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Mar 11

Synthetic Patients: Simulating Difficult Conversations with Multimodal Generative AI for Medical Education

Problem: Effective patient-centered communication is a core competency for physicians. However, both seasoned providers and medical trainees report decreased confidence in leading conversations on sensitive topics such as goals of care or end-of-life discussions. The significant administrative burden and the resources required to provide dedicated training in leading difficult conversations has been a long-standing problem in medical education. Approach: In this work, we present a novel educational tool designed to facilitate interactive, real-time simulations of difficult conversations in a video-based format through the use of multimodal generative artificial intelligence (AI). Leveraging recent advances in language modeling, computer vision, and generative audio, this tool creates realistic, interactive scenarios with avatars, or "synthetic patients." These synthetic patients interact with users throughout various stages of medical care using a custom-built video chat application, offering learners the chance to practice conversations with patients from diverse belief systems, personalities, and ethnic backgrounds. Outcomes: While the development of this platform demanded substantial upfront investment in labor, it offers a highly-realistic simulation experience with minimal financial investment. For medical trainees, this educational tool can be implemented within programs to simulate patient-provider conversations and can be incorporated into existing palliative care curriculum to provide a scalable, high-fidelity simulation environment for mastering difficult conversations. Next Steps: Future developments will explore enhancing the authenticity of these encounters by working with patients to incorporate their histories and personalities, as well as employing the use of AI-generated evaluations to offer immediate, constructive feedback to learners post-simulation.

Truthful AI: Developing and governing AI that does not lie

In many contexts, lying -- the use of verbal falsehoods to deceive -- is harmful. While lying has traditionally been a human affair, AI systems that make sophisticated verbal statements are becoming increasingly prevalent. This raises the question of how we should limit the harm caused by AI "lies" (i.e. falsehoods that are actively selected for). Human truthfulness is governed by social norms and by laws (against defamation, perjury, and fraud). Differences between AI and humans present an opportunity to have more precise standards of truthfulness for AI, and to have these standards rise over time. This could provide significant benefits to public epistemics and the economy, and mitigate risks of worst-case AI futures. Establishing norms or laws of AI truthfulness will require significant work to: (1) identify clear truthfulness standards; (2) create institutions that can judge adherence to those standards; and (3) develop AI systems that are robustly truthful. Our initial proposals for these areas include: (1) a standard of avoiding "negligent falsehoods" (a generalisation of lies that is easier to assess); (2) institutions to evaluate AI systems before and after real-world deployment; and (3) explicitly training AI systems to be truthful via curated datasets and human interaction. A concerning possibility is that evaluation mechanisms for eventual truthfulness standards could be captured by political interests, leading to harmful censorship and propaganda. Avoiding this might take careful attention. And since the scale of AI speech acts might grow dramatically over the coming decades, early truthfulness standards might be particularly important because of the precedents they set.

Causal Inference by String Diagram Surgery

Extracting causal relationships from observed correlations is a growing area in probabilistic reasoning, originating with the seminal work of Pearl and others from the early 1990s. This paper develops a new, categorically oriented view based on a clear distinction between syntax (string diagrams) and semantics (stochastic matrices), connected via interpretations as structure-preserving functors. A key notion in the identification of causal effects is that of an intervention, whereby a variable is forcefully set to a particular value independent of any prior propensities. We represent the effect of such an intervention as an endofunctor which performs `string diagram surgery' within the syntactic category of string diagrams. This diagram surgery in turn yields a new, interventional distribution via the interpretation functor. While in general there is no way to compute interventional distributions purely from observed data, we show that this is possible in certain special cases using a calculational tool called comb disintegration. We demonstrate the use of this technique on a well-known toy example, where we predict the causal effect of smoking on cancer in the presence of a confounding common cause. After developing this specific example, we show this technique provides simple sufficient conditions for computing interventions which apply to a wide variety of situations considered in the causal inference literature.

Image-based Treatment Effect Heterogeneity

Randomized controlled trials (RCTs) are considered the gold standard for estimating the average treatment effect (ATE) of interventions. One use of RCTs is to study the causes of global poverty -- a subject explicitly cited in the 2019 Nobel Memorial Prize awarded to Duflo, Banerjee, and Kremer "for their experimental approach to alleviating global poverty." Because the ATE is a population summary, anti-poverty experiments often seek to unpack the effect variation around the ATE by conditioning (CATE) on tabular variables such as age and ethnicity that were measured during the RCT data collection. Although such variables are key to unpacking CATE, using only such variables may fail to capture historical, geographical, or neighborhood-specific contributors to effect variation, as tabular RCT data are often only observed near the time of the experiment. In global poverty research, when the location of the experiment units is approximately known, satellite imagery can provide a window into such factors important for understanding heterogeneity. However, there is no method that specifically enables applied researchers to analyze CATE from images. In this paper, using a deep probabilistic modeling framework, we develop such a method that estimates latent clusters of images by identifying images with similar treatment effects distributions. Our interpretable image CATE model also includes a sensitivity factor that quantifies the importance of image segments contributing to the effect cluster prediction. We compare the proposed methods against alternatives in simulation; also, we show how the model works in an actual RCT, estimating the effects of an anti-poverty intervention in northern Uganda and obtaining a posterior predictive distribution over effects for the rest of the country where no experimental data was collected. We make all models available in open-source software.

Alice in Wonderland: Simple Tasks Showing Complete Reasoning Breakdown in State-Of-the-Art Large Language Models

Large Language Models (LLMs) are often described as being instances of foundation models - that is, models that transfer strongly across various tasks and conditions in few-show or zero-shot manner, while exhibiting scaling laws that predict function improvement when increasing the pre-training scale. These claims of excelling in different functions and tasks rely on measurements taken across various sets of standardized benchmarks showing high scores for such models. We demonstrate here a dramatic breakdown of function and reasoning capabilities of state-of-the-art models trained at the largest available scales which claim strong function, using a simple, short, conventional common sense problem formulated in concise natural language, easily solvable by humans. The breakdown is dramatic, as models also express strong overconfidence in their wrong solutions, while providing often non-sensical "reasoning"-like explanations akin to confabulations to justify and backup the validity of their clearly failed responses, making them sound plausible. Various standard interventions in an attempt to get the right solution, like various type of enhanced prompting, or urging the models to reconsider the wrong solutions again by multi step re-evaluation, fail. We take these initial observations to the scientific and technological community to stimulate urgent re-assessment of the claimed capabilities of current generation of LLMs, Such re-assessment also requires common action to create standardized benchmarks that would allow proper detection of such basic reasoning deficits that obviously manage to remain undiscovered by current state-of-the-art evaluation procedures and benchmarks. Code for reproducing experiments in the paper and raw experiments data can be found at https://github.com/LAION-AI/AIW

Measuring Large Language Models Capacity to Annotate Journalistic Sourcing

Since the launch of ChatGPT in late 2022, the capacities of Large Language Models and their evaluation have been in constant discussion and evaluation both in academic research and in the industry. Scenarios and benchmarks have been developed in several areas such as law, medicine and math (Bommasani et al., 2023) and there is continuous evaluation of model variants. One area that has not received sufficient scenario development attention is journalism, and in particular journalistic sourcing and ethics. Journalism is a crucial truth-determination function in democracy (Vincent, 2023), and sourcing is a crucial pillar to all original journalistic output. Evaluating the capacities of LLMs to annotate stories for the different signals of sourcing and how reporters justify them is a crucial scenario that warrants a benchmark approach. It offers potential to build automated systems to contrast more transparent and ethically rigorous forms of journalism with everyday fare. In this paper we lay out a scenario to evaluate LLM performance on identifying and annotating sourcing in news stories on a five-category schema inspired from journalism studies (Gans, 2004). We offer the use case, our dataset and metrics and as the first step towards systematic benchmarking. Our accuracy findings indicate LLM-based approaches have more catching to do in identifying all the sourced statements in a story, and equally, in matching the type of sources. An even harder task is spotting source justifications.

Improving Interpersonal Communication by Simulating Audiences with Language Models

How do we communicate with others to achieve our goals? We use our prior experience or advice from others, or construct a candidate utterance by predicting how it will be received. However, our experiences are limited and biased, and reasoning about potential outcomes can be difficult and cognitively challenging. In this paper, we explore how we can leverage Large Language Model (LLM) simulations to help us communicate better. We propose the Explore-Generate-Simulate (EGS) framework, which takes as input any scenario where an individual is communicating to an audience with a goal they want to achieve. EGS (1) explores the solution space by producing a diverse set of advice relevant to the scenario, (2) generates communication candidates conditioned on subsets of the advice, and (3) simulates the reactions from various audiences to determine both the best candidate and advice to use. We evaluate the framework on eight scenarios spanning the ten fundamental processes of interpersonal communication. For each scenario, we collect a dataset of human evaluations across candidates and baselines, and showcase that our framework's chosen candidate is preferred over popular generation mechanisms including Chain-of-Thought. We also find that audience simulations achieve reasonably high agreement with human raters across 5 of the 8 scenarios. Finally, we demonstrate the generality of our framework by applying it to real-world scenarios described by users on web forums. Through evaluations and demonstrations, we show that EGS enhances the effectiveness and outcomes of goal-oriented communication across a variety of situations, thus opening up new possibilities for the application of large language models in revolutionizing communication and decision-making processes.

Therapy as an NLP Task: Psychologists' Comparison of LLMs and Human Peers in CBT

Wider access to therapeutic care is one of the biggest challenges in mental health treatment. Due to institutional barriers, some people seeking mental health support have turned to large language models (LLMs) for personalized therapy, even though these models are largely unsanctioned and untested. We investigate the potential and limitations of using LLMs as providers of evidence-based therapy by using mixed methods clinical metrics. Using HELPERT, a prompt run on a large language model using the same process and training as a comparative group of peer counselors, we replicated publicly accessible mental health conversations rooted in Cognitive Behavioral Therapy (CBT) to compare session dynamics and counselor's CBT-based behaviors between original peer support sessions and their reconstructed HELPERT sessions. Two licensed, CBT-trained clinical psychologists evaluated the sessions using the Cognitive Therapy Rating Scale and provided qualitative feedback. Our findings show that the peer sessions are characterized by empathy, small talk, therapeutic alliance, and shared experiences but often exhibit therapist drift. Conversely, HELPERT reconstructed sessions exhibit minimal therapist drift and higher adherence to CBT methods but display a lack of collaboration, empathy, and cultural understanding. Through CTRS ratings and psychologists' feedback, we highlight the importance of human-AI collaboration for scalable mental health. Our work outlines the ethical implication of imparting human-like subjective qualities to LLMs in therapeutic settings, particularly the risk of deceptive empathy, which may lead to unrealistic patient expectations and potential harm.

Detecting Fallacies in Climate Misinformation: A Technocognitive Approach to Identifying Misleading Argumentation

Misinformation about climate change is a complex societal issue requiring holistic, interdisciplinary solutions at the intersection between technology and psychology. One proposed solution is a "technocognitive" approach, involving the synthesis of psychological and computer science research. Psychological research has identified that interventions in response to misinformation require both fact-based (e.g., factual explanations) and technique-based (e.g., explanations of misleading techniques) content. However, little progress has been made on documenting and detecting fallacies in climate misinformation. In this study, we apply a previously developed critical thinking methodology for deconstructing climate misinformation, in order to develop a dataset mapping different types of climate misinformation to reasoning fallacies. This dataset is used to train a model to detect fallacies in climate misinformation. Our study shows F1 scores that are 2.5 to 3.5 better than previous works. The fallacies that are easiest to detect include fake experts and anecdotal arguments, while fallacies that require background knowledge, such as oversimplification, misrepresentation, and slothful induction, are relatively more difficult to detect. This research lays the groundwork for development of solutions where automatically detected climate misinformation can be countered with generative technique-based corrections.

Zero-shot Persuasive Chatbots with LLM-Generated Strategies and Information Retrieval

Persuasion plays a pivotal role in a wide range of applications from health intervention to the promotion of social good. Persuasive chatbots can accelerate the positive effects of persuasion in such applications. Existing methods rely on fine-tuning persuasive chatbots with task-specific training data which is costly, if not infeasible, to collect. To address this issue, we propose a method to leverage the generalizability and inherent persuasive abilities of large language models (LLMs) in creating effective and truthful persuasive chatbot for any given domain in a zero-shot manner. Unlike previous studies which used pre-defined persuasion strategies, our method first uses an LLM to generate responses, then extracts the strategies used on the fly, and replaces any unsubstantiated claims in the response with retrieved facts supporting the strategies. We applied our chatbot, PersuaBot, to three significantly different domains needing persuasion skills: donation solicitation, recommendations, and health intervention. Our experiments on simulated and human conversations show that our zero-shot approach is more persuasive than prior work, while achieving factual accuracy surpassing state-of-the-art knowledge-oriented chatbots. Our study demonstrated that when persuasive chatbots are employed responsibly for social good, it is an enabler of positive individual and social change.