Performance of large language models (LLMs) on medical tasks has traditionally been evaluated using multiple choice question benchmarks. However, such benchmarks are highly constrained, saturated with repeated impressive performance by LLMs, and have an unclear relationship to performance in real clinical scenarios. Clinical reasoning, the process by which physicians employ critical thinking to gather and synthesize clinical data to diagnose and manage medical problems, remains an attractive benchmark for model performance. Prior LLMs have shown promise in outperforming clinicians in routine and complex diagnostic scenarios. We sought to evaluate OpenAI's o1-preview model, a model developed to increase run-time via chain of thought processes prior to generating a response. We characterize the performance of o1-preview with five experiments including differential diagnosis generation, display of diagnostic reasoning, triage differential diagnosis, probabilistic reasoning, and management reasoning, adjudicated by physician experts with validated psychometrics. Our primary outcome was comparison of the o1-preview output to identical prior experiments that have historical human controls and benchmarks of previous LLMs. Significant improvements were observed with differential diagnosis generation and quality of diagnostic and management reasoning. No improvements were observed with probabilistic reasoning or triage differential diagnosis. This study highlights o1-preview's ability to perform strongly on tasks that require complex critical thinking such as diagnosis and management while its performance on probabilistic reasoning tasks was similar to past models. New robust benchmarks and scalable evaluation of LLM capabilities compared to human physicians are needed along with trials evaluating AI in real clinical settings.

The impact of using artificial intelligence (AI) to guide patient care or operational processes is an interplay of the AI model's output, the decision-making protocol based on that output, and the capacity of the stakeholders involved to take the necessary subsequent action. Estimating the effects of this interplay before deployment, and studying it in real time afterwards, are essential to bridge the chasm between AI model development and achievable benefit. To accomplish this, the Data Science team at Stanford Health Care has developed a Testing and Evaluation (T&E) mechanism to identify fair, useful and reliable AI models (FURM) by conducting an ethical review to identify potential value mismatches, simulations to estimate usefulness, financial projections to assess sustainability, as well as analyses to determine IT feasibility, design a deployment strategy, and recommend a prospective monitoring and evaluation plan. We report on FURM assessments done to evaluate six AI guided solutions for potential adoption, spanning clinical and operational settings, each with the potential to impact from several dozen to tens of thousands of patients each year. We describe the assessment process, summarize the six assessments, and share our framework to enable others to conduct similar assessments. Of the six solutions we assessed, two have moved into a planning and implementation phase. Our novel contributions - usefulness estimates by simulation, financial projections to quantify sustainability, and a process to do ethical assessments - as well as their underlying methods and open source tools, are available for other healthcare systems to conduct actionable evaluations of candidate AI solutions.

Remarkable progress has been made on automated problem solving through societies of agents based on large language models (LLMs). Existing LLM-based multi-agent systems can already solve simple dialogue tasks. Solutions to more complex tasks, however, are complicated through logic inconsistencies due to cascading hallucinations caused by naively chaining LLMs. Here we introduce MetaGPT, an innovative meta-programming framework incorporating efficient human workflows into LLM-based multi-agent collaborations. MetaGPT encodes Standardized Operating Procedures (SOPs) into prompt sequences for more streamlined workflows, thus allowing agents with human-like domain expertise to verify intermediate results and reduce errors. MetaGPT utilizes an assembly line paradigm to assign diverse roles to various agents, efficiently breaking down complex tasks into subtasks involving many agents working together. On collaborative software engineering benchmarks, MetaGPT generates more coherent solutions than previous chat-based multi-agent systems. Our project can be found at https://github.com/geekan/MetaGPT

Although machine learning (ML) has shown promise in numerous domains, there are concerns about generalizability to out-of-sample data. This is currently addressed by centrally sharing ample, and importantly diverse, data from multiple sites. However, such centralization is challenging to scale (or even not feasible) due to various limitations. Federated ML (FL) provides an alternative to train accurate and generalizable ML models, by only sharing numerical model updates. Here we present findings from the largest FL study to-date, involving data from 71 healthcare institutions across 6 continents, to generate an automatic tumor boundary detector for the rare disease of glioblastoma, utilizing the largest dataset of such patients ever used in the literature (25, 256 MRI scans from 6, 314 patients). We demonstrate a 33% improvement over a publicly trained model to delineate the surgically targetable tumor, and 23% improvement over the tumor's entire extent. We anticipate our study to: 1) enable more studies in healthcare informed by large and diverse data, ensuring meaningful results for rare diseases and underrepresented populations, 2) facilitate further quantitative analyses for glioblastoma via performance optimization of our consensus model for eventual public release, and 3) demonstrate the effectiveness of FL at such scale and task complexity as a paradigm shift for multi-site collaborations, alleviating the need for data sharing.

Procedural content generation via Machine Learning (PCGML) is the umbrella term for approaches that generate content for games via machine learning. One of the benefits of PCGML is that, unlike search or grammar-based PCG, it does not require hand authoring of initial content or rules. Instead, PCGML relies on existing content and black box models, which can be difficult to tune or tweak without expert knowledge. This is especially problematic when a human designer needs to understand how to manipulate their data or models to achieve desired results. We present an approach to Explainable PCGML via Design Patterns in which the design patterns act as a vocabulary and mode of interaction between user and model. We demonstrate that our technique outperforms non-explainable versions of our system in interactions with five expert designers, four of whom lack any machine learning expertise.

In this paper we describe a level design editor designed as an interface to allow different AI agents to creatively collaborate on level design problems with human designers. We intend to investigate the comparative impacts of different AI techniques on user experience in this context.