We study clinical Named Entity Recognition (NER) on the CADEC corpus and compare three families of approaches: (i) BERT-style encoders (BERT Base, BioClinicalBERT, RoBERTa-large), (ii) GPT-4o used with few-shot in-context learning (ICL) under simple vs.\ complex prompts, and (iii) GPT-4o with supervised fine-tuning (SFT). All models are evaluated on standard NER metrics over CADEC's five entity types (ADR, Drug, Disease, Symptom, Finding). RoBERTa-large and BioClinicalBERT offer limited improvements over BERT Base, showing the limit of these family of models. Among LLM settings, simple ICL outperforms a longer, instruction-heavy prompt, and SFT achieves the strongest overall performance (F1 $\approx$ 87.1%), albeit with higher cost. We find that the LLM achieve higher accuracy on simplified tasks, restricting classification to two labels.

The small model (student) is trained by deeply mimicking the self-attention module, which plays a vital role in Transformer networks, of the large model (teacher).

Shared decision-making (SDM) is necessary to achieve patient-centred care. Currently no methodology exists to automatically measure SDM at scale. This study aimed to develop an automated approach to measure SDM by using language modelling and the conversational alignment (CA) score. A total of 157 video-recorded patient-doctor conversations from a randomized multi-centre trial evaluating SDM decision aids for anticoagulation in atrial fibrillations were transcribed and segmented into 42,559 sentences. Context-response pairs and negative sampling were employed to train deep learning (DL) models and fine-tuned BERT models via the next sentence prediction (NSP) task. Each top-performing model was used to calculate four types of CA scores. A random-effects analysis by clinician, adjusting for age, sex, race, and trial arm, assessed the association between CA scores and SDM outcomes: the Decisional Conflict Scale (DCS) and the Observing Patient Involvement in Decision-Making 12 (OPTION12) scores. p-values were corrected for multiple comparisons with the Benjamini-Hochberg method. Among 157 patients (34% female, mean age 70 SD 10.8), clinicians on average spoke more words than patients (1911 vs 773). The DL model without the stylebook strategy achieved a recall@1 of 0.227, while the fine-tuned BERTbase (110M) achieved the highest recall@1 with 0.640. The AbsMax (18.36 SE7.74 p=0.025) and Max CA (21.02 SE7.63 p=0.012) scores generated with the DL without stylebook were associated with OPTION12. The Max CA score generated with the fine-tuned BERTbase (110M) was associated with the DCS score (-27.61 SE12.63 p=0.037). BERT model sizes did not have an impact the association between CA scores and SDM. This study introduces an automated, scalable methodology to measure SDM in patient-doctor conversations through explainable CA scores, with potential to evaluate SDM strategies at scale.

Bias-only fine-tuning has the potential for unprecedented parameter efficiency. However, the link between fine-tuning different bias terms (i.e., bias terms in the query, key, or value projections) and downstream performance remains unclear. The existing approaches, e.g., based on the magnitude of bias change or empirical Fisher information, provide limited guidance for selecting the particular bias term for effective fine-tuning. In this paper, we propose an approach for selecting the bias term to be fine-tuned, forming the foundation of our bias-efficient fine-tuning (BEFT). We extensively evaluate our bias-efficient approach against other bias-selection approaches, across a wide range of large language models (LLMs) spanning encoder-only and decoder-only architectures from 110M to 6.7B parameters. Our results demonstrate the effectiveness and superiority of our bias-efficient approach on diverse downstream tasks, including classification, multiple-choice, and generation tasks.

We run our experiments using PyTorch's distributed training on an Azure ML Nvidia DGX-2 In this section we present all the hyper-parameters used for training our models. We fix the gradient norm to be 1 and set the batch size as 1024 in all experiments based on [ 75, 34 ]. Structured pruning can be done by pruning attention heads, pruning encoder units, or pruning the embedding layer. KD is quite different from ours.