Bridging the Modality Gap in Long-Form Clinical Audio: A Comparative Study of Lightweight and Heavyweight End-to-End SOAP Generation

With the advent of Large Language Models and its instruction following capabilities a promising application is the task of summarization. Within this domain of task the extractive sub-task of clinical protocolling has emerged as a topic of particular interest as it can significantly reduce the downtime and protocolling burden of health-care workers thus enabling them to focus on their core work helping humans. A further step towards automation is the direct generation of clinical notes from speech without intermediate transcripts, reducing processing time while preserving information such as coughing or other paralinguistic cues that may be lost in transcript-based systems. To this end, we present KIT's submission to this years BeTraC challenge in the lightweight track. Our main contribution is a scalable data augmentation pipeline that unifies heterogeneous medical dialogue datasets through synthetic speech generation and automatically generated SOAP supervision, enabling robust adaptation of a speech foundation model for end-to-end speech-to-SOAP generation.

Long-context audio reasoning is underserved in both training data and evaluation. Existing benchmarks target short-context tasks, and the open-ended generation tasks most relevant to long-context reasoning pose well-known challenges for automatic evaluation. We propose a synthetic data generation pipeline designed to serve both as a training resource and as a controlled evaluation environment, and instantiate it for first-visit doctor-patient conversations with SOAP note generation as the task. The pipeline has three stages, persona-driven dialogue generation, multi-speaker audio synthesis with overlap/pause modeling, room acoustics, and sound events, and LLM-based reference SOAP note production, built entirely on open-weight models. We release 8,800 synthetic conversations with 1.3k hours of corresponding audio and reference notes. Evaluating current open-weight systems, we find that cascaded approaches still substantially outperform end-to-end models.

This paper describes TalTech's submissions to the Beyond Transcription Challenge (BeTraC), which requires generating SOAP notes directly from long doctor-patient conversation recordings, without intermediate transcription. After screening open-weight speech LLMs for long-audio robustness, we adapted Voxtral Mini (lightweight track) and Voxtral Small (heavyweight track) with LoRA supervised fine-tuning followed by DAPO reinforcement learning that uses the challenge metric, Open Medical Concept F1, as its reward. Our systems ranked first in both tracks, and an independent LLM-as-a-judge evaluation showed the lowest hallucination rate among all submissions, indicating that reinforcement learning against a concept-matching metric need not compromise factual reliability. We also find that fine-tuning on text transcripts transfers well to speech input and appears to improve robustness on out-of-domain real recordings.