Diagnosing and mitigating changes in model fairness under distribution shift is an important component of the safe deployment of machine learning in healthcare settings. Importantly, the success of any mitigation strategy strongly depends on the \textit{structure} of the shift. Despite this, there has been little discussion of how to empirically assess the structure of a distribution shift that one is encountering in practice. In this work, we adopt a causal framing to motivate conditional independence tests as a key tool for characterizing distribution shifts. Using our approach in two medical applications, we show that this knowledge can help diagnose failures of fairness transfer, including cases where real-world shifts are more complex than is often assumed in the literature. Based on these results, we discuss potential remedies at each step of the machine learning pipeline.

Machine learning (ML) systems often exhibit unexpectedly poor behavior when they are deployed in real-world domains. We identify underspecification in ML pipelines as a key reason for these failures. An ML pipeline is the full procedure followed to train and validate a predictor. Such a pipeline is underspecified when it can return many distinct predictors with equivalently strong test performance. Underspecification is common in modern ML pipelines that primarily validate predictors on held-out data that follow the same distribution as the training data. Predictors returned by underspecified pipelines are often treated as equivalent based on their training domain performance, but we show here that such predictors can behave very differently in deployment domains. This ambiguity can lead to instability and poor model behavior in practice, and is a distinct failure mode from previously identified issues arising from structural mismatch between training and deployment domains. We provide evidence that underspecfication has substantive implications for practical ML pipelines, using examples from computer vision, medical imaging, natural language processing, clinical risk prediction based on electronic health records, and medical genomics. Our results show the need to explicitly account for underspecification in modeling pipelines that are intended for real-world deployment in any domain.

Self-supervised pretraining followed by supervised fine-tuning has seen success in image recognition, especially when labeled examples are scarce, but has received limited attention in medical image analysis. This paper studies the effectiveness of self-supervised learning as a pre-training strategy for medical image classification. We conduct experiments on two distinct tasks: dermatology condition classification from digital camera images and multi-label chest X-ray classification, and demonstrate that self-supervised learning on ImageNet, followed by additional self-supervised learning on unlabeled domain-specific medical images significantly improves the accuracy of medical image classifiers. We introduce a novel Multi-Instance Contrastive Learning (MICLe) method that uses multiple images of the underlying pathology per patient case, when available, to construct more informative positive pairs for self-supervised learning. Combining our contributions, we achieve an improvement of 6.7% in top-1 accuracy and an improvement of 1.1% in mean AUC on dermatology and chest X-ray classification respectively, outperforming strong supervised baselines pretrained on ImageNet. In addition, we show that big self-supervised models are robust to distribution shift and can learn efficiently with a small number of labeled medical images.

OBJECTIVE: Multitask learning (MTL) using electronic health records allows concurrent prediction of multiple endpoints. MTL has shown promise in improving model performance and training efficiency; however, it often suffers from negative transfer - impaired learning if tasks are not appropriately selected. We introduce a sequential subnetwork routing (SeqSNR) architecture that uses soft parameter sharing to find related tasks and encourage cross-learning between them. MATERIALS AND METHODS: Using the MIMIC-III (Medical Information Mart for Intensive Care-III) dataset, we train deep neural network models to predict the onset of 6 endpoints including specific organ dysfunctions and general clinical outcomes: acute kidney injury, continuous renal replacement therapy, mechanical ventilation, vasoactive medications, mortality, and length of stay. We compare single-task (ST) models with naive multitask and SeqSNR in terms of discriminative performance and label efficiency. RESULTS: SeqSNR showed a modest yet statistically significant performance boost across 4 of 6 tasks compared with ST and naive multitasking. When the size of the training dataset was reduced for a given task (label efficiency), SeqSNR outperformed ST for all cases showing an average area under the precision-recall curve boost of 2.1%, 2.9%, and 2.1% for tasks using 1%, 5%, and 10% of labels, respectively. CONCLUSIONS: The SeqSNR architecture shows superior label efficiency compared with ST and naive multitasking, suggesting utility in scenarios in which endpoint labels are difficult to ascertain.