Searcharxiv⌕ Search

arXiv subjects

Karan Singhal

Publications and source records attributed to Karan Singhal.

At least 19 recordsLinked to original sources
arXiv2026

Reinforcement Learning Towards Broadly and Persistently Beneficial Models

As AI systems are deployed across increasingly diverse and high-stakes settings, model alignment must generalize beyond the tasks and domains seen during training. This is especially important for reinforcement learning (RL), which can introduce unexpected misalignment through reward hacking, deception, or other unintended strategies. We study whether RL on beneficial behavior, instantiated in realistic domains, can produce broad and persistent alignment generalization beyond the training distribution. We construct a dataset of realistic situations designed to measure and train beneficial traits, such as truthfulness, fairness, risk awareness, and corrigibility, spanning varied domains, including health, science, and education. We then train models with RL on this dataset and evaluate them on more than 50 independent benchmarks of alignment and beneficial behavior. Compared to a compute-matched baseline, beneficial trait RL improves performance on over 80% of these out-of-distribution benchmarks. We observe substantial out-of-distribution alignment transfer: a beneficial-behavior RL intervention entirely limited to one domain, health, produces broad improvements on non-health alignment evaluations, including reduced reward hacking, deception, and general misalignment. Finally, we study alignment persistence: whether behavior remains robustly aligned under attempts to steer models towards misalignment. Models trained with beneficial trait RL show improved persistence, including greater resistance to adversarial prompting and harmful finetuning; further work is required to isolate the sources of these effects. These results suggest that RL to reinforce beneficial behavior in realistic domains can produce models that are more robustly aligned with human flourishing.

cs.AI↗
arXiv2026

HealthBench Professional: Evaluating Large Language Models on Real Clinician Chats

Millions of clinicians use ChatGPT to support clinical care, but evaluations of the most common use cases in model-clinician conversations are limited. We introduce HealthBench Professional, an open benchmark for evaluating large language models on real tasks that clinicians bring to ChatGPT in the course of their work. The benchmark is organized around three common use cases central to clinical practice: care consult, writing and documentation, and medical research. Each example includes a physician-authored conversation with ChatGPT for Clinicians and is scored via rubrics written and iteratively adjudicated by three or more physicians across three phases. HealthBench Professional examples were carefully selected for quality, representativeness, and difficulty for OpenAI's current frontier models, to enable continued measurement of progress. Difficult examples for recent OpenAI models were enriched by roughly 3.5 times relative to the candidate pool of 15,079 examples. Additionally, about one-third of examples involve physicians conducting deliberate adversarial testing of models. As a strong baseline, we also collected human physician responses for all tasks (unbounded time, specialist-matched, web access). The best scoring system, GPT-5.4 in ChatGPT for Clinicians, outperforms base GPT-5.4, all other models, and human physicians. We hope HealthBench Professional provides the healthcare AI community a measure to track frontier model progress in real-world clinical tasks and build systems that clinicians can trust to improve care.

cs.CL↗
arXiv2025

AI-based Clinical Decision Support for Primary Care: A Real-World Study

We evaluate the impact of large language model-based clinical decision support in live care. In partnership with Penda Health, a network of primary care clinics in Nairobi, Kenya, we studied AI Consult, a tool that serves as a safety net for clinicians by identifying potential documentation and clinical decision-making errors. AI Consult integrates into clinician workflows, activating only when needed and preserving clinician autonomy. We conducted a quality improvement study, comparing outcomes for 39,849 patient visits performed by clinicians with or without access to AI Consult across 15 clinics. Visits were rated by independent physicians to identify clinical errors. Clinicians with access to AI Consult made relatively fewer errors: 16% fewer diagnostic errors and 13% fewer treatment errors. In absolute terms, the introduction of AI Consult would avert diagnostic errors in 22,000 visits and treatment errors in 29,000 visits annually at Penda alone. In a survey of clinicians with AI Consult, all clinicians said that AI Consult improved the quality of care they delivered, with 75% saying the effect was "substantial". These results required a clinical workflow-aligned AI Consult implementation and active deployment to encourage clinician uptake. We hope this study demonstrates the potential for LLM-based clinical decision support tools to reduce errors in real-world settings and provides a practical framework for advancing responsible adoption.

cs.CL↗
arXiv2025

HealthBench: Evaluating Large Language Models Towards Improved Human Health

We present HealthBench, an open-source benchmark measuring the performance and safety of large language models in healthcare. HealthBench consists of 5,000 multi-turn conversations between a model and an individual user or healthcare professional. Responses are evaluated using conversation-specific rubrics created by 262 physicians. Unlike previous multiple-choice or short-answer benchmarks, HealthBench enables realistic, open-ended evaluation through 48,562 unique rubric criteria spanning several health contexts (e.g., emergencies, transforming clinical data, global health) and behavioral dimensions (e.g., accuracy, instruction following, communication). HealthBench performance over the last two years reflects steady initial progress (compare GPT-3.5 Turbo's 16% to GPT-4o's 32%) and more rapid recent improvements (o3 scores 60%). Smaller models have especially improved: GPT-4.1 nano outperforms GPT-4o and is 25 times cheaper. We additionally release two HealthBench variations: HealthBench Consensus, which includes 34 particularly important dimensions of model behavior validated via physician consensus, and HealthBench Hard, where the current top score is 32%. We hope that HealthBench grounds progress towards model development and applications that benefit human health.

cs.CL↗
arXiv2025

Enhancing User Sequence Modeling through Barlow Twins-based Self-Supervised Learning

User sequence modeling is crucial for modern large-scale recommendation systems, as it enables the extraction of informative representations of users and items from their historical interactions. These user representations are widely used for a variety of downstream tasks to enhance users' online experience. A key challenge for learning these representations is the lack of labeled training data. While self-supervised learning (SSL) methods have emerged as a promising solution for learning representations from unlabeled data, many existing approaches rely on extensive negative sampling, which can be computationally expensive and may not always be feasible in real-world scenario. In this work, we propose an adaptation of Barlow Twins, a state-of-the-art SSL methods, to user sequence modeling by incorporating suitable augmentation methods. Our approach aims to mitigate the need for large negative sample batches, enabling effective representation learning with smaller batch sizes and limited labeled data. We evaluate our method on the MovieLens-1M, MovieLens-20M, and Yelp datasets, demonstrating that our method consistently outperforms the widely-used dual encoder model across three downstream tasks, achieving an 8%-20% improvement in accuracy. Our findings underscore the effectiveness of our approach in extracting valuable sequence-level information for user modeling, particularly in scenarios where labeled data is scarce and negative examples are limited.

cs.IR↗
arXiv2024

A Toolbox for Surfacing Health Equity Harms and Biases in Large Language Models

Large language models (LLMs) hold promise to serve complex health information needs but also have the potential to introduce harm and exacerbate health disparities. Reliably evaluating equity-related model failures is a critical step toward developing systems that promote health equity. We present resources and methodologies for surfacing biases with potential to precipitate equity-related harms in long-form, LLM-generated answers to medical questions and conduct a large-scale empirical case study with the Med-PaLM 2 LLM. Our contributions include a multifactorial framework for human assessment of LLM-generated answers for biases, and EquityMedQA, a collection of seven datasets enriched for adversarial queries. Both our human assessment framework and dataset design process are grounded in an iterative participatory approach and review of Med-PaLM 2 answers. Through our empirical study, we find that our approach surfaces biases that may be missed via narrower evaluation approaches. Our experience underscores the importance of using diverse assessment methodologies and involving raters of varying backgrounds and expertise. While our approach is not sufficient to holistically assess whether the deployment of an AI system promotes equitable health outcomes, we hope that it can be leveraged and built upon towards a shared goal of LLMs that promote accessible and equitable healthcare.

cs.CY↗
arXiv2024

Augmentations vs Algorithms: What Works in Self-Supervised Learning

We study the relative effects of data augmentations, pretraining algorithms, and model architectures in Self-Supervised Learning (SSL). While the recent literature in this space leaves the impression that the pretraining algorithm is of critical importance to performance, understanding its effect is complicated by the difficulty in making objective and direct comparisons between methods. We propose a new framework which unifies many seemingly disparate SSL methods into a single shared template. Using this framework, we identify aspects in which methods differ and observe that in addition to changing the pretraining algorithm, many works also use new data augmentations or more powerful model architectures. We compare several popular SSL methods using our framework and find that many algorithmic additions, such as prediction networks or new losses, have a minor impact on downstream task performance (often less than $1\%$), while enhanced augmentation techniques offer more significant performance improvements ($2-4\%$). Our findings challenge the premise that SSL is being driven primarily by algorithmic improvements, and suggest instead a bitter lesson for SSL: that augmentation diversity and data / model scale are more critical contributors to recent advances in self-supervised learning.

cs.LG↗
arXiv2024

Towards Conversational Diagnostic AI

At the heart of medicine lies the physician-patient dialogue, where skillful history-taking paves the way for accurate diagnosis, effective management, and enduring trust. Artificial Intelligence (AI) systems capable of diagnostic dialogue could increase accessibility, consistency, and quality of care. However, approximating clinicians' expertise is an outstanding grand challenge. Here, we introduce AMIE (Articulate Medical Intelligence Explorer), a Large Language Model (LLM) based AI system optimized for diagnostic dialogue. AMIE uses a novel self-play based simulated environment with automated feedback mechanisms for scaling learning across diverse disease conditions, specialties, and contexts. We designed a framework for evaluating clinically-meaningful axes of performance including history-taking, diagnostic accuracy, management reasoning, communication skills, and empathy. We compared AMIE's performance to that of primary care physicians (PCPs) in a randomized, double-blind crossover study of text-based consultations with validated patient actors in the style of an Objective Structured Clinical Examination (OSCE). The study included 149 case scenarios from clinical providers in Canada, the UK, and India, 20 PCPs for comparison with AMIE, and evaluations by specialist physicians and patient actors. AMIE demonstrated greater diagnostic accuracy and superior performance on 28 of 32 axes according to specialist physicians and 24 of 26 axes according to patient actors. Our research has several limitations and should be interpreted with appropriate caution. Clinicians were limited to unfamiliar synchronous text-chat which permits large-scale LLM-patient interactions but is not representative of usual clinical practice. While further research is required before AMIE could be translated to real-world settings, the results represent a milestone towards conversational diagnostic AI.

cs.AI↗
arXiv2023

SASSL: Enhancing Self-Supervised Learning via Neural Style Transfer

Existing data augmentation in self-supervised learning, while diverse, fails to preserve the inherent structure of natural images. This results in distorted augmented samples with compromised semantic information, ultimately impacting downstream performance. To overcome this limitation, we propose SASSL: Style Augmentations for Self Supervised Learning, a novel data augmentation technique based on Neural Style Transfer. SASSL decouples semantic and stylistic attributes in images and applies transformations exclusively to their style while preserving content, generating diverse samples that better retain semantic information. SASSL boosts top-1 image classification accuracy on ImageNet by up to 2 percentage points compared to established self-supervised methods like MoCo, SimCLR, and BYOL, while achieving superior transfer learning performance across various datasets. Because SASSL can be performed asynchronously as part of the data augmentation pipeline, these performance impacts can be obtained with no change in pretraining throughput.

cs.CV↗
arXiv2023

Disentangling the Effects of Data Augmentation and Format Transform in Self-Supervised Learning of Image Representations

Self-Supervised Learning (SSL) enables training performant models using limited labeled data. One of the pillars underlying vision SSL is the use of data augmentations/perturbations of the input which do not significantly alter its semantic content. For audio and other temporal signals, augmentations are commonly used alongside format transforms such as Fourier transforms or wavelet transforms. Unlike augmentations, format transforms do not change the information contained in the data; rather, they express the same information in different coordinates. In this paper, we study the effects of format transforms and augmentations both separately and together on vision SSL. We define augmentations in frequency space called Fourier Domain Augmentations (FDA) and show that training SSL models on a combination of these and image augmentations can improve the downstream classification accuracy by up to 1.3% on ImageNet-1K. We also show improvements against SSL baselines in few-shot and transfer learning setups using FDA. Surprisingly, we also observe that format transforms can improve the quality of learned representations even without augmentations; however, the combination of the two techniques yields better quality.

cs.CV↗
arXiv2023

Consensus, dissensus and synergy between clinicians and specialist foundation models in radiology report generation

Radiology reports are an instrumental part of modern medicine, informing key clinical decisions such as diagnosis and treatment. The worldwide shortage of radiologists, however, restricts access to expert care and imposes heavy workloads, contributing to avoidable errors and delays in report delivery. While recent progress in automated report generation with vision-language models offer clear potential in ameliorating the situation, the path to real-world adoption has been stymied by the challenge of evaluating the clinical quality of AI-generated reports. In this study, we build a state-of-the-art report generation system for chest radiographs, $\textit{Flamingo-CXR}$, by fine-tuning a well-known vision-language foundation model on radiology data. To evaluate the quality of the AI-generated reports, a group of 16 certified radiologists provide detailed evaluations of AI-generated and human written reports for chest X-rays from an intensive care setting in the United States and an inpatient setting in India. At least one radiologist (out of two per case) preferred the AI report to the ground truth report in over 60$\%$ of cases for both datasets. Amongst the subset of AI-generated reports that contain errors, the most frequently cited reasons were related to the location and finding, whereas for human written reports, most mistakes were related to severity and finding. This disparity suggested potential complementarity between our AI system and human experts, prompting us to develop an assistive scenario in which Flamingo-CXR generates a first-draft report, which is subsequently revised by a clinician. This is the first demonstration of clinician-AI collaboration for report writing, and the resultant reports are assessed to be equivalent or preferred by at least one radiologist to reports written by experts alone in 80$\%$ of in-patient cases and 60$\%$ of intensive care cases.

eess.IV↗
arXiv2023

Towards Accurate Differential Diagnosis with Large Language Models

An accurate differential diagnosis (DDx) is a cornerstone of medical care, often reached through an iterative process of interpretation that combines clinical history, physical examination, investigations and procedures. Interactive interfaces powered by Large Language Models (LLMs) present new opportunities to both assist and automate aspects of this process. In this study, we introduce an LLM optimized for diagnostic reasoning, and evaluate its ability to generate a DDx alone or as an aid to clinicians. 20 clinicians evaluated 302 challenging, real-world medical cases sourced from the New England Journal of Medicine (NEJM) case reports. Each case report was read by two clinicians, who were randomized to one of two assistive conditions: either assistance from search engines and standard medical resources, or LLM assistance in addition to these tools. All clinicians provided a baseline, unassisted DDx prior to using the respective assistive tools. Our LLM for DDx exhibited standalone performance that exceeded that of unassisted clinicians (top-10 accuracy 59.1% vs 33.6%, [p = 0.04]). Comparing the two assisted study arms, the DDx quality score was higher for clinicians assisted by our LLM (top-10 accuracy 51.7%) compared to clinicians without its assistance (36.1%) (McNemar's Test: 45.7, p < 0.01) and clinicians with search (44.4%) (4.75, p = 0.03). Further, clinicians assisted by our LLM arrived at more comprehensive differential lists than those without its assistance. Our study suggests that our LLM for DDx has potential to improve clinicians' diagnostic reasoning and accuracy in challenging cases, meriting further real-world evaluation for its ability to empower physicians and widen patients' access to specialist-level expertise.

cs.CY↗
arXiv2023

Random Field Augmentations for Self-Supervised Representation Learning

Self-supervised representation learning is heavily dependent on data augmentations to specify the invariances encoded in representations. Previous work has shown that applying diverse data augmentations is crucial to downstream performance, but augmentation techniques remain under-explored. In this work, we propose a new family of local transformations based on Gaussian random fields to generate image augmentations for self-supervised representation learning. These transformations generalize the well-established affine and color transformations (translation, rotation, color jitter, etc.) and greatly increase the space of augmentations by allowing transformation parameter values to vary from pixel to pixel. The parameters are treated as continuous functions of spatial coordinates, and modeled as independent Gaussian random fields. Empirical results show the effectiveness of the new transformations for self-supervised representation learning. Specifically, we achieve a 1.7% top-1 accuracy improvement over baseline on ImageNet downstream classification, and a 3.6% improvement on out-of-distribution iNaturalist downstream classification. However, due to the flexibility of the new transformations, learned representations are sensitive to hyperparameters. While mild transformations improve representations, we observe that strong transformations can degrade the structure of an image, indicating that balancing the diversity and strength of augmentations is important for improving generalization of learned representations.

cs.CV↗
arXiv2023

Towards Federated Learning Under Resource Constraints via Layer-wise Training and Depth Dropout

Large machine learning models trained on diverse data have recently seen unprecedented success. Federated learning enables training on private data that may otherwise be inaccessible, such as domain-specific datasets decentralized across many clients. However, federated learning can be difficult to scale to large models when clients have limited resources. This challenge often results in a trade-off between model size and access to diverse data. To mitigate this issue and facilitate training of large models on edge devices, we introduce a simple yet effective strategy, Federated Layer-wise Learning, to simultaneously reduce per-client memory, computation, and communication costs. Clients train just a single layer each round, reducing resource costs considerably with minimal performance degradation. We also introduce Federated Depth Dropout, a complementary technique that randomly drops frozen layers during training, to further reduce resource usage. Coupling these two techniques enables us to effectively train significantly larger models on edge devices. Specifically, we reduce training memory usage by 5x or more in federated self-supervised representation learning and demonstrate that performance in downstream tasks is comparable to conventional federated self-supervised learning.

cs.LG↗
arXiv2023

Towards Generalist Biomedical AI

Medicine is inherently multimodal, with rich data modalities spanning text, imaging, genomics, and more. Generalist biomedical artificial intelligence (AI) systems that flexibly encode, integrate, and interpret this data at scale can potentially enable impactful applications ranging from scientific discovery to care delivery. To enable the development of these models, we first curate MultiMedBench, a new multimodal biomedical benchmark. MultiMedBench encompasses 14 diverse tasks such as medical question answering, mammography and dermatology image interpretation, radiology report generation and summarization, and genomic variant calling. We then introduce Med-PaLM Multimodal (Med-PaLM M), our proof of concept for a generalist biomedical AI system. Med-PaLM M is a large multimodal generative model that flexibly encodes and interprets biomedical data including clinical language, imaging, and genomics with the same set of model weights. Med-PaLM M reaches performance competitive with or exceeding the state of the art on all MultiMedBench tasks, often surpassing specialist models by a wide margin. We also report examples of zero-shot generalization to novel medical concepts and tasks, positive transfer learning across tasks, and emergent zero-shot medical reasoning. To further probe the capabilities and limitations of Med-PaLM M, we conduct a radiologist evaluation of model-generated (and human) chest X-ray reports and observe encouraging performance across model scales. In a side-by-side ranking on 246 retrospective chest X-rays, clinicians express a pairwise preference for Med-PaLM M reports over those produced by radiologists in up to 40.50% of cases, suggesting potential clinical utility. While considerable work is needed to validate these models in real-world use cases, our results represent a milestone towards the development of generalist biomedical AI systems.

cs.CL↗
arXiv2023

Federated Variational Inference: Towards Improved Personalization and Generalization

Conventional federated learning algorithms train a single global model by leveraging all participating clients' data. However, due to heterogeneity in client generative distributions and predictive models, these approaches may not appropriately approximate the predictive process, converge to an optimal state, or generalize to new clients. We study personalization and generalization in stateless cross-device federated learning setups assuming heterogeneity in client data distributions and predictive models. We first propose a hierarchical generative model and formalize it using Bayesian Inference. We then approximate this process using Variational Inference to train our model efficiently. We call this algorithm Federated Variational Inference (FedVI). We use PAC-Bayes analysis to provide generalization bounds for FedVI. We evaluate our model on FEMNIST and CIFAR-100 image classification and show that FedVI beats the state-of-the-art on both tasks.

cs.LG↗
arXiv2023

Towards Expert-Level Medical Question Answering with Large Language Models

Recent artificial intelligence (AI) systems have reached milestones in "grand challenges" ranging from Go to protein-folding. The capability to retrieve medical knowledge, reason over it, and answer medical questions comparably to physicians has long been viewed as one such grand challenge. Large language models (LLMs) have catalyzed significant progress in medical question answering; Med-PaLM was the first model to exceed a "passing" score in US Medical Licensing Examination (USMLE) style questions with a score of 67.2% on the MedQA dataset. However, this and other prior work suggested significant room for improvement, especially when models' answers were compared to clinicians' answers. Here we present Med-PaLM 2, which bridges these gaps by leveraging a combination of base LLM improvements (PaLM 2), medical domain finetuning, and prompting strategies including a novel ensemble refinement approach. Med-PaLM 2 scored up to 86.5% on the MedQA dataset, improving upon Med-PaLM by over 19% and setting a new state-of-the-art. We also observed performance approaching or exceeding state-of-the-art across MedMCQA, PubMedQA, and MMLU clinical topics datasets. We performed detailed human evaluations on long-form questions along multiple axes relevant to clinical applications. In pairwise comparative ranking of 1066 consumer medical questions, physicians preferred Med-PaLM 2 answers to those produced by physicians on eight of nine axes pertaining to clinical utility (p < 0.001). We also observed significant improvements compared to Med-PaLM on every evaluation axis (p < 0.001) on newly introduced datasets of 240 long-form "adversarial" questions to probe LLM limitations. While further studies are necessary to validate the efficacy of these models in real-world settings, these results highlight rapid progress towards physician-level performance in medical question answering.

cs.CL↗
arXiv2022

Large Language Models Encode Clinical Knowledge

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.

cs.CL↗