How Reliable Are System-One Decisions in Medicine? A Comparative Study of Jev, Jev-like Models, and LLMs

Jev is a non-generative System One model that assigns probabilities to predefined answer options and cannot answer outside them. Its accuracy and calibration on medical question-answering and case-based diagnostic-reasoning tasks are unknown. We evaluated Jev 1.13 on four medical benchmarks: MetaMedQA, PubMedQA, DiagnosisArena-MCQ and the NEJM Case Challenges. GPT-6 Sol, with (medium) and without reasoning, was the reference. The primary outcome was top-1 accuracy; key secondary outcomes were calibration, selective prediction and recognition of unanswerable questions. All 8,469 requests returned a valid answer. Jev's accuracy was similar to that of GPT-6 Sol with medium reasoning on PubMedQA (78.4% vs 78.2%;), lower on MetaMedQA (74.8% vs 82.7%) and much lower on DiagnosisArena-MCQ (59.8% vs 82.4%;) and the NEJM cases (61.8% vs 82.4%). On MetaMedQA, Jev's probabilities were the best calibrated (expected calibration error 0.063 vs 0.146), and its answers with a probability of at least 0.9 (52.9% of questions) were 93.4% accurate, but GPT-6 Sol was as accurate when it accepted a similar proportion of questions. On DiagnosisArena-MCQ, Jev's probabilities discriminated poorly (AUROC 0.645 vs 0.768). Of the 162 questions whose correct answer was "I don't know or cannot answer", Jev chose that option for 10.5% (GPT-6 Sol, 8.6%). Median latency was 0.27-0.31 s; all 2,823 items cost USD 0.08. Jev was fast and inexpensive, and its accuracy was similar to that of a frontier LLM on research abstracts but lower on examination questions and much lower on complex diagnostic cases. Task-specific validation is required before clinical use.

General decision models, such as Jev, have recently emerged as efficient alternatives to LLMs for structured judgment and selection. But what kinds of decisions can these models reliably make, and how does their behavior change when individual decisions are composed into larger systems? To study this, we introduce JEVal, a bilingual benchmark comprising 11,257 instances from 36 datasets across 10 application domains, and evaluate 25 model configurations spanning general decision models and generative LLMs. Our results show that (1) general decision models are most competitive when decisions can be resolved from available evidence, but weaken when they require specialist knowledge or faithful uncertainty estimation: they can often identify the most likely outcome while substantially overstating its probability. (2) In more dynamic and realistic systems involving long-horizon, multi-step interactions, the advantages of fast local decision making are offset by reliability failures at the system level. on $τ$-bench, faster local decisions reduce median episode time but lower task success as decision errors accumulate over long trajectories. (3) In large-scale social simulation, decision models approach strong generative LLMs on individual response prediction at substantially lower inference cost, yet remain weaker in user profiling and exhibit larger aggregate estimation errors and systematic bias. Finally, we propose SII-Decision-4B and SII-Decision-27B, which internalize an open-weight LLM's own reasoning into a single-pass first-token decision through Reasoning-to-Readout Self-Distillation, with SII-Decision-27B performing on par with Jev on JEVal while answering a typical query in about 0.1 s.

LLM-based decision-making systems, also called System One models, have recently gained popularity, most notably through Jev (Almeida, 2026). Given a typed input state, a question, and a set of options, they return a probability for each option in a single forward pass, without text generation. We show that existing open instruction-tuned language models can achieve comparable performance without any additional training, by reading out answers from letters (A, B, C, etc.) in the model's output logits at the last token position. Furthermore, we show how a simple supervised fine-tuning recipe can improve their performance further. We evaluate four open instruction-tuned language models: Gemma 4 31B, Gemma 4 12B, Qwen3.6-27B, and Qwen3.5-4B. We fine-tune each using LoRA and a decision head initialized from a slice of the language model head. Furthermore, we introduce OpenDecisions, a novel 2,352-question validation dataset designed to reflect the task composition of JevBench (JevBench main- tainers, 2026) and which computes a Capability score based on accuracy and calibration metrics. Without fine-tuning, Gemma 4 31B scores 79.6 on OpenDecisions, compared to Jev's 80.1. After undergoing our fine-tuning recipe, it scores 84.4 on OpenDecisions and 81.5 on JevBench v1.7, outperforming Jev by 4.3 and 4.4 Capability points respectively and setting a new state-of-the-art on OpenDecisions. On a suite of public decision datasets, our models achieve accuracy comparable to Jev, with lower calibration error. Our results show that open language models already possess System One capabilities, and with simple fine-tuning they outperform Jev on a wide range of decision tasks. We release our models, serving code, and OpenDecisions.