Ryutaro Tanno
Famous AuthorPublications
A prospective clinical feasibility study of a conversational diagnostic AI in an ambulatory primary care clinic
Large language model (LLM)-based AI systems have shown promise for patient-facing diagnostic and management conversations in simulated settings. Translating these systems into clinical practice requires assessment in real-world workflows with rigorous safety oversight. We report a prospective, single-arm feasibility study of an LLM-based conversational AI, the Articulate Medical Intelligence Explorer (AMIE), conducting clinical history taking and presentation of potential diagnoses for patients to discuss with their provider at urgent care appointments at a leading academic medical center. 100 adult patients completed an AMIE text-chat interaction up to 5 days before their appointment. We sought to assess the conversational safety and quality, patient and clinician experience, and clinical reasoning capabilities compared to primary care providers (PCPs). Human safety supervisors monitored all patient-AMIE interactions in real time and did not need to intervene to stop any consultations based on pre-defined criteria. Patients reported high satisfaction and their attitudes towards AI improved after interacting with AMIE (p < 0.001). PCPs found AMIE's output useful with a positive impact on preparedness. AMIE's differential diagnosis (DDx) included the final diagnosis, per chart review 8 weeks post-encounter, in 90% of cases, with 75% top-3 accuracy. Blinded assessment of AMIE and PCP DDx and management (Mx) plans suggested similar overall DDx and Mx plan quality, without significant differences for DDx (p = 0.6) and appropriateness and safety of Mx (p = 0.1 and 1.0, respectively). PCPs outperformed AMIE in the practicality (p = 0.003) and cost effectiveness (p = 0.004) of Mx. While further research is needed, this study demonstrates the initial feasibility, safety, and user acceptance of conversational AI in a real-world setting, representing crucial steps towards clinical translation.
CoRefine: Confidence-Guided Self-Refinement for Adaptive Test-Time Compute
Large Language Models (LLMs) often rely on test-time scaling via parallel decoding (for example, 512 samples) to boost reasoning accuracy, but this incurs substantial compute. We introduce CoRefine, a confidence-guided self-refinement method that achieves competitive accuracy using a fraction of the tokens via a lightweight 211k-parameter Conv1D controller atop a frozen LLM. The controller consumes full-trace confidence to decide whether to halt, re-examine, or try a different approach, enabling targeted self-correction with an average of 2.7 refinement steps per problem and roughly 190-fold token reduction relative to 512-sample baselines. Across diverse reasoning benchmarks and three open-source models, the controller achieves 92.6 percent precision when it confidently halts, indicating that confidence dynamics reliably signal correctness without ground-truth verification. We extend this to CoRefine-Tree, a hybrid sequential-parallel variant that adaptively balances exploration and exploitation, with easy serving integration and verifier compatibility. By treating confidence as a control signal rather than a correctness guarantee, CoRefine provides a modular primitive for scalable reasoning and agentic settings with imperfect verifiers.