cs.CRMay 7, 2026

Research on Security Enhancement Methods for Adversarial Robust Large Language Model Intelligent Agents for Medical Decision-Making Tasks

Authors: Saisai Hu

Organizations: Pace University · New York, NY 10038 · United States

Abstract

Motivated by the challenge to improve the adversarial robustness, security, and trust of medical decision making intelligent agents, this study develops a full-link security enhancement framework, which describes "input risk perception - medical evidence constraint - knowledge consistency verification - decision confidence reweighting - security output control - adversarial feedback update." We propose ARSM-Agent and define a weighted joint objective consisting of decision accuracy loss, adversarial robustness loss, safety refusal loss, and knowledge consistency loss, with weights of 0.3, 0.3, 0.2, and 0.2, respectively. The whole medical decision formulation is implemented by multi-module collaborative linkage. We verify that the algorithm is more efficient than four baselines, including LLM-Agent, Retrieval-Agent, Filter-Agent, and Adv-Train-Agent. Under semantic perturbation, prompt injection, drug-name confusion, and false-evidence attacks, ARSM-Agent reduces the overall attack success rate to 8.7% and achieves a knowledge consistency score of 0.91. Ablation experiments quantify each module's contribution: removing risk perception, evidence retrieval, consistency verification, and confidence reweighting reduces accuracy by 6.7%, 9.1%, 7.6%, and 4.4%, respectively, and increases attack success rate by 13.8%, 11.1%, 8.6%, and 6.9%. The proposed approach addresses key security issues of medical decision making intelligent agents, obtains secure decision making in challenging scenarios, and provides reliable intelligent support for medical decision-making intelligent agents.

Explore similar work

CardsList
Jun 27, 2026cs.CR

Why Trust Your Agent? Empirical Security Gains from TRiSM-Guided Agentic Workflows in Healthcare

Agent-based AI has enabled the automation of tasks by exposing application tools and resources to large language models (LLMs). However, to improve scope and accuracy, agents are often given access rights that exceed those of ordinary users, introducing significant security risks. AI is routinely integrated into applications with a disregard to security, risking data exposure and breaching regulations. This paper applies the AI Trust, Risk, and Security Management (TRiSM) framework to a medical report-generation application to demonstrate how an insecure agent workflow can be transformed into security-conscious agentic workflow. Both workflows were evaluated across five LLMs (Claude Haiku 4.5, GPT-4.1-nano, GPT-4.1-mini, GPT-5.4-mini, and Gemini 2.5 Flash) on two report types, totalling 800 generations and 500 attack scenarios including RAG poisoning, data-field injection, and client-side network injection. The TRiSM-guided agentic workflow reduced mean attack success rates from 31% to 10% for RAG poisoning and from 42% to 25% for data-field injection, while eliminating the network injection vector entirely through server-side prompt construction. Furthermore, report accuracy increased by 14 percentage points (72.5% to 86.5%) with the agentic workflow, demonstrating a secure design which provides more reliable outputs. This paper contributes to knowledge by demonstrating least-privilege, defence in depth agentic workflows improving security and accuracy, while also highlighting model choice is a necessary architectural consideration.
Liam Kearns
Agentic WorkflowsSecurity AnalysisLarge Language Model SafetyReal-World Clinical WorkflowsHigher Attack Success RatesMedical Report Generation+1
AskPDF
Apr 23, 2026cs.AI

When Correct Beliefs Collapse: Epistemic Resilience of LLMs under Clinical Pressure

Despite strong medical benchmark accuracy, LLMs can exhibit severe multi-turn sycophancy in clinical dialogue, abandoning initial correct diagnosis under escalating pressure. We propose \textbf{\textsc{Med-Stress}}, a targeted stress test framework that evaluates belief stability under escalating pressure. Across nine frontier large language models (LLMs), we find a clear dissociation between medical knowledge and robustness: high initial diagnostic capability does not imply high belief stability, yielding large knowledge-robustness gaps for several LLMs. To mitigate this failure mode, we propose a lightweight inference-time defense, \textbf{\texttt{RBED}} (\textbf{R}ole-\textbf{B}ased \textbf{E}pistemic \textbf{D}efense), and \textbf{\texttt{R-FT}} (\textbf{R}esilience-oriented \textbf{F}ine-\textbf{T}uning), a training-time approach that internalizes evidence-based resistance to pressure. Experiments show that \textbf{\texttt{R-FT}} nearly eliminates belief change and substantially improves robustness.
Boyu Xiao, Xiuqi Tian, Xuwen Song +4
Large Language Model ReliabilityStress TestingBeliefEpistemic ActionsSplit Hopkinson Pressure Bar Configuration
AskPDF
May 27, 2026cs.AI

SafeMed-R1: Clinician-Audited Safety and Ethics Alignment for Medical Large Language Models

Large language models(LLMs) increasingly match expert performance on licensing examinations, yet routine clinical use remains limited because governance requires auditable reasoning, safety and ethics alignment, and resilience to adversarial misuse. Here we present SafeMed-R1, trained with a traceable Clinical Trust Signals(CTS) pipeline that links each reasoning instance to clinician rubric scores and edit histories, and aligned through safety and ethics supervision and red team stress testing. SafeMed-R1 attains a macro-averaged accuracy of 79.6% across clinical benchmarks. Under adversarial safety testing, it shows the lowest aggregated risk and reduces unsafe outputs by about 3 to 5% relative to its baseline. In a paired expert study of 30 medication safety vignettes, SafeMed-R1 matches PGY1 and PGY2 residents on medical correctness and scores higher for medication safety, guideline consistency, and clinical usefulness. Collectively, these results suggest that clinician-audited supervision provenance, together with domain-tailored safety and ethics alignment, can strengthen governance-relevant evidence without relying on inference-time retrieval or citation grounding.
Chao Ding, Mouxiao Bian, Tianbin Li +12
Large Language Model SafetySafetySafeguardAdversarial EvaluationEthics
AskPDF