We examined how model size, temperature, and prompt style affect Large Language Models' (LLMs) alignment within itself, between models, and with human in assessing clinical reasoning skills. Model size emerged as a key factor in LLM-human score alignment. Study highlights the importance of checking alignments across multiple levels.

Assisting medical students with clinical reasoning (CR) during clinical scenario training remains a persistent challenge in medical education. This paper presents the design and architecture of the Fuzzy Supervisor Agent (FSA), a novel component for the Multi-Agent Educational Clinical Scenario Simulation (MAECSS) platform. The FSA leverages a Fuzzy Inference System (FIS) to continuously interpret student interactions with specialized clinical agents (e.g., patient, physical exam, diagnostic, intervention) using pre-defined fuzzy rule bases for professionalism, medical relevance, ethical behavior, and contextual distraction. By analyzing student decision-making processes in real-time, the FSA is designed to deliver adaptive, context-aware feedback and provides assistance precisely when students encounter difficulties. This work focuses on the technical framework and rationale of the FSA, highlighting its potential to provide scalable, flexible, and human-like supervision in simulation-based medical education. Future work will include empirical evaluation and integration into broader educational settings. More detailed design and implementation is open sourced here.

Clinical communication skills are critical in medical education, and practicing and assessing clinical communication skills on a scale is challenging. Although LLM-powered clinical scenario simulations have shown promise in enhancing medical students' clinical practice, providing automated and scalable clinical evaluation that follows nuanced physician judgment is difficult. This paper combines fuzzy logic and Large Language Model (LLM) and proposes LLM-as-a-Fuzzy-Judge to address the challenge of aligning the automated evaluation of medical students' clinical skills with subjective physicians' preferences. LLM-as-a-Fuzzy-Judge is an approach that LLM is fine-tuned to evaluate medical students' utterances within student-AI patient conversation scripts based on human annotations from four fuzzy sets, including Professionalism, Medical Relevance, Ethical Behavior, and Contextual Distraction. The methodology of this paper started from data collection from the LLM-powered medical education system, data annotation based on multidimensional fuzzy sets, followed by prompt engineering and the supervised fine-tuning (SFT) of the pre-trained LLMs using these human annotations. The results show that the LLM-as-a-Fuzzy-Judge achieves over 80\% accuracy, with major criteria items over 90\%, effectively leveraging fuzzy logic and LLM as a solution to deliver interpretable, human-aligned assessment. This work suggests the viability of leveraging fuzzy logic and LLM to align with human preferences, advances automated evaluation in medical education, and supports more robust assessment and judgment practices. The GitHub repository of this work is available at https://github.com/2sigmaEdTech/LLMAsAJudge

The performance of Large Language Models (LLMs) on multiple-choice question (MCQ) benchmarks is frequently cited as proof of their medical capabilities. We hypothesized that LLM performance on medical MCQs may in part be illusory and driven by factors beyond medical content knowledge and reasoning capabilities. To assess this, we created a novel benchmark of free-response questions with paired MCQs (FreeMedQA). Using this benchmark, we evaluated three state-of-the-art LLMs (GPT-4o, GPT-3.5, and LLama-3-70B-instruct) and found an average absolute deterioration of 39.43% in performance on free-response questions relative to multiple-choice (p = 1.3 * 10-5) which was greater than the human performance decline of 22.29%. To isolate the role of the MCQ format on performance, we performed a masking study, iteratively masking out parts of the question stem. At 100% masking, the average LLM multiple-choice performance was 6.70% greater than random chance (p = 0.002) with one LLM (GPT-4o) obtaining an accuracy of 37.34%. Notably, for all LLMs the free-response performance was near zero. Our results highlight the shortcomings in medical MCQ benchmarks for overestimating the capabilities of LLMs in medicine, and, broadly, the potential for improving both human and machine assessments using LLM-evaluated free-response questions.

Medical education faces challenges in scalability, accessibility, and consistency, particularly in clinical skills training for physician-patient communication. Traditional simulation-based learning, while effective, is resource-intensive, difficult to schedule, and often highly variable in feedback quality. Through a collaboration between AI, learning science, and medical education experts, we co-developed MedSimAI, an AI-powered simulation platform that enables deliberate practice, self-regulated learning (SRL), and automated assessment through interactive patient encounters. Leveraging large language models (LLMs), MedSimAI generates realistic clinical interactions and provides immediate, structured feedback using established medical evaluation frameworks such as the Master Interview Rating Scale (MIRS). In a pilot study with 104 first-year medical students, we examined engagement, conversation patterns, and user perceptions. Students found MedSimAI beneficial for repeated, realistic patient-history practice. Conversation analysis revealed that certain higher-order skills were often overlooked, though students generally performed systematic histories and empathic listening. By integrating unlimited practice opportunities, real-time AI assessment, and SRL principles, MedSimAI addresses key limitations of traditional simulation-based training, making high-quality clinical education more accessible and scalable.

Artificial intelligence (AI) tools are now available for future medical professionals at one Texas university to navigate the complexities of pregnancy and abortion--a development that further blurs the line between technology, politics and healthcare. A group of medical students at the University of Texas Medical Branch in Galveston recently created a simulation of a pregnant patient, powered by AI, that the next generation of health experts can use to interpret various maternal health situations, including abortion. The new tech allows users to engage in all-options pregnancy counseling in Texas while also avoiding the potential consequences of the state's abortion restrictions. Anu Sharma, the CEO and founder of a tech-enabled maternity care company called Millie, told Fox News Digital that while this kind of tech is not without controversy or political discourse, it could provide much needed innovation and help to a healthcare system with significant gaps. Texas medical students have developed new AI tools to assist women with different pregnancy options, including abortion.

The rapid adoption of generative AI in the public sector, encompassing diverse applications ranging from automated public assistance to welfare services and immigration processes, highlights its transformative potential while underscoring the pressing need for thorough risk assessments. Despite its growing presence, evaluations of risks associated with AI-driven systems in the public sector remain insufficiently explored. Building upon an established taxonomy of AI risks derived from diverse government policies and corporate guidelines, we investigate the critical risks posed by generative AI in the public sector while extending the scope to account for its multimodal capabilities. In addition, we propose a Systematic dAta generatIon Framework for evaluating the risks of generative AI (SAIF). SAIF involves four key stages: breaking down risks, designing scenarios, applying jailbreak methods, and exploring prompt types. It ensures the systematic and consistent generation of prompt data, facilitating a comprehensive evaluation while providing a solid foundation for mitigating the risks. Furthermore, SAIF is designed to accommodate emerging jailbreak methods and evolving prompt types, thereby enabling effective responses to unforeseen risk scenarios. We believe that this study can play a crucial role in fostering the safe and responsible integration of generative AI into the public sector.

Grading Objective Structured Clinical Examinations (OSCEs) is a time-consuming and expensive process, traditionally requiring extensive manual effort from human experts. In this study, we explore the potential of Large Language Models (LLMs) to assess skills related to medical student communication. We analyzed 2,027 video-recorded OSCE examinations from the University of Texas Southwestern Medical Center (UTSW), spanning four years (2019-2022), and several different medical cases or "stations." Specifically, our focus was on evaluating students' ability to summarize patients' medical history: we targeted the rubric item 'did the student summarize the patients' medical history?' from the communication skills rubric. After transcribing speech audio captured by OSCE videos using Whisper-v3, we studied the performance of various LLM-based approaches for grading students on this summarization task based on their examination transcripts. Using various frontier-level open-source and proprietary LLMs, we evaluated different techniques such as zero-shot chain-of-thought prompting, retrieval augmented generation, and multi-model ensemble methods. Our results show that frontier LLM models like GPT-4 achieved remarkable alignment with human graders, demonstrating a Cohen's kappa agreement of 0.88 and indicating strong potential for LLM-based OSCE grading to augment the current grading process. Open-source models also showed promising results, suggesting potential for widespread, cost-effective deployment. Further, we present a failure analysis identifying conditions where LLM grading may be less reliable in this context and recommend best practices for deploying LLMs in medical education settings.

Large language models (LLMs) have had a significant impact on diverse research domains, including medicine and healthcare. However, the potential of LLMs as copilots in medical education remains underexplored. Current AI-assisted educational tools are limited by their solitary learning approach and inability to simulate the multi-disciplinary and interactive nature of actual medical training. To address these limitations, we propose MEDCO (Medical EDucation COpilots), a novel multi-agent-based copilot system specially developed to emulate real-world medical training environments. MEDCO incorporates three primary agents: an agentic patient, an expert doctor, and a radiologist, facilitating a multi-modal and interactive learning environment. Our framework emphasizes the learning of proficient question-asking skills, multi-disciplinary collaboration, and peer discussions between students. Our experiments show that simulated virtual students who underwent training with MEDCO not only achieved substantial performance enhancements comparable to those of advanced models, but also demonstrated human-like learning behaviors and improvements, coupled with an increase in the number of learning samples. This work contributes to medical education by introducing a copilot that implements an interactive and collaborative learning approach. It also provides valuable insights into the effectiveness of AI-integrated training paradigms.

As more clinical workflows continue to be augmented by artificial intelligence (AI), AI literacy among physicians will become a critical requirement for ensuring safe and ethical AI-enabled patient care. Despite the evolving importance of AI in healthcare, the extent to which it has been adopted into traditional and often-overloaded medical curricula is currently unknown. In a scoping review of 1,699 articles published between January 2016 and June 2024, we identified 18 studies which propose guiding frameworks, and 11 studies documenting real-world instruction, centered around the integration of AI into medical education. We found that comprehensive guidelines will require greater clinical relevance and personalization to suit medical student interests and career trajectories. Current efforts highlight discrepancies in the teaching guidelines, emphasizing AI evaluation and ethics over technical topics such as data science and coding. Additionally, we identified several challenges associated with integrating AI training into the medical education program, including a lack of guidelines to define medical students AI literacy, a perceived lack of proven clinical value, and a scarcity of qualified instructors. With this knowledge, we propose an AI literacy framework to define competencies for medical students. To prioritize relevant and personalized AI education, we categorize literacy into four dimensions: Foundational, Practical, Experimental, and Ethical, with tailored learning objectives to the pre-clinical, clinical, and clinical research stages of medical education. This review provides a road map for developing practical and relevant education strategies for building an AI-competent healthcare workforce.