Daily Papers

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

This paper investigates the challenges of developing large language models (LLMs) proficient in both multilingual understanding and medical knowledge. We demonstrate that simply translating medical data does not guarantee strong performance on clinical tasks in the target language. Our experiments reveal that the optimal language mix in training data varies significantly across different medical tasks. We find that larger models with carefully calibrated language ratios achieve superior performance on native-language clinical tasks. Furthermore, our results suggest that relying solely on fine-tuning may not be the most effective approach for incorporating new language knowledge into LLMs. Instead, data and computationally intensive pretraining methods may still be necessary to achieve optimal performance in multilingual medical settings. These findings provide valuable guidance for building effective and inclusive medical AI systems for diverse linguistic communities.

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

Adapting medical Large Language Models to local languages can reduce barriers to accessing healthcare services, but data scarcity remains a significant challenge, particularly for low-resource languages. To address this, we first construct a high-quality medical dataset and conduct analysis to ensure its quality. In order to leverage the generalization capability of multilingual LLMs to efficiently scale to more resource-constrained languages, we explore the internal information flow of LLMs from a multilingual perspective using Mixture of Experts (MoE) modularity. Technically, we propose a novel MoE routing method that employs language-specific experts and cross-lingual routing. Inspired by circuit theory, our routing analysis revealed a Spread Out in the End information flow mechanism: while earlier layers concentrate cross-lingual information flow, the later layers exhibit language-specific divergence. This insight directly led to the development of the Post-MoE architecture, which applies sparse routing only in the later layers while maintaining dense others. Experimental results demonstrate that this approach enhances the generalization of multilingual models to other languages while preserving interpretability. Finally, to efficiently scale the model to 50 languages, we introduce the concept of language family experts, drawing on linguistic priors, which enables scaling the number of languages without adding additional parameters.

Multilingual automatic speech recognition (ASR) in the medical domain serves as a foundational task for various downstream applications such as speech translation, spoken language understanding, and voice-activated assistants. This technology enhances patient care by enabling efficient communication across language barriers, alleviating specialized workforce shortages, and facilitating improved diagnosis and treatment, particularly during pandemics. In this work, we introduce MultiMed, a collection of small-to-large end-to-end ASR models for the medical domain, spanning five languages: Vietnamese, English, German, French, and Mandarin Chinese, together with the corresponding real-world ASR dataset. To our best knowledge, MultiMed stands as the largest and the first multilingual medical ASR dataset, in terms of total duration, number of speakers, diversity of diseases, recording conditions, speaker roles, unique medical terms, accents, and ICD-10 codes. Secondly, we establish the empirical baselines, present the first reproducible study of multilinguality in medical ASR, conduct a layer-wise ablation study for end-to-end ASR training, and provide the first linguistic analysis for multilingual medical ASR. All code, data, and models are available online https://github.com/leduckhai/MultiMed/tree/master/MultiMed

In the era of digital healthcare, the huge volumes of textual information generated every day in hospitals constitute an essential but underused asset that could be exploited with task-specific, fine-tuned biomedical language representation models, improving patient care and management. For such specialized domains, previous research has shown that fine-tuning models stemming from broad-coverage checkpoints can largely benefit additional training rounds over large-scale in-domain resources. However, these resources are often unreachable for less-resourced languages like Italian, preventing local medical institutions to employ in-domain adaptation. In order to reduce this gap, our work investigates two accessible approaches to derive biomedical language models in languages other than English, taking Italian as a concrete use-case: one based on neural machine translation of English resources, favoring quantity over quality; the other based on a high-grade, narrow-scoped corpus natively written in Italian, thus preferring quality over quantity. Our study shows that data quantity is a harder constraint than data quality for biomedical adaptation, but the concatenation of high-quality data can improve model performance even when dealing with relatively size-limited corpora. The models published from our investigations have the potential to unlock important research opportunities for Italian hospitals and academia. Finally, the set of lessons learned from the study constitutes valuable insights towards a solution to build biomedical language models that are generalizable to other less-resourced languages and different domain settings.

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

The "massively-multilingual" training of multilingual models is known to limit their utility in any one language, and they perform particularly poorly on low-resource languages. However, there is evidence that low-resource languages can benefit from targeted multilinguality, where the model is trained on closely related languages. To test this approach more rigorously, we systematically study best practices for adapting a pre-trained model to a language family. Focusing on the Uralic family as a test case, we adapt XLM-R under various configurations to model 15 languages; we then evaluate the performance of each experimental setting on two downstream tasks and 11 evaluation languages. Our adapted models significantly outperform mono- and multilingual baselines. Furthermore, a regression analysis of hyperparameter effects reveals that adapted vocabulary size is relatively unimportant for low-resource languages, and that low-resource languages can be aggressively up-sampled during training at little detriment to performance in high-resource languages. These results introduce new best practices for performing language adaptation in a targeted setting.

Natural language tasks like Named Entity Recognition (NER) in the clinical domain on non-English texts can be very time-consuming and expensive due to the lack of annotated data. Cross-lingual transfer (CLT) is a way to circumvent this issue thanks to the ability of multilingual large language models to be fine-tuned on a specific task in one language and to provide high accuracy for the same task in another language. However, other methods leveraging translation models can be used to perform NER without annotated data in the target language, by either translating the training set or test set. This paper compares cross-lingual transfer with these two alternative methods, to perform clinical NER in French and in German without any training data in those languages. To this end, we release MedNERF a medical NER test set extracted from French drug prescriptions and annotated with the same guidelines as an English dataset. Through extensive experiments on this dataset and on a German medical dataset (Frei and Kramer, 2021), we show that translation-based methods can achieve similar performance to CLT but require more care in their design. And while they can take advantage of monolingual clinical language models, those do not guarantee better results than large general-purpose multilingual models, whether with cross-lingual transfer or translation.

In this work, we compare the domain-specific translation performance of open-source autoregressive decoder-only large language models (LLMs) with task-oriented machine translation (MT) models. Our experiments focus on the medical domain and cover four language pairs with varied resource availability: English-to-French, English-to-Portuguese, English-to-Swahili, and Swahili-to-English. Despite recent advancements, LLMs exhibit a clear gap in specialized translation quality compared to multilingual encoder-decoder MT models such as NLLB-200. In three out of four language directions in our study, NLLB-200 3.3B outperforms all LLMs in the size range of 8B parameters in medical translation. While fine-tuning LLMs such as Mistral and Llama improves their performance at medical translation, these models still fall short compared to fine-tuned NLLB-200 3.3B models. Our findings highlight the ongoing need for specialized MT models to achieve higher-quality domain-specific translation, especially in medium-resource and low-resource settings. As larger LLMs outperform their 8B variants, this also encourages pre-training domain-specific medium-sized LMs to improve quality and efficiency in specialized translation tasks.

Multilingual speech translation (ST) in the medical domain enhances patient care by enabling efficient communication across language barriers, alleviating specialized workforce shortages, and facilitating improved diagnosis and treatment, particularly during pandemics. In this work, we present the first systematic study on medical ST, to our best knowledge, by releasing MultiMed-ST, a large-scale ST dataset for the medical domain, spanning all translation directions in five languages: Vietnamese, English, German, French, Traditional Chinese and Simplified Chinese, together with the models. With 290,000 samples, our dataset is the largest medical machine translation (MT) dataset and the largest many-to-many multilingual ST among all domains. Secondly, we present the most extensive analysis study in ST research to date, including: empirical baselines, bilingual-multilingual comparative study, end-to-end vs. cascaded comparative study, task-specific vs. multi-task sequence-to-sequence (seq2seq) comparative study, code-switch analysis, and quantitative-qualitative error analysis. All code, data, and models are available online: https://github.com/leduckhai/MultiMed-ST.

Despite rapid progress in large language models (LLMs), their performance on a vast majority of languages remain unsatisfactory. In this paper, we study building language-specific LLMs by adapting monolingual and multilingual LLMs. We conduct systematic experiments on how design choices (base model selection, vocabulary extension, and continued fine-tuning) impact the adapted LLM, both in terms of efficiency (how many tokens are needed to encode the same amount of information) and end task performance. We find that (1) the initial performance before the adaptation is not always indicative of the final performance. (2) Efficiency can easily improved with simple vocabulary extension and continued fine-tuning in most LLMs we study, and (3) The optimal adaptation method is highly language-dependent, and the simplest approach works well across various experimental settings. Adapting English-centric models can yield better results than adapting multilingual models despite their worse initial performance on low-resource languages. Together, our work lays foundations on efficiently building language-specific LLMs by adapting existing LLMs.

Obtaining text datasets with semantic annotations is an effortful process, yet crucial for supervised training in natural language processsing (NLP). In general, developing and applying new NLP pipelines in domain-specific contexts for tasks often requires custom designed datasets to address NLP tasks in supervised machine learning fashion. When operating in non-English languages for medical data processing, this exposes several minor and major, interconnected problems such as lack of task-matching datasets as well as task-specific pre-trained models. In our work we suggest to leverage pretrained language models for training data acquisition in order to retrieve sufficiently large datasets for training smaller and more efficient models for use-case specific tasks. To demonstrate the effectiveness of your approach, we create a custom dataset which we use to train a medical NER model for German texts, GPTNERMED, yet our method remains language-independent in principle. Our obtained dataset as well as our pre-trained models are publicly available at: https://github.com/frankkramer-lab/GPTNERMED

We introduce mEdIT, a multi-lingual extension to CoEdIT -- the recent state-of-the-art text editing models for writing assistance. mEdIT models are trained by fine-tuning multi-lingual large, pre-trained language models (LLMs) via instruction tuning. They are designed to take instructions from the user specifying the attributes of the desired text in the form of natural language instructions, such as Grammatik korrigieren (German) or Parafrasee la oraci\'on (Spanish). We build mEdIT by curating data from multiple publicly available human-annotated text editing datasets for three text editing tasks (Grammatical Error Correction (GEC), Text Simplification, and Paraphrasing) across diverse languages belonging to six different language families. We detail the design and training of mEdIT models and demonstrate their strong performance on many multi-lingual text editing benchmarks against other multilingual LLMs. We also find that mEdIT generalizes effectively to new languages over multilingual baselines. We publicly release our data, code, and trained models at https://github.com/vipulraheja/medit.

Large language models exhibit promising general capabilities but often lack specialized knowledge for domain-specific tasks. Developing domain experts from a base model enables a range of applications without prohibitive training costs. This work demonstrates a method using continuous training and instruction fine-tuning to rapidly adapt Llama 2 base models to the Chinese medical domain. We first conduct continuous training on 1B tokens from Chinese medical references to teach relevant vocabulary and knowledge. The models are then fine-tuned on 54K examples sourced from the Chinese National Medical Licensing Examination. Experiments on Chinese medical data confirm the effectiveness of this approach, producing a model comparable to GPT-3.5-turbo while using way less computational resource. The resulting domain-specific model could be useful for various Chinese medical applications. More broadly, this provides a template for domain-specific training of large language models in areas where pre-trained models lack the required expertise, such as law, science, and engineering.

Recent advances in natural language processing (NLP) can be largely attributed to the advent of pre-trained language models such as BERT and RoBERTa. While these models demonstrate remarkable performance on general datasets, they can struggle in specialized domains such as medicine, where unique domain-specific terminologies, domain-specific abbreviations, and varying document structures are common. This paper explores strategies for adapting these models to domain-specific requirements, primarily through continuous pre-training on domain-specific data. We pre-trained several German medical language models on 2.4B tokens derived from translated public English medical data and 3B tokens of German clinical data. The resulting models were evaluated on various German downstream tasks, including named entity recognition (NER), multi-label classification, and extractive question answering. Our results suggest that models augmented by clinical and translation-based pre-training typically outperform general domain models in medical contexts. We conclude that continuous pre-training has demonstrated the ability to match or even exceed the performance of clinical models trained from scratch. Furthermore, pre-training on clinical data or leveraging translated texts have proven to be reliable methods for domain adaptation in medical NLP tasks.

Research on language technology for the development of medical applications is currently a hot topic in Natural Language Understanding and Generation. Thus, a number of large language models (LLMs) have recently been adapted to the medical domain, so that they can be used as a tool for mediating in human-AI interaction. While these LLMs display competitive performance on automated medical texts benchmarks, they have been pre-trained and evaluated with a focus on a single language (English mostly). This is particularly true of text-to-text models, which typically require large amounts of domain-specific pre-training data, often not easily accessible for many languages. In this paper, we address these shortcomings by compiling, to the best of our knowledge, the largest multilingual corpus for the medical domain in four languages, namely English, French, Italian and Spanish. This new corpus has been used to train Medical mT5, the first open-source text-to-text multilingual model for the medical domain. Additionally, we present two new evaluation benchmarks for all four languages with the aim of facilitating multilingual research in this domain. A comprehensive evaluation shows that Medical mT5 outperforms both encoders and similarly sized text-to-text models for the Spanish, French, and Italian benchmarks, while being competitive with current state-of-the-art LLMs in English.

Natural Language Processing (NLP) has seen remarkable advances in recent years, particularly with the emergence of Large Language Models that have achieved unprecedented performance across many tasks. However, these developments have mainly benefited a small number of high-resource languages such as English. The majority of languages still face significant challenges due to the scarcity of training data and computational resources. To address this issue, this thesis focuses on cross-lingual transfer learning, a research area aimed at leveraging data and models from high-resource languages to improve NLP performance for low-resource languages. Specifically, we focus on Sequence Labeling tasks such as Named Entity Recognition, Opinion Target Extraction, and Argument Mining. The research is structured around three main objectives: (1) advancing data-based cross-lingual transfer learning methods through improved translation and annotation projection techniques, (2) developing enhanced model-based transfer learning approaches utilizing state-of-the-art multilingual models, and (3) applying these methods to real-world problems while creating open-source resources that facilitate future research in low-resource NLP. More specifically, this thesis presents a new method to improve data-based transfer with T-Projection, a state-of-the-art annotation projection method that leverages text-to-text multilingual models and machine translation systems. T-Projection significantly outperforms previous annotation projection methods by a wide margin. For model-based transfer, we introduce a constrained decoding algorithm that enhances cross-lingual Sequence Labeling in zero-shot settings using text-to-text models. Finally, we develop Medical mT5, the first multilingual text-to-text medical model, demonstrating the practical impact of our research on real-world applications.

Pre-trained multilingual language models underpin a large portion of modern NLP tools outside of English. A strong baseline for specializing these models for specific languages is Language-Adaptive Pre-Training (LAPT). However, retaining a large cross-lingual vocabulary and embedding matrix comes at considerable excess computational cost during adaptation. In this study, we propose several simple techniques to replace a cross-lingual vocabulary with a compact, language-specific one. Namely, we address strategies for re-initializing the token embedding matrix after vocabulary specialization. We then provide a systematic experimental comparison of our techniques, in addition to the recently-proposed Focus method. We demonstrate that: 1) Embedding-replacement techniques in the monolingual transfer literature are inadequate for adapting multilingual models. 2) Replacing cross-lingual vocabularies with smaller specialized ones provides an efficient method to improve performance in low-resource languages. 3) Simple embedding re-initialization techniques based on script-wise sub-distributions rival techniques such as Focus, which rely on similarity scores obtained from an auxiliary model.

Large Language Models (LLMs) have shown promising results on machine translation for high resource language pairs and domains. However, in specialised domains (e.g. medical) LLMs have shown lower performance compared to standard neural machine translation models. The consistency in the machine translation of terminology is crucial for users, researchers, and translators in specialised domains. In this study, we compare the performance between baseline LLMs and instruction-tuned LLMs in the medical domain. In addition, we introduce terminology from specialised medical dictionaries into the instruction formatted datasets for fine-tuning LLMs. The instruction-tuned LLMs significantly outperform the baseline models with automatic metrics.

Large language models like ChatGPT have shown substantial progress in natural language understanding and generation, proving valuable across various disciplines, including the medical field. Despite advancements, challenges persist due to the complexity and diversity inherent in medical tasks which often require multi-task learning capabilities. Previous approaches, although beneficial, fall short in real-world applications because they necessitate task-specific annotations at inference time, limiting broader generalization. This paper introduces MING-MOE, a novel Mixture-of-Expert~(MOE)-based medical large language model designed to manage diverse and complex medical tasks without requiring task-specific annotations, thus enhancing its usability across extensive datasets. MING-MOE employs a Mixture of Low-Rank Adaptation (MoLoRA) technique, allowing for efficient parameter usage by maintaining base model parameters static while adapting through a minimal set of trainable parameters. We demonstrate that MING-MOE achieves state-of-the-art (SOTA) performance on over 20 medical tasks, illustrating a significant improvement over existing models. This approach not only extends the capabilities of medical language models but also improves inference efficiency.

The utilization of clinical reports for various secondary purposes, including health research and treatment monitoring, is crucial for enhancing patient care. Natural Language Processing (NLP) tools have emerged as valuable assets for extracting and processing relevant information from these reports. However, the availability of specialized language models for the clinical domain in Spanish has been limited. In this paper, we introduce EriBERTa, a bilingual domain-specific language model pre-trained on extensive medical and clinical corpora. We demonstrate that EriBERTa outperforms previous Spanish language models in the clinical domain, showcasing its superior capabilities in understanding medical texts and extracting meaningful information. Moreover, EriBERTa exhibits promising transfer learning abilities, allowing for knowledge transfer from one language to another. This aspect is particularly beneficial given the scarcity of Spanish clinical data.

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

Current ophthalmology clinical workflows are plagued by over-referrals, long waits, and complex and heterogeneous medical records. Large language models (LLMs) present a promising solution to automate various procedures such as triaging, preliminary tests like visual acuity assessment, and report summaries. However, LLMs have demonstrated significantly varied performance across different languages in natural language question-answering tasks, potentially exacerbating healthcare disparities in Low and Middle-Income Countries (LMICs). This study introduces the first multilingual ophthalmological question-answering benchmark with manually curated questions parallel across languages, allowing for direct cross-lingual comparisons. Our evaluation of 6 popular LLMs across 7 different languages reveals substantial bias across different languages, highlighting risks for clinical deployment of LLMs in LMICs. Existing debiasing methods such as Translation Chain-of-Thought or Retrieval-augmented generation (RAG) by themselves fall short of closing this performance gap, often failing to improve performance across all languages and lacking specificity for the medical domain. To address this issue, We propose CLARA (Cross-Lingual Reflective Agentic system), a novel inference time de-biasing method leveraging retrieval augmented generation and self-verification. Our approach not only improves performance across all languages but also significantly reduces the multilingual bias gap, facilitating equitable LLM application across the globe.

This paper presents the outcomes of fine-tuning Mistral 7B, a general-purpose large language model (LLM), for adaptive machine translation (MT). The fine-tuning process involves utilising a combination of zero-shot and one-shot translation prompts within the medical domain. The primary objective is to enhance real-time adaptive MT capabilities of Mistral 7B, enabling it to adapt translations to the required domain at inference time. The results, particularly for Spanish-to-English MT, showcase the efficacy of the fine-tuned model, demonstrating quality improvements in both zero-shot and one-shot translation scenarios, surpassing Mistral 7B's baseline performance. Notably, the fine-tuned Mistral outperforms ChatGPT "gpt-3.5-turbo" in zero-shot translation while achieving comparable one-shot translation quality. Moreover, the zero-shot translation of the fine-tuned Mistral matches NLLB 3.3B's performance, and its one-shot translation quality surpasses that of NLLB 3.3B. These findings emphasise the significance of fine-tuning efficient LLMs like Mistral 7B to yield high-quality zero-shot translations comparable to task-oriented models like NLLB 3.3B. Additionally, the adaptive gains achieved in one-shot translation are comparable to those of commercial LLMs such as ChatGPT. Our experiments demonstrate that, with a relatively small dataset of 20,000 segments that incorporate a mix of zero-shot and one-shot prompts, fine-tuning significantly enhances Mistral's in-context learning ability, especially for real-time adaptive MT.

Developing the required technology to assist medical experts in their everyday activities is currently a hot topic in the Artificial Intelligence research field. Thus, a number of large language models (LLMs) and automated benchmarks have recently been proposed with the aim of facilitating information extraction in Evidence-Based Medicine (EBM) using natural language as a tool for mediating in human-AI interaction. The most representative benchmarks are limited to either multiple-choice or long-form answers and are available only in English. In order to address these shortcomings, in this paper we present a new dataset which, unlike previous work: (i) includes not only explanatory arguments for the correct answer, but also arguments to reason why the incorrect answers are not correct; (ii) the explanations are written originally by medical doctors to answer questions from the Spanish Residency Medical Exams. Furthermore, this new benchmark allows us to setup a novel extractive task which consists of identifying the explanation of the correct answer written by medical doctors. An additional benefit of our setting is that we can leverage the extractive QA paradigm to automatically evaluate performance of LLMs without resorting to costly manual evaluation by medical experts. Comprehensive experimentation with language models for Spanish shows that sometimes multilingual models fare better than monolingual ones, even outperforming models which have been adapted to the medical domain. Furthermore, results across the monolingual models are mixed, with supposedly smaller and inferior models performing competitively. In any case, the obtained results show that our novel dataset and approach can be an effective technique to help medical practitioners in identifying relevant evidence-based explanations for medical questions.

In the ongoing wave of impact driven by large language models (LLMs) like ChatGPT, the adaptation of LLMs to medical domain has emerged as a crucial research frontier. Since mainstream LLMs tend to be designed for general-purpose applications, constructing a medical LLM through domain adaptation is a huge challenge. While instruction-tuning is used to fine-tune some LLMs, its precise roles in domain adaptation remain unknown. Here we show the contribution of LoRA-based instruction-tuning to performance in Japanese medical question-answering tasks. In doing so, we employ a multifaceted evaluation for multiple-choice questions, including scoring based on "Exact match" and "Gestalt distance" in addition to the conventional accuracy. Our findings suggest that LoRA-based instruction-tuning can partially incorporate domain-specific knowledge into LLMs, with larger models demonstrating more pronounced effects. Furthermore, our results underscore the potential of adapting English-centric models for Japanese applications in domain adaptation, while also highlighting the persisting limitations of Japanese-centric models. This initiative represents a pioneering effort in enabling medical institutions to fine-tune and operate models without relying on external services.

Large Language Models (LLMs) have demonstrated significant enhancements in instruction-following abilities through instruction tuning, achieving notable performances across various tasks. Previous research has focused on fine-tuning medical domain-specific LLMs using an extensive array of medical-specific data, incorporating millions of pieces of biomedical literature to augment their medical capabilities. However, existing medical instruction-tuned LLMs have been constrained by the limited scope of tasks and instructions available, restricting the efficacy of instruction tuning and adversely affecting performance in the general domain. In this paper, we fine-tune LLaMA-series models using 52k diverse, machine-generated, medical instruction-following data, MedInstruct-52k, resulting in the model AlpaCare. Comprehensive experimental results on both general and medical-specific domain free-form instruction evaluations showcase AlpaCare's strong medical proficiency and generalizability compared to previous instruction-tuned models in both medical and general domains. We provide public access to our MedInstruct-52k dataset and a clinician-crafted free-form instruction test set, MedInstruct-test, along with our codebase, to foster further research and development. Our project page is available at https://github.com/XZhang97666/AlpaCare.

This study evaluates the performance of large language models (LLMs) as medical agents in Portuguese, aiming to develop a reliable and relevant virtual assistant for healthcare professionals. The HealthCareMagic-100k-en and MedQuAD datasets, translated from English using GPT-3.5, were used to fine-tune the ChatBode-7B model using the PEFT-QLoRA method. The InternLM2 model, with initial training on medical data, presented the best overall performance, with high precision and adequacy in metrics such as accuracy, completeness and safety. However, DrBode models, derived from ChatBode, exhibited a phenomenon of catastrophic forgetting of acquired medical knowledge. Despite this, these models performed frequently or even better in aspects such as grammaticality and coherence. A significant challenge was low inter-rater agreement, highlighting the need for more robust assessment protocols. This work paves the way for future research, such as evaluating multilingual models specific to the medical field, improving the quality of training data, and developing more consistent evaluation methodologies for the medical field.

Large language models (LLMs) are transforming the ways the general public accesses and consumes information. Their influence is particularly pronounced in pivotal sectors like healthcare, where lay individuals are increasingly appropriating LLMs as conversational agents for everyday queries. While LLMs demonstrate impressive language understanding and generation proficiencies, concerns regarding their safety remain paramount in these high-stake domains. Moreover, the development of LLMs is disproportionately focused on English. It remains unclear how these LLMs perform in the context of non-English languages, a gap that is critical for ensuring equity in the real-world use of these systems.This paper provides a framework to investigate the effectiveness of LLMs as multi-lingual dialogue systems for healthcare queries. Our empirically-derived framework XlingEval focuses on three fundamental criteria for evaluating LLM responses to naturalistic human-authored health-related questions: correctness, consistency, and verifiability. Through extensive experiments on four major global languages, including English, Spanish, Chinese, and Hindi, spanning three expert-annotated large health Q&A datasets, and through an amalgamation of algorithmic and human-evaluation strategies, we found a pronounced disparity in LLM responses across these languages, indicating a need for enhanced cross-lingual capabilities. We further propose XlingHealth, a cross-lingual benchmark for examining the multilingual capabilities of LLMs in the healthcare context. Our findings underscore the pressing need to bolster the cross-lingual capacities of these models, and to provide an equitable information ecosystem accessible to all.

We introduce MULTI-EURLEX, a new multilingual dataset for topic classification of legal documents. The dataset comprises 65k European Union (EU) laws, officially translated in 23 languages, annotated with multiple labels from the EUROVOC taxonomy. We highlight the effect of temporal concept drift and the importance of chronological, instead of random splits. We use the dataset as a testbed for zero-shot cross-lingual transfer, where we exploit annotated training documents in one language (source) to classify documents in another language (target). We find that fine-tuning a multilingually pretrained model (XLM-ROBERTA, MT5) in a single source language leads to catastrophic forgetting of multilingual knowledge and, consequently, poor zero-shot transfer to other languages. Adaptation strategies, namely partial fine-tuning, adapters, BITFIT, LNFIT, originally proposed to accelerate fine-tuning for new end-tasks, help retain multilingual knowledge from pretraining, substantially improving zero-shot cross-lingual transfer, but their impact also depends on the pretrained model used and the size of the label set.

Large Language Models (LLMs) have demonstrated remarkable versatility in recent years, offering potential applications across specialized domains such as healthcare and medicine. Despite the availability of various open-source LLMs tailored for health contexts, adapting general-purpose LLMs to the medical domain presents significant challenges. In this paper, we introduce BioMistral, an open-source LLM tailored for the biomedical domain, utilizing Mistral as its foundation model and further pre-trained on PubMed Central. We conduct a comprehensive evaluation of BioMistral on a benchmark comprising 10 established medical question-answering (QA) tasks in English. We also explore lightweight models obtained through quantization and model merging approaches. Our results demonstrate BioMistral's superior performance compared to existing open-source medical models and its competitive edge against proprietary counterparts. Finally, to address the limited availability of data beyond English and to assess the multilingual generalization of medical LLMs, we automatically translated and evaluated this benchmark into 7 other languages. This marks the first large-scale multilingual evaluation of LLMs in the medical domain. Datasets, multilingual evaluation benchmarks, scripts, and all the models obtained during our experiments are freely released.

Large language models (LLMs) hold great promise for medical applications and are evolving rapidly, with new models being released at an accelerated pace. However, current evaluations of LLMs in clinical contexts remain limited. Most existing benchmarks rely on medical exam-style questions or PubMed-derived text, failing to capture the complexity of real-world electronic health record (EHR) data. Others focus narrowly on specific application scenarios, limiting their generalizability across broader clinical use. To address this gap, we present BRIDGE, a comprehensive multilingual benchmark comprising 87 tasks sourced from real-world clinical data sources across nine languages. We systematically evaluated 52 state-of-the-art LLMs (including DeepSeek-R1, GPT-4o, Gemini, and Llama 4) under various inference strategies. With a total of 13,572 experiments, our results reveal substantial performance variation across model sizes, languages, natural language processing tasks, and clinical specialties. Notably, we demonstrate that open-source LLMs can achieve performance comparable to proprietary models, while medically fine-tuned LLMs based on older architectures often underperform versus updated general-purpose models. The BRIDGE and its corresponding leaderboard serve as a foundational resource and a unique reference for the development and evaluation of new LLMs in real-world clinical text understanding.

Despite the widespread availability of LLMs, there remains a substantial gap in their capabilities and availability across diverse languages. One approach to address these issues has been to take an existing pre-trained LLM and continue to train it on new languages. While prior works have experimented with language adaptation, many questions around best practices and methodology have not been covered. In this paper, we present a comprehensive investigation into the adaptation of LLMs to new languages. Our study covers the key components in this process, including vocabulary extension, direct preference optimization and the data scarcity problem for human alignment in low-resource languages. We scale these experiments across 9 languages and 2 parameter scales (7B and 70B). We compare our models against Llama 2, Aya-101, XGLM, BLOOM and existing language experts, outperforming all prior published baselines. Additionally, all evaluation code and checkpoints are made public to facilitate future research.

In this study, we investigate the potential of Large Language Models to complement biomedical knowledge graphs in the training of semantic models for the biomedical and clinical domains. Drawing on the wealth of the UMLS knowledge graph and harnessing cutting-edge Large Language Models, we propose a new state-of-the-art approach for obtaining high-fidelity representations of biomedical concepts and sentences, consisting of three steps: an improved contrastive learning phase, a novel self-distillation phase, and a weight averaging phase. Through rigorous evaluations via the extensive BioLORD testing suite and diverse downstream tasks, we demonstrate consistent and substantial performance improvements over the previous state of the art (e.g. +2pts on MedSTS, +2.5pts on MedNLI-S, +6.1pts on EHR-Rel-B). Besides our new state-of-the-art biomedical model for English, we also distill and release a multilingual model compatible with 50+ languages and finetuned on 7 European languages. Many clinical pipelines can benefit from our latest models. Our new multilingual model enables a range of languages to benefit from our advancements in biomedical semantic representation learning, opening a new avenue for bioinformatics researchers around the world. As a result, we hope to see BioLORD-2023 becoming a precious tool for future biomedical applications.

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

Sifting through vast textual data and summarizing key information imposes a substantial burden on how clinicians allocate their time. Although large language models (LLMs) have shown immense promise in natural language processing (NLP) tasks, their efficacy across diverse clinical summarization tasks has not yet been rigorously examined. In this work, we employ domain adaptation methods on eight LLMs, spanning six datasets and four distinct summarization tasks: radiology reports, patient questions, progress notes, and doctor-patient dialogue. Our thorough quantitative assessment reveals trade-offs between models and adaptation methods in addition to instances where recent advances in LLMs may not lead to improved results. Further, in a clinical reader study with six physicians, we depict that summaries from the best adapted LLM are preferable to human summaries in terms of completeness and correctness. Our ensuing qualitative analysis delineates mutual challenges faced by both LLMs and human experts. Lastly, we correlate traditional quantitative NLP metrics with reader study scores to enhance our understanding of how these metrics align with physician preferences. Our research marks the first evidence of LLMs outperforming human experts in clinical text summarization across multiple tasks. This implies that integrating LLMs into clinical workflows could alleviate documentation burden, empowering clinicians to focus more on personalized patient care and other irreplaceable human aspects of medicine.

Most biomedical pretrained language models are monolingual and cannot handle the growing cross-lingual requirements. The scarcity of non-English domain corpora, not to mention parallel data, poses a significant hurdle in training multilingual biomedical models. Since knowledge forms the core of domain-specific corpora and can be translated into various languages accurately, we propose a model called KBioXLM, which transforms the multilingual pretrained model XLM-R into the biomedical domain using a knowledge-anchored approach. We achieve a biomedical multilingual corpus by incorporating three granularity knowledge alignments (entity, fact, and passage levels) into monolingual corpora. Then we design three corresponding training tasks (entity masking, relation masking, and passage relation prediction) and continue training on top of the XLM-R model to enhance its domain cross-lingual ability. To validate the effectiveness of our model, we translate the English benchmarks of multiple tasks into Chinese. Experimental results demonstrate that our model significantly outperforms monolingual and multilingual pretrained models in cross-lingual zero-shot and few-shot scenarios, achieving improvements of up to 10+ points. Our code is publicly available at https://github.com/ngwlh-gl/KBioXLM.

Large Language Models (LLMs) have the potential of facilitating the development of Artificial Intelligence technology to assist medical experts for interactive decision support, which has been demonstrated by their competitive performances in Medical QA. However, while impressive, the required quality bar for medical applications remains far from being achieved. Currently, LLMs remain challenged by outdated knowledge and by their tendency to generate hallucinated content. Furthermore, most benchmarks to assess medical knowledge lack reference gold explanations which means that it is not possible to evaluate the reasoning of LLMs predictions. Finally, the situation is particularly grim if we consider benchmarking LLMs for languages other than English which remains, as far as we know, a totally neglected topic. In order to address these shortcomings, in this paper we present MedExpQA, the first multilingual benchmark based on medical exams to evaluate LLMs in Medical Question Answering. To the best of our knowledge, MedExpQA includes for the first time reference gold explanations written by medical doctors which can be leveraged to establish various gold-based upper-bounds for comparison with LLMs performance. Comprehensive multilingual experimentation using both the gold reference explanations and Retrieval Augmented Generation (RAG) approaches show that performance of LLMs still has large room for improvement, especially for languages other than English. Furthermore, and despite using state-of-the-art RAG methods, our results also demonstrate the difficulty of obtaining and integrating readily available medical knowledge that may positively impact results on downstream evaluations for Medical Question Answering. So far the benchmark is available in four languages, but we hope that this work may encourage further development to other languages.

Objective: To improve performance of medical entity normalization across many languages, especially when fewer language resources are available compared to English. Materials and Methods: We introduce xMEN, a modular system for cross-lingual medical entity normalization, which performs well in both low- and high-resource scenarios. When synonyms in the target language are scarce for a given terminology, we leverage English aliases via cross-lingual candidate generation. For candidate ranking, we incorporate a trainable cross-encoder model if annotations for the target task are available. We also evaluate cross-encoders trained in a weakly supervised manner based on machine-translated datasets from a high resource domain. Our system is publicly available as an extensible Python toolkit. Results: xMEN improves the state-of-the-art performance across a wide range of multilingual benchmark datasets. Weakly supervised cross-encoders are effective when no training data is available for the target task. Through the compatibility of xMEN with the BigBIO framework, it can be easily used with existing and prospective datasets. Discussion: Our experiments show the importance of balancing the output of general-purpose candidate generators with subsequent trainable re-rankers, which we achieve through a rank regularization term in the loss function of the cross-encoder. However, error analysis reveals that multi-word expressions and other complex entities are still challenging. Conclusion: xMEN exhibits strong performance for medical entity normalization in multiple languages, even when no labeled data and few terminology aliases for the target language are available. Its configuration system and evaluation modules enable reproducible benchmarks. Models and code are available online at the following URL: https://github.com/hpi-dhc/xmen

The paper introduces methods of adaptation of multilingual masked language models for a specific language. Pre-trained bidirectional language models show state-of-the-art performance on a wide range of tasks including reading comprehension, natural language inference, and sentiment analysis. At the moment there are two alternative approaches to train such models: monolingual and multilingual. While language specific models show superior performance, multilingual models allow to perform a transfer from one language to another and solve tasks for different languages simultaneously. This work shows that transfer learning from a multilingual model to monolingual model results in significant growth of performance on such tasks as reading comprehension, paraphrase detection, and sentiment analysis. Furthermore, multilingual initialization of monolingual model substantially reduces training time. Pre-trained models for the Russian language are open sourced.

The increasing use of tools and solutions based on Large Language Models (LLMs) for various tasks in the medical domain has become a prominent trend. Their use in this highly critical and sensitive domain has thus raised important questions about their robustness, especially in response to variations in input, and the reliability of the generated outputs. This study addresses these questions by constructing a textual dataset based on the ICD-10-CM code descriptions, widely used in US hospitals and containing many clinical terms, and their easily reproducible rephrasing. We then benchmarked existing embedding models, either generalist or specialized in the clinical domain, in a semantic search task where the goal was to correctly match the rephrased text to the original description. Our results showed that generalist models performed better than clinical models, suggesting that existing clinical specialized models are more sensitive to small changes in input that confuse them. The highlighted problem of specialized models may be due to the fact that they have not been trained on sufficient data, and in particular on datasets that are not diverse enough to have a reliable global language understanding, which is still necessary for accurate handling of medical documents.

In this paper, we introduce BiMediX, the first bilingual medical mixture of experts LLM designed for seamless interaction in both English and Arabic. Our model facilitates a wide range of medical interactions in English and Arabic, including multi-turn chats to inquire about additional details such as patient symptoms and medical history, multiple-choice question answering, and open-ended question answering. We propose a semi-automated English-to-Arabic translation pipeline with human refinement to ensure high-quality translations. We also introduce a comprehensive evaluation benchmark for Arabic medical LLMs. Furthermore, we introduce BiMed1.3M, an extensive Arabic-English bilingual instruction set covering 1.3 Million diverse medical interactions, resulting in over 632 million healthcare specialized tokens for instruction tuning. Our BiMed1.3M dataset includes 250k synthesized multi-turn doctor-patient chats and maintains a 1:2 Arabic-to-English ratio. Our model outperforms state-of-the-art Med42 and Meditron by average absolute gains of 2.5% and 4.1%, respectively, computed across multiple medical evaluation benchmarks in English, while operating at 8-times faster inference. Moreover, our BiMediX outperforms the generic Arabic-English bilingual LLM, Jais-30B, by average absolute gains of 10% on our Arabic medical benchmark and 15% on bilingual evaluations across multiple datasets. Our project page with source code and trained model is available at https://github.com/mbzuai-oryx/BiMediX .

While Large Language Models (LLMs) excel in world knowledge understanding, adapting them to specific subfields requires precise adjustments. Due to the model's vast scale, traditional global fine-tuning methods for large models can be computationally expensive and impact generalization. To address this challenge, a range of innovative Parameters-Efficient Fine-Tuning (PEFT) methods have emerged and achieved remarkable success in both LLMs and Large Vision-Language Models (LVLMs). In the medical domain, fine-tuning a medical Vision-Language Pretrained (VLP) model is essential for adapting it to specific tasks. Can the fine-tuning methods for large models be transferred to the medical field to enhance transfer learning efficiency? In this paper, we delve into the fine-tuning methods of LLMs and conduct extensive experiments to investigate the impact of fine-tuning methods for large models on the existing multimodal model in the medical domain from the training data level and the model structure level. We show the different impacts of fine-tuning methods for large models on medical VLMs and develop the most efficient ways to fine-tune medical VLP models. We hope this research can guide medical domain researchers in optimizing VLMs' training costs, fostering the broader application of VLMs in healthcare fields. The code and dataset have been released at https://github.com/TIMMY-CHAN/MILE.

Recent breakthroughs in large language models (LLMs) offer unprecedented natural language understanding and generation capabilities. However, existing surveys on LLMs in biomedicine often focus on specific applications or model architectures, lacking a comprehensive analysis that integrates the latest advancements across various biomedical domains. This review, based on an analysis of 484 publications sourced from databases including PubMed, Web of Science, and arXiv, provides an in-depth examination of the current landscape, applications, challenges, and prospects of LLMs in biomedicine, distinguishing itself by focusing on the practical implications of these models in real-world biomedical contexts. Firstly, we explore the capabilities of LLMs in zero-shot learning across a broad spectrum of biomedical tasks, including diagnostic assistance, drug discovery, and personalized medicine, among others, with insights drawn from 137 key studies. Then, we discuss adaptation strategies of LLMs, including fine-tuning methods for both uni-modal and multi-modal LLMs to enhance their performance in specialized biomedical contexts where zero-shot fails to achieve, such as medical question answering and efficient processing of biomedical literature. Finally, we discuss the challenges that LLMs face in the biomedicine domain including data privacy concerns, limited model interpretability, issues with dataset quality, and ethics due to the sensitive nature of biomedical data, the need for highly reliable model outputs, and the ethical implications of deploying AI in healthcare. To address these challenges, we also identify future research directions of LLM in biomedicine including federated learning methods to preserve data privacy and integrating explainable AI methodologies to enhance the transparency of LLMs.

This paper introduces BiMediX2, a bilingual (Arabic-English) Bio-Medical EXpert Large Multimodal Model (LMM) with a unified architecture that integrates text and visual modalities, enabling advanced image understanding and medical applications. BiMediX2 leverages the Llama3.1 architecture and integrates text and visual capabilities to facilitate seamless interactions in both English and Arabic, supporting text-based inputs and multi-turn conversations involving medical images. The model is trained on an extensive bilingual healthcare dataset consisting of 1.6M samples of diverse medical interactions for both text and image modalities, mixed in Arabic and English. We also propose the first bilingual GPT-4o based medical LMM benchmark named BiMed-MBench. BiMediX2 is benchmarked on both text-based and image-based tasks, achieving state-of-the-art performance across several medical benchmarks. It outperforms recent state-of-the-art models in medical LLM evaluation benchmarks. Our model also sets a new benchmark in multimodal medical evaluations with over 9% improvement in English and over 20% in Arabic evaluations. Additionally, it surpasses GPT-4 by around 9% in UPHILL factual accuracy evaluations and excels in various medical Visual Question Answering, Report Generation, and Report Summarization tasks. The project page including source code and the trained model, is available at https://github.com/mbzuai-oryx/BiMediX2.

Despite the vast repository of global medical knowledge predominantly being in English, local languages are crucial for delivering tailored healthcare services, particularly in areas with limited medical resources. To extend the reach of medical AI advancements to a broader population, we aim to develop medical LLMs across the six most widely spoken languages, encompassing a global population of 6.1 billion. This effort culminates in the creation of the ApolloCorpora multilingual medical dataset and the XMedBench benchmark. In the multilingual medical benchmark, the released Apollo models, at various relatively-small sizes (i.e., 0.5B, 1.8B, 2B, 6B, and 7B), achieve the best performance among models of equivalent size. Especially, Apollo-7B is the state-of-the-art multilingual medical LLMs up to 70B. Additionally, these lite models could be used to improve the multi-lingual medical capabilities of larger models without fine-tuning in a proxy-tuning fashion. We will open-source training corpora, code, model weights and evaluation benchmark.

Multilingual pre-trained language models (PLMs) have demonstrated impressive performance on several downstream tasks for both high-resourced and low-resourced languages. However, there is still a large performance drop for languages unseen during pre-training, especially African languages. One of the most effective approaches to adapt to a new language is language adaptive fine-tuning (LAFT) -- fine-tuning a multilingual PLM on monolingual texts of a language using the pre-training objective. However, adapting to a target language individually takes a large disk space and limits the cross-lingual transfer abilities of the resulting models because they have been specialized for a single language. In this paper, we perform multilingual adaptive fine-tuning on 17 most-resourced African languages and three other high-resource languages widely spoken on the African continent to encourage cross-lingual transfer learning. To further specialize the multilingual PLM, we removed vocabulary tokens from the embedding layer that corresponds to non-African writing scripts before MAFT, thus reducing the model size by around 50%. Our evaluation on two multilingual PLMs (AfriBERTa and XLM-R) and three NLP tasks (NER, news topic classification, and sentiment classification) shows that our approach is competitive to applying LAFT on individual languages while requiring significantly less disk space. Additionally, we show that our adapted PLM also improves the zero-shot cross-lingual transfer abilities of parameter efficient fine-tuning methods.

Recently, large language model (LLM) based artificial intelligence (AI) systems have demonstrated remarkable capabilities in natural language understanding and generation. However, these models face a significant challenge when it comes to sensitive applications, such as reasoning over medical knowledge and answering medical questions in a physician-like manner. Prior studies attempted to overcome this challenge by increasing the model size (>100B) to learn more general medical knowledge, while there is still room for improvement in LLMs with smaller-scale model sizes (<100B). In this work, we start from a pre-trained general LLM model (AntGLM-10B) and fine-tune it from a medical beginner towards a medical expert (called AntGLM-Med-10B), which leverages a 3-stage optimization procedure, i.e., general medical knowledge injection, medical domain instruction tuning, and specific medical task adaptation. Our contributions are threefold: (1) We specifically investigate how to adapt a pre-trained general LLM in medical domain, especially for a specific medical task. (2) We collect and construct large-scale medical datasets for each stage of the optimization process. These datasets encompass various data types and tasks, such as question-answering, medical reasoning, multi-choice questions, and medical conversations. (3) Specifically for multi-choice questions in the medical domain, we propose a novel Verification-of-Choice approach for prompting engineering, which significantly enhances the reasoning ability of LLMs. Remarkably, by combining the above approaches, our AntGLM-Med-10B model can outperform the most of LLMs on PubMedQA, including both general and medical LLMs, even when these LLMs have larger model size.

Machine translation for Vietnamese-English in the medical domain is still an under-explored research area. In this paper, we introduce MedEV -- a high-quality Vietnamese-English parallel dataset constructed specifically for the medical domain, comprising approximately 360K sentence pairs. We conduct extensive experiments comparing Google Translate, ChatGPT (gpt-3.5-turbo), state-of-the-art Vietnamese-English neural machine translation models and pre-trained bilingual/multilingual sequence-to-sequence models on our new MedEV dataset. Experimental results show that the best performance is achieved by fine-tuning "vinai-translate" for each translation direction. We publicly release our dataset to promote further research.

The number of pretrained Large Language Models (LLMs) is increasing steadily, though the majority are designed predominantly for the English language. While state-of-the-art LLMs can handle other languages, due to language contamination or some degree of multilingual pretraining data, they are not optimized for non-English languages, leading to inefficient encoding (high token "fertility") and slower inference speed. In this work, we thoroughly compare a variety of vocabulary adaptation techniques for optimizing English LLMs for the Italian language, and put forward Semantic Alignment Vocabulary Adaptation (SAVA), a novel method that leverages neural mapping for vocabulary substitution. SAVA achieves competitive performance across multiple downstream tasks, enhancing grounded alignment strategies. We adapt two LLMs: Mistral-7b-v0.1, reducing token fertility by 25\%, and Llama-3.1-8B, optimizing the vocabulary and reducing the number of parameters by 1 billion. We show that, following the adaptation of the vocabulary, these models can recover their performance with a relatively limited stage of continual training on the target language. Finally, we test the capabilities of the adapted models on various multi-choice and generative tasks.

Large multilingual language models such as mBERT or XLM-R enable zero-shot cross-lingual transfer in various IR and NLP tasks. Cao et al. (2020) proposed a data- and compute-efficient method for cross-lingual adjustment of mBERT that uses a small parallel corpus to make embeddings of related words across languages similar to each other. They showed it to be effective in NLI for five European languages. In contrast we experiment with a typologically diverse set of languages (Spanish, Russian, Vietnamese, and Hindi) and extend their original implementations to new tasks (XSR, NER, and QA) and an additional training regime (continual learning). Our study reproduced gains in NLI for four languages, showed improved NER, XSR, and cross-lingual QA results in three languages (though some cross-lingual QA gains were not statistically significant), while mono-lingual QA performance never improved and sometimes degraded. Analysis of distances between contextualized embeddings of related and unrelated words (across languages) showed that fine-tuning leads to "forgetting" some of the cross-lingual alignment information. Based on this observation, we further improved NLI performance using continual learning.

Nowadays the medical domain is receiving more and more attention in applications involving Artificial Intelligence. Clinicians have to deal with an enormous amount of unstructured textual data to make a conclusion about patients' health in their everyday life. Argument mining helps to provide a structure to such data by detecting argumentative components in the text and classifying the relations between them. However, as it is the case for many tasks in Natural Language Processing in general and in medical text processing in particular, the large majority of the work on computational argumentation has been done only for English. This is also the case with the only dataset available for argumentation in the medical domain, namely, the annotated medical data of abstracts of Randomized Controlled Trials (RCT) from the MEDLINE database. In order to mitigate the lack of annotated data for other languages, we empirically investigate several strategies to perform argument mining and classification in medical texts for a language for which no annotated data is available. This project shows that automatically translating and project annotations from English to a target language (Spanish) is an effective way to generate annotated data without manual intervention. Furthermore, our experiments demonstrate that the translation and projection approach outperforms zero-shot cross-lingual approaches using a large masked multilingual language model. Finally, we show how the automatically generated data in Spanish can also be used to improve results in the original English evaluation setting.

Since the rise of large language models (LLMs), the domain adaptation has been one of the hot topics in various domains. Many medical LLMs trained with English medical dataset have made public recently. However, Japanese LLMs in medical domain still lack its research. Here we utilize multiple 70B-parameter LLMs for the first time and show that instruction tuning using Japanese medical question-answering dataset significantly improves the ability of Japanese LLMs to solve Japanese medical license exams, surpassing 50\% in accuracy. In particular, the Japanese-centric models exhibit a more significant leap in improvement through instruction tuning compared to their English-centric counterparts. This underscores the importance of continual pretraining and the adjustment of the tokenizer in our local language. We also examine two slightly different prompt formats, resulting in non-negligible performance improvement.

Large language models (LLMs) have shown substantial progress in natural language understanding and generation, proving valuable especially in the medical field. Despite advancements, challenges persist due to the complexity and diversity inherent in medical tasks, which can be categorized as knowledge-intensive tasks and alignment-required tasks. Previous approaches either ignore the latter task or focus on a minority of tasks and hence lose generalization. To address these drawbacks, we propose a progressive fine-tuning pipeline. This pipeline employs a Knowledge Aggregator and a Noise aggregator to encode diverse knowledge in the first stage and filter out detrimental information. In the second stage, we drop the Noise Aggregator to avoid the interference of suboptimal representation and leverage an additional alignment module optimized towards an orthogonal direction to the knowledge space to mitigate knowledge forgetting. Based on this two-stage paradigm, we proposed a Medical LLM through decoupling Clinical Alignment and Knowledge Aggregation (MedCare), which is designed to achieve state-of-the-art (SOTA) performance on over 20 medical tasks, as well as SOTA results on specific medical alignment tasks. Various model sizes of MedCare (1.8B, 7B, 14B) all demonstrate significant improvements over existing models with similar model sizes.

This paper provides a comprehensive survey of the latest research on multilingual large language models (MLLMs). MLLMs not only are able to understand and generate language across linguistic boundaries, but also represent an important advancement in artificial intelligence. We first discuss the architecture and pre-training objectives of MLLMs, highlighting the key components and methodologies that contribute to their multilingual capabilities. We then discuss the construction of multilingual pre-training and alignment datasets, underscoring the importance of data quality and diversity in enhancing MLLM performance. An important focus of this survey is on the evaluation of MLLMs. We present a detailed taxonomy and roadmap covering the assessment of MLLMs' cross-lingual knowledge, reasoning, alignment with human values, safety, interpretability and specialized applications. Specifically, we extensively discuss multilingual evaluation benchmarks and datasets, and explore the use of LLMs themselves as multilingual evaluators. To enhance MLLMs from black to white boxes, we also address the interpretability of multilingual capabilities, cross-lingual transfer and language bias within these models. Finally, we provide a comprehensive review of real-world applications of MLLMs across diverse domains, including biology, medicine, computer science, mathematics and law. We showcase how these models have driven innovation and improvements in these specialized fields while also highlighting the challenges and opportunities in deploying MLLMs within diverse language communities and application scenarios. We listed the paper related in this survey and publicly available at https://github.com/tjunlp-lab/Awesome-Multilingual-LLMs-Papers.

We present HealthGPT, a powerful Medical Large Vision-Language Model (Med-LVLM) that integrates medical visual comprehension and generation capabilities within a unified autoregressive paradigm. Our bootstrapping philosophy is to progressively adapt heterogeneous comprehension and generation knowledge to pre-trained large language models (LLMs). This is achieved through a novel heterogeneous low-rank adaptation (H-LoRA) technique, which is complemented by a tailored hierarchical visual perception approach and a three-stage learning strategy. To effectively learn the HealthGPT, we devise a comprehensive medical domain-specific comprehension and generation dataset called VL-Health. Experimental results demonstrate exceptional performance and scalability of HealthGPT in medical visual unified tasks. Our project can be accessed at https://github.com/DCDmllm/HealthGPT.

Large Language Models (LLMs) have demonstrated remarkable success in diverse natural language processing (NLP) tasks in general domains. However, LLMs sometimes generate responses with the hallucination about medical facts due to limited domain knowledge. Such shortcomings pose potential risks in the utilization of LLMs within medical contexts. To address this challenge, we propose knowledge-tuning, which leverages structured medical knowledge bases for the LLMs to grasp domain knowledge efficiently and facilitate reliable response generation. We also release cMedKnowQA, a Chinese medical knowledge question-answering dataset constructed from medical knowledge bases to assess the medical knowledge proficiency of LLMs. Experimental results show that the LLMs which are knowledge-tuned with cMedKnowQA, can exhibit higher levels of accuracy in response generation compared with vanilla instruction-tuning and offer a new reliable way for the domain adaptation of LLMs.

Massively multilingual models are promising for transfer learning across tasks and languages. However, existing methods are unable to fully leverage training data when it is available in different task-language combinations. To exploit such heterogeneous supervision, we propose Hyper-X, a single hypernetwork that unifies multi-task and multilingual learning with efficient adaptation. This model generates weights for adapter modules conditioned on both tasks and language embeddings. By learning to combine task and language-specific knowledge, our model enables zero-shot transfer for unseen languages and task-language combinations. Our experiments on a diverse set of languages demonstrate that Hyper-X achieves the best or competitive gain when a mixture of multiple resources is available, while being on par with strong baselines in the standard scenario. Hyper-X is also considerably more efficient in terms of parameters and resources compared to methods that train separate adapters. Finally, Hyper-X consistently produces strong results in few-shot scenarios for new languages, showing the versatility of our approach beyond zero-shot transfer.

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

Vision-Language Models (VLMs) trained via contrastive learning have achieved notable success in natural image tasks. However, their application in the medical domain remains limited due to the scarcity of openly accessible, large-scale medical image-text datasets. Existing medical VLMs either train on closed-source proprietary or relatively small open-source datasets that do not generalize well. Similarly, most models remain specific to a single or limited number of medical imaging domains, again restricting their applicability to other modalities. To address this gap, we introduce UniMed, a large-scale, open-source multi-modal medical dataset comprising over 5.3 million image-text pairs across six diverse imaging modalities: X-ray, CT, MRI, Ultrasound, Pathology, and Fundus. UniMed is developed using a data-collection framework that leverages Large Language Models (LLMs) to transform modality-specific classification datasets into image-text formats while incorporating existing image-text data from the medical domain, facilitating scalable VLM pretraining. Using UniMed, we trained UniMed-CLIP, a unified VLM for six modalities that significantly outperforms existing generalist VLMs and matches modality-specific medical VLMs, achieving notable gains in zero-shot evaluations. For instance, UniMed-CLIP improves over BiomedCLIP (trained on proprietary data) by an absolute gain of +12.61, averaged over 21 datasets, while using 3x less training data. To facilitate future research, we release UniMed dataset, training codes, and models at https://github.com/mbzuai-oryx/UniMed-CLIP.

Despite the impressive performance recently achieved by automatic speech recognition (ASR), we observe two primary challenges that hinder its broader applications: (1) The difficulty of introducing scalability into the model to support more languages with limited training, inference, and storage overhead; (2) The low-resource adaptation ability that enables effective low-resource adaptation while avoiding over-fitting and catastrophic forgetting issues. Inspired by recent findings, we hypothesize that we can address the above challenges with modules widely shared across languages. To this end, we propose an ASR framework, dubbed \METHODNS, that, for the first time, simultaneously achieves strong multilingual scalability and low-resource adaptation ability thanks to its modularize-then-assemble strategy. Specifically, \METHOD learns a small set of generalizable sub-modules and adaptively assembles them for different languages to reduce the multilingual overhead and enable effective knowledge transfer for low-resource adaptation. Extensive experiments and visualizations demonstrate that \METHOD can effectively discover language similarity and improve multilingual and low-resource ASR performance over state-of-the-art (SOTA) methods, e.g., under multilingual-ASR, our framework achieves a 0.13sim2.41 lower character error rate (CER) with 30\% smaller inference overhead over SOTA solutions on multilingual ASR and a comparable CER, with nearly 50 times fewer trainable parameters over SOTA solutions on low-resource tuning, respectively.

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.

Adapting a language model into a specific domain, a.k.a `domain adaption', is a common practice when specialized knowledge, e.g. medicine, is not encapsulated in a general language model like Llama2. The challenge lies in the heterogeneity of data across the two training stages, as it varies in languages, genres, or formats. To tackle this and simplify the learning protocol, we propose to transform heterogeneous data, from the both pre-training and supervised stages, into a unified, simple input-output pair format. We validate the new protocol in the domains where proprietary LLMs like ChatGPT perform relatively poorly, such as Traditional Chinese Medicine. The developed model, HuatuoGPT-II, has shown state-of-the-art performance in Chinese medicine domain on a number of benchmarks, e.g. medical licensing exams. It even outperforms proprietary models like ChatGPT and GPT-4 in some aspects, especially in Traditional Chinese Medicine. Expert manual evaluations further validate HuatuoGPT-II's advantages over existing LLMs. Notably, HuatuoGPT-II was benchmarked in a fresh Chinese National Medical Licensing Examination where it achieved the best performance, showcasing not only its effectiveness but also its generalization capabilities.

In order to simulate human language capacity, natural language processing systems must be able to reason about the dynamics of everyday situations, including their possible causes and effects. Moreover, they should be able to generalise the acquired world knowledge to new languages, modulo cultural differences. Advances in machine reasoning and cross-lingual transfer depend on the availability of challenging evaluation benchmarks. Motivated by both demands, we introduce Cross-lingual Choice of Plausible Alternatives (XCOPA), a typologically diverse multilingual dataset for causal commonsense reasoning in 11 languages, which includes resource-poor languages like Eastern Apur\'imac Quechua and Haitian Creole. We evaluate a range of state-of-the-art models on this novel dataset, revealing that the performance of current methods based on multilingual pretraining and zero-shot fine-tuning falls short compared to translation-based transfer. Finally, we propose strategies to adapt multilingual models to out-of-sample resource-lean languages where only a small corpus or a bilingual dictionary is available, and report substantial improvements over the random baseline. The XCOPA dataset is freely available at github.com/cambridgeltl/xcopa.

Large language models (LLMs) have shown impressive capabilities in natural language processing tasks, including dialogue generation. This research aims to conduct a novel comparative analysis of two prominent techniques, fine-tuning with LoRA (Low-Rank Adaptation) and the Retrieval-Augmented Generation (RAG) framework, in the context of doctor-patient chat conversations with multiple datasets of mixed medical domains. The analysis involves three state-of-the-art models: Llama-2, GPT, and the LSTM model. Employing real-world doctor-patient dialogues, we comprehensively evaluate the performance of models, assessing key metrics such as language quality (perplexity, BLEU score), factual accuracy (fact-checking against medical knowledge bases), adherence to medical guidelines, and overall human judgments (coherence, empathy, safety). The findings provide insights into the strengths and limitations of each approach, shedding light on their suitability for healthcare applications. Furthermore, the research investigates the robustness of the models in handling diverse patient queries, ranging from general health inquiries to specific medical conditions. The impact of domain-specific knowledge integration is also explored, highlighting the potential for enhancing LLM performance through targeted data augmentation and retrieval strategies.

State-of-the-art neural retrievers predominantly focus on high-resource languages like English, which impedes their adoption in retrieval scenarios involving other languages. Current approaches circumvent the lack of high-quality labeled data in non-English languages by leveraging multilingual pretrained language models capable of cross-lingual transfer. However, these models require substantial task-specific fine-tuning across multiple languages, often perform poorly in languages with minimal representation in the pretraining corpus, and struggle to incorporate new languages after the pretraining phase. In this work, we present a novel modular dense retrieval model that learns from the rich data of a single high-resource language and effectively zero-shot transfers to a wide array of languages, thereby eliminating the need for language-specific labeled data. Our model, ColBERT-XM, demonstrates competitive performance against existing state-of-the-art multilingual retrievers trained on more extensive datasets in various languages. Further analysis reveals that our modular approach is highly data-efficient, effectively adapts to out-of-distribution data, and significantly reduces energy consumption and carbon emissions. By demonstrating its proficiency in zero-shot scenarios, ColBERT-XM marks a shift towards more sustainable and inclusive retrieval systems, enabling effective information accessibility in numerous languages. We publicly release our code and models for the community.

This study presents a comprehensive analysis and comparison of two predominant fine-tuning methodologies - full-parameter fine-tuning and parameter-efficient tuning - within the context of medical Large Language Models (LLMs). We developed and refined a series of LLMs, based on the Llama-2 architecture, specifically designed to enhance medical knowledge retrieval, reasoning, and question-answering capabilities. Our experiments systematically evaluate the effectiveness of these tuning strategies across various well-known medical benchmarks. Notably, our medical LLM Med42 showed an accuracy level of 72% on the US Medical Licensing Examination (USMLE) datasets, setting a new standard in performance for openly available medical LLMs. Through this comparative analysis, we aim to identify the most effective and efficient method for fine-tuning LLMs in the medical domain, thereby contributing significantly to the advancement of AI-driven healthcare applications.

Natural language processing (NLP) has witnessed a profound impact of large language models (LLMs) that excel in a multitude of tasks. However, the limitation of LLMs in multilingual settings, particularly in underrepresented languages, remains a significant hurdle. This thesis aims to bridge the gap in NLP research and development by focusing on underrepresented languages. A comprehensive evaluation of LLMs is conducted to assess their capabilities in these languages, revealing the challenges of multilingual and multicultural generalization. Addressing the multilingual generalization gap, this thesis proposes data-and-compute-efficient methods to mitigate the disparity in LLM ability in underrepresented languages, allowing better generalization on underrepresented languages without the loss of task generalization ability. The proposed solutions cover cross-lingual continual instruction tuning, retrieval-based cross-lingual in-context learning, and in-context query alignment. Furthermore, a novel method to measure cultural values alignment between LLMs operating in different languages is proposed, ensuring cultural sensitivity and inclusivity. These contributions aim to enhance the multilingual and multicultural alignment of LLMs in underrepresented languages, ultimately advancing the NLP field toward greater equality and inclusiveness.

LLMs are increasingly being deployed for multilingual applications and have demonstrated impressive translation capabilities between several low and high resource languages. An aspect of translation that often gets overlooked is that of cultural adaptation, or modifying source culture references to suit the target culture. Cultural adaptation has applications across several creative industries and requires intimate knowledge of source and target cultures during translation. While specialized translation models still outperform LLMs on the machine translation task when viewed from the lens of correctness, they are not sensitive to cultural differences often requiring manual correction. LLMs on the other hand have a rich reservoir of cultural knowledge embedded within its parameters that can be potentially exploited for such applications. In this paper we define the task of cultural adaptation and create an evaluation framework to benchmark different models for this task. We evaluate the performance of modern LLMs for cultural adaptation and analyze their cross cultural knowledge while connecting related concepts across different cultures. We also analyze possible issues with automatic adaptation including cultural biases and stereotypes. We hope that this task will offer more insight into the cultural understanding of LLMs and their creativity in cross-cultural scenarios.

The development of state-of-the-art generative large language models (LLMs) disproportionately relies on English-centric tokenizers, vocabulary and pre-training data. Despite the fact that some LLMs have multilingual capabilities, recent studies have shown that their inference efficiency deteriorates when generating text in languages other than English. This results in increased inference time and costs. Cross-lingual vocabulary adaptation methods have been proposed for adapting models to a target language aiming to improve downstream performance. However, the effectiveness of these methods on increasing inference efficiency of generative LLMs has yet to be explored. In this paper, we perform an empirical study of various cross-lingual vocabulary adaptation methods on five generative LLMs (including monolingual and multilingual models) across four typologically-diverse languages and four natural language understanding tasks. We find that cross-lingual vocabulary adaptation substantially contributes to LLM inference speedups of up to 271.5%. We also show that adapting LLMs that have been pre-trained on more balanced multilingual data results in downstream performance comparable to the original models.

Curated datasets for healthcare are often limited due to the need of human annotations from experts. In this paper, we present MedEval, a multi-level, multi-task, and multi-domain medical benchmark to facilitate the development of language models for healthcare. MedEval is comprehensive and consists of data from several healthcare systems and spans 35 human body regions from 8 examination modalities. With 22,779 collected sentences and 21,228 reports, we provide expert annotations at multiple levels, offering a granular potential usage of the data and supporting a wide range of tasks. Moreover, we systematically evaluated 10 generic and domain-specific language models under zero-shot and finetuning settings, from domain-adapted baselines in healthcare to general-purposed state-of-the-art large language models (e.g., ChatGPT). Our evaluations reveal varying effectiveness of the two categories of language models across different tasks, from which we notice the importance of instruction tuning for few-shot usage of large language models. Our investigation paves the way toward benchmarking language models for healthcare and provides valuable insights into the strengths and limitations of adopting large language models in medical domains, informing their practical applications and future advancements.

The recommendation of medication is a vital aspect of intelligent healthcare systems, as it involves prescribing the most suitable drugs based on a patient's specific health needs. Unfortunately, many sophisticated models currently in use tend to overlook the nuanced semantics of medical data, while only relying heavily on identities. Furthermore, these models face significant challenges in handling cases involving patients who are visiting the hospital for the first time, as they lack prior prescription histories to draw upon. To tackle these issues, we harness the powerful semantic comprehension and input-agnostic characteristics of Large Language Models (LLMs). Our research aims to transform existing medication recommendation methodologies using LLMs. In this paper, we introduce a novel approach called Large Language Model Distilling Medication Recommendation (LEADER). We begin by creating appropriate prompt templates that enable LLMs to suggest medications effectively. However, the straightforward integration of LLMs into recommender systems leads to an out-of-corpus issue specific to drugs. We handle it by adapting the LLMs with a novel output layer and a refined tuning loss function. Although LLM-based models exhibit remarkable capabilities, they are plagued by high computational costs during inference, which is impractical for the healthcare sector. To mitigate this, we have developed a feature-level knowledge distillation technique, which transfers the LLM's proficiency to a more compact model. Extensive experiments conducted on two real-world datasets, MIMIC-III and MIMIC-IV, demonstrate that our proposed model not only delivers effective results but also is efficient. To ease the reproducibility of our experiments, we release the implementation code online.

The integration of large language model (LLM) techniques in the field of medical analysis has brought about significant advancements, yet the scarcity of large, diverse, and well-annotated datasets remains a major challenge. Medical data and tasks, which vary in format, size, and other parameters, require extensive preprocessing and standardization for effective use in training LLMs. To address these challenges, we introduce MedINST, the Meta Dataset of Biomedical Instructions, a novel multi-domain, multi-task instructional meta-dataset. MedINST comprises 133 biomedical NLP tasks and over 7 million training samples, making it the most comprehensive biomedical instruction dataset to date. Using MedINST as the meta dataset, we curate MedINST32, a challenging benchmark with different task difficulties aiming to evaluate LLMs' generalization ability. We fine-tune several LLMs on MedINST and evaluate on MedINST32, showcasing enhanced cross-task generalization.

While large language models (LLMs) have been increasingly adopted for machine translation (MT), their performance for specialist domains such as medicine and law remains an open challenge. Prior work has shown that LLMs can be domain-adapted at test-time by retrieving targeted few-shot demonstrations or terminologies for inclusion in the prompt. Meanwhile, for general-purpose LLM MT, recent studies have found some success in generating similarly useful domain knowledge from an LLM itself, prior to translation. Our work studies domain-adapted MT with LLMs through a careful prompting setup, finding that demonstrations consistently outperform terminology, and retrieval consistently outperforms generation. We find that generating demonstrations with weaker models can close the gap with larger model's zero-shot performance. Given the effectiveness of demonstrations, we perform detailed analyses to understand their value. We find that domain-specificity is particularly important, and that the popular multi-domain benchmark is testing adaptation to a particular writing style more so than to a specific domain.

Massively multilingual language models such as multilingual BERT offer state-of-the-art cross-lingual transfer performance on a range of NLP tasks. However, due to limited capacity and large differences in pretraining data sizes, there is a profound performance gap between resource-rich and resource-poor target languages. The ultimate challenge is dealing with under-resourced languages not covered at all by the models and written in scripts unseen during pretraining. In this work, we propose a series of novel data-efficient methods that enable quick and effective adaptation of pretrained multilingual models to such low-resource languages and unseen scripts. Relying on matrix factorization, our methods capitalize on the existing latent knowledge about multiple languages already available in the pretrained model's embedding matrix. Furthermore, we show that learning of the new dedicated embedding matrix in the target language can be improved by leveraging a small number of vocabulary items (i.e., the so-called lexically overlapping tokens) shared between mBERT's and target language vocabulary. Our adaptation techniques offer substantial performance gains for languages with unseen scripts. We also demonstrate that they can yield improvements for low-resource languages written in scripts covered by the pretrained model.

The development of domain-specific language models has significantly advanced natural language processing applications in various specialized fields, particularly in biomedicine. However, the focus has largely been on English-language models, leaving a gap for less-resourced languages such as Italian. This paper introduces Igea, the first decoder-only language model designed explicitly for biomedical text generation in Italian. Built on the Minerva model and continually pretrained on a diverse corpus of Italian medical texts, Igea is available in three model sizes: 350 million, 1 billion, and 3 billion parameters. The models aim to balance computational efficiency and performance, addressing the challenges of managing the peculiarities of medical terminology in Italian. We evaluate Igea using a mix of in-domain biomedical corpora and general-purpose benchmarks, highlighting its efficacy and retention of general knowledge even after the domain-specific training. This paper discusses the model's development and evaluation, providing a foundation for future advancements in Italian biomedical NLP.

The current generation of large language models (LLMs) is typically designed for broad, general-purpose applications, while domain-specific LLMs, especially in vertical fields like medicine, remain relatively scarce. In particular, the development of highly efficient and practical LLMs for the medical domain is challenging due to the complexity of medical knowledge and the limited availability of high-quality data. To bridge this gap, we introduce Baichuan-M1, a series of large language models specifically optimized for medical applications. Unlike traditional approaches that simply continue pretraining on existing models or apply post-training to a general base model, Baichuan-M1 is trained from scratch with a dedicated focus on enhancing medical capabilities. Our model is trained on 20 trillion tokens and incorporates a range of effective training methods that strike a balance between general capabilities and medical expertise. As a result, Baichuan-M1 not only performs strongly across general domains such as mathematics and coding but also excels in specialized medical fields. We have open-sourced Baichuan-M1-14B, a mini version of our model, which can be accessed through the following links.

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

Large language models (LLMs) can potentially democratize access to medical knowledge. While many efforts have been made to harness and improve LLMs' medical knowledge and reasoning capacities, the resulting models are either closed-source (e.g., PaLM, GPT-4) or limited in scale (<= 13B parameters), which restricts their abilities. In this work, we improve access to large-scale medical LLMs by releasing MEDITRON: a suite of open-source LLMs with 7B and 70B parameters adapted to the medical domain. MEDITRON builds on Llama-2 (through our adaptation of Nvidia's Megatron-LM distributed trainer), and extends pretraining on a comprehensively curated medical corpus, including selected PubMed articles, abstracts, and internationally-recognized medical guidelines. Evaluations using four major medical benchmarks show significant performance gains over several state-of-the-art baselines before and after task-specific finetuning. Overall, MEDITRON achieves a 6% absolute performance gain over the best public baseline in its parameter class and 3% over the strongest baseline we finetuned from Llama-2. Compared to closed-source LLMs, MEDITRON-70B outperforms GPT-3.5 and Med-PaLM and is within 5% of GPT-4 and 10% of Med-PaLM-2. We release our code for curating the medical pretraining corpus and the MEDITRON model weights to drive open-source development of more capable medical LLMs.

Modular deep learning has been proposed for the efficient adaption of pre-trained models to new tasks, domains and languages. In particular, combining language adapters with task adapters has shown potential where no supervised data exists for a language. In this paper, we explore the role of language adapters in zero-shot cross-lingual transfer for natural language understanding (NLU) benchmarks. We study the effect of including a target-language adapter in detailed ablation studies with two multilingual models and three multilingual datasets. Our results show that the effect of target-language adapters is highly inconsistent across tasks, languages and models. Retaining the source-language adapter instead often leads to an equivalent, and sometimes to a better, performance. Removing the language adapter after training has only a weak negative effect, indicating that the language adapters do not have a strong impact on the predictions.

The BLOOM model is a large open-source multilingual language model capable of zero-shot learning, but its pretraining was limited to 46 languages. To improve its zero-shot performance on unseen languages, it is desirable to adapt BLOOM, but previous works have only explored adapting small language models. In this work, we apply existing language adaptation strategies to BLOOM and benchmark its zero-shot prompting performance on eight new languages. We find language adaptation to be effective at improving zero-shot performance in new languages. Surprisingly, adapter-based finetuning is more effective than continued pretraining for large models. In addition, we discover that prompting performance is not significantly affected by language specifics, such as the writing system. It is primarily determined by the size of the language adaptation data. We also add new languages to BLOOMZ, which is a multitask finetuned version of BLOOM capable of following task instructions zero-shot. We find including a new language in the multitask fine-tuning mixture to be the most effective method to teach BLOOMZ a new language. We conclude that with sufficient training data language adaptation can generalize well to diverse languages. Our code is available at https://github.com/bigscience-workshop/multilingual-modeling/.

Adapting pretrained language models to novel domains, such as clinical applications, traditionally involves retraining their entire set of parameters. Parameter-Efficient Fine-Tuning (PEFT) techniques for fine-tuning language models significantly reduce computational requirements by selectively fine-tuning small subsets of parameters. In this study, we propose a two-step PEFT framework and evaluate it in the clinical domain. Our approach combines a specialised PEFT adapter layer designed for clinical domain adaptation with another adapter specialised for downstream tasks. We evaluate the framework on multiple clinical outcome prediction datasets, comparing it to clinically trained language models. Our framework achieves a better AUROC score averaged across all clinical downstream tasks compared to clinical language models. In particular, we observe large improvements of 4-5% AUROC in large-scale multilabel classification tasks, such as diagnoses and procedures classification. To our knowledge, this study is the first to provide an extensive empirical analysis of the interplay between PEFT techniques and domain adaptation in an important real-world domain of clinical applications.

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

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

A major consideration in multilingual language modeling is how to best represent languages with diverse vocabularies and scripts. Although contemporary text encoding methods cover most of the world's writing systems, they exhibit bias towards the high-resource languages of the Global West. As a result, texts of underrepresented languages tend to be segmented into long sequences of linguistically meaningless units. To address the disparities, we introduce a new paradigm that encodes the same information with segments of consistent size across diverse languages. Our encoding convention (MYTE) is based on morphemes, as their inventories are more balanced across languages than characters, which are used in previous methods. We show that MYTE produces shorter encodings for all 99 analyzed languages, with the most notable improvements for non-European languages and non-Latin scripts. This, in turn, improves multilingual LM performance and diminishes the perplexity gap throughout diverse languages.

Biomedical data and benchmarks are highly valuable yet very limited in low-resource languages other than English such as Vietnamese. In this paper, we make use of a state-of-the-art translation model in English-Vietnamese to translate and produce both pretrained as well as supervised data in the biomedical domains. Thanks to such large-scale translation, we introduce ViPubmedT5, a pretrained Encoder-Decoder Transformer model trained on 20 million translated abstracts from the high-quality public PubMed corpus. ViPubMedT5 demonstrates state-of-the-art results on two different biomedical benchmarks in summarization and acronym disambiguation. Further, we release ViMedNLI - a new NLP task in Vietnamese translated from MedNLI using the recently public En-vi translation model and carefully refined by human experts, with evaluations of existing methods against ViPubmedT5.

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

State-of-the-art neural (re)rankers are notoriously data-hungry which -- given the lack of large-scale training data in languages other than English -- makes them rarely used in multilingual and cross-lingual retrieval settings. Current approaches therefore commonly transfer rankers trained on English data to other languages and cross-lingual setups by means of multilingual encoders: they fine-tune all parameters of pretrained massively multilingual Transformers (MMTs, e.g., multilingual BERT) on English relevance judgments, and then deploy them in the target language(s). In this work, we show that two parameter-efficient approaches to cross-lingual transfer, namely Sparse Fine-Tuning Masks (SFTMs) and Adapters, allow for a more lightweight and more effective zero-shot transfer to multilingual and cross-lingual retrieval tasks. We first train language adapters (or SFTMs) via Masked Language Modelling and then train retrieval (i.e., reranking) adapters (SFTMs) on top, while keeping all other parameters fixed. At inference, this modular design allows us to compose the ranker by applying the (re)ranking adapter (or SFTM) trained with source language data together with the language adapter (or SFTM) of a target language. We carry out a large scale evaluation on the CLEF-2003 and HC4 benchmarks and additionally, as another contribution, extend the former with queries in three new languages: Kyrgyz, Uyghur and Turkish. The proposed parameter-efficient methods outperform standard zero-shot transfer with full MMT fine-tuning, while being more modular and reducing training times. The gains are particularly pronounced for low-resource languages, where our approaches also substantially outperform the competitive machine translation-based rankers.

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

Detoxifying multilingual Large Language Models (LLMs) has become crucial due to their increasing global use. In this work, we explore zero-shot cross-lingual generalization of preference tuning in detoxifying LLMs. Unlike previous studies that show limited cross-lingual generalization for other safety tasks, we demonstrate that Direct Preference Optimization (DPO) training with only English data can significantly reduce toxicity in multilingual open-ended generations. For example, the probability of mGPT-1.3B generating toxic continuations drops from 46.8% to 3.9% across 17 different languages after training. Our results also extend to other multilingual LLMs, such as BLOOM, Llama3, and Aya-23. Using mechanistic interpretability tools like causal intervention and activation analysis, we identified the dual multilinguality property of MLP layers in LLMs, which explains the cross-lingual generalization of DPO. Finally, we show that bilingual sentence retrieval can predict the cross-lingual transferability of DPO preference tuning.

Recently, Large Language Models (LLMs) have showcased remarkable capabilities in natural language understanding. While demonstrating proficiency in everyday conversations and question-answering situations, these models frequently struggle in domains that require precision, such as medical applications, due to their lack of domain-specific knowledge. In this paper, we describe the procedure for building a powerful, open-source language model specifically designed for medicine applications, termed as PMC-LLaMA. Our contributions are threefold: (i) we systematically investigate the process of adapting a general-purpose foundation language model towards medical domain, this involves data-centric knowledge injection through the integration of 4.8M biomedical academic papers and 30K medical textbooks, as well as comprehensive fine-tuning for alignment with domain-specific instructions; (ii) we contribute a large-scale, comprehensive dataset for instruction tuning. This dataset encompasses medical question-answering (QA), rationale for reasoning, and conversational dialogues, comprising a total of 202M tokens; (iii) we conduct thorough ablation studies to demonstrate the effectiveness of each proposed component. While evaluating on various public medical question-answering benchmarks, our lightweight PMCLLaMA, which consists of only 13 billion parameters, exhibits superior performance, even surpassing ChatGPT. All models, codes, datasets can be found in https://github.com/chaoyi-wu/PMC-LLaMA.

While deep networks have achieved broad success in analyzing natural images, when applied to medical scans, they often fail in unexcepted situations. We investigate this challenge and focus on model sensitivity to domain shifts, such as data sampled from different hospitals or data confounded by demographic variables such as sex, race, etc, in the context of chest X-rays and skin lesion images. A key finding we show empirically is that existing visual backbones lack an appropriate prior from the architecture for reliable generalization in these settings. Taking inspiration from medical training, we propose giving deep networks a prior grounded in explicit medical knowledge communicated in natural language. To this end, we introduce Knowledge-enhanced Bottlenecks (KnoBo), a class of concept bottleneck models that incorporates knowledge priors that constrain it to reason with clinically relevant factors found in medical textbooks or PubMed. KnoBo uses retrieval-augmented language models to design an appropriate concept space paired with an automatic training procedure for recognizing the concept. We evaluate different resources of knowledge and recognition architectures on a broad range of domain shifts across 20 datasets. In our comprehensive evaluation with two imaging modalities, KnoBo outperforms fine-tuned models on confounded datasets by 32.4% on average. Finally, evaluations reveal that PubMed is a promising resource for making medical models less sensitive to domain shift, outperforming other resources on both diversity of information and final prediction performance.

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 seven 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 regime for medical question-answering (QA) tasks. For instance, across the tasks and model pairs we consider in the 3-shot setting, medical LLMs only outperform their base models in 12.1% of cases, reach a (statistical) tie in 49.8% of cases, and are significantly worse than their base models in the remaining 38.2% 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; 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. 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.

Cross-lingual transfer enables vision-language models (VLMs) to perform vision tasks in various languages with training data only in one language. Current approaches rely on large pre-trained multilingual language models. However, they face the curse of multilinguality, sacrificing downstream task performance for multilingual capabilities, struggling with lexical ambiguities, and falling behind recent advances. In this work, we study the scaling laws of systematic generalization with monolingual VLMs for multilingual tasks, focusing on the impact of model size and seen training samples. We propose Florenz, a monolingual encoder-decoder VLM with 0.4B to 11.2B parameters combining the pre-trained VLM Florence-2 and the large language model Gemma-2. Florenz is trained with varying compute budgets on a synthetic dataset that features intentionally incomplete language coverage for image captioning, thus, testing generalization from the fully covered translation task. We show that not only does indirectly learning unseen task-language pairs adhere to a scaling law, but also that with our data generation pipeline and the proposed Florenz model family, image captioning abilities can emerge in a specific language even when only data for the translation task is available. Fine-tuning on a mix of downstream datasets yields competitive performance and demonstrates promising scaling trends in multimodal machine translation (Multi30K, CoMMuTE), lexical disambiguation (CoMMuTE), and image captioning (Multi30K, XM3600, COCO Karpathy).

Pre-trained multilingual language models have enabled significant advancements in cross-lingual transfer. However, these models often exhibit a performance disparity when transferring from high-resource languages to low-resource languages, especially for languages that are underrepresented or not in the pre-training data. Motivated by the superior performance of these models on high-resource languages compared to low-resource languages, we introduce a Translation-and-fusion framework, which translates low-resource language text into a high-resource language for annotation using fully supervised models before fusing the annotations back into the low-resource language. Based on this framework, we present TransFusion, a model trained to fuse predictions from a high-resource language to make robust predictions on low-resource languages. We evaluate our methods on two low-resource named entity recognition (NER) datasets, MasakhaNER2.0 and LORELEI NER, covering 25 languages, and show consistent improvement up to +16 F_1 over English fine-tuning systems, achieving state-of-the-art performance compared to Translate-train systems. Our analysis depicts the unique advantages of the TransFusion method which is robust to translation errors and source language prediction errors, and complimentary to adapted multilingual language models.

Multilingual models, such as M-BERT and XLM-R, have gained increasing popularity, due to their zero-shot cross-lingual transfer learning capabilities. However, their generalization ability is still inconsistent for typologically diverse languages and across different benchmarks. Recently, meta-learning has garnered attention as a promising technique for enhancing transfer learning under low-resource scenarios: particularly for cross-lingual transfer in Natural Language Understanding (NLU). In this work, we propose X-METRA-ADA, a cross-lingual MEta-TRAnsfer learning ADAptation approach for NLU. Our approach adapts MAML, an optimization-based meta-learning approach, to learn to adapt to new languages. We extensively evaluate our framework on two challenging cross-lingual NLU tasks: multilingual task-oriented dialog and typologically diverse question answering. We show that our approach outperforms naive fine-tuning, reaching competitive performance on both tasks for most languages. Our analysis reveals that X-METRA-ADA can leverage limited data for faster adaptation.

Large language models (LLMs) are increasingly essential in processing natural languages, yet their application is frequently compromised by biases and inaccuracies originating in their training data. In this study, we introduce Cross-Care, the first benchmark framework dedicated to assessing biases and real world knowledge in LLMs, specifically focusing on the representation of disease prevalence across diverse demographic groups. We systematically evaluate how demographic biases embedded in pre-training corpora like ThePile influence the outputs of LLMs. We expose and quantify discrepancies by juxtaposing these biases against actual disease prevalences in various U.S. demographic groups. Our results highlight substantial misalignment between LLM representation of disease prevalence and real disease prevalence rates across demographic subgroups, indicating a pronounced risk of bias propagation and a lack of real-world grounding for medical applications of LLMs. Furthermore, we observe that various alignment methods minimally resolve inconsistencies in the models' representation of disease prevalence across different languages. For further exploration and analysis, we make all data and a data visualization tool available at: www.crosscare.net.

Adapters and Low-Rank Adaptation (LoRA) are parameter-efficient fine-tuning techniques designed to make the training of language models more efficient. Previous results demonstrated that these methods can even improve performance on some classification tasks. This paper complements the existing research by investigating how these techniques influence the classification performance and computation costs compared to full fine-tuning when applied to multilingual text classification tasks (genre, framing, and persuasion techniques detection; with different input lengths, number of predicted classes and classification difficulty), some of which have limited training data. In addition, we conduct in-depth analyses of their efficacy across different training scenarios (training on the original multilingual data; on the translations into English; and on a subset of English-only data) and different languages. Our findings provide valuable insights into the applicability of the parameter-efficient fine-tuning techniques, particularly to complex multilingual and multilabel classification tasks.

Open-source large language models (LLMs) have gained significant strength across diverse fields. Nevertheless, the majority of studies primarily concentrate on English, with only limited exploration into the realm of multilingual supervised fine-tuning. In this work, we therefore construct an open-source multilingual supervised fine-tuning dataset. Different from previous works that simply translate English instructions, we consider both the language-specific and language-agnostic abilities of LLMs. For language-specific abilities, we introduce a knowledge-grounded data augmentation approach to elicit more culture-specific knowledge of LLMs, improving their ability to serve users from different countries. For language-agnostic abilities, we find through experiments that modern LLMs exhibit strong cross-lingual transfer capabilities, thus repeatedly learning identical content in various languages is not necessary. Consequently, we can substantially prune the language-agnostic SFT data without any performance degradation, making the SFT process more efficient. The resulting UltraLink dataset comprises approximately 1 million samples across five languages, and the proposed data construction method can also be easily extended to other languages. UltraLink-LM, which is trained on UltraLink, outperforms several representative baselines across many tasks.

Adapting English-based large language models (LLMs) to other languages has become increasingly popular due to the efficiency and potential of cross-lingual transfer. However, existing language adaptation methods often overlook the benefits of cross-lingual supervision. In this study, we introduce LEIA, a language adaptation tuning method that utilizes Wikipedia entity names aligned across languages. This method involves augmenting the target language corpus with English entity names and training the model using left-to-right language modeling. We assess LEIA on diverse question answering datasets using 7B-parameter LLMs, demonstrating significant performance gains across various non-English languages. The source code is available at https://github.com/studio-ousia/leia.

Recent advances in large language models (LLMs) have demonstrated exceptional performance in various natural language processing (NLP) tasks. However, their effective application in the medical domain is hampered by a lack of medical domain knowledge. In this study, we present SA-MDKIF, a scalable and adaptable framework that aims to inject medical knowledge into general-purpose LLMs through instruction tuning, thereby enabling adaptability for various downstream tasks. SA-MDKIF consists of two stages: skill training and skill adaptation. In the first stage, we define 12 basic medical skills and use AdaLoRA to train these skills based on uniformly formatted instructional datasets that we have constructed. In the next stage, we train the skill router using task-specific downstream data and use this router to integrate the acquired skills with LLMs during inference. Experimental results on 9 different medical tasks show that SA-MDKIF improves performance by 10-20% compared to the original LLMs. Notably, this improvement is particularly pronounced for unseen medical tasks, showing an improvement of up to 30%.

Large language models (LLMs) have shown remarkable capabilities in many languages beyond English. Yet, LLMs require more inference steps when generating non-English text due to their reliance on English-centric tokenizers, vocabulary, and pre-training data, resulting in higher usage costs to non-English speakers. Vocabulary expansion with target language tokens is a widely used cross-lingual vocabulary adaptation approach to remedy this issue. Despite its effectiveness in inference speedup, the majority of previous work has focused on high-resource settings assuming access to a substantial amount of target language data to effectively initialize the embeddings of the new tokens and adapt the LLM to the target language. However, vocabulary expansion for LLMs in low-resource settings (i.e. languages and compute) has yet to be explored. In this paper, we investigate sample-efficient adaptation strategies from different angles, including target vocabulary size and initialization methods, and the amount of target data available for adaptation. Extensive experiments across typologically diverse languages, tasks and models show that simpler heuristic-based embedding initialization is more efficient and robust to changes in target vocabulary size and adaptation data in low-resource settings, outperforming a popular random initialization and a more sophisticated state-of-the-art approach that relies on external data and model.

Cross-lingual open information extraction aims to extract structured information from raw text across multiple languages. Previous work uses a shared cross-lingual pre-trained model to handle the different languages but underuses the potential of the language-specific representation. In this paper, we propose an effective multi-stage tuning framework called MT4CrossIE, designed for enhancing cross-lingual open information extraction by injecting language-specific knowledge into the shared model. Specifically, the cross-lingual pre-trained model is first tuned in a shared semantic space (e.g., embedding matrix) in the fixed encoder and then other components are optimized in the second stage. After enough training, we freeze the pre-trained model and tune the multiple extra low-rank language-specific modules using mixture-of-LoRAs for model-based cross-lingual transfer. In addition, we leverage two-stage prompting to encourage the large language model (LLM) to annotate the multi-lingual raw data for data-based cross-lingual transfer. The model is trained with multi-lingual objectives on our proposed dataset OpenIE4++ by combing the model-based and data-based transfer techniques. Experimental results on various benchmarks emphasize the importance of aggregating multiple plug-in-and-play language-specific modules and demonstrate the effectiveness of MT4CrossIE in cross-lingual OIE\url{https://github.com/CSJianYang/Multilingual-Multimodal-NLP}.

Limited availability of multilingual text corpora for training language models often leads to poor performance on downstream tasks due to undertrained representation spaces for languages other than English. This 'under-representation' has motivated recent cross-lingual transfer methods to leverage the English representation space by e.g. mixing English and 'non-English' tokens at the input level or extending model parameters to accommodate new languages. However, these approaches often come at the cost of increased computational complexity. We propose Fusion forLanguage Representations (FLARE) in adapters, a novel method that enhances representation quality and downstream performance for languages other than English while maintaining parameter efficiency. FLARE integrates source and target language representations within low-rank (LoRA) adapters using lightweight linear transformations, maintaining parameter efficiency while improving transfer performance. A series of experiments across representative cross-lingual natural language understanding tasks, including natural language inference, question-answering and sentiment analysis, demonstrate FLARE's effectiveness. FLARE achieves performance improvements of 4.9% for Llama 3.1 and 2.2% for Gemma~2 compared to standard LoRA fine-tuning on question-answering tasks, as measured by the exact match metric.

Since the emergence of the Transformer architecture, language model development has increased, driven by their promising potential. However, releasing these models into production requires properly understanding their behavior, particularly in sensitive domains such as medicine. Despite this need, the medical literature still lacks technical assessments of pre-trained language models, which are especially valuable in resource-constrained settings in terms of computational power or limited budget. To address this gap, we provide a comprehensive survey of language models in the medical domain. In addition, we selected a subset of these models for thorough evaluation, focusing on classification and text generation tasks. Our subset encompasses 53 models, ranging from 110 million to 13 billion parameters, spanning the three families of Transformer-based models and from diverse knowledge domains. This study employs a series of approaches for text classification together with zero-shot prompting instead of model training or fine-tuning, which closely resembles the limited resource setting in which many users of language models find themselves. Encouragingly, our findings reveal remarkable performance across various tasks and datasets, underscoring the latent potential of certain models to contain medical knowledge, even without domain specialization. Consequently, our study advocates for further exploration of model applications in medical contexts, particularly in resource-constrained settings. The code is available on https://github.com/anpoc/Language-models-in-medicine.

The vast majority of today's large language models are English-centric, having been pretrained predominantly on English text. Yet, in order to meet user expectations, models need to be able to respond appropriately in multiple languages once deployed in downstream applications. Given limited exposure to other languages during pretraining, cross-lingual transfer is important for achieving decent performance in non-English settings. In this work, we investigate just how much multilinguality is required during finetuning to elicit strong cross-lingual generalisation across a range of tasks and target languages. We find that, compared to English-only finetuning, multilingual instruction tuning with as few as three languages significantly improves a model's cross-lingual transfer abilities on generative tasks that assume input/output language agreement, while being of less importance for highly structured tasks. Our code and data is available at https://github.com/ZurichNLP/multilingual-instruction-tuning.

Massively multilingual Transformers (MMTs), such as mBERT and XLM-R, are widely used for cross-lingual transfer learning. While these are pretrained to represent hundreds of languages, end users of NLP systems are often interested only in individual languages. For such purposes, the MMTs' language coverage makes them unnecessarily expensive to deploy in terms of model size, inference time, energy, and hardware cost. We thus propose to extract compressed, language-specific models from MMTs which retain the capacity of the original MMTs for cross-lingual transfer. This is achieved by distilling the MMT bilingually, i.e., using data from only the source and target language of interest. Specifically, we use a two-phase distillation approach, termed BiStil: (i) the first phase distils a general bilingual model from the MMT, while (ii) the second, task-specific phase sparsely fine-tunes the bilingual "student" model using a task-tuned variant of the original MMT as its "teacher". We evaluate this distillation technique in zero-shot cross-lingual transfer across a number of standard cross-lingual benchmarks. The key results indicate that the distilled models exhibit minimal degradation in target language performance relative to the base MMT despite being significantly smaller and faster. Furthermore, we find that they outperform multilingually distilled models such as DistilmBERT and MiniLMv2 while having a very modest training budget in comparison, even on a per-language basis. We also show that bilingual models distilled from MMTs greatly outperform bilingual models trained from scratch. Our code and models are available at https://github.com/AlanAnsell/bistil.

Existing work in translation demonstrated the potential of massively multilingual machine translation by training a single model able to translate between any pair of languages. However, much of this work is English-Centric by training only on data which was translated from or to English. While this is supported by large sources of training data, it does not reflect translation needs worldwide. In this work, we create a true Many-to-Many multilingual translation model that can translate directly between any pair of 100 languages. We build and open source a training dataset that covers thousands of language directions with supervised data, created through large-scale mining. Then, we explore how to effectively increase model capacity through a combination of dense scaling and language-specific sparse parameters to create high quality models. Our focus on non-English-Centric models brings gains of more than 10 BLEU when directly translating between non-English directions while performing competitively to the best single systems of WMT. We open-source our scripts so that others may reproduce the data, evaluation, and final M2M-100 model.

Multilingual machine translation suffers from negative interference across languages. A common solution is to relax parameter sharing with language-specific modules like adapters. However, adapters of related languages are unable to transfer information, and their total number of parameters becomes prohibitively expensive as the number of languages grows. In this work, we overcome these drawbacks using hyper-adapters -- hyper-networks that generate adapters from language and layer embeddings. While past work had poor results when scaling hyper-networks, we propose a rescaling fix that significantly improves convergence and enables training larger hyper-networks. We find that hyper-adapters are more parameter efficient than regular adapters, reaching the same performance with up to 12 times less parameters. When using the same number of parameters and FLOPS, our approach consistently outperforms regular adapters. Also, hyper-adapters converge faster than alternative approaches and scale better than regular dense networks. Our analysis shows that hyper-adapters learn to encode language relatedness, enabling positive transfer across languages.

Foundational large language models (LLMs) can be instruction-tuned to develop open-ended question-answering capability, facilitating applications such as the creation of AI assistants. While such efforts are often carried out in a single language, building on prior research, we empirically analyze cost-efficient approaches of monolingual and multilingual tuning, shedding light on the efficacy of LLMs in responding to queries across monolingual and multilingual contexts. Our study employs the Alpaca dataset and machine translations of it to form multilingual training data, which is then used to tune LLMs through low-rank adaptation and full-parameter training. Comparisons reveal that multilingual tuning is not crucial for an LLM's English performance, but is key to its robustness in a multilingual environment. With a fixed budget, a multilingual instruction-tuned model, merely trained on downsampled data, can be as powerful as training monolingual models for each language. Our findings serve as a guide for expanding language support through instruction tuning with constrained computational resources.

User-generated data sources have gained significance in uncovering Adverse Drug Reactions (ADRs), with an increasing number of discussions occurring in the digital world. However, the existing clinical corpora predominantly revolve around scientific articles in English. This work presents a multilingual corpus of texts concerning ADRs gathered from diverse sources, including patient fora, social media, and clinical reports in German, French, and Japanese. Our corpus contains annotations covering 12 entity types, four attribute types, and 13 relation types. It contributes to the development of real-world multilingual language models for healthcare. We provide statistics to highlight certain challenges associated with the corpus and conduct preliminary experiments resulting in strong baselines for extracting entities and relations between these entities, both within and across languages.

Recent advancements in large language models (LLMs) have shown promise in medical applications such as disease diagnosis and treatment planning. However, most existing medical LLMs struggle with the advanced reasoning required for complex clinical scenarios, such as differential diagnosis or personalized treatment suggestions. We proposed FineMedLM-o1, which leverages high-quality synthetic medical data and long-form reasoning data for Supervised Fine-Tuning (SFT) and Direct Preference Optimization (DPO), enabling advanced dialogue and deep reasoning capabilities. Additionally, we introduced Test-Time Training (TTT) in the medical domain for the first time, facilitating domain adaptation and ensuring reliable, accurate reasoning. Experimental results demonstrate that FineMedLM-o1 achieves a 23% average performance improvement over prior models on key medical benchmarks. Furthermore, the introduction of TTT provides an additional 14% performance boost, highlighting its effectiveness in enhancing medical reasoning capabilities. To support this process, we also proposed a novel method for synthesizing medical dialogue. Compared to other open-source datasets, our dataset stands out as superior in both quality and complexity. The project and data will be released on GitHub.

Large Language Models (LLMs) have introduced a new era of proficiency in comprehending complex healthcare and biomedical topics. However, there is a noticeable lack of models in languages other than English and models that can interpret multi-modal input, which is crucial for global healthcare accessibility. In response, this study introduces Qilin-Med-VL, the first Chinese large vision-language model designed to integrate the analysis of textual and visual data. Qilin-Med-VL combines a pre-trained Vision Transformer (ViT) with a foundational LLM. It undergoes a thorough two-stage curriculum training process that includes feature alignment and instruction tuning. This method enhances the model's ability to generate medical captions and answer complex medical queries. We also release ChiMed-VL, a dataset consisting of more than 1M image-text pairs. This dataset has been carefully curated to enable detailed and comprehensive interpretation of medical data using various types of images.

The main goal behind state-of-the-art pre-trained multilingual models such as multilingual BERT and XLM-R is enabling and bootstrapping NLP applications in low-resource languages through zero-shot or few-shot cross-lingual transfer. However, due to limited model capacity, their transfer performance is the weakest exactly on such low-resource languages and languages unseen during pre-training. We propose MAD-X, an adapter-based framework that enables high portability and parameter-efficient transfer to arbitrary tasks and languages by learning modular language and task representations. In addition, we introduce a novel invertible adapter architecture and a strong baseline method for adapting a pre-trained multilingual model to a new language. MAD-X outperforms the state of the art in cross-lingual transfer across a representative set of typologically diverse languages on named entity recognition and causal commonsense reasoning, and achieves competitive results on question answering. Our code and adapters are available at AdapterHub.ml

Consistency is a key requirement of high-quality translation. It is especially important to adhere to pre-approved terminology and adapt to corrected translations in domain-specific projects. Machine translation (MT) has achieved significant progress in the area of domain adaptation. However, real-time adaptation remains challenging. Large-scale language models (LLMs) have recently shown interesting capabilities of in-context learning, where they learn to replicate certain input-output text generation patterns, without further fine-tuning. By feeding an LLM at inference time with a prompt that consists of a list of translation pairs, it can then simulate the domain and style characteristics. This work aims to investigate how we can utilize in-context learning to improve real-time adaptive MT. Our extensive experiments show promising results at translation time. For example, LLMs can adapt to a set of in-domain sentence pairs and/or terminology while translating a new sentence. We observe that the translation quality with few-shot in-context learning can surpass that of strong encoder-decoder MT systems, especially for high-resource languages. Moreover, we investigate whether we can combine MT from strong encoder-decoder models with fuzzy matches, which can further improve translation quality, especially for less supported languages. We conduct our experiments across five diverse language pairs, namely English-to-Arabic (EN-AR), English-to-Chinese (EN-ZH), English-to-French (EN-FR), English-to-Kinyarwanda (EN-RW), and English-to-Spanish (EN-ES).

Multilingual pre-trained models (mPLMs) have shown impressive performance on cross-lingual transfer tasks. However, the transfer performance is often hindered when a low-resource target language is written in a different script than the high-resource source language, even though the two languages may be related or share parts of their vocabularies. Inspired by recent work that uses transliteration to address this problem, our paper proposes a transliteration-based post-pretraining alignment (PPA) method aiming to improve the cross-lingual alignment between languages using diverse scripts. We select two areal language groups, Mediterranean-Amharic-Farsi and South+East Asian Languages, wherein the languages are mutually influenced but use different scripts. We apply our method to these language groups and conduct extensive experiments on a spectrum of downstream tasks. The results show that after PPA, models consistently outperform the original model (up to 50% for some tasks) in English-centric transfer. In addition, when we use languages other than English as sources in transfer, our method obtains even larger improvements. We will make our code and models publicly available at https://github.com/cisnlp/Transliteration-PPA.

Large Language Models (LLMs) have demonstrated remarkable success as general-purpose task solvers across various fields, including NLP, healthcare, finance, and law. However, their capabilities remain limited when addressing domain-specific problems, particularly in downstream NLP tasks. Research has shown that models fine-tuned on instruction-based downstream NLP datasets outperform those that are not fine-tuned. While most efforts in this area have primarily focused on resource-rich languages like English and broad domains, little attention has been given to multilingual settings and specific domains. To address this gap, this study focuses on developing a specialized LLM, LlamaLens, for analyzing news and social media content in a multilingual context. To the best of our knowledge, this is the first attempt to tackle both domain specificity and multilinguality, with a particular focus on news and social media. Our experimental setup includes 19 tasks, represented by 52 datasets covering Arabic, English, and Hindi. We demonstrate that LlamaLens outperforms the current state-of-the-art (SOTA) on 16 testing sets, and achieves comparable performance on 10 sets. We make the models and resources publicly available for the research community.(https://huggingface.co/QCRI)

As instruction-tuned large language models (LLMs) gain global adoption, their ability to follow instructions in multiple languages becomes increasingly crucial. One promising approach is cross-lingual transfer, where a model acquires specific functionality on some language by finetuning on another language. In this work, we investigate how multilinguality during instruction tuning of a multilingual LLM affects instruction-following across languages. We first show that many languages transfer some instruction-following capabilities to other languages from even monolingual tuning. Furthermore, we find that only 40 multilingual examples in an English tuning set substantially improve multilingual instruction-following, both in seen and unseen languages during tuning. In general, we observe that models tuned on multilingual mixtures exhibit comparable or superior performance in several languages compared to monolingually tuned models, despite training on 10x fewer examples in those languages. Finally, we find that increasing the number of languages in the instruction tuning set from 1 to only 2, 3, or 4 increases cross-lingual generalization. Our results suggest that building massively multilingual instruction-tuned models can be done with only a very small set of multilingual instruction-responses.

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

Cross-lingual alignment, the meaningful similarity of representations across languages in multilingual language models, has been an active field of research in recent years. We survey the literature of techniques to improve cross-lingual alignment, providing a taxonomy of methods and summarising insights from throughout the field. We present different understandings of cross-lingual alignment and their limitations. We provide a qualitative summary of results from a large number of surveyed papers. Finally, we discuss how these insights may be applied not only to encoder models, where this topic has been heavily studied, but also to encoder-decoder or even decoder-only models, and argue that an effective trade-off between language-neutral and language-specific information is key.

In the expanding field of language model applications, medical knowledge representation remains a significant challenge due to the specialized nature of the domain. Large language models, such as GPT-4, obtain reasonable scores on medical question answering tasks, but smaller models are far behind. In this work, we introduce a method to improve the proficiency of a small language model in the medical domain by employing a two-fold approach. We first fine-tune the model on a corpus of medical textbooks. Then, we use GPT-4 to generate questions similar to the downstream task, prompted with textbook knowledge, and use them to fine-tune the model. Additionally, we introduce ECN-QA, a novel medical question answering dataset containing ``progressive questions'' composed of related sequential questions. We show the benefits of our training strategy on this dataset. The study's findings highlight the potential of small language models in the medical domain when appropriately fine-tuned. The code and weights are available at https://github.com/raidium-med/MQG.

This work presents biomedical and clinical language models for Spanish by experimenting with different pretraining choices, such as masking at word and subword level, varying the vocabulary size and testing with domain data, looking for better language representations. Interestingly, in the absence of enough clinical data to train a model from scratch, we applied mixed-domain pretraining and cross-domain transfer approaches to generate a performant bio-clinical model suitable for real-world clinical data. We evaluated our models on Named Entity Recognition (NER) tasks for biomedical documents and challenging hospital discharge reports. When compared against the competitive mBERT and BETO models, we outperform them in all NER tasks by a significant margin. Finally, we studied the impact of the model's vocabulary on the NER performances by offering an interesting vocabulary-centric analysis. The results confirm that domain-specific pretraining is fundamental to achieving higher performances in downstream NER tasks, even within a mid-resource scenario. To the best of our knowledge, we provide the first biomedical and clinical transformer-based pretrained language models for Spanish, intending to boost native Spanish NLP applications in biomedicine. Our best models are freely available in the HuggingFace hub: https://huggingface.co/BSC-TeMU.

This paper discusses the methods that we used for our submissions to the WMT 2023 Terminology Shared Task for German-to-English (DE-EN), English-to-Czech (EN-CS), and Chinese-to-English (ZH-EN) language pairs. The task aims to advance machine translation (MT) by challenging participants to develop systems that accurately translate technical terms, ultimately enhancing communication and understanding in specialised domains. To this end, we conduct experiments that utilise large language models (LLMs) for two purposes: generating synthetic bilingual terminology-based data, and post-editing translations generated by an MT model through incorporating pre-approved terms. Our system employs a four-step process: (i) using an LLM to generate bilingual synthetic data based on the provided terminology, (ii) fine-tuning a generic encoder-decoder MT model, with a mix of the terminology-based synthetic data generated in the first step and a randomly sampled portion of the original generic training data, (iii) generating translations with the fine-tuned MT model, and (iv) finally, leveraging an LLM for terminology-constrained automatic post-editing of the translations that do not include the required terms. The results demonstrate the effectiveness of our proposed approach in improving the integration of pre-approved terms into translations. The number of terms incorporated into the translations of the blind dataset increases from an average of 36.67% with the generic model to an average of 72.88% by the end of the process. In other words, successful utilisation of terms nearly doubles across the three language pairs.

In today's interconnected globe, moving abroad is more and more prevalent, whether it's for employment, refugee resettlement, or other causes. Language difficulties between natives and immigrants present a common issue on a daily basis, especially in medical domain. This can make it difficult for patients and doctors to communicate during anamnesis or in the emergency room, which compromises patient care. The goal of the HYKIST Project is to develop a speech translation system to support patient-doctor communication with ASR and MT. ASR systems have recently displayed astounding performance on particular tasks for which enough quantities of training data are available, such as LibriSpeech. Building a good model is still difficult due to a variety of speaking styles, acoustic and recording settings, and a lack of in-domain training data. In this thesis, we describe our efforts to construct ASR systems for a conversational telephone speech recognition task in the medical domain for Vietnamese language to assist emergency room contact between doctors and patients across linguistic barriers. In order to enhance the system's performance, we investigate various training schedules and data combining strategies. We also examine how best to make use of the little data that is available. The use of publicly accessible models like XLSR-53 is compared to the use of customized pre-trained models, and both supervised and unsupervised approaches are utilized using wav2vec 2.0 as architecture.

Recently, the increasing demand for superior medical services has highlighted the discrepancies in the medical infrastructure. With big data, especially texts, forming the foundation of medical services, there is an exigent need for effective natural language processing (NLP) solutions tailored to the healthcare domain. Conventional approaches leveraging pre-trained models present promising results in this domain and current large language models (LLMs) offer advanced foundation for medical text processing. However, most medical LLMs are trained only with supervised fine-tuning (SFT), even though it efficiently empowers LLMs to understand and respond to medical instructions but is ineffective in learning domain knowledge and aligning with human preference. Another engineering barrier that prevents current medical LLM from better text processing ability is their restricted context length (e.g., 2,048 tokens), making it hard for the LLMs to process long context, which is frequently required in the medical domain. In this work, we propose ChiMed-GPT, a new benchmark LLM designed explicitly for Chinese medical domain, with enlarged context length to 4,096 tokens and undergoes a comprehensive training regime with pre-training, SFT, and RLHF. Evaluations on real-world tasks including information extraction, question answering, and dialogue generation demonstrate ChiMed-GPT's superior performance over general domain LLMs. Furthermore, we analyze possible biases through prompting ChiMed-GPT to perform attitude scales regarding discrimination of patients, so as to contribute to further responsible development of LLMs in the medical domain. The code and model are released at https://github.com/synlp/ChiMed-GPT.

The rapid progress in Large Language Models (LLMs) has prompted the creation of numerous benchmarks to evaluate their capabilities.This study focuses on the Comprehensive Medical Benchmark in Chinese (CMB), showcasing how dataset diversity and distribution in supervised fine-tuning (SFT) may enhance LLM performance.Remarkably, We successfully trained a smaller base model to achieve scores comparable to larger models, indicating that a diverse and well-distributed dataset can optimize performance regardless of model size.This study suggests that even smaller models may reach high performance levels with carefully curated and varied datasets.By integrating a wide range of instructional content, our approach addresses potential issues such as data quality inconsistencies. Our results imply that a broader spectrum of training data may enhance a model's ability to generalize and perform effectively across different medical scenarios, highlighting the importance of dataset quality and diversity in fine-tuning processes.

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

This study investigates the feasibility of automating clinical coding in Russian, a language with limited biomedical resources. We present a new dataset for ICD coding, which includes diagnosis fields from electronic health records (EHRs) annotated with over 10,000 entities and more than 1,500 unique ICD codes. This dataset serves as a benchmark for several state-of-the-art models, including BERT, LLaMA with LoRA, and RAG, with additional experiments examining transfer learning across domains (from PubMed abstracts to medical diagnosis) and terminologies (from UMLS concepts to ICD codes). We then apply the best-performing model to label an in-house EHR dataset containing patient histories from 2017 to 2021. Our experiments, conducted on a carefully curated test set, demonstrate that training with the automated predicted codes leads to a significant improvement in accuracy compared to manually annotated data from physicians. We believe our findings offer valuable insights into the potential for automating clinical coding in resource-limited languages like Russian, which could enhance clinical efficiency and data accuracy in these contexts.

While Large Language Models (LLMs) have shown remarkable capabilities in natural language understanding and generation, their performance often lags in lower-resource, non-English languages due to biases in the training data. In this work, we explore strategies for adapting the primarily English LLMs (Llama-2 and Llama-3) to Dutch, a language spoken by 30 million people worldwide yet often underrepresented in LLM development. We collect 104GB of Dutch text (32B tokens) from various sources to first apply continued pretraining using low-rank adaptation (LoRA), complemented with Dutch posttraining strategies provided by prior work. For Llama-2, we consider using (i) the tokenizer of the original model, and (ii) training a new, Dutch-specific tokenizer combined with embedding reinitialization. We evaluate our adapted models, ChocoLlama-2, both on standard benchmarks and a novel Dutch benchmark, ChocoLlama-Bench. Our results demonstrate that LoRA can effectively scale for language adaptation, and that tokenizer modification with careful weight reinitialization can improve performance. Notably, Llama-3 was released during the course of this project and, upon evaluation, demonstrated superior Dutch capabilities compared to our Dutch-adapted versions of Llama-2. We hence apply the same adaptation technique to Llama-3, using its original tokenizer. While our adaptation methods enhanced Llama-2's Dutch capabilities, we found limited gains when applying the same techniques to Llama-3. This suggests that for ever improving, multilingual foundation models, language adaptation techniques may benefit more from focusing on language-specific posttraining rather than on continued pretraining. We hope this work contributes to the broader understanding of adapting LLMs to lower-resource languages, and to the development of Dutch LLMs in particular.

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.

With the increasing prevalence of Large Language Models, traditional full fine-tuning approaches face growing challenges, especially in memory-intensive tasks. This paper investigates the potential of Parameter-Efficient Fine-Tuning, focusing on Low-Rank Adaptation (LoRA), for complex and under-explored multilingual summarisation tasks. We conduct an extensive study across different data availability scenarios, including full-data, low-data, and cross-lingual transfer, leveraging models of different sizes. Our findings reveal that LoRA lags behind full fine-tuning when trained with full data, however, it excels in low-data scenarios and cross-lingual transfer. Interestingly, as models scale up, the performance gap between LoRA and full fine-tuning diminishes. Additionally, we investigate effective strategies for few-shot cross-lingual transfer, finding that continued LoRA tuning achieves the best performance compared to both full fine-tuning and dynamic composition of language-specific LoRA modules.

In recent years, pre-trained language models (PLMs) achieve the best performance on a wide range of natural language processing (NLP) tasks. While the first models were trained on general domain data, specialized ones have emerged to more effectively treat specific domains. In this paper, we propose an original study of PLMs in the medical domain on French language. We compare, for the first time, the performance of PLMs trained on both public data from the web and private data from healthcare establishments. We also evaluate different learning strategies on a set of biomedical tasks. In particular, we show that we can take advantage of already existing biomedical PLMs in a foreign language by further pre-train it on our targeted data. Finally, we release the first specialized PLMs for the biomedical field in French, called DrBERT, as well as the largest corpus of medical data under free license on which these models are trained.

Multimodal models trained on large natural image-text pair datasets have exhibited astounding abilities in generating high-quality images. Medical imaging data is fundamentally different to natural images, and the language used to succinctly capture relevant details in medical data uses a different, narrow but semantically rich, domain-specific vocabulary. Not surprisingly, multi-modal models trained on natural image-text pairs do not tend to generalize well to the medical domain. Developing generative imaging models faithfully representing medical concepts while providing compositional diversity could mitigate the existing paucity of high-quality, annotated medical imaging datasets. In this work, we develop a strategy to overcome the large natural-medical distributional shift by adapting a pre-trained latent diffusion model on a corpus of publicly available chest x-rays (CXR) and their corresponding radiology (text) reports. We investigate the model's ability to generate high-fidelity, diverse synthetic CXR conditioned on text prompts. We assess the model outputs quantitatively using image quality metrics, and evaluate image quality and text-image alignment by human domain experts. We present evidence that the resulting model (RoentGen) is able to create visually convincing, diverse synthetic CXR images, and that the output can be controlled to a new extent by using free-form text prompts including radiology-specific language. Fine-tuning this model on a fixed training set and using it as a data augmentation method, we measure a 5% improvement of a classifier trained jointly on synthetic and real images, and a 3% improvement when trained on a larger but purely synthetic training set. Finally, we observe that this fine-tuning distills in-domain knowledge in the text-encoder and can improve its representation capabilities of certain diseases like pneumothorax by 25%.

In this paper, we consider enhancing medical visual-language pre-training (VLP) with domain-specific knowledge, by exploiting the paired image-text reports from the radiological daily practice. In particular, we make the following contributions: First, unlike existing works that directly process the raw reports, we adopt a novel triplet extraction module to extract the medical-related information, avoiding unnecessary complexity from language grammar and enhancing the supervision signals; Second, we propose a novel triplet encoding module with entity translation by querying a knowledge base, to exploit the rich domain knowledge in medical field, and implicitly build relationships between medical entities in the language embedding space; Third, we propose to use a Transformer-based fusion model for spatially aligning the entity description with visual signals at the image patch level, enabling the ability for medical diagnosis; Fourth, we conduct thorough experiments to validate the effectiveness of our architecture, and benchmark on numerous public benchmarks, e.g., ChestX-ray14, RSNA Pneumonia, SIIM-ACR Pneumothorax, COVIDx CXR-2, COVID Rural, and EdemaSeverity. In both zero-shot and fine-tuning settings, our model has demonstrated strong performance compared with the former methods on disease classification and grounding.

While pretrained language models (PLMs) primarily serve as general-purpose text encoders that can be fine-tuned for a wide variety of downstream tasks, recent work has shown that they can also be rewired to produce high-quality word representations (i.e., static word embeddings) and yield good performance in type-level lexical tasks. While existing work primarily focused on the lexical specialization of monolingual PLMs with immense quantities of monolingual constraints, in this work we expose massively multilingual transformers (MMTs, e.g., mBERT or XLM-R) to multilingual lexical knowledge at scale, leveraging BabelNet as the readily available rich source of multilingual and cross-lingual type-level lexical knowledge. Concretely, we use BabelNet's multilingual synsets to create synonym pairs (or synonym-gloss pairs) across 50 languages and then subject the MMTs (mBERT and XLM-R) to a lexical specialization procedure guided by a contrastive objective. We show that such massively multilingual lexical specialization brings substantial gains in two standard cross-lingual lexical tasks, bilingual lexicon induction and cross-lingual word similarity, as well as in cross-lingual sentence retrieval. Crucially, we observe gains for languages unseen in specialization, indicating that multilingual lexical specialization enables generalization to languages with no lexical constraints. In a series of subsequent controlled experiments, we show that the number of specialization constraints plays a much greater role than the set of languages from which they originate.

Creating neural text encoders for written Swiss German is challenging due to a dearth of training data combined with dialectal variation. In this paper, we build on several existing multilingual encoders and adapt them to Swiss German using continued pre-training. Evaluation on three diverse downstream tasks shows that simply adding a Swiss German adapter to a modular encoder achieves 97.5% of fully monolithic adaptation performance. We further find that for the task of retrieving Swiss German sentences given Standard German queries, adapting a character-level model is more effective than the other adaptation strategies. We release our code and the models trained for our experiments at https://github.com/ZurichNLP/swiss-german-text-encoders

In recent years, pre-trained Multilingual Language Models (MLLMs) have shown a strong ability to transfer knowledge across different languages. However, given that the aspiration for such an ability has not been explicitly incorporated in the design of the majority of MLLMs, it is challenging to obtain a unique and straightforward explanation for its emergence. In this review paper, we survey literature that investigates different factors contributing to the capacity of MLLMs to perform zero-shot cross-lingual transfer and subsequently outline and discuss these factors in detail. To enhance the structure of this review and to facilitate consolidation with future studies, we identify five categories of such factors. In addition to providing a summary of empirical evidence from past studies, we identify consensuses among studies with consistent findings and resolve conflicts among contradictory ones. Our work contextualizes and unifies existing research streams which aim at explaining the cross-lingual potential of MLLMs. This review provides, first, an aligned reference point for future research and, second, guidance for a better-informed and more efficient way of leveraging the cross-lingual capacity of MLLMs.

The world's more than 7000 languages are written in at least 293 scripts. Due to various reasons, many closely related languages use different scripts, which poses a difficulty for multilingual pretrained language models (mPLMs) in learning crosslingual knowledge through lexical overlap. As a consequence, mPLMs are faced with a script barrier: representations from different scripts are located in different subspaces, which can result in crosslingual transfer involving languages of different scripts performing suboptimally. To address this problem, we propose TransliCo, a framework that optimizes the Transliteration Contrastive Modeling (TCM) objective to fine-tune an mPLM by contrasting sentences in its training data and their transliterations in a unified script (in our case Latin), which enhances uniformity in the representation space for different scripts. Using Glot500-m, an mPLM pretrained on over 500 languages, as our source model, we fine-tune it on a small portion (5%) of its training data, and refer to the resulting model as Furina. We show that Furina not only better aligns representations from distinct scripts but also outperforms the original Glot500-m on various zero-shot crosslingual transfer tasks. Additionally, we achieve consistent improvement in a case study on the Indic group where the languages exhibit areal features but use different scripts. We make our code and models publicly available.

In this paper, we explore the challenging problem of performing a generative task in a target language when labeled data is only available in English, using summarization as a case study. We assume a strict setting with no access to parallel data or machine translation and find that common transfer learning approaches struggle in this setting, as a generative multilingual model fine-tuned purely on English catastrophically forgets how to generate non-English. Given the recent rise of parameter-efficient adaptation techniques, we conduct the first investigation into how one such method, prompt tuning (Lester et al., 2021), can overcome catastrophic forgetting to enable zero-shot cross-lingual generation. Our experiments show that parameter-efficient prompt tuning provides gains over standard fine-tuning when transferring between less-related languages, e.g., from English to Thai. However, a significant gap still remains between these methods and fully-supervised baselines. To improve cross-lingual transfer further, we explore several approaches, including: (1) mixing in unlabeled multilingual data, and (2) explicitly factoring prompts into recombinable language and task components. Our approaches can provide further quality gains, suggesting that robust zero-shot cross-lingual generation is within reach.

Recent researches of large language models(LLM), which is pre-trained on massive general-purpose corpora, have achieved breakthroughs in responding human queries. However, these methods face challenges including limited data insufficiency to support extensive pre-training and can not align responses with users' instructions. To address these issues, we introduce a medical instruction dataset, CMedINS, containing six medical instructions derived from actual medical tasks, which effectively fine-tunes LLM in conjunction with other data. Subsequently, We launch our medical model, IIMedGPT, employing an efficient preference alignment method, Direct preference Optimization(DPO). The results show that our final model outperforms existing medical models in medical dialogue.Datsets, Code and model checkpoints will be released upon acceptance.

Detoxification is a task of generating text in polite style while preserving meaning and fluency of the original toxic text. Existing detoxification methods are designed to work in one exact language. This work investigates multilingual and cross-lingual detoxification and the behavior of large multilingual models like in this setting. Unlike previous works we aim to make large language models able to perform detoxification without direct fine-tuning in given language. Experiments show that multilingual models are capable of performing multilingual style transfer. However, models are not able to perform cross-lingual detoxification and direct fine-tuning on exact language is inevitable.

While general-purpose large language models (LLMs) demonstrate proficiency on multiple tasks within the domain of translation, approaches based on open LLMs are competitive only when specializing on a single task. In this paper, we propose a recipe for tailoring LLMs to multiple tasks present in translation workflows. We perform continued pretraining on a multilingual mixture of monolingual and parallel data, creating TowerBase, followed by finetuning on instructions relevant for translation processes, creating TowerInstruct. Our final model surpasses open alternatives on several tasks relevant to translation workflows and is competitive with general-purpose closed LLMs. To facilitate future research, we release the Tower models, our specialization dataset, an evaluation framework for LLMs focusing on the translation ecosystem, and a collection of model generations, including ours, on our benchmark.

To achieve equitable performance across languages, multilingual large language models (LLMs) must be able to abstract knowledge beyond the language in which it was acquired. However, the current literature lacks reliable ways to measure LLMs' capability of cross-lingual knowledge transfer. To that end, we present ECLeKTic, a multilingual closed-book QA (CBQA) dataset that Evaluates Cross-Lingual Knowledge Transfer in a simple, black-box manner. We detected information with uneven coverage across languages by controlling for presence and absence of Wikipedia articles in 12 languages. We generated knowledge-seeking questions in a source language, for which the answer appears in a relevant Wikipedia article and translated them to all other 11 languages, for which the respective Wikipedias lack equivalent articles. Assuming that Wikipedia reflects the prominent knowledge in the LLM's training data, to solve ECLeKTic's CBQA task the model is required to transfer knowledge between languages. Experimenting with 8 LLMs, we show that SOTA models struggle to effectively share knowledge across, languages even if they can predict the answer well for queries in the same language the knowledge was acquired in.

Language barriers present a great challenge in our increasingly connected and global world. Especially within the medical domain, e.g. hospital or emergency room, communication difficulties and delays may lead to malpractice and non-optimal patient care. In the HYKIST project, we consider patient-physician communication, more specifically between a German-speaking physician and an Arabic- or Vietnamese-speaking patient. Currently, a doctor can call the Triaphon service to get assistance from an interpreter in order to help facilitate communication. The HYKIST goal is to support the usually non-professional bilingual interpreter with an automatic speech translation system to improve patient care and help overcome language barriers. In this work, we present our ASR system development efforts for this conversational telephone speech translation task in the medical domain for two languages pairs, data collection, various acoustic model architectures and dialect-induced difficulties.

Multilingual semantic search is the task of retrieving relevant contents to a query expressed in different language combinations. This requires a better semantic understanding of the user's intent and its contextual meaning. Multilingual semantic search is less explored and more challenging than its monolingual or bilingual counterparts, due to the lack of multilingual parallel resources for this task and the need to circumvent "language bias". In this work, we propose an alignment approach: MAML-Align, specifically for low-resource scenarios. Our approach leverages meta-distillation learning based on MAML, an optimization-based Model-Agnostic Meta-Learner. MAML-Align distills knowledge from a Teacher meta-transfer model T-MAML, specialized in transferring from monolingual to bilingual semantic search, to a Student model S-MAML, which meta-transfers from bilingual to multilingual semantic search. To the best of our knowledge, we are the first to extend meta-distillation to a multilingual search application. Our empirical results show that on top of a strong baseline based on sentence transformers, our meta-distillation approach boosts the gains provided by MAML and significantly outperforms naive fine-tuning methods. Furthermore, multilingual meta-distillation learning improves generalization even to unseen languages.

Brief hospital course (BHC) summaries are common clinical documents generated by summarizing clinical notes. While large language models (LLMs) depict remarkable capabilities in automating real-world tasks, their capabilities for healthcare applications such as BHC synthesis have not been shown. To enable the adaptation of LLMs for BHC synthesis, we introduce a novel benchmark consisting of a pre-processed dataset extracted from MIMIC-IV notes, encapsulating clinical note, and brief hospital course (BHC) pairs. We assess the performance of two general-purpose LLMs and three healthcare-adapted LLMs to improve BHC synthesis from clinical notes. Using clinical notes as input for generating BHCs, we apply prompting-based (using in-context learning) and fine-tuning-based adaptation strategies to three open-source LLMs (Clinical-T5-Large, Llama2-13B, FLAN-UL2) and two proprietary LLMs (GPT-3.5, GPT-4). We quantitatively evaluate the performance of these LLMs across varying context-length inputs using conventional natural language similarity metrics. We further perform a qualitative study where five diverse clinicians blindly compare clinician-written BHCs and two LLM-generated BHCs for 30 samples across metrics of comprehensiveness, conciseness, factual correctness, and fluency. Overall, we present a new benchmark and pre-processed dataset for using LLMs in BHC synthesis from clinical notes. We observe high-quality summarization performance for both in-context proprietary and fine-tuned open-source LLMs using both quantitative metrics and a qualitative clinical reader study. We propose our work as a benchmark to motivate future works to adapt and assess the performance of LLMs in BHC synthesis.

Much recent progress in applications of machine learning models to NLP has been driven by benchmarks that evaluate models across a wide variety of tasks. However, these broad-coverage benchmarks have been mostly limited to English, and despite an increasing interest in multilingual models, a benchmark that enables the comprehensive evaluation of such methods on a diverse range of languages and tasks is still missing. To this end, we introduce the Cross-lingual TRansfer Evaluation of Multilingual Encoders XTREME benchmark, a multi-task benchmark for evaluating the cross-lingual generalization capabilities of multilingual representations across 40 languages and 9 tasks. We demonstrate that while models tested on English reach human performance on many tasks, there is still a sizable gap in the performance of cross-lingually transferred models, particularly on syntactic and sentence retrieval tasks. There is also a wide spread of results across languages. We release the benchmark to encourage research on cross-lingual learning methods that transfer linguistic knowledge across a diverse and representative set of languages and tasks.

Although multilingual language models exhibit impressive cross-lingual transfer capabilities on unseen languages, the performance on downstream tasks is impacted when there is a script disparity with the languages used in the multilingual model's pre-training data. Using transliteration offers a straightforward yet effective means to align the script of a resource-rich language with a target language, thereby enhancing cross-lingual transfer capabilities. However, for mixed languages, this approach is suboptimal, since only a subset of the language benefits from the cross-lingual transfer while the remainder is impeded. In this work, we focus on Maltese, a Semitic language, with substantial influences from Arabic, Italian, and English, and notably written in Latin script. We present a novel dataset annotated with word-level etymology. We use this dataset to train a classifier that enables us to make informed decisions regarding the appropriate processing of each token in the Maltese language. We contrast indiscriminate transliteration or translation to mixing processing pipelines that only transliterate words of Arabic origin, thereby resulting in text with a mixture of scripts. We fine-tune the processed data on four downstream tasks and show that conditional transliteration based on word etymology yields the best results, surpassing fine-tuning with raw Maltese or Maltese processed with non-selective pipelines.

The rapid development of Large Language Models (LLMs) for healthcare applications has spurred calls for holistic evaluation beyond frequently-cited benchmarks like USMLE, to better reflect real-world performance. While real-world assessments are valuable indicators of utility, they often lag behind the pace of LLM evolution, likely rendering findings obsolete upon deployment. This temporal disconnect necessitates a comprehensive upfront evaluation that can guide model selection for specific clinical applications. We introduce MEDIC, a framework assessing LLMs across five critical dimensions of clinical competence: medical reasoning, ethics and bias, data and language understanding, in-context learning, and clinical safety. MEDIC features a novel cross-examination framework quantifying LLM performance across areas like coverage and hallucination detection, without requiring reference outputs. We apply MEDIC to evaluate LLMs on medical question-answering, safety, summarization, note generation, and other tasks. Our results show performance disparities across model sizes, baseline vs medically finetuned models, and have implications on model selection for applications requiring specific model strengths, such as low hallucination or lower cost of inference. MEDIC's multifaceted evaluation reveals these performance trade-offs, bridging the gap between theoretical capabilities and practical implementation in healthcare settings, ensuring that the most promising models are identified and adapted for diverse healthcare applications.

In natural language processing applied to the clinical domain, utilizing large language models has emerged as a promising avenue for error detection and correction on clinical notes, a knowledge-intensive task for which annotated data is scarce. This paper presents MedReAct'N'MedReFlex, which leverages a suite of four LLM-based medical agents. The MedReAct agent initiates the process by observing, analyzing, and taking action, generating trajectories to guide the search to target a potential error in the clinical notes. Subsequently, the MedEval agent employs five evaluators to assess the targeted error and the proposed correction. In cases where MedReAct's actions prove insufficient, the MedReFlex agent intervenes, engaging in reflective analysis and proposing alternative strategies. Finally, the MedFinalParser agent formats the final output, preserving the original style while ensuring the integrity of the error correction process. One core component of our method is our RAG pipeline based on our ClinicalCorp corpora. Among other well-known sources containing clinical guidelines and information, we preprocess and release the open-source MedWiki dataset for clinical RAG application. Our results demonstrate the central role of our RAG approach with ClinicalCorp leveraged through the MedReAct'N'MedReFlex framework. It achieved the ninth rank on the MEDIQA-CORR 2024 final leaderboard.

This paper introduces MedExQA, a novel benchmark in medical question-answering, to evaluate large language models' (LLMs) understanding of medical knowledge through explanations. By constructing datasets across five distinct medical specialties that are underrepresented in current datasets and further incorporating multiple explanations for each question-answer pair, we address a major gap in current medical QA benchmarks which is the absence of comprehensive assessments of LLMs' ability to generate nuanced medical explanations. Our work highlights the importance of explainability in medical LLMs, proposes an effective methodology for evaluating models beyond classification accuracy, and sheds light on one specific domain, speech language pathology, where current LLMs including GPT4 lack good understanding. Our results show generation evaluation with multiple explanations aligns better with human assessment, highlighting an opportunity for a more robust automated comprehension assessment for LLMs. To diversify open-source medical LLMs (currently mostly based on Llama2), this work also proposes a new medical model, MedPhi-2, based on Phi-2 (2.7B). The model outperformed medical LLMs based on Llama2-70B in generating explanations, showing its effectiveness in the resource-constrained medical domain. We will share our benchmark datasets and the trained model.

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.

Advances in natural language processing techniques, such as named entity recognition and normalization to widely used standardized terminologies like UMLS or SNOMED-CT, along with the digitalization of electronic health records, have significantly advanced clinical text analysis. This study presents ClinLinker, a novel approach employing a two-phase pipeline for medical entity linking that leverages the potential of in-domain adapted language models for biomedical text mining: initial candidate retrieval using a SapBERT-based bi-encoder and subsequent re-ranking with a cross-encoder, trained by following a contrastive-learning strategy to be tailored to medical concepts in Spanish. This methodology, focused initially on content in Spanish, substantially outperforming multilingual language models designed for the same purpose. This is true even for complex scenarios involving heterogeneous medical terminologies and being trained on a subset of the original data. Our results, evaluated using top-k accuracy at 25 and other top-k metrics, demonstrate our approach's performance on two distinct clinical entity linking Gold Standard corpora, DisTEMIST (diseases) and MedProcNER (clinical procedures), outperforming previous benchmarks by 40 points in DisTEMIST and 43 points in MedProcNER, both normalized to SNOMED-CT codes. These findings highlight our approach's ability to address language-specific nuances and set a new benchmark in entity linking, offering a potent tool for enhancing the utility of digital medical records. The resulting system is of practical value, both for large scale automatic generation of structured data derived from clinical records, as well as for exhaustive extraction and harmonization of predefined clinical variables of interest.

Recent advances in multimodal vision and language modeling have predominantly focused on the English language, mostly due to the lack of multilingual multimodal datasets to steer modeling efforts. In this work, we address this gap and provide xGQA, a new multilingual evaluation benchmark for the visual question answering task. We extend the established English GQA dataset to 7 typologically diverse languages, enabling us to detect and explore crucial challenges in cross-lingual visual question answering. We further propose new adapter-based approaches to adapt multimodal transformer-based models to become multilingual, and -- vice versa -- multilingual models to become multimodal. Our proposed methods outperform current state-of-the-art multilingual multimodal models (e.g., M3P) in zero-shot cross-lingual settings, but the accuracy remains low across the board; a performance drop of around 38 accuracy points in target languages showcases the difficulty of zero-shot cross-lingual transfer for this task. Our results suggest that simple cross-lingual transfer of multimodal models yields latent multilingual multimodal misalignment, calling for more sophisticated methods for vision and multilingual language modeling.

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

Multilingual proficiency presents a significant challenge for large language models (LLMs). English-centric models are usually suboptimal in other languages, particularly those that are linguistically distant from English. This performance discrepancy mainly stems from the imbalanced distribution of training data across languages during pre-training and instruction tuning stages. To address this problem, we propose a novel approach called CrossIn, which utilizes a mixed composition of cross-lingual instruction tuning data. Our method leverages the compressed representation shared by various languages to efficiently enhance the model's task-solving capabilities and multilingual proficiency within a single process. In addition, we introduce a multi-task and multi-faceted benchmark to evaluate the effectiveness of CrossIn. Experimental results demonstrate that our method substantially improves performance across tasks and languages, and we provide extensive insights into the impact of cross-lingual data volume and the integration of translation data on enhancing multilingual consistency and accuracy.

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

Medicine, by its nature, is a multifaceted domain that requires the synthesis of information across various modalities. Medical generative vision-language models (VLMs) make a first step in this direction and promise many exciting clinical applications. However, existing models typically have to be fine-tuned on sizeable down-stream datasets, which poses a significant limitation as in many medical applications data is scarce, necessitating models that are capable of learning from few examples in real-time. Here we propose Med-Flamingo, a multimodal few-shot learner adapted to the medical domain. Based on OpenFlamingo-9B, we continue pre-training on paired and interleaved medical image-text data from publications and textbooks. Med-Flamingo unlocks few-shot generative medical visual question answering (VQA) abilities, which we evaluate on several datasets including a novel challenging open-ended VQA dataset of visual USMLE-style problems. Furthermore, we conduct the first human evaluation for generative medical VQA where physicians review the problems and blinded generations in an interactive app. Med-Flamingo improves performance in generative medical VQA by up to 20\% in clinician's rating and firstly enables multimodal medical few-shot adaptations, such as rationale generation. We release our model, code, and evaluation app under https://github.com/snap-stanford/med-flamingo.

Multi-lingual language models (LM), such as mBERT, XLM-R, mT5, mBART, have been remarkably successful in enabling natural language tasks in low-resource languages through cross-lingual transfer from high-resource ones. In this work, we try to better understand how such models, specifically mT5, transfer *any* linguistic and semantic knowledge across languages, even though no explicit cross-lingual signals are provided during pre-training. Rather, only unannotated texts from each language are presented to the model separately and independently of one another, and the model appears to implicitly learn cross-lingual connections. This raises several questions that motivate our study, such as: Are the cross-lingual connections between every language pair equally strong? What properties of source and target language impact the strength of cross-lingual transfer? Can we quantify the impact of those properties on the cross-lingual transfer? In our investigation, we analyze a pre-trained mT5 to discover the attributes of cross-lingual connections learned by the model. Through a statistical interpretation framework over 90 language pairs across three tasks, we show that transfer performance can be modeled by a few linguistic and data-derived features. These observations enable us to interpret cross-lingual understanding of the mT5 model. Through these observations, one can favorably choose the best source language for a task, and can anticipate its training data demands. A key finding of this work is that similarity of syntax, morphology and phonology are good predictors of cross-lingual transfer, significantly more than just the lexical similarity of languages. For a given language, we are able to predict zero-shot performance, that increases on a logarithmic scale with the number of few-shot target language data points.

As the size of Large Multi-Modal Models (LMMs) increases consistently, the adaptation of these pre-trained models to specialized tasks has become a computationally and memory-intensive challenge. Traditional fine-tuning methods require isolated, exhaustive retuning for each new task, limiting the models' versatility. Moreover, current efficient adaptation techniques often overlook modality alignment, focusing only on the knowledge extraction of new tasks. To tackle these issues, we introduce Multiway-Adapter, an innovative framework incorporating an 'Alignment Enhancer' to deepen modality alignment, enabling high transferability without tuning pre-trained parameters. Our method adds fewer than 1.25\% of additional parameters to LMMs, exemplified by the BEiT-3 model in our study. This leads to superior zero-shot image-text retrieval performance compared to fully fine-tuned models, while achieving up to a 57\% reduction in fine-tuning time. Our approach offers a resource-efficient and effective adaptation pathway for LMMs, broadening their applicability. The source code is publicly available at: https://github.com/longkukuhi/MultiWay-Adapter.