MedFeat: Model-Aware and Explainability-Driven Feature Engineering with LLMs for Tabular Prediction

Progress in tabular machine learning has largely focused on increasingly sophisticated model architectures. At the same time, feature engineering remains a critical yet underexplored component of real-world modeling pipelines that is entirely absent from modern benchmarks, which creates an unquantified evaluation gap. In this work, we introduce TabPrep, a lightweight preprocessing pipeline composed of feature generators that are carefully designed to target three specific structural data patterns. We show that many widely used model classes exhibit predictable blind spots to these patterns and that systematic feature engineering alone can establish new peak performance. Across the TabArena benchmark, integrating TabPrep into model training and tuning consistently improves performance for tree-based, neural, linear, and foundation models, often surpassing gains achieved by model-centric innovations alone. TabPrep outperforms previous automated feature engineering approaches in performance, efficiency, and applicability across datasets, enabling integration into large-scale benchmarks. By releasing TabPrep (see https://github.com/atschalz/tabprep), we enable researchers to integrate feature engineering into their benchmarking setup, filling a longstanding gap in tabular evaluations.

Automatic feature engineering (AutoFE) for tabular data requires discovering informative transformations from a large program space. Existing approaches suffer from three limitations: classical methods rely on fixed operator libraries with limited expressivity, LLM-based methods generate proposals from static prompts without retaining search experience, and evolutionary methods use fixed migration policies that ignore task-specific cross-family transfer utility. We introduce TOPOFE, a framework that formulates AutoFE as graph-structured multi-island evolutionary program search. The transformation space is partitioned into semantically coherent families, each explored by an island through LLM-guided mutation and crossover. Each island maintains a Prompt Adaptation Memory that accumulates accept/reject feedback to steer proposals toward productive regions without parameter updates. To coordinate global exploration, TOPOFE dynamically learns a directed topology graph whose edge weights encode transfer utility between transformation families. Cross-island transfer is triggered by adaptive saturation detection and performed through LLM-mediated hybrid synthesis, enabling discovery of compositional feature programs that cannot emerge from isolated local search. Experiments on 29 tabular datasets show that TOPOFE consistently outperforms most state-of-the-art AutoFE methods on classification and regression tasks. Beyond predictive performance, TOPOFE produces feature sets with lower redundancy and higher representational coverage, while the learned topology graph acquires meaningful task-specific transfer structure correlated with downstream gains. The discovered feature programs transfer reliably across diverse predictors and LLM backbones, demonstrating that improvements arise from TOPOFE's structured search and adaptive coordination rather than backbone-specific generation capability.

Predictive modeling for clinical decision support requires both strong predictive performance and transparent, auditable, and human-reviewable decision logic. Although deep learning and tree-based ensemble methods can achieve high accuracy, their black-box nature remains a major obstacle to trustworthy clinical deployment. Moreover, clinical prediction often operates under practical constraints, including limited sample sizes, severe class imbalance, and feature evolution arising from changes in diagnostic criteria or clinical documentation practices. We propose Medical Heuristic Learning (MHL), a constrained paradigm for LLM-assisted rule learning. Rather than relying on updates to implicit model weights, MHL integrates statistical probes, medical knowledge probes, initial rule synthesis, and iterative rule optimization to construct an executable rule-based expert system. The resulting rule system is expressed entirely using the native logical and control-flow constructs of a programming language. Valid rule versions are recorded and retained along the search trajectory, making the decision logic explicit, interpretable, and auditable. MHL also supports continual learning by using previously validated rules as a starting point and iteratively revising them in response to updated feature information under data drift or feature evolution. MHL is not tied to any specific programming language. Comprehensive experiments on medical datasets show that MHL achieves predictive performance comparable to that of state-of-the-art methods, performs favorably in small-sample and highly imbalanced settings, and supports the transfer and adaptive revision of validated rules under feature evolution. Overall, these findings suggest that non-gradient-based heuristic systems offer an approach to balancing predictive performance and transparency in clinical decision support.