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Nov 6

Towards Accurate Differential Diagnosis with Large Language Models

An accurate differential diagnosis (DDx) is a cornerstone of medical care, often reached through an iterative process of interpretation that combines clinical history, physical examination, investigations and procedures. Interactive interfaces powered by Large Language Models (LLMs) present new opportunities to both assist and automate aspects of this process. In this study, we introduce an LLM optimized for diagnostic reasoning, and evaluate its ability to generate a DDx alone or as an aid to clinicians. 20 clinicians evaluated 302 challenging, real-world medical cases sourced from the New England Journal of Medicine (NEJM) case reports. Each case report was read by two clinicians, who were randomized to one of two assistive conditions: either assistance from search engines and standard medical resources, or LLM assistance in addition to these tools. All clinicians provided a baseline, unassisted DDx prior to using the respective assistive tools. Our LLM for DDx exhibited standalone performance that exceeded that of unassisted clinicians (top-10 accuracy 59.1% vs 33.6%, [p = 0.04]). Comparing the two assisted study arms, the DDx quality score was higher for clinicians assisted by our LLM (top-10 accuracy 51.7%) compared to clinicians without its assistance (36.1%) (McNemar's Test: 45.7, p < 0.01) and clinicians with search (44.4%) (4.75, p = 0.03). Further, clinicians assisted by our LLM arrived at more comprehensive differential lists than those without its assistance. Our study suggests that our LLM for DDx has potential to improve clinicians' diagnostic reasoning and accuracy in challenging cases, meriting further real-world evaluation for its ability to empower physicians and widen patients' access to specialist-level expertise.

  • 28 authors
·
Nov 30, 2023 1

Curry-DPO: Enhancing Alignment using Curriculum Learning & Ranked Preferences

Direct Preference Optimization (DPO) is an effective technique that leverages pairwise preference data (usually one chosen and rejected response pair per user prompt) to align LLMs to human preferences. In practice, multiple responses can exist for a given prompt with varying quality relative to each other. With availability of such quality ratings for multiple responses, we propose utilizing these responses to create multiple preference pairs for a given prompt. Our work focuses on systematically using the constructed multiple preference pair in DPO training via curriculum learning methodology. In particular, we order these multiple pairs of preference data from easy to hard (emulating curriculum training) according to various criteria. We show detailed comparisons of our proposed approach to the standard single-pair DPO setting. Our method, which we call Curry-DPO consistently shows increased performance gains on MTbench, Vicuna, WizardLM, and the UltraFeedback test set, highlighting its effectiveness. More specifically, Curry-DPO achieves a score of 7.43 on MT-bench with Zephy-7B model outperforming majority of existing LLMs with similar parameter size. Curry-DPO also achieves the highest adjusted win rates on Vicuna, WizardLM, and UltraFeedback test datasets (90.7%, 87.1%, and 87.9% respectively) in our experiments, with notable gains of upto 7.5% when compared to standard DPO technique.

  • 5 authors
·
Mar 11, 2024