Medical LLMs

LLM: Large Language Model

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Medical large language models are studied for tasks such as diagnosis, clinical coding, note summarization, triage, and patient communication. Common approaches include clinical pretraining and fine-tuning, retrieval-augmented generation with guidelines or knowledge graphs, tool-using agents, and multimodal models that combine text with images or structured records. Evaluation ranges from question-answering benchmarks to realistic consultations, EHR workflows, and clinician studies, with growing attention to calibration, privacy, bias, and evidence grounding. A central challenge is that strong scores on fixed tests do not ensure reliable behavior with incomplete or changing information, misleading patient input, or high-stakes decisions, so human oversight and real-world validation remain important.

Latest papers

402 papers40 papers in the last four weeks, up 29% on the four weeks before. 0.2% of all new papers.

Apr 9, 2026

Enhancing LLM Medical Coding with Structured External Knowledge

Accurate medical coding requires consulting authoritative resources such as the ICD tabular list and coding guidelines. Existing LLM-based automated methods largely rely on LLMs' internal knowledge, which is prone to hallucination and cannot keep pace with guideline updates. We introduce RAG-Coding, an agentic, training-free method that augments LLMs with structured external knowledge: the tabular list is encoded as a knowledge graph capturing hierarchical and instructional code relationships, and the guidelines are distilled into concise, code-specific summaries rather than retrieved as raw text. To enable our study, we also introduce MDACE-2025, expert re-annotations of the MDACE dataset under the 2025 ICD-10-CM/PCS guidelines, adding code sequencing and justification comments. On MDACE, RAG-Coding outperforms the best LLM-based baseline by 3--13% in micro-F1 across five LLM backbones, and achieves comparable micro- and macro-F1 to the supervised state-of-the-art, with higher recall (

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11%) at the cost of precision (

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6%). On MDACE-2025, RAG-Coding outperforms all baselines, demonstrating effective generalisation to updated guidelines. Ablations confirm stepwise gains, highlighting the importance of integrating structured external knowledge for LLM-based medical coding.

Yidong Gan, David D. Nguyen, Yang Lin +4

Oracle Health and AI · The University of Sydney · CSIRO Data61

Automated Medical Coding Medical LLMs Knowledge Augmentation for Language Models Graph Retrieval-Augmented Generation

Apr 9, 2026

Detecting HIV-Related Stigma in Clinical Narratives Using Large Language Models

Human immunodeficiency virus (HIV)-related stigma is a critical psychosocial determinant of health for people living with HIV (PLWH), influencing mental health, engagement in care, and treatment outcomes. Although stigma-related experiences are documented in clinical narratives, there is a lack of off-the-shelf tools to extract and categorize them. This study aims to develop a large language model (LLM)-based tool for identifying HIV stigma from clinical notes. We identified clinical notes from PLWH receiving care at the University of Florida (UF) Health between 2012 and 2022. Candidate sentences were identified using expert-curated stigma-related keywords and iteratively expanded via clinical word embeddings. A total of 1,332 sentences were manually annotated across four stigma subscales: Concern with Public Attitudes, Disclosure Concerns, Negative Self-Image, and Personalized Stigma. We compared GatorTron-large and BERT as encoder-based baselines, and GPT-OSS-20B, LLaMA-8B, and MedGemma-27B as generative LLMs, under zero-shot and few-shot prompting. GatorTron-large achieved the best overall performance (Micro F1 = 0.62). Few-shot prompting substantially improved generative model performance, with 5-shot GPT-OSS-20B and LLaMA-8B achieving Micro-F1 scores of 0.57 and 0.59, respectively. Performance varied by stigma subscale, with Negative Self-Image showing the highest predictability and Personalized Stigma remaining the most challenging. Zero-shot generative inference exhibited non-trivial failure rates (up to 32%). This study develops the first practical NLP tool for identifying HIV stigma in clinical notes.

Ziyi Chen, Yasir Khan, Mengyuan Zhang +7

Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA · Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA · Preston A. Wells, Jr. Center for Brain Tumor Therapy, Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA

Clinical NLP Medical LLMs

Apr 8, 2026

Efficient and Effective Internal Memory Retrieval for LLM-Based Healthcare Prediction

Large language models (LLMs) hold significant promise for healthcare, yet their reliability in high-stakes clinical settings is often compromised by hallucinations and a lack of granular medical context. While Retrieval Augmented Generation (RAG) can mitigate these issues, standard supervised pipelines require computationally intensive searches over massive external knowledge bases, leading to high latency that is impractical for time-sensitive care. To address this, we introduce Keys to Knowledge (K2K), a novel framework that replaces external retrieval with internal, key-based knowledge access. By encoding essential clinical information directly into the model's parameter space, K2K enables rapid retrieval from internal key-value memory without inference-time overhead. We further enhance retrieval quality through activation-guided probe construction and cross-attention reranking. Experimental results demonstrate that K2K achieves state-of-the-art performance across four benchmark healthcare outcome prediction datasets.

Mingchen Li, Jiatan Huang, Zonghai Yao +1

University of Massachusetts, Amherst · University of Connecticut · University of Massachusetts, Lowell +1

Memory-Augmented Language Models Medical LLMs Clinical Outcome Prediction LLM Inference Acceleration

Apr 8, 2026

Is Biomedical Specialization Still Worth It? Insights from Domain-Adaptive Language Modelling with a New French Health Corpus

Large language models (LLMs) have demonstrated remarkable capabilities across diverse domains, yet their adaptation to specialized fields remains challenging, particularly for non-English languages. This study investigates domain-adaptive pre-training (DAPT) as a strategy for specializing small to mid-sized LLMs in the French biomedical domain through continued pre-training. We address two key research questions: the viability of specialized continued pre-training for domain adaptation and the relationship between domain-specific performance gains and general capability degradation. Our contributions include the release of a fully open-licensed French biomedical corpus suitable for commercial and open-source applications, the training and release of specialized French biomedical LLMs, and novel insights for DAPT implementation. Our methodology encompasses the collection and refinement of high-quality French biomedical texts, the exploration of causal language modeling approaches using DAPT, and conducting extensive comparative evaluations. Our results cast doubt on the efficacy of DAPT, in contrast to previous works, but we highlight its viability in smaller-scale, resource-constrained scenarios under the right conditions. Findings in this paper further suggest that model merging post-DAPT is essential to mitigate generalization trade-offs, and in some cases even improves performance on specialized tasks at which the DAPT was directed.

Aidan Mannion, Cécile Macaire, Armand Violle +5

Université Grenoble Alpes, CNRS, Grenoble INP, LIG, 38000 Grenoble, France · Sorbonne Université, LIMICS, 15 rue de l’École de Médecine, 75006 Paris, France

Domain-Adaptive Pretraining Domain Adaptation for LLMs Medical LLMs

Apr 8, 2026

To Adapt or not to Adapt, Rethinking the Value of Medical Knowledge-Aware Large Language Models

BACKGROUND: Recent studies have shown that domain-adapted large language models (LLMs) do not consistently outperform general-purpose counterparts on standard medical benchmarks, raising questions about the need for specialized clinical adaptation. METHODS: We systematically compare general and clinical LLMs on a diverse set of multiple choice clinical question answering tasks in English and Spanish. We introduce a perturbation based evaluation benchmark that probes model robustness, instruction following, and sensitivity to adversarial variations. Our evaluation includes, one-step and two-step question transformations, multi prompt testing and instruction guided assessment. We analyze a range of state-of-the-art clinical models and their general-purpose counterparts, focusing on Llama 3.1-based models. Additionally, we introduce Marmoka, a family of lightweight 8B-parameter clinical LLMs for English and Spanish, developed via continual domain-adaptive pretraining on medical corpora and instructions. RESULTS: The experiments show that clinical LLMs do not consistently outperform their general purpose counterparts on English clinical tasks, even under the proposed perturbation based benchmark. However, for the Spanish subsets the proposed Marmoka models obtain better results compared to Llama. CONCLUSIONS: Our results show that, under current short-form MCQA benchmarks, clinical LLMs offer only marginal and unstable improvements over general-purpose models in English, suggesting that existing evaluation frameworks may be insufficient to capture genuine medical expertise. We further find that both general and clinical models exhibit substantial limitations in instruction following and strict output formatting. Finally, we demonstrate that robust medical LLMs can be successfully developed for low-resource languages such as Spanish, as evidenced by the Marmoka models.

Ane G. Domingo-Aldama, Iker De La Iglesia, Maitane Urruela +2

Medical LLMs Domain Adaptation for LLMs Clinical Language Model Evaluation Multilingual Language Model Evaluation Language Model Robustness Instruction Following

Apr 8, 2026

MedDialBench: Benchmarking LLM Diagnostic Robustness under Parametric Adversarial Patient Behaviors

Interactive medical dialogue benchmarks have shown that LLM diagnostic accuracy degrades significantly when interacting with non-cooperative patients, yet existing approaches either apply adversarial behaviors without graded severity or case-specific grounding, or reduce patient non-cooperation to a single ungraded axis, and none analyze cross-dimension interactions. We introduce MedDialBench, a benchmark enabling controlled, dose-response characterization of how individual patient behavior dimensions affect LLM diagnostic robustness. It decomposes patient behavior into five dimensions -- Logic Consistency, Health Cognition, Expression Style, Disclosure, and Attitude -- each with graded severity levels and case-specific behavioral scripts. This controlled factorial design enables graded sensitivity analysis, dose-response profiling, and cross-dimension interaction detection. Evaluating five frontier LLMs across 7,225 dialogues (85 cases x 17 configurations x 5 models), we find a fundamental asymmetry: information pollution (fabricating symptoms) produces 1.7-3.4x larger accuracy drops than information deficit (withholding information), and fabricating is the only configuration achieving statistical significance across all five models (McNemar p < 0.05). Among six dimension combinations, fabricating is the sole driver of super-additive interaction: all three fabricating-involving pairs produce O/E ratios of 0.70-0.81 (35-44% of eligible cases fail under the combination despite succeeding under each dimension alone), while all non-fabricating pairs show purely additive effects (O/E ~ 1.0). Inquiry strategy moderates deficit but not pollution: exhaustive questioning recovers withheld information, but cannot compensate for fabricated inputs. Models exhibit distinct vulnerability profiles, with worst-case drops ranging from 38.8 to 54.1 percentage points.

Xiaotian Luo, Xun Jiang, Jiangcheng Wu

Shanda Group

Adversarial Robustness of Language Models Medical LLMs Adversarial Robustness Clinical Language Model Evaluation Clinical Decision-Making

Apr 7, 2026

Severity-Aware Weighted Loss for Arabic Medical Text Generation

Large language models have shown strong potential for Arabic medical text generation; however, traditional fine-tuning objectives treat all medical cases uniformly, ignoring differences in clinical severity. This limitation is particularly critical in healthcare settings, where errors in severe cases contain higher clinical risk. In this work, we propose a severity-aware weighted loss for fine-tuning Arabic language models on medical complaint-response data. The method depends on soft severity probabilities to dynamically scale token-level loss contributions during optimization, thereby prioritizing clinically critical interactions without modifying model architectures. Experiments are conducted using the MAQA dataset, which provides Arabic medical complaints and trusted human responses. Severity labels and probabilistic scores are automatically derived using a fine-tuned AraBERT-based classifier and incorporated exclusively at the loss level. The proposed approach is evaluated across ten Arabic large language models of varying architectures and parameter scales. While standard cross-entropy fine-tuning yields only modest improvements, severity-aware optimization consistently achieves larger gains. Using a balanced weighting configuration, performance improves from 54.04% to 66.14% for AraGPT2-Base, from 59.16% to 67.18% for AraGPT2-Medium, and from 57.83% to 66.86% for Qwen2.5-0.5B, with peak performance reaching 67.18%. Overall, severity-aware fine-tuning delivers improvements of up to 12.10% over non-fine-tuned baselines, demonstrating robust and architecture-consistent gains.

Ahmed Alansary, Molham Mohamed, Ali Hamdi

October University for Modern Sciences & Arts, Egypt

Medical LLMs Text Generation LLM Fine-Tuning Arabic NLP Cost-Sensitive Learning

Apr 7, 2026

CareGuardAI: Context-Aware Multi-Agent Guardrails for Clinical Safety & Hallucination Mitigation in Patient-Facing LLMs

Integrating large language models (LLMs) into patient-facing healthcare systems offers significant potential to improve access to medical information. However, ensuring clinical safety and factual reliability remains a critical challenge. In practice, AI-generated responses may be conditionally correct yet medically inappropriate, as models often fail to interpret patient context and tend to produce agreeable responses rather than challenge unsafe assumptions. Unlike clinicians, who infer risk from incomplete information, LLMs frequently lack contextual awareness. Moreover, real-world patient interactions are open-ended and underspecified, unlike structured benchmark settings. We present CareGuardAI, a risk-aware safety framework for patient-facing medical question answering that addresses two key failure modes: clinical safety risk and hallucination risk. The framework introduces Clinical Safety Risk Assessment (SRA), inspired by ISO 14971, and Hallucination Risk Assessment (HRA) to evaluate medical risk and factual reliability. At inference time, CareGuardAI employs a multi-stage pipeline consisting of a controller agent, safety-constrained generation, and dual risk evaluation, followed by iterative refinement when necessary. Responses are released only when both SRA and HRA are less than or equal to 2, ensuring clinically acceptable outputs with bounded latency. We evaluate CareGuardAI on PatientSafeBench, MedSafetyBench, and MedHallu, covering both safety and hallucination detection. Across these benchmarks, the framework consistently outperforms strong baseline models, including GPT-4o-mini, demonstrating the importance of context-aware, risk-based, inference-time safety mechanisms for reliable deployment in healthcare.

Elham Nasarian, Abhilash Neog, Kwok-Leung Tsui +1

Grado Department of Industrial & Systems Engineering, Virginia Tech, Blacksburg, VA 24061, USA · Department of Computer Science, Virginia Tech, Blacksburg, VA 24061, USA · Dept of Industrial, Manufacturing, and Systems Engineering at University of Texas at Arlington, Arlington, TX 76019, USA

LLM Guardrails LLM Safety LLM Agent Safety LLM Hallucination Mitigation Medical LLMs

Apr 7, 2026

From Retinal Evidence to Safe Decisions: RETINA-SAFE and ECRT for Hallucination Risk Triage in Medical LLMs

Hallucinations in medical large language models (LLMs) remain a safety-critical issue, particularly when available evidence is insufficient or conflicting. We study this problem in diabetic retinopathy (DR) decision settings and introduce RETINA-SAFE, an evidence-grounded benchmark aligned with retinal grading records, comprising 12,522 samples. RETINA-SAFE is organized into three evidence-relation tasks: E-Align (evidence-consistent), E-Conflict (evidence-conflicting), and E-Gap (evidence-insufficient). We further propose ECRT (Evidence-Conditioned Risk Triage), a two-stage white-box detection framework: Stage 1 performs Safe/Unsafe risk triage, and Stage 2 refines unsafe cases into contradiction-driven versus evidence-gap risks. ECRT leverages internal representation and logit shifts under CTX/NOCTX conditions, with class-balanced training for robust learning. Under evidence-grouped (not patient-disjoint) splits across multiple backbones, ECRT provides strong Stage-1 risk triage and explicit subtype attribution, improves Stage-1 balanced accuracy by +0.15 to +0.19 over external uncertainty and self-consistency baselines and by +0.02 to +0.07 over the strongest adapted supervised baseline, and consistently exceeds a single-stage white-box ablation on Stage-1 balanced accuracy. These findings support white-box internal signals grounded in retinal evidence as a practical route to interpretable medical LLM risk triage.

Zhe Yu, Wenpeng Xing, Meng Han

Binjiang Institute of Zhejiang University, Hangzhou, China · Communication University of Zhejiang, Hangzhou, China · Zhejiang University, Hangzhou, China

Hallucination Detection LLM Hallucination Detection Medical LLMs LLM Safety Diabetic Retinopathy Grading

Apr 6, 2026

Retrieval-Augmented LLMs for Evidence Localization in Clinical Trial Recruitment from Longitudinal EHR Narratives

Screening patients for enrollment is a well-known, labor-intensive bottleneck that leads to under-enrollment and, ultimately, trial failures. Recent breakthroughs in large language models (LLMs) offer a promising opportunity to use artificial intelligence to improve screening. This study systematically explored both encoder- and decoder-based generative LLMs for screening clinical narratives to facilitate clinical trial recruitment. We examined both general-purpose LLMs and medical-adapted LLMs and explored three strategies to alleviate the "Lost in the Middle" issue when handling long documents, including 1) Original long-context: using the default context windows of LLMs, 2) NER-based extractive summarization: converting the long document into summarizations using named entity recognition, 3) RAG: dynamic evidence retrieval based on eligibility criteria. The 2018 N2C2 Track 1 benchmark dataset is used for evaluation. Our experimental results show that the MedGemma model with the RAG strategy achieved the best micro-F1 score of 89.05%, outperforming other models. Generative LLMs have remarkably improved trial criteria that require long-term reasoning across long documents, whereas trial criteria that span a short piece of context (e.g., lab tests) show incremental improvements. The real-world adoption of LLMs for trial recruitment must consider specific criteria for selecting among rule-based queries, encoder-based LLMs, and generative LLMs to maximize efficiency within reasonable computing costs.

Ziyi Chen, Mengxian Lyu, Cheng Peng +1

Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL

Medical LLMs Clinical Language Model Evaluation Retrieval-Augmented Generation Long-Context Language Model Evaluation

Apr 6, 2026

This Treatment Works, Right? Evaluating LLM Sensitivity to Patient Question Framing in Medical QA

Patients are increasingly turning to large language models (LLMs) with medical questions that are complex and difficult to articulate clearly. However, LLMs are sensitive to prompt phrasings and can be influenced by the way questions are worded. Ideally, LLMs should respond consistently regardless of phrasing, particularly when grounded in the same underlying evidence. We investigate this through a systematic evaluation in a controlled retrieval-augmented generation (RAG) setting for medical question answering (QA), where expert-selected documents are used rather than retrieved automatically. We examine two dimensions of patient query variation: question framing (positive vs. negative) and language style (technical vs. plain language). We construct a dataset of 6,614 query pairs grounded in clinical trial abstracts and evaluate response consistency across eight LLMs. Our findings show that positively- and negatively-framed pairs are significantly more likely to produce contradictory conclusions than same-framing pairs. This framing effect is further amplified in multi-turn conversations, where sustained persuasion increases inconsistency. We find no significant interaction between framing and language style. Our results demonstrate that LLM responses in medical QA can be systematically influenced through query phrasing alone, even when grounded in the same evidence, highlighting the importance of phrasing robustness as an evaluation criterion for RAG-based systems in high-stakes settings.

Hye Sun Yun, Geetika Kapoor, Michael Mackert +4

Northeastern University · UC Berkeley · UT Austin +2

Framing Effects in Language Models Medical LLMs Reasoning Consistency in Language Models Clinical Language Model Evaluation Retrieval-Augmented Generation

Apr 2, 2026

Countering Catastrophic Forgetting of Large Language Models for Better Instruction Following via Weight-Space Model Merging

Large language models have been adopted in the medical domain for clinical documentation to reduce clinician burden. However, studies have reported that LLMs often "forget" a significant amount of instruction-following ability when fine-tuned using a task-specific medical dataset, a critical challenge in adopting general-purpose LLMs for clinical applications. This study presents a model merging framework to efficiently adapt general-purpose LLMs to the medical domain by countering this forgetting issue. By merging a clinical foundation model (GatorTronLlama) with a general instruct model (Llama-3.1-8B-Instruct) via interpolation-based merge methods, we seek to derive a domain-adapted model with strong performance on clinical tasks while retaining instruction-following ability. Comprehensive evaluation across medical benchmarks and five clinical generation tasks (e.g., radiology and discharge summarization) shows that merged models can effectively mitigate catastrophic forgetting, preserve clinical domain expertise, and retain instruction-following ability. In addition, our model merging strategies demonstrate training efficiency, achieving performance on par with fully fine-tuned baselines under severely constrained supervision (e.g., 64-shot vs. 256-shot). Consequently, weight-space merging constitutes a highly scalable solution for adapting open-source LLMs to clinical applications, facilitating broader deployment in resource-constrained healthcare environments.

Mengxian Lyu, Cheng Peng, Ziyi Chen +3

Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA · Department of Engineering Education, Herbert Wertheim College of Engineering, University of Florida, Gainesville, FL, USA · Preston A. Wells, Jr. Center for Brain Tumor Therapy, Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA

Domain Adaptation for LLMs Medical LLMs Catastrophic Forgetting Instruction Following Language Model Merging

Mar 31, 2026

Learning Diagnostic Reasoning for Decision Support in Toxicology

Acute poly-substance intoxication requires rapid, life-saving decisions under substantial uncertainty, as clinicians must rely on incomplete ingestion details and nonspecific symptoms. Effective diagnostic reasoning in this chaotic environment requires fusing unstructured, non-medical narratives (e.g. paramedic scene descriptions and unreliable patient self-reports or known histories), with structured medical data like vital signs. While Large Language Models (LLMs) show potential for processing such heterogeneous inputs, they struggle in this setting, often underperforming simple baselines that rely solely on patient histories. To address this, we present DeToxR (Decision-support for Toxicology with Reasoning), the first adaptation of Reinforcement Learning (RL) to emergency toxicology. We design a robust data-fusion engine for multi-label prediction across 14 substance classes based on an LLM finetuned with Group Relative Policy Optimization (GRPO). We optimize the model's reasoning directly using a clinical performance reward. By formulating a multi-label agreement metric as the reward signal, the model is explicitly penalized for missing co-ingested substances and hallucinating absent poisons. Our model significantly outperforms its unadapted base LLM counterpart and supervised baselines. Furthermore, in a preliminary clinical validation study, the model indicates a clinical advantage by achieving higher micro-F1 (0.644 vs 0.473) and recall in identifying the correct poisons. These results demonstrate the potential of RL-aligned LLMs to synthesize unstructured pre-clinical narratives and structured medical data for decision support in high-stakes environments.

Nico Oberländer, David Bani-Harouni, Tobias Zellner +3

Computer Aided Medical Procedures, Technical University of Munich, Germany · Munich Center for Machine Learning (MCML), Germany · Department of Clinical Toxicology and Poison Control Center Munich, TUM Klinikum rechts der Isar, Germany

Clinical Decision Support RL for Language Model Reasoning Clinical Reasoning Medical LLMs

Mar 31, 2026

Beyond Idealized Patients: Evaluating LLMs under Challenging Patient Behaviors in Medical Consultations

Large language models (LLMs) are increasingly used for medical consultation and health information support, where safety depends not only on medical knowledge but also on robust responses to unclear, inconsistent, or misleading patient input. However, most existing medical LLM evaluations assume idealized and well-posed patient questions, limiting their realism. We study challenging patient behaviors that commonly arise in real medical consultations and complicate safe clinical reasoning. We define four clinically grounded categories of such behaviors: information contradiction, factual inaccuracy, self-diagnosis, and care resistance. For each behavior, we specify concrete failure criteria that capture unsafe responses. Building on four existing medical dialogue datasets, we introduce CPB-Bench (Challenging Patient Behaviors Benchmark), a bilingual (English and Chinese) benchmark of multi-turn dialogues annotated for these behaviors. We find that although models perform well overall, they exhibit consistent behavior-specific failures, especially when handling contradictory or medically implausible patient information. We further evaluate four intervention strategies and find inconsistent improvements, with some interventions introducing unnecessary corrections.

Yahan Li, Xinyi Jie, Wanjia Ruan +5

University of Southern California

Healthcare Clinical Reasoning LLM Safety Evaluation Clinical Language Model Evaluation Language Model Robustness Medical LLMs

Mar 31, 2026

AI-Generated Prior Authorization Letters: Strong Clinical Content, Weak Administrative Scaffolding

Prior authorization remains one of the most burdensome administrative processes in U.S. healthcare, consuming billions of dollars and thousands of physician hours each year. While large language models have shown promise across clinical text tasks, their ability to produce submission-ready prior authorization letters has received only limited attention, with existing work confined to single-case demonstrations rather than structured multi-scenario evaluation. We assessed three commercially available LLMs (GPT-4o, Claude Sonnet 4.5, and Gemini 2.5 Pro) across 45 physician-validated synthetic scenarios spanning rheumatology, psychiatry, oncology, cardiology, and orthopedics. All three models generated letters with strong clinical content: accurate diagnoses, well-structured medical necessity arguments, and thorough step therapy documentation. However, a secondary analysis of real-world administrative requirements revealed consistent gaps that clinical scoring alone did not capture, including absent billing codes, missing authorization duration requests, and inadequate follow-up plans. These findings reframe the question: the challenge for clinical deployment is not whether LLMs can write clinically adequate letters, but whether the systems built around them can supply the administrative precision that payer workflows require.

Moiz Sadiq Awan, Maryam Raza

Independent Researcher

Medical LLMs Medical Report Generation Clinical Language Model Evaluation

Mar 30, 2026

An Underexplored Frontier: Large Language Models for Rare Disease Patient Education and Communication -- A scoping review

Rare diseases affect over 300 million people worldwide and are characterized by complex care pathways, limited clinical expertise, and substantial unmet communication needs throughout the long patient journey. Recent advances in large language models (LLMs) offer new opportunities to support patient education and communication, yet their application in rare diseases remains unclear. We conducted a scoping review of studies published between January 2022 and March 2026 across major databases, identifying 12 studies on LLM-based rare disease patient education and communication. Data were extracted on study characteristics, application scenarios, model usage, and evaluation methods, and synthesized using descriptive and qualitative analyses. The literature is highly recent and dominated by general-purpose models, particularly ChatGPT. Most studies focus on patient question answering using curated question sets, with limited use of real-world data or longitudinal communication scenarios. Evaluations are primarily centered on accuracy, with limited attention to patient-centered dimensions such as readability, empathy, and communication quality. Multilingual communication is rarely addressed. Overall, the field remains at an early stage. Future research should prioritize patient-centered design, domain-adapted methods, and real-world deployment to support safe, adaptive, and effective communication in rare diseases.

Zaifu Zhan, Yu Hou, Kai Yu +4

Division of Computational Health Sciences, Department of Surgery, University of Minnesota, Minneapolis, USA · Department of Electrical and Computer Engineering, University of Minnesota, Minneapolis, USA · Clinical Bioinformatics Lab, Université Paris Cité, Institut Imagine, INSERM UMR 1163, Paris, France +1

Medical LLMs Healthcare Medical QA

Mar 30, 2026

DongYuan: An LLM-Based Framework for Integrative Chinese and Western Medicine Spleen-Stomach Disorders Diagnosis

The clinical burden of spleen-stomach disorders is substantial. While large language models (LLMs) offer new potential for medical applications, they face three major challenges in the context of integrative Chinese and Western medicine (ICWM): a lack of high-quality data, the absence of models capable of effectively integrating the reasoning logic of traditional Chinese medicine (TCM) syndrome differentiation with that of Western medical (WM) disease diagnosis, and the shortage of a standardized evaluation benchmark. To address these interrelated challenges, we propose DongYuan, an ICWM spleen-stomach diagnostic framework. Specifically, three ICWM datasets (SSDF-Syndrome, SSDF-Dialogue, and SSDF-PD) were curated to fill the gap in high-quality data for spleen-stomach disorders. We then developed SSDF-Core, a core diagnostic LLM that acquires robust ICWM reasoning capabilities through a two-stage training regimen of supervised fine-tuning. tuning (SFT) and direct preference optimization (DPO), and complemented it with SSDF-Navigator, a pluggable consultation navigation model designed to optimize clinical inquiry strategies. Additionally, we established SSDF-Bench, a comprehensive evaluation benchmark focused on ICWM diagnosis of spleen-stomach disorders. Experimental results demonstrate that SSDF-Core significantly outperforms 12 mainstream baselines on SSDF-Bench. DongYuan lays a solid methodological foundation and provides practical technical references for the future development of intelligent ICWM diagnostic systems.

Hua Li, Yingying Li, Xiaobin Feng +8

Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China · Beijing Wenge Technology Co., Ltd., Beijing, China · Institute of Automation, Chinese Academy of Sciences, Beijing, China +1

Medical Diagnosis Medical LLMs Traditional Chinese Medicine

Mar 28, 2026

Development and Preliminary Evaluation of a Domain-Specific Large Language Model for Tuberculosis Care in South Africa

Tuberculosis (TB) is one of the world's deadliest infectious diseases, and in South Africa, it contributes a significant burden to the country's health care system. This paper presents an experimental study on the development of a domain-specific Large Language Model (DS-LLM) for TB care that can help to alleviate the burden on patients and healthcare providers. To achieve this, a literature review was conducted to understand current LLM development strategies, specifically in the medical domain. Thereafter, data were collected from South African TB guidelines, selected TB literature, and existing benchmark medical datasets. We performed LLM fine-tuning by using the Quantised Low-Rank Adaptation (QLoRA) algorithm on a medical LLM (BioMistral-7B), and also implemented Retrieval-Augmented Generation using GraphRAG. The developed DS-LLM was evaluated against the base BioMistral-7B model and a general-purpose LLM using a mix of automated metrics and quantitative ratings. The results show that the DS-LLM had better performance compared to the base model in terms of its contextual alignment (lexical, semantic, and knowledge) for TB care in South Africa.

Thokozile Khosa, Olawande Daramola

Department of Computer Science, University of Pretoria, South Africa · Department of Informatics, University of Pretoria, South Africa

Medical LLMs Healthcare LLM Fine-Tuning Clinical Language Model Evaluation

Mar 27, 2026

Phase 1 Implementation of LLM-generated Discharge Summaries showing high Adoption in a Dutch Academic Hospital

Writing discharge summaries to transfer medical information is an important but time-consuming process that can be assisted by Large Language Models (LLMs). This prospective mixed methods pilot study evaluated an Electronic Health Record (EHR)-integrated LLM to generate discharge summaries drafts. In total, 379 discharge summaries were generated in clinical practice by 21 residents and 4 physician assistants during 9 weeks in our academic hospital. LLM-generated text was copied in 58.5% of admissions, and identifiable LLM content could be traced to 29.1% of final discharge letters. Notably, 86.9% of users self-reported a reduction in documentation time, and 60.9% a reduction in administrative workload. Intent to use after the pilot phase was high (91.3%), supporting further implementation of this use-case. Accurately measuring the documentation time of users on discharge summaries remains challenging, but will be necessary for future extrinsic evaluation of LLM-assisted documentation.

Nettuno Nadalini, Tarannom Mehri, Anne H Hoekman +6

Department of Health Information Office, Data & Digitalization, University Medical Center, Groningen, the Netherlands · Department of Trauma Surgery / Orthopedics, University Medical Center, Groningen, the Netherlands · Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA +5

Medical Report Generation Medical LLMs Electronic Health Records

Mar 27, 2026

Clinical named entity recognition in the Portuguese language: a benchmark of modern BERT models and LLMs

Clinical notes contain valuable unstructured information. Named entity recognition (NER) enables the automatic extraction of medical concepts; however, benchmarks for Portuguese remain scarce. In this study, we aimed to evaluate BERT-based models and large language models (LLMs) for clinical NER in Portuguese and to test strategies for addressing multilabel imbalance. We compared BioBERTpt, BERTimbau, ModernBERT, and mmBERT with LLMs such as GPT-5 and Gemini-2.5, using the public SemClinBr corpus and a private breast cancer dataset. Models were trained under identical conditions and evaluated using precision, recall, and F1-score. Iterative stratification, weighted loss, and oversampling were explored to mitigate class imbalance. The mmBERT-base model achieved the best performance (micro F1 = 0.76), outperforming all other models. Iterative stratification improved class balance and overall performance. Multilingual BERT models, particularly mmBERT, perform strongly for Portuguese clinical NER and can run locally with limited computational resources. Balanced data-splitting strategies further enhance performance.

Vinicius Anjos de Almeida, Sandro Saorin da Silva, Josimar Chire +8

Spesia, Curitiba - PR, Brazil · Faculdade de Medicina, Universidade de São Paulo, São Paulo - SP, Brazil · Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba - PR, Brazil +2

Named Entity Recognition Clinical NLP Clinical Language Model Evaluation Medical LLMs

Mar 27, 2026

Automating Clinical Information Retrieval from Finnish Electronic Health Records Using Large Language Models

Clinicians often need to retrieve patient-specific information from electronic health records (EHRs), a task that is time-consuming and error-prone. We present a locally deployable Clinical Contextual Question Answering (CCQA) framework that answers clinical questions directly from EHRs without external data transfer. Open-source large language models (LLMs) ranging from 4B to 70B parameters were benchmarked under fully offline conditions using 1,664 expert-annotated question-answer pairs derived from records of 183 patients. The dataset consisted predominantly of Finnish clinical text. In free-text generation, Llama-3.1-70B achieved 95.3% accuracy and 97.3% consistency across semantically equivalent question variants, while the smaller Qwen3-30B-A3B-2507 model achieved comparable performance. In a multiple-choice setting, models showed similar accuracy but variable calibration. Low-precision quantization (4-bit and 8-bit) preserved predictive performance while reducing GPU memory requirements and improving deployment feasibility. Clinical evaluation identified clinically significant errors in 2.9% of outputs, and semantically equivalent questions occasionally yielded discordant responses, including instances where one formulation was correct and the other contained a clinically significant error (0.96% of cases). These findings demonstrate that locally hosted open-source LLMs can accurately retrieve patient-specific information from EHRs using natural-language queries, while highlighting the need for validation and human oversight in clinical deployment.

Mikko Saukkoriipi, Nicole Hernandez, Jaakko Sahlsten +2

Department of Computer Science, Aalto University School of Science, Espoo, 02150, Finland. · Faculty of Medicine and Health Technology, Tampere University, Tampere, 33520, Finland. · Department of Oncology, TAYS Cancer Centrer, Tampere University Hospital, Tampere, 33520, Finland.

EHR QA Clinical QA Medical LLMs Clinical Language Model Evaluation

Mar 26, 2026

When Chain-of-Thought Backfires: Evaluating Prompt Sensitivity in Medical Language Models

Large Language Models (LLMs) are increasingly deployed in medical settings, yet their sensitivity to prompt formatting remains poorly characterized. We evaluate MedGemma (4B and 27B parameters) on MedMCQA (4,183 questions) and PubMedQA (1,000 questions) across a broad suite of robustness tests. Our experiments reveal several concerning findings. Chain-of-Thought (CoT) prompting decreases accuracy by 5.7% compared to direct answering. Few-shot examples degrade performance by 11.9% while increasing position bias from 0.14 to 0.47. Shuffling answer options causes the model to change predictions 59.1% of the time, with accuracy dropping up to 27.4 percentage points. Front-truncating context to 50% causes accuracy to plummet below the no-context baseline, yet back-truncation preserves 97% of full-context accuracy. We further show that cloze scoring (selecting the highest log-probability option token) achieves 51.8% (4B) and 64.5% (27B), surpassing all prompting strategies and revealing that models "know" more than their generated text shows. Permutation voting recovers 4 percentage points over single-ordering inference. These results demonstrate that prompt engineering techniques validated on general-purpose models do not transfer to domain-specific medical LLMs, and that reliable alternatives exist.

Binesh Sadanandan, Vahid Behzadan

SAIL Lab, University of New Haven, West Haven, CT 06516, USA

Prompt Sensitivity LLM Prompting Language Model Robustness Medical LLMs Clinical Language Model Evaluation Medical QA

Mar 26, 2026

AD-CARE: A Guideline-grounded, Modality-agnostic LLM Agent for Real-world Alzheimer's Disease Diagnosis with Multi-cohort Assessment, Fairness Analysis, and Reader Study

Alzheimer's disease (AD) is a growing global health challenge as populations age, and timely, accurate diagnosis is essential to reduce individual and societal burden. However, real-world AD assessment is hampered by incomplete, heterogeneous multimodal data and variability across sites and patient demographics. Although large language models (LLMs) have shown promise in biomedicine, their use in AD has largely been confined to answering narrow, disease-specific questions rather than generating comprehensive diagnostic reports that support clinical decision-making. Here we expand LLM capabilities for clinical decision support by introducing AD-CARE, a modality-agnostic agent that performs guideline-grounded diagnostic assessment from incomplete, heterogeneous inputs without imputing missing modalities. By dynamically orchestrating specialized diagnostic tools and embedding clinical guidelines into LLM-driven reasoning, AD-CARE generates transparent, report-style outputs aligned with real-world clinical workflows. Across six cohorts comprising 10,303 cases, AD-CARE achieved 84.9% diagnostic accuracy, delivering 4.2%-13.7% relative improvements over baseline methods. Despite cohort-level differences, dataset-specific accuracies remain robust (80.4%-98.8%), and the agent consistently outperforms all baselines. AD-CARE reduced performance disparities across racial and age subgroups, decreasing the average dispersion of four metrics by 21%-68% and 28%-51%, respectively. In a controlled reader study, the agent improved neurologist and radiologist accuracy by 6%-11% and more than halved decision time. The framework yielded 2.29%-10.66% absolute gains over eight backbone LLMs and converges their performance. These results show that AD-CARE is a scalable, practically deployable framework that can be integrated into routine clinical workflows for multimodal decision support in AD.

Wenlong Hou, Sheng Bi, Guangqian Yang +16

Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China. · Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China. · Amazon, USA. +10

Alzheimer's Disease Classification Clinical Decision Support Medical LLMs LLM Agents Algorithmic Fairness

Mar 26, 2026

A Decade-Scale Benchmark Evaluating LLMs' Clinical Practice Guidelines Detection and Adherence in Multi-turn Conversations

Clinical practice guidelines (CPGs) play a pivotal role in ensuring evidence-based decision-making and improving patient outcomes. While Large Language Models (LLMs) are increasingly deployed in healthcare scenarios, it is unclear to which extend LLMs could identify and adhere to CPGs during conversations. To address this gap, we introduce CPGBench, an automated framework benchmarking the clinical guideline detection and adherence capabilities of LLMs in multi-turn conversations. We collect 3,418 CPG documents from 9 countries/regions and 2 international organizations published in the last decade spanning across 24 specialties. From these documents, we extract 32,155 clinical recommendations with corresponding publication institute, date, country, specialty, recommendation strength, evidence level, etc. One multi-turn conversation is generated for each recommendation accordingly to evaluate the detection and adherence capabilities of 8 leading LLMs. We find that the 71.1%-89.6% recommendations can be correctly detected, while only 3.6%-29.7% corresponding titles can be correctly referenced, revealing the gap between knowing the guideline contents and where they come from. The adherence rates range from 21.8% to 63.2% in different models, indicating a large gap between knowing the guidelines and being able to apply them. To confirm the validity of our automatic analysis, we further conduct a comprehensive human evaluation involving 56 clinicians from different specialties. To our knowledge, CPGBench is the first benchmark systematically revealing which clinical recommendations LLMs fail to detect or adhere to during conversations. Given that each clinical recommendation may affect a large population and that clinical applications are inherently safety critical, addressing these gaps is crucial for the safe and responsible deployment of LLMs in real world clinical practice.

Andong Tan, Shuyu Dai, Jinglu Wang +7

Media Computing Group, Microsoft Research Asia, Beijing, China · Department of Computer Science and Engineering, Hong Kong University of Science and Technology, Hong Kong, China · School of Computer Science, Peking University, Beijing, China +6

Clinical Language Model Evaluation Medical LLMs LLM Safety Benchmarks

Mar 26, 2026

OMIND: Framework for Knowledge Grounded Finetuning and Multi-Turn Dialogue Benchmark for Mental Health LLMs

Large Language Models (LLMs) have shown remarkable capabilities for complex tasks, yet adaptation in medical domain, specifically mental health, poses specific challenges. Mental health is a rising concern globally with LLMs having large potential to help address the same. We highlight three primary challenges for LLMs in mental health - lack of high quality interpretable and knowledge grounded training data; training paradigms restricted to core capabilities, and evaluation of multi turn dialogue settings. Addressing it, we present oMind framework which includes training and aligning LLM agents for diverse capabilities including conversations; high quality ~164k multi-task SFT dataset, as a result of our generation pipeline based on Structured Knowledge retrieval, LLM based pruning, and review actions. We also introduce oMind-Chat - a novel multi turn benchmark dataset with expert annotated turn level and conversation level rubrics. Our diverse experiments on both core capabilities and conversations shows oMind LLMs consistently outperform baselines. oMind-LLM also shows significantly better reasoning with up to 80% win rate.

Suraj Racha, Prashant Harish Joshi, Utkarsh Maurya +6

Indian Institute of Technology Bombay

Medical LLMs LLM Fine-Tuning LLM Grounding Clinical Language Model Evaluation

Mar 25, 2026

Evaluating Fine-Tuned LLM Model For Medical Transcription With Small Low-Resource Languages Validated Dataset

Clinical documentation is a critical factor for patient safety, diagnosis, and continuity of care. The administrative burden of EHRs is a significant factor in physician burnout. This is a critical issue for low-resource languages, including Finnish. This study aims to investigate the effectiveness of a domain-aligned natural language processing (NLP); large language model for medical transcription in Finnish by fine-tuning LLaMA 3.1-8B on a small validated corpus of simulated clinical conversations by students at Metropolia University of Applied Sciences. The fine-tuning process for medical transcription used a controlled preprocessing and optimization approach. The fine-tuning effectiveness was evaluated by sevenfold cross-validation. The evaluation metrics for fine-tuned LLaMA 3.1-8B were BLEU = 0.1214, ROUGE-L = 0.4982, and BERTScore F1 = 0.8230. The results showed a low n-gram overlap but a strong semantic similarity with reference transcripts. This study indicate that fine-tuning can be an effective approach for translation of medical discourse in spoken Finnish and support the feasibility of fine-tuning a privacy-oriented domain-specific large language model for clinical documentation in Finnish. Beside that provide directions for future work.

Mohammed Nowshad Ruhani Chowdhury, Mohammed Nowaz Rabbani Chowdhury, Sakari Lukkarinen

School of ICT and Industrial Management, Metropolia University of Applied Sciences, Helsinki, Finland · Department of Electrical, Computer, and Systems Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA

LLM Fine-Tuning Medical LLMs Clinical Language Model Evaluation Low-Resource Language Processing

Mar 25, 2026

MedAidDialog: A Multilingual Multi-Turn Medical Dialogue Dataset for Accessible Healthcare

Conversational artificial intelligence has the potential to assist users in preliminary medical consultations, particularly in settings where access to healthcare professionals is limited. However, many existing medical dialogue systems operate in a single-turn question--answering paradigm or rely on template-based datasets, limiting conversational realism and multilingual applicability. In this work, we introduce MedAidDialog, a multilingual multi-turn medical dialogue dataset designed to simulate realistic physician--patient consultations. The dataset extends the MDDial corpus by generating synthetic consultations using large language models and further expands them into a parallel multilingual corpus covering seven languages: English, Hindi, Telugu, Tamil, Bengali, Marathi, and Arabic. Building on this dataset, we develop MedAidLM, a conversational medical model trained using parameter-efficient fine-tuning on quantized small language models, enabling deployment without high-end computational infrastructure. Our framework additionally incorporates optional patient pre-context information (e.g., age, gender, allergies) to personalize the consultation process. Experimental results demonstrate that the proposed system can effectively perform symptom elicitation through multi-turn dialogue and generate diagnostic recommendations. We further conduct medical expert evaluation to assess the plausibility and coherence of the generated consultations.

Shubham Kumar Nigam, Suparnojit Sarkar, Piyush Patel

University of Birmingham, Dubai, United Arab Emirates · Heritage Institute of Technology, Kolkata, India · Madan Mohan Malaviya University of Technology, India

Medical LLMs Text Generation Multilingual Language Models Synthetic Data Generation for Language Models

Mar 25, 2026

VOLMO: Versatile and Open Large Models for Ophthalmology

Vision impairment affects millions globally, and early detection is critical to preventing irreversible vision loss. Ophthalmology workflows require clinicians to integrate medical images, structured clinical data, and free-text notes to determine disease severity and management, which is time-consuming and burdensome. Recent multimodal large language models (MLLMs) show promise, but existing general and medical MLLMs perform poorly in ophthalmology, and few ophthalmology-specific MLLMs are openly available. We present VOLMO (Versatile and Open Large Models for Ophthalmology), a model-agnostic, data-open framework for developing ophthalmology-specific MLLMs. VOLMO includes three stages: ophthalmology knowledge pretraining on 86,965 image-text pairs from 26,569 articles across 82 journals; domain task fine-tuning on 26,929 annotated instances spanning 12 eye conditions for disease screening and severity classification; and multi-step clinical reasoning on 913 patient case reports for assessment, planning, and follow-up care. Using this framework, we trained a compact 2B-parameter MLLM and compared it with strong baselines, including InternVL-2B, LLaVA-Med-7B, MedGemma-4B, MedGemma-27B, and RETFound. We evaluated these models on image description generation, disease screening and staging classification, and assessment-and-management generation, with additional manual review by two healthcare professionals and external validation on three independent cohorts for age-related macular degeneration and diabetic retinopathy. Across settings, VOLMO-2B consistently outperformed baselines, achieving stronger image description performance, an average F1 of 87.4% across 12 eye conditions, and higher scores in external validation.

Zhenyue Qin, Younjoon Chung, Elijah Lee +16

Department of Biomedical Informatics & Data Science, Yale University · Ray and Stephanie Lane Computational Biology Department, Carnegie Mellon University · Yong Loo Lin School of Medicine, National University of Singapore +4

Medical VLMs Medical LLMs Ophthalmology Ophthalmic Image Analysis

Mar 25, 2026

Dialogue to Question Generation for Evidence-based Medical Guideline Agent Development

Evidence-based medicine (EBM) is central to high-quality care, but remains difficult to implement in fast-paced primary care settings. Physicians face short consultations, increasing patient loads, and lengthy guideline documents that are impractical to consult in real time. To address this gap, we investigate the feasibility of using large language models (LLMs) as ambient assistants that surface targeted, evidence-based questions during physician-patient encounters. Our study focuses on question generation rather than question answering, with the aim of scaffolding physician reasoning and integrating guideline-based practice into brief consultations. We implemented two prompting strategies, a zero-shot baseline and a multi-stage reasoning variant, using Gemini 2.5 as the backbone model. We evaluated on a benchmark of 80 de-identified transcripts from real clinical encounters, with six experienced physicians contributing over 90 hours of structured review. Results indicate that while general-purpose LLMs are not yet fully reliable, they can produce clinically meaningful and guideline-relevant questions, suggesting significant potential to reduce cognitive burden and make EBM more actionable at the point of care.

Zongliang Ji, Ziyang Zhang, Xincheng Tan +5

Google Research · University of Toronto, Canada · Vector Institute, Canada +1

Clinical Decision Support Evidence-Grounded Generation Medical LLMs LLM Prompting

Mar 24, 2026

PLACID: Privacy-preserving Large language models for Acronym Clinical Inference and Disambiguation

Large Language Models (LLMs) offer transformative solutions across many domains, but healthcare integration is hindered by strict data privacy constraints. Clinical narratives are dense with ambiguous acronyms, misinterpretation these abbreviations can precipitate severe outcomes like life-threatening medication errors. While cloud-dependent LLMs excel at Acronym Disambiguation, transmitting Protected Health Information to external servers violates privacy frameworks. To bridge this gap, this study pioneers the evaluation of small-parameter models deployed entirely on-device to ensure privacy preservation. We introduce a privacy-preserving cascaded pipeline leveraging general-purpose local models to detect clinical acronyms, routing them to domain-specific biomedical models for context-relevant expansions. Results reveal that while general instruction-following models achieve high detection accuracy (~0.988), their expansion capabilities plummet (~0.655). Our cascaded approach utilizes domain-specific medical models to increase expansion accuracy to (~0.81). This novel work demonstrates that privacy-preserving, on-device (2B-10B) models deliver high-fidelity clinical acronym disambiguation support.

Manjushree B. Aithal, Ph. D., Alexander Kotz +2

Department of Biomedical Informatics, University of Colorado Anschutz, Aurora, CO

Clinical NLP Privacy-Preserving Language Models Medical LLMs On-Device Language Model Inference