Clinical Language Model Evaluation

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37 papers in the last four weeks, up 118% on the four weeks before. 0.4% of all new papers.

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Latest papers 259

May 15, 2026cs.CL

MHGraphBench: Knowledge Graph-Grounded Benchmarking of Mental Health Knowledge in Large Language Models

Large language models (LLMs) are increasingly used in the mental health domain, yet it remains unclear how well they capture related biomedical knowledge and how reliably they apply it to clinically salient structured judgments. Here, we present a knowledge-graph (KG)-grounded benchmark for assessing LLMs on mental-health entity recognition, relation judgment, and two-hop reasoning. The benchmark is derived from PrimeKG and comprises nine task families with KG-supported answers and controlled negative options. Experiments across 15 closed- and open-source LLMs reveal a persistent recognition-to-judgment gap: leading models achieve near-ceiling performance on entity typing and on the small relation-typing subset, yet they still struggle with relation prediction and two-hop reasoning. Additionally, short KG-derived snippets benefit some models but degrade performance for others. Moreover, output-format reliability can substantially influence measured performance under constrained multiple-choice settings, highlighting the critical role of response validity in benchmark-based evaluation. MHGraphBench should therefore be interpreted as evaluating agreement with a curated mental-health slice of PrimeKG under a constrained multiple-choice interface, rather than as a direct assessment of real-world clinical safety.

Weixin Liu, Congning Ni, Shelagh A. Mulvaney +4

Vanderbilt University, Nashville, TN, USA · Vanderbilt University Medical Center, Nashville, TN, USA · Virginia Tech, Blacksburg, VA, USA

LLM Evaluation Healthcare Mental Health Clinical Language Model Evaluation Knowledge Graphs LLM Reasoning+1

May 14, 2026cs.CL

Quantifying and Mitigating Premature Closure in Frontier LLMs

Premature closure, or committing to a conclusion before sufficient information is available, is a recognized contributor to diagnostic error but remains underexamined in large language models (LLMs). We define LLM premature closure as inappropriate commitment under uncertainty: providing an answer, recommendation, or clinical guidance when the safer response would be clarification, abstention, escalation, or refusal. We evaluated five frontier LLMs across structured and open-ended medical tasks. In MedQA (n = 500) and AfriMed-QA (n = 490) questions where the correct choice had been removed, models still selected an answer at high rates, with baseline false-action rates of 55-81% and 53-82%, respectively. In open-ended evaluation, models gave inappropriate answers on an average of 30% of 861 HealthBench questions and 78% of 191 physician-authored adversarial queries. Safety-oriented prompting reduced premature closure across models, but residual failure persisted, highlighting the need to evaluate whether medical LLMs know when not to answer.

Rebecca Handler, Suhana Bedi, Nigam Shah

Department of Medicine, Stanford University · Department of Biomedical Data Science, Stanford University

Healthcare LLM Prompting LLM Safety Clinical Language Model Evaluation Medical LLMs LLM Abstention

May 14, 2026cs.LG

RxEval: A Prescription-Level Benchmark for Evaluating LLM Medication Recommendation

Inpatient medication recommendation requires clinicians to repeatedly select specific medications, doses, and routes as a patient's condition evolves. Existing benchmarks formulate this task as admission-level prediction over coarse drug codes with multi-hot diagnostic and procedure code inputs, failing to capture the per-timepoint, information-rich nature of real prescribing. We propose RxEval, a prescription-level benchmark that evaluates LLM prescribing capability by multiple-choice questions: each question presents a detailed patient profile and time-ordered clinical trajectory, requiring selection of specific medication-dose-route triples from real prescriptions and patient-specific distractors generated via reasoning-chain perturbation. RxEval comprises 1,547 questions spanning 584 patients, 18 diagnostic categories, and 969 unique medications. Evaluation of 16 LLMs shows that RxEval is both challenging and discriminative: F1 ranges from 45.18 to 77.10 across models, and the best Exact Match is only 46.10%. Error analysis reveals that even frontier models may overlook stated patient information and fail to derive clinical conclusions.

Shuhao Chen, Weisen Jiang, Changmiao Wang +4

The Hong Kong University of Science and Technology · Southern University of Science and Technology · The Chinese University of Hong Kong +2

Healthcare Clinical Decision Support Clinical Decision-Making Large Language Model-Based Recommendation Clinical Language Model Evaluation

May 13, 2026cs.HC

Patients With Personality: Realistic Patient Simulation through Controlled Diversity and Selective Disclosure

Simulating realistic patient interactions is a key requirement to testing clinical applications of LLMs at scale without time-consuming and expensive user studies. However, existing approaches often lack realism and controllability, often oversharing information unprompted, and failing to capture the wide variability of patient behavior. Here, we introduce PatientsWithPersonality (PWP), a patient simulation framework that generates realistic yet diverse virtual patient responses through explicit personality parametrization over a latent patient state. Grounded in HEXACO, a six-dimensional personality space used to quantify and parameterize human behavioral traits, our approach enables fine-grained control over conversational style, cooperativeness, and information disclosure within a unified framework. In a clinician evaluation, PWP is judged nearly as realistic as recorded human actors and clearly ahead of prior simulators, while being flagged as "too informative" far less often. Conditioning on HEXACO axes yields personas whose configured traits are recoverable by both clinicians and an autorater, span a substantially wider behavioral footprint than the closest baseline, and prevent oversharing. Altogether, our framework paves the way for more accurate and informative LLM benchmarking through our realistic and steerable patient simulator.

Moritz Schlager, Friederike Jungmann, Samuel Schmidgall +12

Technical University of Munich (TUM) · Munich Center for Machine Learning (MCML) · TUM University Hospital +3

Personality Modeling in Language Models Persona-Conditioned Generation Clinical Language Model Evaluation

May 13, 2026cs.AI

RealICU: Do LLM Agents Understand Long-Context ICU Data? A Benchmark Beyond Behavior Imitation

Intensive care units (ICU) generate long, dense and evolving streams of clinical information, where physicians must repeatedly reassess patient states under time pressure, underscoring a clear need for reliable AI decision support. Existing ICU benchmarks typically treat historical clinician actions as ground truth. However, these actions are made under incomplete information and limited temporal context of the underlying patient state, and may therefore be suboptimal, making it difficult to assess the true reasoning capabilities of AI systems. We introduce RealICU, a hindsight-annotated benchmark for evaluating large language models (LLMs) under realistic ICU conditions, where labels are created after senior physicians review the full patient trajectory. We formulate four physician-motivated tasks: assess Patient Status, Acute Problems, Recommended Actions, and Red Flag actions that risk unsafe outcomes. We partition each trajectory with 30-min windows and release two datasets: RealICU-Gold with 930-window annotations from 94 MIMIC-IV patients, and RealICU-Scale with 11,862 windows extended by Oracle, a physician-validated LLM hindsight labeler. Existing LLMs including memory-augmented ones performed poorly on RealICU, exposing two failure modes: a recall-safety tradeoff for clinical recommendations, and an anchoring bias to early interpretations of the patient. We further introduce ICU-Evo to study structured-memory agents that improves long-horizon reasoning but does not fully eliminate safety failures. Together, RealICU provides a clinically grounded testbed for measuring and improving AI sequential decision-support in high-stakes care. Project page: https://chengzhi-leo.github.io/RealICU-Bench/

Chengzhi Shen, Weixiang Shen, Tobias Susetzky +8

Cherise · Technical University of Munich (TUM) · TUM University Hospital +8

Healthcare Clinical Decision-Making Clinical Reasoning Clinical Language Model Evaluation Memory-Augmented Language Model Agents

May 13, 2026cs.AI

VERA-MH: Validation of Ethical and Responsible AI in Mental Health

Chatbot usage has increased, including in fields for which they were never developed for--notably mental health support. To that end, we introduce Validations of Ethical and Responsible AI in Mental Health (VERA-MH), a novel clinically-validated evaluation for safety of chatbots in the context of mental health support. The first iteration of VERA-MH focuses on Suicidal Ideation (SI) risks, by assessing how well chatbots can responds to users that might be in crisis. VERA-MH is comprised of three steps: conversation simulation, conversation judging and model rating. First, to simulate conversations with the chatbot under evaluation, another chatbot is tasked with role-playing users based on specific personas. Such user personas have been developed under clinical guidance, to make sure that, among others, multiple risk factors, demographic characteristics and disclosure factors were represented. In the judging step, a second support model is used as an LLM-as-a-Judge, together with a clinically-developed rubric. The rubric is structured as a flow, with a single Yes/No question asked each time, to improve answers' consistency and highlight models' failure modes. In the last stage, results of each conversation are aggregated to present the final evaluation of the chatbot. Together with the framework, we present the result of the evaluations for four leading LLM providers.

Luca Belli, Kate H. Bentley, Josh Gieringer +6

Spring Health · Yale University

Healthcare Mental Health AI Safety Evaluation LLM Safety Evaluation Clinical Language Model Evaluation

May 13, 2026cs.LG

Large Language Models Lack Temporal Awareness of Medical Knowledge

The existing methods for evaluating the medical knowledge of Large Language Models (LLMs) are largely based on atemporal examination-style benchmarks, while in reality, medical knowledge is inherently dynamic and continuously evolves as new evidence emerges and treatments are approved. Consequently, evaluating medical knowledge without a temporal context may provide an incomplete assessment of whether LLMs can accurately reason about time-specific medical knowledge. Moreover, most medical data are historical, requiring the models not only to recall the correct knowledge, but also to know when that knowledge is correct. To bridge the gap, we built TempoMed-Bench, the first-of-its-kind benchmark for evaluating the temporal awareness of the LLMs in the medical domain through evolving guideline knowledge. Based on the TempoMed-Bench, our evaluation analysis first reveals that LLMs lack temporal awareness in medical knowledge through the key findings: (1) model performance on up-to-date medical knowledge exhibits a gradual linear decline over time rather than a sharp knowledge-cutoff behavior, suggesting that parametric medical knowledge is not strictly bounded by knowledge cutoffs; (2) LLMs consistently struggle more with recalling outdated historical medical knowledge than with up-to-date recommendations: accuracy of historical knowledge is only 25.37%-53.89% of up-to-date knowledge, indicating potential knowledge forgetting effects during training; and (3) LLMs often exhibit temporally inconsistent behaviors, where predictions fluctuate irregularly across neighboring years. We also show that the temporal awareness problem is a challenge that cannot be easily solved when integrated with agentic search tools (-3.15%-14.14%). This work highlights an important yet underexplored challenge and motivates future research on developing LLMs that can better encode time-specific medical knowledge.

Zihan Guan, Qiao Jin, Guangzhi Xiong +6

University of Virginia · National Institutes of Health · Dana-Farber Cancer Institute +2

Healthcare Temporal Reasoning in Language Models Factual Knowledge in Language Models Clinical Language Model Evaluation Medical LLMs

May 12, 2026cs.CY

Simulating Eating Disorder Patients with LLMs: Evaluating Psychological Persona Stability in Multi-Turn Conversations

Large language model (LLM)-based simulations of clinical patients are increasingly used for research and training, yet their validity requires persona stability: coherent maintenance of an assigned psychological profile across and within conversations. We evaluate this prerequisite using eating disorder personas grounded in five published case vignettes, a dual-assessment framework (self-report + independent observer ratings), and validated psychometric instruments (EDE-Q) with known ground-truth scores. Across six LLMs and two experiments (between-conversation stability (Exp. I) and within-conversation stability (Exp. II)), we find that LLMs are paradoxically too stable and too inaccurate: variability is negligible, yet all models systematically overshoot ground-truth severity by 12-30% of the scale range (0.7-1.8 points on a 0-6 scale). The mechanism is selective stereotyping: models differentiate cases on behavioural items (dietary restraint) but maximise cognitive-affective items (body dissatisfaction, weight preoccupation) at ceiling regardless of case severity. Additional conversational context does not improve accuracy; it compounds the overshoot. LLMs can portray severe eating pathology but lack a representation of moderate clinical presentations, a "missing middle".

Jennifer Haase, Jana Gonnermann-Müller, See Heng Yim +3

Weizenbaum Institute, Berlin, Germany · HU Berlin, Berlin, Germany · Zuse Institute Berlin, Berlin, Germany +1

Persona Consistency Personality Modeling in Language Models Mental Health Language Model Bias Evaluation Clinical Language Model Evaluation

May 12, 2026cs.AI

AcuityBench: Evaluating Clinical Acuity Identification and Uncertainty Alignment

We introduce AcuityBench, a benchmark for evaluating whether language models identify the appropriate urgency of care from user medical presentations. Existing health benchmarks emphasize medical question answering, broad health interactions, or narrow workflow-specific triage tasks, but they do not offer a unified evaluation of acuity identification across these settings. AcuityBench addresses this gap by harmonizing five public datasets spanning user conversations, online forum posts, clinical vignettes, and patient portal messages under a shared four-level acuity framework ranging from home monitoring to immediate emergency care. The benchmark contains 914 cases, including 697 consensus cases for standard accuracy evaluation and 217 physician-confirmed ambiguous cases for uncertainty-aware evaluation. It supports two complementary task formats: explicit four-way classification in a QA setting, and free-form conversational responses evaluated with a rubric-based judge anchored to the same framework. Across 12 frontier proprietary and open-weight models, we find substantial variation in clear-case acuity accuracy and error direction. Comparing task formats reveals a systematic tradeoff: conversational responses reduce over-triage but increase under-triage relative to QA, especially in higher-acuity cases. In ambiguous cases, no model closely matches the distribution of physician judgments, and model predictions are more concentrated than expert clinical uncertainty. We also compare expert and model adjudication on a subset of maximally ambiguous cases, using those cases to examine the role of clinical uncertainty in label disagreement. Together, these results position acuity identification as a distinct safety-critical capability and show that AcuityBench enables systematic comparison and stress-testing of how well models guide users to the right level of care in real-world health use.

Robin Linzmayer, Georgianna Lin, Di Coneybeare +22

Department of Computer Science, Columbia University · Department of Biomedical Informatics, Columbia University · Department of Computer Science, Columbia University, New York, NY, USA +3

Healthcare Clinical Triage Clinical Decision Support LLM Uncertainty Estimation Clinical Language Model Evaluation Medical LLMs

May 11, 2026cs.AI

CPEMH: An Agentic Framework for Prompt-Driven Behavior Evaluation and Assurance in Foundation-Model Systems for Mental Health Screening

This paper presents CPEMH, an agentic framework designed to evaluate prompt-driven behavior in foundation-model systems operating on transcript-based datasets for mental-health screening. CPEMH serves as an engineering methodology for behavioral assurance in large-scale language systems, introducing an orchestrated architecture that autonomously performs the design, evaluation, and selection of prompt strategies, enabling systematic control of behavioral variability across contexts. Its modular agentic design, combining orchestrator, inference, and evaluation agents, ensures traceability, reproducibility, and robustness throughout the prompting lifecycle. A case study on automated depression screening from interview transcripts demonstrates the framework's capacity to stabilize and audit foundation-model behavior in conversational and clinically sensitive domains. Lessons learned emphasize the role of modular orchestration in behavioral assurance, the prioritization of stability over architectural complexity, and the integration of F1, bias, and robustness as core acceptance criteria.

Giuliano Lorenzoni, Ivens Portugal, Paulo Alencar +1

University of Waterloo · University of Waterloo Waterloo, ON, Canada

LLM Auditing Prompt Optimization Clinical Language Model Evaluation Language Model Robustness

May 11, 2026cs.CV

Auditing Multimodal LLM Raters: Central Tendency Bias in Clinical Ordinal Scoring

Multimodal large language models (LLMs) are increasingly explored as automated evaluators in clinical settings, yet their scoring behavior on ordinal clinical scales remains poorly understood. We benchmark three frontier LLM families against supervised deep learning models for scoring Clock Drawing Test (CDT) images on two public datasets using the Shulman rubric. While fully fine-tuned Vision Transformers achieve the best calibration (MAE 0.52, within-1 accuracy 91%), zero-shot LLMs remain competitive on tolerance-based agreement (GPT-5 MAE 0.67, within-1 accuracy 92%) despite higher absolute error. However, per-score analysis reveals that all three LLM families exhibit a pronounced central tendency effect (systematic endpoint compression): predictions are systematically compressed toward the middle of the scale, with over-prediction at the low end (score 0 to 1) and under-prediction at the high end (score 5 to 4). This effect disproportionately affects the clinically critical extremes where accurate scoring most impacts screening decisions for cognitive impairment. Targeted ablations show that neither few-shot exemplars spanning the full score range nor removing clinical terminology from the prompt eliminates the effect. Our findings extend the LLM-as-a-judge bias literature from NLP evaluation to clinical assessment, and highlight the need for calibration-aware evaluation and post-hoc calibration before deploying LLM-based raters in high-stakes screening workflows.

Jiaqing Zhang, Sandeep Elluri, Bhanu Cherukuvada +7

Department of Electrical & Computer Engineering · Department of Computer and Information Science and Engineering · Department of Clinical and Health Psychology +1

LLM Auditing Multimodal Large Language Models Language Model Calibration Language Model Bias Evaluation Clinical Language Model Evaluation

May 10, 2026cs.CL

MedMeta: A Benchmark for LLMs in Synthesizing Meta-Analysis Conclusion from Medical Studies

Large language models (LLMs) have saturated standard medical benchmarks that test factual recall, yet their ability to perform higher-order reasoning, such as synthesizing evidence from multiple sources, remains critically under-explored. To address this gap, we introduce MedMeta, the first benchmark designed to evaluate an LLM's ability to generate conclusions from medical meta-analyses using only the abstracts of cited studies. MedMeta comprises 81 meta-analyses from PubMed (2018--2025) and evaluates models using two distinct workflows: a Retrieval-Augmented Generation (Golden-RAG) setting with ground-truth abstracts, and a Parametric-only approach relying on internal knowledge. Our evaluation framework is validated by a well-structured analysis showing our LLM-as-a-judge protocol strongly aligns with human expert ratings, as evidenced by high Pearson's r correlation (0.81) and Bland-Altman analysis revealing negligible systematic bias, establishing it as a reliable proxy for scalable evaluation. Our findings underscore the critical importance of information grounding: the Golden-RAG workflow consistently and significantly outperforms the Parametric-only approach across models. In contrast, the benefits of domain-specific fine-tuning are marginal and largely neutralized when external material is provided. Furthermore, stress tests show that all models, regardless of architecture, fail to identify and reject negated evidence, highlighting a critical vulnerability in current RAG systems. Notably, even under ideal RAG conditions, current LLMs achieve only slightly above-average performance (~2.7/5.0). MedMeta provides a challenging new benchmark for evidence synthesis and demonstrates that for clinical applications, developing robust RAG systems is a more promising direction than model specialization alone.

Huy Hoang Ha, Benoit Favre, Francois Portet

Healthcare RAG Evaluation Clinical Language Model Evaluation

May 10, 2026cs.CL

Can We Trust LLMs for Mental Health Screening? Consistency, ASR Robustness, and Evidence Faithfulness

LLMs can estimate Hospital Anxiety and Depression Scale (HADS) scores from speech in a zero-shot manner, but clinical deployment requires reliability across three dimensions: intra-model consistency, ASR robustness, and evidence faithfulness. We evaluate three LLMs (Phi-4, Gemma-2-9B, and Llama-3.1-8B) on 111 English-speaking participants using ground-truth transcripts and three Whisper ASR variants (Large, Medium, Small), with three independent runs per model-condition pair. We find that (i) Phi-4 and Gemma-2-9B achieve excellent intra-model consistency (ICC > 0.89) with minimal degradation under ASR; (ii) Llama-3.1-8B shows ASR-fragile consistency, with ICC dropping from 0.82 to 0.36 at 10% WER; (iii) predictive validity is largely preserved under ASR for robust models; and (iv) keyword groundedness exceeds 93% for Phi-4 and Gemma-2-9B but falls to 77-81% for Llama-3.1-8B. Inter-model keyword agreement is far lower than score-level agreement, revealing a score-evidence dissociation with implications for clinical interpretability.

Erfan Loweimi, Sofia de la Fuente Garcia, Samira Loveymi +2

Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK · Department of Computer Engineering, Ahvaz Campus, Islamic Azad University, Ahvaz, Iran · School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK

Healthcare Mental Health LLM Reliability Depression Severity Estimation Clinical Language Model Evaluation Language Model Robustness

May 10, 2026cs.CL

CLR-voyance: Reinforcing Open-Ended Reasoning for Inpatient Clinical Decision Support with Outcome-Aware Rubrics

Inpatient clinical reasoning is a sequential decision under partial observability: the clinician sees the admission so far and must choose the next action whose downstream consequences are not yet visible. Existing clinical-LLM evaluations and RL rewards signals collapse this into closed-form retrieval, clinical journey leakage, or unanchored LLM-as-judge scoring. We introduce CLR-voyance, a framework that reformulates inpatient reasoning as a Partially Observable Markov Decision Process (POMDP) and supervises it with rewards that are simultaneously outcome-grounded and clinician-validated. We instantiate the formulation as CLR-POMDP, which partitions successful patient journeys into a policy-visible past and an oracle-only future. Using the past information, an oracle LLM generates a case-specific query-answer pair, and the first adaptive rubric for clinical reasoning which is verifiable in the future of the patient journey. These rubrics are used for both post-training and evaluation of models for inpatient clinical reasoning. We post-train Qwen3-8B and MedGemma-4B with GRPO followed by model merging, yielding state-of-the-art inpatient clinical reasoning while retaining generalist capabilities. CLR-voyance-8B achieves 84.91% on CLR-POMDP, ahead of frontier medical reasoning models like GPT-5 (77.83%) and MedGemma-27B (66.66%) and has comparable or better performance on existing medical benchmarks. To ensure a clinically meaningful setting, we conduct a large-scale clinician alignment study, where physicians curate per-case rubrics, grade candidate responses, and provide blinded pairwise preferences of model reasoning. This study provides insights on clinical LLM-as-a-judge and clinical preference-model selection, which can inform the community at large. CLR-voyance has been deployed for 6+ months at a partner public hospital, drafting thousands of reasoning-heavy inpatient notes.

Aishik Nagar, Arun-Kumar Kaliya-Perumal, Yu-Hsuan Han +5

ASUS Intelligent Cloud Services (AICS) · Rehabilitation Research Institute of Singapore, Nanyang Technological University · Department of Family Medicine,2026 Taipei Veterans General Hospital +2

Healthcare Clinical Decision Support RL for Language Model Reasoning Clinical Reasoning Partially Observable Markov Decision Processes Clinical Language Model Evaluation+1

May 8, 2026cs.LG

Can Revealed Preferences Clarify LLM Alignment and Steering?

LLMs are increasingly used to make or support high-stakes decisions under uncertainty, where alignment depends not only on factual accuracy but on how models weigh tradeoffs between different outcomes. We present an empirical pipeline for estimating the implied preferences that an LLM's observed choices optimize: we elicit the model's probability distribution over unknowns along with the choice it would make for the decision task and then fit a discrete choice model to recover the cost function that best rationalizes the model's decisions. We show how this revealed-preference description allows rigorous evaluation of whether models behave in a consistently goal-directed way, whether they can verbalize a description of their objectives which matches their revealed decision policy, and whether prompting can reliably steer those policies to implement a user-specified cost function. We apply this evaluation across four medical diagnosis domains and multiple frontier and open-source models. We find that while many models have a nontrivial degree of internal coherence, they also have significant weaknesses in faithfully reporting or adopting preferences in response to user direction.

Khurram Yamin, Jingjing Tang, Eric Horvitz +1

1Carnegie Mellon University · 2Microsoft Research

Language Model Steering LLM Decision-Making Preference Alignment Clinical Language Model Evaluation Preference Elicitation

May 8, 2026cs.CL

Can Language Models Identify Side Effects of Breast Cancer Radiation Treatments?

Accurately communicating the side effects of cancer treatments to cancer survivors is critical, particularly in settings such as informed consent, where clinicians must clearly and comprehensively convey potential treatment toxicities. However, this task remains challenging due to clinical knowledge deficits about adverse treatment effects and fragmentation across electronic health record (EHR) systems. Large language models (LLMs) have the potential to assist in this task, though their reliability in oncology survivorship contexts remains poorly understood. We present a deployment-oriented stress-testing framework for evaluating LLM-generated radiation side effect lists in breast cancer treatment and survivorship care. Using 21 breast cancer patient profiles, we construct paired patient clinical scenarios that differ only in radiotherapy regimens to evaluate seven instruction-tuned LLMs under multiple prompting regimes. We then compare LLM outputs to a clinician-curated reference derived from informed consent documents at two major academic medical centers and developed by a team including more than seven breast radiation oncologists. The reference maps radiation dose-fractionation, fields, and locations to associated toxicities, broken down by frequency and temporal onset. Across models, we reveal sensitivity to minor documentation changes, trade-offs between precision and recall, and systematic under-recall of rare and long-term side effects. When used alone, constraints on the number of side effects generated reduce precision, and grounding outputs in clinician-curated side effect lists substantially improves reliability and robustness. These findings highlight important limitations of LLM use in oncology and suggest practical design choices for safer and more informative survivorship-focused applications.

Natalie Seah, Danielle S. Bitterman, Daphna Spiegel +1

University of Virginia · Mass General Brigham, Dana-Farber Cancer Institute, Harvard Medical School

Breast Cancer Healthcare Oncology Clinical Language Model Evaluation Language Model Robustness Medical LLMs

May 7, 2026cs.CL

Automated Clinical Report Generation for Remote Cognitive Remediation: Comparing Knowledge-Engineered Templates and LLMs in Low-Resource Settings

The growing demand for cognitive remediation therapy, combined with limited speech therapist availability, has accelerated the adoption of remote rehabilitation tools. These systems generate large volumes of interaction data that are difficult for clinicians to review efficiently. This paper investigates automated clinical report generation for avatar-guided, home-based cognitive remediation sessions in a low-resource setting with no reference reports. We present and compare two approaches: (1) a rule-based template system encoding speech therapy domain knowledge as explicit decision rules and validated templates, ensuring clinical reliability and traceability; and (2) a zero-shot LLM-based approach (GPT-4) aimed at more fluent and concise output. Both systems use identical pre-extracted, expert-validated structured variables, enabling a controlled factual comparison. Outputs were evaluated by eight speech therapists and final-year students using a nine-criterion questionnaire. Results reveal a clear trade-off between clinical reliability and linguistic quality. The template-based system scored higher on fluidity, coherence, and results presentation, while GPT-4 produced more concise output. Directional differences are consistent across evaluation dimensions, though no comparison reached statistical significance after correction, reflecting the scale constraints of expert clinical evaluation. Based on evaluator feedback, we derive eight design recommendations for clinical reporting systems in remote rehabilitation settings. More broadly, this work contributes a replicable methodology combining expert elicitation, taxonomy-driven generation, and multi-dimensional human evaluation for clinical NLG in low-resource settings, and illustrates how controlled comparisons can inform the responsible adoption of generative AI in healthcare.

Yongxin Zhou, Fabien Ringeval, François Portet

Univ. Grenoble Alpes, CNRS, Grenoble INP, LIG, 38000 Grenoble, France

Medical Report Generation Clinical Language Model Evaluation Medical LLMs Text Generation

May 7, 2026cs.AI

Systematic Evaluation of Large Language Models for Post-Discharge Clinical Action Extraction

The work in this paper evaluates zero-shot and few-shot large language models (LLMs) for safety-critical clinical action extraction using the CLIP discharge-note dataset, with particular emphasis on transitions of care and post-discharge patient safety. To manage the complexity of clinical documentation, we introduce a two-stage extraction framework that decomposes discharge notes, that are written in narrative form, into fine-grained, explicitly actionable clinical tasks through a staged prompting strategy. Our contributions include a systematic assessment of generative LLMs for clinical action extraction, a detailed comparison between general-purpose LLMs and task-specific supervised BERT-based models, and an analysis of annotation inconsistencies across different action categories. We show that contemporary LLMs achieve performance comparable to or exceeding supervised models on binary actionability detection, while supervised baselines retain a meaningful advantage on fine-grained multi-label category classification, despite the absence of task-specific fine-tuning and under strict data-privacy constraints. Qualitative error analysis reveals that many failures stem from misalignment between model reasoning and dataset annotation conventions, particularly in cases involving implicit clinical actions and rigid structural labeling rules. These results indicate that reported performance reflects model limitations due to lack of clinical reasoning, that is not captured by plain annotations. Labels without rationales make it impossible to distinguish clinical reasoning failures from annotation convention mismatches. Advancing clinical NLP requires reasoning-annotated datasets that document why specific spans are actionable, not merely which spans were labeled, enabling proper evaluation of model clinical understanding.

Shivali Dalmia, Ananya Mantravadi, Prasanna Desikan

Centific AI Research · Centific Global Solutions, Inc.

Document Information Extraction Clinical Information Extraction LLM Information Extraction Clinical Language Model Evaluation

May 7, 2026cs.AI

TheraAgent: Self-Improving Therapeutic Agent for Precise and Comprehensive Treatment Planning

Formulating a treatment plan is inherently a complex reasoning and refinement task rather than a simple generation problem. However, existing large language models (LLMs) mainly rely on one-shot output without explicit verification, which may result in rough, incomplete, and potentially unsafe treatment plans. To address these limitations, we propose TheraAgent, an agentic framework that replaces one-shot generation with an iterative generate-judge-refine pipeline. By mirroring the actual reasoning process of human experts who iteratively revise treatment plans, our framework progressively transforms coarse and incomplete drafts into precise, comprehensive, and safer therapeutic regimens. To facilitate the critical judge component, we introduce TheraJudge, a treatment-specific evaluation module integrated into the inference loop to enforce clinical standards. Experiments show TheraAgent achieves state-of-the-art results on HealthBench, leading in Accuracy and Completeness. In expert evaluations, it attains an 86% win rate against physicians, with superior Targeting and Harm Control. Moreover, the highly agreement between TheraJudge and HealthBench evaluations confirms the reliability of our framework.

Junkai Li, Yunghwei Lai, Tianyi Zhu +3

1Dept. of Comp. Sci. & Tech., Institute for AI, Tsinghua University, Beijing, China · Institute for AI Industry Research (AIR), Tsinghua University, Beijing, China · School of Computing, National University of Singapore, Singapore

LLM Self-Refinement Healthcare LLM Agent Self-Improvement Clinical Language Model Evaluation LLM Agent Safety

May 6, 2026cs.CL

Ask Before You Diagnose: Safe-Psych, a Sequential Evaluation Benchmark for LLMs in Psychiatry

Large language models (LLMs) are increasingly used for decision support in healthcare, but clinical evidence is often incomplete or evolving. When the available information is insufficient to support a reliable answer, models should request clarification or abstain rather than provide unsupported responses. Existing medical benchmarks, however, typically assume that complete information is available upfront. We introduce Safe-Psych, a sequential benchmark for evaluating how LLMs handle evolving diagnostic uncertainty in clinical psychiatry. Safe-Psych contains over 1,000 real-world psychiatric clinical notes segmented to simulate incremental evidence disclosure, with psychiatrist-derived action labels at each stage: DIAGNOSE, CLARIFY, or ABSTAIN. We evaluate multiple state-of-the-art LLMs in full-information and sequential settings. Our findings show that capability does not ensure calibration: even strong models struggle under incomplete clinical information, with under-abstention exceeding 60% for most models and safety-aware prompting reducing premature commitment only by shifting errors toward excessive abstention. In sequential evaluation, models frequently diagnose before sufficient evidence is available and rarely seek clarification unless explicitly prompted; these premature diagnoses are less accurate than on-time diagnoses. Overall, Safe-Psych reveals a limitation across the evaluated models: recognizing when clinical evidence is incomplete and additional information is needed. We release Safe-Psych to support research on improving LLM safety in healthcare.

Oriana Presacan, Andreea Grama, Larisa Irimină +6

National University of Science and Technology Politehnica Bucharest · Psychiatric Hospital Doctor Gheorghe Preda · Oslo Metropolitan University +3

Selective Prediction Healthcare Medical Diagnosis Mental Health Clinical Decision-Making LLM Safety Evaluation+1

May 5, 2026cs.CL

Self-Prompting Small Language Models for Privacy-Sensitive Clinical Information Extraction

Clinical named entity recognition from dental progress notes is challenging because documentation is highly unstructured, domain-specific, and often privacy-sensitive. We developed a locally deployable framework that enables small language models to self-generate, verify, refine, and evaluate entity-specific prompts for extracting multiple clinical entities from dental notes. Using 1,200 annotated notes, we evaluated candidate open-weight models with multi-prompt ensemble inference and further adapted selected models using QLoRA-based supervised fine-tuning and direct preference optimization. Model performance varied substantially, highlighting the need for task-specific evaluation rather than reliance on generic benchmarks. Qwen2.5-14B-Instruct achieved the strongest baseline performance. After DPO, Qwen2.5-14B-Instruct and Llama-3.1-8B-Instruct achieved micro/macro F1 scores of 0.864/0.837 and 0.806/0.797, respectively. These findings suggest that automated prompt optimization combined with lightweight preference-based post-training can support scalable clinical information extraction using locally deployed small language models.

Yao-Shun Chuang, Tushti Mody, Uday Pratap Singh +6

McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States · School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States · School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX 77054, United States +1

Named Entity Recognition Healthcare LLM Prompting Small Language Models Clinical Information Extraction Clinical Language Model Evaluation

May 5, 2026cs.CL

Safety and accuracy follow different scaling laws in clinical large language models

Clinical LLMs are often scaled by increasing model size, context length, retrieval complexity, or inference-time compute, with the implicit expectation that higher accuracy implies safer behavior. This assumption is incomplete in medicine, where a few confident, high-risk, or evidence-contradicting errors can matter more than average benchmark performance. We introduce SaFE-Scale, a framework for measuring how clinical LLM safety changes across model scale, evidence quality, retrieval strategy, context exposure, and inference-time compute. To instantiate this framework, we introduce RadSaFE-200, a Radiology Safety-Focused Evaluation benchmark of 200 multiple-choice questions with clinician-defined clean evidence, conflict evidence, and option-level labels for high-risk error, unsafe answer, and evidence contradiction. We evaluated 34 locally deployed LLMs across six deployment conditions: closed-book prompting (zero-shot), clean evidence, conflict evidence, standard RAG, agentic RAG, and max-context prompting. Clean evidence produced the strongest improvement, increasing mean accuracy from 73.5% to 94.1%, while reducing high-risk error from 12.0% to 2.6%, contradiction from 12.7% to 2.3%, and dangerous overconfidence from 8.0% to 1.6%. Standard RAG and agentic RAG did not reproduce this safety profile: agentic RAG improved accuracy over standard RAG and reduced contradiction, but high-risk error and dangerous overconfidence remained elevated. Max-context prompting increased latency without closing the safety gap, and additional inference-time compute produced only limited gains. Worst-case analysis showed that clinically consequential errors concentrated in a small subset of questions. Clinical LLM safety is therefore not a passive consequence of scaling, but a deployment property shaped by evidence quality, retrieval design, context construction, and collective failure behavior.

Sebastian Wind, Tri-Thien Nguyen, Jeta Sopa +9

Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany · Institute of Radiology, University Hospital Erlangen, Erlangen, Germany · Lab for AI in Medicine, RWTH Aachen University, Aachen, Germany +3

LLM Safety Benchmarks Retrieval-Augmented Generation Healthcare Language Model Scaling Laws LLM Safety Evaluation Clinical Language Model Evaluation

May 5, 2026cs.CL

EQUITRIAGE: A Fairness Audit of Gender Bias in LLM-Based Emergency Department Triage

Emergency department triage assigns patients an acuity score that determines treatment priority, and clinical evidence documents persistent gender disparities in human acuity assessment. As hospitals pilot large language models (LLMs) as triage decision support, a critical question is whether these models reproduce or mitigate known biases. We present EQUITRIAGE, a fairness audit of LLM-based ESI assignment evaluating five models (Gemini-3-Flash, Nemotron-3-Super, DeepSeek-V3.1, Mistral-Small-3.2, GPT-4.1-Nano) across 374,275 evaluations on 18,714 MIMIC-IV-ED vignettes under four prompt strategies. Of 9,368 originals, 9,346 are paired with a gender-swapped counterfactual. All five models produced flip rates above a pre-registered 5% threshold (9.9% to 43.8%). Two showed directional female undertriage (DeepSeek F/M 2.15:1, Gemini 1.34:1); two were near-parity; one had high sensitivity with weak male-direction asymmetry. DeepSeek's directional bias coexisted with a low outcome-linked calibration gap (0.013 against MIMIC-IV admission), a Chouldechova-style dissociation between within-group calibration and between-pair counterfactual invariance. Demographic blinding reduced Gemini's flip rate to 0.5%; an age-preserving blind variant left DeepSeek with residual F/M 1.25, implicating age as a residual channel. Chain-of-thought prompting degraded accuracy for all five models. A two-model ablation reveals opposite underlying mechanisms for the same directional phenotype: in Gemini the signal is emergent in the combined name+gender swap, while in DeepSeek the gender token alone carries it. EQUITRIAGE shows that group parity, counterfactual invariance, and gender calibration are distinct fairness properties, that intervention effectiveness is model-dependent, and that per-model counterfactual auditing should precede clinical deployment.

Richard J. Young, Alice M. Matthews

University of Nevada, Las Vegas, Lee Business School, Las Vegas, NV, USA · DeepNeuro AI, Las Vegas, NV, USA · Concorde Career Colleges, Dept. of Cardiovascular and Medical Diagnostic Sonography

Gender Bias in Language Models Clinical Triage Social Bias in Language Models Clinical Decision-Making Language Model Calibration Language Model Bias Evaluation+1

May 5, 2026cs.CL

Atomic Fact-Checking Increases Clinician Trust in Large Language Model Recommendations for Oncology Decision Support: A Randomized Controlled Trial

Question: Does atomic fact-checking, which decomposes AI treatment recommendations into individually verifiable claims linked to source guideline documents, increase clinician trust compared to traditional explainability approaches? Findings: In this randomized trial of 356 clinicians generating 7,476 trust ratings, atomic fact-checking produced a large effect on trust (Cohen's d = 0.94), increasing the proportion of clinicians expressing trust from 26.9% to 66.5%. Traditional transparency mechanisms showed a dose-response gradient of improvement over baseline (d = 0.25 to 0.50). Meaning: Decomposing AI recommendations into individually verifiable claims linked to source guidelines produces substantially higher clinician trust than traditional explainability approaches in high-stakes clinical decisions.

Lisa C. Adams, Linus Marx, Erik Thiele Orberg +8

Department of Diagnostic and Interventional Radiology, TUM University Hospital Rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany · Department of Radiation Oncology, TUM University Hospital Rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany · Department of Internal Medicine III: Hematology and Clinical Oncology, University Hospital Regensburg, University of Regensburg, Regensburg, Germany +4

Healthcare Clinical Decision Support Automated Fact-Checking Oncology Trust in AI Clinical Language Model Evaluation+1

May 5, 2026cs.CL

BIT.UA-AAUBS at ArchEHR-QA 2026: Evaluating Open-Source and Proprietary LLMs via Prompting in Low-Resource QA

This paper presents the joint participation of the BIT.UA and AAUBS groups in the ArchEHR-QA 2026 shared task, which focuses on clinical question answering and evidence grounding in a low-resource setting. Due to the absence of training data and the strict data privacy constraints inherent to the healthcare domain (e.g. GDPR), we investigate the capabilities of Large Language Models (LLMs) without weight updates. We evaluate several state-of-the-art proprietary models and locally deployable open-source alternatives using various prompt engineering strategies, including task decomposition, Chain-of-Thought, and in-context learning. Furthermore, we explore majority voting and LLM-as-a-judge ensembling techniques to maximize predictive robustness. Our results demonstrate that while proprietary models exhibit strong resilience to prompt variations, domain-adapted open-source models (such as MedGemma 3 27B) achieve highly competitive performance when paired with the right prompt. Overall, our prompt-based approach proved highly effective, securing 1st place in Subtask 4 (evidence citation alignment) and 3rd place in Subtask 3 (patient-friendly answer generation). All code, results, and prompts are available on our GitHub repository: https://github.com/bioinformatics-ua/ArchEHR-QA-2026.

Richard A. A. Jonker, Alexander Christiansen, Alexandros Maniatis +4

Aalborg University Business School Fibigerstræde 2, Aalborg East 9220, Denmark · IEETA, DETI, LASI, University of Aveiro Campus Universitário de Santiago, Aveiro 3810-193, Portugal

LLM Grounding Healthcare LLM Prompting Clinical QA Clinical Language Model Evaluation

May 5, 2026cs.CL

Auditing Stealth Sycophancy in Mental-Health Dialogue: Structured Clinical-State Diagnostics and Clean Matched Benchmarks

Mental-health dialogue models are increasingly evaluated by AI-based evaluators, yet these evaluators often treat surface empathy, supportiveness, or fluency as evidence of safety. In this paper, we study a hidden failure mode that we call implicit sycophancy: a response may appear empathetic while implicitly reinforcing catastrophizing, avoidance, hopeless prediction, or CBT-style labeling. To examine this problem, we introduce a diagnostic benchmark for implicit-sycophancy detection, built from three representative mental-health dialogue sources covering everyday peer support, counseling-style emotional support, and crisis-oriented interaction, and further construct a leakage-audited clean single-response matched benchmark with 500 contexts and 1,500 matched response windows. We then propose Dynamic Emotional Signature Graphs (DESG), a structured offline audit framework that separates LLM-based state extraction from final scoring and evaluates clinical direction through semantic, affective, and cognitive-distortion state transitions rather than free-form LLM judgment. Unlike metadata, surface-style, lexical, embedding, and rubric-LLM baselines, DESG scores the direction of clinical-state change induced by a response; on the leakage-audited clean matched benchmark, DESG-StateRisk improves over the strongest non-DESG baseline by 0.0488 macro-F1 and achieves the best harmful-risk detection result. These results suggest that evaluating implicit sycophancy requires explicit clinical-state modeling together with leakage checks, shortcut controls, and competitive baselines.

Tianze Han, Beining Xu, Hanbo Zhang +1

Shenzhen MSU-BIT University, Shenzhen, China

Mental Health Counseling LLM Sycophancy Emotional Support Conversation LLM Auditing Mental Health Clinical Language Model Evaluation

May 4, 2026cs.AI

ADAPTS: Agentic Decomposition for Automated Protocol-agnostic Tracking of Symptoms

Modeling latent clinical constructs from unconstrained clinical interactions is a unique challenge in affective computing. We present ADAPTS (Agentic Decomposition for Automated Protocol-agnostic Tracking of Symptoms), a framework for automated rating of depression and anxiety severity using a mixture-of-agents LLM architecture. This approach decomposes long-form clinical interviews into symptom-specific reasoning tasks, producing auditable justifications while preserving temporal and speaker alignment. Generalization was evaluated across two independent datasets (

N=204

) with distinct interview structures. On high-discrepancy interviews, automated ratings approximated expert benchmarks (

\text{absolute error}=22

) more closely than original human ratings (

\text{absolute error}=26

). Implementing an ``extended'' protocol that incorporates qualitative clinical conventions significantly stabilized ratings, with absolute agreement reaching

\text{ICC(2,1)} = 0.877

. These findings suggest that the ADAPTS framework enables promising evaluations of psychiatric severity. While the current implementation is purely text-based, the underlying architecture is readily extensible to multimodal inputs, including acoustic and visual features. By approximating expert-level precision in a protocol-agnostic manner, this framework provides a foundation for objective and scalable psychiatric assessment, especially in resource-limited settings.

Alexandria K. Vail, Marcelo Cicconet, Katie Aafjes-van Doorn +2

Deliberate Solutions, Inc. New York, New York, USA

Depression Detection Mental Health Depression Severity Estimation Clinical Language Model Evaluation Clinical NLP

May 4, 2026cs.CL

Reliability-Oriented Multilingual Orthopedic Diagnosis: A Domain-Adaptive Modeling and a Conceptual Validation Framework

Large Language Models (LLMs) are increasingly proposed for clinical decision support including multilingual diagnosis in low-resource settings. However, their reliability, calibration and safety characteristics remain insufficiently understood for structured, high-risk tasks. We present a system-level analysis of multilingual orthopedic diagnosis from free-text clinical notes in English, Hindi and Punjabi. We evaluate three modeling regimes: (i) task-aligned multilingual transformer encoders, (ii) a task-fine-tuned baseline (DistilBERT), and (iii) a domain-adaptive architecture tailored to orthopedic text (IndicBERT-HPA). These models are compared with zero-shot, instruction-tuned LLMs to assess suitability for structured diagnostic classification. Results indicate that while LLMs exhibit strong linguistic fluency, they show unstable calibration and reduced reliability under structured multilingual conditions, particularly in low-resource languages. These findings are specific to zero-shot evaluation and do not imply limitations of fine-tuned models. Domain-adaptive specialization substantially improves cross-lingual discrimination and confidence behavior. IndicBERT-HPA, with language-specific orthopedic adapter heads achieves consistently strong performance across six diagnostic categories and more predictable deployment characteristics than task-only adaptation. Building on these observations, we outline a conceptual deterministic agent-based validation framework for future implementation, formalizing evidence checks, language-sensitive validation and conservative human-in-the-loop gating. Reliable multilingual clinical decision support requires specialized architecture, explicit reliability analysis, and structured validation for safety-critical systems.

Danish Ali, Li Xiaojian, Sundas Iqbal +1

School of Computer Science, Wuhan University, China · School of Software, Nanjing University of Information Science and Technology (NUIST), China · Department of Orthopedic, Bahawal Victoria Hospital, Pakistan

Multilingual Language Model Evaluation Healthcare Domain Adaptation Medical Diagnosis Language Model Calibration Clinical Language Model Evaluation+1

May 4, 2026cs.AI

PhysicianBench: Evaluating LLM Agents in Real-World EHR Environments

We introduce PhysicianBench, a benchmark for evaluating LLM agents on physician tasks grounded in real clinical setting within electronic health record (EHR) environments. Existing medical agent benchmarks primarily focus on static knowledge recall, single-step atomic actions, or action intent without verifiable execution against the environment. As a result, they fail to capture the long-horizon, composite workflows that characterize real clinical systems. PhysicianBench comprises 100 long-horizon tasks adapted from real consultation cases between primary care and subspecialty physicians, with each task independently reviewed by a separate panel of physicians. Tasks are instantiated in an EHR environment with real patient records and accessed through the same standard APIs used by commercial EHR vendors. Tasks span 21 specialties (e.g., cardiology, endocrinology, oncology, psychiatry) and diverse workflow types (e.g., diagnosis interpretation, medication prescribing, treatment planning), requiring an average of 27 tool calls per task. Solving each task requires retrieving data across encounters, reasoning over heterogeneous clinical information, executing consequential clinical actions, and producing clinical documentation. Each task is decomposed into structured checkpoints (670 in total across the benchmark) capturing distinct stages of completion graded by task-specific scripts with execution-grounded verification. Across 13 proprietary and open-source LLM agents, the best-performing model achieves only 46% success rate (pass@1), while open-source models reach at most 19%, revealing a substantial gap between current agent capabilities and the demands of real-world clinical workflows. PhysicianBench provides a realistic and execution-grounded benchmark for measuring progress toward autonomous clinical agents.

Ruoqi Liu, Imran Q. Mohiuddin, Austin J. Schoeffler +10

Stanford University

Healthcare Long-Horizon Agent Evaluation AI Agent Benchmarks LLM Agents Clinical Language Model Evaluation Electronic Health Records

May 2, 2026cs.CL

Artificial intelligence language technologies in multilingual healthcare: Grand challenges ahead

AI language technologies (AILTs), increasingly enabled by large language models (LLMs), are becoming embedded in multilingual healthcare workflows for translation, rewriting, documentation, interpreting, and messaging in language-discordant settings. Yet fluent output is not the same as clinically safe or equitable communication: performance varies across languages, accents, tasks, and workflows, and efficiency gains can hide errors, reduce traceability, and shift responsibility across clinicians, translators, interpreters, and health systems. This narrative review synthesises recent peer-reviewed evidence across written communication, spoken communication, and emerging agentic workflows. Using the Human-Centered AI Language Technology (HCAILT) lens, it examines capabilities, evaluation practices, implementation patterns, and recurrent errors through reliability, safety culture, and trustworthiness. We identify key convergences and contradictions in the literature and propose seven grand challenges for the next phase of research and deployment. Progress, we argue, requires not only better models but also accountable sociotechnical design, calibrated human oversight, and stronger collaboration across MT/NLP, translation studies, HCI, clinical practice, implementation science, and policy.

Vicent Briva-Iglesias

School of Applied Languages and Intercultural Studies (SALIS) · CTTS, ADAPT Centre · Dublin City University

Multilingual Language Model Evaluation Language Model Safety Evaluation Healthcare Clinical Language Model Evaluation Clinical NLP