Fine-tuning pretrained models for automatically summarizing doctor-patient conversation transcripts presents many challenges: limited training data, significant domain shift, long and noisy transcripts, and high target summary variability. In this paper, we explore the feasibility of using pretrained transformer models for automatically summarizing doctor-patient conversations directly from transcripts. We show that fluent and adequate summaries can be generated with limited training data by fine-tuning BART on a specially constructed dataset. The resulting models greatly surpass the performance of an average human annotator and the quality of previous published work for the task. We evaluate multiple methods for handling long conversations, comparing them to the obvious baseline of truncating the conversation to fit the pretrained model length limit. We introduce a multistage approach that tackles the task by learning two fine-tuned models: one for summarizing conversation chunks into partial summaries, followed by one for rewriting the collection of partial summaries into a complete summary. Using a carefully chosen fine-tuning dataset, this method is shown to be effective at handling longer conversations, improving the quality of generated summaries. We conduct both an automatic evaluation (through ROUGE and two concept-based metrics focusing on medical findings) and a human evaluation (through qualitative examples from literature, assessing hallucination, generalization, fluency, and general quality of the generated summaries).

Structured prediction is often approached by training a locally normalized model with maximum likelihood and decoding approximately with beam search. This approach leads to mismatches as, during training, the model is not exposed to its mistakes and does not use beam search. Beam-aware training aims to address these problems, but unfortunately, it is not yet widely used due to a lack of understanding about how it impacts performance, when it is most useful, and whether it is stable. Recently, Negrinho et al. (2018) proposed a meta-algorithm that captures beam-aware training algorithms and suggests new ones, but unfortunately did not provide empirical results. In this paper, we begin an empirical investigation: we train the supertagging model of Vaswani et al. (2018) and a simpler model with instantiations of the meta-algorithm. We explore the influence of various design choices and make recommendations for choosing them. We observe that beam-aware training improves performance for both models, with large improvements for the simpler model which must effectively manage uncertainty during decoding. Our results suggest that a model must be learned with search to maximize its effectiveness.