This paper examines the extent to which large language models (LLMs) have developed higher-order theory of mind (ToM); the human ability to reason about multiple mental and emotional states in a recursive manner (e.g. I think that you believe that she knows). This paper builds on prior work by introducing a handwritten test suite -- Multi-Order Theory of Mind Q&A -- and using it to compare the performance of five LLMs to a newly gathered adult human benchmark. We find that GPT-4 and Flan-PaLM reach adult-level and near adult-level performance on ToM tasks overall, and that GPT-4 exceeds adult performance on 6th order inferences. Our results suggest that there is an interplay between model size and finetuning for the realisation of ToM abilities, and that the best-performing LLMs have developed a generalised capacity for ToM. Given the role that higher-order ToM plays in a wide range of cooperative and competitive human behaviours, these findings have significant implications for user-facing LLM applications.

Two artificial intelligence (AI) programs -- including ChatGPT -- have passed the U.S. Medical Licensing Examination (USMLE), according to two recent papers. The papers highlighted different approaches to using large language models to take the USMLE, which is comprised of three exams: Step 1, Step 2 CK, and Step 3. ChatGPT is an artificial intelligence (AI) search tool that mimics long-form writing based on prompts from human users. It was developed by OpenAI, and became popular after several social media posts showed potential uses for the tool in clinical practice, often with mixed results. The first paper, published on medRxiv in December, investigated ChatGPT's performance on the USMLE without any special training or reinforcement prior to the exams. According to Victor Tseng, MD, of Ansible Health in Mountain View, California, and colleagues, the results showed "new and surprising evidence" that this AI tool was up to the challenge.

Large language models (LLMs) have demonstrated impressive capabilities in natural language understanding and generation, but the quality bar for medical and clinical applications is high. Today, attempts to assess models' clinical knowledge typically rely on automated evaluations on limited benchmarks. There is no standard to evaluate model predictions and reasoning across a breadth of tasks. To address this, we present MultiMedQA, a benchmark combining six existing open question answering datasets spanning professional medical exams, research, and consumer queries; and HealthSearchQA, a new free-response dataset of medical questions searched online. We propose a framework for human evaluation of model answers along multiple axes including factuality, precision, possible harm, and bias. In addition, we evaluate PaLM (a 540-billion parameter LLM) and its instruction-tuned variant, Flan-PaLM, on MultiMedQA. Using a combination of prompting strategies, Flan-PaLM achieves state-of-the-art accuracy on every MultiMedQA multiple-choice dataset (MedQA, MedMCQA, PubMedQA, MMLU clinical topics), including 67.6% accuracy on MedQA (US Medical License Exam questions), surpassing prior state-of-the-art by over 17%. However, human evaluation reveals key gaps in Flan-PaLM responses. To resolve this we introduce instruction prompt tuning, a parameter-efficient approach for aligning LLMs to new domains using a few exemplars. The resulting model, Med-PaLM, performs encouragingly, but remains inferior to clinicians. We show that comprehension, recall of knowledge, and medical reasoning improve with model scale and instruction prompt tuning, suggesting the potential utility of LLMs in medicine. Our human evaluations reveal important limitations of today's models, reinforcing the importance of both evaluation frameworks and method development in creating safe, helpful LLM models for clinical applications.

Finetuning language models on a collection of datasets phrased as instructions has been shown to improve model performance and generalization to unseen tasks. In this paper we explore instruction finetuning with a particular focus on (1) scaling the number of tasks, (2) scaling the model size, and (3) finetuning on chain-of-thought data. We find that instruction finetuning with the above aspects dramatically improves performance on a variety of model classes (PaLM, T5, U-PaLM), prompting setups (zero-shot, few-shot, CoT), and evaluation benchmarks (MMLU, BBH, TyDiQA, MGSM, open-ended generation). For instance, Flan-PaLM 540B instruction-finetuned on 1.8K tasks outperforms PALM 540B by a large margin (+9.4% on average). Flan-PaLM 540B achieves state-of-the-art performance on several benchmarks, such as 75.2% on five-shot MMLU. We also publicly release Flan-T5 checkpoints, which achieve strong few-shot performance even compared to much larger models, such as PaLM 62B. Overall, instruction finetuning is a general method for improving the performance and usability of pretrained language models.