CARF: Context-Aware Reasoning Supervision for Scientific Evidence Screening
Authors: Nishtha Agarwal, Adam Visokay, Astha Wahi, Kwabena Owusu Aninkora, Amy Gu, Tyler McCormick, Li Liu
Organizations: University of Washington · University of California, Berkeley · Johns Hopkins University · SUNY Downstate Health Sciences University · Independent Researcher
Systematic reviews synthesize biomedical evidence to inform clinical and public-health decision-making, but require domain experts to manually screen thousands of studies against detailed eligibility criteria. We investigate whether language models can assist with this bottleneck by learning from expert feedback on title and abstract screening decisions and model-generated reasoning. We introduce the Context-Aware Reasoning Framework (CARF), a human-in-the-loop framework that uses expert feedback on model-generated reasoning to adapt language models to context-dependent screening tasks. We evaluate CARF on systematic reviews of verbal autopsy and cause-of-death ascertainment methods used in global public health mortality surveillance. CARF shows competitive screening performance compared to evaluated models while retaining high sensitivity, and is more inclined to retain ambiguous, context-dependent studies for human review. Together, these findings suggest that expert-corrected reasoning is a promising supervision signal for context-dependent scientific screening, while retaining a role for human oversight.
Figures & tables
Figure 1: Overview of the Context-Aware Reasoning Framework (CARF) applied to the title and abstract screening stage of a systematic review, illustrating four stages: blind model screening, expert correction of disagreements, construction of an expert-reasoned dataset, and reasoning-based model adaptation through LoRA fine-tuning.
Method
Rec.
95% CI
Spec.
Prec.
F1
FP
Fine-tuned (ours, 14B)
CARF
0.964
0.923–0.987
0.857
0.573
0.719
119
Reasoning (teacher-distilled)
0.964
0.923–0.987
0.610
0.330
0.492
325
Label-only
0.910
0.855–0.949
0.873
0.588
0.714
106
Zero-shot frontier
DeepSeek-V3.2
0.940
0.892–0.971
0.821
0.511
0.662
149
Table 1: Include-class screening performance on the held-out test set ( n=1,000 ; 166 eligible studies). CARF achieves the most favorable combination of recall (0.964) and F1 score (0.719) among all evaluated methods, outperforming zero-shot frontier models on both metrics. Fine-tuned results are from a single training run; zero-shot results are from a single inference pass. 95% confidence intervals for recall use the Clopper–Pearson method.
Appendix figures & tables7 assets
Supplementary material from the paper’s appendix.
Appendix
Method
Rec.
Spec.
Prec.
F1
FP
Missed
Fine-tuned (ours, 14B)
Label Conditioned Reasoning
0.958
0.787
0.472
0.632
178
7/166
Label-only
0.910
0.873
0.588
0.714
106
15/166
Zero-shot frontier
Claude Sonnet-5
0.922
0.860
0.567
0.702
117
13/166
DeepSeek-V3.2
0.940
0.821
0.511
0.662
149
10/166
Appendix
Table F1: Include-class screening performance of the label-conditioned reasoning variant compared with the label-only fine-tuned model and zero-shot frontier models on the held-out test set.
Model
FP
Ambig.
Clear
% ambig. (95% CI)
PubMedBERT
56
19
37
33.9 (21.8–47.8)
CARF
119
36
83
30.3 (22.2–39.3)
Claude Sonnet-5
117
33
84
28.2 (20.3–37.3)
Grok-4.3
123
33
90
26.8 (19.2–35.6)
DeepSeek-V3.2
149
40
109
26.8 (19.9–34.7)
Label-only
106
26
80
24.5 (16.7–33.8)
Appendix
Table G1: False positives of each model on the held-out test set, split by the blinded expert rating and ordered by the share rated ambiguous. Ambig.: ambiguous; Clear: clearly ineligible.
Figure G1: False positives by model, split into clearly ineligible and ambiguous articles by a blinded expert rating (single rater; 347 pooled articles).
Rating
Teacher-dist. FP
Also in CARF
Removed
Clearly ineligible
255
82 (32%)
173 (68%)
Ambiguous
70
35 (50%)
35 (50%)
Appendix
Table G2: False positives of the teacher-distilled reasoning model and whether CARF also includes them.
Feedback notes
Rec.
95% CI
Spec.
Prec.
F1
FP
100
0.922
0.870–0.958
0.871
0.586
0.717
108
500
0.964
0.923–0.987
0.836
0.539
0.691
137
1,346 (full)
0.964
0.923–0.987
0.857
0.573
0.719
119
Appendix
Table H1: Screening performance of CARF trained with different amounts of expert feedback, on the 1000 test articles (166 true includes). Single training run per configuration. 95% CI: exact Clopper–Pearson interval for recall.
Figure H1: Include recall and specificity for CARF trained with 100, 500, and all 1,346 expert feedback notes. Specificity points are labelled with the corresponding number of false positives (FP). The full model is evaluated on all 1,000 test articles, as in Table 1 ; Single training run per configuration.
Figure I1: Screening outcomes on excluded test articles by whether the model self-corrected its reasoning.
Systematic reviews traditionally have taken considerable amounts of human time and energy to complete, in part due to the extensive number of titles and abstracts that must be reviewed for potential inclusion. Recently, researchers have begun to explore how to use large language models (LLMs) to make this process more efficient. However, research to date has shown inconsistent results. We posit this is because prompting alone may not provide sufficient context for the model(s) to perform well. In this study, we fine-tune a small 1.2 billion parameter open-weight LLM specifically for study screening in the context of a systematic review in which humans rated more than 8500 titles and abstracts for potential inclusion. Our results showed strong performance improvements from the fine-tuned model, with the weighted F1 score improving 80.79% compared to the base model. When run on the full dataset of 8,277 studies, the fine-tuned model had 86.40% agreement with the human coder, a 91.18% true positive rate, a 86.38% true negative rate, and perfect agreement across multiple inference runs. Taken together, our results show that there is promise for fine-tuning LLMs for title and abstract screening in large-scale systematic reviews.
Systematic reviews require sustained human judgment across thousands of records, yet existing evaluations of large language models (LLMs) typically examine review stages in isolation. We introduce SciLitBench, a multi-stage benchmark spanning title and abstract screening, full-text screening, and schema-guided data extraction, with 42,981 retrieved records, 1,012 full texts, and annotations for 888 included papers. Across 22 open-weight LLMs from six model families, explicit inclusion and exclusion criteria improve title and abstract screening F2 by 28.8%, while researcher-authored rationales improve full-text screening by 15%. Data extraction reveals a different reliability regime: performance declines from 0.97 accuracy for publication year to 0.37 Jaccard overlap for computational approach, while the strongest models recover only 30% of annotated evaluation evidence and 25% of limitations. SciLitBench identifies a practical boundary between high-recall screening and evidence-complete extraction and provides a reproducible resource for evaluating LLM-assisted evidence synthesis.
Miguel Zabaleta, Baihan Lin
Department of AI and Human Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA · Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA · Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
Systematic literature reviews follow the PRISMA process of screening scholarly works and extracting evidence from included studies. Deep research tools based on large language models (LLMs) can search and summarize the literature but do not record which studies are excluded or where extracted values come from. We develop a conversational multi-agent system called ReviewPilot that automates the PRISMA workflow from paper screening to information extraction. Researchers can tailor criteria and schemas through dialogue, and a project memory keeps their configurations and revisions. Each screening decision comes with its reason and each extracted value with its source. On epidemiological expert reviews, ReviewPilot outperforms a single-prompt LLM and AgentSLR across three LLMs, with screening macro F1 up to 0.776 and extraction F1 up to 0.788. Case studies in biomedicine and human-computer interaction show close agreement with human annotators, suggesting that ReviewPilot can transfer beyond epidemiology. Code is available at https://github.com/ZhaoqianXue/ReviewPilot.
Zhaoqian Xue, Shaoze Zhou, Xuexin Li +10
University of Arizona · Florida International University · Vanderbilt University +7