Enhancing Large Language Models for Improved Accuracy and Safety in Medical Question Answering: Comparative Study

BACKGROUND: Large language models (LLMs) offer the potential to improve virtual patient-physician communication and reduce health care professionals' workload. However, limitations in accuracy, outdated knowledge, and safety issues restrict their effective use in real clinical settings. Addressing these challenges is crucial for making LLMs a reliable health care tool. OBJECTIVE: This study aimed to evaluate the efficacy of Med-RISE, an information retrieval and augmentation tool, in comparison with baseline LLMs, focusing on enhancing accuracy and safety in medical question answering across diverse clinical domains. METHODS: This comparative study introduces Med-RISE, an enhanced version of a retrieval-augmented generation framework specifically designed to improve question-answering performance across wide-ranging medical domains and diverse disciplines. Med-RISE consists of 4 key steps: query rewriting, information retrieval (providing local and real-time retrieval), summarization, and execution (a fact and safety filter before output). This study integrated Med-RISE with 4 LLMs (GPT-3.5, GPT-4, Vicuna-13B, and ChatGLM-6B) and assessed their performance on 4 multiple-choice medical question datasets: MedQA (US Medical Licensing Examination), PubMedQA (original and revised versions), MedMCQA, and EYE500. Primary outcome measures included answer accuracy and hallucination rates, with hallucinations categorized into factuality (inaccurate information) or faithfulness (inconsistency with instructions) types. This study was conducted between March 2024 and August 2024. RESULTS: The integration of Med-RISE with each LLM led to a substantial increase in accuracy, with improvements ranging from 9.8% to 16.3% (mean 13%, SD 2.3%) across the 4 datasets. The enhanced accuracy rates were 16.3%, 12.9%, 13%, and 9.8% for GPT-3.5, GPT-4, Vicuna-13B, and ChatGLM-6B, respectively. In addition, Med-RISE effectively reduced hallucinations, with reductions ranging from 11.8% to 18% (mean 15.1%, SD 2.8%), factuality hallucinations decreasing by 13.5%, and faithfulness hallucinations decreasing by 5.8%. The hallucination rate reductions were 17.7%, 12.8%, 18%, and 11.8% for GPT-3.5, GPT-4, Vicuna-13B, and ChatGLM-6B, respectively. CONCLUSIONS: The Med-RISE framework significantly improves the accuracy and reduces the hallucinations of LLMs in medical question answering across benchmark datasets. By providing local and real-time information retrieval and fact and safety filtering, Med-RISE enhances the reliability and interpretability of LLMs in the medical domain, offering a promising tool for clinical practice and decision support.