Organizations: National University of Singapore · Yunnan University · The Ohio State University · Mohamed bin Zayed University of Artificial Intelligence
Large Language Model (LLM)-augmented Community Notes offer a scalable path for timely, evidence-grounded correction of health misinformation on social platforms. However, they still reset at every post, leaving useful correction experience from prior cases unused. We introduce EvoNote, an agentic framework that enables health Community Notes generation to self-evolve through an evolving experience memory of prior misinformation correction episodes. Its core is fine-grained credit assignment: EvoNote grounds trajectory-level feedback in health-specific note qualities and distills it into action-level memory for claim analysis, evidence acquisition, and note writing. We evaluate EvoNote on MM-HealthCN, a 1.2K-instance multimodal benchmark of user-flagged health posts with human-written Community Notes and crowd-derived helpfulness labels. Under a human-validated hierarchical utility judge, EvoNote-generated notes are preferred over corresponding human-written notes in 89.6% of cases; on a separate set of Needs More Ratings posts without a crowd helpfulness verdict, EvoNote produces helpful notes for 82.0% of cases. It also reduces the median time needed to produce a candidate correction from over 13 hours in the human-note pipeline to under 2 minutes. Analyses link these gains to stronger evidence use and reusable correction strategies, positioning self-evolving note generation as a promising paradigm for health misinformation governance.
As Large Language Models (LLMs) are increasingly deployed in healthcare settings, accurate error detection and correction in generated or existing text becomes critical, as even minor mistakes can pose risks to patient safety. Existing methods for error detection and correction, including automated checks and heuristic-based approaches, do not generalize well across unseen datasets. In this paper, we propose MedGuards as a medical safety guardrail, which is a new framework that treats medical error detection and correction as a multi-agent in-context learning task. Specialized agents separately detect, localize, and correct errors, while a confidence-guided arbitration mechanism resolves disagreements using reasoning traces and confidence scores. This design enhances interpretability, robustness, and adaptability, without requiring additional training of the base LLMs. Additionally, we introduce the Keyword-Prioritized Correction Score (KPCS), a new evaluation metric that considers whether critical keywords within the reference text are generated correctly, providing a more comprehensive assessment than conventional metrics. Experiments across four multilingual medical datasets consisting of clinical notes demonstrate significant improvements by the proposed framework across several metrics and models. Our aim is to enable safer deployment of LLMs in real-world healthcare applications. For reproducibility, we make our code publicly available at https://github.com/congboma/MedGuards.
Medical knowledge evolves continuously, whereas the parametric knowledge encoded in large language models (LLMs) is fixed at training time. External retrieval, including retrieval-augmented generation (RAG), can provide access to newly available evidence, but retrieved information may be irrelevant, incomplete, or conflicting. As a result, external retrieval can in turn degrade the factual accuracy and evidence grounding of LLM outputs. To address this challenge, we propose \textbf{CLEAR}, an agentic framework for cross-source evidence adjudication in LLMs in medicine. CLEAR independently generates candidate answers from three complementary pathways---parametric knowledge, locally curated corpora, and dynamically retrieved evidence---reflecting three common sources of information available to LLMs. An aggregation verifier jointly evaluates the candidates, supporting evidence, provenance, and source-quality information to identify agreement and conflict across sources. An adjudication module then determines whether the current conclusion should be preserved or revised through complementary override-guard and challenge-audit mechanisms, while unresolved conflicts trigger targeted follow-up search and re-adjudication.
Large language models (LLMs) can generate or synthesize clinical text for a wide range of applications, from improving clinical documentation to augmenting clinical text analytics. Yet evaluations typically focus on a narrow aspect -- such as similarity or utility comparisons -- even though these aspects are complementary and best viewed in parallel. In this study, we aim to conduct a systematic evaluation of LLM-generated clinical text, which includes intrinsic, extrinsic, and factuality evaluations of synthetic clinical notes rephrased from MIMIC databases at million-note scale. Our analysis demonstrates that synthetic notes preserve core clinical information and predictive utility for coarse-grained tasks despite substantial linguistic changes, but lose fine-grained details for task like ICD coding. We show this loss of detail can be substantially mitigated by rephrasing notes by chunks rather than by the whole note, but at the cost of reduced factual precision under incomplete context. Through fact-checking and error analysis, we further find that synthesis errors are dominated by misinterpretation of clinical context, alongside temporal confusion, measurement errors, and fabricated claims. Finally, we show that the synthetic notes -- despite their task-agnostic nature -- can effectively augment task-specific training for rare ICD codes.