Daily Papers

Quantification of real-time informal feedback delivered by an experienced surgeon to a trainee during surgery is important for skill improvements in surgical training. Such feedback in the live operating room is inherently multimodal, consisting of verbal conversations (e.g., questions and answers) as well as non-verbal elements (e.g., through visual cues like pointing to anatomic elements). In this work, we leverage a clinically-validated five-category classification of surgical feedback: "Anatomic", "Technical", "Procedural", "Praise" and "Visual Aid". We then develop a multi-label machine learning model to classify these five categories of surgical feedback from inputs of text, audio, and video modalities. The ultimate goal of our work is to help automate the annotation of real-time contextual surgical feedback at scale. Our automated classification of surgical feedback achieves AUCs ranging from 71.5 to 77.6 with the fusion improving performance by 3.1%. We also show that high-quality manual transcriptions of feedback audio from experts improve AUCs to between 76.5 and 96.2, which demonstrates a clear path toward future improvements. Empirically, we find that the Staged training strategy, with first pre-training each modality separately and then training them jointly, is more effective than training different modalities altogether. We also present intuitive findings on the importance of modalities for different feedback categories. This work offers an important first look at the feasibility of automated classification of real-world live surgical feedback based on text, audio, and video modalities.

During surgical training, real-time feedback from trainers to trainees is important for preventing errors and enhancing long-term skill acquisition. Accurately predicting the effectiveness of this feedback, specifically whether it leads to a change in trainee behavior, is crucial for developing methods for improving surgical training and education. However, relying on human annotations to assess feedback effectiveness is laborious and prone to biases, underscoring the need for an automated, scalable, and objective method. Creating such an automated system poses challenges, as it requires an understanding of both the verbal feedback delivered by the trainer and the visual context of the real-time surgical scene. To address this, we propose a method that integrates information from transcribed verbal feedback and corresponding surgical video to predict feedback effectiveness. Our findings show that both transcribed feedback and surgical video are individually predictive of trainee behavior changes, and their combination achieves an AUROC of 0.70+/-0.02, improving prediction accuracy by up to 6.6%. Additionally, we introduce self-supervised fine-tuning as a strategy for enhancing surgical video representation learning, which is scalable and further enhances prediction performance. Our results demonstrate the potential of multi-modal learning to advance the automated assessment of surgical feedback.

This work introduces the first framework for reconstructing surgical dialogue from unstructured real-world recordings, which is crucial for characterizing teaching tasks. In surgical training, the formative verbal feedback that trainers provide to trainees during live surgeries is crucial for ensuring safety, correcting behavior immediately, and facilitating long-term skill acquisition. However, analyzing and quantifying this feedback is challenging due to its unstructured and specialized nature. Automated systems are essential to manage these complexities at scale, allowing for the creation of structured datasets that enhance feedback analysis and improve surgical education. Our framework integrates voice activity detection, speaker diarization, and automated speech recaognition, with a novel enhancement that 1) removes hallucinations (non-existent utterances generated during speech recognition fueled by noise in the operating room) and 2) separates speech from trainers and trainees using few-shot voice samples. These aspects are vital for reconstructing accurate surgical dialogues and understanding the roles of operating room participants. Using data from 33 real-world surgeries, we demonstrated the system's capability to reconstruct surgical teaching dialogues and detect feedback instances effectively (F1 score of 0.79+/-0.07). Moreover, our hallucination removal step improves feedback detection performance by ~14%. Evaluation on downstream clinically relevant tasks of predicting Behavioral Adjustment of trainees and classifying Technical feedback, showed performances comparable to manual annotations with F1 scores of 0.82+/0.03 and 0.81+/0.03 respectively. These results highlight the effectiveness of our framework in supporting clinically relevant tasks and improving over manual methods.

This study investigates GPT-4's assessment of its performance in healthcare applications. A simple prompting technique was used to prompt the LLM with questions taken from the United States Medical Licensing Examination (USMLE) questionnaire and it was tasked to evaluate its confidence score before posing the question and after asking the question. The questionnaire was categorized into two groups-questions with feedback (WF) and questions with no feedback(NF) post-question. The model was asked to provide absolute and relative confidence scores before and after each question. The experimental findings were analyzed using statistical tools to study the variability of confidence in WF and NF groups. Additionally, a sequential analysis was conducted to observe the performance variation for the WF and NF groups. Results indicate that feedback influences relative confidence but doesn't consistently increase or decrease it. Understanding the performance of LLM is paramount in exploring its utility in sensitive areas like healthcare. This study contributes to the ongoing discourse on the reliability of AI, particularly of LLMs like GPT-4, within healthcare, offering insights into how feedback mechanisms might be optimized to enhance AI-assisted medical education and decision support.

The growing capabilities of large language models (LLMs) have led to their use as substitutes for human feedback for training and assessing other LLMs. These methods often rely on `constitutions', written guidelines which a critic model uses to provide feedback and improve generations. We investigate how the choice of constitution affects feedback quality by using four different constitutions to improve patient-centered communication in medical interviews. In pairwise comparisons conducted by 215 human raters, we found that detailed constitutions led to better results regarding emotive qualities. However, none of the constitutions outperformed the baseline in learning more practically-oriented skills related to information gathering and provision. Our findings indicate that while detailed constitutions should be prioritised, there are possible limitations to the effectiveness of AI feedback as a reward signal in certain areas.

Surgical robot automation has attracted increasing research interest over the past decade, expecting its potential to benefit surgeons, nurses and patients. Recently, the learning paradigm of embodied intelligence has demonstrated promising ability to learn good control policies for various complex tasks, where embodied AI simulators play an essential role to facilitate relevant research. However, existing open-sourced simulators for surgical robot are still not sufficiently supporting human interactions through physical input devices, which further limits effective investigations on how the human demonstrations would affect policy learning. In this work, we study human-in-the-loop embodied intelligence with a new interactive simulation platform for surgical robot learning. Specifically, we establish our platform based on our previously released SurRoL simulator with several new features co-developed to allow high-quality human interaction via an input device. We showcase the improvement of our simulation environment with the designed new features, and validate effectiveness of incorporating human factors in embodied intelligence through the use of human demonstrations and reinforcement learning as a representative example. Promising results are obtained in terms of learning efficiency. Lastly, five new surgical robot training tasks are developed and released, with which we hope to pave the way for future research on surgical embodied intelligence. Our learning platform is publicly released and will be continuously updated in the website: https://med-air.github.io/SurRoL.

In this work, we take aim towards increasing the effectiveness of surgical assistant robots. We intended to make assistant robots safer by making them aware about the actions of surgeon, so it can take appropriate assisting actions. In other words, we aim to solve the problem of surgeon action detection in endoscopic videos. To this, we introduce a challenging dataset for surgeon action detection in real-world endoscopic videos. Action classes are picked based on the feedback of surgeons and annotated by medical professional. Given a video frame, we draw bounding box around surgical tool which is performing action and label it with action label. Finally, we presenta frame-level action detection baseline model based on recent advances in ob-ject detection. Results on our new dataset show that our presented dataset provides enough interesting challenges for future method and it can serveas strong benchmark corresponding research in surgeon action detection in endoscopic videos.

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

The field of computer vision applied to videos of minimally invasive surgery is ever-growing. Workflow recognition pertains to the automated recognition of various aspects of a surgery: including which surgical steps are performed; and which surgical instruments are used. This information can later be used to assist clinicians when learning the surgery; during live surgery; and when writing operation notes. The Pituitary Vision (PitVis) 2023 Challenge tasks the community to step and instrument recognition in videos of endoscopic pituitary surgery. This is a unique task when compared to other minimally invasive surgeries due to the smaller working space, which limits and distorts vision; and higher frequency of instrument and step switching, which requires more precise model predictions. Participants were provided with 25-videos, with results presented at the MICCAI-2023 conference as part of the Endoscopic Vision 2023 Challenge in Vancouver, Canada, on 08-Oct-2023. There were 18-submissions from 9-teams across 6-countries, using a variety of deep learning models. A commonality between the top performing models was incorporating spatio-temporal and multi-task methods, with greater than 50% and 10% macro-F1-score improvement over purely spacial single-task models in step and instrument recognition respectively. The PitVis-2023 Challenge therefore demonstrates state-of-the-art computer vision models in minimally invasive surgery are transferable to a new dataset, with surgery specific techniques used to enhance performance, progressing the field further. Benchmark results are provided in the paper, and the dataset is publicly available at: https://doi.org/10.5522/04/26531686.

Frozen models trained to mimic static datasets can never improve their performance. Models that can employ internet-retrieval for up-to-date information and obtain feedback from humans during deployment provide the promise of both adapting to new information, and improving their performance. In this work we study how to improve internet-driven conversational skills in such a learning framework. We collect deployment data, which we make publicly available, of human interactions, and collect various types of human feedback -- including binary quality measurements, free-form text feedback, and fine-grained reasons for failure. We then study various algorithms for improving from such feedback, including standard supervised learning, rejection sampling, model-guiding and reward-based learning, in order to make recommendations on which type of feedback and algorithms work best. We find the recently introduced Director model (Arora et al., '22) shows significant improvements over other existing approaches.

In this work, we develop an open-source surgical simulation environment that includes a realistic model obtained by MRI-scanning a physical phantom, for the purpose of training and evaluating a Learning from Demonstration (LfD) algorithm for autonomous suturing. The LfD algorithm utilizes Dynamic Movement Primitives (DMP) and Locally Weighted Regression (LWR), but focuses on the needle trajectory, rather than the instruments, to obtain better generality with respect to needle grasps. We conduct a user study to collect multiple suturing demonstrations and perform a comprehensive analysis of the ability of the LfD algorithm to generalize from a demonstration at one location in one phantom to different locations in the same phantom and to a different phantom. Our results indicate good generalization, on the order of 91.5%, when learning from more experienced subjects, indicating the need to integrate skill assessment in the future.

The ability to automatically detect and track surgical instruments in endoscopic videos can enable transformational interventions. Assessing surgical performance and efficiency, identifying skilled tool use and choreography, and planning operational and logistical aspects of OR resources are just a few of the applications that could benefit. Unfortunately, obtaining the annotations needed to train machine learning models to identify and localize surgical tools is a difficult task. Annotating bounding boxes frame-by-frame is tedious and time-consuming, yet large amounts of data with a wide variety of surgical tools and surgeries must be captured for robust training. Moreover, ongoing annotator training is needed to stay up to date with surgical instrument innovation. In robotic-assisted surgery, however, potentially informative data like timestamps of instrument installation and removal can be programmatically harvested. The ability to rely on tool installation data alone would significantly reduce the workload to train robust tool-tracking models. With this motivation in mind we invited the surgical data science community to participate in the challenge, SurgToolLoc 2022. The goal was to leverage tool presence data as weak labels for machine learning models trained to detect tools and localize them in video frames with bounding boxes. We present the results of this challenge along with many of the team's efforts. We conclude by discussing these results in the broader context of machine learning and surgical data science. The training data used for this challenge consisting of 24,695 video clips with tool presence labels is also being released publicly and can be accessed at https://console.cloud.google.com/storage/browser/isi-surgtoolloc-2022.

AI assistance continues to help advance applications in education, from language learning to intelligent tutoring systems, yet current methods for providing students feedback are still quite limited. Most automatic feedback systems either provide binary correctness feedback, which may not help a student understand how to improve, or require hand-coding feedback templates, which may not generalize to new domains. This can be particularly challenging for physical control tasks, where the rich diversity in student behavior and specialized domains make it challenging to leverage general-purpose assistive tools for providing feedback. We design and build CORGI, a model trained to generate language corrections for physical control tasks, such as learning to ride a bike. CORGI takes in as input a pair of student and expert trajectories, and then generates natural language corrections to help the student improve. We collect and train CORGI over data from three diverse physical control tasks (drawing, steering, and joint movement). Through both automatic and human evaluations, we show that CORGI can (i) generate valid feedback for novel student trajectories, (ii) outperform baselines on domains with novel control dynamics, and (iii) improve student learning in an interactive drawing task.

Today's robot policies exhibit subpar performance when faced with the challenge of generalizing to novel environments. Human corrective feedback is a crucial form of guidance to enable such generalization. However, adapting to and learning from online human corrections is a non-trivial endeavor: not only do robots need to remember human feedback over time to retrieve the right information in new settings and reduce the intervention rate, but also they would need to be able to respond to feedback that can be arbitrary corrections about high-level human preferences to low-level adjustments to skill parameters. In this work, we present Distillation and Retrieval of Online Corrections (DROC), a large language model (LLM)-based system that can respond to arbitrary forms of language feedback, distill generalizable knowledge from corrections, and retrieve relevant past experiences based on textual and visual similarity for improving performance in novel settings. DROC is able to respond to a sequence of online language corrections that address failures in both high-level task plans and low-level skill primitives. We demonstrate that DROC effectively distills the relevant information from the sequence of online corrections in a knowledge base and retrieves that knowledge in settings with new task or object instances. DROC outperforms other techniques that directly generate robot code via LLMs by using only half of the total number of corrections needed in the first round and requires little to no corrections after two iterations. We show further results, videos, prompts and code on https://sites.google.com/stanford.edu/droc .

Large Language Models (LLMs) such as GPT & Llama have demonstrated significant achievements in summarization tasks but struggle with factual inaccuracies, a critical issue in clinical NLP applications where errors could lead to serious consequences. To counter the high costs and limited availability of expert-annotated data for factual alignment, this study introduces an innovative pipeline that utilizes >100B parameter GPT variants like GPT-3.5 & GPT-4 to act as synthetic experts to generate high-quality synthetics feedback aimed at enhancing factual consistency in clinical note summarization. Our research primarily focuses on edit feedback generated by these synthetic feedback experts without additional human annotations, mirroring and optimizing the practical scenario in which medical professionals refine AI system outputs. Although such 100B+ parameter GPT variants have proven to demonstrate expertise in various clinical NLP tasks, such as the Medical Licensing Examination, there is scant research on their capacity to act as synthetic feedback experts and deliver expert-level edit feedback for improving the generation quality of weaker (<10B parameter) LLMs like GPT-2 (1.5B) & Llama 2 (7B) in clinical domain. So in this work, we leverage 100B+ GPT variants to act as synthetic feedback experts offering expert-level edit feedback, that is used to reduce hallucinations and align weaker (<10B parameter) LLMs with medical facts using two distinct alignment algorithms (DPO & SALT), endeavoring to narrow the divide between AI-generated content and factual accuracy. This highlights the substantial potential of LLM-based synthetic edits in enhancing the alignment of clinical factuality.

Expert feedback lays the foundation of rigorous research. However, the rapid growth of scholarly production and intricate knowledge specialization challenge the conventional scientific feedback mechanisms. High-quality peer reviews are increasingly difficult to obtain. Researchers who are more junior or from under-resourced settings have especially hard times getting timely feedback. With the breakthrough of large language models (LLM) such as GPT-4, there is growing interest in using LLMs to generate scientific feedback on research manuscripts. However, the utility of LLM-generated feedback has not been systematically studied. To address this gap, we created an automated pipeline using GPT-4 to provide comments on the full PDFs of scientific papers. We evaluated the quality of GPT-4's feedback through two large-scale studies. We first quantitatively compared GPT-4's generated feedback with human peer reviewer feedback in 15 Nature family journals (3,096 papers in total) and the ICLR machine learning conference (1,709 papers). The overlap in the points raised by GPT-4 and by human reviewers (average overlap 30.85% for Nature journals, 39.23% for ICLR) is comparable to the overlap between two human reviewers (average overlap 28.58% for Nature journals, 35.25% for ICLR). The overlap between GPT-4 and human reviewers is larger for the weaker papers. We then conducted a prospective user study with 308 researchers from 110 US institutions in the field of AI and computational biology to understand how researchers perceive feedback generated by our GPT-4 system on their own papers. Overall, more than half (57.4%) of the users found GPT-4 generated feedback helpful/very helpful and 82.4% found it more beneficial than feedback from at least some human reviewers. While our findings show that LLM-generated feedback can help researchers, we also identify several limitations.

Feedback is crucial for every design process, such as user interface (UI) design, and automating design critiques can significantly improve the efficiency of the design workflow. Although existing multimodal large language models (LLMs) excel in many tasks, they often struggle with generating high-quality design critiques -- a complex task that requires producing detailed design comments that are visually grounded in a given design's image. Building on recent advancements in iterative refinement of text output and visual prompting methods, we propose an iterative visual prompting approach for UI critique that takes an input UI screenshot and design guidelines and generates a list of design comments, along with corresponding bounding boxes that map each comment to a specific region in the screenshot. The entire process is driven completely by LLMs, which iteratively refine both the text output and bounding boxes using few-shot samples tailored for each step. We evaluated our approach using Gemini-1.5-pro and GPT-4o, and found that human experts generally preferred the design critiques generated by our pipeline over those by the baseline, with the pipeline reducing the gap from human performance by 50% for one rating metric. To assess the generalizability of our approach to other multimodal tasks, we applied our pipeline to open-vocabulary object and attribute detection, and experiments showed that our method also outperformed the baseline.

Recent developments in large language models (LLMs) have been impressive. However, these models sometimes show inconsistencies and problematic behavior, such as hallucinating facts, generating flawed code, or creating offensive and toxic content. Unlike these models, humans typically utilize external tools to cross-check and refine their initial content, like using a search engine for fact-checking, or a code interpreter for debugging. Inspired by this observation, we introduce a framework called CRITIC that allows LLMs, which are essentially "black boxes" to validate and progressively amend their own outputs in a manner similar to human interaction with tools. More specifically, starting with an initial output, CRITIC interacts with appropriate tools to evaluate certain aspects of the text, and then revises the output based on the feedback obtained during this validation process. Comprehensive evaluations involving free-form question answering, mathematical program synthesis, and toxicity reduction demonstrate that CRITIC consistently enhances the performance of LLMs. Meanwhile, our research highlights the crucial importance of external feedback in promoting the ongoing self-improvement of LLMs.

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

Many recent advances in natural language generation have been fueled by training large language models on internet-scale data. However, this paradigm can lead to models that generate toxic, inaccurate, and unhelpful content, and automatic evaluation metrics often fail to identify these behaviors. As models become more capable, human feedback is an invaluable signal for evaluating and improving models. This survey aims to provide an overview of the recent research that has leveraged human feedback to improve natural language generation. First, we introduce an encompassing formalization of feedback, and identify and organize existing research into a taxonomy following this formalization. Next, we discuss how feedback can be described by its format and objective, and cover the two approaches proposed to use feedback (either for training or decoding): directly using the feedback or training feedback models. We also discuss existing datasets for human-feedback data collection, and concerns surrounding feedback collection. Finally, we provide an overview of the nascent field of AI feedback, which exploits large language models to make judgments based on a set of principles and minimize the need for human intervention.

Reinforcement learning from human feedback (RLHF) is fundamentally limited by the capacity of humans to correctly evaluate model output. To improve human evaluation ability and overcome that limitation this work trains "critic" models that help humans to more accurately evaluate model-written code. These critics are themselves LLMs trained with RLHF to write natural language feedback highlighting problems in code from real-world assistant tasks. On code containing naturally occurring LLM errors model-written critiques are preferred over human critiques in 63% of cases, and human evaluation finds that models catch more bugs than human contractors paid for code review. We further confirm that our fine-tuned LLM critics can successfully identify hundreds of errors in ChatGPT training data rated as "flawless", even though the majority of those tasks are non-code tasks and thus out-of-distribution for the critic model. Critics can have limitations of their own, including hallucinated bugs that could mislead humans into making mistakes they might have otherwise avoided, but human-machine teams of critics and contractors catch similar numbers of bugs to LLM critics while hallucinating less than LLMs alone.

Lectures are a learning experience for both students and teachers. Students learn from teachers about the subject material, while teachers learn from students about how to refine their instruction. However, online student feedback is unstructured and abundant, making it challenging for teachers to learn and improve. We take a step towards tackling this challenge. First, we contribute a dataset for studying this problem: SIGHT is a large dataset of 288 math lecture transcripts and 15,784 comments collected from the Massachusetts Institute of Technology OpenCourseWare (MIT OCW) YouTube channel. Second, we develop a rubric for categorizing feedback types using qualitative analysis. Qualitative analysis methods are powerful in uncovering domain-specific insights, however they are costly to apply to large data sources. To overcome this challenge, we propose a set of best practices for using large language models (LLMs) to cheaply classify the comments at scale. We observe a striking correlation between the model's and humans' annotation: Categories with consistent human annotations (>0.9 inter-rater reliability, IRR) also display higher human-model agreement (>0.7), while categories with less consistent human annotations (0.7-0.8 IRR) correspondingly demonstrate lower human-model agreement (0.3-0.5). These techniques uncover useful student feedback from thousands of comments, costing around 0.002$ per comment. We conclude by discussing exciting future directions on using online student feedback and improving automated annotation techniques for qualitative research.

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.

We introduce UbiPhysio, a milestone framework that delivers fine-grained action description and feedback in natural language to support people's daily functioning, fitness, and rehabilitation activities. This expert-like capability assists users in properly executing actions and maintaining engagement in remote fitness and rehabilitation programs. Specifically, the proposed UbiPhysio framework comprises a fine-grained action descriptor and a knowledge retrieval-enhanced feedback module. The action descriptor translates action data, represented by a set of biomechanical movement features we designed based on clinical priors, into textual descriptions of action types and potential movement patterns. Building on physiotherapeutic domain knowledge, the feedback module provides clear and engaging expert feedback. We evaluated UbiPhysio's performance through extensive experiments with data from 104 diverse participants, collected in a home-like setting during 25 types of everyday activities and exercises. We assessed the quality of the language output under different tuning strategies using standard benchmarks. We conducted a user study to gather insights from clinical physiotherapists and potential users about our framework. Our initial tests show promise for deploying UbiPhysio in real-life settings without specialized devices.

Providing high-quality feedback is crucial for student success but is constrained by time, cost, and limited data availability. We introduce Synthetic Educational Feedback Loops (SEFL), a novel framework designed to deliver immediate, on-demand feedback at scale without relying on extensive, real-world student data. In SEFL, two large language models (LLMs) operate in teacher--student roles to simulate assignment completion and formative feedback, generating abundant synthetic pairs of student work and corresponding critiques. We then fine-tune smaller, more computationally efficient LLMs on these synthetic pairs, enabling them to replicate key features of high-quality, goal-oriented feedback. Unlike personalized tutoring approaches that offer multi-turn, individualized instruction, SEFL specifically focuses on replicating the teacher-->student feedback loop for diverse assignments. Through both LLM-as-a-judge and human evaluations, we demonstrate that SEFL-tuned models outperform their non-tuned counterparts in feedback quality, clarity, and timeliness. These findings reveal SEFL's potential to transform feedback processes for higher education and beyond, offering an ethical and scalable alternative to conventional manual feedback cycles.

When developing new large language models (LLMs), a key step is evaluating their final performance, often by computing the win-rate against a reference model based on external feedback. Human feedback is the gold standard, particularly for capturing nuanced qualities like coherence, readability, and alignment with human expectations. However, human evaluations are costly -- even for large tech companies -- and when conducted with active users, they may negatively impact user experience. A promising alternative is synthetic feedback, where evaluations are conducted by other large language models, including reward models. While this eliminates the need for costly human annotations, it introduces biases that may distort the evaluation process. In this work, we propose a statistically principled framework that integrates human and synthetic feedback to reduce reliance on human annotations while maintaining unbiased win-rate calculations. Our experiments demonstrate a reduction in human annotations by up to 12.2% with an off-the-shelf synthetic evaluator and up to 24.8% with a finetuned variant. Apart from being generalizable, scalable, and free of hyper-parameter tuning, our method offers predictable annotation savings, which can be estimated based on data-dependent characteristics.

Realistic practice and tailored feedback are key processes for training peer counselors with clinical skills. However, existing mechanisms of providing feedback largely rely on human supervision. Peer counselors often lack mechanisms to receive detailed feedback from experienced mentors, making it difficult for them to support the large number of people with mental health issues who use peer counseling. Our work aims to leverage large language models to provide contextualized and multi-level feedback to empower peer counselors, especially novices, at scale. To achieve this, we co-design with a group of senior psychotherapy supervisors to develop a multi-level feedback taxonomy, and then construct a publicly available dataset with comprehensive feedback annotations of 400 emotional support conversations. We further design a self-improvement method on top of large language models to enhance the automatic generation of feedback. Via qualitative and quantitative evaluation with domain experts, we demonstrate that our method minimizes the risk of potentially harmful and low-quality feedback generation which is desirable in such high-stakes scenarios.

Over the past decade, computer vision applications in minimally invasive surgery have rapidly increased. Despite this growth, the impact of surgical computer vision remains limited compared to other medical fields like pathology and radiology, primarily due to the scarcity of representative annotated data. Whereas transfer learning from large annotated datasets such as ImageNet has been conventionally the norm to achieve high-performing models, recent advancements in self-supervised learning (SSL) have demonstrated superior performance. In medical image analysis, in-domain SSL pretraining has already been shown to outperform ImageNet-based initialization. Although unlabeled data in the field of surgical computer vision is abundant, the diversity within this data is limited. This study investigates the role of dataset diversity in SSL for surgical computer vision, comparing procedure-specific datasets against a more heterogeneous general surgical dataset across three different downstream surgical applications. The obtained results show that using solely procedure-specific data can lead to substantial improvements of 13.8%, 9.5%, and 36.8% compared to ImageNet pretraining. However, extending this data with more heterogeneous surgical data further increases performance by an additional 5.0%, 5.2%, and 2.5%, suggesting that increasing diversity within SSL data is beneficial for model performance. The code and pretrained model weights are made publicly available at https://github.com/TimJaspers0801/SurgeNet.

Several studies showed that Large Language Models (LLMs) can answer medical questions correctly, even outperforming the average human score in some medical exams. However, to our knowledge, no study has been conducted to assess the ability of language models to validate existing or generated medical text for correctness and consistency. In this paper, we introduce MEDEC (https://github.com/abachaa/MEDEC), the first publicly available benchmark for medical error detection and correction in clinical notes, covering five types of errors (Diagnosis, Management, Treatment, Pharmacotherapy, and Causal Organism). MEDEC consists of 3,848 clinical texts, including 488 clinical notes from three US hospital systems that were not previously seen by any LLM. The dataset has been used for the MEDIQA-CORR shared task to evaluate seventeen participating systems [Ben Abacha et al., 2024]. In this paper, we describe the data creation methods and we evaluate recent LLMs (e.g., o1-preview, GPT-4, Claude 3.5 Sonnet, and Gemini 2.0 Flash) for the tasks of detecting and correcting medical errors requiring both medical knowledge and reasoning capabilities. We also conducted a comparative study where two medical doctors performed the same task on the MEDEC test set. The results showed that MEDEC is a sufficiently challenging benchmark to assess the ability of models to validate existing or generated notes and to correct medical errors. We also found that although recent LLMs have a good performance in error detection and correction, they are still outperformed by medical doctors in these tasks. We discuss the potential factors behind this gap, the insights from our experiments, the limitations of current evaluation metrics, and share potential pointers for future research.

Human feedback can prevent overtly harmful utterances in conversational models, but may not automatically mitigate subtle problematic behaviors such as a stated desire for self-preservation or power. Constitutional AI offers an alternative, replacing human feedback with feedback from AI models conditioned only on a list of written principles. We find this approach effectively prevents the expression of such behaviors. The success of simple principles motivates us to ask: can models learn general ethical behaviors from only a single written principle? To test this, we run experiments using a principle roughly stated as "do what's best for humanity". We find that the largest dialogue models can generalize from this short constitution, resulting in harmless assistants with no stated interest in specific motivations like power. A general principle may thus partially avoid the need for a long list of constitutions targeting potentially harmful behaviors. However, more detailed constitutions still improve fine-grained control over specific types of harms. This suggests both general and specific principles have value for steering AI safely.

Computer-assisted surgery has been developed to enhance surgery correctness and safety. However, researchers and engineers suffer from limited annotated data to develop and train better algorithms. Consequently, the development of fundamental algorithms such as Simultaneous Localization and Mapping (SLAM) is limited. This article elaborates on the efforts of preparing the dataset for semantic segmentation, which is the foundation of many computer-assisted surgery mechanisms. Based on the Cholec80 dataset [3], we extracted 8,080 laparoscopic cholecystectomy image frames from 17 video clips in Cholec80 and annotated the images. The dataset is named CholecSeg8K and its total size is 3GB. Each of these images is annotated at pixel-level for thirteen classes, which are commonly founded in laparoscopic cholecystectomy surgery. CholecSeg8k is released under the license CC BY- NC-SA 4.0.

Learning from human feedback is a prominent technique to align the output of large language models (LLMs) with human expectations. Reinforcement learning from human feedback (RLHF) leverages human preference signals that are in the form of ranking of response pairs to perform this alignment. However, human preference on LLM outputs can come in much richer forms including natural language, which may provide detailed feedback on strengths and weaknesses of a given response. In this work we investigate data efficiency of modeling human feedback that is in natural language. Specifically, we fine-tune an open-source LLM, e.g., Falcon-40B-Instruct, on a relatively small amount (1000 records or even less) of human feedback in natural language in the form of critiques and revisions of responses. We show that this model is able to improve the quality of responses from even some of the strongest LLMs such as ChatGPT, BARD, and Vicuna, through critique and revision of those responses. For instance, through one iteration of revision of ChatGPT responses, the revised responses have 56.6% win rate over the original ones, and this win rate can be further improved to 65.9% after applying the revision for five iterations.

In this paper, we study the role of feedback in online learning with switching costs. It has been shown that the minimax regret is Theta(T^{2/3}) under bandit feedback and improves to Theta(T) under full-information feedback, where T is the length of the time horizon. However, it remains largely unknown how the amount and type of feedback generally impact regret. To this end, we first consider the setting of bandit learning with extra observations; that is, in addition to the typical bandit feedback, the learner can freely make a total of B_{ex} extra observations. We fully characterize the minimax regret in this setting, which exhibits an interesting phase-transition phenomenon: when B_{ex} = O(T^{2/3}), the regret remains Theta(T^{2/3}), but when B_{ex} = Omega(T^{2/3}), it becomes Theta(T/B_{mathrm{ex}}), which improves as the budget B_{ex} increases. To design algorithms that can achieve the minimax regret, it is instructive to consider a more general setting where the learner has a budget of B total observations. We fully characterize the minimax regret in this setting as well and show that it is Theta(T/B), which scales smoothly with the total budget B. Furthermore, we propose a generic algorithmic framework, which enables us to design different learning algorithms that can achieve matching upper bounds for both settings based on the amount and type of feedback. One interesting finding is that while bandit feedback can still guarantee optimal regret when the budget is relatively limited, it no longer suffices to achieve optimal regret when the budget is relatively large.

In recent years, the potential applications of machine learning to Minimally Invasive Surgery (MIS) have spurred interest in data sets that can be used to develop data-driven tools. This paper introduces a novel dataset recorded during ex vivo pseudo-cholecystectomy procedures on pig livers, utilizing the da Vinci Research Kit (dVRK). Unlike current datasets, ours bridges a critical gap by offering not only full kinematic data but also capturing all pedal inputs used during the procedure and providing a time-stamped record of the endoscope's movements. Contributed by seven surgeons, this data set introduces a new dimension to surgical robotics research, allowing the creation of advanced models for automating console functionalities. Our work addresses the existing limitation of incomplete recordings and imprecise kinematic data, common in other datasets. By introducing two models, dedicated to predicting clutch usage and camera activation, we highlight the dataset's potential for advancing automation in surgical robotics. The comparison of methodologies and time windows provides insights into the models' boundaries and limitations.

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.

In this technical report we present our collected dataset of laparoscopic cholecystectomies (LapChole). Laparoscopic videos of a total of 20 surgeries were recorded and annotated with surgical phase labels, of which 15 were randomly pre-determined as training data, while the remaining 5 videos are selected as test data. This dataset was later included as part of the M2CAI 2016 workflow detection challenge during MICCAI 2016 in Athens.

Large language models (LLMs) have shown promise for generative and knowledge-intensive tasks including question-answering (QA) tasks. However, the practical deployment still faces challenges, notably the issue of "hallucination", where models generate plausible-sounding but unfaithful or nonsensical information. This issue becomes particularly critical in the medical domain due to the uncommon professional concepts and potential social risks involved. This paper analyses the phenomenon of hallucination in medical generative QA systems using widely adopted LLMs and datasets. Our investigation centers on the identification and comprehension of common problematic answers, with a specific emphasis on hallucination. To tackle this challenge, we present an interactive self-reflection methodology that incorporates knowledge acquisition and answer generation. Through this feedback process, our approach steadily enhances the factuality, consistency, and entailment of the generated answers. Consequently, we harness the interactivity and multitasking ability of LLMs and produce progressively more precise and accurate answers. Experimental results on both automatic and human evaluation demonstrate the superiority of our approach in hallucination reduction compared to baselines.

This paper proposes a feedback mechanism to 'break bad habits' using the Pavlok device. Pavlok utilises beeps, vibration and shocks as a mode of aversion technique to help individuals with behaviour modification. While the device can be useful in certain periodic daily life situations, like alarms and exercise notifications, the device relies on manual operations that limit its usage. To this end, we design a user interface to generate an automatic feedback mechanism that integrates Pavlok and a deep learning based model to detect certain behaviours via an integrated user interface i.e. mobile or desktop application. Our proposed solution is implemented and verified in the context of snoring, which first detects audio from the environment following a prediction of whether the audio content is a snore or not. Based on the prediction of the deep learning model, we use Pavlok to alert users for preventive measures. We believe that this simple solution can help people to change their atomic habits, which may lead to long-term benefits.

Survey data can contain a high number of features while having a comparatively low quantity of examples. Machine learning models that attempt to predict outcomes from survey data under these conditions can overfit and result in poor generalizability. One remedy to this issue is feature selection, which attempts to select an optimal subset of features to learn upon. A relatively unexplored source of information in the feature selection process is the usage of textual names of features, which may be semantically indicative of which features are relevant to a target outcome. The relationships between feature names and target names can be evaluated using language models (LMs) to produce semantic textual similarity (STS) scores, which can then be used to select features. We examine the performance using STS to select features directly and in the minimal-redundancy-maximal-relevance (mRMR) algorithm. The performance of STS as a feature selection metric is evaluated against preliminary survey data collected as a part of a clinical study on persistent post-surgical pain (PPSP). The results suggest that features selected with STS can result in higher performance models compared to traditional feature selection algorithms.

The effectiveness of feedback in enhancing learning outcomes is well documented within Educational Data Mining (EDM). Various prior research has explored methodologies to enhance the effectiveness of feedback. Recent developments in Large Language Models (LLMs) have extended their utility in enhancing automated feedback systems. This study aims to explore the potential of LLMs in facilitating automated feedback in math education. We examine the effectiveness of LLMs in evaluating student responses by comparing 3 different models: Llama, SBERT-Canberra, and GPT4 model. The evaluation requires the model to provide both a quantitative score and qualitative feedback on the student's responses to open-ended math problems. We employ Mistral, a version of Llama catered to math, and fine-tune this model for evaluating student responses by leveraging a dataset of student responses and teacher-written feedback for middle-school math problems. A similar approach was taken for training the SBERT model as well, while the GPT4 model used a zero-shot learning approach. We evaluate the model's performance in scoring accuracy and the quality of feedback by utilizing judgments from 2 teachers. The teachers utilized a shared rubric in assessing the accuracy and relevance of the generated feedback. We conduct both quantitative and qualitative analyses of the model performance. By offering a detailed comparison of these methods, this study aims to further the ongoing development of automated feedback systems and outlines potential future directions for leveraging generative LLMs to create more personalized learning experiences.

This paper investigates the use of deep learning approaches to estimate the femur caput-collum-diaphyseal (CCD) angle from X-ray images. The CCD angle is an important measurement in the diagnosis of hip problems, and correct prediction can help in the planning of surgical procedures. Manual measurement of this angle, on the other hand, can be time-intensive and vulnerable to inter-observer variability. In this paper, we present a deep-learning algorithm that can reliably estimate the femur CCD angle from X-ray images. To train and test the performance of our model, we employed an X-ray image dataset with associated femur CCD angle measurements. Furthermore, we built a prototype to display the resulting predictions and to allow the user to interact with the predictions. As this is happening in a sterile setting during surgery, we expanded our interface to the possibility of being used only by voice commands. Our results show that our deep learning model predicts the femur CCD angle on X-ray images with great accuracy, with a mean absolute error of 4.3 degrees on the left femur and 4.9 degrees on the right femur on the test dataset. Our results suggest that deep learning has the potential to give a more efficient and accurate technique for predicting the femur CCD angle, which might have substantial therapeutic implications for the diagnosis and management of hip problems.

Modern Code Review (MCR) is an informal tool-assisted quality assurance practice. It relies on the asynchronous communication among the authors of code changes and reviewers, who are developers that provide feedback. However, from candidate developers, some are able to provide better feedback than others given a particular context. The selection of reviewers is thus an important task, which can benefit from automated support. Many approaches have been proposed in this direction, using for example data from code review repositories to recommend reviewers. In this paper, we propose the use of team-related features to improve the performance of predictions that are helpful to build code reviewer recommenders, with our target predictions being the identification of reviewers that would participate in a review and the provided amount of feedback. We evaluate the prediction power of these features, which are related to code ownership, workload, and team relationship. This evaluation was done by carefully addressing challenges imposed by the MCR domain, such as temporal aspects of the dataset and unbalanced classes. Moreover, given that it is currently unknown how much past data is needed for building MCR prediction models with acceptable performance, we explore the amount of past data used to build prediction models. Our results show that, individually, features related to code ownership have the best prediction power. However, based on feature selection, we conclude that all proposed features together with lines of code can make the best predictions for both reviewer participation and amount of feedback. Regarding the amount of past data, the timeframes of 3, 6, 9, and 12 months of data produce similar results. Therefore, models can be trained considering short timeframes, thus reducing the computational costs with negligible impact in the prediction performance ...

There is a lack of benchmarks for evaluating large language models (LLMs) in long-form medical question answering (QA). Most existing medical QA evaluation benchmarks focus on automatic metrics and multiple-choice questions. While valuable, these benchmarks fail to fully capture or assess the complexities of real-world clinical applications where LLMs are being deployed. Furthermore, existing studies on evaluating long-form answer generation in medical QA are primarily closed-source, lacking access to human medical expert annotations, which makes it difficult to reproduce results and enhance existing baselines. In this work, we introduce a new publicly available benchmark featuring real-world consumer medical questions with long-form answer evaluations annotated by medical doctors. We performed pairwise comparisons of responses from various open and closed-source medical and general-purpose LLMs based on criteria such as correctness, helpfulness, harmfulness, and bias. Additionally, we performed a comprehensive LLM-as-a-judge analysis to study the alignment between human judgments and LLMs. Our preliminary results highlight the strong potential of open LLMs in medical QA compared to leading closed models. Code & Data: https://github.com/lavita-ai/medical-eval-sphere

Recent advancements in Large Language Models (LLMs) have garnered wide attention and led to successful products such as ChatGPT and GPT-4. Their proficiency in adhering to instructions and delivering harmless, helpful, and honest (3H) responses can largely be attributed to the technique of Reinforcement Learning from Human Feedback (RLHF). In this paper, we aim to link the research in conventional RL to RL techniques used in LLM research. Demystify this technique by discussing why, when, and how RL excels. Furthermore, we explore potential future avenues that could either benefit from or contribute to RLHF research. Highlighted Takeaways: 1. RLHF is Online Inverse RL with Offline Demonstration Data. 2. RLHF > SFT because Imitation Learning (and Inverse RL) > Behavior Cloning (BC) by alleviating the problem of compounding error. 3. The RM step in RLHF generates a proxy of the expensive human feedback, such an insight can be generalized to other LLM tasks such as prompting evaluation and optimization where feedback is also expensive. 4. The policy learning in RLHF is more challenging than conventional problems studied in IRL due to their high action dimensionality and feedback sparsity. 5. The main superiority of PPO over off-policy value-based methods is its stability gained from (almost) on-policy data and conservative policy updates.

Several recent works seek to develop foundation models specifically for medical applications, adapting general-purpose large language models (LLMs) and vision-language models (VLMs) via continued pretraining on publicly available biomedical corpora. These works typically claim that such domain-adaptive pretraining (DAPT) improves performance on downstream medical tasks, such as answering medical licensing exam questions. In this paper, we compare ten public "medical" LLMs and two VLMs against their corresponding base models, arriving at a different conclusion: all medical VLMs and nearly all medical LLMs fail to consistently improve over their base models in the zero-/few-shot prompting and supervised fine-tuning regimes for medical question-answering (QA). For instance, across all tasks and model pairs we consider in the 3-shot setting, medical LLMs only outperform their base models in 22.7% of cases, reach a (statistical) tie in 36.8% of cases, and are significantly worse than their base models in the remaining 40.5% of cases. Our conclusions are based on (i) comparing each medical model head-to-head, directly against the corresponding base model; (ii) optimizing the prompts for each model separately in zero-/few-shot prompting; and (iii) accounting for statistical uncertainty in comparisons. While these basic practices are not consistently adopted in the literature, our ablations show that they substantially impact conclusions. Meanwhile, we find that after fine-tuning on specific QA tasks, medical LLMs can show performance improvements, but the benefits do not carry over to tasks based on clinical notes. Our findings suggest that state-of-the-art general-domain models may already exhibit strong medical knowledge and reasoning capabilities, and offer recommendations to strengthen the conclusions of future studies.

Large language models (LLMs) have shown remarkable progress in encoding clinical knowledge and responding to complex medical queries with appropriate clinical reasoning. However, their applicability in subspecialist or complex medical settings remains underexplored. In this work, we probe the performance of AMIE, a research conversational diagnostic AI system, in the subspecialist domain of breast oncology care without specific fine-tuning to this challenging domain. To perform this evaluation, we curated a set of 50 synthetic breast cancer vignettes representing a range of treatment-naive and treatment-refractory cases and mirroring the key information available to a multidisciplinary tumor board for decision-making (openly released with this work). We developed a detailed clinical rubric for evaluating management plans, including axes such as the quality of case summarization, safety of the proposed care plan, and recommendations for chemotherapy, radiotherapy, surgery and hormonal therapy. To improve performance, we enhanced AMIE with the inference-time ability to perform web search retrieval to gather relevant and up-to-date clinical knowledge and refine its responses with a multi-stage self-critique pipeline. We compare response quality of AMIE with internal medicine trainees, oncology fellows, and general oncology attendings under both automated and specialist clinician evaluations. In our evaluations, AMIE outperformed trainees and fellows demonstrating the potential of the system in this challenging and important domain. We further demonstrate through qualitative examples, how systems such as AMIE might facilitate conversational interactions to assist clinicians in their decision making. However, AMIE's performance was overall inferior to attending oncologists suggesting that further research is needed prior to consideration of prospective uses.

Large language models (LLMs), such as Codex, hold great promise in enhancing programming education by automatically generating feedback for students. We investigate using LLMs to generate feedback for fixing syntax errors in Python programs, a key scenario in introductory programming. More concretely, given a student's buggy program, our goal is to generate feedback comprising a fixed program along with a natural language explanation describing the errors/fixes, inspired by how a human tutor would give feedback. While using LLMs is promising, the critical challenge is to ensure high precision in the generated feedback, which is imperative before deploying such technology in classrooms. The main research question we study is: Can we develop LLMs-based feedback generation techniques with a tunable precision parameter, giving educators quality control over the feedback that students receive? To this end, we introduce PyFiXV, our technique to generate high-precision feedback powered by Codex. The key idea behind PyFiXV is to use a novel run-time validation mechanism to decide whether the generated feedback is suitable for sharing with the student; notably, this validation mechanism also provides a precision knob to educators. We perform an extensive evaluation using two real-world datasets of Python programs with syntax errors and show the efficacy of PyFiXV in generating high-precision feedback.

Throughout the course of my Ph.D., I have been designing the user experience (UX) of various machine learning (ML) systems. In this workshop, I share two projects as case studies in which people engage with ML in much more complicated and nuanced ways than the technical HCML work might assume. The first case study describes how cardiology teams in three hospitals used a clinical decision-support system that helps them decide whether and when to implant an artificial heart to a heart failure patient. I demonstrate that physicians cannot draw on their decision-making experience by seeing only patient data on paper. They are also confused by some fundamental premises upon which ML operates. For example, physicians asked: Are ML predictions made based on clinicians' best efforts? Is it ethical to make decisions based on previous patients' collective outcomes? In the second case study, my collaborators and I designed an intelligent text editor, with the goal of improving authors' writing experience with NLP (Natural Language Processing) technologies. We prototyped a number of generative functionalities where the system provides phrase-or-sentence-level writing suggestions upon user request. When writing with the prototype, however, authors shared that they need to "see where the sentence is going two paragraphs later" in order to decide whether the suggestion aligns with their writing; Some even considered adopting machine suggestions as plagiarism, therefore "is simply wrong". By sharing these unexpected and intriguing responses from these real-world ML users, I hope to start a discussion about such previously-unknown complexities and nuances of -- as the workshop proposal states -- "putting ML at the service of people in a way that is accessible, useful, and trustworthy to all".

Natural language (NL) feedback contains rich information about the user experience. Existing studies focus on an instance-level approach, where feedback is used to refine specific examples, disregarding its system-wide application. This paper proposes a general framework for unlocking the system-level use of NL feedback. We show how to use feedback to formalize system-level design decisions in a human-in-the-loop-process -- in order to produce better models. In particular this is done through: (i) metric design for tasks; and (ii) language model prompt design for refining model responses. We conduct two case studies of this approach for improving search query generation and dialog response generation, demonstrating the effectiveness of the use of system-level feedback. We show the combination of system-level feedback and instance-level feedback brings further gains, and that human written instance-level feedback results in more grounded refinements than GPT-3.5 written ones, underlying the importance of human feedback for building systems.

Human feedback on conversations with language language models (LLMs) is central to how these systems learn about the world, improve their capabilities, and are steered toward desirable and safe behaviors. However, this feedback is mostly collected by frontier AI labs and kept behind closed doors. In this work, we bring together interdisciplinary experts to assess the opportunities and challenges to realizing an open ecosystem of human feedback for AI. We first look for successful practices in peer production, open source, and citizen science communities. We then characterize the main challenges for open human feedback. For each, we survey current approaches and offer recommendations. We end by envisioning the components needed to underpin a sustainable and open human feedback ecosystem. In the center of this ecosystem are mutually beneficial feedback loops, between users and specialized models, incentivizing a diverse stakeholders community of model trainers and feedback providers to support a general open feedback pool.

We present DRESS, a large vision language model (LVLM) that innovatively exploits Natural Language feedback (NLF) from Large Language Models to enhance its alignment and interactions by addressing two key limitations in the state-of-the-art LVLMs. First, prior LVLMs generally rely only on the instruction finetuning stage to enhance alignment with human preferences. Without incorporating extra feedback, they are still prone to generate unhelpful, hallucinated, or harmful responses. Second, while the visual instruction tuning data is generally structured in a multi-turn dialogue format, the connections and dependencies among consecutive conversational turns are weak. This reduces the capacity for effective multi-turn interactions. To tackle these, we propose a novel categorization of the NLF into two key types: critique and refinement. The critique NLF identifies the strengths and weaknesses of the responses and is used to align the LVLMs with human preferences. The refinement NLF offers concrete suggestions for improvement and is adopted to improve the interaction ability of the LVLMs-- which focuses on LVLMs' ability to refine responses by incorporating feedback in multi-turn interactions. To address the non-differentiable nature of NLF, we generalize conditional reinforcement learning for training. Our experimental results demonstrate that DRESS can generate more helpful (9.76%), honest (11.52%), and harmless (21.03%) responses, and more effectively learn from feedback during multi-turn interactions compared to SOTA LVMLs.

Recent research on large language models (LLMs) has primarily focused on their adaptation and application in specialized domains. The application of LLMs in the medical field is mainly concentrated on tasks such as the automation of medical report generation, summarization, diagnostic reasoning, and question-and-answer interactions between doctors and patients. The challenge of becoming a good teacher is more formidable than that of becoming a good student, and this study pioneers the application of LLMs in the field of medical education. In this work, we investigate the extent to which LLMs can generate medical qualification exam questions and corresponding answers based on few-shot prompts. Utilizing a real-world Chinese dataset of elderly chronic diseases, we tasked the LLMs with generating open-ended questions and answers based on a subset of sampled admission reports across eight widely used LLMs, including ERNIE 4, ChatGLM 4, Doubao, Hunyuan, Spark 4, Qwen, Llama 3, and Mistral. Furthermore, we engaged medical experts to manually evaluate these open-ended questions and answers across multiple dimensions. The study found that LLMs, after using few-shot prompts, can effectively mimic real-world medical qualification exam questions, whereas there is room for improvement in the correctness, evidence-based statements, and professionalism of the generated answers. Moreover, LLMs also demonstrate a decent level of ability to correct and rectify reference answers. Given the immense potential of artificial intelligence in the medical field, the task of generating questions and answers for medical qualification exams aimed at medical students, interns and residents can be a significant focus of future research.

Feedback data plays an important role in fine-tuning and evaluating state-of-the-art AI models. Often pairwise text preferences are used: given two texts, human (or AI) annotators select the "better" one. Such feedback data is widely used to align models to human preferences (e.g., reinforcement learning from human feedback), or to rank models according to human preferences (e.g., Chatbot Arena). Despite its wide-spread use, prior work has demonstrated that human-annotated pairwise text preference data often exhibits unintended biases. For example, human annotators have been shown to prefer assertive over truthful texts in certain contexts. Models trained or evaluated on this data may implicitly encode these biases in a manner hard to identify. In this paper, we formulate the interpretation of existing pairwise text preference data as a compression task: the Inverse Constitutional AI (ICAI) problem. In constitutional AI, a set of principles (or constitution) is used to provide feedback and fine-tune AI models. The ICAI problem inverts this process: given a dataset of feedback, we aim to extract a constitution that best enables a large language model (LLM) to reconstruct the original annotations. We propose a corresponding initial ICAI algorithm and validate its generated constitutions quantitatively based on reconstructed annotations. Generated constitutions have many potential use-cases -- they may help identify undesirable biases, scale feedback to unseen data or assist with adapting LLMs to individual user preferences. We demonstrate our approach on a variety of datasets: (a) synthetic feedback datasets with known underlying principles; (b) the AlpacaEval dataset of cross-annotated human feedback; and (c) the crowdsourced Chatbot Arena data set. We release the code for our algorithm and experiments at https://github.com/rdnfn/icai .

In this study, we aimed to determine if fine-tuned large language models (LLMs) can generate accurate, personalized impressions for whole-body PET reports. Twelve language models were trained on a corpus of PET reports using the teacher-forcing algorithm, with the report findings as input and the clinical impressions as reference. An extra input token encodes the reading physician's identity, allowing models to learn physician-specific reporting styles. Our corpus comprised 37,370 retrospective PET reports collected from our institution between 2010 and 2022. To identify the best LLM, 30 evaluation metrics were benchmarked against quality scores from two nuclear medicine (NM) physicians, with the most aligned metrics selecting the model for expert evaluation. In a subset of data, model-generated impressions and original clinical impressions were assessed by three NM physicians according to 6 quality dimensions (3-point scale) and an overall utility score (5-point scale). Each physician reviewed 12 of their own reports and 12 reports from other physicians. Bootstrap resampling was used for statistical analysis. Of all evaluation metrics, domain-adapted BARTScore and PEGASUSScore showed the highest Spearman's rank correlations (0.568 and 0.563) with physician preferences. Based on these metrics, the fine-tuned PEGASUS model was selected as the top LLM. When physicians reviewed PEGASUS-generated impressions in their own style, 89% were considered clinically acceptable, with a mean utility score of 4.08 out of 5. Physicians rated these personalized impressions as comparable in overall utility to the impressions dictated by other physicians (4.03, P=0.41). In conclusion, personalized impressions generated by PEGASUS were clinically useful, highlighting its potential to expedite PET reporting.

Code editing is an essential step towards reliable program synthesis to automatically correct critical errors generated from code LLMs. Recent studies have demonstrated that closed-source LLMs (i.e., ChatGPT and GPT-4) are capable of generating corrective feedback to edit erroneous inputs. However, it remains challenging for open-source code LLMs to generate feedback for code editing, since these models tend to adhere to the superficial formats of feedback and provide feedback with misleading information. Hence, the focus of our work is to leverage open-source code LLMs to generate helpful feedback with correct guidance for code editing. To this end, we present Coffee, a collected dataset specifically designed for code fixing with feedback. Using this dataset, we construct CoffeePots, a framework for COde Fixing with FEEdback via Preference-Optimized Tuning and Selection. The proposed framework aims to automatically generate helpful feedback for code editing while minimizing the potential risk of superficial feedback. The combination of Coffee and CoffeePots marks a significant advancement, achieving state-of-the-art performance on HumanEvalFix benchmark. Codes and model checkpoints are publicly available at https://github.com/Lune-Blue/COFFEE.

This paper investigates the problem of interactively learning behaviors communicated by a human teacher using positive and negative feedback. Much previous work on this problem has made the assumption that people provide feedback for decisions that is dependent on the behavior they are teaching and is independent from the learner's current policy. We present empirical results that show this assumption to be false -- whether human trainers give a positive or negative feedback for a decision is influenced by the learner's current policy. Based on this insight, we introduce {\em Convergent Actor-Critic by Humans} (COACH), an algorithm for learning from policy-dependent feedback that converges to a local optimum. Finally, we demonstrate that COACH can successfully learn multiple behaviors on a physical robot.

Even though machine learning (ML) pipelines affect an increasing array of stakeholders, there is little work on how input from stakeholders is recorded and incorporated. We propose FeedbackLogs, addenda to existing documentation of ML pipelines, to track the input of multiple stakeholders. Each log records important details about the feedback collection process, the feedback itself, and how the feedback is used to update the ML pipeline. In this paper, we introduce and formalise a process for collecting a FeedbackLog. We also provide concrete use cases where FeedbackLogs can be employed as evidence for algorithmic auditing and as a tool to record updates based on stakeholder feedback.

Documentation burden is a major contributor to clinician burnout, which is rising nationally and is an urgent threat to our ability to care for patients. Artificial intelligence (AI) chatbots, such as ChatGPT, could reduce clinician burden by assisting with documentation. Although many hospitals are actively integrating such systems into electronic medical record systems, AI chatbots utility and impact on clinical decision-making have not been studied for this intended use. We are the first to examine the utility of large language models in assisting clinicians draft responses to patient questions. In our two-stage cross-sectional study, 6 oncologists responded to 100 realistic synthetic cancer patient scenarios and portal messages developed to reflect common medical situations, first manually, then with AI assistance. We find AI-assisted responses were longer, less readable, but provided acceptable drafts without edits 58% of time. AI assistance improved efficiency 77% of time, with low harm risk (82% safe). However, 7.7% unedited AI responses could severely harm. In 31% cases, physicians thought AI drafts were human-written. AI assistance led to more patient education recommendations, fewer clinical actions than manual responses. Results show promise for AI to improve clinician efficiency and patient care through assisting documentation, if used judiciously. Monitoring model outputs and human-AI interaction remains crucial for safe implementation.

Tumor documentation in Germany is largely done manually, requiring reading patient records and entering data into structured databases. Large language models (LLMs) could potentially enhance this process by improving efficiency and reliability. This evaluation tests eleven different open source LLMs with sizes ranging from 1-70 billion model parameters on three basic tasks of the tumor documentation process: identifying tumor diagnoses, assigning ICD-10 codes, and extracting the date of first diagnosis. For evaluating the LLMs on these tasks, a dataset of annotated text snippets based on anonymized doctors' notes from urology was prepared. Different prompting strategies were used to investigate the effect of the number of examples in few-shot prompting and to explore the capabilities of the LLMs in general. The models Llama 3.1 8B, Mistral 7B, and Mistral NeMo 12 B performed comparably well in the tasks. Models with less extensive training data or having fewer than 7 billion parameters showed notably lower performance, while larger models did not display performance gains. Examples from a different medical domain than urology could also improve the outcome in few-shot prompting, which demonstrates the ability of LLMs to handle tasks needed for tumor documentation. Open source LLMs show a strong potential for automating tumor documentation. Models from 7-12 billion parameters could offer an optimal balance between performance and resource efficiency. With tailored fine-tuning and well-designed prompting, these models might become important tools for clinical documentation in the future. The code for the evaluation is available from https://github.com/stefan-m-lenz/UroLlmEval. We also release the dataset as a new valuable resource that addresses the shortage of authentic and easily accessible benchmarks in German-language medical NLP.

Prior to the deep learning era, shape was commonly used to describe the objects. Nowadays, state-of-the-art (SOTA) algorithms in medical imaging are predominantly diverging from computer vision, where voxel grids, meshes, point clouds, and implicit surface models are used. This is seen from numerous shape-related publications in premier vision conferences as well as the growing popularity of ShapeNet (about 51,300 models) and Princeton ModelNet (127,915 models). For the medical domain, we present a large collection of anatomical shapes (e.g., bones, organs, vessels) and 3D models of surgical instrument, called MedShapeNet, created to facilitate the translation of data-driven vision algorithms to medical applications and to adapt SOTA vision algorithms to medical problems. As a unique feature, we directly model the majority of shapes on the imaging data of real patients. As of today, MedShapeNet includes 23 dataset with more than 100,000 shapes that are paired with annotations (ground truth). Our data is freely accessible via a web interface and a Python application programming interface (API) and can be used for discriminative, reconstructive, and variational benchmarks as well as various applications in virtual, augmented, or mixed reality, and 3D printing. Exemplary, we present use cases in the fields of classification of brain tumors, facial and skull reconstructions, multi-class anatomy completion, education, and 3D printing. In future, we will extend the data and improve the interfaces. The project pages are: https://medshapenet.ikim.nrw/ and https://github.com/Jianningli/medshapenet-feedback

People increasingly search online for answers to their medical questions but the rate at which medical questions are asked online significantly exceeds the capacity of qualified people to answer them. This leaves many questions unanswered or inadequately answered. Many of these questions are not unique, and reliable identification of similar questions would enable more efficient and effective question answering schema. COVID-19 has only exacerbated this problem. Almost every government agency and healthcare organization has tried to meet the informational need of users by building online FAQs, but there is no way for people to ask their question and know if it is answered on one of these pages. While many research efforts have focused on the problem of general question similarity, these approaches do not generalize well to domains that require expert knowledge to determine semantic similarity, such as the medical domain. In this paper, we show how a double fine-tuning approach of pretraining a neural network on medical question-answer pairs followed by fine-tuning on medical question-question pairs is a particularly useful intermediate task for the ultimate goal of determining medical question similarity. While other pretraining tasks yield an accuracy below 78.7% on this task, our model achieves an accuracy of 82.6% with the same number of training examples, an accuracy of 80.0% with a much smaller training set, and an accuracy of 84.5% when the full corpus of medical question-answer data is used. We also describe a currently live system that uses the trained model to match user questions to COVID-related FAQs.

Language models (LMs) often exhibit undesirable text generation behaviors, including generating false, toxic, or irrelevant outputs. Reinforcement learning from human feedback (RLHF) - where human preference judgments on LM outputs are transformed into a learning signal - has recently shown promise in addressing these issues. However, such holistic feedback conveys limited information on long text outputs; it does not indicate which aspects of the outputs influenced user preference; e.g., which parts contain what type(s) of errors. In this paper, we use fine-grained human feedback (e.g., which sentence is false, which sub-sentence is irrelevant) as an explicit training signal. We introduce Fine-Grained RLHF, a framework that enables training and learning from reward functions that are fine-grained in two respects: (1) density, providing a reward after every segment (e.g., a sentence) is generated; and (2) incorporating multiple reward models associated with different feedback types (e.g., factual incorrectness, irrelevance, and information incompleteness). We conduct experiments on detoxification and long-form question answering to illustrate how learning with such reward functions leads to improved performance, supported by both automatic and human evaluation. Additionally, we show that LM behaviors can be customized using different combinations of fine-grained reward models. We release all data, collected human feedback, and codes at https://FineGrainedRLHF.github.io.

Black box optimisation of an unknown function from expensive and noisy evaluations is a ubiquitous problem in machine learning, academic research and industrial production. An abstraction of the problem can be formulated as a kernel based bandit problem (also known as Bayesian optimisation), where a learner aims at optimising a kernelized function through sequential noisy observations. The existing work predominantly assumes feedback is immediately available; an assumption which fails in many real world situations, including recommendation systems, clinical trials and hyperparameter tuning. We consider a kernel bandit problem under stochastically delayed feedback, and propose an algorithm with mathcal{O}(Gamma_k(T)T+E[tau]) regret, where T is the number of time steps, Gamma_k(T) is the maximum information gain of the kernel with T observations, and tau is the delay random variable. This represents a significant improvement over the state of the art regret bound of mathcal{O}(Gamma_k(T)T+E[tau]Gamma_k(T)) reported in Verma et al. (2022). In particular, for very non-smooth kernels, the information gain grows almost linearly in time, trivializing the existing results. We also validate our theoretical results with simulations.

Every day, countless surgeries are performed worldwide, each within the distinct settings of operating rooms (ORs) that vary not only in their setups but also in the personnel, tools, and equipment used. This inherent diversity poses a substantial challenge for achieving a holistic understanding of the OR, as it requires models to generalize beyond their initial training datasets. To reduce this gap, we introduce ORacle, an advanced vision-language model designed for holistic OR domain modeling, which incorporates multi-view and temporal capabilities and can leverage external knowledge during inference, enabling it to adapt to previously unseen surgical scenarios. This capability is further enhanced by our novel data augmentation framework, which significantly diversifies the training dataset, ensuring ORacle's proficiency in applying the provided knowledge effectively. In rigorous testing, in scene graph generation, and downstream tasks on the 4D-OR dataset, ORacle not only demonstrates state-of-the-art performance but does so requiring less data than existing models. Furthermore, its adaptability is displayed through its ability to interpret unseen views, actions, and appearances of tools and equipment. This demonstrates ORacle's potential to significantly enhance the scalability and affordability of OR domain modeling and opens a pathway for future advancements in surgical data science. We will release our code and data upon acceptance.

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.

Radiologists play a crucial role by translating medical images into medical reports. However, the field faces staffing shortages and increasing workloads. While automated approaches using vision-language models (VLMs) show promise as assistants, they require exceptionally high accuracy. Most current VLMs in radiology rely solely on supervised fine-tuning (SFT). Meanwhile, in the general domain, additional preference fine-tuning has become standard practice. The challenge in radiology lies in the prohibitive cost of obtaining radiologist feedback. We propose a scalable automated preference alignment technique for VLMs in radiology, focusing on chest X-ray (CXR) report generation. Our method leverages publicly available datasets with an LLM-as-a-Judge mechanism, eliminating the need for additional expert radiologist feedback. We evaluate and benchmark five direct alignment algorithms (DAAs). Our results show up to a 57.4% improvement in average GREEN scores, a LLM-based metric for evaluating CXR reports, and a 9.2% increase in an average across six metrics (domain specific and general), compared to the SFT baseline. We study reward overoptimization via length exploitation, with reports lengthening by up to 3.2x. To assess a potential alignment tax, we benchmark on six additional diverse tasks, finding no significant degradations. A reader study involving four board-certified radiologists indicates win rates of up to 0.62 over the SFT baseline, while significantly penalizing verbosity. Our analysis provides actionable insights for the development of VLMs in high-stakes fields like radiology.