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Developing reliable AI tools for healthcare

New research proposes a system to determine the relative accuracy of predictive AI in a hypothetical medical setting, and when the system should defer to a human clinician
Artificial intelligence (AI) has great potential to enhance how people work across a range of industries. But to integrate AI tools into the workplace in a safe and responsible way, we need to develop more robust methods for understanding when they can be most useful.
So when is AI more accurate, and when is a human? This question is particularly important in healthcare, where predictive AI is increasingly used in high-stakes tasks to assist clinicians.
Today in Nature Medicine, we’ve published our joint paper with Google Research, which proposes CoDoC (Complementarity-driven Deferral-to-Clinical Workflow), an AI system that learns when to rely on predictive AI tools or defer to a clinician for the most accurate interpretation of medical images.
CoDoC explores how we could harness human-AI collaboration in hypothetical medical settings to deliver the best results. In one example scenario, CoDoC reduced the number of false positives by 25% for a large, de-identified UK mammography dataset, compared with commonly used clinical workflows – without missing any true positives.
This work is a collaboration with several healthcare organisations, including the United Nations Office for Project Services’ Stop TB Partnership. To help researchers build on our work to improve the transparency and safety of AI models for the real world, we’ve also open-sourced CoDoC’s code on GitHub.
CoDoC: Add-on tool for human-AI collaboration
Building more reliable AI models often requires re-engineering the complex inner workings of predictive AI models. However, for many healthcare providers, it’s simply not possible to redesign a predictive AI model. CoDoC can potentially help improve predictive AI tools for its users without requiring them to modify the underlying AI tool itself.
When developing CoDoC, we had three criteria:
- Non-machine learning experts, like healthcare providers, should be able to deploy the system and run it on a single computer.
- Training would require a relatively small amount of data – typically, just a few hundred examples.
- The system could be compatible with any proprietary AI models and would not need access to the model’s inner workings or data it was trained on.
Determining when predictive AI or a clinician is more accurate
With CoDoC, we propose a simple and usable AI system to improve reliability by helping predictive AI systems to ‘know when they don’t know’. We looked at scenarios, where a clinician might have access to an AI tool designed to help interpret an image, for example, examining a chest x-ray for whether a tuberculosis test is needed.
For any theoretical clinical setting, CoDoC’s system requires only three inputs for each case in the training dataset.
- The predictive AI outputs a confidence score between 0 (certain no disease is present) and 1 (certain that disease is present).
- The clinician’s interpretation of the medical image.
- The ground truth of whether disease was present, as, for example, established via biopsy or other clinical follow-up.
Note: CoDoC requires no access to any medical images.
CoDoC learns to establish the relative accuracy of the predictive AI model compared with clinicians’ interpretation, and how that relationship fluctuates with the predictive AI’s confidence scores.
Once trained, CoDoC could be inserted into a hypothetical future clinical workflow involving both an AI and a clinician. When a new patient image is evaluated by the predictive AI model, its associated confidence score is fed into the system. Then, CoDoC assesses whether accepting the AI’s decision or deferring to a clinician will ultimately result in the most accurate interpretation.
Increased accuracy and efficiency
Our comprehensive testing of CoDoC with multiple real-world datasets – including only historic and de-identified data – has shown that combining the best of human expertise and predictive AI results in greater accuracy than with either alone.
As well as achieving a 25% reduction in false positives for a mammography dataset, in hypothetical simulations where an AI was allowed to act autonomously on certain occasions, CoDoC was able to reduce the number of cases that needed to be read by a clinician by two thirds. We also showed how CoDoC could hypothetically improve the triage of chest X-rays for onward testing for tuberculosis.
Responsibly developing AI for healthcare
While this work is theoretical, it shows our AI system’s potential to adapt: CoDoC was able to improve performance on interpreting medical imaging across varied demographic populations, clinical settings, medical imaging equipment used, and disease types.
CoDoC is a promising example of how we can harness the benefits of AI in combination with human strengths and expertise. We are working with external partners to rigorously evaluate our research and the system’s potential benefits. To bring technology like CoDoC safely to real-world medical settings, healthcare providers and manufacturers will also have to understand how clinicians interact differently with AI, and validate systems with specific medical AI tools and settings.
Learn more about CoDoC:
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From postmodernism to artificial intelligence

Postmodernism can also be read as a prophecy. It denied inspiration and promoted combination. Postmodernism as a combinatorial art has brought the algorithmic model ChatGPT. This new machine surpasses even the most encyclopedic postmodern writer. Therefore, there is no point in competing with technology in the work of information. We were lucky to be the smartest on the planet. Now we must accept that AI is ahead of us
Albanian literature of Kosovo is a new literature, after the Second World War. But, it is only a branch, which is naturally linked linguistically and literaryly to Albania, as well as to the Albanian part of Montenegro and Macedonia, and of course also to the Diaspora. There have been and continue to be voices that insist that the literature of Kosovo is independent of the literature of Albania, and vice versa. So, Albanians with two states have two literatures, while the United States of America with 50 states has one literature. A provincialist voice that is not taken seriously today.
However, at a time when Kosovo and Albania were also part of the Communist Bloc, although separately, the official method of literary writing was socialist realism, but since Kosovo was included within Yugoslavia, there was greater freedom of writing, thanks to the Croatian writer Miroslav Kërlezha, who, being the president of the Writers’ League of Yugoslavia and an indisputable literary authority, managed to make the official method optional, not mandatory. So, the preferred method was socialist realism, but others were also allowed. Taking advantage of this freedom, since the 60s, in Yugoslavia we have novels like those by Danillo Kishi, “Attic”, “Psalm 44”, and later “A Grave for Boris Davidović”, “Encyclopedia of the Dead”, etc.
The most famous novel of Kosovo
In this free atmosphere for narrative experiments, the first practices of an alternative aesthetic in Kosovo also appeared. In the magazine “Jeta e Re”, from the first issue of 1972 to the first issue of 1974, stories appeared whose author was an unknown name in Kosovo: Luan Dukagjini. No one knew this name, except for the founder and publisher of the magazine, Esad Mekuli, who kept the author in complete secrecy. Only after the stories were published in the magazine and aroused a double interest: for the new storytelling model and for the unknown author, was the issue resolved, by publishing all the stories in a book with the author’s real name: Rexhep Qosja, “Death Comes to Me from Such Eyes”, thirteen stories that could make a novel. So, behind the mask of an unknown author, he was the most famous author in Kosovo, about whom critic Ali Aliu says that even his studies were read more than the prose and poetry of other Kosovar authors.
Rexhep Qosja did not hide behind the pseudonym for political reasons, but because he thought that, being already known as a professor and researcher, he would not be taken seriously in prose. This fear of moving from the academic world to the artistic world has been shared by many others, including Umberto Eco, because people who are known for works of consciousness are afraid of suddenly moving into works of the subconscious. They consider themselves more scientists than writers. So, they want to be known as knowledgeable, not as stupid.
Thus, postmodernism entered Albanian literature with great hesitation, but in a natural flow. A man who was known as a scholar, became a writer. There was no better way, when it is known that this formation has its strongest point in knowledge (information). Talent and inspiration alone are not enough to be a postmodernist. Knowledge, preferably encyclopedic, is a necessary condition. Thus, it was necessary for someone who had completed studies, had earned titles, and had accumulated knowledge, to be able to bring this poetics among us. So, it was no coincidence that this man brought this model to Kosovo and became not only the founder, but also the main representative in Albanian literature. And it is no wonder that, to this day, “Death Comes to Me Through Such Eyes” is the most translated novel from Kosovo. So, for more than half a century this is still the most famous novel from Kosovo.
In the 70s, Qosja dominated as a writer of prose and drama. In the 80s, due to the worsening situation, he returned to the role of scholar and public intellectual.
In Kosovo, the postmodernist model of the writer coming to the field of fiction from epistemological fields only re-emerged in the 90s with Kujtim Rrahmani, who had begun his career as a researcher. This trend continued into the 21st century, when researchers moved into prose: Agron Y. Gashi, Gëzim Aliu, Adil Olluri, and others.
In Albania, postmodernism was unimaginable before the 90s. Just take a look at Vath Koreshi’s essays written during the dictatorship. Meanwhile, during the 90s, new prose writers emerged who embraced the postmodern model, such as Ridvan Dibra and Agron Tufa, or even two others who came from the world of film (screenwriting): Bashkim Hoxha and Bashkim Shehu. Surprisingly, this model also attracted the author Vath Koreshi, who once publicly reviled postmodernism. There were also authors who had started out in communism, but quickly switched to the new model, such as Zija Çela and Besnik Mustafaj. This model did not even leave the most famous Albanian writer, Ismail Kadare, indifferent, who was not very concerned with fashion. Meanwhile, in Macedonia, two works appeared that can now be considered classic works of postmodernism, “The Time of Goats” (Luan Starova) and “The Years of Urith” (Kim Mehmeti).
This means that a literary model, welcomed by readers and ignored by scholars, became dominant in Albanian literature at the end of the 20th century, and continues to this day. Even the most beautiful postmodern novels were written in this century by authors such as: Ridvan Dibra, Agron Tufa, Besnik Mustafaj, Stefan Çapaliku, Durim Taçi, etc.
Heresy and the Inquisition
We must not forget that Kosovo’s literature, until the postmodern alternative was found, was written either with a simplistic and traditional realism, or with a “psychedelic modernism”, trying to graft European modernism (Proust, Joyce, Kafka, up to Alain Rob-Grillet, Nathalie Sarraute, Claude Simon) with the modernism of pre-war Albania (Koliqi, Kuteli, Fishta, Migjeni, etc.). Thus, the two best modernist authors of Kosovo, Anton Pashku and Azem Shkreli, one in prose, the other in poetry, brought ethno-modernist works, that is, a modernism with a twist. Pashku between Koliqi and Claude Simon, Azem Shkreli between Migjeni, Martin Camaj and Vasko Popa, whom he also translated. While Migjeni is a frequent reference to Shkreli, while Camaj mainly in the wisdom of the highlander, the shadow of Vasko Popa appears in his best poems. Just read them one after the other: “Instead of Greetings” (Shkreli) and “Let’s Get My Pieces Back” (Popa).
Meanwhile, Rexhep Qosjen, who was not impressed by Albanian modernism, neither the pre-war one in Albania nor the post-war one in Kosovo, as can be seen from his novel, and as he says in his diary, was particularly impressed by Danillo Kish and Kurt Vonnegut, who at that time was quite translated and well-known in Yugoslavia. In this way, the postmodern alternative was a kind of aesthetic heresy. And it was normal for the heretic to talk about persecution by the Inquisition, which monitored the intellectual like a Big Brother. Therefore, the title could also be “Death Comes to Me from the Eyes of Big Brother”.
This alternative, this heresy, was necessary for Albanian literature. It overturned literary monism (modernist, or socialist realist, it doesn’t matter) and promoted pluralism. Many writers from Kosovo, Albania and Macedonia joined this heresy, while Montenegro has the merit of bringing our first heretic. So, in a way, all the pieces of Albanian lands were united. This is a fact, however, the last thing postmodernism would like to promote is patriotism.
Although ignored by Albanian literary criticism, which was completely unprepared to follow the rapid pace of literary change, postmodernism changed the face of Albanian literature. This change was made both in terms of structuring and in the way of communication. Paradoxically, writers abandoned hermetic modernist forms, through double coding. While, for example, Pashku’s novel was barely decipherable by specialists, Dibra’s novels are understood by both types of readers: specialists and amateurs. So, while Pashku barely penetrated a type of reader who, when unable to decipher, invented the meaning, because the reader has the right to invent the meaning, in Dibra the elite reader has fun decoding the semiotic line, while the popular reader (the one who reads just to pass the time) has fun with the semantic line. Let’s not forget that Albanian literature had reached the point where it was easier to understand Proust, Kafka, Joyce, TS Eliot, Faulkner than the Kosovar modernists. On the other hand, as soon as you read any discursive writing by these people, you realized that their education was very modest. I think this only happens to poser writers, not real ones. Paul Valéry is a genius in poetry, prose and essays, even in occasional speeches. You can be a genius in something and mediocre in something else, but not a genius in prose and an idiot in essays, for example. Therefore, I suggest that when we like an Albanian poet or prose writer, we also read his essay writings, before forming an impression of him. This is not always the clearest indicator, but in most cases, it helps a lot.
So, postmodernism has great merit for the survival of the reader, who was in his last moments due to fatigue from socialist realist literature and lack of communication with modernist literature. On one side there were extremely open works, and on the other side there were hermetically closed works. Albanian postmodern authors, with alternative poetics, created two types of readers, of which the semiotic reader was often profiled as a critic. And, in this way, the author created the model reader, while the reader the model author. The postmodern author has saved, entertained, formed and emancipated the reader in general, while he has also familiarized the new reader with new techniques and notions.
Postmodernism and criticism
Until the end of the first decade of this century, one could not speak of criticism of postmodernism, but only of criticism of postmodernism. Since structuralist criticism was applied, the postmodernist paradigm was rejected. However, in the meantime, new voices of scholars emerged and master’s and doctoral theses began to be defended, and books were written on postmodern works and phenomena, consequently new approaches began to appear, with a different terminology, completely different from that which analyzed modernist texts. Many novels appeared as found manuscripts, while the author as a discoverer and commentator of them, such as, for example, Vath Koreshi with “Ulku dhe Uilli”, Rexhep Qosja with “Një dashuri dhe shtëtë faje”, or Agron Tufa with “Gurit të varrit ia rrëfej”. Also, Qosja’s prose, like that of Dibra, was distinguished by the frequent use of anaphora and enumeration. While, almost all authors played with historiographic metafiction, double coding, poioumenon, intertextual irony, collage, bricolage, pastiche, etc., and this created a postmodern condition, which displayed distrust in all metanarratives, and also included gynocentric discourse to destabilize patriarchal and androcentric discourse, in general. This category includes novels and stories by authors such as Flutura Açka, Besa Myftiu, Rita Petro and others. I would like to list many poets here, but poetry is not a representative genre in postmodernism.
In the 90s, when Albanian postmodern works flooded in, people started talking about the death of postmodernism in Europe. In 2008, Raoul Eshelman published the book “Performatism, or the End of Postmodernism”, while in 2009, Alan Kirby published the book “Digimodernism, How New Technologies Dismantle the Postmodern and Reconfigure Our Culture”. In 2010, I published a sketch of the end of postmodernism. This sketch was expanded in the meantime, and in 2017, it was published in English and in several languages and magazines, under the title “The End of the Age of Endings”, and this year it is also being published as a separate book. Usually, I am not self-referential in criticism, but I mentioned this to show that we, Albanians, have also begun to say goodbye to postmodernism, and, as they say today, we have coordinated with foreigners before going to the funeral ceremony of this formation, which remains the last ‘ism’ accepted by foreign scholars. Some scholars and artists have also proposed names for the new era, the era that comes after postmodernism: post-postmodernism, trans-postmodernism, post-millennialism, performatism, digital modernism, metamodernism, stacism, remodernism, altermodernism, hypermodernism, etc., but also other names and manifestos, related to a certain field, that contribute to, or compete with these concepts, such as: New Sincerity, New Puritanism, Dogma 95, etc. I think that the term Hysterical Realism used by James Wood, helps a lot in distancing ourselves from postmodernism. This year marks a quarter of a century since this term was first used, and authors themselves have begun to be more careful not to categorize themselves within it.
Now theorists say that postmodernism has ended, while we see that Albanian writers continue to write postmodern works. However, in the last decade we see that some authors are successfully distancing themselves from postmodernism, since in their narratives either sincerity or emotion dominates, or both. Postmodern work, in its best manifestation, was rational, rarely had emotional elements. Now the narrative has been personalized, autofiction has become dominant. So, we see a retreat of postmodernism to make way for a new current, or spirit.
It is now clear that even in Albanian literature, postmodernism is in its final stages. We are now at a time when we can divide writers into dinosaurs and chameleons. That is, into those who die as soon as their poetics are finished, and into others who adapt to new poetics, even leading to poetics that have not yet arrived. New poetics are created either by completely ignoring old poetics, or by taking from them marginal elements and turning them into central ones. The latter is happening in Albanian literature.
Results register
As proof that postmodernism has been present and successful for half a century, are the names of prominent authors and their works. One cannot ignore a formation that has brought works such as these: “Death comes to me from such eyes”, “A love and seven sins”, “The night is our day”, “Nude”, “The legend of loneliness”, “In search of the lost child”, “Sleeping on the snow”, “I tell the tombstone”, “The Chronicles of the fog”, “The time of the goats”, “The years of the urith”, “Each goes crazy in his own way”, “Born backwards”, etc. Another element that unites Albanian postmodernism is the theme of communism, treated by Qosja, Starova, Mehmeti, Dibra, Tufa, Çapaliku, Shehu, Hoxha, Açka, Petro etc. But, perhaps communism is the most generally treated theme in contemporary Albanian literature. It can be freely said that he is its main theme.
That postmodern authors have enriched Albanian literature, in many aspects (thematic, stylistic, formal, philosophical, etc.), is today indisputable. But why was postmodernism received with kicks from the departments and critics? Because one thing was not understood: that literature does not progress, but only changes. The reader gets tired of one form and seeks another. Poetics that are closed are not thrown away (not even socialist realism, which in the history of literature is the most politically instrumental); they are only conserved, turned into classics. Postmodernism, like modernism and all other isms, is not a value, but a new form of expression. Therefore, even the most postmodern works of an author do not mean that they are his best. For example, Qosje’s most postmodern work is “Nobody’s Sons”, but it is not the best (the first three novels are much better); the novels about Gjergj Elez Ali by Ridvan Dibra are the most postmodern, but not the best (“The Legend of Solitude” and “Sleep on the Snow” are much better); the novel “I Tell the Gravestone” by Agron Tufa is the most postmodern, but not the best (“Black Friday” is much better); “An Impossible Novel” by Besnik Mustafaj is the most postmodern, but not the best (many of his other novels are better), and so on. Perhaps only “Ulku dhe Uilli” is the best and most postmodern novel by Vath Koresh.
So, what criticism should have understood and then supported is the fact that poetics (models, paradigms, formations, currents) come back into fashion for a while, but this does not invalidate the old ones. It is ridiculous to think that any contemporary writer is better than Homer, Aeschylus, Dante, Shakespeare, Goethe, or Gogol. Beyond poetics, beyond forms, writers are valued for the depth of reflection, the beauty of expression, and vision. They do not simply bear witness to an event. No. They reflect on the event, tell it in a specific way, and from it derive messages for the present and the future. Poetics unites writers of a time or a place, while what separates them from each other is precisely the authenticity thanks to which they occupy an eternal place not only in literature, but in the history of civilization. As Ezra Pound says: a civilization is founded on Homer.
So, it should be clear that postmodern authors are not better than modern authors, or that today’s authors are not better than those of yesterday. Not at all. Model and value are two things. Each time has its own fashion, but when we compare beyond fashion, that is, only what is deep, philosophical, or spiritual, we cannot help but agree with the painter Marc Chagall who said: what value is the Pope’s expensive suit compared to the rags of Christ?!
We must always be aware of this.
Postmodernism and ChatGPT
Postmodernism can also be read as a prophecy. It denied inspiration and, instead, promoted combination. Almost all postmodern theorists and writers agree that literature is an ars combinatoria. So, postmodernism was the master of combining information. Towards the end of 2022, ChatGPT was invented, as a generative artificial intelligence. A few years ago, I said that the death certificate of postmodernism should include the date of Umberto Eco’s death (February 19, 2016). He was an information machine before the invention of this artificial platform. But an author who writes postmodern works after 2022 cannot be taken seriously, and even deserves to be reviled as a hysterical realist, or as Don Quixote. ChatGPT has already replaced the scribblers (requests, recommendations, descriptive articles), as well as the average writer and translator.
Postmodernism as a combinatorial art has brought this algorithmic model. Once the competition in literature was only between people, now we have a new competition, with Artificial Intelligence (AI). As for information, this new machine surpasses even the most encyclopedic postmodern writer. Therefore, it makes no sense to compete with technology in the work of information. We were lucky to be the smartest on the planet. We must now accept that AI is ahead of us, and that, as one of the CEOs said, no child born from now on will be more intelligent than Artificial Intelligence. Kazuo Ishiguro (“Klara and the Sun”, 2021) and Olga Ravn (“The Employees”, 2020) have already successfully thematized this new challenge: humans versus humanoids.
Let’s not forget that postmodernism was information. Now information has been taken over by technology. We know the challenge that awaits us, but we don’t know how we will face it as writers. In an interview towards the end of his life, Martin Heidegger said that cybernetics will replace philosophy. What artificial intelligence will do to literature is difficult to say today, but let’s ask: Will there be a second death of the author, after what Roland Barthes declared (La mort de l’auteur, 1967)? Will the book be written by AI, or by me? In what way am I better than AI? Since I have invented something that is more intelligent than me, will AI be able to invent something more intelligent than itself?
These will be the questions that will become dominant themes in tomorrow’s literature. So, for everything we ask today, we will receive the answers tomorrow. Meanwhile, since narration is an anthropological necessity, man will walk through the narrative forests of three worlds: the material world, the spiritual world, and the artificial world.
Lecture read at the International Seminar on Albanian Language, Literature and Culture, on August 27, 2025, at the Faculty of Philology, University of Prishtina. Published with permission of the author.
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