Showing 1–41 of 41 results for author: Schmidgall, S

Towards Expert-level Medical AI for Real-time Video Consultations

Authors: Mahvish Nagda, Jihyeon Lee, Matthew Thompson, Chunjong Park, Tim Strother, Valentin Liévin, Roma Ruparel, Akshay Goel, Teya Bergamaschi, Suhana Bedi, Meet Shah, Pavel Dubov, Liviu Panait, Toshiyuki Fukuzawa, Sam Schmidgall, Craig Schiff, Joseph Xu, Aliya Rysbek, Yana Lunts, Jan Freyberg, Rebecca Hemengway, Sunny Virmani, David Racz, Carey Radebaugh, Joëlle Barral , et al. (15 additional authors not shown)

Abstract: Audio-visual interaction is the standard for patient-physician consultations, enabling natural communication and effective assessment of illness through non-verbal cues. While text-based AI has shown promise, it discards essential perceptual dimensions and limits patients who cannot articulate symptoms in writing. Early efforts to extend medical AI to audio-visual interaction have demonstrated fea… ▽ More Audio-visual interaction is the standard for patient-physician consultations, enabling natural communication and effective assessment of illness through non-verbal cues. While text-based AI has shown promise, it discards essential perceptual dimensions and limits patients who cannot articulate symptoms in writing. Early efforts to extend medical AI to audio-visual interaction have demonstrated feasibility but not reached clinician-level performance. Here, we provide the first demonstration of expert-level AI in real-time clinical video consultations using AMIE (Articulate Medical Intelligence Explorer) in a video configuration. AMIE (Video) is a Gemini-based multi-agent system integrating low-latency dialogue, clinical reasoning, and real-time audio-visual perception. To guide development, we established a taxonomy and automated evaluations for clinical audio-visual cues in telehealth settings. In a randomized Objective Structured Clinical Examination (OSCE) study with 30 primary care physicians (PCPs), 15 patient actors and 100 clinical scenarios, we compared AMIE (Video), its text-only counterpart AMIE (Text), and PCPs consulting via video. Clinical evaluators rated AMIE (Video) on par or better than PCPs in history-taking, diagnosis, management, and physical observation and examination. Patient actors preferred AMIE's approach to assessing and explaining conditions, while PCPs were preferred for rapport and partnership building. In modality ablation, patient actors preferred AMIE (Video)'s interface over text chat for communicative effectiveness, convenience, and feeling understood. Limitations remain in fine anatomical precision, subtle affective nuances, and high-frequency movements. While further research is needed before real-world translation, these results mark an important milestone toward AI systems capable of augmenting care across the sensory complexity of clinical practice. △ Less

Submitted 10 August, 2026; originally announced August 2026.

ResidencyRL: Reinforcement Learning in Simulated Clinical Environments

Authors: Valentin Liévin, Samuel Schmidgall, Tim Strother, Alex Bijamov, Akshay Goel, Anil Palepu, Chunjong Park, Vahid Balazadeh, Min Woo Sun, Marius Guerard, Justin Chen, Dave Steiner, Vikram Dhillon, Ibrahim Azar, Akhil Mehta, Nicholas Spetsieris, Shilpan Shah, Maen Abdelrahim, Amit Dahiya, Yun Liu, Katherine Chou, Yossi Matias, Avinatan Hassidim, Dale R. Webster, Quoc V. Le , et al. (10 additional authors not shown)

Abstract: In medical education, physicians convert academic knowledge into clinical expertise through residency: years of training across thousands of encounters, with diverse sources of feedback and progressively greater autonomy. Much of clinical reasoning relies on the patient encounter, a dialogue in which a clinician elicits history, refines diagnostic hypotheses, and decides management under uncertain… ▽ More In medical education, physicians convert academic knowledge into clinical expertise through residency: years of training across thousands of encounters, with diverse sources of feedback and progressively greater autonomy. Much of clinical reasoning relies on the patient encounter, a dialogue in which a clinician elicits history, refines diagnostic hypotheses, and decides management under uncertainty. While large language models (LLMs) excel on static medical benchmarks, methods to optimize the full sequence of clinical decisions remain underdeveloped. We present ResidencyRL, a reinforcement learning (RL) method for training clinical artificial intelligence (AI) agents through simulated multi-turn clinical encounters (up to 60 dialogue turns and 8 tool calls per trajectory). ResidencyRL pairs the policy agent with LLM simulators capable of complex, adversarial behaviors, training against a structured reward aligned to diagnostic accuracy, management quality, communication, documentation, and safety. On held-out evaluations, the ResidencyRL agent improves diagnostic accuracy by 7.0% under adversarial conditions (88.0% vs. 81.0%) and reduces missed red flag rates by 31%, demonstrating rigorous mitigation of premature closure. Blinded expert clinicians validated these gains, preferring the trained agent in 87.6% of side-by-side comparisons. The procedural competencies transfer to unseen benchmarks: the agent outperforms the base model across all six clinical axes of the AMIE multi-visit benchmark, and shows consistent directional improvements on AgentClinic and CRAFT-MD. Our findings demonstrate that sequential clinical decision-making can be effectively learned through multi-turn RL in simulation, yielding robust, generalizable capabilities, paving the way towards clinical mastery. Prospective validation with real-world workflows remains necessary to establish clinical utility. △ Less

Submitted 7 August, 2026; originally announced August 2026.

MatrAIx: Simulating the World with 8.3 Billion Persona Agents

Authors: Xiaomin Li, Yuexing Hao, Jianheng Hou, Jintao Huang, Qianfeng Wen, Shirley Huang, Yifan Liu, Xiaoyi Liu, Yilan Fan, Yijun Wang, Koutian Wu, Ruoqi Gao, Muhammad Ahmed Mohsin, Jing Tang, Brihi Joshi, Heming Liu, Zheyuan Deng, Zonglin Di, Sankalp Jajee, Jiuyao Lu, Zhiwei Zhang, Saksham Kapoor, Ishan Gupta, Yunhan Zhao, Chanwoo Park , et al. (68 additional authors not shown)

Abstract: Human evaluation of AI systems and digital products is costly, slow, and difficult to scale. Offline evaluations are more scalable but often abstract away human diversity and interactive behavior. We therefore introduce MatrAIx, a population-scale simulated-user evaluation infrastructure for testing AI systems and digital products with heterogeneous users. MatrAIx has three core components: First,… ▽ More Human evaluation of AI systems and digital products is costly, slow, and difficult to scale. Offline evaluations are more scalable but often abstract away human diversity and interactive behavior. We therefore introduce MatrAIx, a population-scale simulated-user evaluation infrastructure for testing AI systems and digital products with heterogeneous users. MatrAIx has three core components: First, Persona 8B contains 8.3 billion persona records represented by 1,290 categorical dimensions. Records are either sampled from a dependency graph that preserves correlated attributes or derived from human-authored profiles. We release a quality-filtered coreset of approximately 1 million personas, comprising 599,847 human-grounded and 400,000 synthetic records. Second, the MatrAIx Playground provides four environments in which diverse users evaluate and interact with digital products: Survey, AI Chatbot, Web, and App. Third, MatrAIx provides 1,010 application tasks spanning more than 25 domains, including Commerce, Software, Finance, and Healthcare. We conducted 18,189 evaluation trials across eight representative tasks. Persona agents were powered by three LLMs: Claude Opus 4.8, GPT 5.5, and Claude Haiku 4.5. The resulting feedback captures how decisions and preferences vary across persona backgrounds, including hesitation after a price increase, willingness to continue after an AI assistant fails, and latency tolerance. We conducted two main validation studies: First, a 400-trial controlled study evaluated persona adherence across ten behavioral attributes and all four environments. The declared behavior was expressed or correctly suppressed in 366 trials (91.5%). Second, human and LLM judges evaluated the extraction quality of human-grounded personas. Overall, MatrAIx provides an end-to-end infrastructure for evaluating AI systems and digital products with diverse simulated human users. △ Less

Submitted 4 August, 2026; originally announced August 2026.

Comments: Project website: https://matraix.ai

Gemma 4 Technical Report

Authors: Gemma Team, Sherif El Abd, Vaibhav Aggarwal, Robin Algayres, Alek Andreev, Olivier Bachem, Ian Ballantyne, Cormac Brick, Victor Cărbune, Michelle Casbon, Mayank Chaturvedi, Aditya Chawla, Victor Cotruta, Alice Coucke, Phil Culliton, Robert Dadashi, Lucas Dixon, Mohamed Elhawaty, Utku Evci, Clément Farabet, Johan Ferret, Filippo Galgani, Sertan Girgin, Jean-Bastien Grill, Maarten Grootendorst , et al. (298 additional authors not shown)

Abstract: We introduce Gemma 4, a new generation of open-weight, natively multimodal language models in the Gemma model family. Designed to advance compute efficiency and reasoning, the Gemma 4 model suite features dense and Mixture-of-Experts architectures, ranging from 2.3B to 31B parameters. Alongside improved vision and audio encoders for all model sizes, we propose a unified, encoder-free architecture… ▽ More We introduce Gemma 4, a new generation of open-weight, natively multimodal language models in the Gemma model family. Designed to advance compute efficiency and reasoning, the Gemma 4 model suite features dense and Mixture-of-Experts architectures, ranging from 2.3B to 31B parameters. Alongside improved vision and audio encoders for all model sizes, we propose a unified, encoder-free architecture for our 12B model, which ingests raw audio and image patches. Furthermore, we integrate a thinking mode, enabling Gemma models to generate reasoning traces prior to responding. We improve inference speed, memory, and compute efficiency, as well as long-context abilities through critical design choices. Gemma 4 establishes a leap in performance across STEM, multimodal, and long-context benchmarks, and rivals larger, frontier open models in human-rated tasks. △ Less

Submitted 24 July, 2026; v1 submitted 2 July, 2026; originally announced July 2026.

Comments: 17 pages, 2 figures, technical report, updated

Patients With Personality: Realistic Patient Simulation through Controlled Diversity and Selective Disclosure

Authors: Moritz Schlager, Friederike Jungmann, Samuel Schmidgall, Philipp Raffler, Franziska Hartl, Eva Wende, Paula Roßmüller, Conrad Ketzer, Avinatan Hassidim, Dale R. Webster, Yossi Matias, Yun Liu, Daniel Rueckert, Mike Schaekermann, Paul Hager

Abstract: Simulating realistic patient interactions is a key requirement to testing clinical applications of LLMs at scale without time-consuming and expensive user studies. However, existing approaches often lack realism and controllability, often oversharing information unprompted, and failing to capture the wide variability of patient behavior. Here, we introduce PatientsWithPersonality (PWP), a patient… ▽ More Simulating realistic patient interactions is a key requirement to testing clinical applications of LLMs at scale without time-consuming and expensive user studies. However, existing approaches often lack realism and controllability, often oversharing information unprompted, and failing to capture the wide variability of patient behavior. Here, we introduce PatientsWithPersonality (PWP), a patient simulation framework that generates realistic yet diverse virtual patient responses through explicit personality parametrization over a latent patient state. Grounded in HEXACO, a six-dimensional personality space used to quantify and parameterize human behavioral traits, our approach enables fine-grained control over conversational style, cooperativeness, and information disclosure within a unified framework. In a clinician evaluation, PWP is judged nearly as realistic as recorded human actors and clearly ahead of prior simulators, while being flagged as "too informative" far less often. Conditioning on HEXACO axes yields personas whose configured traits are recoverable by both clinicians and an autorater, span a substantially wider behavioral footprint than the closest baseline, and prevent oversharing. Altogether, our framework paves the way for more accurate and informative LLM benchmarking through our realistic and steerable patient simulator. △ Less

Submitted 11 August, 2026; v1 submitted 13 May, 2026; originally announced June 2026.

Comments: 22 pages, 11 figures

TeamBench: Evaluating Agent Coordination under Enforced Role Separation

Authors: Yubin Kim, Chanwoo Park, Taehan Kim, Eugene Park, Samuel Schmidgall, Salman Rahman, Chunjong Park, Cynthia Breazeal, Xin Liu, Hamid Palangi, Hae Won Park, Daniel McDuff

Abstract: Agent systems often decompose a task across multiple roles, but these roles are typically specified by prompts rather than enforced by access controls. Without enforcement, a team pass rate can mask whether agents actually coordinated or whether one role effectively did another role's work. We present TeamBench, a benchmark with 851 task templates and 931 seeded instances for evaluating agent coor… ▽ More Agent systems often decompose a task across multiple roles, but these roles are typically specified by prompts rather than enforced by access controls. Without enforcement, a team pass rate can mask whether agents actually coordinated or whether one role effectively did another role's work. We present TeamBench, a benchmark with 851 task templates and 931 seeded instances for evaluating agent coordination under operating system-enforced role separation. TeamBench separates specification access, workspace editing, and final certification across Planner, Executor, and Verifier roles, so that no role can read the full requirements, modify the workspace, and certify the final answer. Prompt-only and sandbox-enforced teams reach statistically indistinguishable pass rates, but prompt-only runs produce 3.6 times more cases where the verifier attempts to edit the executor's code. Verifiers approve 49% of submissions that fail the deterministic grader, and removing the verifier improves mean partial score in the ablation. Team value is also conditional. Teams benefit when single agents struggle, but hurt when single agents already perform well. A 40-session human study under the same role separation shows that our benchmark exposes interaction patterns that pass rate misses. Solo participants work through the task directly, human participants paired with agents often collapse into quick approval, and human teams spend more effort coordinating missing information across roles. △ Less

Submitted 7 May, 2026; originally announced May 2026.

SymptomAI: Toward a Conversational AI Agent for Everyday Symptom Assessment

Authors: Joseph Breda, Fadi Yousif, Beszel Hawkins, Marinela Cotoi, Miao Liu, Ray Luo, Po-Hsuan Cameron Chen, Mike Schaekermann, Samuel Schmidgall, Xin Liu, Girish Narayanswamy, Samuel Solomon, Maxwell A. Xu, Xiaoran Fan, Longfei Shangguan, Anran Wang, Bhavna Daryani, Buddy Herkenham, Cara Tan, Mark Malhotra, Shwetak Patel, John B. Hernandez, Quang Duong, Yun Liu, Zach Wasson , et al. (8 additional authors not shown)

Abstract: Language models excel at diagnostic assessments on curated medical case-studies and vignettes, performing on par with, or better than, clinical professionals. However, existing studies focus on complex scenarios with rich context making it difficult to draw conclusions about how these systems perform for patients reporting symptoms in everyday life. We deployed SymptomAI, a set of conversational A… ▽ More Language models excel at diagnostic assessments on curated medical case-studies and vignettes, performing on par with, or better than, clinical professionals. However, existing studies focus on complex scenarios with rich context making it difficult to draw conclusions about how these systems perform for patients reporting symptoms in everyday life. We deployed SymptomAI, a set of conversational AI agents for end-to-end patient interviewing and differential diagnosis (DDx), via the Fitbit app in a study that randomized participants (N=13,917) to interact with five AI agents. This corpus captures diverse communication and a realistic distribution of illnesses from a real world population. A subset of 1,228 participants reported a clinician-provided diagnosis, and 517 of these were further evaluated by a panel of clinicians during over 250 hours of annotation. SymptomAI DDx were significantly more accurate (OR = 2.56, p < 0.001) than those from independent clinicians given the same dialogue in a blinded randomized comparison. Moreover, agentic strategies which conduct a dedicated symptom interview that elicit additional symptom information before providing a diagnosis, perform substantially better than baseline, user-guided conversations (p < 0.001). An auxiliary analysis on 1,509 conversations from a general US population panel validated that these results generalize beyond wearable device users. We used SymptomAI diagnoses as labels for all 13,917 participants to analyze over 500,000 days of wearable metrics across nearly 400 unique conditions. We identified strong associations between acute infections and physiological shifts (e.g., OR > 7 for influenza). While limited by self-reported ground truth, these results demonstrate the benefits of a dedicated and complete symptom interview compared to a user-guided symptom discussion, which is the default of most consumer LLMs. △ Less

Submitted 10 May, 2026; v1 submitted 5 May, 2026; originally announced May 2026.

Comments: 13 page main text, 54 pages total. 16 figures total

An AI Co-Data-Scientist for Prioritizing Candidate Biomarkers from Wearable Sensor Data

Authors: Yubin Kim, Salman Rahman, Samuel Schmidgall, Chunjong Park, A. Ali Heydari, Ahmed A. Metwally, Hong Yu, Xin Liu, Xuhai Xu, Yuzhe Yang, Hyeonhoon Lee, Hyewon Jeong, Kyungho Lim, MingYu Lu, Dongjae Lee, Theodora Pappa, Hanseul Cho, Maxwell A. Xu, Zhihan Zhang, Cynthia Breazeal, Tim Althoff, Petar Sirkovic, Ivor Rendulic, Annalisa Pawlosky, Nicolas Stroppa , et al. (11 additional authors not shown)

Abstract: Wearable devices generate continuous physiological and behavioral data, but converting these signals into clinically reviewable biomarker hypotheses remains labor-intensive. We introduce CoDaS, an AI co-data-scientist that integrates multi-agent hypothesis generation, deterministic statistical analysis, adversarial validation and literature-grounded interpretation under human oversight. Across thr… ▽ More Wearable devices generate continuous physiological and behavioral data, but converting these signals into clinically reviewable biomarker hypotheses remains labor-intensive. We introduce CoDaS, an AI co-data-scientist that integrates multi-agent hypothesis generation, deterministic statistical analysis, adversarial validation and literature-grounded interpretation under human oversight. Across three wearable cohorts comprising 9,279 participant-observations, CoDaS prioritized candidate associations for mental-health and metabolic endpoints after internal checks for replication, stability, robustness and leakage. The system identified related circadian-instability signals associated with depression, including sleep-duration variability in DWB ($ρ$ = 0.252, $p$ < 0.001) and sleep-onset variability in GLOBEM ($ρ$ = 0.126, $p$ < 0.001), and derived a wearable cardiovascular-fitness index associated with insulin resistance (steps/resting heart rate; $ρ$ = -0.374, $p$ < 0.001). Adding these features to demographic models produced modest gains ($ΔR^2$ = 0.040 for depression, 0.021 for insulin resistance). In a 12-clinician review totaling approximately 25 active hours, clinician validity judgments aligned with CoDaS confidence tiers ($ρ$ = 0.67, $p$ = 0.005), whereas added clinical value and confidence to act were rated lower. CoDaS supports traceable, hypothesis-generating prioritization of wearable candidate biomarkers. △ Less

Submitted 19 June, 2026; v1 submitted 16 April, 2026; originally announced April 2026.

MedGemma 1.5 Technical Report

Authors: Andrew Sellergren, Chufan Gao, Fereshteh Mahvar, Timo Kohlberger, Fayaz Jamil, Madeleine Traverse, Alberto Tono, Bashir Sadjad, Lin Yang, Charles Lau, Liron Yatziv, Tiffany Chen, Bram Sterling, Kenneth Philbrick, Richa Tiwari, Yun Liu, Madhuram Jajoo, Chandrashekar Sankarapu, Swapnil Vispute, Harshad Purandare, Abhishek Bijay Mishra, Sam Schmidgall, Tao Tu, Anil Palepu, Chunjong Park , et al. (17 additional authors not shown)

Abstract: We introduce MedGemma 1.5 4B, the latest model in the MedGemma collection. MedGemma 1.5 expands on MedGemma 1 by integrating additional capabilities: high-dimensional medical imaging (CT/MRI volumes and histopathology whole slide images), anatomical localization via bounding boxes, multi-timepoint chest X-ray analysis, and improved medical document understanding (lab reports, electronic health rec… ▽ More We introduce MedGemma 1.5 4B, the latest model in the MedGemma collection. MedGemma 1.5 expands on MedGemma 1 by integrating additional capabilities: high-dimensional medical imaging (CT/MRI volumes and histopathology whole slide images), anatomical localization via bounding boxes, multi-timepoint chest X-ray analysis, and improved medical document understanding (lab reports, electronic health records). We detail the innovations required to enable these modalities within a single architecture, including new training data, long-context 3D volume slicing, and whole-slide pathology sampling. Compared to MedGemma 1 4B, MedGemma 1.5 4B demonstrates significant gains in these new areas, improving 3D MRI condition classification accuracy by 11% and 3D CT condition classification by 3% (absolute improvements). In whole slide pathology imaging, MedGemma 1.5 4B achieves a 47% macro F1 gain. Additionally, it improves anatomical localization with a 35% increase in Intersection over Union on chest X-rays and achieves a 4% macro accuracy for longitudinal (multi-timepoint) chest x-ray analysis. Beyond its improved multimodal performance over MedGemma 1, MedGemma 1.5 improves on text-based clinical knowledge and reasoning, improving by 5% on MedQA accuracy and 22% on EHRQA accuracy. It also achieves an average of 18% macro F1 on 4 different lab report information extraction datasets (EHR Datasets 2, 3, 4, and Mendeley Clinical Laboratory Test Reports). Taken together, MedGemma 1.5 serves as a robust, open resource for the community, designed as an improved foundation on which developers can create the next generation of medical AI systems. Resources and tutorials for building upon MedGemma 1.5 can be found at https://goo.gle/medgemma. △ Less

Submitted 1 May, 2026; v1 submitted 6 April, 2026; originally announced April 2026.

Proof of Time: A Benchmark for Evaluating Scientific Idea Judgments

Authors: Bingyang Ye, Shan Chen, Jingxuan Tu, Chen Liu, Zidi Xiong, Samuel Schmidgall, Danielle S. Bitterman

Abstract: Large language models are increasingly being used to assess and forecast research ideas, yet we lack scalable ways to evaluate the quality of models' judgments about these scientific ideas. Towards this goal, we introduce PoT, a semi-verifiable benchmarking framework that links scientific idea judgments to downstream signals that become observable later (e.g., citations and shifts in researchers'… ▽ More Large language models are increasingly being used to assess and forecast research ideas, yet we lack scalable ways to evaluate the quality of models' judgments about these scientific ideas. Towards this goal, we introduce PoT, a semi-verifiable benchmarking framework that links scientific idea judgments to downstream signals that become observable later (e.g., citations and shifts in researchers' agendas). PoT freezes a pre-cutoff snapshot of evidence in an offline sandbox and asks models to forecast post-cutoff outcomes, enabling verifiable evaluation when ground truth arrives, scalable benchmarking without exhaustive expert annotation, and analysis of human-model misalignment against signals such as peer-review awards. In addition, PoT provides a controlled testbed for agent-based research judgments that evaluate scientific ideas, comparing tool-using agents to non-agent baselines under prompt ablations and budget scaling. Across 30,000+ instances spanning four benchmark domains, we find that, compared with non-agent baselines, higher interaction budgets generally improve agent performance, while the benefit of tool use is strongly task-dependent. By combining time-partitioned, future-verifiable targets with an offline sandbox for tool use, PoT supports scalable evaluation of agents on future-facing scientific idea judgment tasks. △ Less

Submitted 12 January, 2026; originally announced January 2026.

Comments: under review

Towards a Science of Scaling Agent Systems

Authors: Yubin Kim, Ken Gu, Chanwoo Park, Chunjong Park, Samuel Schmidgall, A. Ali Heydari, Yao Yan, Zhihan Zhang, Yuchen Zhuang, Yun Liu, Mark Malhotra, Paul Pu Liang, Hae Won Park, Yuzhe Yang, Xuhai Xu, Yilun Du, Shwetak Patel, Tim Althoff, Daniel McDuff, Xin Liu

Abstract: Agents, language model-based systems capable of reasoning, planning, and acting are widely adopted in real-world tasks, yet how their performance changes as these systems scale across key dimensions remains underexplored. We introduce quantitative scaling principles for agent systems as a predictive model, capturing how performance varies with coordination, model capability, and measurable system… ▽ More Agents, language model-based systems capable of reasoning, planning, and acting are widely adopted in real-world tasks, yet how their performance changes as these systems scale across key dimensions remains underexplored. We introduce quantitative scaling principles for agent systems as a predictive model, capturing how performance varies with coordination, model capability, and measurable system and task factors. Across 260 configurations spanning six agentic benchmarks, five canonical architectures (Single-Agent and four Multi-Agent: Independent, Centralized, Decentralized, Hybrid), and three LLM families, we perform controlled evaluations, standardizing tools, prompts, and compute to isolate architectural effects. The resulting model achieves a cross-validated R^2=0.373 across all six benchmarks (R^2=0.413 with a task-grounded capability metric). We identify a robust capability-saturation effect and additional patterns: (1) a coordination yields diminishing returns once single-agent baselines exceed certain performance; (2) tool-heavy tasks appear to incur multi-agent overhead; and (3) architectures without centralized verification tend to propagate errors more than those with centralized coordination. Relative performance change compared to single-agent baseline ranges from +80.8% on decomposable financial reasoning to -70.0% on sequential planning, demonstrating that architecture-task alignment determines collaborative success. The framework identifies the best-performing architecture for 87% of held-out configurations and shows consistent relative architecture preferences on unseen frontier models. Agent effectiveness depends on alignment between coordination and task structure, and that mismatched coordination degrades the performance. △ Less

Submitted 8 April, 2026; v1 submitted 9 December, 2025; originally announced December 2025.

Current validation practice undermines surgical AI development

Authors: Annika Reinke, Ziying O. Li, Minu D. Tizabi, Pascaline André, Marcel Knopp, Mika M. Rother, Ines P. Machado, Maria S. Altieri, Deepak Alapatt, Sophia Bano, Sebastian Bodenstedt, Oliver Burgert, Elvis C. S. Chen, Justin W. Collins, Olivier Colliot, Evangelia Christodoulou, Tobias Czempiel, Adrito Das, Reuben Docea, Daniel Donoho, Qi Dou, Jennifer Eckhoff, Sandy Engelhardt, Gabor Fichtinger, Philipp Fuernstahl , et al. (75 additional authors not shown)

Abstract: Surgical data science (SDS) is rapidly advancing, yet clinical adoption of artificial intelligence (AI) in surgery remains limited, with inadequate validation as an important contributing factor. Existing validation practices often neglect the temporal and hierarchical structure of intraoperative videos, yielding misleading or clinically irrelevant results. We introduce a comprehensive catalogue o… ▽ More Surgical data science (SDS) is rapidly advancing, yet clinical adoption of artificial intelligence (AI) in surgery remains limited, with inadequate validation as an important contributing factor. Existing validation practices often neglect the temporal and hierarchical structure of intraoperative videos, yielding misleading or clinically irrelevant results. We introduce a comprehensive catalogue of validation pitfalls in AI-based surgical video analysis, derived from a multi-stage Delphi process with 92 international experts. Pitfalls span three categories: (1) data, (2) metric selection/configuration, and (3) aggregation and reporting. A systematic review of surgical AI papers reveals that these pitfalls are widespread. Experiments on surgical video datasets show that ignoring temporal and hierarchical data structures can understate uncertainty, obscure critical failure modes, and alter algorithm rankings. To address these shortcomings, we provide consensus-based best practices compiled. Together, this work provides an evidence-based framework for rigorous validation of surgical video analysis algorithms, guiding benchmarking, reporting, regulatory review, and clinical translation. △ Less

Submitted 31 July, 2026; v1 submitted 5 November, 2025; originally announced November 2025.

Comments: Under review in Nature BME

MedGemma Technical Report

Authors: Andrew Sellergren, Sahar Kazemzadeh, Tiam Jaroensri, Atilla Kiraly, Madeleine Traverse, Timo Kohlberger, Shawn Xu, Fayaz Jamil, Cían Hughes, Charles Lau, Justin Chen, Fereshteh Mahvar, Liron Yatziv, Tiffany Chen, Bram Sterling, Stefanie Anna Baby, Susanna Maria Baby, Jeremy Lai, Samuel Schmidgall, Lu Yang, Kejia Chen, Per Bjornsson, Shashir Reddy, Ryan Brush, Kenneth Philbrick , et al. (56 additional authors not shown)

Abstract: Artificial intelligence (AI) has significant potential in healthcare applications, but its training and deployment faces challenges due to healthcare's diverse data, complex tasks, and the need to preserve privacy. Foundation models that perform well on medical tasks and require less task-specific tuning data are critical to accelerate the development of healthcare AI applications. We introduce Me… ▽ More Artificial intelligence (AI) has significant potential in healthcare applications, but its training and deployment faces challenges due to healthcare's diverse data, complex tasks, and the need to preserve privacy. Foundation models that perform well on medical tasks and require less task-specific tuning data are critical to accelerate the development of healthcare AI applications. We introduce MedGemma, a collection of medical vision-language foundation models based on Gemma 3 4B and 27B. MedGemma demonstrates advanced medical understanding and reasoning on images and text, significantly exceeding the performance of similar-sized generative models and approaching the performance of task-specific models, while maintaining the general capabilities of the Gemma 3 base models. For out-of-distribution tasks, MedGemma achieves 2.6-10% improvement on medical multimodal question answering, 15.5-18.1% improvement on chest X-ray finding classification, and 10.8% improvement on agentic evaluations compared to the base models. Fine-tuning MedGemma further improves performance in subdomains, reducing errors in electronic health record information retrieval by 50% and reaching comparable performance to existing specialized state-of-the-art methods for pneumothorax classification and histopathology patch classification. We additionally introduce MedSigLIP, a medically-tuned vision encoder derived from SigLIP. MedSigLIP powers the visual understanding capabilities of MedGemma and as an encoder achieves comparable or better performance than specialized medical image encoders. Taken together, the MedGemma collection provides a strong foundation of medical image and text capabilities, with potential to significantly accelerate medical research and development of downstream applications. The MedGemma collection, including tutorials and model weights, can be found at https://goo.gle/medgemma. △ Less

Submitted 6 April, 2026; v1 submitted 7 July, 2025; originally announced July 2025.

Comments: Fix references

MedBrowseComp: Benchmarking Medical Deep Research and Computer Use

Authors: Shan Chen, Pedro Moreira, Yuxin Xiao, Sam Schmidgall, Jeremy Warner, Hugo Aerts, Thomas Hartvigsen, Jack Gallifant, Danielle S. Bitterman

Abstract: Large language models (LLMs) are increasingly envisioned as decision-support tools in clinical practice, yet safe clinical reasoning demands integrating heterogeneous knowledge bases -- trials, primary studies, regulatory documents, and cost data -- under strict accuracy constraints. Existing evaluations often rely on synthetic prompts, reduce the task to single-hop factoid queries, or conflate re… ▽ More Large language models (LLMs) are increasingly envisioned as decision-support tools in clinical practice, yet safe clinical reasoning demands integrating heterogeneous knowledge bases -- trials, primary studies, regulatory documents, and cost data -- under strict accuracy constraints. Existing evaluations often rely on synthetic prompts, reduce the task to single-hop factoid queries, or conflate reasoning with open-ended generation, leaving their real-world utility unclear. To close this gap, we present MedBrowseComp, the first benchmark that systematically tests an agent's ability to reliably retrieve and synthesize multi-hop medical facts from live, domain-specific knowledge bases. MedBrowseComp contains more than 1,000 human-curated questions that mirror clinical scenarios where practitioners must reconcile fragmented or conflicting information to reach an up-to-date conclusion. Applying MedBrowseComp to frontier agentic systems reveals performance shortfalls as low as ten percent, exposing a critical gap between current LLM capabilities and the rigor demanded in clinical settings. MedBrowseComp therefore offers a clear testbed for reliable medical information seeking and sets concrete goals for future model and toolchain upgrades. You can visit our project page at: https://moreirap12.github.io/mbc-browse-app/ △ Less

Submitted 20 May, 2025; originally announced May 2025.

Comments: You can visit our project page at: https://moreirap12.github.io/mbc-browse-app/

SRT-H: A Hierarchical Framework for Autonomous Surgery via Language Conditioned Imitation Learning

Authors: Ji Woong Kim, Juo-Tung Chen, Pascal Hansen, Lucy X. Shi, Antony Goldenberg, Samuel Schmidgall, Paul Maria Scheikl, Anton Deguet, Brandon M. White, De Ru Tsai, Richard Cha, Jeffrey Jopling, Chelsea Finn, Axel Krieger

Abstract: Research on autonomous surgery has largely focused on simple task automation in controlled environments. However, real-world surgical applications demand dexterous manipulation over extended durations and generalization to the inherent variability of human tissue. These challenges remain difficult to address using existing logic-based or conventional end-to-end learning approaches. To address this… ▽ More Research on autonomous surgery has largely focused on simple task automation in controlled environments. However, real-world surgical applications demand dexterous manipulation over extended durations and generalization to the inherent variability of human tissue. These challenges remain difficult to address using existing logic-based or conventional end-to-end learning approaches. To address this gap, we propose a hierarchical framework for performing dexterous, long-horizon surgical steps. Our approach utilizes a high-level policy for task planning and a low-level policy for generating robot trajectories. The high-level planner plans in language space, generating task-level or corrective instructions that guide the robot through the long-horizon steps and correct for the low-level policy's errors. We validate our framework through ex vivo experiments on cholecystectomy, a commonly-practiced minimally invasive procedure, and conduct ablation studies to evaluate key components of the system. Our method achieves a 100\% success rate across eight unseen ex vivo gallbladders, operating fully autonomously without human intervention. This work demonstrates step-level autonomy in a surgical procedure, marking a milestone toward clinical deployment of autonomous surgical systems. △ Less

Submitted 8 July, 2025; v1 submitted 15 May, 2025; originally announced May 2025.

TxGemma: Efficient and Agentic LLMs for Therapeutics

Authors: Eric Wang, Samuel Schmidgall, Paul F. Jaeger, Fan Zhang, Rory Pilgrim, Yossi Matias, Joelle Barral, David Fleet, Shekoofeh Azizi

Abstract: Therapeutic development is a costly and high-risk endeavor that is often plagued by high failure rates. To address this, we introduce TxGemma, a suite of efficient, generalist large language models (LLMs) capable of therapeutic property prediction as well as interactive reasoning and explainability. Unlike task-specific models, TxGemma synthesizes information from diverse sources, enabling broad a… ▽ More Therapeutic development is a costly and high-risk endeavor that is often plagued by high failure rates. To address this, we introduce TxGemma, a suite of efficient, generalist large language models (LLMs) capable of therapeutic property prediction as well as interactive reasoning and explainability. Unlike task-specific models, TxGemma synthesizes information from diverse sources, enabling broad application across the therapeutic development pipeline. The suite includes 2B, 9B, and 27B parameter models, fine-tuned from Gemma-2 on a comprehensive dataset of small molecules, proteins, nucleic acids, diseases, and cell lines. Across 66 therapeutic development tasks, TxGemma achieved superior or comparable performance to the state-of-the-art generalist model on 64 (superior on 45), and against state-of-the-art specialist models on 50 (superior on 26). Fine-tuning TxGemma models on therapeutic downstream tasks, such as clinical trial adverse event prediction, requires less training data than fine-tuning base LLMs, making TxGemma suitable for data-limited applications. Beyond these predictive capabilities, TxGemma features conversational models that bridge the gap between general LLMs and specialized property predictors. These allow scientists to interact in natural language, provide mechanistic reasoning for predictions based on molecular structure, and engage in scientific discussions. Building on this, we further introduce Agentic-Tx, a generalist therapeutic agentic system powered by Gemini 2.5 that reasons, acts, manages diverse workflows, and acquires external domain knowledge. Agentic-Tx surpasses prior leading models on the Humanity's Last Exam benchmark (Chemistry & Biology) with 52.3% relative improvement over o3-mini (high) and 26.7% over o3-mini (high) on GPQA (Chemistry) and excels with improvements of 6.3% (ChemBench-Preference) and 2.4% (ChemBench-Mini) over o3-mini (high). △ Less

Submitted 8 April, 2025; originally announced April 2025.

AgentRxiv: Towards Collaborative Autonomous Research

Authors: Samuel Schmidgall, Michael Moor

Abstract: Progress in scientific discovery is rarely the result of a single "Eureka" moment, but is rather the product of hundreds of scientists incrementally working together toward a common goal. While existing agent workflows are capable of producing research autonomously, they do so in isolation, without the ability to continuously improve upon prior research results. To address these challenges, we int… ▽ More Progress in scientific discovery is rarely the result of a single "Eureka" moment, but is rather the product of hundreds of scientists incrementally working together toward a common goal. While existing agent workflows are capable of producing research autonomously, they do so in isolation, without the ability to continuously improve upon prior research results. To address these challenges, we introduce AgentRxiv-a framework that lets LLM agent laboratories upload and retrieve reports from a shared preprint server in order to collaborate, share insights, and iteratively build on each other's research. We task agent laboratories to develop new reasoning and prompting techniques and find that agents with access to their prior research achieve higher performance improvements compared to agents operating in isolation (11.4% relative improvement over baseline on MATH-500). We find that the best performing strategy generalizes to benchmarks in other domains (improving on average by 3.3%). Multiple agent laboratories sharing research through AgentRxiv are able to work together towards a common goal, progressing more rapidly than isolated laboratories, achieving higher overall accuracy (13.7% relative improvement over baseline on MATH-500). These findings suggest that autonomous agents may play a role in designing future AI systems alongside humans. We hope that AgentRxiv allows agents to collaborate toward research goals and enables researchers to accelerate discovery. △ Less

Submitted 23 March, 2025; originally announced March 2025.

Surgical Gaussian Surfels: Highly Accurate Real-time Surgical Scene Rendering using Gaussian Surfels

Authors: Idris O. Sunmola, Zhenjun Zhao, Samuel Schmidgall, Yumeng Wang, Paul Maria Scheikl, Viet Pham, Axel Krieger

Abstract: Accurate geometric reconstruction of deformable tissues in monocular endoscopic video remains a fundamental challenge in robot-assisted minimally invasive surgery. Although recent volumetric and point primitive methods based on neural radiance fields (NeRF) and 3D Gaussian primitives have efficiently rendered surgical scenes, they still struggle with handling artifact-free tool occlusions and pres… ▽ More Accurate geometric reconstruction of deformable tissues in monocular endoscopic video remains a fundamental challenge in robot-assisted minimally invasive surgery. Although recent volumetric and point primitive methods based on neural radiance fields (NeRF) and 3D Gaussian primitives have efficiently rendered surgical scenes, they still struggle with handling artifact-free tool occlusions and preserving fine anatomical details. These limitations stem from unrestricted Gaussian scaling and insufficient surface alignment constraints during reconstruction. To address these issues, we introduce Surgical Gaussian Surfels (SGS), which transform anisotropic point primitives into surface-aligned elliptical splats by constraining the scale component of the Gaussian covariance matrix along the view-aligned axis. We also introduce the Fully Fused Deformation Multilayer Perceptron (FFD-MLP), a lightweight Multi-Layer Perceptron (MLP) that predicts accurate surfel motion fields up to 5x faster than a standard MLP. This is coupled with locality constraints to handle complex tissue deformations. We use homodirectional view-space positional gradients to capture fine image details by splitting Gaussian Surfels in over-reconstructed regions. In addition, we define surface normals as the direction of the steepest density change within each Gaussian surfel primitive, enabling accurate normal estimation without requiring monocular normal priors. We evaluate our method on two in-vivo surgical datasets, where it outperforms current state-of-the-art methods in surface geometry, normal map quality, and rendering efficiency, while remaining competitive in real-time rendering performance. We make our code available at https://github.com/aloma85/SurgicalGaussianSurfels △ Less

Submitted 3 August, 2025; v1 submitted 5 March, 2025; originally announced March 2025.

Agent Laboratory: Using LLM Agents as Research Assistants

Authors: Samuel Schmidgall, Yusheng Su, Ze Wang, Ximeng Sun, Jialian Wu, Xiaodong Yu, Jiang Liu, Michael Moor, Zicheng Liu, Emad Barsoum

Abstract: Historically, scientific discovery has been a lengthy and costly process, demanding substantial time and resources from initial conception to final results. To accelerate scientific discovery, reduce research costs, and improve research quality, we introduce Agent Laboratory, an autonomous LLM-based framework capable of completing the entire research process. This framework accepts a human-provide… ▽ More Historically, scientific discovery has been a lengthy and costly process, demanding substantial time and resources from initial conception to final results. To accelerate scientific discovery, reduce research costs, and improve research quality, we introduce Agent Laboratory, an autonomous LLM-based framework capable of completing the entire research process. This framework accepts a human-provided research idea and progresses through three stages--literature review, experimentation, and report writing to produce comprehensive research outputs, including a code repository and a research report, while enabling users to provide feedback and guidance at each stage. We deploy Agent Laboratory with various state-of-the-art LLMs and invite multiple researchers to assess its quality by participating in a survey, providing human feedback to guide the research process, and then evaluate the final paper. We found that: (1) Agent Laboratory driven by o1-preview generates the best research outcomes; (2) The generated machine learning code is able to achieve state-of-the-art performance compared to existing methods; (3) Human involvement, providing feedback at each stage, significantly improves the overall quality of research; (4) Agent Laboratory significantly reduces research expenses, achieving an 84% decrease compared to previous autonomous research methods. We hope Agent Laboratory enables researchers to allocate more effort toward creative ideation rather than low-level coding and writing, ultimately accelerating scientific discovery. △ Less

Submitted 17 June, 2025; v1 submitted 7 January, 2025; originally announced January 2025.

Tracking Tumors under Deformation from Partial Point Clouds using Occupancy Networks

Authors: Pit Henrich, Jiawei Liu, Jiawei Ge, Samuel Schmidgall, Lauren Shepard, Ahmed Ezzat Ghazi, Franziska Mathis-Ullrich, Axel Krieger

Abstract: To track tumors during surgery, information from preoperative CT scans is used to determine their position. However, as the surgeon operates, the tumor may be deformed which presents a major hurdle for accurately resecting the tumor, and can lead to surgical inaccuracy, increased operation time, and excessive margins. This issue is particularly pronounced in robot-assisted partial nephrectomy (RAP… ▽ More To track tumors during surgery, information from preoperative CT scans is used to determine their position. However, as the surgeon operates, the tumor may be deformed which presents a major hurdle for accurately resecting the tumor, and can lead to surgical inaccuracy, increased operation time, and excessive margins. This issue is particularly pronounced in robot-assisted partial nephrectomy (RAPN), where the kidney undergoes significant deformations during operation. Toward addressing this, we introduce a occupancy network-based method for the localization of tumors within kidney phantoms undergoing deformations at interactive speeds. We validate our method by introducing a 3D hydrogel kidney phantom embedded with exophytic and endophytic renal tumors. It closely mimics real tissue mechanics to simulate kidney deformation during in vivo surgery, providing excellent contrast and clear delineation of tumor margins to enable automatic threshold-based segmentation. Our findings indicate that the proposed method can localize tumors in moderately deforming kidneys with a margin of 6mm to 10mm, while providing essential volumetric 3D information at over 60Hz. This capability directly enables downstream tasks such as robotic resection. △ Less

Submitted 4 November, 2024; originally announced November 2024.

Comments: Accepted at IROS 2024

SurGen: Text-Guided Diffusion Model for Surgical Video Generation

Authors: Joseph Cho, Samuel Schmidgall, Cyril Zakka, Mrudang Mathur, Dhamanpreet Kaur, Rohan Shad, William Hiesinger

Abstract: Diffusion-based video generation models have made significant strides, producing outputs with improved visual fidelity, temporal coherence, and user control. These advancements hold great promise for improving surgical education by enabling more realistic, diverse, and interactive simulation environments. In this study, we introduce SurGen, a text-guided diffusion model tailored for surgical video… ▽ More Diffusion-based video generation models have made significant strides, producing outputs with improved visual fidelity, temporal coherence, and user control. These advancements hold great promise for improving surgical education by enabling more realistic, diverse, and interactive simulation environments. In this study, we introduce SurGen, a text-guided diffusion model tailored for surgical video synthesis. SurGen produces videos with the highest resolution and longest duration among existing surgical video generation models. We validate the visual and temporal quality of the outputs using standard image and video generation metrics. Additionally, we assess their alignment to the corresponding text prompts through a deep learning classifier trained on surgical data. Our results demonstrate the potential of diffusion models to serve as valuable educational tools for surgical trainees. △ Less

Submitted 24 September, 2024; v1 submitted 26 August, 2024; originally announced August 2024.

GP-VLS: A general-purpose vision language model for surgery

Authors: Samuel Schmidgall, Joseph Cho, Cyril Zakka, William Hiesinger

Abstract: Surgery requires comprehensive medical knowledge, visual assessment skills, and procedural expertise. While recent surgical AI models have focused on solving task-specific problems, there is a need for general-purpose systems that can understand surgical scenes and interact through natural language. This paper introduces GP-VLS, a general-purpose vision language model for surgery that integrates m… ▽ More Surgery requires comprehensive medical knowledge, visual assessment skills, and procedural expertise. While recent surgical AI models have focused on solving task-specific problems, there is a need for general-purpose systems that can understand surgical scenes and interact through natural language. This paper introduces GP-VLS, a general-purpose vision language model for surgery that integrates medical and surgical knowledge with visual scene understanding. For comprehensively evaluating general-purpose surgical models, we propose SurgiQual, which evaluates across medical and surgical knowledge benchmarks as well as surgical vision-language questions. To train GP-VLS, we develop six new datasets spanning medical knowledge, surgical textbooks, and vision-language pairs for tasks like phase recognition and tool identification. We show that GP-VLS significantly outperforms existing open- and closed-source models on surgical vision-language tasks, with 8-21% improvements in accuracy across SurgiQual benchmarks. GP-VLS also demonstrates strong performance on medical and surgical knowledge tests compared to open-source alternatives. Overall, GP-VLS provides an open-source foundation for developing AI assistants to support surgeons across a wide range of tasks and scenarios. The code and data for this work is publicly available at gpvls-surgery-vlm.github.io. △ Less

Submitted 6 August, 2024; v1 submitted 27 July, 2024; originally announced July 2024.

Surgical Robot Transformer (SRT): Imitation Learning for Surgical Tasks

Authors: Ji Woong Kim, Tony Z. Zhao, Samuel Schmidgall, Anton Deguet, Marin Kobilarov, Chelsea Finn, Axel Krieger

Abstract: We explore whether surgical manipulation tasks can be learned on the da Vinci robot via imitation learning. However, the da Vinci system presents unique challenges which hinder straight-forward implementation of imitation learning. Notably, its forward kinematics is inconsistent due to imprecise joint measurements, and naively training a policy using such approximate kinematics data often leads to… ▽ More We explore whether surgical manipulation tasks can be learned on the da Vinci robot via imitation learning. However, the da Vinci system presents unique challenges which hinder straight-forward implementation of imitation learning. Notably, its forward kinematics is inconsistent due to imprecise joint measurements, and naively training a policy using such approximate kinematics data often leads to task failure. To overcome this limitation, we introduce a relative action formulation which enables successful policy training and deployment using its approximate kinematics data. A promising outcome of this approach is that the large repository of clinical data, which contains approximate kinematics, may be directly utilized for robot learning without further corrections. We demonstrate our findings through successful execution of three fundamental surgical tasks, including tissue manipulation, needle handling, and knot-tying. △ Less

Submitted 17 July, 2024; originally announced July 2024.

Comments: 8 pages

AgentClinic: a multimodal agent benchmark to evaluate AI in simulated clinical environments

Authors: Samuel Schmidgall, Rojin Ziaei, Carl Harris, Eduardo Reis, Jeffrey Jopling, Michael Moor

Abstract: Evaluating large language models (LLM) in clinical scenarios is crucial to assessing their potential clinical utility. Existing benchmarks rely heavily on static question-answering, which does not accurately depict the complex, sequential nature of clinical decision-making. Here, we introduce AgentClinic, a multimodal agent benchmark for evaluating LLMs in simulated clinical environments that incl… ▽ More Evaluating large language models (LLM) in clinical scenarios is crucial to assessing their potential clinical utility. Existing benchmarks rely heavily on static question-answering, which does not accurately depict the complex, sequential nature of clinical decision-making. Here, we introduce AgentClinic, a multimodal agent benchmark for evaluating LLMs in simulated clinical environments that include patient interactions, multimodal data collection under incomplete information, and the usage of various tools, resulting in an in-depth evaluation across nine medical specialties and seven languages. We find that solving MedQA problems in the sequential decision-making format of AgentClinic is considerably more challenging, resulting in diagnostic accuracies that can drop to below a tenth of the original accuracy. Overall, we observe that agents sourced from Claude-3.5 outperform other LLM backbones in most settings. Nevertheless, we see stark differences in the LLMs' ability to make use of tools, such as experiential learning, adaptive retrieval, and reflection cycles. Strikingly, Llama-3 shows up to 92% relative improvements with the notebook tool that allows for writing and editing notes that persist across cases. To further scrutinize our clinical simulations, we leverage real-world electronic health records, perform a clinical reader study, perturb agents with biases, and explore novel patient-centric metrics that this interactive environment firstly enables. △ Less

Submitted 24 May, 2025; v1 submitted 13 May, 2024; originally announced May 2024.

General surgery vision transformer: A video pre-trained foundation model for general surgery

Authors: Samuel Schmidgall, Ji Woong Kim, Jeffrey Jopling, Axel Krieger

Abstract: The absence of openly accessible data and specialized foundation models is a major barrier for computational research in surgery. Toward this, (i) we open-source the largest dataset of general surgery videos to-date, consisting of 680 hours of surgical videos, including data from robotic and laparoscopic techniques across 28 procedures; (ii) we propose a technique for video pre-training a general… ▽ More The absence of openly accessible data and specialized foundation models is a major barrier for computational research in surgery. Toward this, (i) we open-source the largest dataset of general surgery videos to-date, consisting of 680 hours of surgical videos, including data from robotic and laparoscopic techniques across 28 procedures; (ii) we propose a technique for video pre-training a general surgery vision transformer (GSViT) on surgical videos based on forward video prediction that can run in real-time for surgical applications, toward which we open-source the code and weights of GSViT; (iii) we also release code and weights for procedure-specific fine-tuned versions of GSViT across 10 procedures; (iv) we demonstrate the performance of GSViT on the Cholec80 phase annotation task, displaying improved performance over state-of-the-art single frame predictors. △ Less

Submitted 12 April, 2024; v1 submitted 9 March, 2024; originally announced March 2024.

Addressing cognitive bias in medical language models

Authors: Samuel Schmidgall, Carl Harris, Ime Essien, Daniel Olshvang, Tawsifur Rahman, Ji Woong Kim, Rojin Ziaei, Jason Eshraghian, Peter Abadir, Rama Chellappa

Abstract: There is increasing interest in the application large language models (LLMs) to the medical field, in part because of their impressive performance on medical exam questions. While promising, exam questions do not reflect the complexity of real patient-doctor interactions. In reality, physicians' decisions are shaped by many complex factors, such as patient compliance, personal experience, ethical… ▽ More There is increasing interest in the application large language models (LLMs) to the medical field, in part because of their impressive performance on medical exam questions. While promising, exam questions do not reflect the complexity of real patient-doctor interactions. In reality, physicians' decisions are shaped by many complex factors, such as patient compliance, personal experience, ethical beliefs, and cognitive bias. Taking a step toward understanding this, our hypothesis posits that when LLMs are confronted with clinical questions containing cognitive biases, they will yield significantly less accurate responses compared to the same questions presented without such biases. In this study, we developed BiasMedQA, a benchmark for evaluating cognitive biases in LLMs applied to medical tasks. Using BiasMedQA we evaluated six LLMs, namely GPT-4, Mixtral-8x70B, GPT-3.5, PaLM-2, Llama 2 70B-chat, and the medically specialized PMC Llama 13B. We tested these models on 1,273 questions from the US Medical Licensing Exam (USMLE) Steps 1, 2, and 3, modified to replicate common clinically-relevant cognitive biases. Our analysis revealed varying effects for biases on these LLMs, with GPT-4 standing out for its resilience to bias, in contrast to Llama 2 70B-chat and PMC Llama 13B, which were disproportionately affected by cognitive bias. Our findings highlight the critical need for bias mitigation in the development of medical LLMs, pointing towards safer and more reliable applications in healthcare. △ Less

Submitted 20 February, 2024; v1 submitted 12 February, 2024; originally announced February 2024.

General-purpose foundation models for increased autonomy in robot-assisted surgery

Authors: Samuel Schmidgall, Ji Woong Kim, Alan Kuntz, Ahmed Ezzat Ghazi, Axel Krieger

Abstract: The dominant paradigm for end-to-end robot learning focuses on optimizing task-specific objectives that solve a single robotic problem such as picking up an object or reaching a target position. However, recent work on high-capacity models in robotics has shown promise toward being trained on large collections of diverse and task-agnostic datasets of video demonstrations. These models have shown i… ▽ More The dominant paradigm for end-to-end robot learning focuses on optimizing task-specific objectives that solve a single robotic problem such as picking up an object or reaching a target position. However, recent work on high-capacity models in robotics has shown promise toward being trained on large collections of diverse and task-agnostic datasets of video demonstrations. These models have shown impressive levels of generalization to unseen circumstances, especially as the amount of data and the model complexity scale. Surgical robot systems that learn from data have struggled to advance as quickly as other fields of robot learning for a few reasons: (1) there is a lack of existing large-scale open-source data to train models, (2) it is challenging to model the soft-body deformations that these robots work with during surgery because simulation cannot match the physical and visual complexity of biological tissue, and (3) surgical robots risk harming patients when tested in clinical trials and require more extensive safety measures. This perspective article aims to provide a path toward increasing robot autonomy in robot-assisted surgery through the development of a multi-modal, multi-task, vision-language-action model for surgical robots. Ultimately, we argue that surgical robots are uniquely positioned to benefit from general-purpose models and provide three guiding actions toward increased autonomy in robot-assisted surgery. △ Less

Submitted 1 January, 2024; originally announced January 2024.

Surgical Gym: A high-performance GPU-based platform for reinforcement learning with surgical robots

Authors: Samuel Schmidgall, Axel Krieger, Jason Eshraghian

Abstract: Recent advances in robot-assisted surgery have resulted in progressively more precise, efficient, and minimally invasive procedures, sparking a new era of robotic surgical intervention. This enables doctors, in collaborative interaction with robots, to perform traditional or minimally invasive surgeries with improved outcomes through smaller incisions. Recent efforts are working toward making robo… ▽ More Recent advances in robot-assisted surgery have resulted in progressively more precise, efficient, and minimally invasive procedures, sparking a new era of robotic surgical intervention. This enables doctors, in collaborative interaction with robots, to perform traditional or minimally invasive surgeries with improved outcomes through smaller incisions. Recent efforts are working toward making robotic surgery more autonomous which has the potential to reduce variability of surgical outcomes and reduce complication rates. Deep reinforcement learning methodologies offer scalable solutions for surgical automation, but their effectiveness relies on extensive data acquisition due to the absence of prior knowledge in successfully accomplishing tasks. Due to the intensive nature of simulated data collection, previous works have focused on making existing algorithms more efficient. In this work, we focus on making the simulator more efficient, making training data much more accessible than previously possible. We introduce Surgical Gym, an open-source high performance platform for surgical robot learning where both the physics simulation and reinforcement learning occur directly on the GPU. We demonstrate between 100-5000x faster training times compared with previous surgical learning platforms. The code is available at: https://github.com/SamuelSchmidgall/SurgicalGym. △ Less

Submitted 27 January, 2024; v1 submitted 6 October, 2023; originally announced October 2023.

Language models are susceptible to incorrect patient self-diagnosis in medical applications

Authors: Rojin Ziaei, Samuel Schmidgall

Abstract: Large language models (LLMs) are becoming increasingly relevant as a potential tool for healthcare, aiding communication between clinicians, researchers, and patients. However, traditional evaluations of LLMs on medical exam questions do not reflect the complexity of real patient-doctor interactions. An example of this complexity is the introduction of patient self-diagnosis, where a patient attem… ▽ More Large language models (LLMs) are becoming increasingly relevant as a potential tool for healthcare, aiding communication between clinicians, researchers, and patients. However, traditional evaluations of LLMs on medical exam questions do not reflect the complexity of real patient-doctor interactions. An example of this complexity is the introduction of patient self-diagnosis, where a patient attempts to diagnose their own medical conditions from various sources. While the patient sometimes arrives at an accurate conclusion, they more often are led toward misdiagnosis due to the patient's over-emphasis on bias validating information. In this work we present a variety of LLMs with multiple-choice questions from United States medical board exams which are modified to include self-diagnostic reports from patients. Our findings highlight that when a patient proposes incorrect bias-validating information, the diagnostic accuracy of LLMs drop dramatically, revealing a high susceptibility to errors in self-diagnosis. △ Less

Submitted 17 September, 2023; originally announced September 2023.

Comments: 4 pages, Deep Generative Models for Health NeurIPS 2023

Synaptic motor adaptation: A three-factor learning rule for adaptive robotic control in spiking neural networks

Authors: Samuel Schmidgall, Joe Hays

Abstract: Legged robots operating in real-world environments must possess the ability to rapidly adapt to unexpected conditions, such as changing terrains and varying payloads. This paper introduces the Synaptic Motor Adaptation (SMA) algorithm, a novel approach to achieving real-time online adaptation in quadruped robots through the utilization of neuroscience-derived rules of synaptic plasticity with thre… ▽ More Legged robots operating in real-world environments must possess the ability to rapidly adapt to unexpected conditions, such as changing terrains and varying payloads. This paper introduces the Synaptic Motor Adaptation (SMA) algorithm, a novel approach to achieving real-time online adaptation in quadruped robots through the utilization of neuroscience-derived rules of synaptic plasticity with three-factor learning. To facilitate rapid adaptation, we meta-optimize a three-factor learning rule via gradient descent to adapt to uncertainty by approximating an embedding produced by privileged information using only locally accessible onboard sensing data. Our algorithm performs similarly to state-of-the-art motor adaptation algorithms and presents a clear path toward achieving adaptive robotics with neuromorphic hardware. △ Less

Submitted 2 June, 2023; originally announced June 2023.

Brain-inspired learning in artificial neural networks: a review

Authors: Samuel Schmidgall, Jascha Achterberg, Thomas Miconi, Louis Kirsch, Rojin Ziaei, S. Pardis Hajiseyedrazi, Jason Eshraghian

Abstract: Artificial neural networks (ANNs) have emerged as an essential tool in machine learning, achieving remarkable success across diverse domains, including image and speech generation, game playing, and robotics. However, there exist fundamental differences between ANNs' operating mechanisms and those of the biological brain, particularly concerning learning processes. This paper presents a comprehens… ▽ More Artificial neural networks (ANNs) have emerged as an essential tool in machine learning, achieving remarkable success across diverse domains, including image and speech generation, game playing, and robotics. However, there exist fundamental differences between ANNs' operating mechanisms and those of the biological brain, particularly concerning learning processes. This paper presents a comprehensive review of current brain-inspired learning representations in artificial neural networks. We investigate the integration of more biologically plausible mechanisms, such as synaptic plasticity, to enhance these networks' capabilities. Moreover, we delve into the potential advantages and challenges accompanying this approach. Ultimately, we pinpoint promising avenues for future research in this rapidly advancing field, which could bring us closer to understanding the essence of intelligence. △ Less

Submitted 18 May, 2023; originally announced May 2023.

NeuroBench: A Framework for Benchmarking Neuromorphic Computing Algorithms and Systems

Authors: Jason Yik, Korneel Van den Berghe, Douwe den Blanken, Younes Bouhadjar, Maxime Fabre, Paul Hueber, Weijie Ke, Mina A Khoei, Denis Kleyko, Noah Pacik-Nelson, Alessandro Pierro, Philipp Stratmann, Pao-Sheng Vincent Sun, Guangzhi Tang, Shenqi Wang, Biyan Zhou, Soikat Hasan Ahmed, George Vathakkattil Joseph, Benedetto Leto, Aurora Micheli, Anurag Kumar Mishra, Gregor Lenz, Tao Sun, Zergham Ahmed, Mahmoud Akl , et al. (75 additional authors not shown)

Abstract: Neuromorphic computing shows promise for advancing computing efficiency and capabilities of AI applications using brain-inspired principles. However, the neuromorphic research field currently lacks standardized benchmarks, making it difficult to accurately measure technological advancements, compare performance with conventional methods, and identify promising future research directions. Prior neu… ▽ More Neuromorphic computing shows promise for advancing computing efficiency and capabilities of AI applications using brain-inspired principles. However, the neuromorphic research field currently lacks standardized benchmarks, making it difficult to accurately measure technological advancements, compare performance with conventional methods, and identify promising future research directions. Prior neuromorphic computing benchmark efforts have not seen widespread adoption due to a lack of inclusive, actionable, and iterative benchmark design and guidelines. To address these shortcomings, we present NeuroBench: a benchmark framework for neuromorphic computing algorithms and systems. NeuroBench is a collaboratively-designed effort from an open community of researchers across industry and academia, aiming to provide a representative structure for standardizing the evaluation of neuromorphic approaches. The NeuroBench framework introduces a common set of tools and systematic methodology for inclusive benchmark measurement, delivering an objective reference framework for quantifying neuromorphic approaches in both hardware-independent (algorithm track) and hardware-dependent (system track) settings. In this article, we outline tasks and guidelines for benchmarks across multiple application domains, and present initial performance baselines across neuromorphic and conventional approaches for both benchmark tracks. NeuroBench is intended to continually expand its benchmarks and features to foster and track the progress made by the research community. △ Less

Submitted 14 January, 2025; v1 submitted 10 April, 2023; originally announced April 2023.

Comments: To appear in Nature Neuromorphic Hardware and Computing collection

Biological connectomes as a representation for the architecture of artificial neural networks

Authors: Samuel Schmidgall, Catherine Schuman, Maryam Parsa

Abstract: Grand efforts in neuroscience are working toward mapping the connectomes of many new species, including the near completion of the Drosophila melanogaster. It is important to ask whether these models could benefit artificial intelligence. In this work we ask two fundamental questions: (1) where and when biological connectomes can provide use in machine learning, (2) which design principles are nec… ▽ More Grand efforts in neuroscience are working toward mapping the connectomes of many new species, including the near completion of the Drosophila melanogaster. It is important to ask whether these models could benefit artificial intelligence. In this work we ask two fundamental questions: (1) where and when biological connectomes can provide use in machine learning, (2) which design principles are necessary for extracting a good representation of the connectome. Toward this end, we translate the motor circuit of the C. Elegans nematode into artificial neural networks at varying levels of biophysical realism and evaluate the outcome of training these networks on motor and non-motor behavioral tasks. We demonstrate that biophysical realism need not be upheld to attain the advantages of using biological circuits. We also establish that, even if the exact wiring diagram is not retained, the architectural statistics provide a valuable prior. Finally, we show that while the C. Elegans locomotion circuit provides a powerful inductive bias on locomotion problems, its structure may hinder performance on tasks unrelated to locomotion such as visual classification problems. △ Less

Submitted 5 October, 2022; v1 submitted 28 September, 2022; originally announced September 2022.

Learning to learn online with neuromodulated synaptic plasticity in spiking neural networks

Authors: Samuel Schmidgall, Joe Hays

Abstract: We propose that in order to harness our understanding of neuroscience toward machine learning, we must first have powerful tools for training brain-like models of learning. Although substantial progress has been made toward understanding the dynamics of learning in the brain, neuroscience-derived models of learning have yet to demonstrate the same performance capabilities as methods in deep learni… ▽ More We propose that in order to harness our understanding of neuroscience toward machine learning, we must first have powerful tools for training brain-like models of learning. Although substantial progress has been made toward understanding the dynamics of learning in the brain, neuroscience-derived models of learning have yet to demonstrate the same performance capabilities as methods in deep learning such as gradient descent. Inspired by the successes of machine learning using gradient descent, we demonstrate that models of neuromodulated synaptic plasticity from neuroscience can be trained in Spiking Neural Networks (SNNs) with a framework of learning to learn through gradient descent to address challenging online learning problems. This framework opens a new path toward developing neuroscience inspired online learning algorithms. △ Less

Submitted 27 June, 2022; v1 submitted 24 June, 2022; originally announced June 2022.

Stable Lifelong Learning: Spiking neurons as a solution to instability in plastic neural networks

Authors: Samuel Schmidgall, Joe Hays

Abstract: Synaptic plasticity poses itself as a powerful method of self-regulated unsupervised learning in neural networks. A recent resurgence of interest has developed in utilizing Artificial Neural Networks (ANNs) together with synaptic plasticity for intra-lifetime learning. Plasticity has been shown to improve the learning capabilities of these networks in generalizing to novel environmental circumstan… ▽ More Synaptic plasticity poses itself as a powerful method of self-regulated unsupervised learning in neural networks. A recent resurgence of interest has developed in utilizing Artificial Neural Networks (ANNs) together with synaptic plasticity for intra-lifetime learning. Plasticity has been shown to improve the learning capabilities of these networks in generalizing to novel environmental circumstances. However, the long-term stability of these trained networks has yet to be examined. This work demonstrates that utilizing plasticity together with ANNs leads to instability beyond the pre-specified lifespan used during training. This instability can lead to the dramatic decline of reward seeking behavior, or quickly lead to reaching environment terminal states. This behavior is shown to hold consistent for several plasticity rules on two different environments across many training time-horizons: a cart-pole balancing problem and a quadrupedal locomotion problem. We present a solution to this instability through the use of spiking neurons. △ Less

Submitted 7 November, 2021; originally announced November 2021.

Self-Replicating Neural Programs

Authors: Samuel Schmidgall

Abstract: In this work, a neural network is trained to replicate the code that trains it using only its own output as input. A paradigm for evolutionary self-replication in neural programs is introduced, where program parameters are mutated, and the ability for the program to more efficiently train itself leads to greater reproductive success. This evolutionary paradigm is demonstrated to produce more effic… ▽ More In this work, a neural network is trained to replicate the code that trains it using only its own output as input. A paradigm for evolutionary self-replication in neural programs is introduced, where program parameters are mutated, and the ability for the program to more efficiently train itself leads to greater reproductive success. This evolutionary paradigm is demonstrated to produce more efficient learning in organisms from a setting without any explicit guidance, solely based on natural selection favoring organisms with faster reproductive maturity. △ Less

Submitted 4 October, 2021; v1 submitted 27 September, 2021; originally announced September 2021.

Evolutionary Self-Replication as a Mechanism for Producing Artificial Intelligence

Authors: Samuel Schmidgall, Joseph Hays

Abstract: Can reproduction alone in the context of survival produce intelligence in our machines? In this work, self-replication is explored as a mechanism for the emergence of intelligent behavior in modern learning environments. By focusing purely on survival, while undergoing natural selection, evolved organisms are shown to produce meaningful, complex, and intelligent behavior, demonstrating creative so… ▽ More Can reproduction alone in the context of survival produce intelligence in our machines? In this work, self-replication is explored as a mechanism for the emergence of intelligent behavior in modern learning environments. By focusing purely on survival, while undergoing natural selection, evolved organisms are shown to produce meaningful, complex, and intelligent behavior, demonstrating creative solutions to challenging problems without any notion of reward or objectives. Atari and robotic learning environments are re-defined in terms of natural selection, and the behavior which emerged in self-replicating organisms during these experiments is described in detail. △ Less

Submitted 23 September, 2022; v1 submitted 16 September, 2021; originally announced September 2021.

SpikePropamine: Differentiable Plasticity in Spiking Neural Networks

Authors: Samuel Schmidgall, Julia Ashkanazy, Wallace Lawson, Joe Hays

Abstract: The adaptive changes in synaptic efficacy that occur between spiking neurons have been demonstrated to play a critical role in learning for biological neural networks. Despite this source of inspiration, many learning focused applications using Spiking Neural Networks (SNNs) retain static synaptic connections, preventing additional learning after the initial training period. Here, we introduce a f… ▽ More The adaptive changes in synaptic efficacy that occur between spiking neurons have been demonstrated to play a critical role in learning for biological neural networks. Despite this source of inspiration, many learning focused applications using Spiking Neural Networks (SNNs) retain static synaptic connections, preventing additional learning after the initial training period. Here, we introduce a framework for simultaneously learning the underlying fixed-weights and the rules governing the dynamics of synaptic plasticity and neuromodulated synaptic plasticity in SNNs through gradient descent. We further demonstrate the capabilities of this framework on a series of challenging benchmarks, learning the parameters of several plasticity rules including BCM, Oja's, and their respective set of neuromodulatory variants. The experimental results display that SNNs augmented with differentiable plasticity are sufficient for solving a set of challenging temporal learning tasks that a traditional SNN fails to solve, even in the presence of significant noise. These networks are also shown to be capable of producing locomotion on a high-dimensional robotic learning task, where near-minimal degradation in performance is observed in the presence of novel conditions not seen during the initial training period. △ Less

Submitted 4 June, 2021; originally announced June 2021.

Journal ref: Frontiers in Neurorobotics, 22 September 2021

Self-Constructing Neural Networks Through Random Mutation

Authors: Samuel Schmidgall

Abstract: The search for neural architecture is producing many of the most exciting results in artificial intelligence. It has increasingly become apparent that task-specific neural architecture plays a crucial role for effectively solving problems. This paper presents a simple method for learning neural architecture through random mutation. This method demonstrates 1) neural architecture may be learned dur… ▽ More The search for neural architecture is producing many of the most exciting results in artificial intelligence. It has increasingly become apparent that task-specific neural architecture plays a crucial role for effectively solving problems. This paper presents a simple method for learning neural architecture through random mutation. This method demonstrates 1) neural architecture may be learned during the agent's lifetime, 2) neural architecture may be constructed over a single lifetime without any initial connections or neurons, and 3) architectural modifications enable rapid adaptation to dynamic and novel task scenarios. Starting without any neurons or connections, this method constructs a neural architecture capable of high-performance on several tasks. The lifelong learning capabilities of this method are demonstrated in an environment without episodic resets, even learning with constantly changing morphology, limb disablement, and changing task goals all without losing locomotion capabilities. △ Less

Submitted 29 March, 2021; originally announced March 2021.

Comments: Accepted to ICLR 'A Roadmap to Never-Ending RL' (NERL) 2021 Workshop

Locked fronts in a discrete time discrete space population model

Authors: Matt Holzer, Zachary Richey, Wyatt Rush, Samuel Schmidgall

Abstract: A model of population growth and dispersal is considered where the spatial habitat is a lattice and reproduction occurs generationally. The resulting discrete dynamical systems exhibits velocity locking, where rational speed invasion fronts are observed to persist as parameters are varied. In this article, we construct locked fronts for a particular piecewise linear reproduction function. These fr… ▽ More A model of population growth and dispersal is considered where the spatial habitat is a lattice and reproduction occurs generationally. The resulting discrete dynamical systems exhibits velocity locking, where rational speed invasion fronts are observed to persist as parameters are varied. In this article, we construct locked fronts for a particular piecewise linear reproduction function. These fronts are shown to be linear combinations of exponentially decaying solutions to the linear system near the unstable state. Based upon these front solutions, we then derive expressions for the boundary of locking regions in parameter space. We obtain leading order expansions for the locking regions in the limit as the migration parameter tends to zero. Strict spectral stability in exponentially weighted spaces is also established. △ Less

Submitted 21 December, 2021; v1 submitted 11 September, 2020; originally announced September 2020.

Adaptive Reinforcement Learning through Evolving Self-Modifying Neural Networks

Authors: Samuel Schmidgall

Abstract: The adaptive learning capabilities seen in biological neural networks are largely a product of the self-modifying behavior emerging from online plastic changes in synaptic connectivity. Current methods in Reinforcement Learning (RL) only adjust to new interactions after reflection over a specified time interval, preventing the emergence of online adaptivity. Recent work addressing this by endowing… ▽ More The adaptive learning capabilities seen in biological neural networks are largely a product of the self-modifying behavior emerging from online plastic changes in synaptic connectivity. Current methods in Reinforcement Learning (RL) only adjust to new interactions after reflection over a specified time interval, preventing the emergence of online adaptivity. Recent work addressing this by endowing artificial neural networks with neuromodulated plasticity have been shown to improve performance on simple RL tasks trained using backpropagation, but have yet to scale up to larger problems. Here we study the problem of meta-learning in a challenging quadruped domain, where each leg of the quadruped has a chance of becoming unusable, requiring the agent to adapt by continuing locomotion with the remaining limbs. Results demonstrate that agents evolved using self-modifying plastic networks are more capable of adapting to complex meta-learning learning tasks, even outperforming the same network updated using gradient-based algorithms while taking less time to train. △ Less

Submitted 21 May, 2020; originally announced June 2020.

Comments: GECCO'2020 Poster: Submitted and accepted

Journal ref: Proc. of GECCO 2020