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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Latest papers 238

Jul 28, 2026cs.AI

Cognivia: A Cognitive Behavioral Therapy Copilot for Evidence-Based Mental Healthcare

Cognitive distortion amplifies negative emotions and contributes to mental health disorders. Cognitive Behavioral Therapy (CBT) is an effective way to address cognitive distortions, but its large-scale application is limited by the shortage of professional therapists. Although large language models (LLMs) have recently been explored for mental health applications, existing methods still suffer from limited domain specificity, overly flattering responses, and the absence of well-defined annotations for cognitive distortions. This paper proposes Cognivia, an evidence-based artificial intelligence therapist that integrates automatic cognitive distortion identification and rational response generation. Our framework is built on authoritative CBT texts widely regarded as core paradigms and standard references. It is further augmented with mental health question-answer (Q and A) data, and employs multi-stage prompting and structured generation strategies under the supervision of behavioral science experts. Then we fine-tune a lightweight LLM on this augmented CBT dataset to obtain Cognivia. In addition, we propose the first hierarchical quality evaluation framework for assessing LLM-generated rational responses, developed through collaboration between AI researchers and behavioral science experts. Cognivia is evaluated using lexical metrics, LLM-based Judges with two complementary criteria, and human evaluation by 10 behavioral science experts. It consistently outperforms the baseline methods in cognitive distortion recognition and rational response generation, demonstrating its effectiveness. Our code is available at https://github.com/SNOWTEAM2023/Cognivia.

Qi Chen, Siria Xiyueyao Luo, Jian Wang +3

Sichuan University Sichuan, China · Southwest Petroleum University Sichuan, China · University of Groningen Netherland +3

Mental Health Counseling Conversational Agents Clinical Language Model Evaluation Medical LLMs Text Generation Cognitive Behavioral Therapy

Jul 28, 2026cs.CL

CardioBench: A Real-World Data Benchmark for Evaluating Large Language Models in Clinically Authentic Cardiovascular Care Scenarios

Background: Most medical large language model (LLM) benchmarks focus on examination knowledge or isolated tasks and may not reflect the longitudinal, multimodal, and safety-critical workflow of cardiovascular care. Objective: To develop CardioBench, a real-world benchmark spanning the cardiovascular care continuum, and assess LLM performance across clinical dimensions and specialist tasks. Methods: CardioBench includes 2,263 items from 13 task-specific datasets derived from de-identified cardiovascular records and examination data. Sixteen cardiology physicians conducted annotation and reference construction, followed by cross-review from two senior cardiologists. Seven LLMs generated 15,841 outputs under standardized zero-shot settings. Open-ended tasks were evaluated using key-point coverage and holistic clinical quality, while CardioEthics was scored by accuracy. Results: GPT-5.4 achieved the highest macro-average (62.55) and item-weighted mean (62.19), followed by Gemini 3.1 Pro (59.95) and Qwen 3.6 27B (59.72). GPT-5.4 ranked first in all three dimensions. CardioAuxReport performed best (86.38), whereas CardioECGRead (17.25) and CardioEthics (17.34) were lowest. The largest gaps between holistic clinical quality and key-point coverage occurred in CardioComm (52.71), CardioEmergRescue (52.05), and CardioTreatPlan (48.80). Conclusions: To our knowledge, CardioBench is the largest real-world, multi-task benchmark for LLM evaluation across the cardiovascular care continuum and offers the broadest coverage of clinically authentic cardiology scenarios reported to date. It provides a rigorous framework for identifying model strengths, clinically important omissions, and priorities for future development.

Xiao Li, Mouxiao Bian, Zhaodi Wu +8

Department of Cardiology, Zhongshan Hospital Fudan University , Shanhai, China · Shanghai Institute of Cardiovascular Diseases, National Clinical , Shanghai, China · Research Center for Interventional Medicine , Shanghai, China +2

Healthcare Clinical Language Model Evaluation Medical LLMs

Jul 24, 2026cs.IR

MedJudgeRAG: Option-Wise Evidence Judgment with Dynamic Knowledge Graphs for Medical MCQA

In medical multiple-choice question answering (MCQA), Retrieval-Augmented Generation (RAG) can supplement the domain knowledge of language models (LMs). However, since vanilla RAG indiscriminately utilizes retrieved documents, it can degrade LM performance. To address this, we propose MedJudgeRAG. Our framework represents retrieved documents as a dynamic knowledge graph (KG) composed of entities and relations. For each option, the model judges an evidence verdict from the retrieved documents and the KG. Based on the verdict combination, the model determines a knowledge utilization strategy to reason toward the final answer. These capabilities are trained via supervised fine-tuning using structured reasoning traces generated by a teacher LM. The training employs a weighted cross-entropy loss that differentially weights the KG and reasoning segments. Experiments on two medical MCQA benchmarks demonstrate that MedJudgeRAG consistently outperforms both vanilla RAG and parametric baselines. Furthermore, ablation analysis reveals that the dynamic KG is more effective as graph-conditioned supervision at training time than as an explicit output at inference time. Our code is available at https://github.com/hyu-amllab/medjudgerag, and the generated reasoning traces are released at https://huggingface.co/datasets/youarethewon/medjudgerag.

Seongwon Seo, Seung Hwan Cho, Young-Min Kim

Department of Industrial Data Engineering, Hanyang University, Seoul, South Korea · School of Interdisciplinary Industrial Studies, Hanyang University, Seoul, South Korea

Graph Retrieval-Augmented Generation Medical QA Medical Reasoning Knowledge Graphs Medical LLMs

Jul 23, 2026cs.MA

Spectral Dynamics of Semantic Drift in Clinical Multi-Agent Language Model Networks

The integration of iterative LLMs within multi-agent diagnostic frameworks requires a rigorous quantitative reevaluation of underlying communication topologies. Frequently used architectural paradigms depend on scale-free or small-world networks, assuming optimal communication efficiency. Our study mathematically dismantles that assumption for semantic data. By mapping multi-agent communication uncertainty trajectories onto a 768-dimensional Bio_ClinicalBERT embedding space via an analytical isotropic variance proxy using Barab'asi--Albert (BA) and Watts--Strogatz (WS) networks, we prove that structural bottlenecks compromise diagnostic safety. Our phase transition matrices illustrate that localized dense cliques confine hallucinated data, preventing global consensus and forcing the system toward a permanent entropy saturation threshold of

H_{\infty} \approx 5.947

. As a result, we measure a severe terminal cosine similarity degradation of 53.29%, completely overwriting the original ground-truth. Moreover, the terminal semantic drift reveals a catastrophic variance amplification of 51.81% (

ρ= 1.5181

) in highly clustered architectures, proving total system unpredictability when compared to Erdős--R'enyi configurations (

ρ= 1.0766

). Instead of reducing errors, hub-centric systems autonomously compound localized hallucinations. By introducing dynamic spectral monitoring operating at an

\mathcal{O}(N^3)

time complexity and imposing a strict lower bound on algebraic connectivity (

λ_{2_{min}}

) via the continuous eigen-decomposition of the graph Laplacian, we present a mathematically rigorous technique to ensure global state diffusion. Securing the reliability of autonomous medical diagnostics necessitates treating topological stability as a non-negotiable quantitative imperative.

Amritesh Banerjee

University of Massachusetts Amherst, USA

Language Modeling Spectral Methods Multi-Agent Communication Multi-Agent LLMs Medical LLMs LLM Agent Reliability

Jul 23, 2026cs.CL

MedGame: Storytelling Gamification Empowered by Large Language Models for Medical Education

Large Language Models (LLMs) show promise for medical education, but most existing systems focus on localized interactions such as question answering or single-turn feedback, rather than organizing an entire clinical case into a decision-centered learning trajectory. We introduce \textit{MedGame}, a framework that transforms static clinical cases into structured, executable storytelling games. MedGame uses a dual-engine design: a Medical Narrative Designer synthesizes case-grounded clinical storylines with states and decision nodes, while a Story Director converts them into dependency-aware multimodal orchestration plans rendered by our released interactive platform. We construct MedGame Bench, a 5,000-case benchmark and evaluation protocol for Medical Narrative Generation and Story Direction. Experiments show that task-specific fine-tuning substantially improves open-source LLMs on MedGame Bench and narrows the gap with commercial models. A pilot student study further shows that learners perceive MedGame as more engaging and useful than text-only alternatives.

Qian Wu, Xinrong Zhou, Zizhan Ma +8

CUHK · Tencent · Southern Medical University +1

Educational Technology Clinical Language Model Evaluation Medical LLMs Text Generation

Jul 23, 2026cs.IR

Improving Rare Medication Recommendation with Counterfactual Data Augmentation and Large Language Models

AI-based medication recommendation systems have attracted substantial attention due to their potential to enhance patient safety and therapeutic outcomes. Despite the clinical importance of accurately recommending rarely prescribed medications (rare-meds), we observe that most existing methods show significantly lower predictive performance for rare-meds. We attribute this issue to two intrinsic limitations: (a) the inherent scarcity of data for rare-meds and (b) limited consideration of co-recommended medications. To address these limitations, we propose GenRxR, a novel framework based on large language models (LLMs). GenRxR leverages the medical knowledge and clinical reasoning capability of LLMs to generate counterfactual medical data, mitigating the data scarcity issue for rare-meds. It also integrates an LLM into the medication recommendation process to model relationships among co-recommended medications. To further enhance the clinical reasoning, we introduce an instruction tuning step that aligns the LLM's capability with the recommendation task, enabling better handling of clinical context, including rare-meds cases. In our experiments, we show that GenRxR outperforms 14 (including 5 LLM-based) baselines in most cases. Specifically, it achieves up to 30.9% higher predictive performance for rare-meds than the strongest baseline.

Shinhwan Kang, Soo Yong Lee, Jaewon Kim +2

KAIST Seoul, South Korea · KAIST Daejeon, South Korea · Korea University Seoul, South Korea

Clinical Decision Support Large Language Model-Based Recommendation Counterfactual Data Augmentation Medical LLMs

Jul 21, 2026cs.AI

OntoBook: Ontology-Grounded Synthetic Textbooks for Medical Encoder Pretraining

We present OntoBook, a method that converts medical ontology structure into pretraining signal for encoder language models. Our approach has three stages: random walks through ontology graphs capture hierarchical and causal relations between medical codes, a large language model reformulates these walks into fluent textbook-style prose, and the resulting text is used to train ModernCamemBERT, a 149M-parameter French encoder, with two objectives on the same data: masked language modeling and relation prediction between code pairs. On three French medical coding benchmarks (FRACCO, Cantemist-FR, Distemist-FR), OntoBook achieves significant improvements over MLM-only pretraining, with +2.5 micro-F1 on FRACCO and +8.0 micro-F1 on Distemist. We find that alignment between objectives is necessary: misaligned training, where each task uses different data, causes a 30-point degradation. We release 1.3 million LLM-reformulated medical textbooks across three French ontologies (CIM-10, CCAM, ATC) and pretrained model checkpoints.

Rian Touchent, Éric de la Clergerie

ALMAnaCH · Inria, Sorbonne Université · rue Barrault 75013 Paris, 21 rue de l’école de médecine 75006 Paris

Language Model Pretraining Automated Medical Coding Synthetic Data Generation for Language Models Medical LLMs

Jul 20, 2026cs.DL

Benchmarking Resource-Efficient LLMs for Research Topic Ontology Generation in the Biomedical Field

Knowledge Organization Systems like Ontologies and taxonomies are fundamental for structuring scientific knowledge, yet their manual curation presents a persistent bottleneck in knowledge management. While Large Language Models (LLMs) offer a scalable mechanism for automated ontology generation, their capacity to classify complex, domain-specific semantics requires systematic evaluation. In this paper, we assess the performance of five small, open-source LLMs (up to 9 billion parameters) in identifying semantic relationships between biomedical concepts. To support this evaluation, we introduce MeSH-Rel-4K, a dataset comprising 4K semantic relationships extracted from the Medical Subject Headings (MeSH). We analyse three adaptation strategies: standard prompting, Chain-of-Thought prompting, and fine-tuning. While parameter-constrained models traditionally struggle with the nuances of in-context logic, our results reveal that targeted fine-tuning increases the average F1-score by 34.1 percentage points. These results confirm that direct fine-tuning effectively exceeds the reasoning bottlenecks of smaller LLMs, providing an accurate, automated methodology for the construction and evolution of specialised biomedical ontologies.

Tanay Aggarwal, Angelo Salatino, Francesco Osborne +1

Knowledge Media Institute, The Open University, Milton Keynes, UK · Department of Business and Law, University of Milano-Bicocca, Milan, IT

Relation Extraction LLM Evaluation LLM Prompting LLM Fine-Tuning Medical LLMs Ontology Learning

Jul 19, 2026cs.CL

Robust Summarization of Doctor-Patient Conversations: TalTech Systems for the Beyond Transcription Challenge

This paper describes TalTech's submissions to the Beyond Transcription Challenge (BeTraC), which requires generating SOAP notes directly from long doctor-patient conversation recordings, without intermediate transcription. After screening open-weight speech LLMs for long-audio robustness, we adapted Voxtral Mini (lightweight track) and Voxtral Small (heavyweight track) with LoRA supervised fine-tuning followed by DAPO reinforcement learning that uses the challenge metric, Open Medical Concept F1, as its reward. Our systems ranked first in both tracks, and an independent LLM-as-a-judge evaluation showed the lowest hallucination rate among all submissions, indicating that reinforcement learning against a concept-matching metric need not compromise factual reliability. We also find that fine-tuning on text transcripts transfers well to speech input and appears to improve robustness on out-of-domain real recordings.

Aivo Olev, Tanel Alumäe

Tallinn University of Technology Tallinn, Estonia

LLM Hallucination Mitigation Text Summarization Speech Language Models Medical LLMs

Jul 15, 2026cs.AI

Cura 1T: Healthcare Foundation Model via Recursive Self-Improvement

Healthcare spans high-stakes communication, expert reasoning, and workflow execution, yet specialized language models that cover these use cases together remain limited. A healthcare model must handle patient consultation, clinical reasoning over text and images, interactive diagnosis, and electronic health record (EHR) tool use. These capabilities fail in different ways, and a narrow update for one task can degrade another. We present Cura 1T, a healthcare foundation model trained through recursive self-improvement (RSI). In each RSI round, the RSI harness runs the current model on healthcare benchmarks, evaluates the trajectories to locate capability gaps, and refines the training mixture by synthesizing training data. On 6 healthcare benchmarks, Cura 1T scores highest on MedAgentBench, HealthBench Professional, HealthBench Hard, MedXpertQA text, and AgentClinic, and second on MedXpertQA multimodal. It preserves performances on out-of-domain reasoning and agentic benchmarks including AIME, GPQA-Diamond, and

τ^2

-Bench.

Haolin Chen, Leon Qi, Steve Brown +7

actAVA AI Team

Medical VLMs LLM Agent Training Language Model Self-Improvement Medical LLMs Recursive Self-Improvement

Jul 14, 2026cs.CL

Evaluating Large Language Models on Misconceptions in Multi-Turn Medical Conversations

Patients seeking medical information often ask questions that embed incorrect assumptions or misconceptions. In such cases, safe medical communication requires not only answering the question, but identifying and correcting the underlying false belief. These interactions naturally unfold over multiple turns, a pattern now mirrored in interactions with LLMs. Yet current evaluation frameworks do not capture model behavior in these settings, where misconceptions can emerge, persist, or evolve over the course of a conversation. Whether LLMs can reliably correct such misconceptions over time remains largely unexamined. To study this, we introduce ThReadMed-QA, a multi-turn medical dialogue dataset of 2,437 patient-physician conversation threads comprising 8,204 question-answer pairs, derived from real patient interactions on AskDocs. This dataset enables systematic evaluation of whether models can detect and correct misconceptions under a multi-turn context. We evaluate five LLMs using a rubric-based LLM-as-a-Judge framework that scores responses based on their ability to identify and correct misconceptions. Our experiments reveal a consistent pattern: even frontier models that can address misconceptions in a single interaction degrade substantially over subsequent turns. GPT-5 and Claude-Haiku correct these false presuppositions around 85% on initial questions but drop to roughly 50% within two follow-ups. An oracle analysis replacing prior model outputs with physician responses shows that much of the degradation is driven by error propagation, while performance remains imperfect even under correct context. Even when models tend to correct misconceptions initially, their performance degrades substantially over later turns, leading to inconsistent and potentially unsafe guidance in patient-facing settings and highlighting the need for evaluation frameworks that capture multi-turn behavior.

Monica Munnangi, Saiph Savage

Khoury College of Computer Sciences Northeastern University

Multi-Turn Dialogue Evaluation Clinical Language Model Evaluation Medical LLMs

Jul 14, 2026cs.AI

Evidence-Grounded AI for Musculoskeletal Care

Musculoskeletal diseases are among the leading causes of disability worldwide and create the greatest global need for rehabilitation. Because recovery, remodelling and degeneration often unfold over months to years, musculoskeletal care requires longitudinal management that repeatedly integrates evolving patient evidence, external medical knowledge and stage-specific functional goals. In routine practice, this evidence is fragmented across visits, departments and hospital systems, limiting individualized, evidence-based care. Here we report OrthoPilot, a clinical artificial intelligence system powered by a large language model that integrates hospital data streams with authoritative external knowledge for continuous musculoskeletal management. OrthoPilot autonomously retrieves real-time imaging, laboratory, pathology and order data and converts evolving patient states into evidence-based decisions from admission diagnosis to rehabilitation planning. We established a specialist-validated benchmark from real-world electronic health records spanning 1,000 disease codes. In a reader study across the complete care pathway, OrthoPilot was compared with 81 orthopaedic physicians and surpassed experts with 25 years of experience in diagnostic reasoning, clinical decision-making and management planning. It also outperformed all evaluated intelligent systems across 60 external clinical centres. In a prospective study of 1,870 complex cases, OrthoPilot increased full-chain management success by 10.6%. During an 8-month randomised deployment involving 8,240 inpatients, it increased cumulative cases per bed by 9.7% and improved patient-reported access to health information. These results move clinical AI from predicting isolated events toward executing longitudinal management across complete musculoskeletal care pathways.

Wenjie Li, Yujie Zhang, Fanrui Zhang +34

Department of Orthopaedics, Ruijin Hospital, College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China · Shanghai Innovation Institute, Shanghai, China · Shanghai Artificial Intelligence Laboratory, Shanghai, China +7

Healthcare Clinical Decision Support Clinical Reasoning Longitudinal EHR Modeling Medical LLMs

Jul 14, 2026cs.LG

From Many to Meaningful: Feature-Guided Zero-Shot Chronic Kidney Disease Screening Using Large Language Models

Early screening of chronic kidney disease (CKD) is essential for preventing irreversible progression; however, many machine learning (ML)-based screening methods remain difficult to deploy in community and resource-limited screening settings due to their reliance on large labeled datasets, resource-intensive pathology tests, or high-dimensional clinical features, and limited robustness to population and distributional shifts. This study examines the feasibility of using large language models (LLMs) for early-stage CKD screening in a zero-shot setting, without dataset-specific training. We propose a feature-guided zero-shot framework that evaluates LLM performance using a selected set of clinically meaningful, readily available community-based features, rather than exhaustive clinical inputs. Feature selection was guided by ML-based analysis to identify a compact, clinically relevant subset of variables. Tabular patient records were subsequently serialized into text using standardized prompt templates to enable zero-shot inference. The zero-shot performance of four LLMs (LLaMA-3, Qwen-3, Mistral, and GPT-4o-mini) was evaluated using both the full feature set and the selected subset. Generalizability was assessed across three heterogeneous CKD datasets spanning three countries. Across models and datasets, the selected feature set yielded consistent and statistically significant improvements in balanced accuracy and probability estimates, achieving performance levels suitable for screening purposes. These findings suggest that LLMs can support clinically meaningful, training-free CKD screening using minimal community-accessible patient features, offering a practical complement to conventional ML methods in real-world screening contexts.

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

Zero-Shot Learning Medical Diagnosis Clinical Prediction Medical LLMs

Jul 10, 2026cs.AI

MedRealMM: A Real-World Multimodal Benchmark for Chinese Online Medical Consultation

Large language models (LLMs) are increasingly deployed in online medical consultation, yet existing benchmarks remain poorly aligned with real clinical practice. Many rely on synthetic conversations or patient simulators, omit patient-uploaded medical images, or evaluate open-ended clinical responses using multiple-choice or lexical-overlap metrics that poorly reflect clinical quality. We introduce \textbf{MedRealMM}, a large-scale benchmark for multimodal online medical consultation built from de-identified patient-doctor interactions collected from a nationwide Chinese internet hospital. MedRealMM uses a Multimodal Clinical Challenge Point (MCCP) extraction framework to identify clinically demanding moments in authentic consultation trajectories and converts each into a standardized next-response generation task while preserving the preceding text-image context. Each instance is paired with a case-specific rubric refined by physicians that rewards clinically desirable behaviors and penalizes unsafe, unsupported, or contradictory responses. The current release contains 5,620 real-world multimodal cases spanning 64 clinical departments. We evaluate 19 general-purpose and medical-specialized LLMs, including text-only and multimodal systems. Our results show that image information is critical for reliable clinical performance and that current frontier models remain below the online physician response. Although some frontier models satisfy as many or more positive clinical criteria than physicians, they trigger more negative criteria, indicating that safety-sensitive error avoidance remains a central bottleneck. MedRealMM offers a realistic and reproducible benchmark for evaluating multimodal medical reasoning in real-world online consultation. The dataset will be publicly available on Hugging Face at https://huggingface.co/datasets/jdh-algo/MedRealMM.

Runhan Shi, Quan Zhou, Yuqian Xu +14

JD Health International Inc. · Shanghai Jiao Tong University · National University of Singapore +3

Healthcare Clinical Language Model Evaluation Multimodal Model Evaluation Medical LLMs Text Generation

Jul 9, 2026cs.CR

Trivial Prompt Reframing Bypasses Safety Guardrails in Googleś MedGemma-4B

Open-weight medical language models are increasingly used as the base of patient-facing and clinician-support applications. Their model cards prohibit specific behaviors -- recommending exact drug dosages, issuing definitive diagnoses, prescribing treatments, adjudicating drug-drug interactions, and advising that emergency care can be skipped -- yet a model card describes intended behavior, not robust behavior. We quantify that gap for MedGemma-4B-it under attacks that require no technical sophistication. We build a fully factorial benchmark of 5 guarded-behavior concepts x 50 deterministically templated questions x 6 lay-accessible attack manners x 3 repetitions (4,500 generations), serve the model locally through Ollama under default sampling, and code every response refuse/hedge/comply with three independent judges (an LLM judge, a transparent regex judge, and an NLI-entailment judge). Under the primary LLM judge the overall Attack Success Rate (ASR, the fraction coded comply) is 38.0%. The two framings that reinterpret the request as legitimate dominate: recasting a question as a "medical board exam" item raises ASR from a 29.0% baseline to 53.1% (+24.0 points), and an appeal to an alleged doctor's authority raises it to 43.7% (+14.7); crude instruction-override prefixes have no significant effect. Robustness is dominated by topic: the drug-interaction guardrail is nearly absent (83.2% ASR) while the emergency-deferral guardrail is strong (4.7%) -- and the authority framing is the only attack that breaches it. We report Wilson confidence intervals, cluster-bootstrap effect sizes, a cluster-robust logistic regression, Cochran's Q, per-manner McNemar tests, and inter-judge reliability (Fleiss' kappa = 0.26); absolute ASR is judge-dependent while the ordering of attacks and topics is not. Our findings motivate stronger deployment-time guardrails for open medical models.

Avi-ad Avraam Buskila

Department of Information Science and Applied Artificial Intelligence, Bar-Ilan University, Ramat Gan, Israel

LLM Safety Benchmarks Language Model Safety Evaluation LLM Guardrails LLM Jailbreak Attacks Medical LLMs

Jul 9, 2026cs.AI

The complexities of patient-centred conversational artificial intelligence

Consumer-facing health chatbots powered by large language models (LLMs) are increasingly used for symptom assessment. However, chatbot development and evaluation often rely on cooperative, articulate, simulated patients. We analysed 2,053 real patient-chatbot conversations and found that communication patterns and expression of emotions vary widely across users. We developed a patient simulator that separately models clinical content, emotional state, conversational strategy, and communication style. In a Turing-inspired evaluation of realism with 15 human graders, simulated conversations were nearly indistinguishable from real ones, with human graders achieving an accuracy of 55%. We used five distinct patient personae, across 1,164 clinician-graded cases, to evaluate the performance of four LLMs in urgency assessment. We found that communication style can significantly alter triage outcomes. Patient-centred conversational artificial intelligence must accommodate communication diversity: systems designed for idealised, rather than realistic, interactions risk underperforming and amplifying health disparities when deployed in the real world.

João Matos, Olivia Buege, Donny Cheung +8

Verily Health, Dallas, TX, USA · Centre for Statistics in Medicine, University of Oxford, Oxford, UK · Department of Applied Health Sciences, School of Health Sciences, University of Birmingham, Birmingham, UK +2

Clinical Triage Conversational Agents Clinical Language Model Evaluation Medical LLMs

Jul 9, 2026cs.AI

Towards Precision Therapy in Hepatocellular Carcinoma: A Clinical-Reasoning LLM for Risk Stratification and Treatment Guidance

Hepatocellular carcinoma (HCC) is a common malignancy and a leading cause of cancer-related mortality. Current guidelines and staging systems provide coarse categories, but often miss within-stage heterogeneity and the clinical context in electronic medical records (EMRs). We present HCC-STAR (Hepatocellular Carcinoma Staging, Treatment And pRognosis), a clinically aligned large language model that reads routine EMR narratives and jointly outputs risk score-based staging, ranked guideline-consistent treatments with evidence-based rationales, and individualized survival estimates. We curated about 30,000 HCC cases from SEER and expanded them into EMR-style narrative training data using a clinician-validated, prompt-based augmentation workflow. On this corpus, we developed a knowledge-aligned reasoning framework optimized with a step-verifiable composite reward, moving beyond text-level memorization of clinical guidelines. In a multi-center cohort of 6,668 patients from 12 hospitals in China, HCC-STAR achieved state-of-the-art performance in treatment recommendation and risk stratification compared with clinical guidelines and competitive models, including GPT-5 and Gemini-2.5 Pro. Hypothetical overall-survival analysis showed a median survival of 51 months under adherence to HCC-STAR recommendations, compared with 29 and 32 months under BCLC and CNLC. In clinician-centric evaluations, blinded hepatobiliary specialists rated HCC-STAR's reasoning and evidence-based justifications as trustworthy. The model surpassed resident and attending physicians in treatment accuracy and helped physicians make more accurate decisions faster when used as an assistant. These findings support HCC-STAR as a reliable and verifiable decision-support system for risk stratification and precision therapy in HCC.

Peng Cui, Jitao Wang, Siyan Xue +41

Cancer Survival Prediction Clinical Decision Support Clinical Reasoning Oncology Medical LLMs Clinical Risk Prediction

Jul 9, 2026cs.AI

MentalHospital: A Virtual Environment for Evaluating Psychiatric Clinical Encounters

Large language models (LLMs) have shown strong performance on isolated psychiatric tasks, including dialogue, diagnosis, and treatment planning, yet existing benchmarks rarely simulate complete psychiatric clinical encounters. We introduce

\textbf{MentalHospital}

, a virtual evaluation environment for LLM-based psychiatric clinical encounters. MentalHospital instantiates the Subjective Interviewing, Objective Examination, Diagnostic Assessment, and Treatment Planning (S.O.A.P.) workflow, using skill-augmented standardized patients constructed from 1,193 de-identified psychiatric electronic health record (EHR) cases spanning all major ICD-11 categories and 76 disorders. Each encounter is assessed through a dual-track protocol that combines objective comparison against EHR-derived references with subjective assessment of clinical process quality. To scale specialist judgment, we develop

\textbf{MentalEval}

, five domain-specific evaluators covering communication empathy, interviewing professionalism, clinical-note quality, diagnostic rigor, and treatment appropriateness, trained with rubric-grounded SFT and expert-guided DPO. Survey responses from 22 clinicians support MentalHospital's clinical fidelity (3.88/5), while MentalEval achieves strong expert alignment with an average QWK of 0.944. Benchmarking shows that even the strongest LLM trails clinicians by 37.28 percentage points in objective psychiatric competence, with mental status assessment as a key bottleneck.

Yuming Yang, Xiao Sun, Yuanwei Zou +6

School of Computer Science, Chongqing University, Chongqing, China · School of Computer Science, Hunan University, Changsha, China

Mental Health Clinical Reasoning Clinical Language Model Evaluation Medical LLMs

Jul 9, 2026cs.AI

A safety-oriented hypothetico-deductive framework for AI-assisted differential diagnosis

Diagnostic error is a major threat to patient safety, yet current large language model (LLM) systems often treat diagnosis as a one-shot prediction task, lacking safeguards against missed high-risk alternatives or rigorous verification of their reasoning. Here, we present AegisDx, a safety-oriented framework for hypothetico-deductive clinical reasoning. AegisDx coordinates specialized LLM components through role-specific contracts, structured intermediate outputs, evidence-retrieval interfaces, and verification gates to generate broad differential diagnoses, enforce explicit screening for dangerous "must-not-miss" conditions, verify reasoning against grounded medical evidence, and structure actionable next steps. We evaluated AegisDx across three layers. On literature-derived case reports from NEJM and JAMA, with GPT-oss-120B as the shared backbone, Top-3 diagnostic accuracy was 59.9% versus 52.1% for the standalone LLM on JAMA cases and 62.7% versus 51.4% on NEJM cases. On cases from Annals of Emergency Medicine, Top-3 accuracy was 85.7% versus 68.6%; against physician-consensus must-not-miss diagnosis sets, AegisDx captured at least one such condition among its top three diagnoses in 78.0% of cases versus 52.0%. In a blinded physician evaluation of 43 real-world emergency department notes from the Yale New Haven Health System compared against GPT-5, AegisDx improved the physician-rated composite safety score from 4.31 to 4.55 on a 5-point scale (adjusted p = 2.1x10^-4), with qualitative gains in must-not-miss identification and reasoning safety. Our findings suggest that engineering diagnostic AI as a safety-oriented reasoning framework, rather than optimizing raw predictive accuracy alone, can provide a safer, more transparent, and clinically meaningful layer of bedside decision support for acute care workflows.

Fan Ma, Mauro Giuffrè, Donald Wright +12

Department of Biomedical Informatics and Data Science, Yale School of Medicine, Yale University, New Haven, USA · Department of Medical, Surgical and Health Sciences, Università degli Studi di Trieste, Trieste, Italy · Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, USA +3

Scientific Reasoning Medical Diagnosis Clinical Decision Support LLM Safety Clinical Reasoning Differential Diagnosis+1

Jul 8, 2026cs.AI

Aligning Clinical Needs and AI Capabilities: A Survey on LLMs for Medical Reasoning

Large language models (LLMs) have emerged as important tools in healthcare, showing growing potential for clinical reasoning and patient care. This survey examines recent progress in medical LLMs, focusing on reasoning applications and requirements. We present a dual-view approach that connects clinical practice with computational methods. On the clinical side, we establish a five-level competency scheme following Miller's Pyramid, progressing from knowledge recall to dynamic case management. On the computational side, we link deductive, inductive, and abductive reasoning patterns to common medical goals and tasks. We also introduce a benchmark dataset spanning five levels of medical reasoning capability and report results on 18 state-of-the-art models, revealing that medical specialist models excel in diagnosis-centric tasks while general models lead in decision support and dialogue. We conclude by discussing current progress and open challenges, including data limitations, hallucination, and grounding issues, and outline directions toward safer, more reliable, and workflow-ready systems.

Qi Peng, Jiatong Li, Sirui Huang +10

1The Hong Kong Polytechnic University, Hong Kong, China. · 2Hong Kong University, Hong Kong, China. · 3South China University of Technology, Guangzhou, China. +3

Clinical Reasoning Clinical Language Model Evaluation Medical LLMs

Jul 6, 2026cs.AI

Medi-Gemma: A Hybrid Clinical Decision Support System Integrating Deterministic EMR Analytics and Retrieval-Augmented Generation

Deploying Large Language Models (LLMs) in high-stakes clinical settings remains limited by structural hallucinations, weak deterministic reasoning over tabular patient data, and omissions in vector retrieval. This paper presents the architecture and validation of Medi-Gemma, a Clinical Decision Support System (CDSS) for wound pathology triage and workflow automation. The platform introduces a decoupled framework that separates clinical perception from data orchestration while preserving traceable reasoning. Medi-Gemma uses a multi-stage pipeline coordinated by a centralized ClinicalOrchestrator. Data requests are handled without generative inference by a DataManager that cleans unstructured Electronic Medical Record (EMR) files through type coercion. Natural language queries are processed by a hierarchical IntentRouter, which routes requests to deterministic analytics paths executed by a PandasQueryEngine or to patient-specific reasoning managed by a ClinicalRAGEngine using a CPU-optimized vector store. A key contribution is the Ground Truth Injection Module, which intercepts patient-specific queries, extracts numeric identification tokens, queries the structured dataframe via Pandas, retrieves the latest validated clinical state, and embeds this snapshot as an overriding context block in the LLM prompt before generation. Safety compliance is enforced by a deterministic ProtocolManager that maps clinical terminology to fixed evidence-based risk pathways, while a SafetyVerifier phrase filter prevents output rule violations. Validation shows that this architecture eliminates semantic context drift, prevents database compilation crashes, and improves factual adherence to backend clinical repositories. These results support Medi-Gemma as a safer pattern for LLM-based clinical decision support where structured data fidelity, retrieval grounding, and deterministic safeguards are essential.

Mohammed Saim Ahmed Quadri, Yunzhe Xue, Justin W. Ady +1

Department of Computer Science, New Jersey Institute of Technology Newark, NJ, USA · Department of Data Science, New Jersey Institute of Technology Newark, NJ, USA · Vascular and Endovascular Surgery, Robert Wood Johnson Hospital New Brunswick, NJ, USA

Retrieval-Augmented Generation LLM Hallucination Mitigation Clinical Decision Support Clinical Reasoning Medical LLMs

Jul 3, 2026cs.AI

Reinforcement Learning for Evidence-Seeking Diagnostic Reasoning with Large Language Models

Recent reasoning-centric Large Language Models (LLMs) have made significant strides, yet they predominantly operate on a passive-inference pattern that assumes complete information. In contrast, real-world clinical intelligence is inherently an iterative investigative process requiring strategic evidence acquisition. To bridge this gap, we formalize medical diagnosis as an Iterative Evidence-Seeking Task. We leverage Reinforcement Learning with Verifiable Rewards (RLVR) to elicit intrinsic reasoning within a closed-loop environment, guided by a novel suite of rewards that enforce diagnostic precision and examination consistency. To facilitate this, we introduce the Retrieval-Augmented Generation-based Examination Simulator (RAGES), a high-fidelity clinical oracle that provides realistic, knowledge-grounded follow-up evidence. Empirical results across diverse datasets demonstrate that our framework enables LLMs to transition from passive responders to autonomous assistants. Notably, our model demonstrates comparable performance to larger and reasoning-enhanced baselines, while RAGES proves superior to vanilla LLMs in generating biologically plausible clinical feedback.

Shengyi Hua, Kangzhe Hu, Conghui He +2

Qing Yuan Research Institute, Shanghai Jiao Tong University · Shanghai AI Laboratoty · Shanghai Innovation Institute

Medical Diagnosis RL for Language Model Reasoning Active Information Gathering Clinical Reasoning Medical LLMs

Jul 3, 2026cs.AI

MedCalc-Pro: Solving Complex Medical Calculations with LLM Agents

Current benchmarks for evaluating large language models (LLMs) in medical calculation are largely based on simplified settings, where each patient case corresponds to a single calculator and the required tool is explicitly specified in the query. However, real clinical scenarios often require multiple calculators for joint evaluation, nested-scale calculation, and fuzzy queries that do not directly specify the target calculator. To this end, we propose a new medical calculation benchmark, MedCalc-Pro, which covers three progressively challenging task settings: single-calculator, multi-calculator, and nested-calculator calculation settings. MedCalc-Pro contains 2,268 real-world clinical cases, covering 77 medical calculators across 14 clinical departments. Meanwhile, to address the limited performance of existing frameworks and methods in complex clinical scenarios, we further propose a more generalizable agent framework that supports multi-tool selection and nested-tool calling, while suppressing parameter error propagation through structured validation and evidence review. We conduct systematic comparisons across open-source, closed-source, and medical-specialized LLMs, and the results show that our framework achieves the best performance across all three task settings. This work provides a new benchmark and method for evaluating and applying LLMs in challenging medical calculation scenarios.

Siran Zhao, Ruihui Hou, Ziyue Huai +2

East China University of Science and Technology, Shanghai, China

LLM Agent Evaluation LLM Tool Use Medical LLMs

Jul 1, 2026cs.CL

FaithMed: Training LLMs For Faithful Evidence-Based Medical Reasoning

Faithful reasoning is essential in medicine, where clinical decisions require transparent justification grounded in reliable evidence. Current medical LLMs either lack active access to evidence or use retrieved evidence without supervising how it should be appraised and applied during reasoning. To address this, we formalize evidence-based medicine principles as process-level criteria and introduce FaithMed, a framework that combines clinician-designed, automatically refined rubrics with reinforcement learning using step-level process reward assignment and advantage grouping. Across seven medical benchmarks, FaithMed improves over agentic-search baselines (+9% on average) and outcome-only RL (+5.8%), while raising average evidence-based medicine rubric scores over agentic-search Qwen3 baselines (+15.5%). This work demonstrates that explicit step-level supervision can improve both task success and the faithfulness of the reasoning process. Code is available at https://github.com/cxcscmu/FaithMed.

Zhiyun Zhang, Liwen Sun, Xiang Qian +1

Carnegie Mellon University · Stanford University School of Medicine · Xlue

RL for Language Model Reasoning Process Supervision Medical Reasoning Medical LLMs

Jun 30, 2026cs.CL

Readable but Not Controllable: Neuron-Level Evidence for Medical LLM Hallucination

Hallucination remains one of the central obstacles to deploying medical LLMs. Yet, even when hallucination can be detected, it is still unclear whether the internal representations associated with it can be used for control rather than detection alone. Using four open-source models across a suite of medical question-answering datasets, we show that a simple, carefully conditioned probe can reliably detect hallucination, with AUROC scores between 0.77 and 0.86 in our case. We further show that this signal is distributed and redundant rather than narrowly localized. Systematically selected neurons outperform random neurons only at very small subset sizes, whereas random subsets of a few hundred neurons recover nearly the full signal, and low-dimensional random projections preserve most of the detection performance. Beyond detection, we test whether this representation is causally actionable. Across 16 model--dataset combinations, our results reveal a sharp gap between decodability and controllability. The same internal structure that makes hallucination easy to detect does not translate into reliable neuron-level control. These findings show that medical hallucination seems to be readily visible in internal activations, but not easily corrected by steering the neurons most associated with it. More broadly, our results suggest that hallucination mitigation is not simply a matter of identifying the right neurons, and point to a deeper separation between what representations reveal and what they allow us to change.

Vijay Vankadaru, Asha Matthews, Tanya Roosta +1

School of Information University of California, Berkeley California, USA

LLM Hallucination Mitigation LLM Interpretability LLM Hallucination Detection Causal Interventions in Language Models Medical LLMs

Jun 30, 2026cs.AI

RareDxR1: Autonomous Medical Reasoning for Rare Disease Diagnosis Beyond Human Annotation

Rare disease differential diagnosis is a critical yet arduous clinical task, requiring physicians to identify precise phenotypes from complex, unstructured patient symptoms and execute intricate reasoning within a vast search space. However, existing AI approaches typically rely on pipeline-based phenotype extraction or retrieval-augmented generation, which suffer from critical information loss due to predefined ontologies, retrieval bottlenecks, and a lack of diagnostic logic. To address these challenges, we introduce RareDxR1, an end-to-end reasoning-centric large language model designed for open-domain rare disease diagnosis directly from unstructured clinical notes. We design a progressive end-to-end training framework by synergizing knowledge internalization with autonomous evolutionary learning, thereby bypassing reliance on structured phenotypes and closed-set decision-making. To overcome the limitations of RAG and phenotype restriction, we enabled the deep internalization of fragmented rare-disease knowledge directly into the model's parameters. Moreover, to bridge the gap between model generation and expert reasoning, we propose Reflection-Enhanced Reasoning Sampling (RERS), a strategy that synthesizes expert-level diagnostic trajectories by learning from failures without human annotation. Additionally, we propose a dual-level curriculum reinforcement learning approach for gradually mastering rare disease diagnosis. Experimental results demonstrate that RareDxR1 achieves state-of-the-art accuracy across different benchmarks, marking a significant breakthrough in open-domain rare disease diagnosis. Our code and dataset will be publicly available.

Deyang Jiang, Haoran Wu, Ziyi Wang +4

The Key Laboratory of Cognition and Decision Intelligence for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China · Peking Union Medical College Hospital, Beijing, China · School of Future Technology, University of Chinese Academy of Sciences, Beijing, China

Rare Disease Diagnosis RL for Language Model Reasoning Clinical Reasoning Medical LLMs

Jun 30, 2026cs.CL

Team MKC at CLPsych 2026: Capturing and Characterizing Mental Health Changes through Social Media Timeline Dynamics

Recent advances in Large Language Models (LLMs) have motivated their adoption across a wide range of domains, including Artificial Intelligence (AI) for mental health. Given the growing prevalence of mental health disorders worldwide and the limited accessibility of professional care, there is an increasing demand for scalable computational approaches that can assist in early detection and continuous monitoring of psychological well-being. In this area, ongoing efforts have focused on curating domain-specific datasets and leveraging them to develop LLMs capable of supporting holistic mental health analysis. In line with this direction, we propose an LLM-based pipeline for comprehensive mental health analysis over sequentially ordered user posts, as part of the CLPsych shared task. Our pipeline offers a unified framework that jointly enables post-level assessment and user-level temporal modeling.

Kyomin Hwang, Hyeonjin Kim, Hyunho Lee +1

Seoul National University, Seoul, Republic of Korea

Social Media Analysis Medical LLMs

Jun 30, 2026cs.LG

Teaching LLMs to Recommend and Defer in Underrepresented Epilepsy Care

Specialist epilepsy expertise is scarce in resource-constrained settings, making LLM-based decision support attractive for frontline clinicians managing longitudinal treatment. Such systems must adapt to local prescribing practice and know when to defer. We study this problem in Ugandan pediatric epilepsy care, predicting anti-seizure medication regimens from longitudinal unstructured clinic notes. Standard prompting achieves non-trivial agreement with physician prescriptions, but neurologist review shows that many errors reflect distribution-miscalibrated prescribing defaults rather than failures to parse the local record. We introduce MANANA, a non-parametric prompt-learning framework that learns local prescribing guidance from a small patient-level training set. MANANA converts observed prescription errors into auditable prompt memories, instantiated in single-agent and multi-agent variants, and improves over classical ML models, direct LLM prompting, and prompt-optimization baselines across two independently collected Ugandan cohorts. We further propose Bayesian prompt averaging, which converts the learned prompt trajectory into prescription likelihoods and an uncertainty-based deferral signal. On the independently collected held-out cohort, this improves visit-level top-3 prescription accuracy by 4-8 percentage points over prompt-optimization baselines and enables selective prediction: the system can auto-handle the most confident half of cases at 95% precision, or the most confident quarter at 99% precision, while deferring lower-confidence cases for specialist review.

Shreyas Rajesh, Kartik Sharma, Tonmoy Monsoor +8

Electrical and Computer Engineering, University of California, Los Angeles · Makerere University · St. Francis Hospital Nsambya +1

Prompt Learning Selective Prediction LLM Decision-Making Longitudinal EHR Modeling Medical LLMs

Jun 29, 2026cs.CL

Clinical Reasoning Graphs: Structured Evaluation of LLM Diagnostic Reasoning Reveals Competence Without Consistency

Modern large language models (LLMs) reach 60-70% diagnostic accuracy on complex clinical case benchmarks, but accuracy alone cannot distinguish stable clinically-grounded reasoning from pattern matching. We introduce clinical reasoning graphs, structured graph representations extracted from free-text LLM diagnostic traces using a domain-grounded ontology with 5 node types and 7 edge types. We apply this pipeline to 750 traces from five LLMs across 50 New England Journal of Medicine Clinicopathological Conference cases and three prompt conditions, and test whether diagnostic traces show stable structured reasoning patterns, or diagnostic schemas, for clinically similar cases. We operationalize this as higher graph similarity among clinically similar cases than among clinically dissimilar ones. Across 15 model-condition comparisons, within-cluster and between-cluster composite similarity are nearly equal, and no comparison survives multiple-testing correction; a component-level analysis finds any residual content signal far below schema scale. Graph similarity is also nearly identical for pairs of models that are both correct (0.488) and both incorrect (0.484), suggesting that graph structure captures a dimension not reflected in diagnostic accuracy. Structured reflection prompting increases explicit discriminating-feature analysis within traces (+33%) but does not increase cross-case consistency. These results show diagnostic competence without schema-scale reasoning consistency, and indicate that final-answer accuracy should be complemented by process-level evaluation. We release the ontology, extraction pipeline, validation protocol, and the extracted reasoning graphs and similarity artifacts as resources for structured evaluation of LLM clinical reasoning.

Nisarg A. Patel

University of California, San Francisco · Department of Oral and Maxillofacial Surgery, University of California, San Francisco, CA, USA · Department of Medicine, Division of Clinical Informatics and Digital Transformation, University of California, San Francisco, CA, USA

LLM Evaluation Reasoning Consistency in Language Models Clinical Reasoning Clinical Language Model Evaluation Medical LLMs

Jun 28, 2026cs.CL

TriageRA-CCF: Source-Side Clinical Confidence and Coverage Signals for Adaptive Rank Budgeting in Medical LLMs

Medical large language models are commonly adapted with a fixed low-rank budget, even though medical questions differ substantially in confidence, clinical coverage, and cross-domain difficulty. We study adaptive rank budgeting for parameter-efficient medical question answering: for each question, the adapter decides whether to activate a small, medium, or large subset of LoRA rank channels. The central challenge is that a naive adaptive budget router can collapse to unstable choices or spend capacity without improving shifted benchmarks. We propose TriageRA-CCF, a source-side teacher for adaptive rank-budgeted LoRA. It combines three signals computed only from source training data: base-model answer confidence, metadata-cell clinical coverage, and a counterfactual close-miss proxy. These signals supervise a straight-through budget router over active ranks {2,4,8}, together with budget-cost, entropy, and rank-balance regularization. Under a matched CMB-source training protocol, TriageRA-CCF achieves the best average accuracy among LoRA, DoRA, and MoELoRA baselines on both Qwen3-8B and Llama3.1-8B. The gains are modest and non-uniform across benchmarks: +0.21 average points over the strongest external baseline on Qwen3-8B and +0.16 on Llama3.1-8B. Component ablations show that confidence, coverage, and counterfactual signals all provide useful budget supervision, but their combination is not monotonically best on every backbone.

Shucan Ji, Yining Huang, Hongliang Guo

College of Computer Science, Sichuan University, Chengdu, China · Meta Emergence Laboratory

Low-Rank Adaptation Medical QA LLM Routing Adaptive Rank Allocation Medical LLMs