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

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

Pretrained Language Models (PLMs) harbor inherent social biases that can result in harmful real-world implications. Such social biases are measured through the probability values that PLMs output for different social groups and attributes appearing in a set of test sentences. However, bias testing is currently cumbersome since the test sentences are generated either from a limited set of manual templates or need expensive crowd-sourcing. We instead propose using ChatGPT for the controllable generation of test sentences, given any arbitrary user-specified combination of social groups and attributes appearing in the test sentences. When compared to template-based methods, our approach using ChatGPT for test sentence generation is superior in detecting social bias, especially in challenging settings such as intersectional biases. We present an open-source comprehensive bias testing framework (BiasTestGPT), hosted on HuggingFace, that can be plugged into any open-source PLM for bias testing. User testing with domain experts from various fields has shown their interest in being able to test modern AI for social biases. Our tool has significantly improved their awareness of such biases in PLMs, proving to be learnable and user-friendly. We thus enable seamless open-ended social bias testing of PLMs by domain experts through an automatic large-scale generation of diverse test sentences for any combination of social categories and attributes.

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

Text-to-image diffusion models have been adopted into key commercial workflows, such as art generation and image editing. Characterising the implicit social biases they exhibit, such as gender and racial stereotypes, is a necessary first step in avoiding discriminatory outcomes. While existing studies on social bias focus on image generation, the biases exhibited in alternate applications of diffusion-based foundation models remain under-explored. We propose methods that use synthetic images to probe two applications of diffusion models, image editing and classification, for social bias. Using our methodology, we uncover meaningful and significant inter-sectional social biases in \textit{Stable Diffusion}, a state-of-the-art open-source text-to-image model. Our findings caution against the uninformed adoption of text-to-image foundation models for downstream tasks and services.

Labeling social-media data for custom dimensions of toxicity and social bias is challenging and labor-intensive. Existing transfer and active learning approaches meant to reduce annotation effort require fine-tuning, which suffers from over-fitting to noise and can cause domain shift with small sample sizes. In this work, we propose a novel Active Transfer Few-shot Instructions (ATF) approach which requires no fine-tuning. ATF leverages the internal linguistic knowledge of pre-trained language models (PLMs) to facilitate the transfer of information from existing pre-labeled datasets (source-domain task) with minimum labeling effort on unlabeled target data (target-domain task). Our strategy can yield positive transfer achieving a mean AUC gain of 10.5% compared to no transfer with a large 22b parameter PLM. We further show that annotation of just a few target-domain samples via active learning can be beneficial for transfer, but the impact diminishes with more annotation effort (26% drop in gain between 100 and 2000 annotated examples). Finally, we find that not all transfer scenarios yield a positive gain, which seems related to the PLMs initial performance on the target-domain task.

Detecting social bias in text is challenging due to nuance, subjectivity, and difficulty in obtaining good quality labeled datasets at scale, especially given the evolving nature of social biases and society. To address these challenges, we propose a few-shot instruction-based method for prompting pre-trained language models (LMs). We select a few label-balanced exemplars from a small support repository that are closest to the query to be labeled in the embedding space. We then provide the LM with instruction that consists of this subset of labeled exemplars, the query text to be classified, a definition of bias, and prompt it to make a decision. We demonstrate that large LMs used in a few-shot context can detect different types of fine-grained biases with similar and sometimes superior accuracy to fine-tuned models. We observe that the largest 530B parameter model is significantly more effective in detecting social bias compared to smaller models (achieving at least 20% improvement in AUC metric compared to other models). It also maintains a high AUC (dropping less than 5%) in a few-shot setting with a labeled repository reduced to as few as 100 samples. Large pretrained language models thus make it easier and quicker to build new bias detectors.