搜索结果：NEJM

Large language models (LLMs) assisted literature retrieval may lead to erroneous references, but these errors have not been rigorously quantified. Therefore, we quantitatively assess errors in reference retrieval of widely used free-version LLM platforms and identify the factors associated with retrieval errors. We evaluated 2,000 references retrieved by 5 LLMs (Grok-2, ChatGPT GPT-4.1, Google Gemini Flash 2.5, Perplexity AI, and DeepSeek GPT-4) for 40 randomly-selected original articles (10 per journal) published Jan. 2024 to July 2025 from British Medical Journal (BMJ), Journal of the American Medical Association, and The New England Journal of Medicine (NEJM). Primary outcomes were a multimetric score ratio combining validity of digital object identifier, PubMed ID, Google-Scholar link, and relevance; and complete miss rate (proportion of references failing all applicable metrics). Multivariable regression was used to examine independent associations. LLM platforms completely failed to retrieve correct reference data 47.8% of the time. The average score ratio of the 5 LLM platforms was 0.29 (standard deviation, 0.35; range, 0-1.25), with a higher score ratio indicating a higher

Artificial intelligence holds great promise for expanding access to expert medical knowledge and reasoning. However, most evaluations of language models rely on static vignettes and multiple-choice questions that fail to reflect the complexity and nuance of evidence-based medicine in real-world settings. In clinical practice, physicians iteratively formulate and revise diagnostic hypotheses, adapting each subsequent question and test to what they've just learned, and weigh the evolving evidence before committing to a final diagnosis. To emulate this iterative process, we introduce the Sequential Diagnosis Benchmark, which transforms 304 diagnostically challenging New England Journal of Medicine clinicopathological conference (NEJM-CPC) cases into stepwise diagnostic encounters. A physician or AI begins with a short case abstract and must iteratively request additional details from a gatekeeper model that reveals findings only when explicitly queried. Performance is assessed not just by diagnostic accuracy but also by the cost of physician visits and tests performed. We also present the MAI Diagnostic Orchestrator (MAI-DxO), a model-agnostic orchestrator that simulates a panel of ph

Differential diagnosis is an iterative process that integrates patient information with broader medical knowledge. Clinical case series such as the NEJM Clinicopathologic Conferences (CPCs), published continuously since 1923, feature expert physicians who demonstrate diagnostic reasoning to peers, and have been used for decades to evaluate AI. However, prior AI evaluations have largely focused on final diagnostic accuracy rather than nuanced clinical reasoning. Here, we introduce Dr. CaBot, an agentic AI system that emulates an expert diagnostician by generating written and narrated slide-based presentations from an initial case description alone. CaBot recently generated the first AI diagnosis published in the 100+ year history of the NEJM CPCs. In blinded evaluations, physicians misclassified the source of the differential (CaBot vs. physician-written) in 46/62 (74%) of trials and rated them favorably across quality dimensions. When tasked with solving cases for 72 patients with undiagnosed disease from the NIH Undiagnosed Diseases Network, CaBot identified the working diagnosis in 50/72 (69%) of cases from referral notes alone. To promote transparency and research, we also devel

The integration of large language models (LLMs) into healthcare holds promise to enhance clinical decision-making, yet their susceptibility to biases remains a critical concern. Gender has long influenced physician behaviors and patient outcomes, raising concerns that LLMs assuming human-like roles, such as clinicians or medical educators, may replicate or amplify gender-related biases. Using case studies from the New England Journal of Medicine Challenge (NEJM), we assigned genders (female, male, or unspecified) to multiple open-source and proprietary LLMs. We evaluated their response consistency across LLM-gender assignments regarding both LLM-based diagnosis and models' judgments on the clinical relevance or necessity of patient gender. In our findings, diagnoses were relatively consistent across LLM genders for most models. However, for patient gender's relevance and necessity in LLM-based diagnosis, all models demonstrated substantial inconsistency across LLM genders, particularly for relevance judgements. Some models even displayed a systematic female-male disparity in their interpretation of patient gender. These findings present an underexplored bias that could undermine th

Serious illness communication (SIC) in end-of-life care faces challenges such as emotional stress, cultural barriers, and balancing hope with honesty. Despite its importance, one of the few available ways for clinicians to practice SIC is with standardized patients, which is expensive, time-consuming, and inflexible. In this paper, we present SOPHIE, an AI-powered standardized patient simulation and automated feedback system. SOPHIE combines large language models (LLMs), a lifelike virtual avatar, and automated, personalized feedback based on clinical literature to provide remote, on-demand SIC training. In a randomized control study with healthcare students and professionals, SOPHIE users demonstrated significant improvement across three critical SIC domains: Empathize, Be Explicit, and Empower. These results suggest that AI-driven tools can enhance complex interpersonal communication skills, offering scalable, accessible solutions to address a critical gap in clinician education.

Excellence in a wide variety of medical applications poses considerable challenges for AI, requiring advanced reasoning, access to up-to-date medical knowledge and understanding of complex multimodal data. Gemini models, with strong general capabilities in multimodal and long-context reasoning, offer exciting possibilities in medicine. Building on these core strengths of Gemini, we introduce Med-Gemini, a family of highly capable multimodal models that are specialized in medicine with the ability to seamlessly use web search, and that can be efficiently tailored to novel modalities using custom encoders. We evaluate Med-Gemini on 14 medical benchmarks, establishing new state-of-the-art (SoTA) performance on 10 of them, and surpass the GPT-4 model family on every benchmark where a direct comparison is viable, often by a wide margin. On the popular MedQA (USMLE) benchmark, our best-performing Med-Gemini model achieves SoTA performance of 91.1% accuracy, using a novel uncertainty-guided search strategy. On 7 multimodal benchmarks including NEJM Image Challenges and MMMU (health & medicine), Med-Gemini improves over GPT-4V by an average relative margin of 44.5%. We demonstrate the

Recent studies indicate that Generative Pre-trained Transformer 4 with Vision (GPT-4V) outperforms human physicians in medical challenge tasks. However, these evaluations primarily focused on the accuracy of multi-choice questions alone. Our study extends the current scope by conducting a comprehensive analysis of GPT-4V's rationales of image comprehension, recall of medical knowledge, and step-by-step multimodal reasoning when solving New England Journal of Medicine (NEJM) Image Challenges - an imaging quiz designed to test the knowledge and diagnostic capabilities of medical professionals. Evaluation results confirmed that GPT-4V performs comparatively to human physicians regarding multi-choice accuracy (81.6% vs. 77.8%). GPT-4V also performs well in cases where physicians incorrectly answer, with over 78% accuracy. However, we discovered that GPT-4V frequently presents flawed rationales in cases where it makes the correct final choices (35.5%), most prominent in image comprehension (27.2%). Regardless of GPT-4V's high accuracy in multi-choice questions, our findings emphasize the necessity for further in-depth evaluations of its rationales before integrating such multimodal AI m

Large language models (LLMs) have shown potential in biomedical applications, leading to efforts to fine-tune them on domain-specific data. However, the effectiveness of this approach remains unclear. This study evaluates the performance of biomedically fine-tuned LLMs against their general-purpose counterparts on a variety of clinical tasks. We evaluated their performance on clinical case challenges from the New England Journal of Medicine (NEJM) and the Journal of the American Medical Association (JAMA) and on several clinical tasks (e.g., information extraction, document summarization, and clinical coding). Using benchmarks specifically chosen to be likely outside the fine-tuning datasets of biomedical models, we found that biomedical LLMs mostly perform inferior to their general-purpose counterparts, especially on tasks not focused on medical knowledge. While larger models showed similar performance on case tasks (e.g., OpenBioLLM-70B: 66.4% vs. Llama-3-70B-Instruct: 65% on JAMA cases), smaller biomedical models showed more pronounced underperformance (e.g., OpenBioLLM-8B: 30% vs. Llama-3-8B-Instruct: 64.3% on NEJM cases). Similar trends were observed across the CLUE (Clinical

Large language models (LLMs) have exhibited remarkable capabilities across various domains and tasks, pushing the boundaries of our knowledge in learning and cognition. The latest model, OpenAI's o1, stands out as the first LLM with an internalized chain-of-thought technique using reinforcement learning strategies. While it has demonstrated surprisingly strong capabilities on various general language tasks, its performance in specialized fields such as medicine remains unknown. To this end, this report provides a comprehensive exploration of o1 on different medical scenarios, examining 3 key aspects: understanding, reasoning, and multilinguality. Specifically, our evaluation encompasses 6 tasks using data from 37 medical datasets, including two newly constructed and more challenging question-answering (QA) tasks based on professional medical quizzes from the New England Journal of Medicine (NEJM) and The Lancet. These datasets offer greater clinical relevance compared to standard medical QA benchmarks such as MedQA, translating more effectively into real-world clinical utility. Our analysis of o1 suggests that the enhanced reasoning ability of LLMs may (significantly) benefit their

While recent advancements in commercial large language models (LM) have shown promising results in medical tasks, their closed-source nature poses significant privacy and security concerns, hindering their widespread use in the medical field. Despite efforts to create open-source models, their limited parameters often result in insufficient multi-step reasoning capabilities required for solving complex medical problems. To address this, we introduce Meerkat, a new family of medical AI systems ranging from 7 to 70 billion parameters. The models were trained using our new synthetic dataset consisting of high-quality chain-of-thought reasoning paths sourced from 18 medical textbooks, along with diverse instruction-following datasets. Our systems achieved remarkable accuracy across six medical benchmarks, surpassing the previous best models such as MediTron and BioMistral, and GPT-3.5 by a large margin. Notably, Meerkat-7B surpassed the passing threshold of the United States Medical Licensing Examination (USMLE) for the first time for a 7B-parameter model, while Meerkat-70B outperformed GPT-4 by an average of 1.3%. Additionally, Meerkat-70B correctly diagnosed 21 out of 38 complex clin

Cardiovascular diseases (CVDs) are the leading cause of global mortality, necessitating accessible and accurate diagnostic tools. While cardiac magnetic resonance imaging (CMR) provides gold-standard insights into cardiac structure and function, its clinical utility is limited by high cost and complexity. In contrast, electrocardiography (ECG) is inexpensive and widely available but lacks the granularity of CMR. We propose CardioNets, a deep learning framework that translates 12-lead ECG signals into CMR-level functional parameters and synthetic images, enabling scalable cardiac assessment. CardioNets integrates cross-modal contrastive learning and generative pretraining, aligning ECG with CMR-derived cardiac phenotypes and synthesizing high-resolution CMR images via a masked autoregressive model. Trained on 159,819 samples from five cohorts, including the UK Biobank (n=42,483) and MIMIC-IV-ECG (n=164,550), and externally validated on independent clinical datasets (n=3,767), CardioNets achieved strong performance across disease screening and phenotype estimation tasks. In the UK Biobank, it improved cardiac phenotype regression R2 by 24.8% and cardiomyopathy AUC by up to 39.3% over

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

We present VisionFM, a foundation model pre-trained with 3.4 million ophthalmic images from 560,457 individuals, covering a broad range of ophthalmic diseases, modalities, imaging devices, and demography. After pre-training, VisionFM provides a foundation to foster multiple ophthalmic artificial intelligence (AI) applications, such as disease screening and diagnosis, disease prognosis, subclassification of disease phenotype, and systemic biomarker and disease prediction, with each application enhanced with expert-level intelligence and accuracy. The generalist intelligence of VisionFM outperformed ophthalmologists with basic and intermediate levels in jointly diagnosing 12 common ophthalmic diseases. Evaluated on a new large-scale ophthalmic disease diagnosis benchmark database, as well as a new large-scale segmentation and detection benchmark database, VisionFM outperformed strong baseline deep neural networks. The ophthalmic image representations learned by VisionFM exhibited noteworthy explainability, and demonstrated strong generalizability to new ophthalmic modalities, disease spectrum, and imaging devices. As a foundation model, VisionFM has a large capacity to learn from div

Randomised controlled trials aim to assess the impact of one (or more) health interventions relative to other standard interventions. RCTs sometimes use an ordinal outcome, which is an endpoint that comprises of multiple, monotonically ordered categories that are not necessarily separated by a quantifiable distance. Ordinal outcomes are appealing in clinical settings as disease states can represent meaningful categories that may be of clinical importance. They can also retain information and increase statistical power compared to dichotomised outcomes. Target parameters for ordinal outcomes in RCTs may vary depending on the nature of the research question, the modelling assumptions, and the expertise of the data analyst. The aim of this scoping review is to systematically describe the use of ordinal outcomes in contemporary RCTs. Specifically, we aim to (i) identify which target parameters are of interest in trials that use an ordinal outcome; (ii) describe how ordinal outcomes are analysed in RCTs to estimate a treatment effect; and (iii) describe whether RCTs that use an ordinal outcome adequately report key methodological aspects specific to the analysis of the outcome. Results

In intensive care units (ICUs), critically ill patients are monitored with electroencephalograms (EEGs) to prevent serious brain injury. The number of patients who can be monitored is constrained by the availability of trained physicians to read EEGs, and EEG interpretation can be subjective and prone to inter-observer variability. Automated deep learning systems for EEG could reduce human bias and accelerate the diagnostic process. However, black box deep learning models are untrustworthy, difficult to troubleshoot, and lack accountability in real-world applications, leading to a lack of trust and adoption by clinicians. To address these challenges, we propose a novel interpretable deep learning model that not only predicts the presence of harmful brainwave patterns but also provides high-quality case-based explanations of its decisions. Our model performs better than the corresponding black box model, despite being constrained to be interpretable. The learned 2D embedded space provides the first global overview of the structure of ictal-interictal-injury continuum brainwave patterns. The ability to understand how our model arrived at its decisions will not only help clinicians to

Publication statistics are ubiquitous in the ratings of scientific achievement, with citation counts and paper tallies factoring into an individual's consideration for postdoctoral positions, junior faculty, tenure, and even visa status for international scientists. Citation statistics are designed to quantify individual career achievement, both at the level of a single publication, and over an individual's entire career. While some academic careers are defined by a few significant papers (possibly out of many), other academic careers are defined by the cumulative contribution made by the author's publications to the body of science. Several metrics have been formulated to quantify an individual's publication career, yet none of these metrics account for the dependence of citation counts and journal size on time. In this paper, we normalize publication metrics across both time and discipline in order to achieve a universal framework for analyzing and comparing scientific achievement. We study the publication careers of individual authors over the 50-year period 1958-2008 within six high-impact journals: CELL, the New England Journal of Medicine (NEJM), Nature, the Proceedings of th

Two newly confirmed "super-puff" planets are so diffuse that they are less dense than cotton candy, despite being about the size of Jupiter。 Their rare orbital relationship and enormous, lightweight atmospheres could provide valuable clues about how some of the strangest planets in the galaxy come to exist

A strange "chirping" signal from a distant supernova has revealed the birth of a magnetar, confirming that these incredibly magnetic neutron stars can power the universe's brightest stellar explosions。 The discovery also marks the first time Einstein's general relativity has been used to explain the mechanics of a supernova

A rare meteorite has revealed evidence of a massive lost world that once orbited the young Sun before being destroyed in a catastrophic collision。 The discovery suggests some early planets formed from dramatically different materials than Earth and Mars, rewriting part of the solar system’s origin story