Large language models (LLMs) have demonstrated impressive capabilities, but the bar for clinical applications is high. Attempts to assess the clinical knowledge of models typically rely on automated evaluations based on limited benchmarks. Here, to address these limitations, we present MultiMedQA, a benchmark combining six existing medical question answering datasets spanning professional medicine, research and consumer queries and a new dataset of medical questions searched online, HealthSearchQA. We propose a human evaluation framework for model answers along multiple axes including factuality, comprehension, reasoning, possible harm and bias. In addition, we evaluate Pathways Language Model1 (PaLM, a 540-billion parameter LLM) and its instruction-tuned variant, Flan-PaLM2 on MultiMedQA. Using a combination of prompting strategies, Flan-PaLM achieves state-of-the-art accuracy on every MultiMedQA multiple-choice dataset (MedQA3, MedMCQA4, PubMedQA5 and Measuring Massive Multitask Language Understanding (MMLU) clinical topics6), including 67.6% accuracy on MedQA (US Medical Licensing Exam-style questions), surpassing the prior state of the art by more than 17%. However, human evaluation reveals key gaps. 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, knowledge recall and reasoning improve with model scale and instruction prompt tuning, suggesting the potential utility of LLMs in medicine. Our human evaluations reveal limitations of today’s models, reinforcing the importance of both evaluation frameworks and method development in creating safe, helpful LLMs for clinical applications.

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We propose a novel prompting strategy, least-to-most prompting, that enables large language models to better perform multi-step reasoning tasks. Least-to-most prompting first reduces a complex problem into a list of subproblems, and then sequentially solves the subproblems, whereby solving a given subproblem is facilitated by the model's answers to previously solved subproblems. Experiments on symbolic manipulation, compositional generalization and numerical reasoning demonstrate that least-to-most prompting can generalize to examples that are harder than those seen in the prompt context, outperforming other promptingbased approaches by a large margin. A notable empirical result is that the GPT-3 code-davinci-002 model with least-to-most-prompting can solve the SCAN benchmark with an accuracy of 99.7% using 14 examples. As a comparison, the neural-symbolic models in the literature specialized for solving SCAN are trained with the full training set of more than 15,000 examples.

A model that combines HRV and laboratory values may help ED physicians evaluate risk of deterioration in patients with sepsis and merits validation and further evaluation.