Medical LLMs

LLM: Large Language Model

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26 papers in the last four weeks, up 160% on the four weeks before. 0.3% of all new papers.

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Sep 11, 2026cs.CL

The widening evaluation gap in medical large language model research 2023 to 2026

Large language models are superseded every few quarters; clinical evidence takes years. We asked whether medical research is keeping pace with the systems it evaluates. PubMed returned 11,628 records for January 2023 to June 2026 across fourteen clinical domains, growing 45-fold; 2.5% used a randomised, controlled or prospective design. Evaluation lag, from a study's newest named model release to its own publication, widened from 1.33 to 6.08 quarters. Because discontinued models age mechanically, we benchmarked this against a counterfactual holding model composition fixed: migration to newer systems offset only 56% of the drift (95% CI 50-65). Randomised trials evaluated models a median 4.6 quarters older than other designs (P = 3 x 10^-19), yet among studies naming a model still under development no design differed from any other; 62% of randomised trials evaluated a discontinued family. Rigour and currency are in tension, and that tension reflects model selection rather than research timelines.

Raad Bin Tareaf, Murad Al-Rajab, Samia Loucif

XU Exponential University of Applied Sciences, Data Science and Artificial Intelligence Cluster, Marlene-Dietrich-Allee 12B, 14482 Potsdam, Germany · College of Engineering, Abu Dhabi University, Abu Dhabi, United Arab Emirates · College of Technological Innovation, Zayed University, Abu Dhabi, United Arab Emirates

LLM Evaluation Clinical Language Model Evaluation Medical LLMs

Sep 10, 2026cs.CL

Auditable Emergency Triage for Maternal and Newborn Care in India

At Noora Health, our nurses answer more than 50,000 medical queries per month on our WhatsApp-based service that provides caregivers with on-demand support. Their most time-critical task is emergency triage: deciding which queries need immediate in-person attention. To support them, we built a system that uses a large language model (LLM) to classify whether a message is an emergency and provide a rationale for interpretability. But the system was opaque: analyzing mistakes meant reading reasoning chains for each message, which is infeasible at our scale. Prompt changes meant re-running a full evaluation to prevent regressions, which was both costly and operationally challenging. Clinicians follow a decision tree to make this call, but it was never documented or passed to the model, which relied on a flat list of danger signs. To address these issues, we decomposed triage into two steps: an LLM extracts canonical symptoms and patient context from the query using a clinician-authored vocabulary, and a deterministic rule engine captures the scenarios that indicate an emergency. We show that the new system raised recall from 0.565 to 0.810 and F1 from 0.606 to 0.702, with structured rules driving most of the accuracy gains while the decomposition provides auditability: clinical experts can inspect each stage of the new system to see whether the query was mistranslated, symptoms were incorrectly extracted, patient context was wrongly inferred, or the necessary rules were missing. They can add new rules independently without causing regressions and avoid running costly evaluations. Since deployment, the new system has triaged 152,421 patient queries and flagged 28,535 (18.7%) as emergencies. The over-escalation rate has been 17.8%, without any increase in missed emergencies. Clinicians have also added 48 new rules since deployment, evidence of the faster correction loop we set out to build.

Shobhit Jagga, Aman Dalmia, Niharika Priyadarshini +7

Noora Health · The Agency Fund

Healthcare LLM Auditing Clinical Triage Clinical Decision Support Medical LLMs

Sep 7, 2026cs.LG

Automated Chest CT Protocol Selection via Large Language Model Derived Text Embeddings from Imaging Request Text

Purpose: Accurate CT protocol selection is critical for diagnostic quality and patient safety, yet the current process is manual, time-consuming, and prone to inconsistencies. Prior Machine Learning methods using keywords or bag-of-words lack contextual understanding and perform poorly on rare protocols. We propose a decision support system using large language model (LLM) features to recommend protocols from free-text clinical indications, capturing clinical nuance and phrasing variation for more consistent, efficient selection. Methods: In this REB-approved retrospective study, 285,123 chest CT imaging requests from a large academic medical center (2017-2024) were split into training (228,099, 80%) and held-out test (57,024, 20%) sets. Each request included procedure names, clinical indication, HIS comments, and the selected protocol. Clinical text was embedded using a fine-tuned LLM, Meta's LLaMA-3.1-70B; these features input a logistic regression classifier predicting 18 protocol labels (e.g., PE, LDCT). Results: The pipeline achieved a weighted precision of 0.84, weighted F1-score of 0.81, and overall accuracy of 79% across 18 CT protocols. On 300 independent cases with expert consensus, the LLM reached an overall accuracy of 80% versus 83% for radiologists, with no significant difference (p = 0.263). Performance was comparable across most classes, with the LLM exceeding radiologists for some challenging categories, and entropy analyses indicated more balanced protocol use, suggesting reduced variability. Conclusion: An LLM-based recommendation system can leverage general knowledge from a large natural-text corpus to accurately assign chest CT protocols from free-text imaging requests, and may serve as a viable foundation for protocol recommendation tools where inputs require language understanding.

Zahra Hosseini, Mahan Pouromidi, Farzad Khalvati +1

Joint Department of Medical Imaging (JDMI), University Health Network – Toronto General Hospital, The Hospital for Sick Children, Toronto, Ontario, Canada · Department of Medical Imaging, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada · Joint Department of Medical Imaging (JDMI), University Health Network – Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada

Medical Imaging Clinical Decision Support Clinical NLP Medical LLMs

Sep 7, 2026cs.CL

Perspectives on Cross-Lingual Consistency in LLMs for Medical Questions

Should multilingual LLMs answer medical questions consistently across input languages, or adapt responses to cultural cues? Existing multilingual medical benchmarks usually assume that medically correct answers should remain consistent across languages and treat cross-lingual variation as model error. In contrast, cultural adaptation research argues that appropriate medical answers may legitimately differ across contexts. We review the multilingual medical NLP literature through these two perspectives, we identify three gaps: limited stakeholder perspectives (e.g., of medical professionals), a lack of empirical evidence on which approach better serves users, and no benchmarks capable of distinguishing universally correct from culture-specific cases. To address the first gap, we survey 356 participants across three stakeholder groups (medical, NLP, and anthropology professionals) in three countries (Germany, Spain, and the United States). Anthropologists consistently favor adaptation, while medical and NLP respondents remain divided, with notable divergence between U.S. and European medical professionals. LLMs prompted with profession and country personas fail to reproduce this variation, overestimating cross-lingual consistency preference among NLP and medical personas. We conclude that neither consistency nor adaptation can currently be considered clearly preferable, highlighting the need for empirical evidence on which approach better serves users across cultural contexts.

Minh Duc Bui, Mario Sanz-Guerrero, Abteen Ebrahimi +4

Johannes Gutenberg University Mainz, Germany · University of Colorado Boulder, USA · University of Marburg, Germany +1

Multilingual QA Cross-Lingual Consistency in Language Models Medical LLMs

Sep 3, 2026cs.AI

LLM4CKD: Large Language Models for Early Stage Chronic Kidney Disease Screening

Early screening of chronic kidney disease (CKD) is critical for timely intervention, yet most machine learning (ML) and deep learning (DL) approaches require labeled data and model training, limiting their use in real-world screening settings. This study evaluates the effectiveness of large language models (LLMs) for CKD screening under zero-shot and few-shot in-context learning settings and compares them with traditional ML and DL methods. We propose a framework that uses clinically selected tabular features and structured prompt templates to enable LLM-based inference without task-specific training. LLM performance is evaluated across multiple prompt styles, feature configurations, and data settings, and compared with standard ML, DL, and tabular foundation model (TFM) baselines, and existing CKD screening tools. The results show that LLMs can achieve competitive performance using only a small number of examples, often matching or outperforming traditional approaches in low-data settings. However, their performance remains model-dependent and less stable as input complexity increases. In contrast, ML, DL, and TFM models show more consistent improvement with larger training data. Overall, the findings highlight a trade-off between data efficiency and stability, suggesting that LLMs may serve as a flexible complementary approach for CKD screening when labeled data are limited.

Muhammad Ashad Kabir, Sirajam Munira

School of Computing, Mathematics and Engineering Charles Sturt University NSW, Australia · Department of Computer Science Rensselaer Polytechnic Institute NY, USA

Medical Diagnosis In-Context Learning Clinical Language Model Evaluation Medical LLMs

Sep 3, 2026cs.CL

Investigating the Ability of Large Language Models to Analyze Recipes for Diabetes

Several studies have evaluated the ability of Large Language Models (LLMs) for meal planning, yielding positive outcomes. These models can process natural language inputs and leverage learned knowledge from their pretraining to generate meal plans. In this work, we investigate the ability of LLMs to analyze the suitability of given recipes for diabetes. The primary challenge for LLMs is to retrieve relevant dietary guidelines for diabetes, decompose recipes into ingredients and cooking methods, and apply these guidelines to determine the recipe's suitability. To study these challenges, we employ three kinds of prompts namely, (i) Direct Query Prompt (ii) Context-Guided Prompt, and (iii) Exemplary Context Prompt that incorporate different levels of diabetes dietary guidelines from medical sources. We introduce a benchmark dataset curated for this investigation consisting of 7607 recipes that include 3807 recipes suitable for diabetes and 3800 recipes not suitable for diabetes. Our results demonstrate that most LLMs are cautious in predicting recipes as suitable to prevent detrimental outcomes. Further, the models that can reason using the dietary guidelines performed better in predicting the suitability of recipes for diabetes. Overall, Mistral-7B and Llama 70B showed superior performance to their counterparts.

Revathy Venkataramanan, Aditya Luthra, Venkatesan Nadimuthu +1

AI Institute, University of South Carolina 1112 Greene Street, Columbia, SC 29201 USA

LLM Evaluation Healthcare LLM Prompting Medical LLMs

Aug 31, 2026cs.AI

Dense Clinical Contrasts Enhance Medical Knowledge Updating in Large Language Models

Medical knowledge changes continually, making large language models vulnerable to relying on outdated yet clinically plausible information. We study whether the format of supervision affects medical knowledge updating under a matched training-budget setting. We introduce SEER-Bench, a temporally anchored oncology-staging benchmark curated from the latest versioned SEER Research Data release, and render identical medical update events from NCCN oncology guidelines into four supervision formats: EMQ, MSQ, FITB, and SAQ. Across SEER-Bench and HealthBench Professional, EMQ gives the most stable external transfer and retention among same-budget SFT variants. With EMQ supervision, the updated 4B model produces competitive results on temporally anchored oncology staging, reaching 64.8% answer accuracy and 59.6% rationale accuracy on SEER-Bench. Diagnostic analyses suggest that EMQ exposes denser clinical contrast signals while preserving discriminative representations with smaller movement from the base model. These results show that medical knowledge updating depends not only on the update algorithm, but also on how knowledge is structured as supervision.

Yangmin Huang, Shu Quan, He Geng +5

Xunfei Healthcare Technology Co., Ltd. · USTC-Xunfei Healthcare Digital and Health Joint Laboratory

Supervised Fine-Tuning Factual Knowledge in Language Models Medical LLMs

Aug 30, 2026cs.AI

Automatic Conversion of NICE Guidelines to an Executable Computational Model Using Large Language Models

Introduction: NICE guidelines provide evidence-based recommendations for clinical care but remain largely in unstructured natural language. Existing approaches to converting them into computable representations often focus on individual diseases, require substantial manual encoding, and do not scale. Large language models (LLMs) may enable much of this translation to be automated. Methods: We present an end-to-end approach that converts textual clinical guidelines into executable models capable of generating explainable, patient-specific recommendations. A stepwise LLM-based transformation with in-context examples produces human-inspectable intermediate artifacts. We apply the approach to NICE pancreatic and lung cancer guidelines, use expert review to assess rule alignment, and evaluate the executable pancreatic cancer model on 20 patient vignettes. Results: Expert review showed strong alignment between the source guidelines and generated executable models. Most discrepancies were partial omissions rather than incorrect logic, while hallucinated or fundamentally incorrect rules were rare. On the patient vignettes, the executable model achieved an F1 score of 82.5%. Conclusion: LLMs can transform natural-language NICE guidelines into interpretable, executable models that preserve guideline structure, support transparent inspection and modification, and generate patient-specific recommendations. These findings demonstrate the feasibility of scalable automated generation of computable clinical guidelines.

Ashvin Gupta, Denys Prociuk, Alessandra Russo +1

Department of Computing, Imperial College London, London, UK · Department of Surgery and Cancer and I-X/Digital Foundry, Imperial College London, London, UK

Clinical Decision Support Knowledge Representation Medical LLMs

Aug 12, 2026cs.CL

A corpus-specific clinical RAG system matches or outperforms newer frontier LLMs on HealthBench

General-purpose large language models (LLMs) have recently been reported to match or exceed specialized clinical AI tools on medical benchmarks, but such comparisons draw on a narrow set of systems and on benchmarks developed largely in high-income settings. We evaluate VITA, a retrieval-augmented generation (RAG) system purpose-built for contextual knowledge retrieval in India and other low- and middle-income (LMIC) settings. VITA retrieves from a curated corpus of disease-specific guidelines, India-specific antimicrobial resistance data, national formulary constraints, and resource-limited care protocols; its architecture and corpus are proprietary, but the benchmark, the physician-written rubrics, and our full response and scoring outputs are public for independent verification. On 4,023 English-language HealthBench questions (80.5% of the benchmark), scored with a GPT-4.1 judge, VITA ranked first with 51.9% of possible rubric points, ahead of GPT-5.4 (46.1%), o4-mini (44.3%), Gemini 3.1 Pro (42.6%), and Claude Sonnet 4.6 (37.3%), and scored highest on 45.4% of questions. To test robustness to newer models and judge lineage, a 500-question subset was re-run against current-generation models (GPT-5.5, Claude Opus 4.8, Gemini 3.5 Pro, Grok 4.3) and graded by a neutral open-weight judge (DeepSeek-V4-Pro) sharing no lineage with any system tested. Here the gap narrowed to parity: VITA and GPT-5.5 were statistically indistinguishable on mean per-question score, while VITA led on points-weighted score and won the most questions. VITA's advantages in accuracy and completeness persisted under the neutral judge; its communication scores were lower. These results indicate that a purpose-built clinical RAG system remains competitive with frontier LLMs on an open benchmark, consistent with corpus specificity as a design variable that improves grounding at some cost to communication polish.

Praveen Reddy, Charuta Mandke, Suvrankar Datta +4

Retrieval-Augmented Generation LLM Grounding RAG Evaluation Clinical Language Model Evaluation Medical LLMs

Aug 11, 2026cs.CV

Rethinking LLM Verification: Evidence Structure, Uncertainty, and Selective Refinement

Large language models (LLMs) often rely on shortcuts rather than systematic reasoning, raising safety concerns in medical applications. Allowing models to abstain when uncertain improves reliability but introduces a coverage accuracy tradeoff. We propose a two-stage framework for medical hypothesis verification in multiple-choice settings that manages this tradeoff through targeted ontology grounding, applied only when the model abstains. We show that abstention is not random but reflects genuine uncertainty, with abstained predictions associated with lower confidence. Across two frontier models (GPT-5.5, accessed via the Azure OpenAI API, and DeepSeek-R1), the proposed framework improves question-level accuracy by 9.6 percentage points (82.9% to 92.5%) and hypothesis-level accuracy by 4.2 percentage points (92.0% to 96.2%). Our experiments conducted on MedReason and MedQA show that abstention can be repurposed as a control signal for selective reasoning refinement, achieving knowledge-graph-level performance without explicit knowledge graph construction.

Uma Ranjan, Kunal Tilaganji, Aditya Koul +9

Indian Institute of Technology Jammu · Microsoft Research · SCB Dental College and Hospital, Cuttack

LLM Grounding LLM Answer Verification Selective Prediction Question Answering LLM Uncertainty Estimation Medical LLMs

Aug 10, 2026cs.CL

Locally Deployable Small Language Models for Emergency Department Decision Support: A Systematic Benchmark of Fine-Tuning Strategies

Deploying large language models (LLMs) for decision support in emergency departments (EDs) faces two major challenges: privacy risks of transmitting patient data to closed-source commercial LLMs and the lack of systematic evaluation of fine-tuning strategies for locally deployable open-source small language models (SLMs). We benchmarked eight open-source SLMs using zero-shot prompting, prefix tuning, Low-Rank Adaptation (LoRA), and full fine-tuning on three ED tasks: triage level prediction, specialist referral recommendation, and diagnosis prediction. Using 2,083 MIMIC-IV-ED cases and Claude Haiku 4.5 and Claude Sonnet 4.5 as baselines, we found that LoRA fine-tuned open-source SLMs outperform commercial baselines on triage level prediction and specialist referral recommendation, while diagnosis prediction remains challenging for open-source SLMs. Confusion matrix analysis further shows that fine-tuned open-source SLMs can detect highest-severity patients missed by the commercial baselines. These results demonstrate that locally deployable SLMs can achieve clinically competitive performance for ED decision support.

Qingfeng Zhang, Yuanxiong Guo, Yanmin Gong

The University of Texas at San Antonio, San Antonio, TX · Texas A&M University, Houston, TX

LLM Fine-Tuning Clinical Decision Support Small Language Models Clinical Language Model Evaluation Medical LLMs

Aug 10, 2026cs.CL

TAF-MED: Multi-Turn Safety Refusal Collapse in LLMs Under Declared Self-Treatment Intent

Large language models (LLMs) increasingly provide conversational health information that may influence treatment decisions, yet existing benchmarks do not isolate whether medication-safety boundaries persist across follow-ups after explicit self-treatment intent. We introduce TAF-MED, a physician-reviewed benchmark of 500 fixed three-turn scenarios, and evaluate eight LLMs across 4,000 conversations. A rubric-based automated judge labelled responses as SAFE, LEAKY, or UNSAFE, and two physicians independently annotated a model-balanced random subset of 400 conversations. We assessed unsafe guidance, collapse after a strictly SAFE initial response, and model-ranking stability. Overall, 71.6% of conversations contained an UNSAFE response, and 61.4% of those beginning with a strictly SAFE response later collapsed to UNSAFE; model-level collapse rates ranged from 24.4% to 96.2%. Four of 28 model pairs reversed order between initial unsafe and collapse rates. Automated labels achieved 94.3% agreement with the adjudicated physician reference (

κ= 0.895

). These findings show that first-turn safety is an incomplete proxy for conversational safety persistence and motivate evaluation across complete dialogue trajectories. We will release TAF-MED on Hugging Face to support reproducible research on multi-turn medical safety.

Waleed Jamil, Raphael Schmitt

1Independent Researcher, Edinburgh, United Kingdom · School of Computation, Information and Technology, Technical University of Munich, Germany · Institute of General Practice, Faculty of Medicine and Medical Center, University of Freiburg, Germany

LLM Safety Benchmarks LLM Safety Evaluation Clinical Language Model Evaluation Refusal Behavior in Language Models Medical LLMs

Aug 10, 2026cs.AI

Coupled Graph--Policy Distillation for Personalized Medication Safety in Older Adults with Multimorbidity

Large language model (LLM) agents can support medication review between clinical visits, but safe choices for older adults with multimorbidity depend on conditions, medications, and geriatric risks that users may omit. We introduce ATLAS, a coupled graph--policy distillation framework for patient-adaptive medication safety. ATLAS structures guideline evidence as a medication-safety graph. Targeted questions update the patient state and distill relevant relations into a patient-specific medication conflict graph (PMCG). A risk-first multi-agent policy uses the PMCG to screen contraindications, assess cautions and monitoring needs, identify safer alternatives, and verify the final medication plan. We also introduce GeriMedBench, an interactive benchmark that tests safety-critical information acquisition and evidence-based decision revision. Across a European non-interactive multimorbidity benchmark, an Asian interactive multimorbidity benchmark, and an Asian non-interactive cross-guideline benchmark, ATLAS achieves the strongest complete-decision performance among the compared systems. On the European non-interactive multimorbidity benchmark, it exceeds the strongest proprietary LLM baseline by 53.73 points in Strict Success Rate and 14.63 points in overall safety reasoning score (OSRS), with no unsafe recommendations under the automated evaluator. A blinded clinician evaluation gives ATLAS higher mean ratings across all five criteria and flags potentially unsafe recommendations in one ATLAS case and two Gemini cases.

Zihan Wang, Anglin Liu, Rongyi Wang +6

1Artificial Intelligence Thrust, The Hong Kong University of Science and Technology (Guangzhou) · Faculty of Engineering, University of New South Wales · 3Medical Big Data Center, Guangdong Provincial People’s Hospital, Southern Medical University +2

Multi-Agent LLM Systems Healthcare AI Agent Safety Benchmarks Medical LLMs

Aug 10, 2026cs.CL

An Agentic Generative Large Language Model for Treatment Planning of Colorectal Cancer

Treatment planning in precision oncology requires synthesizing heterogeneous patient information with rapidly evolving clinical guidelines to ensure guideline-concordant care. While large language models (LLMs) show promise in many diagnostic tasks, their adoption for high-stakes treatment planning is hindered by complex reasoning, adherence to timely clinical guidelines, and safety concerns. In this study, we present GatorOnco, an agentic LLM for colorectal cancer (CRC) treatment planning. GatorOnco is developed using a total of 282 billion tokens of biomedical text, including healthcare system-scale clinical text comprising 166 billion tokens from UF Health. We implemented a domain-adaptation method that integrates pre-training, model merging, a two-stage post-training approach, and agent-based reinforcement learning. An agentic retrieval-augmented generation (RAG) approach dynamically integrates time-sensitive clinical guidelines into the reasoning process. In a blind, randomized clinical evaluation conducted by five UF Health oncologists, GatorOnco significantly outperformed open-source LLMs (P < 0.01) and achieved expert-level performance comparable to UF Health oncologists. Compared with expert oncologists, GatorOnco received significantly higher ratings for readability (4.46 vs. 4.19, P < 0.01) and completeness (3.91 vs. 3.52, P < 0.01), while showing statistically comparable performance in correctness (4.09 vs. 4.11, P = 0.921), currency (4.04 vs. 3.98, P = 0.478), and safety (4.22 vs. 4.22, P = 0.999). These findings demonstrate that integrating agentic reasoning with large-scale domain adaptation can help bridge the gap for generative AI in high-stakes cancer treatment planning.

Mengxian Lyu, Cheng Peng, Tim Jang +18

Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA. · Division of Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA · University of Florida Health Cancer Institute, Gainesville, FL, USA +8

Clinical Decision-Making Domain Adaptation for LLMs Oncology Clinical Language Model Evaluation Medical LLMs

Aug 9, 2026cs.AI

From Manuals to Maintenance: Fine-Tuning MedGemma for Multi-Modal Imaging System Support in Low-Resource Settings

Imaging device downtime is a major barrier to healthcare delivery in low- and middle-income countries (LMICs), often driven by limited access to specialized biomedical engineering support. We present a multi-modality medical equipment maintenance question-answering (QA) framework and demonstrate the fine-tuning of a medical foundation model for specialized technical troubleshooting tasks. Guided by a multi-country survey across nine LMICs, we curated technical manuals from MRI and ultrasound systems to generate the INGENZI_DatasetV1, containing 10,294 high-quality, filtered QA-context pairs. Using QLoRA-based parameter-efficient fine-tuning, we adapted the MedGemma-4b-it model to interpret system error logs and generate step-by-step equipment repair instructions. Compared to the baseline model, the fine-tuned system achieved substantial improvements across metrics, including F1 score (0.22 to 0.38), ROUGE-2 (0.18 to 0.41), and BERTScore F1 (0.86 to 0.91). These metric gains demonstrate that the model generates significantly more precise and procedurally accurate technical responses to new troubleshooting queries. This work establishes a reliable foundation for AI-assisted diagnostic and maintenance tools in resource-constrained settings.

Bernes Lorier Atabonfack, Zion Kongbi Nfo, Ahmed Tahiru Issah +9

Carnegie Mellon University Africa, Kigali, Rwanda · IngenziAI, Kigali, Rwanda · Medical Artificial Intelligence Laboratory, Lagos, Nigeria +5

LLM Fine-Tuning Document QA Medical LLMs Fault Diagnosis

Aug 9, 2026cs.AI

Scale-to-Dialogue: Low-Burden Elicitation of Daily Premenstrual Symptom Ratings with Small Language Models

Prospective daily symptom tracking is central to premenstrual health assessment, but repeated ordinal forms impose substantial response burden. We formulate conversational administration as an ordinal label-recovery problem: the system actively elicits a small set of symptom clusters and maps each response to the original severity labels. We used 3,320 complete participant-days from the mcPHASES dataset, covering cramps, mood swing, fatigue, sleep issues, stress, and bloating on a six-level scale. Six participants were reserved for development and 36 for a frozen evaluation comprising 360 participant-days and 2,160 item labels. A ModernBERT evidence gate detected whether a symptom was expressed, and Qwen2.5-1.5B-Instruct produced deterministic structured severity scores. Fixed six-item questioning achieved a quadratic weighted kappa of 0.976, whereas three joint symptom-cluster questions achieved 0.913, 97.45% agreement within one severity level, and 80.94% recall for moderate-or-higher symptoms while reducing questions by 50%. Open-first adaptive policies required 3.92-5.98 questions and produced lower agreement than the corresponding fixed policies. Participant-cluster bootstrap analysis estimated a kappa difference of -0.062 (95% CI -0.076 to -0.048) between the three-cluster and six-item strategies. Active cluster-level elicitation provides a direct, local-model route from natural conversation to reusable daily symptom labels.

Yifan Wang

The Chinese University of Hong Kong, Shenzhen (CUHK-Shenzhen)

Aug 6, 2026cs.LG

MetaboLLM: a metabolomics-specialized large language model for biochemical knowledge integration and predictive metabolite graph construction

Metabolomics knowledge is distributed across heterogeneous resources and remains difficult to translate into predictive representations. We developed MetaboLLM, a metabolomics-specialized large language model adapted through continual pretraining, supervised fine-tuning, and structured retrieval, together with MetaboLLM-GIN, which converts generated biochemical descriptions into metabolite graphs for patient-level prediction using a graph isomorphism network. Across four backbone families, MetaboLLM outperformed corresponding base and medically adapted models on metabolomics knowledge, relational, and description tasks, and transferred to an external public benchmark. MetaboLLM-GIN achieved the highest AUC for stress hyperglycemia prediction after coronary artery bypass grafting (0.8616) and postmenopausal hormone-regimen classification (0.8123), outperforming conventional models, alternative graph constructions, and graphs generated from unadapted or non-retrieval LLM configurations. Model interpretation further produced biologically meaningful findings in both applications. These results show that domain-specialized language models can organize heterogeneous biochemical knowledge into predictive and interpretable metabolite graph representations.

Dohyun Ku, Min Gu Kwak, Francisco J. Pasquel +1

H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA · Capital One, NY · Department of Medicine, Division of Endocrinology, Emory University School of Medicine, Atlanta, GA

LLM Fine-Tuning Clinical Outcome Prediction Medical LLMs Molecular Representation Learning

Aug 5, 2026cs.CL

Guideline-as-Oracle: Zero-Annotation Training of an Ophthalmic Telephone Triage Agent

Scaling supervision for multi-turn medical agents is difficult because expert dialogue annotation is costly and clinical conversations are privacy-restricted. We introduce Guideline-as-Oracle (GAO), which compiles American Academy of Ophthalmology guidance into a 70-row operational rule table and uses it as the sole source of instance-level supervision for 3,000 training dialogues, reserving human labeling for evaluation. Because converting rules into dialogues is itself a design problem, we catalog eight construction strategies, including cited-row tier assignment, one-fact boundary pairs, metadata-only repair, and label repair, and characterize the evidential status of each: labeling mechanism, null, confounded, or evaluated only as a package. Fine-tuning a 9B backbone on this corpus yields GAO-Triage, improving agreement with a 201-case operational reference from 61.7% to 74.1% (exact McNemar p=0.0046) and emergent-case recall from 9.5% to 69.0%; the gains persist across a second seed and patient simulator. None of the seven general-purpose systems we test dominates GAO-Triage on both metrics, and GAO-Triage requires no frontier model at inference time. Permuting label-dialogue assignments collapses the model to a constant-routine predictor, indicating that the signal lies in guideline-derived assignment rather than dialogue surface form. Label repair coincides with the disappearance of a late-training safety degradation.

Chenyu Wang, Yi Liu, Baoqing Li +2

Shanghai Institute of Microsystem and Information Technology, Chinese Academy of Sciences · Shanghai Artificial Intelligence Laboratory · ByteDance Inc.

Supervised Fine-Tuning Clinical Triage Synthetic Data Generation Medical LLMs

Aug 4, 2026cs.LG

Quantization Effects on Biomedical LLM Reliability

When decoder language models are used as classifiers, predicted class probabilities depend on implementation choices, including the prompt template, verbalizer (label-to-token mapping), and scoring rule, that are rarely treated as experimental variables. We present a controlled evaluation of three Mistral-7B variants (Base, BioMistral, and Instruct) on PubMed RCT sentence classification (n=2000) under FP16, INT8, and INT4 precision using four answer-text prompt templates. Our primary finding is that the probability extraction protocol dominates apparent calibration. Switching from summed to mean token log-likelihood scoring reverses the calibration ranking between models: BioMistral average expected calibration error increases from 0.097 to 0.289, whereas Instruct decreases from 0.237 to 0.096, while accuracy changes by less than 1 percentage point for the specialized models but 4-6 percentage points for the base model. Prompt template choice produces accuracy differences of 7-24 percentage points, comparable to or larger than model-level effects. On one template, BioMistral outperforms Instruct although the overall mean favors Instruct by only 1.3 percentage points. For BioMistral and Instruct, INT8 quantization changes accuracy and F1 by only 1-2 percentage points relative to FP16, whereas the base model shows larger INT8 effects on some templates (up to +4.2 percentage points). INT4 produces heterogeneous but non-catastrophic effects. Temperature scaling reduces expected calibration error under summed scoring for both models but only for that scoring rule. A fine-tuned PubMedBERT reference achieves 82.7% accuracy but uses about 176000 labeled training examples, precluding direct comparison. These results demonstrate that prompt template design and scoring normalization are first-order experimental decisions when evaluating decoder language model calibration.

Anton Rasmussen, Hong Qin

Old Dominion University Norfolk, VA 23529, USA

LLM Quantization Text Classification Language Model Calibration Medical LLMs

Aug 3, 2026cs.CL

MedPRESS: A Multi-turn Benchmark for Patient-Pressure-Induced Medical Sycophancy in LLMs

Large language models (LLMs) are increasingly used for health-related advice. Existing research measures their safety with static questions rather than pressured patient-facing conversations. We introduce MedPRESS, a multi-turn benchmark for measuring patient-pressure-induced sycophancy in LLMs. MedPRESS contains 600 medically grounded five-turn dialogues across three scenario families: medication and treatment demand, personal health self-care, and symptom triage and care resistance. Each dialogue begins with a health query and escalates through personal experience, social proof, external evidence claims, and direct adversarial challenge. We evaluate 20 LLMs across general, medical-domain, lightweight, large, open-weight, and proprietary families using structured judging and safety-focused metrics. Results show that models frequently shift toward unsafe agreement under repeated patient pressure, with substantial variation across model families, model scale, and prompt type. Anti-sycophancy prompting improves robustness for several models, but does not eliminate unsafe agreement. MedPRESS highlights a critical gap in medical LLM evaluation: safe medical knowledge is not enough unless models can maintain it under conversational pressure.

Saman Sarker Joy, Niloy Farhan

Universiti Malaya, Malaysia · BRAC University, Bangladesh

LLM Safety Benchmarks LLM Sycophancy Clinical Language Model Evaluation Medical LLMs

Aug 3, 2026cs.CV

Generative AI and Foundation Models in Medical Image

In recent years, generative AI has attracted significant public attention, and its use has been rapidly expanding across a wide range of domains. From creative tasks such as text summarization, idea generation, and source code generation, to the streamlining of medical support tasks like diagnostic report generation and summarization, AI is now deeply involved in many areas. Today's breadth of AI applications is clearly distinct from what was seen before generative AI gained widespread recognition. Representative generative AI services include DALL-E 3 (OpenAI, California, USA) and Stable Diffusion (Stability AI, London, England, UK) for image generation, ChatGPT (OpenAI, California, USA), and Gemini (Google, California, USA) for text generation. The rise of generative AI has been influenced by advances in deep learning models and the scaling up of data, models, and computational resources based on the scaling laws. Moreover, the emergence of foundation models, which are trained on large-scale datasets and possess general-purpose knowledge applicable to various downstream tasks, is creating a new paradigm in AI development. These shifts brought about by generative AI and foundation models also profoundly impact medical image processing, fundamentally changing the framework for AI development in healthcare. This paper provides an overview of diffusion models used in image generation AI and large language models (LLMs) used in text generation AI, and introduces their applications in medical support. This paper also discusses foundation models, which are gaining attention alongside generative AI, including their construction methods and applications in the medical field. Finally, the paper explores how to develop foundation models and high-performance AI for medical support by fully utilizing national data and computational resources.

Masahiro Oda

Data Science Research Division, Information Technology Center, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan. · Graduate School of Informatics, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan.

Medical Imaging Foundation Models Medical Image Synthesis Medical LLMs

Aug 2, 2026cs.CL

Why LLMs Give In: Conversational Factors and Reasoning Behind Medical Sycophancy

Large language models can answer a medical question correctly and still abandon that answer when a user pushes back. We study this failure as medical sycophancy and ask when models are most likely to give in. Across five open-weight models, 500 MedQuAD questions, and 1.2 million trials, we use a fully crossed design over four conversational factors: user role, user evidence, interaction structure, and grounding. Medical sycophancy is nearly three times more common when users challenge an answer the model has already given than when the false claim appears in the initial query. Models are also more susceptible to users presented as physicians or medical students. Most strikingly, fabricated evidence has opposite effects across interaction structures. It increases sycophancy in single-turn interactions but reduces it after the model has already answered. Grounding helps, but does not eliminate the behavior. Sycophancy varies more across medical questions than across models, making question selection an important part of benchmark design. Reasoning traces suggest that multi-turn failures are associated with models turning back toward their own prior answer, while fabricated evidence receives more scrutiny after an initial response. Together, the results show that medical sycophancy depends as much on how a model is challenged and evaluated as on which model is tested.

Kaike Ping, Buse Çarık, Caleb Wohn +3

Virginia Tech · Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine · Emory University

LLM Sycophancy Language Modeling Clinical Language Model Evaluation Medical LLMs

Aug 2, 2026cs.CL

MedUPS: Towards Diagnostic Assistance in Uncommon Medical Cases with Large Language Models

Uncommon and off-guideline cases are difficult for clinical decision support, because physicians must make a series of management decisions under diagnostic uncertainty and rarely see the full case at once. Most large language model (LLM) benchmarks for medicine score only the final diagnosis, yet much of clinical care turns on the next appropriate action: the next test to order, the imaging study to obtain, the specialist to involve, or the differential to pursue. We introduce MedUPSQA, a dataset of 21,874 mid-stream clinical decision points built from 5,535 real case reports, and MedUPS, an alignment framework that supervises models on these intermediate decisions as they unfold along a patient's trajectory. We segment free-text case presentations into chronologically ordered, accumulating clinical chunks and align models to predict the next step with reinforcement learning (GRPO), using an external LLM-as-a-Judge reward. This objective mirrors how clinicians actually meet patients, reasoning forward from accumulating evidence toward the next decision, rather than committing to a final label. Across three backbones, mid-stream alignment raises next-step accuracy from 55.2 to 66.7 for Qwen3.6-27B, from 47.2 to 57.8 for Qwen3.5-9B, and from 37.8 to 44.4 for HuatuoGPT-3-8B, with 95% CI. In several model scales we test the objective improves accuracy more than scale, with smaller models surpassing larger, frontier models we evaluate. We further train supervised fine-tuning (SFT) baselines on the mid-stream task, SFT improves all backbones above base, indicating the target framwork carries signal independently of the optimizer. We release the dataset, code, and aligned checkpoints.

Ofir Ben Shoham, Oriel Perets, Nir Grinberg +1

Stein Faculty of Computer and Information Science Ben-Gurion University of the Negev

LLM Alignment Clinical Decision Support Clinical Decision-Making Clinical Prediction Medical LLMs

Aug 2, 2026cs.CL

Gaokerena: A Small Persian Medical Language Model Family

The integration of artificial intelligence into medical question-answering systems has advanced rapidly; however, research remains predominantly focused on English, leaving low-resource languages like Persian significantly underserved. To address this gap, this paper introduces Gaokerena, a novel family of compact Persian medical language models optimized for deployment on consumer-grade hardware. As a foundational step toward localized digital healthcare, we first present Gaokerena-V, developed by training a baseline model on a strategically selected subset of a newly curated 90-million-token Persian medical corpus (approximately 54 million tokens) together with 20,000 expert-vetted physician Q&A pairs (approximately 3 million tokens), for a total of 57 million new tokens. This training improved performance on a translated medical MMLU benchmark from 46.64% to 49.31%. Second, recognizing the critical demands of clinical reasoning, we developed Gaokerena-R by integrating a Chain-of-Thought approach with two novel Reinforcement Learning with AI Feedback (RLAIF) frameworks to optimize preference-based reasoning. Despite utilizing the same baseline architecture and a smaller dataset than Gaokerena-V, Gaokerena-R achieved a superior benchmark score of 52.98%. Furthermore, both models are equipped with custom-developed uncertainty heads that predict the models confidence in its responses based solely on internal hidden states. While these results demonstrate significant progress in Persian medical language modeling and proactive safety estimation, current performance levels remain insufficient for direct clinical application, highlighting the necessity for further research into robust knowledge acquisition and rigorous safety verification prior to real-world deployment.

Mehrdad Ghassabi, Hamidreza Baradaran Kashani, Pedram Rostami +5

University of Isfahan, Isfahan, Iran · University of Tehran, Tehran, Iran · University of Windsor, Windsor, ON, Canada +3

RL for Language Model Reasoning Small Language Models Medical QA Medical LLMs

Aug 1, 2026cs.AI

Large language models improve physician accuracy but lead to false reliance

Retrieval-augmented large language models (LLMs) promise source-linked clinical support, but their value depends on whether displayed evidence guides rather than distorts physician reliance. We developed CORA, an agentic retrieval-augmented LLM, to investigate how source-linked assistance affects physician decision-making. CORA maintained benchmark performance and achieved larger gains on cases published after the models' training-data cutoffs. In a study of 46 physicians, accuracy increased from 70.8% unaided to 82.6% with CORA. Supporting citations predicted correct answers (87.7% vs 65.5%), but citations created an important asymmetry: perceived support increased adoption of correct advice from 34% to 76.9% but when an incorrect LLM answer appeared citation-supported, physician resistance to it fell from 92% to 34.8%. These findings show that source-linked LLM assistance can improve physician accuracy while introducing a grounding-dependent safety risk.

Tirtha Chanda, Christoph Wies, Franziska Schramm +10

Division of Digital Prevention, Diagnostics and Therapy Guidance, German Cancer Research Center (DKFZ), Heidelberg, Germany · Medical Faculty, University Heidelberg, Heidelberg, Germany · Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany +6

Retrieval-Augmented Generation LLM Grounding Clinical Decision Support Clinical Language Model Evaluation Medical LLMs

Aug 1, 2026cs.CL

TreeProbe : A Tibetan Medicine Benchmark for Cultural Bias in LLMs

Large language models are increasingly viewed as a potential means of mitigating global health inequities, yet their outputs often reflect dominant high-resource medical traditions and provide limited coverage of traditional medical knowledge systems. Tibetan medicine, one of the world's four major traditional medical systems, has an independent and highly structured theoretical framework. When models lack grounded understanding of Tibetan medicine, they may fall back on dominant epistemic systems and distort the native knowledge structure during reasoning. However, quantitative tools for evaluating cultural bias in Tibetan medicine remain largely absent. To address this gap, we introduce TreeProbe, the first cultural-bias benchmark organized around the native Tree of Medicine framework in Tibetan medicine. It contains 4,719 expert-adjudicated items covering 467 diseases and 10 subtasks along the three roots. Experiments on representative LLMs show that current models remain limited in native Tibetan medical contexts and exhibit systematic external ontology drift. Further analysis reveals that models diverge in whether they drift toward biomedical or TCM reasoning, shaped by pretraining data composition and surface resemblance between TCM and Tibetan medicine. TreeProbe provides a diagnostic benchmark for developing medical AI systems that are both linguistically inclusive and epistemically fair. Code and data are available in an anonymous repository at https://anonymous.4open.science/r/TreeProbe/.

Jin Zhang, Linyu Li, Weili Jiang +7

University of Electronic Science and Technology of China · Peking University · Southwest Jiaotong University +1

Cultural Bias in Language Models Language Model Bias Evaluation Medical LLMs

Jul 31, 2026cs.CL

Bridging the English-Arabic Medical Knowledge Gap: Targeted Low-Rank Adaptation via Causal Layer Selection

Large Language Models (LLMs) perform strongly in English medical tasks but degrade substantially in Arabic, a gap widely attributed to limited training data. We systematically investigate this assumption via tuned lens probing and causal activation patching, and find that Arabic medical knowledge is present in intermediate model representations but fails to surface at the output. This mechanistic insight motivates a targeted adaptation strategy: rather than fine-tuning the full network, we propose Targeted Low-Rank Adaptation (TLoRA), restricted to the layer window where cross-lingual representations diverge, upstream of the output layers where the failure manifests. We evaluate TLoRA on multiple-choice medical QA, where our approach outperforms full-network LoRA, zero-shot, and few-shot baselines. We further evaluate it on short-answer generation and multi-turn clinical dialogue, where it performs competitively without the need for task-specific finetuning. We additionally introduce AraClinicDialog, a clinician-constructed Arabic medical dialogue benchmark in MSA with validated variants across four Arabic dialects. Together, these contributions demonstrate that mechanistic diagnosis can serve as a practical guide for targeted adaptation in underrepresented-language medical LLMs.

Chaimae Abouzahir, Musa Khan, Hala Ali-Hassan +7

New York University Abu Dhabi · Cleveland Clinic Abu Dhabi

LLM Fine-Tuning Low-Rank Adaptation Medical QA Low-Resource Language Processing Causal Interventions in Language Models Medical LLMs

Jul 30, 2026cs.CL

The MADRS Pipeline: Supporting Depression Assessment in Clinical Trials

Depression is a major mental disorder for which diagnosis relies primarily on clinical assessments. Automated methods to support its detection via the psychiatric MADRS scale are getting more and more attention. While existing solutions primarily focus on detecting the disorder from different text sources (e.g., online text, social media), there is still limited support for clinical trials, where clinical assessments are conducted through structured interviews based on standard guidelines such as SIGMA. In this work, we develop a LLM pipeline specifically designed to support clinicians in supporting the assessment of depression in patients enrolled in clinical trials. Our pipeline converts audio interviews into transcripts, maps them into the ten MADRS symptom items, estimates their severity, and identify problematic clinical ratings associated with them. Evaluation on real clinical interviews shows a strong overall correlation of 0.867 with expert ratings, providing interpretable support for future assessments in clinical trials.

Mila Fodor, Katalin Ócsai, Francesco Periti +2

Clario, part of Thermo Fisher Scientific

Depression Detection Clinical Decision Support Depression Severity Estimation Medical LLMs

Jul 29, 2026cs.AI

MedLLM: An Open Medical Language Model at the Sub-Billion Scale

Open medical language models have converged on a single scale: every widely used system runs at 7B parameters or more, leaving the sub-billion regime uncharacterized. We present MedLLM, an open 0.1B-parameter medical language model trained through a fully open three-phase pipeline: general pretraining with curriculum sequence-length scheduling, domain fine-tuning on MedFineWeb, a reference-guided medical corpus we release that is selected from general web data by embedding similarity to medical question-answering (QA) data, and preference-aligned fine-tuning combining SFT with direct preference optimization (DPO). Across medical benchmarks, MedLLM shows a pattern visible only at sub-billion scale: medical competence does not degrade uniformly under compression but splits by task type. On context-grounded QA it comes within

2.9

pp of a medically adapted 7B model and surpasses the instruction-tuned and general-purpose 7B baselines; on knowledge-recall QA it stays near the task floor on clinical-vignette MedQA yet significantly exceeds every 7B and sub-7B baseline on MedMCQA, indicating that where recall fails the constraint is model capacity rather than adaptation. This dissociation is masked at 7B, where both capabilities are present, and surfaces only when capacity is scarce.

Maxx Richard Rahman, Asim Ahmed, Mihan Mohagheghzadeh +1

German Research Center for Artificial Intelligence (DFKI), Germany · Saarland University, Germany

LLM Fine-Tuning Small Language Models Medical QA Medical LLMs

Jul 28, 2026cs.AI

GuideSkill: Evolving Executable LLM Agent Skills for Guideline-Grounded Clinical Reasoning

Clinical practice guidelines (CPGs) encode diagnostic criteria, but LLM systems typically retrieve guideline text or absorb it through training rather than execute its rules. We introduce GuideSkill, an external reasoning layer that compiles disease-specific criteria into executable functions returning ordinal diagnostic-support scores. GuideSkill-Zero is initialized from guidelines, while GuideSkill-Evo uses case--diagnosis pairs to refine covered skills and add missing diagnoses. At inference, an LLM proposes a differential diagnosis, grounds the features required by each matched skill, and fuses its ranking with the executed skill scores. Across four benchmarks and four backbones, GuideSkill-Zero improves macro-average accuracy over guideline RAG by 13.45% on average. GuideSkill-Evo achieves the highest macro-average for every backbone, improves over direct inference by 18.49% relatively, and increases gold-label skill coverage from 56.5% to 99.5%. On Qwen3.5-9B, it also exceeds the strongest parameter-update baseline by 11.16% without updating the backbone. Expert evaluation further indicates that GuideSkill produces clinically sound and broadly acceptable skills, suggesting that its initialized and evolved rules are reliable and practically meaningful. These results support executable skills as a model-agnostic mechanism for combining guideline-derived procedures with case-derived diagnostic patterns.

Lang Cao, Yuhao Shen, Tianyang Luo +3

University of Illinois Urbana-Champaign · ♦The Chinese University of Hong Kong, Shenzhen · ⋂Albert Einstein College of Medicine

Clinical Decision Support LLM Agent Skill Learning Clinical Reasoning Medical LLMs