Bridging the English-Arabic Medical Knowledge Gap: Targeted Low-Rank Adaptation via Causal Layer Selection
Authors: Chaimae Abouzahir, Musa Khan, Hala Ali-Hassan, Congbo Ma, Khaled Saleh, Yousra Sadqi, Jihad Mallat, Walid Al-Eisawi, +2 more
Organizations: New York University Abu Dhabi · Cleveland Clinic Abu Dhabi
Abstract
Large Language Models (LLMs) perform strongly in English medical tasks but degrade substantially in Arabic, a gap widely attributed to limited training data. We systematically investigate this assumption via tuned lens probing and causal activation patching, and find that Arabic medical knowledge is present in intermediate model representations but fails to surface at the output. This mechanistic insight motivates a targeted adaptation strategy: rather than fine-tuning the full network, we propose Targeted Low-Rank Adaptation (TLoRA), restricted to the layer window where cross-lingual representations diverge, upstream of the output layers where the failure manifests. We evaluate TLoRA on multiple-choice medical QA, where our approach outperforms full-network LoRA, zero-shot, and few-shot baselines. We further evaluate it on short-answer generation and multi-turn clinical dialogue, where it performs competitively without the need for task-specific finetuning. We additionally introduce AraClinicDialog, a clinician-constructed Arabic medical dialogue benchmark in MSA with validated variants across four Arabic dialects. Together, these contributions demonstrate that mechanistic diagnosis can serve as a practical guide for targeted adaptation in underrepresented-language medical LLMs.
We present a systematic study of healthcare-domain cross-lingual transfer to address the scarcity of biomedical NMT resources for Arabic-script languages. We use Arabic and Persian as higher-resource pivots to improve translation for \textbf{four severely low-resource} targets: Dari (Afghan Persian, a standardised variety of Persian), Pashto, Sorani Kurdish (Central Kurdish, a major standardized variety of Kurdish), and Urdu (closely related to Hindi). Using LoRA fine-tuning on small decoder-only LLMs, we train \textit{domain-specific pivot adapters} and evaluate \textbf{three transfer strategies}: few-shot in-context learning, minimal supervised adaptation, and, to the best of our knowledge, for the first time in this setting, zero-data LoRA adapter merging. Supervised adaptation with just 500 sentences achieves near pivot-language quality for Dari (CHrF++ 41.01) and meaningful gains for Urdu (28.88), while adapter merging reaches within 3.5 CHrF++ of supervised adaptation for Dari at zero additional cost. Pashto and Sorani Kurdish remain insufficient for high-stakes clinical deployment exposing the limits of cross-lingual transfer when structural distance from the pivots is too great. LoRA adapter merging works surprisingly well for closely related languages, even without target-language biomedical data.
Abdullah Alabdullah, Arash Eslamighayour, Sarp Harbalioglu +1
The development of large language models (LLMs) has led to an increased focus on their adaptation to specialized domains and languages, yet the effectiveness of domain adaptation strategies remains unclear. We present a study of medical domain adaptation using French medical question-answering (QA) as a case study. We compare continual pretraining (CPT), supervised fine-tuning (SFT), and their combination across three model families, multiple sizes, and three initialization types, explicitly disentangling adaptation effects from base model choice. We evaluate both multiple-choice (MCQA) and open-ended QA (OEQA) under greedy and constrained decoding using automatic metrics and LLM-as-a-Judge evaluation. For MCQA, CPT+SFT most often achieves the best scores, but gains over SFT are small and frequently not statistically significant, making SFT a strong and cost-effective default. For OEQA, CPT consistently improves overlap-based metrics, while SFT often degrades generation quality; instruction tuning and CPT+SFT are preferred by LLM-based evaluation. Cross-lingual experiments further show effective transfer from French adaptation to English benchmarks. Overall, we provide practical guidelines for selecting adaptation strategies under computational constraints.
Ikram Belmadani, Oumaima El Khettari, Carlos Ramisch +3
Medical large language models hold promise for reducing healthcare disparities, yet Hindi remains severely underrepresented. While medical LLMs excel in high-resource languages, their performance degrades sharply in Hindi, particularly on Indian systems of medicine. We argue that robust cross-lingual medical transfer requires Hindi reasoning. To this end, we introduce HiMed, a Hindi reasoning medical corpus and benchmark suite covering both Western and Indian medicine. We further propose HiMed-8B, a Hindi-form medical reasoning LLM, through the design of decaying scaffolding reward. Extensive experiments demonstrate improvement in Hindi medical reasoning performance and reduction in the English--Hindi accuracy gap. Ablation studies validate the contribution of each training stage and reward component. All data and code are available on GitHub: https://github.com/FreedomIntelligence/HiMed.