Effects of Cross-lingual Evidence in Multilingual Medical Question Answering

Large Language Models (LLMs) with reasoning capabilities have recently demonstrated strong potential in medical Question Answering (QA). Existing approaches are largely English-focused and primarily rely on distillation from general-purpose LLMs, raising concerns about the reliability of their medical knowledge. In this work, we present a method to generate multilingual reasoning traces based on medical knowledge extracted from Wikipedia. We produce 500k traces in English, Italian, and Spanish, using a retrieval-augmented generation approach over medical information from Wikipedia. The traces are generated to solve medical questions drawn from MedQA and MedMCQA, which we extend to Italian and Spanish. We test our pipeline in both in-domain and out-of-domain settings across Medical QA benchmarks, and demonstrate that our reasoning traces improve performance both when utilized via in-context learning (few-shot) and supervised fine-tuning, yielding state-of-the-art results among 8B-parameter LLMs. We believe that these resources can support the development of more transparent clinical decision-support tools in multilingual settings. We release the full suite of resources: reasoning traces, translated QA datasets, Medical-Wikipedia, and fine-tuned models.

Retrieval-augmented generation (RAG) in clinical settings increasingly requires multilingual retrieval against predominantly English evidence corpora. Multilingual medical retrieval demands three capabilities: cross-lingual alignment, concept discrimination, and evidence retrieval. However, existing benchmarks evaluate these only in isolation, leaving the interaction between biomedical expertise and multilingual coverage unmeasured. We introduce MMed-Bench-IR, a benchmark designed to disentangle these axes across 6 languages and three structurally heterogeneous tasks: (1) cross-lingual medical QA retrieval with 6,127 queries grounded in the Unified Medical Language System (UMLS), (2) concept discrimination over 4,975 confusion sets at three difficulty tiers, and (3) multilingual evidence retrieval for RAG with 2,040 quality-assured queries. The three tasks share zero concept and query overlap by design, ensuring that aggregate scores reflect genuine capability breadth. Evaluation of ten systems across six paradigm families reveals severe cross-lingual failure: biomedical encoders that score 0.818 nDCG@10 in English drop to 0.056 in Japanese, a gap that English-only benchmarks cannot detect.

Equitable access to reliable health information is vital when integrating AI into healthcare. Yet, information quality varies across languages, raising concerns about the reliability and consistency of multilingual Large Language Models (LLMs). We systematically examine cross-lingual disparities in pre-training source and factuality alignment in LLM answers for multilingual healthcare Q&A across English, German, Turkish, Chinese (Mandarin), and Italian. We (i) constructed Multilingual Wiki Health Care (MultiWikiHealthCare), a multilingual dataset from Wikipedia; (ii) analyzed cross-lingual healthcare coverage; (iii) assessed LLM response alignment with these references; and (iv) conducted a case study on factual alignment through the use of contextual information and Retrieval-Augmented Generation (RAG). Our findings reveal substantial cross-lingual disparities in both Wikipedia coverage and LLM factual alignment. Across LLMs, responses align more with English Wikipedia, even when the prompts are non-English. Providing contextual excerpts from non-English Wikipedia at inference time effectively shifts factual alignment toward culturally relevant knowledge. These results highlight practical pathways for building more equitable, multilingual AI systems for healthcare.