Asad Aali, Muhammad Ahmed Mohsin, Vasiliki Bikia, Arnav Singhvi, Richard Gaus, Suhana Bedi, Hejie Cui, Miguel Fuentes 等 18 位作者
As language models (LMs) are increasingly adopted across domains, high-quality benchmarking frameworks are essential for guiding deployment decisions. However, frameworks such as Holistic Evaluation of Language Models (HELM) typically evaluate models under a single static prompt configuration, even though model behavior depends strongly on prompt choice. As a result, reported scores can reflect prompt choice as much as model capability. Declarative prompting frameworks, such as DSPy, offer a scalable way to operationalize this evaluation protocol by evaluating models under structured prompting strategies rather than static prompts. Here, we conduct a reproducible DSPy+HELM benchmarking study and quantify how prompt choice impacts benchmark outcomes. Using five prompting methods, we evaluate four frontier and two open-source LMs across seven benchmarks against HELM baseline scores and find that prompt choice can materially impact leaderboards. Structured prompting improves performance (by 6% on average), alters comparisons (leaderboard rankings shift on $5/7$ benchmarks); chain-of-thought provides the strongest cost-performance tradeoff while more advanced optimizers offer smaller additional gains. Beyond the known intuition that prompts affect outputs, our benchmarking study integrates structured prompting into an established evaluation framework and quantifies how prompt choice alone impacts leaderboards. We open-source (i) DSPy+HELM Evaluation (https://github.com/stanford-crfm/helm/pull/3893) and (ii) Prompt Optimization Pipeline (https://github.com/StanfordMIMI/dspy-helm).
Large language models (LLMs) and medical AI tools are routinely used by physicians and patients for medical advice, yet their clinical safety profiles remain poorly characterized. We present NOHARM (Numerous Options Harm Assessment for Risk in Medicine), a 1,100-task benchmark of primary care-to-specialist consultation cases to measure the frequency and severity of potentially harmful errors from LLM-generated medical consultation recommendations. NOHARM covers 10 specialties, with 12,747 expert annotations for 4,249 clinical management options. Across 20 notable LLMs and 4 widely used retrieval-augmented generation (RAG) clinical AI tools, direct application of recommendations carried potential for severe harm in up to 24.6% of cases, with errors of omission accounting for more than 80% of severe errors. Harm potential was not uniform across systems, with clinical AI tools outperforming generalist LLMs, and multi-agent AI teaming further improving performance in generalist models. In a randomized study of 101 U.S.-licensed generalist physicians, AI assistance improved physician performance compared to conventional resources. However, AI-assisted physicians frequently omitted valuable AI-generated recommendations and still scored lower than many AI systems alone. Had those recommendations been incorporated, combined human-AI responses would have outperformed both the human and AI system as used, suggesting complementary strengths and unrealized potential in human-AI teaming. Collectively, these results show that despite strong performance on medical knowledge benchmarks, widely used AI tools can produce medical consultation advice with the potential for severe harm, and highlight the need for explicit measurement of clinical safety. The benchmark and leaderboard are publicly available to support ongoing evaluation and improvement of AI systems used for clinical care.