDB database. Along with the dataset, we developed a GUI aimed at navigating efficiently the MongoDB instance, and obtaining the raw data that can be easily used for training and/or fine-tuning MLLMs. To enforce this point, we also propose a CLIP-based model trained on MedPix 2.0 for scan classification tasks.

Being able to thoroughly assess massive multi-task language understanding (MMLU) capabilities is essential for advancing the applicability of multilingual language models. However, preparing such benchmarks in high quality native language is often costly and therefore limits the representativeness of evaluation datasets. While recent efforts focused on building more inclusive MMLU benchmarks, these are conventionally built using machine translation from high-resource languages, which may introduce errors and fail to account for the linguistic and cultural intricacies of the target languages. In this paper, we address the lack of native language MMLU benchmark especially in the under-represented Turkic language family with distinct morphosyntactic and cultural characteristics. We propose two benchmarks for Turkic language MMLU: TUMLU is a comprehensive, multilingual, and natively developed language understanding benchmark specifically designed for Turkic languages. It consists of middle- and high-school level questions spanning 11 academic subjects in Azerbaijani, Crimean Tatar, Karakalpak, Kazakh, Tatar, Turkish, Uyghur, and Uzbek. We also present TUMLU-mini, a more concise, balanced, and manually verified subset of the dataset. Using this dataset, we systematically evaluate a diverse range of open and proprietary multilingual large language models (LLMs), including Claude, Gemini, GPT, and LLaMA, offering an in-depth analysis of their performance across different languages, subjects, and alphabets. To promote further research and development in multilingual language understanding, we release TUMLU-mini and all corresponding evaluation scripts.

The approval success rate of drug candidates is very low with the majority of failure due to safety and efficacy. Increasingly available high dimensional information on targets, drug molecules and indications provides an opportunity for ML methods to integrate multiple data modalities and better predict clinically promising drug targets. Notably, drug targets with human genetics evidence are shown to have better odds to succeed. However, a recent tensor factorization-based approach found that additional information on targets and indications might not necessarily improve the predictive accuracy. Here we revisit this approach by integrating different types of human genetics evidence collated from publicly available sources to support each target-indication pair. We use Bayesian tensor factorization to show that models incorporating all available human genetics evidence (rare disease, gene burden, common disease) modestly improves the clinical outcome prediction over models using single line of genetics evidence. We provide additional insight into the relative predictive power of different types of human genetics evidence for predicting the success of clinical outcomes.

Comprehensive evaluation of Multimodal Large Language Models (MLLMs) has recently garnered widespread attention in the research community. However, we observe that existing benchmarks present several common barriers that make it difficult to measure the significant challenges that models face in the real world, including: 1) small data scale leads to a large performance variance; 2) reliance on model-based annotations results in restricted data quality; 3) insufficient task difficulty, especially caused by the limited image resolution. To tackle these issues, we introduce MME-RealWorld. Specifically, we collect more than 300K images from public datasets and the Internet, filtering 13,366 high-quality images for annotation. This involves the efforts of professional 25 annotators and 7 experts in MLLMs, contributing to 29,429 question-answer pairs that cover 43 subtasks across 5 real-world scenarios, extremely challenging even for humans. As far as we know, MME-RealWorld is the largest manually annotated benchmark to date, featuring the highest resolution and a targeted focus on real-world applications. We further conduct a thorough evaluation involving 28 prominent MLLMs, such as GPT-4o, Gemini 1.5 Pro, and Claude 3.5 Sonnet. Our results show that even the most advanced models struggle with our benchmarks, where none of them reach 60% accuracy. The challenges of perceiving high-resolution images and understanding complex real-world scenarios remain urgent issues to be addressed. The data and evaluation code are released at https://mme-realworld.github.io/ .

In the healthcare domain, summarizing medical questions posed by patients is critical for improving doctor-patient interactions and medical decision-making. Although medical data has grown in complexity and quantity, the current body of research in this domain has primarily concentrated on text-based methods, overlooking the integration of visual cues. Also prior works in the area of medical question summarisation have been limited to the English language. This work introduces the task of multimodal medical question summarization for codemixed input in a low-resource setting. To address this gap, we introduce the Multimodal Medical Codemixed Question Summarization MMCQS dataset, which combines Hindi-English codemixed medical queries with visual aids. This integration enriches the representation of a patient's medical condition, providing a more comprehensive perspective. We also propose a framework named MedSumm that leverages the power of LLMs and VLMs for this task. By utilizing our MMCQS dataset, we demonstrate the value of integrating visual information from images to improve the creation of medically detailed summaries. This multimodal strategy not only improves healthcare decision-making but also promotes a deeper comprehension of patient queries, paving the way for future exploration in personalized and responsive medical care. Our dataset, code, and pre-trained models will be made publicly available.

In this study, we present MedS-Bench, a comprehensive benchmark designed to evaluate the performance of large language models (LLMs) in clinical contexts. Unlike existing benchmarks that focus on multiple-choice question answering, MedS-Bench spans 11 high-level clinical tasks, including clinical report summarization, treatment recommendations, diagnosis, named entity recognition, and medical concept explanation, among others. We evaluated six leading LLMs, e.g., MEDITRON, Mistral, InternLM 2, Llama 3, GPT-4, and Claude-3.5 using few-shot prompting, and found that even the most sophisticated models struggle with these complex tasks. To address these limitations, we developed MedS-Ins, a large-scale instruction tuning dataset for medicine. MedS-Ins comprises 58 medically oriented language corpora, totaling 13.5 million samples across 122 tasks. To demonstrate the dataset's utility, we conducted a proof-of-concept experiment by performing instruction tuning on a lightweight, open-source medical language model. The resulting model, MMedIns-Llama 3, significantly outperformed existing models across nearly all clinical tasks. To promote further advancements in the application of LLMs to clinical challenges, we have made the MedS-Ins dataset fully accessible and invite the research community to contribute to its expansion.Additionally, we have launched a dynamic leaderboard for MedS-Bench, which we plan to regularly update the test set to track progress and enhance the adaptation of general LLMs to the medical domain. Leaderboard: https://henrychur.github.io/MedS-Bench/. Github: https://github.com/MAGIC-AI4Med/MedS-Ins.

Vision-Language Models (VLM) can support clinicians by analyzing medical images and engaging in natural language interactions to assist in diagnostic and treatment tasks. However, VLMs often exhibit "hallucinogenic" behavior, generating textual outputs not grounded in contextual multimodal information. This challenge is particularly pronounced in the medical domain, where we do not only require VLM outputs to be accurate in single interactions but also to be consistent with clinical reasoning and diagnostic pathways throughout multi-turn conversations. For this purpose, we propose a new alignment algorithm that uses symbolic representations of clinical reasoning to ground VLMs in medical knowledge. These representations are utilized to (i) generate GPT-4-guided visual instruction tuning data at scale, simulating clinician-VLM conversations with demonstrations of clinical reasoning, and (ii) create an automatic reward function that evaluates the clinical validity of VLM generations throughout clinician-VLM interactions. Our algorithm eliminates the need for human involvement in training data generation or reward model construction, reducing costs compared to standard reinforcement learning with human feedback (RLHF). We apply our alignment algorithm to develop Dr-LLaVA, a conversational VLM finetuned for analyzing bone marrow pathology slides, demonstrating strong performance in multi-turn medical conversations.

Social media platforms are hubs for multimodal information exchange, encompassing text, images, and videos, making it challenging for machines to comprehend the information or emotions associated with interactions in online spaces. Multimodal Large Language Models (MLLMs) have emerged as a promising solution to address these challenges, yet struggle with accurately interpreting human emotions and complex contents like misinformation. This paper introduces MM-Soc, a comprehensive benchmark designed to evaluate MLLMs' understanding of multimodal social media content. MM-Soc compiles prominent multimodal datasets and incorporates a novel large-scale YouTube tagging dataset, targeting a range of tasks from misinformation detection, hate speech detection, and social context generation. Through our exhaustive evaluation on ten size-variants of four open-source MLLMs, we have identified significant performance disparities, highlighting the need for advancements in models' social understanding capabilities. Our analysis reveals that, in a zero-shot setting, various types of MLLMs generally exhibit difficulties in handling social media tasks. However, MLLMs demonstrate performance improvements post fine-tuning, suggesting potential pathways for improvement.

Recent Multimodal Large Language Models (MLLMs) have demonstrated significant progress in perceiving and reasoning over multimodal inquiries, ushering in a new research era for foundation models. However, vision-language misalignment in MLLMs has emerged as a critical challenge, where the textual responses generated by these models are not factually aligned with the given text-image inputs. Existing efforts to address vision-language misalignment have focused on developing specialized vision-language connectors or leveraging visual instruction tuning from diverse domains. In this paper, we tackle this issue from a fundamental yet unexplored perspective by revisiting the core architecture of MLLMs. Most MLLMs are typically built on decoder-only LLMs consisting of a causal attention mechanism, which limits the ability of earlier modalities (e.g., images) to incorporate information from later modalities (e.g., text). To address this problem, we propose AKI, a novel MLLM that unlocks causal attention into modality-mutual attention (MMA) to enable image tokens to attend to text tokens. This simple yet effective design allows AKI to achieve superior performance in 12 multimodal understanding benchmarks (+7.2% on average) without introducing additional parameters and increasing training time. Our MMA design is intended to be generic, allowing for application across various modalities, and scalable to accommodate diverse multimodal scenarios. The code is publicly available at https://github.com/sony/aki, and we will release our AKI-4B model to encourage further advancements in MLLMs across various directions.

Large language models (LLMs), such as ChatGPT, have received substantial attention due to their impressive human language understanding and generation capabilities. Therefore, the application of LLMs in medicine to assist physicians and patient care emerges as a promising research direction in both artificial intelligence and clinical medicine. To reflect this trend, this survey provides a comprehensive overview of the principles, applications, and challenges faced by LLMs in medicine. Specifically, we aim to address the following questions: 1) How can medical LLMs be built? 2) What are the downstream performances of medical LLMs? 3) How can medical LLMs be utilized in real-world clinical practice? 4) What challenges arise from the use of medical LLMs? and 5) How can we better construct and utilize medical LLMs? As a result, this survey aims to provide insights into the opportunities and challenges of LLMs in medicine and serve as a valuable resource for constructing practical and effective medical LLMs. A regularly updated list of practical guides on medical LLMs can be found at https://github.com/AI-in-Health/MedLLMsPracticalGuide.

As advances in large language models (LLMs) and multimodal techniques continue to mature, the development of general-purpose multimodal large language models (MLLMs) has surged, offering significant applications in interpreting natural images. However, the field of pathology has largely remained untapped, particularly in gathering high-quality data and designing comprehensive model frameworks. To bridge the gap in pathology MLLMs, we present PathAsst, a multimodal generative foundation AI assistant to revolutionize diagnostic and predictive analytics in pathology. The development of PathAsst involves three pivotal steps: data acquisition, CLIP model adaptation, and the training of PathAsst's multimodal generative capabilities. Firstly, we collect over 207K high-quality pathology image-text pairs from authoritative sources. Leveraging the advanced power of ChatGPT, we generate over 180K instruction-following samples. Furthermore, we devise additional instruction-following data specifically tailored for invoking eight pathology-specific sub-models we prepared, allowing the PathAsst to effectively collaborate with these models, enhancing its diagnostic ability. Secondly, by leveraging the collected data, we construct PathCLIP, a pathology-dedicated CLIP, to enhance PathAsst's capabilities in interpreting pathology images. Finally, we integrate PathCLIP with the Vicuna-13b and utilize pathology-specific instruction-tuning data to enhance the multimodal generation capacity of PathAsst and bolster its synergistic interactions with sub-models. The experimental results of PathAsst show the potential of harnessing AI-powered generative foundation model to improve pathology diagnosis and treatment processes.

Multimodal large language models (MLLMs) represent an evolutionary expansion in the capabilities of traditional large language models, enabling them to tackle challenges that surpass the scope of purely text-based applications. It leverages the knowledge previously encoded within these language models, thereby enhancing their applicability and functionality in the reign of multimodal contexts. Recent works investigate the adaptation of MLLMs to predict free-form answers as a generative task to solve medical visual question answering (Med-VQA) tasks. In this paper, we propose a parameter efficient framework for fine-tuning MLLM specifically tailored to Med-VQA applications, and empirically validate it on a public benchmark dataset. To accurately measure the performance, we employ human evaluation and the results reveal that our model achieves an overall accuracy of 81.9%, and outperforms the GPT-4v model by a significant margin of 26% absolute accuracy on closed-ended questions. The code will be available here: https://github.com/jinlHe/PeFoMed.

With the rapid development of artificial intelligence, large language models (LLMs) have shown promising capabilities in mimicking human-level language comprehension and reasoning. This has sparked significant interest in applying LLMs to enhance various aspects of healthcare, ranging from medical education to clinical decision support. However, medicine involves multifaceted data modalities and nuanced reasoning skills, presenting challenges for integrating LLMs. This paper provides a comprehensive review on the applications and implications of LLMs in medicine. It begins by examining the fundamental applications of general-purpose and specialized LLMs, demonstrating their utilities in knowledge retrieval, research support, clinical workflow automation, and diagnostic assistance. Recognizing the inherent multimodality of medicine, the review then focuses on multimodal LLMs, investigating their ability to process diverse data types like medical imaging and EHRs to augment diagnostic accuracy. To address LLMs' limitations regarding personalization and complex clinical reasoning, the paper explores the emerging development of LLM-powered autonomous agents for healthcare. Furthermore, it summarizes the evaluation methodologies for assessing LLMs' reliability and safety in medical contexts. Overall, this review offers an extensive analysis on the transformative potential of LLMs in modern medicine. It also highlights the pivotal need for continuous optimizations and ethical oversight before these models can be effectively integrated into clinical practice. Visit https://github.com/mingze-yuan/Awesome-LLM-Healthcare for an accompanying GitHub repository containing latest papers.

Multimodal Large Language Models (MLLMs) are gaining increasing popularity in both academia and industry due to their remarkable performance in various applications such as visual question answering, visual perception, understanding, and reasoning. Over the past few years, significant efforts have been made to examine MLLMs from multiple perspectives. This paper presents a comprehensive review of 180 benchmarks and evaluation for MLLMs, focusing on (1)perception and understanding, (2)cognition and reasoning, (3)specific domains, (4)key capabilities, and (5)other modalities. Finally, we discuss the limitations of the current evaluation methods for MLLMs and explore promising future directions. Our key argument is that evaluation should be regarded as a crucial discipline to better support the development of MLLMs. For more details, please visit our GitHub repository: https://github.com/swordlidev/Evaluation-Multimodal-LLMs-Survey.

Medical open-domain question answering demands substantial access to specialized knowledge. Recent efforts have sought to decouple knowledge from model parameters, counteracting architectural scaling and allowing for training on common low-resource hardware. The retrieve-then-read paradigm has become ubiquitous, with model predictions grounded on relevant knowledge pieces from external repositories such as PubMed, textbooks, and UMLS. An alternative path, still under-explored but made possible by the advent of domain-specific large language models, entails constructing artificial contexts through prompting. As a result, "to generate or to retrieve" is the modern equivalent of Hamlet's dilemma. This paper presents MedGENIE, the first generate-then-read framework for multiple-choice question answering in medicine. We conduct extensive experiments on MedQA-USMLE, MedMCQA, and MMLU, incorporating a practical perspective by assuming a maximum of 24GB VRAM. MedGENIE sets a new state-of-the-art (SOTA) in the open-book setting of each testbed, even allowing a small-scale reader to outcompete zero-shot closed-book 175B baselines while using up to 706times fewer parameters. Overall, our findings reveal that generated passages are more effective than retrieved counterparts in attaining higher accuracy.

Clinicians spend a significant amount of time reviewing medical images and transcribing their findings regarding patient diagnosis, referral and treatment in text form. Vision-language models (VLMs), which automatically interpret images and summarize their findings as text, have enormous potential to alleviate clinical workloads and increase patient access to high-quality medical care. While foundational models have stirred considerable interest in the medical community, it is unclear whether their general capabilities translate to real-world clinical utility. In this work, we show that foundation VLMs markedly underperform compared to practicing ophthalmologists on specialist tasks crucial to the care of patients with age-related macular degeneration (AMD). To address this, we initially identified the essential capabilities required for image-based clinical decision-making, and then developed a curriculum to selectively train VLMs in these skills. The resulting model, RetinaVLM, can be instructed to write reports that significantly outperform those written by leading foundation medical VLMs in disease staging (F1 score of 0.63 vs. 0.11) and patient referral (0.67 vs. 0.39), and approaches the diagnostic performance of junior ophthalmologists (who achieve 0.77 and 0.78 on the respective tasks). Furthermore, in a reader study involving two senior ophthalmologists with up to 32 years of experience, RetinaVLM's reports were found to be similarly correct (78.6% vs. 82.1%) and complete (both 78.6%) as reports written by junior ophthalmologists with up to 10 years of experience. These results demonstrate that our curriculum-based approach provides a blueprint for specializing generalist foundation medical VLMs to handle real-world clinical tasks.

Medical benchmark datasets significantly contribute to developing Large Language Models (LLMs) for medical knowledge extraction, diagnosis, summarization, and other uses. Yet, current benchmarks are mainly derived from exam questions given to medical students or cases described in the medical literature, lacking the complexity of real-world patient cases that deviate from classic textbook abstractions. These include rare diseases, uncommon presentations of common diseases, and unexpected treatment responses. Here, we construct Clinically Uncommon Patient Cases and Diagnosis Dataset (CUPCase) based on 3,562 real-world case reports from BMC, including diagnoses in open-ended textual format and as multiple-choice options with distractors. Using this dataset, we evaluate the ability of state-of-the-art LLMs, including both general-purpose and Clinical LLMs, to identify and correctly diagnose a patient case, and test models' performance when only partial information about cases is available. Our findings show that general-purpose GPT-4o attains the best performance in both the multiple-choice task (average accuracy of 87.9%) and the open-ended task (BERTScore F1 of 0.764), outperforming several LLMs with a focus on the medical domain such as Meditron-70B and MedLM-Large. Moreover, GPT-4o was able to maintain 87% and 88% of its performance with only the first 20% of tokens of the case presentation in multiple-choice and free text, respectively, highlighting the potential of LLMs to aid in early diagnosis in real-world cases. CUPCase expands our ability to evaluate LLMs for clinical decision support in an open and reproducible manner.

LLMs have become increasingly capable at accomplishing a range of specialized-tasks and can be utilized to expand equitable access to medical knowledge. Most medical LLMs have involved extensive fine-tuning, leveraging specialized medical data and significant, thus costly, amounts of computational power. Many of the top performing LLMs are proprietary and their access is limited to very few research groups. However, open-source (OS) models represent a key area of growth for medical LLMs due to significant improvements in performance and an inherent ability to provide the transparency and compliance required in healthcare. We present OpenMedLM, a prompting platform which delivers state-of-the-art (SOTA) performance for OS LLMs on medical benchmarks. We evaluated a range of OS foundation LLMs (7B-70B) on four medical benchmarks (MedQA, MedMCQA, PubMedQA, MMLU medical-subset). We employed a series of prompting strategies, including zero-shot, few-shot, chain-of-thought (random selection and kNN selection), and ensemble/self-consistency voting. We found that OpenMedLM delivers OS SOTA results on three common medical LLM benchmarks, surpassing the previous best performing OS models that leveraged computationally costly extensive fine-tuning. The model delivers a 72.6% accuracy on the MedQA benchmark, outperforming the previous SOTA by 2.4%, and achieves 81.7% accuracy on the MMLU medical-subset, establishing itself as the first OS LLM to surpass 80% accuracy on this benchmark. Our results highlight medical-specific emergent properties in OS LLMs which have not yet been documented to date elsewhere, and showcase the benefits of further leveraging prompt engineering to improve the performance of accessible LLMs for medical applications.

Automatic disease diagnosis has become increasingly valuable in clinical practice. The advent of large language models (LLMs) has catalyzed a paradigm shift in artificial intelligence, with growing evidence supporting the efficacy of LLMs in diagnostic tasks. Despite the increasing attention in this field, a holistic view is still lacking. Many critical aspects remain unclear, such as the diseases and clinical data to which LLMs have been applied, the LLM techniques employed, and the evaluation methods used. In this article, we perform a comprehensive review of LLM-based methods for disease diagnosis. Our review examines the existing literature across various dimensions, including disease types and associated clinical specialties, clinical data, LLM techniques, and evaluation methods. Additionally, we offer recommendations for applying and evaluating LLMs for diagnostic tasks. Furthermore, we assess the limitations of current research and discuss future directions. To our knowledge, this is the first comprehensive review for LLM-based disease diagnosis.

With the rapid advancement of multimodal large language models (MLLMs), their evaluation has become increasingly comprehensive. However, understanding long multimodal content, as a foundational ability for real-world applications, remains underexplored. In this work, we present Needle In A Multimodal Haystack (MM-NIAH), the first benchmark specifically designed to systematically evaluate the capability of existing MLLMs to comprehend long multimodal documents. Our benchmark includes three types of evaluation tasks: multimodal retrieval, counting, and reasoning. In each task, the model is required to answer the questions according to different key information scattered throughout the given multimodal document. Evaluating the leading MLLMs on MM-NIAH, we observe that existing models still have significant room for improvement on these tasks, especially on vision-centric evaluation. We hope this work can provide a platform for further research on long multimodal document comprehension and contribute to the advancement of MLLMs. Code and benchmark are released at https://github.com/OpenGVLab/MM-NIAH.

Multimodal Large Language Models (MLLMs) have shown significant promise in various applications, leading to broad interest from researchers and practitioners alike. However, a comprehensive evaluation of their long-context capabilities remains underexplored. To address these gaps, we introduce the MultiModal Needle-in-a-haystack (MMNeedle) benchmark, specifically designed to assess the long-context capabilities of MLLMs. Besides multi-image input, we employ image stitching to further increase the input context length, and develop a protocol to automatically generate labels for sub-image level retrieval. Essentially, MMNeedle evaluates MLLMs by stress-testing their capability to locate a target sub-image (needle) within a set of images (haystack) based on textual instructions and descriptions of image contents. This setup necessitates an advanced understanding of extensive visual contexts and effective information retrieval within long-context image inputs. With this benchmark, we evaluate state-of-the-art MLLMs, encompassing both API-based and open-source models. The findings reveal that GPT-4o consistently surpasses other models in long-context scenarios, but suffers from hallucination problems in negative samples, i.e., when needles are not in the haystacks. Our comprehensive long-context evaluation of MLLMs also sheds lights on the considerable performance gap between API-based and open-source models. All the code, data, and instructions required to reproduce the main results are available at https://github.com/Wang-ML-Lab/multimodal-needle-in-a-haystack.

The advent of Large Language Models (LLMs) has paved the way for AI search engines, e.g., SearchGPT, showcasing a new paradigm in human-internet interaction. However, most current AI search engines are limited to text-only settings, neglecting the multimodal user queries and the text-image interleaved nature of website information. Recently, Large Multimodal Models (LMMs) have made impressive strides. Yet, whether they can function as AI search engines remains under-explored, leaving the potential of LMMs in multimodal search an open question. To this end, we first design a delicate pipeline, MMSearch-Engine, to empower any LMMs with multimodal search capabilities. On top of this, we introduce MMSearch, a comprehensive evaluation benchmark to assess the multimodal search performance of LMMs. The curated dataset contains 300 manually collected instances spanning 14 subfields, which involves no overlap with the current LMMs' training data, ensuring the correct answer can only be obtained within searching. By using MMSearch-Engine, the LMMs are evaluated by performing three individual tasks (requery, rerank, and summarization), and one challenging end-to-end task with a complete searching process. We conduct extensive experiments on closed-source and open-source LMMs. Among all tested models, GPT-4o with MMSearch-Engine achieves the best results, which surpasses the commercial product, Perplexity Pro, in the end-to-end task, demonstrating the effectiveness of our proposed pipeline. We further present error analysis to unveil current LMMs still struggle to fully grasp the multimodal search tasks, and conduct ablation study to indicate the potential of scaling test-time computation for AI search engine. We hope MMSearch may provide unique insights to guide the future development of multimodal AI search engine. Project Page: https://mmsearch.github.io

Multimodal Language Language Models (MLLMs) demonstrate the emerging abilities of "world models" -- interpreting and reasoning about complex real-world dynamics. To assess these abilities, we posit videos are the ideal medium, as they encapsulate rich representations of real-world dynamics and causalities. To this end, we introduce MMWorld, a new benchmark for multi-discipline, multi-faceted multimodal video understanding. MMWorld distinguishes itself from previous video understanding benchmarks with two unique advantages: (1) multi-discipline, covering various disciplines that often require domain expertise for comprehensive understanding; (2) multi-faceted reasoning, including explanation, counterfactual thinking, future prediction, etc. MMWorld consists of a human-annotated dataset to evaluate MLLMs with questions about the whole videos and a synthetic dataset to analyze MLLMs within a single modality of perception. Together, MMWorld encompasses 1,910 videos across seven broad disciplines and 69 subdisciplines, complete with 6,627 question-answer pairs and associated captions. The evaluation includes 2 proprietary and 10 open-source MLLMs, which struggle on MMWorld (e.g., GPT-4V performs the best with only 52.3\% accuracy), showing large room for improvement. Further ablation studies reveal other interesting findings such as models' different skill sets from humans. We hope MMWorld can serve as an essential step towards world model evaluation in videos.

Background:Speech patterns have emerged as potential diagnostic markers for conditions with varying etiologies. Machine learning (ML) presents an opportunity to harness these patterns for accurate disease diagnosis. Objective: This review synthesized findings from studies exploring ML's capability in leveraging speech for the diagnosis of neurological, laryngeal and mental disorders. Methods: A systematic examination of 564 articles was conducted with 91 articles included in the study, which encompassed a wide spectrum of conditions, ranging from voice pathologies to mental and neurological disorders. Methods for speech classifications were assessed based on the relevant studies and scored between 0-10 based on the reported diagnostic accuracy of their ML models. Results: High diagnostic accuracies were consistently observed for laryngeal disorders, dysarthria, and changes related to speech in Parkinsons disease. These findings indicate the robust potential of speech as a diagnostic tool. Disorders like depression, schizophrenia, mild cognitive impairment and Alzheimers dementia also demonstrated high accuracies, albeit with some variability across studies. Meanwhile, disorders like OCD and autism highlighted the need for more extensive research to ascertain the relationship between speech patterns and the respective conditions. Conclusion: ML models utilizing speech patterns demonstrate promising potential in diagnosing a range of mental, laryngeal, and neurological disorders. However, the efficacy varies across conditions, and further research is needed. The integration of these models into clinical practice could potentially revolutionize the evaluation and diagnosis of a number of different medical conditions.

Recent advancements in multimodal models have shown a strong ability in visual perception, reasoning abilities, and vision-language understanding. However, studies on visual matching ability are missing, where finding the visual correspondence of objects is essential in vision research. Our research reveals that the matching capabilities in recent multimodal LLMs (MLLMs) still exhibit systematic shortcomings, even with current strong MLLMs models, GPT-4o. In particular, we construct a Multimodal Visual Matching (MMVM) benchmark to fairly benchmark over 30 different MLLMs. The MMVM benchmark is built from 15 open-source datasets and Internet videos with manual annotation. We categorize the data samples of MMVM benchmark into eight aspects based on the required cues and capabilities to more comprehensively evaluate and analyze current MLLMs. In addition, we have designed an automatic annotation pipeline to generate the MMVM SFT dataset, including 220K visual matching data with reasoning annotation. Finally, we present CoLVA, a novel contrastive MLLM with two novel technical designs: fine-grained vision expert with object-level contrastive learning and instruction augmentation strategy. CoLVA achieves 51.06\% overall accuracy (OA) on the MMVM benchmark, surpassing GPT-4o and baseline by 8.41\% and 23.58\% OA, respectively. The results show the effectiveness of our MMVM SFT dataset and our novel technical designs. Code, benchmark, dataset, and models are available at https://github.com/zhouyiks/CoLVA.

Generating natural and meaningful responses to communicate with multi-modal human inputs is a fundamental capability of Large Vision-Language Models(LVLMs). While current open-source LVLMs demonstrate promising performance in simplified scenarios such as single-turn single-image input, they fall short in real-world conversation scenarios such as following instructions in a long context history with multi-turn and multi-images. Existing LVLM benchmarks primarily focus on single-choice questions or short-form responses, which do not adequately assess the capabilities of LVLMs in real-world human-AI interaction applications. Therefore, we introduce MMDU, a comprehensive benchmark, and MMDU-45k, a large-scale instruction tuning dataset, designed to evaluate and improve LVLMs' abilities in multi-turn and multi-image conversations. We employ the clustering algorithm to ffnd the relevant images and textual descriptions from the open-source Wikipedia and construct the question-answer pairs by human annotators with the assistance of the GPT-4o model. MMDU has a maximum of 18k image+text tokens, 20 images, and 27 turns, which is at least 5x longer than previous benchmarks and poses challenges to current LVLMs. Our in-depth analysis of 15 representative LVLMs using MMDU reveals that open-source LVLMs lag behind closed-source counterparts due to limited conversational instruction tuning data. We demonstrate that ffne-tuning open-source LVLMs on MMDU-45k signiffcantly address this gap, generating longer and more accurate conversations, and improving scores on MMDU and existing benchmarks (MMStar: +1.1%, MathVista: +1.5%, ChartQA:+1.2%). Our contributions pave the way for bridging the gap between current LVLM models and real-world application demands. This project is available at https://github.com/Liuziyu77/MMDU.

The emergent abilities of large language models (LLMs) have demonstrated great potential in solving medical questions. They can possess considerable medical knowledge, but may still hallucinate and are inflexible in the knowledge updates. While Retrieval-Augmented Generation (RAG) has been proposed to enhance the medical question-answering capabilities of LLMs with external knowledge bases, it may still fail in complex cases where multiple rounds of information-seeking are required. To address such an issue, we propose iterative RAG for medicine (i-MedRAG), where LLMs can iteratively ask follow-up queries based on previous information-seeking attempts. In each iteration of i-MedRAG, the follow-up queries will be answered by a vanilla RAG system and they will be further used to guide the query generation in the next iteration. Our experiments show the improved performance of various LLMs brought by i-MedRAG compared with vanilla RAG on complex questions from clinical vignettes in the United States Medical Licensing Examination (USMLE), as well as various knowledge tests in the Massive Multitask Language Understanding (MMLU) dataset. Notably, our zero-shot i-MedRAG outperforms all existing prompt engineering and fine-tuning methods on GPT-3.5, achieving an accuracy of 69.68\% on the MedQA dataset. In addition, we characterize the scaling properties of i-MedRAG with different iterations of follow-up queries and different numbers of queries per iteration. Our case studies show that i-MedRAG can flexibly ask follow-up queries to form reasoning chains, providing an in-depth analysis of medical questions. To the best of our knowledge, this is the first-of-its-kind study on incorporating follow-up queries into medical RAG.

Large Language Models (LLMs) have attained human-level accuracy on medical question-answer (QA) benchmarks. However, their limitations in navigating open-ended clinical scenarios have recently been shown, raising concerns about the robustness and generalizability of LLM reasoning across diverse, real-world medical tasks. To probe potential LLM failure modes in clinical problem-solving, we present the medical abstraction and reasoning corpus (M-ARC). M-ARC assesses clinical reasoning through scenarios designed to exploit the Einstellung effect -- the fixation of thought arising from prior experience, targeting LLM inductive biases toward inflexible pattern matching from their training data rather than engaging in flexible reasoning. We find that LLMs, including current state-of-the-art o1 and Gemini models, perform poorly compared to physicians on M-ARC, often demonstrating lack of commonsense medical reasoning and a propensity to hallucinate. In addition, uncertainty estimation analyses indicate that LLMs exhibit overconfidence in their answers, despite their limited accuracy. The failure modes revealed by M-ARC in LLM medical reasoning underscore the need to exercise caution when deploying these models in clinical settings.

With the advent of Vision-Language Models (VLMs), medical artificial intelligence (AI) has experienced significant technological progress and paradigm shifts. This survey provides an extensive review of recent advancements in Medical Vision-Language Models (Med-VLMs), which integrate visual and textual data to enhance healthcare outcomes. We discuss the foundational technology behind Med-VLMs, illustrating how general models are adapted for complex medical tasks, and examine their applications in healthcare. The transformative impact of Med-VLMs on clinical practice, education, and patient care is highlighted, alongside challenges such as data scarcity, narrow task generalization, interpretability issues, and ethical concerns like fairness, accountability, and privacy. These limitations are exacerbated by uneven dataset distribution, computational demands, and regulatory hurdles. Rigorous evaluation methods and robust regulatory frameworks are essential for safe integration into healthcare workflows. Future directions include leveraging large-scale, diverse datasets, improving cross-modal generalization, and enhancing interpretability. Innovations like federated learning, lightweight architectures, and Electronic Health Record (EHR) integration are explored as pathways to democratize access and improve clinical relevance. This review aims to provide a comprehensive understanding of Med-VLMs' strengths and limitations, fostering their ethical and balanced adoption in healthcare.

In an era defined by the explosive growth of data and rapid technological advancements, Multimodal Large Language Models (MLLMs) stand at the forefront of artificial intelligence (AI) systems. Designed to seamlessly integrate diverse data types-including text, images, videos, audio, and physiological sequences-MLLMs address the complexities of real-world applications far beyond the capabilities of single-modality systems. In this paper, we systematically sort out the applications of MLLM in multimodal tasks such as natural language, vision, and audio. We also provide a comparative analysis of the focus of different MLLMs in the tasks, and provide insights into the shortcomings of current MLLMs, and suggest potential directions for future research. Through these discussions, this paper hopes to provide valuable insights for the further development and application of MLLM.

Despite notable advancements in Multimodal Large Language Models (MLLMs), most state-of-the-art models have not undergone thorough alignment with human preferences. This gap exists because current alignment research has primarily achieved progress in specific areas (e.g., hallucination reduction), while the broader question of whether aligning models with human preferences can systematically enhance MLLM capability remains largely unexplored. To this end, we introduce MM-RLHF, a dataset containing 120k fine-grained, human-annotated preference comparison pairs. This dataset represents a substantial advancement over existing resources, offering superior size, diversity, annotation granularity, and quality. Leveraging this dataset, we propose several key innovations to improve both the quality of reward models and the efficiency of alignment algorithms. Notably, we introduce a Critique-Based Reward Model, which generates critiques of model outputs before assigning scores, offering enhanced interpretability and more informative feedback compared to traditional scalar reward mechanisms. Additionally, we propose Dynamic Reward Scaling, a method that adjusts the loss weight of each sample according to the reward signal, thereby optimizing the use of high-quality comparison pairs. Our approach is rigorously evaluated across 10 distinct dimensions and 27 benchmarks, with results demonstrating significant and consistent improvements in model performance. Specifically, fine-tuning LLaVA-ov-7B with MM-RLHF and our alignment algorithm leads to a 19.5% increase in conversational abilities and a 60% improvement in safety. We have open-sourced the preference dataset, reward model, training and evaluation code, as well as reward modeling and safety benchmarks. For more details, please visit our project page: https://mm-rlhf.github.io.

Large language models (LLMs) have received much attention and shown their potential in digital health, while their application in mental health is subject to ongoing debate. This systematic review aims to summarize and characterize the use of LLMs in mental health by investigating the strengths and limitations of the latest work in LLMs and discusses the challenges and opportunities for early screening, digital interventions, and other clinical applications in mental health. Following PRISMA guidelines, we examined English articles from PubMed, DBLP Computer Science Bibliography, and IEEE Xplore, published between 1 January 2017, and 1 September 2023, focusing on mental health and LLMs. The review analyzed 32 articles, including mental health analysis using social media datasets (n=13), mental health chatbots (n=10), and other mental health applications (n=9). Findings reveal LLMs' effectiveness in mental health issue detection and the enhancement of telepsychological services through personalised healthcare. Nonetheless, risks like text inconsistencies, hallucinatory content, and the lack of an ethical framework raise concerns about their clinical use. Despite these challenges, the advancement of LLMs underscores their potential as innovative clinical tools, necessitating further research and development. The review emphasizes that LLMs should complement, not replace, professional mental health services.

Large Language Models (LLMs), despite their remarkable progress across various general domains, encounter significant barriers in medicine and healthcare. This field faces unique challenges such as domain-specific terminologies and the reasoning over specialized knowledge. To address these obstinate issues, we propose a novel Multi-disciplinary Collaboration (MC) framework for the medical domain that leverages role-playing LLM-based agents who participate in a collaborative multi-round discussion, thereby enhancing LLM proficiency and reasoning capabilities. This training-free and interpretable framework encompasses five critical steps: gathering domain experts, proposing individual analyses, summarising these analyses into a report, iterating over discussions until a consensus is reached, and ultimately making a decision. Our work particularly focuses on the zero-shot scenario, our results on nine data sets (MedQA, MedMCQA, PubMedQA, and six subtasks from MMLU) establish that our proposed MC framework excels at mining and harnessing the medical expertise in LLMs, as well as extending its reasoning abilities. Based on these outcomes, we further conduct a human evaluation to pinpoint and categorize common errors within our method, as well as ablation studies aimed at understanding the impact of various factors on overall performance. Our code can be found at https://github.com/gersteinlab/MedAgents.

Clinical diagnosis prediction models, when provided with a patient's medical history, aim to detect potential diseases early, facilitating timely intervention and improving prognostic outcomes. However, the inherent scarcity of patient data and large disease candidate space often pose challenges in developing satisfactory models for this intricate task. The exploration of leveraging Large Language Models (LLMs) for encapsulating clinical decision processes has been limited. We introduce MERA, a clinical diagnosis prediction model that bridges pertaining natural language knowledge with medical practice. We apply hierarchical contrastive learning on a disease candidate ranking list to alleviate the large decision space issue. With concept memorization through fine-tuning, we bridge the natural language clinical knowledge with medical codes. Experimental results on MIMIC-III and IV datasets show that MERA achieves the state-of-the-art diagnosis prediction performance and dramatically elevates the diagnosis prediction capabilities of generative LMs.

Multimodal Large Language Model (MLLM) recently has been a new rising research hotspot, which uses powerful Large Language Models (LLMs) as a brain to perform multimodal tasks. The surprising emergent capabilities of MLLM, such as writing stories based on images and OCR-free math reasoning, are rare in traditional methods, suggesting a potential path to artificial general intelligence. In this paper, we aim to trace and summarize the recent progress of MLLM. First of all, we present the formulation of MLLM and delineate its related concepts. Then, we discuss the key techniques and applications, including Multimodal Instruction Tuning (M-IT), Multimodal In-Context Learning (M-ICL), Multimodal Chain of Thought (M-CoT), and LLM-Aided Visual Reasoning (LAVR). Finally, we discuss existing challenges and point out promising research directions. In light of the fact that the era of MLLM has only just begun, we will keep updating this survey and hope it can inspire more research. An associated GitHub link collecting the latest papers is available at https://github.com/BradyFU/Awesome-Multimodal-Large-Language-Models.

Despite the recent advancements in Multi-modal Large Language Models (MLLMs), understanding inter-object relations, i.e., interactions or associations between distinct objects, remains a major challenge for such models. This issue significantly hinders their advanced reasoning capabilities and is primarily due to the lack of large-scale, high-quality, and diverse multi-modal data essential for training and evaluating MLLMs. In this paper, we provide a taxonomy of inter-object relations and introduce Multi-Modal Relation Understanding (MMRel), a comprehensive dataset designed to bridge this gap by providing large-scale, high-quality and diverse data for studying inter-object relations with MLLMs. MMRel features three distinctive attributes: (i) It includes over 15K question-answer pairs, which are sourced from three distinct domains, ensuring large scale and high diversity; (ii) It contains a subset featuring highly unusual relations, on which MLLMs often fail due to hallucinations, thus are very challenging; (iii) It provides manually verified high-quality labels for inter-object relations. Thanks to these features, MMRel is ideal for evaluating MLLMs on relation understanding, as well as being used to fine-tune MLLMs to enhance relation understanding and even benefit overall performance in various vision-language tasks. Extensive experiments on various popular MLLMs validate the effectiveness of MMRel. Both MMRel dataset and the complete labeling scripts have been made publicly available.

In recent years, there have been significant breakthroughs in the field of natural language processing, particularly with the development of large language models (LLMs). These LLMs have showcased remarkable capabilities on various benchmarks. In the healthcare field, the exact role LLMs and other future AI models will play remains unclear. There is a potential for these models in the future to be used as part of adaptive physician training, medical co-pilot applications, and digital patient interaction scenarios. The ability of AI models to participate in medical training and patient care will depend in part on their mastery of the knowledge content of specific medical fields. This study investigated the medical knowledge capability of LLMs, specifically in the context of internal medicine subspecialty multiple-choice test-taking ability. We compared the performance of several open-source LLMs (Koala 7B, Falcon 7B, Stable-Vicuna 13B, and Orca Mini 13B), to GPT-4 and Claude 2 on multiple-choice questions in the field of Nephrology. Nephrology was chosen as an example of a particularly conceptually complex subspecialty field within internal medicine. The study was conducted to evaluate the ability of LLM models to provide correct answers to nephSAP (Nephrology Self-Assessment Program) multiple-choice questions. The overall success of open-sourced LLMs in answering the 858 nephSAP multiple-choice questions correctly was 17.1% - 25.5%. In contrast, Claude 2 answered 54.4% of the questions correctly, whereas GPT-4 achieved a score of 73.3%. We show that current widely used open-sourced LLMs do poorly in their ability for zero-shot reasoning when compared to GPT-4 and Claude 2. The findings of this study potentially have significant implications for the future of subspecialty medical training and patient care.

MM-Vet, with open-ended vision-language questions targeting at evaluating integrated capabilities, has become one of the most popular benchmarks for large multimodal model evaluation. MM-Vet assesses six core vision-language (VL) capabilities: recognition, knowledge, spatial awareness, language generation, OCR, and math. However, its question format is restricted to single image-text pairs, lacking the interleaved image and text sequences prevalent in real-world scenarios. To address this limitation, we introduce MM-Vet v2, which includes a new VL capability called "image-text sequence understanding", evaluating models' ability to process VL sequences. Furthermore, we maintain the high quality of evaluation samples while further expanding the evaluation set size. Using MM-Vet v2 to benchmark large multimodal models, we found that Claude 3.5 Sonnet is the best model with a score of 71.8, slightly outperforming GPT-4o which scored 71.0. Among open-weight models, InternVL2-Llama3-76B leads with a score of 68.4.

Large language models (LLMs) hold great promise in summarizing medical evidence. Most recent studies focus on the application of proprietary LLMs. Using proprietary LLMs introduces multiple risk factors, including a lack of transparency and vendor dependency. While open-source LLMs allow better transparency and customization, their performance falls short compared to proprietary ones. In this study, we investigated to what extent fine-tuning open-source LLMs can further improve their performance in summarizing medical evidence. Utilizing a benchmark dataset, MedReview, consisting of 8,161 pairs of systematic reviews and summaries, we fine-tuned three broadly-used, open-sourced LLMs, namely PRIMERA, LongT5, and Llama-2. Overall, the fine-tuned LLMs obtained an increase of 9.89 in ROUGE-L (95% confidence interval: 8.94-10.81), 13.21 in METEOR score (95% confidence interval: 12.05-14.37), and 15.82 in CHRF score (95% confidence interval: 13.89-16.44). The performance of fine-tuned LongT5 is close to GPT-3.5 with zero-shot settings. Furthermore, smaller fine-tuned models sometimes even demonstrated superior performance compared to larger zero-shot models. The above trends of improvement were also manifested in both human and GPT4-simulated evaluations. Our results can be applied to guide model selection for tasks demanding particular domain knowledge, such as medical evidence summarization.

In recent years, the application of Large Language Models (LLMs) in healthcare has shown significant promise in improving the accessibility and dissemination of medical knowledge. This paper presents a detailed study of various LLMs trained on the MedQuAD medical question-answering dataset, with a focus on identifying the most effective model for providing accurate medical information. Among the models tested, the Sentence-t5 combined with Mistral 7B demonstrated superior performance, achieving a precision score of 0.762. This model's enhanced capabilities are attributed to its advanced pretraining techniques, robust architecture, and effective prompt construction methodologies. By leveraging these strengths, the Sentence-t5 + Mistral 7B model excels in understanding and generating precise medical answers. Our findings highlight the potential of integrating sophisticated LLMs in medical contexts to facilitate efficient and accurate medical knowledge retrieval, thus significantly enhancing patient education and support.

Multimodal Large Language Models (MLLMs) have exhibited impressive capabilities in visual understanding and reasoning, providing sightly reasonable answers, such as image descriptions. This has spurred extensive research on the evaluation of MLLMs. Most evaluation benchmarks assume that incorrect answers indicate a lack of understanding of the visual content. However, our findings reveal that, in many cases, MLLMs answer questions incorrectly despite correctly understanding the visual content. This suggests that incorrect answers do not necessarily imply a lack of comprehension but may instead result from lacking robustness to leading questions. To comprehensively measure MLLMs' understanding capability and robustness to leading questions, we introduce a MultiModal Robustness benchmark (MMR). MMR contains paired positive and negative questions across 12 categories, meticulously annotated by humans. We evaluate 18 leading MLLMs on the MMB benchmark, revealing that MLLMs suffer from fragility to leading questions despite understanding the visual content. To enhance MLLMs' understanding capability and robustness, we further present a training set with paired positive and negative visual question-answer samples. Experiments verify that MLLMs' robustness can be significantly enhanced by tuning on this new training set. The benchmark, training set, and code can be found at https://github.com/BAAI-DCAI/Multimodal-Robustness-Benchmark.

Existing open-source multimodal large language models (MLLMs) generally follow a training process involving pre-training and supervised fine-tuning. However, these models suffer from distribution shifts, which limit their multimodal reasoning, particularly in the Chain-of-Thought (CoT) performance. To address this, we introduce a preference optimization (PO) process to enhance the multimodal reasoning capabilities of MLLMs. Specifically, (1) on the data side, we design an automated preference data construction pipeline to create MMPR, a high-quality, large-scale multimodal reasoning preference dataset. and (2) on the model side, we explore integrating PO with MLLMs, developing a simple yet effective method, termed Mixed Preference Optimization (MPO), which boosts multimodal CoT performance. Our approach demonstrates improved performance across multiple benchmarks, particularly in multimodal reasoning tasks. Notably, our model, InternVL2-8B-MPO, achieves an accuracy of 67.0 on MathVista, outperforming InternVL2-8B by 8.7 points and achieving performance comparable to the 10x larger InternVL2-76B. We hope this study could inspire further advancements in MLLMs. Code, data, and model shall be publicly released.

Objective To solve major clinical natural language processing (NLP) tasks using a unified text-to-text learning architecture based on a generative large language model (LLM) via prompt tuning. Methods We formulated 7 key clinical NLP tasks as text-to-text learning and solved them using one unified generative clinical LLM, GatorTronGPT, developed using GPT-3 architecture and trained with up to 20 billion parameters. We adopted soft prompts (i.e., trainable vectors) with frozen LLM, where the LLM parameters were not updated (i.e., frozen) and only the vectors of soft prompts were updated, known as prompt tuning. We added additional soft prompts as a prefix to the input layer, which were optimized during the prompt tuning. We evaluated the proposed method using 7 clinical NLP tasks and compared them with previous task-specific solutions based on Transformer models. Results and Conclusion The proposed approach achieved state-of-the-art performance for 5 out of 7 major clinical NLP tasks using one unified generative LLM. Our approach outperformed previous task-specific transformer models by ~3% for concept extraction and 7% for relation extraction applied to social determinants of health, 3.4% for clinical concept normalization, 3.4~10% for clinical abbreviation disambiguation, and 5.5~9% for natural language inference. Our approach also outperformed a previously developed prompt-based machine reading comprehension (MRC) model, GatorTron-MRC, for clinical concept and relation extraction. The proposed approach can deliver the ``one model for all`` promise from training to deployment using a unified generative LLM.

We propose MM-Vet, an evaluation benchmark that examines large multimodal models (LMMs) on complicated multimodal tasks. Recent LMMs have shown various intriguing abilities, such as solving math problems written on the blackboard, reasoning about events and celebrities in news images, and explaining visual jokes. Rapid model advancements pose challenges to evaluation benchmark development. Problems include: (1) How to systematically structure and evaluate the complicated multimodal tasks; (2) How to design evaluation metrics that work well across question and answer types; and (3) How to give model insights beyond a simple performance ranking. To this end, we present MM-Vet, designed based on the insight that the intriguing ability to solve complicated tasks is often achieved by a generalist model being able to integrate different core vision-language (VL) capabilities. MM-Vet defines 6 core VL capabilities and examines the 16 integrations of interest derived from the capability combination. For evaluation metrics, we propose an LLM-based evaluator for open-ended outputs. The evaluator enables the evaluation across different question types and answer styles, resulting in a unified scoring metric. We evaluate representative LMMs on MM-Vet, providing insights into the capabilities of different LMM system paradigms and models. Code and data are available at https://github.com/yuweihao/MM-Vet.

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.

Diabetes is a chronic disease that poses a significant global health burden, and optimizing diabetes management requires multi-stakeholder collaboration. Large language models (LLMs) have shown promise in various healthcare scenarios, but their effectiveness across a diverse range of diabetes tasks remains unproven. In this study, we introduced a framework to train and validate diabetes-specific LLMs. We first developed a comprehensive data processing pipeline that includes data collection, filtering, augmentation and refinement. This approach contributes to creating a high-quality, diabetes-specific dataset, and several evaluation benchmarks entirely from scratch. Utilizing the collected training dataset, we fine-tuned a diabetes-specific LLM family that demonstrated state-of-the-art proficiency in understanding and processing various diabetes tasks compared to other LLMs. Furthermore, clinical studies showed the potential applications of our models in diabetes care, including providing personalized healthcare, assisting medical education, and streamlining clinical tasks. In conclusion, our study introduced a framework to develop and evaluate a diabetes-specific LLM family, and highlighted its potential to enhance clinical practice and provide personalized, data-driven support for diabetes support when facing different end users. The code is provided via GitHub at https://github.com/waltonfuture/Diabetica.

Large Language Models (LLMs) have rapidly become important tools in Biomedical and Health Informatics (BHI), enabling new ways to analyze data, treat patients, and conduct research. This bibliometric review aims to provide a panoramic view of how LLMs have been used in BHI by examining research articles and collaboration networks from 2022 to 2023. It further explores how LLMs can improve Natural Language Processing (NLP) applications in various BHI areas like medical diagnosis, patient engagement, electronic health record management, and personalized medicine. To do this, our bibliometric review identifies key trends, maps out research networks, and highlights major developments in this fast-moving field. Lastly, it discusses the ethical concerns and practical challenges of using LLMs in BHI, such as data privacy and reliable medical recommendations. Looking ahead, we consider how LLMs could further transform biomedical research as well as healthcare delivery and patient outcomes. This bibliometric review serves as a resource for stakeholders in healthcare, including researchers, clinicians, and policymakers, to understand the current state and future potential of LLMs in BHI.

Background: Recent advancements in large language models (LLMs) offer potential benefits in healthcare, particularly in processing extensive patient records. However, existing benchmarks do not fully assess LLMs' capability in handling real-world, lengthy clinical data. Methods: We present the LongHealth benchmark, comprising 20 detailed fictional patient cases across various diseases, with each case containing 5,090 to 6,754 words. The benchmark challenges LLMs with 400 multiple-choice questions in three categories: information extraction, negation, and sorting, challenging LLMs to extract and interpret information from large clinical documents. Results: We evaluated nine open-source LLMs with a minimum of 16,000 tokens and also included OpenAI's proprietary and cost-efficient GPT-3.5 Turbo for comparison. The highest accuracy was observed for Mixtral-8x7B-Instruct-v0.1, particularly in tasks focused on information retrieval from single and multiple patient documents. However, all models struggled significantly in tasks requiring the identification of missing information, highlighting a critical area for improvement in clinical data interpretation. Conclusion: While LLMs show considerable potential for processing long clinical documents, their current accuracy levels are insufficient for reliable clinical use, especially in scenarios requiring the identification of missing information. The LongHealth benchmark provides a more realistic assessment of LLMs in a healthcare setting and highlights the need for further model refinement for safe and effective clinical application. We make the benchmark and evaluation code publicly available.

Multimodal/vision language models (VLMs) are increasingly being deployed in healthcare settings worldwide, necessitating robust benchmarks to ensure their safety, efficacy, and fairness. Multiple-choice question and answer (QA) datasets derived from national medical examinations have long served as valuable evaluation tools, but existing datasets are largely text-only and available in a limited subset of languages and countries. To address these challenges, we present WorldMedQA-V, an updated multilingual, multimodal benchmarking dataset designed to evaluate VLMs in healthcare. WorldMedQA-V includes 568 labeled multiple-choice QAs paired with 568 medical images from four countries (Brazil, Israel, Japan, and Spain), covering original languages and validated English translations by native clinicians, respectively. Baseline performance for common open- and closed-source models are provided in the local language and English translations, and with and without images provided to the model. The WorldMedQA-V benchmark aims to better match AI systems to the diverse healthcare environments in which they are deployed, fostering more equitable, effective, and representative applications.

Clinical natural language processing requires methods that can address domain-specific challenges, such as complex medical terminology and clinical contexts. Recently, large language models (LLMs) have shown promise in this domain. Yet, their direct deployment can lead to privacy issues and are constrained by resources. To address this challenge, we delve into synthetic clinical text generation using LLMs for clinical NLP tasks. We propose an innovative, resource-efficient approach, ClinGen, which infuses knowledge into the process. Our model involves clinical knowledge extraction and context-informed LLM prompting. Both clinical topics and writing styles are drawn from external domain-specific knowledge graphs and LLMs to guide data generation. Our extensive empirical study across 7 clinical NLP tasks and 16 datasets reveals that ClinGen consistently enhances performance across various tasks, effectively aligning the distribution of real datasets and significantly enriching the diversity of generated training instances. We will publish our code and all the generated data in https://github.com/ritaranx/ClinGen.

We present Eir Thai Medical LLM, a large language model with 8 billion parameters, specifically designed to enhance the accuracy of handling medical tasks in the Thai language. This model focuses on providing clear and easy-to-understand answers for both healthcare professionals and patients, thereby improving the efficiency of diagnosis and treatment processes. Human evaluation was conducted to ensure that the model adheres to care standards and provides unbiased answers. To prioritize data security, the model is deployed within the hospital's internal network, ensuring both high security and faster processing speeds. The internal API connection is secured with encryption and strict authentication measures to prevent data leaks and unauthorized access. We evaluated several open-source large language models with 8 billion parameters on four medical benchmarks: MedQA, MedMCQA, PubMedQA, and the medical subset of MMLU. The best-performing baselines were used to develop Eir Thai Medical LLM. Our evaluation employed multiple questioning strategies, including zero-shot, few-shot, chain-of-thought reasoning, and ensemble/self-consistency voting methods. Our model outperformed commercially available Thai-language large language models by more than 10%. In addition, we developed enhanced model testing tailored for clinical use in Thai across 18 clinical tasks, where our model exceeded GPT-4o performance by more than 11%

Advances in large language models (LLMs) provide new opportunities in healthcare for improved patient care, clinical decision-making, and enhancement of physician and administrator workflows. However, the potential of these models importantly depends on their ability to generalize effectively across clinical environments and populations, a challenge often underestimated in early development. To better understand reasons for these challenges and inform mitigation approaches, we evaluated ClinicLLM, an LLM trained on [HOSPITAL]'s clinical notes, analyzing its performance on 30-day all-cause readmission prediction focusing on variability across hospitals and patient characteristics. We found poorer generalization particularly in hospitals with fewer samples, among patients with government and unspecified insurance, the elderly, and those with high comorbidities. To understand reasons for lack of generalization, we investigated sample sizes for fine-tuning, note content (number of words per note), patient characteristics (comorbidity level, age, insurance type, borough), and health system aspects (hospital, all-cause 30-day readmission, and mortality rates). We used descriptive statistics and supervised classification to identify features. We found that, along with sample size, patient age, number of comorbidities, and the number of words in notes are all important factors related to generalization. Finally, we compared local fine-tuning (hospital specific), instance-based augmented fine-tuning and cluster-based fine-tuning for improving generalization. Among these, local fine-tuning proved most effective, increasing AUC by 0.25% to 11.74% (most helpful in settings with limited data). Overall, this study provides new insights for enhancing the deployment of large language models in the societally important domain of healthcare, and improving their performance for broader populations.

Visual Language Models (VLMs) have demonstrated impressive capabilities in visual grounding tasks. However, their effectiveness in the medical domain, particularly for abnormality detection and localization within medical images, remains underexplored. A major challenge is the complex and abstract nature of medical terminology, which makes it difficult to directly associate pathological anomaly terms with their corresponding visual features. In this work, we introduce a novel approach to enhance VLM performance in medical abnormality detection and localization by leveraging decomposed medical knowledge. Instead of directly prompting models to recognize specific abnormalities, we focus on breaking down medical concepts into fundamental attributes and common visual patterns. This strategy promotes a stronger alignment between textual descriptions and visual features, improving both the recognition and localization of abnormalities in medical images.We evaluate our method on the 0.23B Florence-2 base model and demonstrate that it achieves comparable performance in abnormality grounding to significantly larger 7B LLaVA-based medical VLMs, despite being trained on only 1.5% of the data used for such models. Experimental results also demonstrate the effectiveness of our approach in both known and previously unseen abnormalities, suggesting its strong generalization capabilities.

We introduce MedXpertQA, a highly challenging and comprehensive benchmark to evaluate expert-level medical knowledge and advanced reasoning. MedXpertQA includes 4,460 questions spanning 17 specialties and 11 body systems. It includes two subsets, Text for text evaluation and MM for multimodal evaluation. Notably, MM introduces expert-level exam questions with diverse images and rich clinical information, including patient records and examination results, setting it apart from traditional medical multimodal benchmarks with simple QA pairs generated from image captions. MedXpertQA applies rigorous filtering and augmentation to address the insufficient difficulty of existing benchmarks like MedQA, and incorporates specialty board questions to improve clinical relevance and comprehensiveness. We perform data synthesis to mitigate data leakage risk and conduct multiple rounds of expert reviews to ensure accuracy and reliability. We evaluate 16 leading models on MedXpertQA. Moreover, medicine is deeply connected to real-world decision-making, providing a rich and representative setting for assessing reasoning abilities beyond mathematics and code. To this end, we develop a reasoning-oriented subset to facilitate the assessment of o1-like models.

Clinical diagnosis is critical in medical practice, typically requiring a continuous and evolving process that includes primary diagnosis, differential diagnosis, and final diagnosis. However, most existing clinical diagnostic tasks are single-step processes, which does not align with the complex multi-step diagnostic procedures found in real-world clinical settings. In this paper, we propose a multi-step diagnostic task and annotate a clinical diagnostic dataset (MSDiagnosis). This dataset includes primary diagnosis, differential diagnosis, and final diagnosis questions. Additionally, we propose a novel and effective framework. This framework combines forward inference, backward inference, reflection, and refinement, enabling the LLM to self-evaluate and adjust its diagnostic results. To assess the effectiveness of our proposed method, we design and conduct extensive experiments. The experimental results demonstrate the effectiveness of the proposed method. We also provide a comprehensive experimental analysis and suggest future research directions for this task.

There is enormous enthusiasm and concerns in using large language models (LLMs) in healthcare, yet current assumptions are all based on general-purpose LLMs such as ChatGPT. This study develops a clinical generative LLM, GatorTronGPT, using 277 billion words of mixed clinical and English text with a GPT-3 architecture of 20 billion parameters. GatorTronGPT improves biomedical natural language processing for medical research. Synthetic NLP models trained using GatorTronGPT generated text outperform NLP models trained using real-world clinical text. Physicians Turing test using 1 (worst) to 9 (best) scale shows that there is no significant difference in linguistic readability (p = 0.22; 6.57 of GatorTronGPT compared with 6.93 of human) and clinical relevance (p = 0.91; 7.0 of GatorTronGPT compared with 6.97 of human) and that physicians cannot differentiate them (p < 0.001). This study provides insights on the opportunities and challenges of LLMs for medical research and healthcare.

Background: Natural Language Processing (NLP) is widely used to extract clinical insights from Electronic Health Records (EHRs). However, the lack of annotated data, automated tools, and other challenges hinder the full utilisation of NLP for EHRs. Various Machine Learning (ML), Deep Learning (DL) and NLP techniques are studied and compared to understand the limitations and opportunities in this space comprehensively. Methodology: After screening 261 articles from 11 databases, we included 127 papers for full-text review covering seven categories of articles: 1) medical note classification, 2) clinical entity recognition, 3) text summarisation, 4) deep learning (DL) and transfer learning architecture, 5) information extraction, 6) Medical language translation and 7) other NLP applications. This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Result and Discussion: EHR was the most commonly used data type among the selected articles, and the datasets were primarily unstructured. Various ML and DL methods were used, with prediction or classification being the most common application of ML or DL. The most common use cases were: the International Classification of Diseases, Ninth Revision (ICD-9) classification, clinical note analysis, and named entity recognition (NER) for clinical descriptions and research on psychiatric disorders. Conclusion: We find that the adopted ML models were not adequately assessed. In addition, the data imbalance problem is quite important, yet we must find techniques to address this underlining problem. Future studies should address key limitations in studies, primarily identifying Lupus Nephritis, Suicide Attempts, perinatal self-harmed and ICD-9 classification.

Multimodal Large Language Models (MLLMs) have recently gained immense popularity. Powerful commercial models like ChatGPT-4V and Gemini, as well as open-source ones such as LLaVA, are essentially general-purpose models and are applied to solve a wide variety of tasks, including those in computer vision. These neural networks possess such strong general knowledge and reasoning abilities that they have proven capable of working even on tasks for which they were not specifically trained. We compared the capabilities of the most powerful MLLMs to date: ShareGPT4V, ChatGPT, LLaVA-Next in a specialized task of age and gender estimation with our state-of-the-art specialized model, MiVOLO. We also updated MiVOLO and provide details and new metrics in this article. This comparison has yielded some interesting results and insights about the strengths and weaknesses of the participating models. Furthermore, we attempted various ways to fine-tune the ShareGPT4V model for this specific task, aiming to achieve state-of-the-art results in this particular challenge. Although such a model would not be practical in production, as it is incredibly expensive compared to a specialized model like MiVOLO, it could be very useful in some tasks, like data annotation.

While Multimodal Large Language Models (MLLMs) are widely used for a variety of vision-language tasks, one observation is that they sometimes misinterpret visual inputs or fail to follow textual instructions even in straightforward cases, leading to irrelevant responses, mistakes, and ungrounded claims. This observation is analogous to a phenomenon in neuropsychology known as Agnosia, an inability to correctly process sensory modalities and recognize things (e.g., objects, colors, relations). In our study, we adapt this similar concept to define "agnosia in MLLMs", and our goal is to comprehensively evaluate and mitigate such agnosia in MLLMs. Inspired by the diagnosis and treatment process in neuropsychology, we propose a novel framework EMMA (Evaluation and Mitigation of Multimodal Agnosia). In EMMA, we develop an evaluation module that automatically creates fine-grained and diverse visual question answering examples to assess the extent of agnosia in MLLMs comprehensively. We also develop a mitigation module to reduce agnosia in MLLMs through multimodal instruction tuning on fine-grained conversations. To verify the effectiveness of our framework, we evaluate and analyze agnosia in seven state-of-the-art MLLMs using 9K test samples. The results reveal that most of them exhibit agnosia across various aspects and degrees. We further develop a fine-grained instruction set and tune MLLMs to mitigate agnosia, which led to notable improvement in accuracy.

Multimodal Large Language Models (MLLMs) excel in vision--language tasks by pre-training solely on coarse-grained concept annotations (e.g., image captions). We hypothesize that integrating fine-grained concept annotations (e.g., object labels and object regions) will further improve performance, as both data granularities complement each other in terms of breadth and depth in concept representation. We introduce a new dataset featuring Multimodal Multi-Grained Concept annotations (MMGiC) for MLLMs. In constructing MMGiC, we explore the impact of different data recipes on multimodal comprehension and generation. Our analyses reveal that multi-grained concept annotations integrate and complement each other, under our structured template and a general MLLM framework. We clearly explore and demonstrate the potential of MMGiC to help MLLMs better locate and learn concepts, aligning vision and language at multiple granularities. We further validate our hypothesis by investigating the fair comparison and effective collaboration between MMGiC and image--caption data on 12 multimodal comprehension and generation benchmarks, e.g., their appropriate combination achieve 3.95% and 2.34% absolute improvements over image--caption data alone on POPE and SEED-Bench. Code, data and models will be available at https://github.com/LooperXX/MMGiC.

Large language models (LLMs) have demonstrated impressive capabilities in disease diagnosis. However, their effectiveness in identifying rarer diseases, which are inherently more challenging to diagnose, remains an open question. Rare disease performance is critical with the increasing use of LLMs in healthcare settings. This is especially true if a primary care physician needs to make a rarer prognosis from only a patient conversation so that they can take the appropriate next step. To that end, several clinical decision support systems are designed to support providers in rare disease identification. Yet their utility is limited due to their lack of knowledge of common disorders and difficulty of use. In this paper, we propose RareScale to combine the knowledge LLMs with expert systems. We use jointly use an expert system and LLM to simulate rare disease chats. This data is used to train a rare disease candidate predictor model. Candidates from this smaller model are then used as additional inputs to black-box LLM to make the final differential diagnosis. Thus, RareScale allows for a balance between rare and common diagnoses. We present results on over 575 rare diseases, beginning with Abdominal Actinomycosis and ending with Wilson's Disease. Our approach significantly improves the baseline performance of black-box LLMs by over 17% in Top-5 accuracy. We also find that our candidate generation performance is high (e.g. 88.8% on gpt-4o generated chats).

Machine translation is indispensable in healthcare for enabling the global dissemination of medical knowledge across languages. However, complex medical terminology poses unique challenges to achieving adequate translation quality and accuracy. This study introduces a novel "LLMs-in-the-loop" approach to develop supervised neural machine translation models optimized specifically for medical texts. While large language models (LLMs) have demonstrated powerful capabilities, this research shows that small, specialized models trained on high-quality in-domain (mostly synthetic) data can outperform even vastly larger LLMs. Custom parallel corpora in six languages were compiled from scientific articles, synthetically generated clinical documents, and medical texts. Our LLMs-in-the-loop methodology employs synthetic data generation, rigorous evaluation, and agent orchestration to enhance performance. We developed small medical translation models using the MarianMT base model. We introduce a new medical translation test dataset to standardize evaluation in this domain. Assessed using BLEU, METEOR, ROUGE, and BERT scores on this test set, our MarianMT-based models outperform Google Translate, DeepL, and GPT-4-Turbo. Results demonstrate that our LLMs-in-the-loop approach, combined with fine-tuning high-quality, domain-specific data, enables specialized models to outperform general-purpose and some larger systems. This research, part of a broader series on expert small models, paves the way for future healthcare-related AI developments, including deidentification and bio-medical entity extraction models. Our study underscores the potential of tailored neural translation models and the LLMs-in-the-loop methodology to advance the field through improved data generation, evaluation, agent, and modeling techniques.

Large Language Models (LLMs) have gained significant attention in the medical domain for their human-level capabilities, leading to increased efforts to explore their potential in various healthcare applications. However, despite such a promising future, there are multiple challenges and obstacles that remain for their real-world uses in practical settings. This work discusses key challenges for LLMs in medical applications from four unique aspects: operational vulnerabilities, ethical and social considerations, performance and assessment difficulties, and legal and regulatory compliance. Addressing these challenges is crucial for leveraging LLMs to their full potential and ensuring their responsible integration into healthcare.

The mining of adverse drug events (ADEs) is pivotal in pharmacovigilance, enhancing patient safety by identifying potential risks associated with medications, facilitating early detection of adverse events, and guiding regulatory decision-making. Traditional ADE detection methods are reliable but slow, not easily adaptable to large-scale operations, and offer limited information. With the exponential increase in data sources like social media content, biomedical literature, and Electronic Medical Records (EMR), extracting relevant ADE-related information from these unstructured texts is imperative. Previous ADE mining studies have focused on text-based methodologies, overlooking visual cues, limiting contextual comprehension, and hindering accurate interpretation. To address this gap, we present a MultiModal Adverse Drug Event (MMADE) detection dataset, merging ADE-related textual information with visual aids. Additionally, we introduce a framework that leverages the capabilities of LLMs and VLMs for ADE detection by generating detailed descriptions of medical images depicting ADEs, aiding healthcare professionals in visually identifying adverse events. Using our MMADE dataset, we showcase the significance of integrating visual cues from images to enhance overall performance. This approach holds promise for patient safety, ADE awareness, and healthcare accessibility, paving the way for further exploration in personalized healthcare.

Multimodal large language models (MLLMs) have demonstrated impressive performance in vision-language tasks across a broad spectrum of domains. However, the large model scale and associated high computational costs pose significant challenges for training and deploying MLLMs on consumer-grade GPUs or edge devices, thereby hindering their widespread application. In this work, we introduce Mini-InternVL, a series of MLLMs with parameters ranging from 1B to 4B, which achieves 90% of the performance with only 5% of the parameters. This significant improvement in efficiency and effectiveness makes our models more accessible and applicable in various real-world scenarios. To further promote the adoption of our models, we develop a unified adaptation framework for Mini-InternVL, which enables our models to transfer and outperform specialized models in downstream tasks, including autonomous driving, medical images, and remote sensing. We believe that our study can provide valuable insights and resources to advance the development of efficient and effective MLLMs. Code is available at https://github.com/OpenGVLab/InternVL.

Rare diseases present unique challenges in healthcare, often suffering from delayed diagnosis and fragmented information landscapes. The scarcity of reliable knowledge in these conditions poses a distinct challenge for Large Language Models (LLMs) in supporting clinical management and delivering precise patient information underscoring the need for focused training on these 'zebra' cases. We present Zebra-Llama, a specialized context-aware language model with high precision Retrieval Augmented Generation (RAG) capability, focusing on Ehlers-Danlos Syndrome (EDS) as our case study. EDS, affecting 1 in 5,000 individuals, exemplifies the complexities of rare diseases with its diverse symptoms, multiple subtypes, and evolving diagnostic criteria. By implementing a novel context-aware fine-tuning methodology trained on questions derived from medical literature, patient experiences, and clinical resources, along with expertly curated responses, Zebra-Llama demonstrates unprecedented capabilities in handling EDS-related queries. On a test set of real-world questions collected from EDS patients and clinicians, medical experts evaluated the responses generated by both models, revealing Zebra-Llama's substantial improvements over base model (Llama 3.1-8B-Instruct) in thoroughness (77.5% vs. 70.1%), accuracy (83.0% vs. 78.8%), clarity (74.7% vs. 72.0%) and citation reliability (70.6% vs. 52.3%). Released as an open-source resource, Zebra-Llama not only provides more accessible and reliable EDS information but also establishes a framework for developing specialized AI solutions for other rare conditions. This work represents a crucial step towards democratizing expert-level knowledge in rare disease management, potentially transforming how healthcare providers and patients navigate the complex landscape of rare diseases.

Generalist Large Language Models (LLMs), such as GPT-4, have shown considerable promise in various domains, including medical diagnosis. Rare diseases, affecting approximately 300 million people worldwide, often have unsatisfactory clinical diagnosis rates primarily due to a lack of experienced physicians and the complexity of differentiating among many rare diseases. In this context, recent news such as "ChatGPT correctly diagnosed a 4-year-old's rare disease after 17 doctors failed" underscore LLMs' potential, yet underexplored, role in clinically diagnosing rare diseases. To bridge this research gap, we introduce RareBench, a pioneering benchmark designed to systematically evaluate the capabilities of LLMs on 4 critical dimensions within the realm of rare diseases. Meanwhile, we have compiled the largest open-source dataset on rare disease patients, establishing a benchmark for future studies in this domain. To facilitate differential diagnosis of rare diseases, we develop a dynamic few-shot prompt methodology, leveraging a comprehensive rare disease knowledge graph synthesized from multiple knowledge bases, significantly enhancing LLMs' diagnostic performance. Moreover, we present an exhaustive comparative study of GPT-4's diagnostic capabilities against those of specialist physicians. Our experimental findings underscore the promising potential of integrating LLMs into the clinical diagnostic process for rare diseases. This paves the way for exciting possibilities in future advancements in this field.

Machine Learning (ML) models are increasingly used to make critical decisions in real-world applications, yet they have become more complex, making them harder to understand. To this end, researchers have proposed several techniques to explain model predictions. However, practitioners struggle to use these explainability techniques because they often do not know which one to choose and how to interpret the results of the explanations. In this work, we address these challenges by introducing TalkToModel: an interactive dialogue system for explaining machine learning models through conversations. Specifically, TalkToModel comprises of three key components: 1) a natural language interface for engaging in conversations, making ML model explainability highly accessible, 2) a dialogue engine that adapts to any tabular model and dataset, interprets natural language, maps it to appropriate explanations, and generates text responses, and 3) an execution component that constructs the explanations. We carried out extensive quantitative and human subject evaluations of TalkToModel. Overall, we found the conversational system understands user inputs on novel datasets and models with high accuracy, demonstrating the system's capacity to generalize to new situations. In real-world evaluations with humans, 73% of healthcare workers (e.g., doctors and nurses) agreed they would use TalkToModel over baseline point-and-click systems for explainability in a disease prediction task, and 85% of ML professionals agreed TalkToModel was easier to use for computing explanations. Our findings demonstrate that TalkToModel is more effective for model explainability than existing systems, introducing a new category of explainability tools for practitioners. Code & demo released here: https://github.com/dylan-slack/TalkToModel.

Rapid progress in multimodal large language models (MLLMs) highlights the need to introduce challenging yet realistic benchmarks to the academic community, while existing benchmarks primarily focus on understanding simple natural images and short context. In this paper, we present MULTI as a cutting-edge benchmark for evaluating MLLMs on understanding complex tables and images, and reasoning with long context. MULTI provides multimodal inputs and requires responses that are either precise or open-ended, reflecting real-life examination styles. MULTI includes over 18,000 questions and challenges MLLMs with a variety of tasks, ranging from formula derivation to image detail analysis and cross-modality reasoning. We also introduce MULTI-Elite, a 500-question selected hard subset, and MULTI-Extend, with more than 4,500 external knowledge context pieces. Our evaluation indicates significant potential for MLLM advancement, with GPT-4V achieving a 63.7% accuracy rate on MULTI, in contrast to other MLLMs scoring between 28.5% and 55.3%. MULTI serves not only as a robust evaluation platform but also paves the way for the development of expert-level AI.

The third ML4H symposium was held in person on December 10, 2023, in New Orleans, Louisiana, USA. The symposium included research roundtable sessions to foster discussions between participants and senior researchers on timely and relevant topics for the ML4H community. Encouraged by the successful virtual roundtables in the previous year, we organized eleven in-person roundtables and four virtual roundtables at ML4H 2022. The organization of the research roundtables at the conference involved 17 Senior Chairs and 19 Junior Chairs across 11 tables. Each roundtable session included invited senior chairs (with substantial experience in the field), junior chairs (responsible for facilitating the discussion), and attendees from diverse backgrounds with interest in the session's topic. Herein we detail the organization process and compile takeaways from these roundtable discussions, including recent advances, applications, and open challenges for each topic. We conclude with a summary and lessons learned across all roundtables. This document serves as a comprehensive review paper, summarizing the recent advancements in machine learning for healthcare as contributed by foremost researchers in the field.

The integration of Artificial Intelligence (AI), especially Large Language Models (LLMs), into the clinical diagnosis process offers significant potential to improve the efficiency and accessibility of medical care. While LLMs have shown some promise in the medical domain, their application in clinical diagnosis remains underexplored, especially in real-world clinical practice, where highly sophisticated, patient-specific decisions need to be made. Current evaluations of LLMs in this field are often narrow in scope, focusing on specific diseases or specialties and employing simplified diagnostic tasks. To bridge this gap, we introduce CliBench, a novel benchmark developed from the MIMIC IV dataset, offering a comprehensive and realistic assessment of LLMs' capabilities in clinical diagnosis. This benchmark not only covers diagnoses from a diverse range of medical cases across various specialties but also incorporates tasks of clinical significance: treatment procedure identification, lab test ordering and medication prescriptions. Supported by structured output ontologies, CliBench enables a precise and multi-granular evaluation, offering an in-depth understanding of LLM's capability on diverse clinical tasks of desired granularity. We conduct a zero-shot evaluation of leading LLMs to assess their proficiency in clinical decision-making. Our preliminary results shed light on the potential and limitations of current LLMs in clinical settings, providing valuable insights for future advancements in LLM-powered healthcare.

Interleaved multimodal comprehension and generation, enabling models to produce and interpret both images and text in arbitrary sequences, have become a pivotal area in multimodal learning. Despite significant advancements, the evaluation of this capability remains insufficient. Existing benchmarks suffer from limitations in data scale, scope, and evaluation depth, while current evaluation metrics are often costly or biased, lacking in reliability for practical applications. To address these challenges, we introduce MMIE, a large-scale knowledge-intensive benchmark for evaluating interleaved multimodal comprehension and generation in Large Vision-Language Models (LVLMs). MMIE comprises 20K meticulously curated multimodal queries, spanning 3 categories, 12 fields, and 102 subfields, including mathematics, coding, physics, literature, health, and arts. It supports both interleaved inputs and outputs, offering a mix of multiple-choice and open-ended question formats to evaluate diverse competencies. Moreover, we propose a reliable automated evaluation metric, leveraging a scoring model fine-tuned with human-annotated data and systematic evaluation criteria, aimed at reducing bias and improving evaluation accuracy. Extensive experiments demonstrate the effectiveness of our benchmark and metrics in providing a comprehensive evaluation of interleaved LVLMs. Specifically, we evaluate eight LVLMs, revealing that even the best models show significant room for improvement, with most achieving only moderate results. We believe MMIE will drive further advancements in the development of interleaved LVLMs. We publicly release our benchmark and code in https://mmie-bench.github.io/.

Despite growing interest in using large language models (LLMs) in healthcare, current explorations do not assess the real-world utility and safety of LLMs in clinical settings. Our objective was to determine whether two LLMs can serve information needs submitted by physicians as questions to an informatics consultation service in a safe and concordant manner. Sixty six questions from an informatics consult service were submitted to GPT-3.5 and GPT-4 via simple prompts. 12 physicians assessed the LLM responses' possibility of patient harm and concordance with existing reports from an informatics consultation service. Physician assessments were summarized based on majority vote. For no questions did a majority of physicians deem either LLM response as harmful. For GPT-3.5, responses to 8 questions were concordant with the informatics consult report, 20 discordant, and 9 were unable to be assessed. There were 29 responses with no majority on "Agree", "Disagree", and "Unable to assess". For GPT-4, responses to 13 questions were concordant, 15 discordant, and 3 were unable to be assessed. There were 35 responses with no majority. Responses from both LLMs were largely devoid of overt harm, but less than 20% of the responses agreed with an answer from an informatics consultation service, responses contained hallucinated references, and physicians were divided on what constitutes harm. These results suggest that while general purpose LLMs are able to provide safe and credible responses, they often do not meet the specific information need of a given question. A definitive evaluation of the usefulness of LLMs in healthcare settings will likely require additional research on prompt engineering, calibration, and custom-tailoring of general purpose models.

Although recent advances in scaling large language models (LLMs) have resulted in improvements on many NLP tasks, it remains unclear whether these models trained primarily with general web text are the right tool in highly specialized, safety critical domains such as clinical text. Recent results have suggested that LLMs encode a surprising amount of medical knowledge. This raises an important question regarding the utility of smaller domain-specific language models. With the success of general-domain LLMs, is there still a need for specialized clinical models? To investigate this question, we conduct an extensive empirical analysis of 12 language models, ranging from 220M to 175B parameters, measuring their performance on 3 different clinical tasks that test their ability to parse and reason over electronic health records. As part of our experiments, we train T5-Base and T5-Large models from scratch on clinical notes from MIMIC III and IV to directly investigate the efficiency of clinical tokens. We show that relatively small specialized clinical models substantially outperform all in-context learning approaches, even when finetuned on limited annotated data. Further, we find that pretraining on clinical tokens allows for smaller, more parameter-efficient models that either match or outperform much larger language models trained on general text. We release the code and the models used under the PhysioNet Credentialed Health Data license and data use agreement.

In this study, we investigated the ability of the large language model (LLM) to enhance healthcare data interoperability. We leveraged the LLM to convert clinical texts into their corresponding FHIR resources. Our experiments, conducted on 3,671 snippets of clinical text, demonstrated that the LLM not only streamlines the multi-step natural language processing and human calibration processes but also achieves an exceptional accuracy rate of over 90% in exact matches when compared to human annotations.

Large vision-language models (LVLMs) have recently achieved rapid progress, sparking numerous studies to evaluate their multi-modal capabilities. However, we dig into current evaluation works and identify two primary issues: 1) Visual content is unnecessary for many samples. The answers can be directly inferred from the questions and options, or the world knowledge embedded in LLMs. This phenomenon is prevalent across current benchmarks. For instance, GeminiPro achieves 42.9% on the MMMU benchmark without any visual input, and outperforms the random choice baseline across six benchmarks over 20% on average. 2) Unintentional data leakage exists in LLM and LVLM training. LLM and LVLM could still answer some visual-necessary questions without visual content, indicating the memorizing of these samples within large-scale training data. For example, Sphinx-X-MoE gets 43.6% on MMMU without accessing images, surpassing its LLM backbone with 17.9%. Both problems lead to misjudgments of actual multi-modal gains and potentially misguide the study of LVLM. To this end, we present MMStar, an elite vision-indispensable multi-modal benchmark comprising 1,500 samples meticulously selected by humans. MMStar benchmarks 6 core capabilities and 18 detailed axes, aiming to evaluate LVLMs' multi-modal capacities with carefully balanced and purified samples. These samples are first roughly selected from current benchmarks with an automated pipeline, human review is then involved to ensure each curated sample exhibits visual dependency, minimal data leakage, and requires advanced multi-modal capabilities. Moreover, two metrics are developed to measure data leakage and actual performance gain in multi-modal training. We evaluate 16 leading LVLMs on MMStar to assess their multi-modal capabilities, and on 7 benchmarks with the proposed metrics to investigate their data leakage and actual multi-modal gain.

Medical applications of machine learning (ML) have experienced a surge in popularity in recent years. The intensive care unit (ICU) is a natural habitat for ML given the abundance of available data from electronic health records. Models have been proposed to address numerous ICU prediction tasks like the early detection of complications. While authors frequently report state-of-the-art performance, it is challenging to verify claims of superiority. Datasets and code are not always published, and cohort definitions, preprocessing pipelines, and training setups are difficult to reproduce. This work introduces Yet Another ICU Benchmark (YAIB), a modular framework that allows researchers to define reproducible and comparable clinical ML experiments; we offer an end-to-end solution from cohort definition to model evaluation. The framework natively supports most open-access ICU datasets (MIMIC III/IV, eICU, HiRID, AUMCdb) and is easily adaptable to future ICU datasets. Combined with a transparent preprocessing pipeline and extensible training code for multiple ML and deep learning models, YAIB enables unified model development. Our benchmark comes with five predefined established prediction tasks (mortality, acute kidney injury, sepsis, kidney function, and length of stay) developed in collaboration with clinicians. Adding further tasks is straightforward by design. Using YAIB, we demonstrate that the choice of dataset, cohort definition, and preprocessing have a major impact on the prediction performance - often more so than model class - indicating an urgent need for YAIB as a holistic benchmarking tool. We provide our work to the clinical ML community to accelerate method development and enable real-world clinical implementations. Software Repository: https://github.com/rvandewater/YAIB.

Background: This study aimed to evaluate and compare the performance of classical machine learning models (CMLs) and large language models (LLMs) in predicting mortality associated with COVID-19 by utilizing a high-dimensional tabular dataset. Materials and Methods: We analyzed data from 9,134 COVID-19 patients collected across four hospitals. Seven CML models, including XGBoost and random forest (RF), were trained and evaluated. The structured data was converted into text for zero-shot classification by eight LLMs, including GPT-4 and Mistral-7b. Additionally, Mistral-7b was fine-tuned using the QLoRA approach to enhance its predictive capabilities. Results: Among the CML models, XGBoost and RF achieved the highest accuracy, with F1 scores of 0.87 for internal validation and 0.83 for external validation. In the LLM category, GPT-4 was the top performer with an F1 score of 0.43. Fine-tuning Mistral-7b significantly improved its recall from 1% to 79%, resulting in an F1 score of 0.74, which was stable during external validation. Conclusion: While LLMs show moderate performance in zero-shot classification, fine-tuning can significantly enhance their effectiveness, potentially aligning them closer to CML models. However, CMLs still outperform LLMs in high-dimensional tabular data tasks.

In recent advancements, multimodal large language models (MLLMs) have been fine-tuned on specific medical image datasets to address medical visual question answering (Med-VQA) tasks. However, this common approach of task-specific fine-tuning is costly and necessitates separate models for each downstream task, limiting the exploration of zero-shot capabilities. In this paper, we introduce MC-CoT, a modular cross-modal collaboration Chain-of-Thought (CoT) framework designed to enhance the zero-shot performance of MLLMs in Med-VQA by leveraging large language models (LLMs). MC-CoT improves reasoning and information extraction by integrating medical knowledge and task-specific guidance, where LLM provides various complex medical reasoning chains and MLLM provides various observations of medical images based on instructions of the LLM. Our experiments on datasets such as SLAKE, VQA-RAD, and PATH-VQA show that MC-CoT surpasses standalone MLLMs and various multimodality CoT frameworks in recall rate and accuracy. These findings highlight the importance of incorporating background information and detailed guidance in addressing complex zero-shot Med-VQA tasks.

Comprehending text-rich visual content is paramount for the practical application of Multimodal Large Language Models (MLLMs), since text-rich scenarios are ubiquitous in the real world, which are characterized by the presence of extensive texts embedded within images. Recently, the advent of MLLMs with impressive versatility has raised the bar for what we can expect from MLLMs. However, their proficiency in text-rich scenarios has yet to be comprehensively and objectively assessed, since current MLLM benchmarks primarily focus on evaluating general visual comprehension. In this work, we introduce SEED-Bench-2-Plus, a benchmark specifically designed for evaluating text-rich visual comprehension of MLLMs. Our benchmark comprises 2.3K multiple-choice questions with precise human annotations, spanning three broad categories: Charts, Maps, and Webs, each of which covers a wide spectrum of text-rich scenarios in the real world. These categories, due to their inherent complexity and diversity, effectively simulate real-world text-rich environments. We further conduct a thorough evaluation involving 34 prominent MLLMs (including GPT-4V, Gemini-Pro-Vision and Claude-3-Opus) and emphasize the current limitations of MLLMs in text-rich visual comprehension. We hope that our work can serve as a valuable addition to existing MLLM benchmarks, providing insightful observations and inspiring further research in the area of text-rich visual comprehension with MLLMs. The dataset and evaluation code can be accessed at https://github.com/AILab-CVC/SEED-Bench.

When we look around and perform complex tasks, how we see and selectively process what we see is crucial. However, the lack of this visual search mechanism in current multimodal LLMs (MLLMs) hinders their ability to focus on important visual details, especially when handling high-resolution and visually crowded images. To address this, we introduce V*, an LLM-guided visual search mechanism that employs the world knowledge in LLMs for efficient visual querying. When combined with an MLLM, this mechanism enhances collaborative reasoning, contextual understanding, and precise targeting of specific visual elements. This integration results in a new MLLM meta-architecture, named Show, sEArch, and TelL (SEAL). We further create V*Bench, a benchmark specifically designed to evaluate MLLMs in their ability to process high-resolution images and focus on visual details. Our study highlights the necessity of incorporating visual search capabilities into multimodal systems. The code is available https://github.com/penghao-wu/vstar.

Large language models (LLMs) have shown potential in biomedical applications, leading to efforts to fine-tune them on domain-specific data. However, the effectiveness of this approach remains unclear. This study evaluates the performance of biomedically fine-tuned LLMs against their general-purpose counterparts on a variety of clinical tasks. We evaluated their performance on clinical case challenges from the New England Journal of Medicine (NEJM) and the Journal of the American Medical Association (JAMA) and on several clinical tasks (e.g., information extraction, document summarization, and clinical coding). Using benchmarks specifically chosen to be likely outside the fine-tuning datasets of biomedical models, we found that biomedical LLMs mostly perform inferior to their general-purpose counterparts, especially on tasks not focused on medical knowledge. While larger models showed similar performance on case tasks (e.g., OpenBioLLM-70B: 66.4% vs. Llama-3-70B-Instruct: 65% on JAMA cases), smaller biomedical models showed more pronounced underperformance (e.g., OpenBioLLM-8B: 30% vs. Llama-3-8B-Instruct: 64.3% on NEJM cases). Similar trends were observed across the CLUE (Clinical Language Understanding Evaluation) benchmark tasks, with general-purpose models often performing better on text generation, question answering, and coding tasks. Our results suggest that fine-tuning LLMs to biomedical data may not provide the expected benefits and may potentially lead to reduced performance, challenging prevailing assumptions about domain-specific adaptation of LLMs and highlighting the need for more rigorous evaluation frameworks in healthcare AI. Alternative approaches, such as retrieval-augmented generation, may be more effective in enhancing the biomedical capabilities of LLMs without compromising their general knowledge.

Large language models (LLMs) such as ChatGPT have exhibited remarkable performance in generating human-like texts. However, machine-generated texts (MGTs) may carry critical risks, such as plagiarism issues, misleading information, or hallucination issues. Therefore, it is very urgent and important to detect MGTs in many situations. Unfortunately, it is challenging to distinguish MGTs and human-written texts because the distributional discrepancy between them is often very subtle due to the remarkable performance of LLMs. In this paper, we seek to exploit maximum mean discrepancy (MMD) to address this issue in the sense that MMD can well identify distributional discrepancies. However, directly training a detector with MMD using diverse MGTs will incur a significantly increased variance of MMD since MGTs may contain multiple text populations due to various LLMs. This will severely impair MMD's ability to measure the difference between two samples. To tackle this, we propose a novel multi-population aware optimization method for MMD called MMD-MP, which can avoid variance increases and thus improve the stability to measure the distributional discrepancy. Relying on MMD-MP, we develop two methods for paragraph-based and sentence-based detection, respectively. Extensive experiments on various LLMs, \eg, GPT2 and ChatGPT, show superior detection performance of our MMD-MP. The source code is available at https://github.com/ZSHsh98/MMD-MP.

Multimodal Large Language Models (MLLMs) have showcased impressive skills in tasks related to visual understanding and reasoning. Yet, their widespread application faces obstacles due to the high computational demands during both the training and inference phases, restricting their use to a limited audience within the research and user communities. In this paper, we investigate the design aspects of Multimodal Small Language Models (MSLMs) and propose an efficient multimodal assistant named Mipha, which is designed to create synergy among various aspects: visual representation, language models, and optimization strategies. We show that without increasing the volume of training data, our Mipha-3B outperforms the state-of-the-art large MLLMs, especially LLaVA-1.5-13B, on multiple benchmarks. Through detailed discussion, we provide insights and guidelines for developing strong MSLMs that rival the capabilities of MLLMs. Our code is available at https://github.com/zhuyiche/llava-phi.

We introduce InternVL 2.5, an advanced multimodal large language model (MLLM) series that builds upon InternVL 2.0, maintaining its core model architecture while introducing significant enhancements in training and testing strategies as well as data quality. In this work, we delve into the relationship between model scaling and performance, systematically exploring the performance trends in vision encoders, language models, dataset sizes, and test-time configurations. Through extensive evaluations on a wide range of benchmarks, including multi-discipline reasoning, document understanding, multi-image / video understanding, real-world comprehension, multimodal hallucination detection, visual grounding, multilingual capabilities, and pure language processing, InternVL 2.5 exhibits competitive performance, rivaling leading commercial models such as GPT-4o and Claude-3.5-Sonnet. Notably, our model is the first open-source MLLMs to surpass 70% on the MMMU benchmark, achieving a 3.7-point improvement through Chain-of-Thought (CoT) reasoning and showcasing strong potential for test-time scaling. We hope this model contributes to the open-source community by setting new standards for developing and applying multimodal AI systems. HuggingFace demo see https://huggingface.co/spaces/OpenGVLab/InternVL

Recently, rapid advancements in Multi-Modal In-Context Learning (MM-ICL) have achieved notable success, which is capable of achieving superior performance across various tasks without requiring additional parameter tuning. However, the underlying rules for the effectiveness of MM-ICL remain under-explored. To fill this gap, this work aims to investigate the research question: "What factors affect the performance of MM-ICL?'' To this end, we investigate extensive experiments on the three core steps of MM-ICL including demonstration retrieval, demonstration ordering, and prompt construction using 6 vision large language models and 20 strategies. Our findings highlight (1) the necessity of a multi-modal retriever for demonstration retrieval, (2) the importance of intra-demonstration ordering over inter-demonstration ordering, and (3) the enhancement of task comprehension through introductory instructions in prompts. We hope this study can serve as a foundational guide for optimizing MM-ICL strategies in future research.

Multimodal large language models (MLLMs) are designed to process and integrate information from multiple sources, such as text, speech, images, and videos. Despite its success in language understanding, it is critical to evaluate the performance of downstream tasks for better human-centric applications. This paper assesses the application of MLLMs with 5 crucial abilities for affective computing, spanning from visual affective tasks and reasoning tasks. The results show that \gpt has high accuracy in facial action unit recognition and micro-expression detection while its general facial expression recognition performance is not accurate. We also highlight the challenges of achieving fine-grained micro-expression recognition and the potential for further study and demonstrate the versatility and potential of \gpt for handling advanced tasks in emotion recognition and related fields by integrating with task-related agents for more complex tasks, such as heart rate estimation through signal processing. In conclusion, this paper provides valuable insights into the potential applications and challenges of MLLMs in human-centric computing. Our interesting examples are at https://github.com/EnVision-Research/GPT4Affectivity.

In this work, we introduce Brain Latent Progression (BrLP), a novel spatiotemporal disease progression model based on latent diffusion. BrLP is designed to predict the evolution of diseases at the individual level on 3D brain MRIs. Existing deep generative models developed for this task are primarily data-driven and face challenges in learning disease progressions. BrLP addresses these challenges by incorporating prior knowledge from disease models to enhance the accuracy of predictions. To implement this, we propose to integrate an auxiliary model that infers volumetric changes in various brain regions. Additionally, we introduce Latent Average Stabilization (LAS), a novel technique to improve spatiotemporal consistency of the predicted progression. BrLP is trained and evaluated on a large dataset comprising 11,730 T1-weighted brain MRIs from 2,805 subjects, collected from three publicly available, longitudinal Alzheimer's Disease (AD) studies. In our experiments, we compare the MRI scans generated by BrLP with the actual follow-up MRIs available from the subjects, in both cross-sectional and longitudinal settings. BrLP demonstrates significant improvements over existing methods, with an increase of 22% in volumetric accuracy across AD-related brain regions and 43% in image similarity to the ground-truth scans. The ability of BrLP to generate conditioned 3D scans at the subject level, along with the novelty of integrating prior knowledge to enhance accuracy, represents a significant advancement in disease progression modeling, opening new avenues for precision medicine. The code of BrLP is available at the following link: https://github.com/LemuelPuglisi/BrLP.

In this paper, we propose an architecture to harness the collective knowledge of multiple trained LLMs to create a new state-of-the-art. At the core of this framework is a LLM-based orchestrator that is adept at picking the right underlying LLM experts for optimal task execution. Inspired by self-play in reinforcement learning, we created a loop of query generation, orchestration, and evaluation to generate training data for the orchestrator. Our evaluation focused on the MMLU benchmark, employing models with 7B, 13B, and 34B parameters available on Hugging Face. The results demonstrate new state-of-the-art open-source models: Our Leeroo orchestrator achieves performance on par with the Mixtral model while incurring only two-thirds of its cost. Moreover, increasing the allowed cost surpasses Mixtral's accuracy by over 5% at the same cost level, reaching an accuracy of 75.9%. Further enhancements were observed when integrating GPT4 into the underlying model pool. The Leeroo orchestrator nearly matches GPT4's performance at half the cost and even exceeds GPT4's results with a 25% cost reduction. These findings illustrate the potential of our architecture in creating state-of-the-art and cost-effective LLMs by optimizing the synergy between multiple LLMs to achieve superior performance outcomes.

We present MM-VID, an integrated system that harnesses the capabilities of GPT-4V, combined with specialized tools in vision, audio, and speech, to facilitate advanced video understanding. MM-VID is designed to address the challenges posed by long-form videos and intricate tasks such as reasoning within hour-long content and grasping storylines spanning multiple episodes. MM-VID uses a video-to-script generation with GPT-4V to transcribe multimodal elements into a long textual script. The generated script details character movements, actions, expressions, and dialogues, paving the way for large language models (LLMs) to achieve video understanding. This enables advanced capabilities, including audio description, character identification, and multimodal high-level comprehension. Experimental results demonstrate the effectiveness of MM-VID in handling distinct video genres with various video lengths. Additionally, we showcase its potential when applied to interactive environments, such as video games and graphic user interfaces.

In the past year, Multimodal Large Language Models (MLLMs) have demonstrated remarkable performance in tasks such as visual question answering, visual understanding and reasoning. However, the extensive model size and high training and inference costs have hindered the widespread application of MLLMs in academia and industry. Thus, studying efficient and lightweight MLLMs has enormous potential, especially in edge computing scenarios. In this survey, we provide a comprehensive and systematic review of the current state of efficient MLLMs. Specifically, we summarize the timeline of representative efficient MLLMs, research state of efficient structures and strategies, and the applications. Finally, we discuss the limitations of current efficient MLLM research and promising future directions. Please refer to our GitHub repository for more details: https://github.com/lijiannuist/Efficient-Multimodal-LLMs-Survey.

To assess the effectiveness of any medical intervention, researchers must conduct a time-intensive and highly manual literature review. NLP systems can help to automate or assist in parts of this expensive process. In support of this goal, we release MS^2 (Multi-Document Summarization of Medical Studies), a dataset of over 470k documents and 20k summaries derived from the scientific literature. This dataset facilitates the development of systems that can assess and aggregate contradictory evidence across multiple studies, and is the first large-scale, publicly available multi-document summarization dataset in the biomedical domain. We experiment with a summarization system based on BART, with promising early results. We formulate our summarization inputs and targets in both free text and structured forms and modify a recently proposed metric to assess the quality of our system's generated summaries. Data and models are available at https://github.com/allenai/ms2

Recent advancements in Multimodal Large Language Models (MLLMs) underscore the significance of scalable models and data to boost performance, yet this often incurs substantial computational costs. Although the Mixture of Experts (MoE) architecture has been employed to efficiently scale large language and image-text models, these efforts typically involve fewer experts and limited modalities. To address this, our work presents the pioneering attempt to develop a unified MLLM with the MoE architecture, named Uni-MoE that can handle a wide array of modalities. Specifically, it features modality-specific encoders with connectors for a unified multimodal representation. We also implement a sparse MoE architecture within the LLMs to enable efficient training and inference through modality-level data parallelism and expert-level model parallelism. To enhance the multi-expert collaboration and generalization, we present a progressive training strategy: 1) Cross-modality alignment using various connectors with different cross-modality data, 2) Training modality-specific experts with cross-modality instruction data to activate experts' preferences, and 3) Tuning the Uni-MoE framework utilizing Low-Rank Adaptation (LoRA) on mixed multimodal instruction data. We evaluate the instruction-tuned Uni-MoE on a comprehensive set of multimodal datasets. The extensive experimental results demonstrate Uni-MoE's principal advantage of significantly reducing performance bias in handling mixed multimodal datasets, alongside improved multi-expert collaboration and generalization. Our findings highlight the substantial potential of MoE frameworks in advancing MLLMs and the code is available at https://github.com/HITsz-TMG/UMOE-Scaling-Unified-Multimodal-LLMs.

Learning to represent free text is a core task in many clinical machine learning (ML) applications, as clinical text contains observations and plans not otherwise available for inference. State-of-the-art methods use large language models developed with immense computational resources and training data; however, applying these models is challenging because of the highly varying syntax and vocabulary in clinical free text. Structured information such as International Classification of Disease (ICD) codes often succinctly abstracts the most important facts of a clinical encounter and yields good performance, but is often not as available as clinical text in real-world scenarios. We propose a multi-view learning framework that jointly learns from codes and text to combine the availability and forward-looking nature of text and better performance of ICD codes. The learned text embeddings can be used as inputs to predictive algorithms independent of the ICD codes during inference. Our approach uses a Graph Neural Network (GNN) to process ICD codes, and Bi-LSTM to process text. We apply Deep Canonical Correlation Analysis (DCCA) to enforce the two views to learn a similar representation of each patient. In experiments using planned surgical procedure text, our model outperforms BERT models fine-tuned to clinical data, and in experiments using diverse text in MIMIC-III, our model is competitive to a fine-tuned BERT at a tiny fraction of its computational effort.

We introduce Latent Meaning Cells, a deep latent variable model which learns contextualized representations of words by combining local lexical context and metadata. Metadata can refer to granular context, such as section type, or to more global context, such as unique document ids. Reliance on metadata for contextualized representation learning is apropos in the clinical domain where text is semi-structured and expresses high variation in topics. We evaluate the LMC model on the task of zero-shot clinical acronym expansion across three datasets. The LMC significantly outperforms a diverse set of baselines at a fraction of the pre-training cost and learns clinically coherent representations. We demonstrate that not only is metadata itself very helpful for the task, but that the LMC inference algorithm provides an additional large benefit.

The emergence of large multimodal models has unlocked remarkable potential in AI, particularly in pathology. However, the lack of specialized, high-quality benchmark impeded their development and precise evaluation. To address this, we introduce PathMMU, the largest and highest-quality expert-validated pathology benchmark for LMMs. It comprises 33,573 multimodal multi-choice questions and 21,599 images from various sources, and an explanation for the correct answer accompanies each question. The construction of PathMMU capitalizes on the robust capabilities of GPT-4V, utilizing approximately 30,000 gathered image-caption pairs to generate Q\&As. Significantly, to maximize PathMMU's authority, we invite six pathologists to scrutinize each question under strict standards in PathMMU's validation and test sets, while simultaneously setting an expert-level performance benchmark for PathMMU. We conduct extensive evaluations, including zero-shot assessments of 14 open-sourced and three closed-sourced LMMs and their robustness to image corruption. We also fine-tune representative LMMs to assess their adaptability to PathMMU. The empirical findings indicate that advanced LMMs struggle with the challenging PathMMU benchmark, with the top-performing LMM, GPT-4V, achieving only a 51.7\% zero-shot performance, significantly lower than the 71.4\% demonstrated by human pathologists. After fine-tuning, even open-sourced LMMs can surpass GPT-4V with a performance of over 60\%, but still fall short of the expertise shown by pathologists. We hope that the PathMMU will offer valuable insights and foster the development of more specialized, next-generation LLMs for pathology.

We introduce MedMNIST v2, a large-scale MNIST-like dataset collection of standardized biomedical images, including 12 datasets for 2D and 6 datasets for 3D. All images are pre-processed into a small size of 28x28 (2D) or 28x28x28 (3D) with the corresponding classification labels so that no background knowledge is required for users. Covering primary data modalities in biomedical images, MedMNIST v2 is designed to perform classification on lightweight 2D and 3D images with various dataset scales (from 100 to 100,000) and diverse tasks (binary/multi-class, ordinal regression, and multi-label). The resulting dataset, consisting of 708,069 2D images and 10,214 3D images in total, could support numerous research / educational purposes in biomedical image analysis, computer vision, and machine learning. We benchmark several baseline methods on MedMNIST v2, including 2D / 3D neural networks and open-source / commercial AutoML tools. The data and code are publicly available at https://medmnist.com/.

The rapid evolution of Multimodal Large Language Models (MLLMs) has brought substantial advancements in artificial intelligence, significantly enhancing the capability to understand and generate multimodal content. While prior studies have largely concentrated on model architectures and training methodologies, a thorough analysis of the benchmarks used for evaluating these models remains underexplored. This survey addresses this gap by systematically reviewing 211 benchmarks that assess MLLMs across four core domains: understanding, reasoning, generation, and application. We provide a detailed analysis of task designs, evaluation metrics, and dataset constructions, across diverse modalities. We hope that this survey will contribute to the ongoing advancement of MLLM research by offering a comprehensive overview of benchmarking practices and identifying promising directions for future work. An associated GitHub repository collecting the latest papers is available.

Multimodal LLMs (MLLMs) are the natural extension of large language models to handle multimodal inputs, combining text and image data. They have recently garnered attention due to their capability to address complex tasks involving both modalities. However, their effectiveness is limited to the knowledge acquired during training, which restricts their practical utility. In this work, we introduce a novel method to enhance the adaptability of MLLMs by integrating external knowledge sources. Our proposed model, Reflective LLaVA (ReflectiVA), utilizes reflective tokens to dynamically determine the need for external knowledge and predict the relevance of information retrieved from an external database. Tokens are trained following a two-stage two-model training recipe. This ultimately enables the MLLM to manage external knowledge while preserving fluency and performance on tasks where external knowledge is not needed. Through our experiments, we demonstrate the efficacy of ReflectiVA for knowledge-based visual question answering, highlighting its superior performance compared to existing methods. Source code and trained models are publicly available at https://github.com/aimagelab/ReflectiVA.

Time series data are ubiquitous across a wide range of real-world domains. While real-world time series analysis (TSA) requires human experts to integrate numerical series data with multimodal domain-specific knowledge, most existing TSA models rely solely on numerical data, overlooking the significance of information beyond numerical series. This oversight is due to the untapped potential of textual series data and the absence of a comprehensive, high-quality multimodal dataset. To overcome this obstacle, we introduce Time-MMD, the first multi-domain, multimodal time series dataset covering 9 primary data domains. Time-MMD ensures fine-grained modality alignment, eliminates data contamination, and provides high usability. Additionally, we develop MM-TSFlib, the first multimodal time-series forecasting (TSF) library, seamlessly pipelining multimodal TSF evaluations based on Time-MMD for in-depth analyses. Extensive experiments conducted on Time-MMD through MM-TSFlib demonstrate significant performance enhancements by extending unimodal TSF to multimodality, evidenced by over 15% mean squared error reduction in general, and up to 40% in domains with rich textual data. More importantly, our datasets and library revolutionize broader applications, impacts, research topics to advance TSA. The dataset and library are available at https://github.com/AdityaLab/Time-MMD and https://github.com/AdityaLab/MM-TSFlib.

Recent studies have demonstrated Large Language Models (LLMs) can extend their zero-shot generalization capabilities to multimodal learning through instruction tuning. As more modalities and downstream tasks are introduced, negative conflicts and interference may have a worse impact on performance. While this phenomenon has been overlooked in previous work, we propose a novel and extensible framework, called Octavius, for comprehensive studies and experimentation on multimodal learning with Multimodal Large Language Models (MLLMs). Specifically, we combine the well-known Mixture-of-Experts (MoE) and one of the representative PEFT techniques, i.e., LoRA, designing a novel LLM-based decoder, called LoRA-MoE, for multimodal learning. To the best of our knowledge, we are one of the pioneering efforts to introduce MoE into MLLMs to address this problem. The experimental results (about 20% improvement) have shown the effectiveness and versatility of our design in various 2D and 3D downstream tasks. Code and datasets are available at https://openlamm.github.io/paper_list/Octavius.

Multimodal learning combines multiple data modalities, broadening the types and complexity of data our models can utilize: for example, from plain text to image-caption pairs. Most multimodal learning algorithms focus on modeling simple one-to-one pairs of data from two modalities, such as image-caption pairs, or audio-text pairs. However, in most real-world settings, entities of different modalities interact with each other in more complex and multifaceted ways, going beyond one-to-one mappings. We propose to represent these complex relationships as graphs, allowing us to capture data with any number of modalities, and with complex relationships between modalities that can flexibly vary from one sample to another. Toward this goal, we propose Multimodal Graph Learning (MMGL), a general and systematic framework for capturing information from multiple multimodal neighbors with relational structures among them. In particular, we focus on MMGL for generative tasks, building upon pretrained Language Models (LMs), aiming to augment their text generation with multimodal neighbor contexts. We study three research questions raised by MMGL: (1) how can we infuse multiple neighbor information into the pretrained LMs, while avoiding scalability issues? (2) how can we infuse the graph structure information among multimodal neighbors into the LMs? and (3) how can we finetune the pretrained LMs to learn from the neighbor context in a parameter-efficient manner? We conduct extensive experiments to answer these three questions on MMGL and analyze the empirical results to pave the way for future MMGL research.

Large language models have the potential to be valuable in the healthcare industry, but it's crucial to verify their safety and effectiveness through rigorous evaluation. For this purpose, we comprehensively evaluated both open-source LLMs and Google's new multimodal LLM called Gemini across Medical reasoning, hallucination detection, and Medical Visual Question Answering tasks. While Gemini showed competence, it lagged behind state-of-the-art models like MedPaLM 2 and GPT-4 in diagnostic accuracy. Additionally, Gemini achieved an accuracy of 61.45\% on the medical VQA dataset, significantly lower than GPT-4V's score of 88\%. Our analysis revealed that Gemini is highly susceptible to hallucinations, overconfidence, and knowledge gaps, which indicate risks if deployed uncritically. We also performed a detailed analysis by medical subject and test type, providing actionable feedback for developers and clinicians. To mitigate risks, we applied prompting strategies that improved performance. Additionally, we facilitated future research and development by releasing a Python module for medical LLM evaluation and establishing a dedicated leaderboard on Hugging Face for medical domain LLMs. Python module can be found at https://github.com/promptslab/RosettaEval

Built on the power of LLMs, numerous multimodal large language models (MLLMs) have recently achieved remarkable performance on various vision-language tasks across multiple benchmarks. However, most existing MLLMs and benchmarks primarily focus on single-image input scenarios, leaving the performance of MLLMs when handling realistic multiple images remain underexplored. Although a few benchmarks consider multiple images, their evaluation dimensions and samples are very limited. Therefore, in this paper, we propose a new benchmark MIBench, to comprehensively evaluate fine-grained abilities of MLLMs in multi-image scenarios. Specifically, MIBench categorizes the multi-image abilities into three scenarios: multi-image instruction (MII), multimodal knowledge-seeking (MKS) and multimodal in-context learning (MIC), and constructs 13 tasks with a total of 13K annotated samples. During data construction, for MII and MKS, we extract correct options from manual annotations and create challenging distractors to obtain multiple-choice questions. For MIC, to enable an in-depth evaluation, we set four sub-tasks and transform the original datasets into in-context learning formats. We evaluate several open-source MLLMs and close-source MLLMs on the proposed MIBench. The results reveal that although current models excel in single-image tasks, they exhibit significant shortcomings when faced with multi-image inputs, such as confused fine-grained perception, limited multi-image reasoning, and unstable in-context learning. The annotated data in MIBench is available at https://huggingface.co/datasets/StarBottle/MIBench.

Recent advances in microscopy have enabled the rapid generation of terabytes of image data in cell biology and biomedical research. Vision-language models (VLMs) offer a promising solution for large-scale biological image analysis, enhancing researchers' efficiency, identifying new image biomarkers, and accelerating hypothesis generation and scientific discovery. However, there is a lack of standardized, diverse, and large-scale vision-language benchmarks to evaluate VLMs' perception and cognition capabilities in biological image understanding. To address this gap, we introduce {\mu}-Bench, an expert-curated benchmark encompassing 22 biomedical tasks across various scientific disciplines (biology, pathology), microscopy modalities (electron, fluorescence, light), scales (subcellular, cellular, tissue), and organisms in both normal and abnormal states. We evaluate state-of-the-art biomedical, pathology, and general VLMs on {\mu}-Bench and find that: i) current models struggle on all categories, even for basic tasks such as distinguishing microscopy modalities; ii) current specialist models fine-tuned on biomedical data often perform worse than generalist models; iii) fine-tuning in specific microscopy domains can cause catastrophic forgetting, eroding prior biomedical knowledge encoded in their base model. iv) weight interpolation between fine-tuned and pre-trained models offers one solution to forgetting and improves general performance across biomedical tasks. We release {\mu}-Bench under a permissive license to accelerate the research and development of microscopy foundation models.

Multimodal Large Language Models (MLLMs) have demonstrated proficiency in handling a variety of visual-language tasks. However, current MLLM benchmarks are predominantly designed to evaluate reasoning based on static information about a single image, and the ability of modern MLLMs to extrapolate from image sequences, which is essential for understanding our ever-changing world, has been less investigated. To address this challenge, this paper introduces Mementos, a new benchmark designed to assess MLLMs' sequential image reasoning abilities. Mementos features 4,761 diverse image sequences with varying lengths. We also employ a GPT-4 assisted method to evaluate MLLM reasoning performance. Through a careful evaluation of nine recent MLLMs on Mementos, including GPT-4V and Gemini, we find that they struggle to accurately describe dynamic information about given image sequences, often leading to hallucinations/misrepresentations of objects and their corresponding behaviors. Our quantitative analysis and case studies identify three key factors impacting MLLMs' sequential image reasoning: the correlation between object and behavioral hallucinations, the influence of cooccurring behaviors, and the compounding impact of behavioral hallucinations. Our dataset is available at https://github.com/umd-huang-lab/Mementos.

The article presents a new multi-label comprehensive image dataset from flexible endoscopy, colonoscopy and capsule endoscopy, named ERS. The collection has been labeled according to the full medical specification of 'Minimum Standard Terminology 3.0' (MST 3.0), describing all possible findings in the gastrointestinal tract (104 possible labels), extended with an additional 19 labels useful in common machine learning applications. The dataset contains around 6000 precisely and 115,000 approximately labeled frames from endoscopy videos, 3600 precise and 22,600 approximate segmentation masks, and 1.23 million unlabeled frames from flexible and capsule endoscopy videos. The labeled data cover almost entirely the MST 3.0 standard. The data came from 1520 videos of 1135 patients. Additionally, this paper proposes and describes four exemplary experiments in gastrointestinal image classification task performed using the created dataset. The obtained results indicate the high usefulness and flexibility of the dataset in training and testing machine learning algorithms in the field of endoscopic data analysis.

Recent advancements in large language model(LLM) performance on medical multiple choice question (MCQ) benchmarks have stimulated interest from healthcare providers and patients globally. Particularly in low-and middle-income countries (LMICs) facing acute physician shortages and lack of specialists, LLMs offer a potentially scalable pathway to enhance healthcare access and reduce costs. However, their effectiveness in the Global South, especially across the African continent, remains to be established. In this work, we introduce AfriMed-QA, the first large scale Pan-African English multi-specialty medical Question-Answering (QA) dataset, 15,000 questions (open and closed-ended) sourced from over 60 medical schools across 16 countries, covering 32 medical specialties. We further evaluate 30 LLMs across multiple axes including correctness and demographic bias. Our findings show significant performance variation across specialties and geographies, MCQ performance clearly lags USMLE (MedQA). We find that biomedical LLMs underperform general models and smaller edge-friendly LLMs struggle to achieve a passing score. Interestingly, human evaluations show a consistent consumer preference for LLM answers and explanations when compared with clinician answers.

Large language models (LLMs) are increasingly applied to clinical decision-making. However, their potential to exhibit bias poses significant risks to clinical equity. Currently, there is a lack of benchmarks that systematically evaluate such clinical bias in LLMs. While in downstream tasks, some biases of LLMs can be avoided such as by instructing the model to answer "I'm not sure...", the internal bias hidden within the model still lacks deep studies. We introduce CLIMB (shorthand for A Benchmark of Clinical Bias in Large Language Models), a pioneering comprehensive benchmark to evaluate both intrinsic (within LLMs) and extrinsic (on downstream tasks) bias in LLMs for clinical decision tasks. Notably, for intrinsic bias, we introduce a novel metric, AssocMAD, to assess the disparities of LLMs across multiple demographic groups. Additionally, we leverage counterfactual intervention to evaluate extrinsic bias in a task of clinical diagnosis prediction. Our experiments across popular and medically adapted LLMs, particularly from the Mistral and LLaMA families, unveil prevalent behaviors with both intrinsic and extrinsic bias. This work underscores the critical need to mitigate clinical bias and sets a new standard for future evaluations of LLMs' clinical bias.

In this paper, we introduce InMD-X, a collection of multiple large language models specifically designed to cater to the unique characteristics and demands of Internal Medicine Doctors (IMD). InMD-X represents a groundbreaking development in natural language processing, offering a suite of language models fine-tuned for various aspects of the internal medicine field. These models encompass a wide range of medical sub-specialties, enabling IMDs to perform more efficient and accurate research, diagnosis, and documentation. InMD-X's versatility and adaptability make it a valuable tool for improving the healthcare industry, enhancing communication between healthcare professionals, and advancing medical research. Each model within InMD-X is meticulously tailored to address specific challenges faced by IMDs, ensuring the highest level of precision and comprehensiveness in clinical text analysis and decision support. This paper provides an overview of the design, development, and evaluation of InMD-X, showcasing its potential to revolutionize the way internal medicine practitioners interact with medical data and information. We present results from extensive testing, demonstrating the effectiveness and practical utility of InMD-X in real-world medical scenarios.

Clinical trial matching is a key process in health delivery and discovery. In practice, it is plagued by overwhelming unstructured data and unscalable manual processing. In this paper, we conduct a systematic study on scaling clinical trial matching using large language models (LLMs), with oncology as the focus area. Our study is grounded in a clinical trial matching system currently in test deployment at a large U.S. health network. Initial findings are promising: out of box, cutting-edge LLMs, such as GPT-4, can already structure elaborate eligibility criteria of clinical trials and extract complex matching logic (e.g., nested AND/OR/NOT). While still far from perfect, LLMs substantially outperform prior strong baselines and may serve as a preliminary solution to help triage patient-trial candidates with humans in the loop. Our study also reveals a few significant growth areas for applying LLMs to end-to-end clinical trial matching, such as context limitation and accuracy, especially in structuring patient information from longitudinal medical records.

Identifying disease phenotypes from electronic health records (EHRs) is critical for numerous secondary uses. Manually encoding physician knowledge into rules is particularly challenging for rare diseases due to inadequate EHR coding, necessitating review of clinical notes. Large language models (LLMs) offer promise in text understanding but may not efficiently handle real-world clinical documentation. We propose a zero-shot LLM-based method enriched by retrieval-augmented generation and MapReduce, which pre-identifies disease-related text snippets to be used in parallel as queries for the LLM to establish diagnosis. We show that this method as applied to pulmonary hypertension (PH), a rare disease characterized by elevated arterial pressures in the lungs, significantly outperforms physician logic rules (F_1 score of 0.62 vs. 0.75). This method has the potential to enhance rare disease cohort identification, expanding the scope of robust clinical research and care gap identification.

Recent advancements in large language models (LLMs) have transformed the field of question answering (QA). However, evaluating LLMs in the medical field is challenging due to the lack of standardized and comprehensive datasets. To address this gap, we introduce CMExam, sourced from the Chinese National Medical Licensing Examination. CMExam consists of 60K+ multiple-choice questions for standardized and objective evaluations, as well as solution explanations for model reasoning evaluation in an open-ended manner. For in-depth analyses of LLMs, we invited medical professionals to label five additional question-wise annotations, including disease groups, clinical departments, medical disciplines, areas of competency, and question difficulty levels. Alongside the dataset, we further conducted thorough experiments with representative LLMs and QA algorithms on CMExam. The results show that GPT-4 had the best accuracy of 61.6% and a weighted F1 score of 0.617. These results highlight a great disparity when compared to human accuracy, which stood at 71.6%. For explanation tasks, while LLMs could generate relevant reasoning and demonstrate improved performance after finetuning, they fall short of a desired standard, indicating ample room for improvement. To the best of our knowledge, CMExam is the first Chinese medical exam dataset to provide comprehensive medical annotations. The experiments and findings of LLM evaluation also provide valuable insights into the challenges and potential solutions in developing Chinese medical QA systems and LLM evaluation pipelines. The dataset and relevant code are available at https://github.com/williamliujl/CMExam.

Clinical trials are fundamental in developing new drugs, medical devices, and treatments. However, they are often time-consuming and have low success rates. Although there have been initial attempts to create large language models (LLMs) for clinical trial design and patient-trial matching, these models remain task-specific and not adaptable to diverse clinical trial tasks. To address this challenge, we propose a clinical trial foundation model named Panacea, designed to handle multiple tasks, including trial search, trial summarization, trial design, and patient-trial matching. We also assemble a large-scale dataset, named TrialAlign, of 793,279 trial documents and 1,113,207 trial-related scientific papers, to infuse clinical knowledge into the model by pre-training. We further curate TrialInstruct, which has 200,866 of instruction data for fine-tuning. These resources enable Panacea to be widely applicable for a range of clinical trial tasks based on user requirements. We evaluated Panacea on a new benchmark, named TrialPanorama, which covers eight clinical trial tasks. Our method performed the best on seven of the eight tasks compared to six cutting-edge generic or medicine-specific LLMs. Specifically, Panacea showed great potential to collaborate with human experts in crafting the design of eligibility criteria, study arms, and outcome measures, in multi-round conversations. In addition, Panacea achieved 14.42% improvement in patient-trial matching, 41.78% to 52.02% improvement in trial search, and consistently ranked at the top for five aspects of trial summarization. Our approach demonstrates the effectiveness of Panacea in clinical trials and establishes a comprehensive resource, including training data, model, and benchmark, for developing clinical trial foundation models, paving the path for AI-based clinical trial development.

The rapid progression of multimodal large language models (MLLMs) has demonstrated superior performance on various multimodal benchmarks. However, the issue of data contamination during training creates challenges in performance evaluation and comparison. While numerous methods exist for detecting dataset contamination in large language models (LLMs), they are less effective for MLLMs due to their various modalities and multiple training phases. In this study, we introduce a multimodal data contamination detection framework, MM-Detect, designed for MLLMs. Our experimental results indicate that MM-Detect is sensitive to varying degrees of contamination and can highlight significant performance improvements due to leakage of the training set of multimodal benchmarks. Furthermore, We also explore the possibility of contamination originating from the pre-training phase of LLMs used by MLLMs and the fine-tuning phase of MLLMs, offering new insights into the stages at which contamination may be introduced.

Recent advancements indicate that scaling up Multimodal Large Language Models (MLLMs) effectively enhances performance on downstream multimodal tasks. The prevailing MLLM paradigm, e.g., LLaVA, transforms visual features into text-like tokens using a static vision-language mapper, thereby enabling static LLMs to develop the capability to comprehend visual information through visual instruction tuning. Although promising, the static tuning strategy~The static tuning refers to the trained model with static parameters. that shares the same parameters may constrain performance across different downstream multimodal tasks. In light of this, we introduce HyperLLaVA, which involves adaptive tuning of the projector and LLM parameters, in conjunction with a dynamic visual expert and language expert, respectively. These experts are derived from HyperNetworks, which generates adaptive parameter shifts through visual and language guidance, enabling dynamic projector and LLM modeling in two-stage training. Our experiments demonstrate that our solution significantly surpasses LLaVA on existing MLLM benchmarks, including MME, MMBench, SEED-Bench, and LLaVA-Bench. ~Our project is available on the link https://github.com/DCDmllm/HyperLLaVA.

Large Multimodal Models (LMMs) have shown remarkable progress in the field of medical Visual Question Answering (Med-VQA), achieving high accuracy on existing benchmarks. However, their reliability under robust evaluation is questionable. This study reveals that state-of-the-art models, when subjected to simple probing evaluation, perform worse than random guessing on medical diagnosis questions. To address this critical evaluation problem, we introduce the Probing Evaluation for Medical Diagnosis (ProbMed) dataset to rigorously assess LMM performance in medical imaging through probing evaluation and procedural diagnosis. Particularly, probing evaluation features pairing original questions with negation questions with hallucinated attributes, while procedural diagnosis requires reasoning across various diagnostic dimensions for each image, including modality recognition, organ identification, clinical findings, abnormalities, and positional grounding. Our evaluation reveals that top-performing models like GPT-4V and Gemini Pro perform worse than random guessing on specialized diagnostic questions, indicating significant limitations in handling fine-grained medical inquiries. Besides, models like LLaVA-Med struggle even with more general questions, and results from CheXagent demonstrate the transferability of expertise across different modalities of the same organ, showing that specialized domain knowledge is still crucial for improving performance. This study underscores the urgent need for more robust evaluation to ensure the reliability of LMMs in critical fields like medical diagnosis, and current LMMs are still far from applicable to those fields.

We introduce MIA-Bench, a new benchmark designed to evaluate multimodal large language models (MLLMs) on their ability to strictly adhere to complex instructions. Our benchmark comprises a diverse set of 400 image-prompt pairs, each crafted to challenge the models' compliance with layered instructions in generating accurate responses that satisfy specific requested patterns. Evaluation results from a wide array of state-of-the-art MLLMs reveal significant variations in performance, highlighting areas for improvement in instruction fidelity. Additionally, we create extra training data and explore supervised fine-tuning to enhance the models' ability to strictly follow instructions without compromising performance on other tasks. We hope this benchmark not only serves as a tool for measuring MLLM adherence to instructions, but also guides future developments in MLLM training methods.

Despite significant advancements in general artificial intelligence, such as GPT-4, their effectiveness in the medical domain (general medical AI, GMAI) remains constrained due to the absence of specialized medical knowledge. To address this challenge, we present GMAI-VL-5.5M, a comprehensive multimodal medical dataset created by converting hundreds of specialized medical datasets into meticulously constructed image-text pairs. This dataset features comprehensive task coverage, diverse modalities, and high-quality image-text data. Building upon this multimodal dataset, we propose GMAI-VL, a general medical vision-language model with a progressively three-stage training strategy. This approach significantly enhances the model's ability by integrating visual and textual information, thereby improving its ability to process multimodal data and support accurate diagnosis and clinical decision-making. Experimental evaluations demonstrate that GMAI-VL achieves state-of-the-art results across a wide range of multimodal medical tasks, such as visual question answering and medical image diagnosis. Our contributions include the development of the GMAI-VL-5.5M dataset, the introduction of the GMAI-VL model, and the establishment of new benchmarks in multiple medical domains. Code and dataset will be released at https://github.com/uni-medical/GMAI-VL.

Large language models (LLMs) represent a transformative class of AI tools capable of revolutionizing various aspects of healthcare by generating human-like responses across diverse contexts and adapting to novel tasks following human instructions. Their potential application spans a broad range of medical tasks, such as clinical documentation, matching patients to clinical trials, and answering medical questions. In this primer paper, we propose an actionable guideline to help healthcare professionals more efficiently utilize LLMs in their work, along with a set of best practices. This approach consists of several main phases, including formulating the task, choosing LLMs, prompt engineering, fine-tuning, and deployment. We start with the discussion of critical considerations in identifying healthcare tasks that align with the core capabilities of LLMs and selecting models based on the selected task and data, performance requirements, and model interface. We then review the strategies, such as prompt engineering and fine-tuning, to adapt standard LLMs to specialized medical tasks. Deployment considerations, including regulatory compliance, ethical guidelines, and continuous monitoring for fairness and bias, are also discussed. By providing a structured step-by-step methodology, this tutorial aims to equip healthcare professionals with the tools necessary to effectively integrate LLMs into clinical practice, ensuring that these powerful technologies are applied in a safe, reliable, and impactful manner.

Background: Social media platforms have become a viable source of medical information, with patients and healthcare professionals using them to share health-related information and track diseases. Similarly, YouTube, the largest video-sharing platform in the world contains vlogs where individuals talk about their illnesses. The aim of our study was to investigate the use of Natural Language Processing (NLP) to identify the spoken content of YouTube vlogs related to the diagnosis of Coronavirus disease of 2019 (COVID-19) for public health screening. Methods: COVID-19 videos on YouTube were searched using relevant keywords. A total of 1000 videos being spoken in English were downloaded out of which 791 were classified as vlogs, 192 were non-vlogs, and 17 were deleted by the channel. The videos were converted into a textual format using Microsoft Streams. The textual data was preprocessed using basic and advanced preprocessing methods. A lexicon of 200 words was created which contained words related to COVID-19. The data was analyzed using topic modeling, word clouds, and lexicon matching. Results: The word cloud results revealed discussions about COVID-19 symptoms like "fever", along with generic terms such as "mask" and "isolation". Lexical analysis demonstrated that in 96.46% of videos, patients discussed generic terms, and in 95.45% of videos, people talked about COVID-19 symptoms. LDA Topic Modeling results also generated topics that successfully captured key themes and content related to our investigation of COVID-19 diagnoses in YouTube vlogs. Conclusion: By leveraging NLP techniques on YouTube vlogs public health practitioners can enhance their ability to mitigate the effects of pandemics and effectively respond to public health challenges.

In the past year, MultiModal Large Language Models (MM-LLMs) have undergone substantial advancements, augmenting off-the-shelf LLMs to support MM inputs or outputs via cost-effective training strategies. The resulting models not only preserve the inherent reasoning and decision-making capabilities of LLMs but also empower a diverse range of MM tasks. In this paper, we provide a comprehensive survey aimed at facilitating further research of MM-LLMs. Specifically, we first outline general design formulations for model architecture and training pipeline. Subsequently, we provide brief introductions of 26 existing MM-LLMs, each characterized by its specific formulations. Additionally, we review the performance of MM-LLMs on mainstream benchmarks and summarize key training recipes to enhance the potency of MM-LLMs. Lastly, we explore promising directions for MM-LLMs while concurrently maintaining a real-time tracking website for the latest developments in the field. We hope that this survey contributes to the ongoing advancement of the MM-LLMs domain.

Recent advances in generative models, including large language models (LLMs), vision language models (VLMs), and diffusion models, have accelerated the field of natural language and image processing in medicine and marked a significant paradigm shift in how biomedical models can be developed and deployed. While these models are highly adaptable to new tasks, scaling and evaluating their usage presents new challenges not addressed in previous frameworks. In particular, the ability of these models to produce useful outputs with little to no specialized training data ("zero-" or "few-shot" approaches), as well as the open-ended nature of their outputs, necessitate the development of new guidelines for robust reporting of clinical generative model research. In response to gaps in standards and best practices for the development of clinical AI tools identified by US Executive Order 141103 and several emerging national networks for clinical AI evaluation, we begin to formalize some of these guidelines by building on the original MI-CLAIM checklist. The new checklist, MI-CLAIM-GEN (Table 1), aims to address differences in training, evaluation, interpretability, and reproducibility of new generative models compared to non-generative ("predictive") AI models. This MI-CLAIM-GEN checklist also seeks to clarify cohort selection reporting with unstructured clinical data and adds additional items on alignment with ethical standards for clinical AI research.