Clinical notes are text documents that are created by clinicians for each patient encounter. They are typically accompanied by medical codes, which describe the diagnosis and treatment. Annotating these codes is labor intensive and error prone; furthermore, the connection between the codes and the text is not annotated, obscuring the reasons and details behind specific diagnoses and treatments. We present an attentional convolutional network that predicts medical codes from clinical text. Our method aggregates information across the document using a convolutional neural network, and uses an attention mechanism to select the most relevant segments for each of the thousands of possible codes. The method is accurate, achieving precision@8 of 0.71 and a Micro-F1 of 0.54, which are both better than the prior state of the art. Furthermore, through an interpretability evaluation by a physician, we show that the attention mechanism identifies meaningful explanations for each code assignment.

Attention mechanisms play a central role in NLP systems, especially within recurrent neural network (RNN) models. Recently, there has been increasing interest in whether or not the intermediate representations offered by these modules may be used to explain the reasoning for a model's prediction, and consequently reach insights regarding the model's decision-making process. A recent paper claims that 'Attention is not Explanation' (Jain and Wallace, 2019). We challenge many of the assumptions underlying this work, arguing that such a claim depends on one's definition of explanation, and that testing it needs to take into account all elements of the model. We propose four alternative tests to determine when/whether attention can be used as explanation: a simple uniform-weights baseline; a variance calibration based on multiple random seed runs; a diagnostic framework using frozen weights from pretrained models; and an end-to-end adversarial attention training protocol. Each allows for meaningful interpretation of attention mechanisms in RNN models. We show that even when reliable adversarial distributions can be found, they don't perform well on the simple diagnostic, indicating that prior work does not disprove the usefulness of attention mechanisms for explainability.

In many settings it is important for one to be able to understand why a model made a particular prediction. In NLP this often entails extracting snippets of an input text 'responsible for' corresponding model output; when such a snippet comprises tokens that indeed informed the model's prediction, it is a faithful explanation. In some settings, faithfulness may be critical to ensure transparency. Lei et al. (2016) proposed a model to produce faithful rationales for neural text classification by defining independent snippet extraction and prediction modules. However, the discrete selection over input tokens performed by this method complicates training, leading to high variance and requiring careful hyperparameter tuning. We propose a simpler variant of this approach that provides faithful explanations by construction. In our scheme, named FRESH, arbitrary feature importance scores (e.g., gradients from a trained model) are used to induce binary labels over token inputs, which an extractor can be trained to predict. An independent classifier module is then trained exclusively on snippets provided by the extractor; these snippets thus constitute faithful explanations, even if the classifier is arbitrarily complex. In both automatic and manual evaluations we find that variants of this simple framework yield predictive performance superior to 'end-to-end' approaches, while being more general and easier to train.

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In interpretable NLP, we require faithful rationales that reflect the model's decision-making process for an explained instance. While prior work focuses on extractive rationales (a subset of the input words), we investigate their lessstudied counterpart: free-text natural language rationales. We demonstrate that pipelines, models for faithful rationalization on informationextraction style tasks, do not work as well on "reasoning" tasks requiring free-text rationales. We turn to models that jointly predict and rationalize, a class of widely used high-performance models for free-text rationalization. We investigate the extent to which the labels and rationales predicted by these models are associated, a necessary property of faithful explanation. Via two tests, robustness equivalence and feature importance agreement, we find that stateof-the-art T5-based joint models exhibit desirable properties for explaining commonsense question-answering and natural language inference, indicating their potential for producing faithful free-text rationales. 1