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 241

Jun 8, 2026cs.LG

From Hazard Functions to Language Space: Cox-Supervised Distillation of Survival Risk into a Large Language Model

We investigate whether information about time-to-event risk estimated by a Cox proportional hazards model can be transferred into a generative large language model. We propose a text-based survival modelling pipeline in which structured clinical covariates are converted into text prompts and a Qwen-based large language model is fine-tuned to generate patient-specific survival risk using Cox model predictions as a training target. Across GBSG2, ACTG320, and WHAS500, the model achieves competitive held-out discrimination and calibration despite being trained as a text-generation task rather than with a conventional survival-analysis loss. We further analyse the geometry of the model's hidden states, where t-SNE visualisations reveal smooth risk gradients in latent space, suggesting that the model represents survival risk as a continuous structure rather than isolated risk categories. Together, these findings suggest that large language models can internalise survival-risk structure while supporting calibrated prediction, providing a route towards time-to-event reasoning in language models.

Nicholas I-Hsien Kuo, Blanca Gallego, Louisa Jorm

Centre for Big Data Research in Health, the University of New South Wales, Sydney, Australia

Survival Analysis Language Model Calibration Language Model Distillation Medical LLMs Clinical Risk Prediction

Jun 8, 2026cs.CL

PACT: Learning Diverse Diagnostic Strategies via Privileged Synthesis and Branch Consensus

Clinical diagnosis requires flexible use of multiple reasoning paradigms under incomplete patient information. Existing LLM-based medical agents show strong medical reasoning ability, but single-paradigm or naively mixed dialogue supervision makes these paradigms difficult to learn without interference. We propose \textbf{PACT} (Periodic Anchor Consensus Training), a framework that couples supervised multi-paradigm dialogue synthesis with consensus-based Branch training. At the data level, \textbf{DPS} (Doctor-Patient-Supervisor) uses complete electronic medical records (EMRs) for quality control while keeping the doctor agent restricted to patient-visible information. This produces validated dialogues under four diagnostic reasoning paradigms without leaking hidden clinical answers. At the training level, PACT trains one paradigm-specific LoRA Branch per paradigm and periodically aggregates Branches into a shared Anchor through sign consensus. We further construct a dynamic multi-turn Chinese medical diagnosis benchmark for interactive consultation. Experiments show that PACT achieves state-of-the-art performance among compared proprietary, medical-specialized, and task-adapted baselines on diagnostic outcome and consultation-process metrics.

Gen Li, Yuanze Hu, Zhichao Yang +10

Beihang University · Baidu · ByteDance +2

Medical Diagnosis Clinical Reasoning LLM Agent Training Medical LLMs Text Generation

Jun 7, 2026cs.AI

Testing the Black Box: Structural Barriers to Independent Evaluation of Consumer-Facing Health LLMs

Background: Consumer-facing large language models are now a common source of health information, and they interpret and personalize responses rather than retrieve them. Whether their responses vary across users is a clinical, equity, and governance question, sharpened by evidence that sycophantic responses can alter judgment and increase trust. Objective: To evaluate response variation and sycophancy in consumer-facing health LLMs under conditions resembling ordinary patient use. Methods: We constructed simulated user profiles differing in geography, browsing context, expressed beliefs, and social determinants of health, drawing on literature linking social context to health attitudes. We adapted validated instruments, including the Vaccination Attitudes Examination scale and reproductive attitudes scales, into multi-turn prompts designed to elicit clinically meaningful variation across users. Results: The evaluation encountered five linked barriers. Factual prompts produced stable responses that masked sycophancy emerging over multi-turn conversation. Browser-based interfaces did not disclose which signals influence outputs and could not be reset to a clean baseline. Large-scale testing was restricted by terms of service, rate limits, and bot detection. Accuracy-based criteria could not capture tone, framing, or omission, and LLM-as-judge methods risked shared alignment bias. Models changed without traceable version identifiers, preventing reliable replication. Conclusions: No reliable independent evaluation framework yet exists for examining how consumer-facing health LLMs behave in ordinary use. Oversight requires disclosure of personalization signals, stable version identifiers, researcher safe harbor programs, and post-deployment monitoring of health-related outputs.

Rahul Gorijavolu, Kaushik Madapati, Pritika Vig +7

MIT Critical Data, Massachusetts Institute of Technology, Cambridge, MA, USA · School of Medicine, Johns Hopkins University, Baltimore, MD, USA · Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA +10

LLM Evaluation LLM Sycophancy LLM Personalization LLM Auditing Medical LLMs

Jun 5, 2026cs.CL

When Large Language Models Fail in Healthcare: Evaluating Sensitivity to Prompt Variations

Large Language Models (LLMs) are increasingly used in healthcare for tasks such as clinical question answering, diagnosis support, and report summarization. Despite their promise, these models remain highly sensitive to subtle prompt perturbations, both lexical and syntactic, posing serious risks in safety-critical clinical applications. In this study, we conduct a systematic sensitivity analysis to evaluate the robustness of both general-purpose (e.g., GPT-3.5, Llama3) and medical-specific LLMs (e.g., ClinicalBERT, BioLlama3, BioBERT) using the MedMCQA benchmark. We categorize perturbations into natural and adversarial types and examine their effect on model consistency, accuracy, and reliability in clinical reasoning tasks. Our findings reveal that medical LLMs are not intrinsically safe. Even minor variations in phrasing can alter clinical advice, and targeted adversarial prompts can provoke harmful outputs. In high-stakes settings like healthcare, such unpredictability is unacceptable-models that change diagnoses due to reworded inputs or hallucinate medications when slightly rephrased cannot be reliably trusted by clinicians. While models tend to show resilience to simple lexical substitutions or paraphrasing, they often break down under syntactic reordering or misleading contextual cues. This fragility is evident across both general-purpose and domain-specific LLMs. Notably, adversarial manipulations can lead to clinically dangerous outputs, such as recommending incorrect dosages or omitting critical findings.

Mahdi Alkaeed

Department of Computer Science and Engineering, Doha, Qatar

Prompt Sensitivity Adversarial Attacks on LLMs Clinical Language Model Evaluation Language Model Robustness Medical LLMs

Jun 4, 2026cs.CL

What's in a Name? Morphological Shortcuts by LLMs in Pharmacology

The morphological form of a word can often give cues to its meaning, but purely relying on these mappings can lead to overgeneralization in high-stakes domains. In the medical domain, for instance, LLMs can confidently reason about fictitious drugs from their affixes alone (e.g., wugcillin) and generate plausible-looking clinical content. We present a behavioral and mechanistic study of LLM "affix heuristics" in pharmacology. Using fictitious drug names built from real affixes, we show that affix signals alone elicit class-level pharmacological responses. We introduce a framework for identifying whether a model's drug semantics are driven mainly by the affix, the stem, or the drug name as a whole. Applied across 653 drugs, our framework reveals that models often induce drug meaning primarily through affix cues, yet rarely explicitly indicate this reliance, and sometimes incorrectly conflate properties among affix-sharing drugs. Activation patching across models further localizes this behavior to early-mid layers. These findings show that morphological shortcuts pose a subtle but measurable risk to safety.

Kaijie Mo, Thomas Yang, Chantal Shaib +6

The University of Texas at Austin · Northeastern University · MD Anderson Cancer Center

Hallucination in Language Models Language Modeling Medical LLMs

Jun 3, 2026cs.AI

Severity-Aware Curriculum Learning with Multi-Model Response Selection for Medical Text Generation

Telehealth systems have become increasingly important for delivering accessible and timely medical information. Existing large language models often struggle to provide consistent and contextually appropriate medical responses across varying levels of case severity. This limitation highlights the need for models that can effectively adapt to the progressive complexity in medical queries. To address this challenge, we introduce a severity-aware multi-model framework that integrates curriculum training strategy with relevance-based response selection. The proposed framework employs a three-stage curriculum learning strategy, where each model is trained sequentially on mild, moderate, and critical cases to progressively acquire domain knowledge. The approach uses five large language models, each trained independently under the same curriculum. During inference, all models generate candidate responses, and the response with highest BERTScore is selected as the final output. The framework is trained and evaluated on the MAQA dataset, which provides annotated medical question-answer pairs. Experimental results evaluated using BERTScore demonstrate that the proposed method achieves superior performance compared to both baseline and fine-tuned models, attaining 86.71% in the baseline setting and 90.30% after fine-tuning. These results highlight the effectiveness of combining curriculum learning with multi-model response selection in improving response quality and relevance in medical text generation.

Ahmed Alansary, Molham Mohamed, Ali Hamdi

Faculty of Computer Science MSA University Giza, Egypt

Medical QA Curriculum Learning Language Model Ensembles Medical LLMs Text Generation

Jun 3, 2026cs.AI

Ten Headache Specialists versus Artificial Intelligence for Clinical Literature Summarization: A Critical Evaluation and Comparison

Summarizing the latest medical literature to guide clinical decision-making is essential for evidence-based medicine and high-quality patient care. Yet clinicians face increasing challenges due to limited time with patients and a rapidly growing volume of published articles. Although retrieval-augmented large language models (LLMs) have shown promise in clinical summarization, human evaluations of their effectiveness in synthesizing broader scientific literature and direct comparisons to expert-written syntheses remain scarce. We constructed a RAG-based agentic AI framework using three state-of-the-art LLMs: Sonnet, GPT-4o, and Llama 3.1. A headache specialist created 13 questions, three for prompt optimization and ten for evaluation. Ten headache specialists across the United States and Canada each wrote a summary for one question, yielding four summaries per question (expert, Sonnet, GPT-4o, and Llama). The experts, blinded to authorship, critically evaluated the summaries, excluding the topic for which they wrote a summary, based on correctness, completeness, conciseness, and clinical utility, scoring each from 1 to 10 using standardized rubrics. They also ranked the summaries by preference and indicated whether they believed each summary was written by an expert or an LLM. Our study, comparing LLM- and expert-written literature summaries evaluated by headache specialists, showed that expert-written summaries were preferred, although experts sometimes found it challenging to distinguish between human- and AI-generated summaries. We also identified key expert-valued features beyond standard evaluation metrics that can guide future refinement of both human and AI literature summarization pipelines.

Alejandro Lozano, Keiko Ihara, Ping-Hao Yang +13

Stanford University, Palo Alto, CA, USA · Department of Neurology, Mayo Clinic, Rochester, MN, USA · Department of Neurology, Dalhousie University, Halifax, Canada +8

Text Summarization RAG Evaluation Clinical Language Model Evaluation Medical LLMs

Jun 2, 2026cs.CL

When Retrieval Doesn't Help: A Large-Scale Study of Biomedical RAG

Medical question answering is a high-stakes setting where factual errors can have serious consequences. Retrieval-augmented generation (RAG) is widely viewed as a promising solution, and prior work has reported substantial gains for large medical QA models. We revisit this assumption across a broad range of open-weight instruction-tuned models spanning 7B to 72B parameters. Across five models, ten biomedical QA datasets, four retrieval methods, and four retrieval corpora, we find that retrieval yields only small and inconsistent improvements over a no-retrieval baseline, typically within 1-2 points. In contrast, the choice of backbone model has a much larger effect than the choice of retriever or corpus, and expert and layman retrieval sources perform similarly in most settings. These results suggest that the main bottleneck is not retrieval quality alone, but the model's limited ability to use retrieved evidence effectively.

Erfan Nourbakhsh, Rocky Slavin, Ke Yang +1

The University of Texas at San Antonio

Retrieval-Augmented Generation LLM Grounding Biomedical QA Biomedical IR RAG Evaluation Medical LLMs

Jun 2, 2026cs.AI

Gender-Dependent Diagnostic Substitution in LLM Medical Triage: Same Symptoms, Unequal Urgency

We investigate whether large language models produce different medical triage recommendations for identical neurological symptoms when only the patient's stated gender and age vary. Using three model families--Gemini 3.5 Flash, Claude Sonnet 4.6, and GPT-5.4-mini--we present a standardized symptom profile (persistent headache, blurred vision, morning nausea, visual disturbances) across seven demographic conditions: three age groups (25, 38, 65) x two genders (male, female), plus a gender-unspecified baseline (n = 30 per condition per model, 630 total trials). We find a stark, systemic gender-dependent triage disparity: young women receive significantly lower emergency room (ER) referral rates than age-matched men (Gemini: 0% vs. 23.3%; Claude: 6.7% vs. 96.7%; GPT: 6.7% vs. 66.7%, all p < 0.001). The disparity disappears at age 65 for all models. The primary mechanism is diagnostic substitution: the models anchor on a gender-associated diagnosis, preferentially classifying young women with Idiopathic Intracranial Hypertension (IIH)--a condition epidemiologically linked to women of childbearing age--while diagnosing men with generic increased intracranial pressure with space-occupying lesions in the differential. This diagnostic closure routes female patients to lower-urgency care (outpatient doctor appointments) despite comparable severity ratings (7-9/10). Our findings demonstrate that clinical LLMs replicate documented human clinical biases by using epidemiological priors to suppress triage urgency, suggesting that AI triage engines must decouple urgency assessment from probabilistic diagnostic priors. We release all code, prompts, and raw results.

Qi Han Wong

Gender Bias in Language Models Clinical Triage Medical Diagnosis Clinical Decision-Making Clinical Language Model Evaluation Differential Diagnosis+1

Jun 2, 2026cs.CL

Selective Token-Level Cryptographic Redaction for Privacy-Preserving Clinical Deployment of Large Language Models

While large language models (LLMs) are increasingly used for clinical applications, many existing pipelines require sending raw sensitive health information to remote servers for processing, which heightens the risk of privacy leakage. A natural approach to mitigate this risk is to encrypt the data before transmission. However, straightforward solutions such as encrypting the entire dataset introduce prohibitive computational, alignment, and communication overheads, rendering large-scale practical deployment infeasible. To preserve privacy while maintaining usability, we present Healthcare Encryption & Redaction via Adaptive Linguistic Decomposition (HERALD), a token-level cryptographic redaction framework designed to achieve this balance by encrypting only sensitive tokens while preserving the surrounding context for downstream model utility. HERALD combines medical named-entity recognizer (NER) with part-of-speech (POS) driven policies to select candidate tokens, performs targeted lemmatization to stabilize surface forms, and substitutes each protected token with a deterministic ciphertext wrapped in explicit delimiters. Notably, HERALD is model-agnostic and operates entirely on the client side, ensuring that sensitive content remains encrypted throughout storage, transmission, and processing without requiring changes to downstream models. We evaluated HERALD on both classification and medical question answering (MQA) tasks on public datasets. Across different tasks, experiments illustrate that fully secured baselines suffer significant utility loss, whereas HERALD consistently recovers performance close to plaintext. Overall, HERALD provides a novel utilization pipeline.

Farhan Sheth, Ziyuan Yang, Yongying Lan +1

MedVisAI Lab, Singapore · Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore · Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China

Privacy-Preserving Language Models Medical LLMs

Jun 2, 2026cs.AI

ClinicalMC: A Benchmark for Multi-Course Clinical Decision-Making with Large Language Models

Large language models (LLMs) have been widely adopted in healthcare, yet they still encounter significant challenges in complex clinical decision-making scenarios. Existing benchmarks primarily assess LLM performance in single-course settings and lack systematic evaluation in multi-course scenarios, where a patient's condition evolves over time. To address this gap, we propose ClinicalMC, a benchmark for multi-course clinical decision-making. It includes 1,275 Chinese and 5,804 English samples across four stages from admission to discharge. These stages cover triage, first-course examination/diagnosis/treatment, subsequent multi-course examination/assessment/treatment, and final diagnosis. In ClinicalMC, patients in the English dataset undergo an average of 5.11 clinical courses, whereas those in the Chinese dataset undergo 3.42. To assess LLM performance, we construct a multi-agent evaluation framework that includes patient, examiner, and doctor agents. Based on the benchmark and framework, we design two experimental settings -- a single-turn static setting and a multi-turn dynamic setting -- and assess three categories of LLMs: 1) closed-source LLMs like GPT5-mini; 2) open-source LLMs like DeepSeek-V3.2; and 3) medical LLMs like HuatuoGPT-o1. Through extensive evaluation, we aim to better understand LLM performance in the medical domain and support its effective deployment in healthcare.

Ruihui Hou, Siyi Zhu, Ziyue Huai +4

East China University of Science and Technology, Shanghai, China · Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.

Clinical Decision-Making Clinical Language Model Evaluation Medical LLMs

Jun 1, 2026cs.AI

Large AI Models in Dental Healthcare: From General-Purpose Systems to Domain-Specific Foundation Models

Background: Oral diseases affect nearly 3.5 billion people worldwide, yet the comparative clinical potential of large-scale AI models in dentistry remains poorly understood. Three distinct model categories have emerged: language-generative models, discriminative vision foundation models, and dental-specific foundation models, with no unified review examining their relationships and collective limitations. Methods: Following PRISMA-ScR guidelines, we systematically searched four databases (PubMed, Google Scholar, Scopus, arXiv), screened independently by two reviewers. After applying inclusion/exclusion criteria, 97 studies (2020-2026) were included. We propose a two-dimensional classification framework organizing models by architectural paradigm and dental specialization degree. Results: Language-generative models excel at text-based tasks (clinical reasoning, licensing exams, patient communication) but show inconsistent performance on image-dependent diagnostics. Adapted SAM and CLIP variants achieve strong tooth segmentation and lesion detection results. Dental-specific models (DentVFM, DentVLM, OralGPT) demonstrate strongest performance on complex multimodal tasks. Integrated pipelines consistently outperform single-model approaches. A data asymmetry is observed: dental-specific pretraining concentrates almost entirely in the vision domain, reflecting scarce large-scale dental text corpora. Conclusions: General-purpose and dental-specific models play complementary roles; the most effective systems combine both within structured pipelines. Safe autonomous deployment requires resolving three persistent barriers: hallucination in generative models, limited annotated dental datasets, and absent standardized clinical evaluation benchmarks.

Sema Helali, Lina Abu Nada, Sausan Al Kawas +3

Department of Computer Science and Software Engineering, College of Information Technology, United Arab Emirates University, Al Ain, 15551, UAE · Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, UAE · Weill Cornell Medicine-Qatar, Doha, Education City, Qatar +1

Medical Imaging Foundation Models Medical VLMs Medical LLMs

Jun 1, 2026cs.CL

Towards Multidisciplinary Summarization of Hospital Stays: Efficient Sentence-Level Clinical Provenance Categorization

Effective "all-team" summarization in high-complexity settings like the Neonatal Intensive Care Unit (NICU) requires aggregating insights from diverse disciplines (physicians, nurses, therapists) spread across hundreds of clinical free-text notes. Simply pooling heterogeneous text often leads to incoherent outputs. Structured summarization therefore first requires accurate categorization of sentence-level provenance across multi-source notes. This pilot study introduces a clinical provenance categorization pipeline using supervised fine-tuning (SFT) of large language models (LLMs). We adapted two Llama-3 models (8B and 70B) to MedSecId, a corpus of 2,002 MIMIC-III (Adult ICU) notes annotated with clinical provenance headers, achieving in-domain Macro F1 scores above 92% for both models. To evaluate cross-domain generalization, we assessed model capacity (8B vs. 70B) and quantization on a gold-standard dataset of 227 sentence-level spans derived from three multi-disciplinary NICU summaries. Experimental results demonstrate a scale-dependent transfer effect: while SFT produced only marginal changes for the 8B model, it substantially improved the 70B model, increasing Macro F1 by 7%. Notably, the quantized fine-tuned 70B model outperformed its full-precision baseline while substantially reducing computational requirements. These findings suggest that sufficient model capacity is critical for preserving semantic flexibility during cross-domain clinical transfer and that efficient quantized adaptation can enable structured provenance modeling for downstream summarization.

Baris Karacan, Vaibhav Bhargava, Barbara Di Eugenio +21

University of Illinois Chicago · University of Iowa · University of Missouri-Columbia

Data Provenance LLM Fine-Tuning LLM Information Extraction Medical LLMs

Jun 1, 2026cs.CL

KliniskVestBERT: BERT Model Specialised to Norwegian Clinical Texts

The increasing application of Natural Language Processing (NLP) in healthcare demands language models specifically attuned to the complexities of clinical language. This work introduces KliniskVestBERT, a suite of three BERT-based encoder models pre-trained on a substantial corpus of real-world, de-identified Norwegian clinical texts from Helse Vest. We continue pretraining existing language models Nb-BERT-large, NorBERT3-large, and ModernBERT on our specialized clinical dataset. This dataset is based on a representative population of Helse Vest patients. The included document types are carefully curated to encompass a broad clinical spectrum in bokmål and nynorsk including discharge summaries, surgical reports, nursing notes etc. ensuring comprehensive representation of the linguistic landscape within Norwegian healthcare settings. Evaluation on three synthtetic Norwegian clinical benchmark datasets and two real-world problems demonstrates that each of our clinically specialized models consistently outperforms their baseline counterparts, highlighting the significant benefit of domain-specific pre-training for NLP tasks within the clinical domain. The project was a joint effort by all Helse Vest entities (Helse Bergen, Helse Fonna, Helse Førde and Helse Stavanger) with DIPS under the project lead of Helse Vest ICT.

Christian Autenried, Cosimo Persia

Helse Vest ICT

Language Model Pretraining Domain-Adaptive Pretraining Clinical Language Model Evaluation Clinical NLP Medical LLMs

May 31, 2026cs.CL

Med-HEAL: Analyzing and Mitigating Hallucinations in Medical LLMs with Hallucination-Aware In-Context Learning

Hallucinations in medical large language models (LLMs) pose serious risks for clinical decision support, particularly when models must reason over complex electronic health records (EHRs). However, existing benchmarks often lack a realistic clinical context and provide limited insight into how hallucinations can be mitigated in practice. We introduce Med-HEAL, a framework for systematically identifying, analyzing, and mitigating hallucinations in medical LLMs using clinically grounded data. Building on the EHRNoteQA benchmark derived from MIMIC-IV discharge summaries, we construct a hallucination dataset by evaluating BioMistral-7B on open-ended clinical question answering tasks. Model outputs are labeled through a dual evaluation pipeline that combines LLM-as-a-Judge assessment (GPT-4o) with human auditing by medical student reviewers, producing correctness judgments and annotations of reasoning errors via a custom web-based evaluation system. We then leverage this dataset to investigate mitigation strategies: a self-critique pipeline, in which the test model reviews its own answers to detect potential errors and regenerates responses for flagged cases, and retrieval-augmented in-context learning (RA-ICL), which exposes the model to hallucinated and corrected examples. Experiments across five open-source LLMs-BioMistral, Llama-3.1, DeepSeek, Qwen2.5, and Qwen3, show that the self-critique strategy improves accuracy for three of five models (p < 0.05) without requiring parameter updates. Med-HEAL provides both a reusable hallucination dataset and a practical framework for studying and mitigating hallucinations in medical LLMs, supporting safer deployment of AI systems in clinical environments. Our code and data are publicly available at https://github.com/yimingliao-blad/med-heal.git.

Yiming Liao, Zeno Franco, Jose Eduardo Lizarraga Mazaba +1

University of Maryland, Baltimore County Baltimore, Maryland, USA · Concordia University Wisconsin · Medical College of Wisconsin Milwaukee, Wisconsin USA

LLM Self-Correction LLM Hallucination Mitigation Clinical QA In-Context Learning LLM Hallucination Detection Retrieval-Augmented ICL+1

May 31, 2026cs.CL

HypothesisMed: Inference-Time Answer Fusion and Structured Hypothesis-Space Reporting for Biomedical Question Answering

Biomedical question answering with large language models is commonly evaluated using answer accuracy, but answer accuracy alone does not indicate whether a model can produce parseable outputs, follow structured reliability instructions, recognize weak answer spaces, or avoid confident incorrect commitments. This paper presents HypothesisMed, an inference-time reliability pipeline for biomedical multiple-choice question answering. It combines direct, chain-of-thought, HypothesisMed-v3 prompting, and answer fusion. The final answer is selected by fusion, while HypothesisMed-v3 supplies SPACE labels and confidence information. SPACE labels mark the answer space as VALID, INCOMPLETE, or CONTRADICTED. We evaluate Qwen2.5-7B, Phi-4-mini, DeepSeek-R1-32B, and BioMistral-7B on MedQA, MedMCQA, and PubMedQA using 1,000 examples per dataset. The pipeline improves weighted accuracy over each model's best direct or chain-of-thought baseline while increasing parse and SPACE coverage. We also scale evaluation to Qwen2.5-7B and Phi-4-mini using 10,183 examples per model. Fusion improves Phi-4-mini accuracy from 0.4296 to 0.5192, while Qwen2.5-7B chain-of-thought remains slightly higher in answer accuracy. However, Qwen2.5-7B fusion achieves complete parse and SPACE coverage with much lower false commitment. A 12,000-example SPACE stress test shows answer-space diagnosis remains difficult, with SPACE accuracy of 0.3074 for Qwen2.5-7B and 0.4168 for Phi-4-mini. These results show that answer accuracy, parseability, structured reliability reporting, calibration behavior, and false-commitment behavior are separable capabilities. The main contribution is not a universal state-of-the-art claim, but a reproducible inference-time framework for evaluating biomedical question answering models as auditable workflow components under structured reliability constraints.

Md Motaleb Hossen Manik, Ge Wang

Department of Computer Science Rensselaer Polytechnic Institute Troy, NY, USA · Department of Biomedical Engineering Rensselaer Polytechnic Institute Troy, NY, USA

Biomedical QA LLM Uncertainty Estimation Medical LLMs

May 28, 2026cs.CL

Same Patient, Different Words, Different Diagnosis? Evaluating Semantic Stability in Clinical LLMs

Large Language Models (LLMs) are increasingly used in clinical applications. However, their behavior remains highly sensitive to subtle linguistic variations, such as rephrasing or syntactic variation. This sensitivity poses risks in safety-critical healthcare settings, where semantically equivalent inputs should produce consistent predictions. However, a key challenge is to ensure that prompt variations truly preserve clinical meaning, as embedding-based similarity metrics often fail to capture distinctions involving negation, temporality, or severity. To address this limitation, we propose a semantic verification framework based on Natural Language Inference (NLI) to filter meaning-preserving prompt variations, which are further refined using an LLM-as-a-judge and audited by a clinical expert. In addition, we introduce three metrics to quantify model sensitivity: MeaningPreserving Variation Sensitivity (MVS), confidence variation (ΔC), and Worst-Case Instability (WCI). We evaluate 16 open-source general-purpose (GP) and medical LLMs within the same model families and parameter scales, using reformulated prompts derived from the DiagnosisQA and MedQA datasets. Our results demonstrate that robustness differences between domain-specific (DS) models are mixed and highly model-dependent, i.e., domain specialization does not consistently improve or reduce robustness to meaning-preserving prompt reformulations. Several DS models rank among the most robust (when compared with GP counterparts), and strong GP baselines remain competitive as well.

Mahdi Alkaeed, Adnan Qayyum, Nabeel Abo Kashreef +2

Department of Computer Science and Engineering, College of Engineering, Qatar University, Doha, Qatar · College of Science and Engineering, Hamad Bin Khalifa University (HBKU), Doha, Qatar · Primary Health Care Corporation (PHCC), Doha, Qatar +1

Prompt Sensitivity Clinical Language Model Evaluation Language Model Robustness Medical LLMs

May 28, 2026cs.LG

OOD-GraphLLM: Graph Large Language Model for Out-of-Distribution Generalized Drug Synergy Prediction

Drug synergy prediction (DSP) aims to identify efficacious drug combinations under various cellular contexts with different targets. However, the continual emergence of novel compounds results in variations in molecular scaffolds and sizes, causing drug synergy data to exhibit out-of-distribution (O.O.D.) shifts with respect to topological structure. Existing works rely on in-distribution (I.D.) assumption, failing to handle the O.O.D. shifts. To solve this problem, we study out-of-distribution generalized drug synergy prediction through a graph large language model for the first time. Nevertheless, O.O.D. generalized DSP is highly non-trivial, posing several challenges: i) how to discover structurally relevant and irrelevant molecular representations with respect to cell targets; ii) how to find the optimal graph neural architectures that accurately calculate molecular representations; and iii) how to jointly leverage molecular structural and semantic information in LLMs. To address these challenges, we propose OOD-GraphLLM, a novel graphLLM framework which is able to accurately predict drug synergy under O.O.D. settings via jointly optimizing molecular graph representation and biomedical semantic language representations in a unified manner. Furthermore, we finetune DrugSyn-LLM, a biomedical LLM, and employ a retrieval-augmented biomedical instruction tuning strategy to align molecular topological information and molecular semantic information with language-based reasoning for O.O.D. generalized DSP. Both the source code (https://github.com/EkkoXiao/Bio-GraphLLM) and released model (https://mn.cs.tsinghua.edu.cn/bio-graphllm/) are publicly available, where users are allowed to download model resources and interactively use the system through a web interface.

Xin Wang, Linxin Xiao, Yang Yao +1

DCST, BNRist, Tsinghua University · Beijing, China · DCST, Tsinghua University

OOD Generalization Multimodal Graph Learning Medical LLMs Molecular Representation Learning

May 28, 2026cs.AI

Why Specialist Models Still Matter: A Heterogeneous Multi-Agent Paradigm for Medical Artificial Intelligence

The impressive performance of generalist large language models (LLMs) such as GPT and Claude in healthcare raises a critical question: will domain-specific medical specialist models become obsolete? We argue that the future of medical artificial intelligence (AI) lies not in building monolithic medical foundation models, nor in replacing human expertise, but in orchestrating collaboration among generalist LLMs, domain-specific specialist models, and clinicians. We propose HetMedAgent, a heterogeneous medical multi-agent framework that enables conflict-aware evidence fusion, uncertainty-based clinician intervention triggering, and adaptive threshold calibration. Experiments on three real-world clinical decision-making tasks demonstrate that the synergy between generalist LLMs and domain-specific specialist models significantly outperforms using either type of model alone, validating the irreplaceable value of specialist models in modality-specific analysis. HetMedAgent represents a shift from building medical LLMs or foundation models to multi-agent collaboration, achieving a balance between general reasoning capabilities and domain-specific precision.

Yanan Wang, Shuaicong Hu, Jian Liu +3

Department of Biomedical Engineering, College of Biomedical Engineering, Fudan University, Shanghai 200433, China · Department of Cardiology, Xinghua City People’s Hospital affiliated to Yangzhou University, Jiangsu 225700, China.

Multi-Agent LLM Systems Healthcare Clinical Decision Support Multi-Agent Collaboration Human-AI Collaboration Medical LLMs

May 28, 2026cs.AI

Think Fast, Talk Smart: Partitioning Deterministic and Neural Computation for Structured Health Text Generation

Large language models (LLMs) are increasingly being used to generate health text from structured records such as wearable time series, biomarkers, vitals, and care-management logs. For recurring health outputs, fluency is not enough: systems must remain faithful to source data, ground explanatory claims in available evidence, follow stated policies, emit machine-readable outputs, and run cheaply enough for repeated use. We ask which responsibilities in structured health generation should be deterministic computation rather than runtime LLM prompting. We introduce Think Fast, Talk Smart, a sleep-health insight pipeline in which deterministic code performs recurring analysis before one bounded LLM writer call. Across 280 user-nights and six models, achieves lower numeric error, lower instruction-compliance error, and lower end-to-end cost than structured zero-shot and few-shot one-call baselines. Layer replacement reveals contract-specific failures: LLM comparison raises numeric error, LLM ranking degrades policy selection, LLM attribution increases unsupported causal language, and an LLM-generated writer interface reintroduces errors even after upstream facts are deterministic. The results support a broader design rule: let code own recurring analysis, and let LLMs express verified facts within bounded interfaces.

Kai-Chen Cheng, Haejun Han, David Q. Sun

Healthcare Neuro-Symbolic AI Medical LLMs Text Generation

May 27, 2026cs.CL

Reverse Probing: Supervised Token-level Uncertainty Quantification for Large Language Models in Clinical Text

As large language models are increasingly deployed for clinical text, ensuring they can reliably signal their own uncertainty becomes critical. Most existing uncertainty quantification (UQ) methods are designed for open-domain generation and cannot localize uncertainty at the token or span level in long clinical text. We propose Reverse Probing, the first UQ framework specialized for clinical summarization, which estimates token-level uncertainty directly from pre-existing labeled summaries. Rather than sampling new outputs, Reverse Probing treats the text as a probe into the model's internal state, extracting uncertainty signals from four categories of internal activations. We evaluate on two expert-annotated clinical datasets and outperform eight adapted baselines on all metrics, achieving up to 4 times higher AUPRC while reducing inference time and computational costs. Feature analysis reveals that delta energy and neighborhood context are the most consistent predictors across all models. This study offers interpretable insights into how models internally respond to unsupported clinical content.

Bushi Xiao, Sarvesh Soni, Daisy Zhe Wang

University of Florida Gainesville, FL · U.S. National Library of Medicine Bethesda, MD

Text Summarization LLM Uncertainty Estimation Medical LLMs Language Model Probing

May 27, 2026cs.AI

SafeMed-R1: Clinician-Audited Safety and Ethics Alignment for Medical Large Language Models

Large language models(LLMs) increasingly match expert performance on licensing examinations, yet routine clinical use remains limited because governance requires auditable reasoning, safety and ethics alignment, and resilience to adversarial misuse. Here we present SafeMed-R1, trained with a traceable Clinical Trust Signals(CTS) pipeline that links each reasoning instance to clinician rubric scores and edit histories, and aligned through safety and ethics supervision and red team stress testing. SafeMed-R1 attains a macro-averaged accuracy of 79.6% across clinical benchmarks. Under adversarial safety testing, it shows the lowest aggregated risk and reduces unsafe outputs by about 3 to 5% relative to its baseline. In a paired expert study of 30 medication safety vignettes, SafeMed-R1 matches PGY1 and PGY2 residents on medical correctness and scores higher for medication safety, guideline consistency, and clinical usefulness. Collectively, these results suggest that clinician-audited supervision provenance, together with domain-tailored safety and ethics alignment, can strengthen governance-relevant evidence without relying on inference-time retrieval or citation grounding.

Chao Ding, Mouxiao Bian, Tianbin Li +12

Shanghai Artificial Intelligence Laboratory, Shanghai, China · Joint Laboratory of Biomedical Artificial Intelligence, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China · School of Computer Science and Technology, Tongji University, Shanghai, China +5

Healthcare LLM Auditing LLM Safety Alignment Adversarial Robustness of Language Models Clinical Language Model Evaluation Medical LLMs

May 27, 2026cs.AI

C-MIG: Multi-view Information Gain-based Retrieval-Augmented Generation for Clinical Diagnosis Reasoning

Retrieval-augmented generation combined with reinforcement learning has shown promise for grounding large language models in trustworthy medical evidence. However, existing methods rely on exact-match binary rewards, which in clinical diagnosis cause two issues: (i) semantically relevant but non-verbatim steps receive zero signal, discarding valuable learning signals; and (ii) uni-dimensional rewards cannot effectively supervise heterogeneous reasoning capabilities. To address these issues, we propose C-MIG, a Multi-view Information Gain-based retrieval-augmented generation framework for Clinical diagnosis. C-MIG estimates information gain under a frozen reference model from two complementary views, retrieved-document and document-refinement, to jointly guide what to retrieve and how to refine, alleviating the issues of valuable reward signal loss and credit assignment. We further design a multi-subquery retrieval augmentation strategy that improves knowledge recall coverage in clinical diagnostic scenarios. Comprehensive experiments on four medical benchmarks demonstrate that C-MIG achieves the best performance among all RAG-RL methods on both in-domain and out-of-domain sets, and outperforms state-of-the-art general-purpose LLMs for clinical diagnosis.

Yuwei Miao, Gen Li, Yunsheng Zeng +8

1Baidu Inc.

Retrieval-Augmented Generation Healthcare RL for Language Model Reasoning Clinical Reasoning Information Retrieval Medical LLMs

May 26, 2026cs.CY

When Medical Safety Alignment Fails: A Benchmark for Evaluating LLMs on High-Risk Medical Queries

Large language models (LLMs) are increasingly used for medical and health-related questions, yet their safety in high-risk medical scenarios remains poorly understood. We introduce \textsc{MedHarm}\footnote{Code and data will be released upon acceptance. Due to the sensitive nature of high-risk medical queries, data access will be available to qualified researchers upon request.}, a high-risk medical safety benchmark with 1,100 medically grounded queries across 10 safety-critical categories, including toxicology, pharmacology, covert poisoning, anesthesia, and fetal harm. Unlike broad medical QA benchmarks, \textsc{MedHarm} targets realistic clinical, educational, and technical prompts that require refusal, caution, or safe redirection rather than direct helpfulness. We evaluate 15 LLMs spanning general-purpose, medical-purpose, closed-source, and downstream SFT models, together with 4 representative guardrail models. Results reveal a substantial gap between apparent alignment and medical safety: aligned models can still produce unsafe or actionable responses, medical fine-tuning can amplify harmful specificity, and external guardrails reduce some failures while introducing brittle blocking and weak safe helpfulness. These findings show that medical safety cannot be inferred from general alignment or medical capability alone, highlighting the need for domain-specific stress testing before deploying LLMs in safety-critical medical applications.

Yige Li, Jun Sun, Wei Zhao +5

Singapore Management University · Deakin University · The University of Melbourne +2

LLM Safety Benchmarks Healthcare LLM Guardrails LLM Safety Alignment LLM Safety Evaluation Medical LLMs

May 26, 2026cs.AI

MedGuideX: Internalizing Decision Logic from Executable Guidelines into Large Language Models for Clinical Reasoning

Clinical practice guidelines (CPGs) encode evidence-based decision logic that clinicians apply by evaluating patient variables, conditional criteria, and recommendation rules. However, existing methods often use CPGs as free-text training data or retrieval sources, underutilizing their procedural decision structure. To better exploit this structure, we introduce a guideline-derived training pipeline that transforms CPG recommendations into executable clinical decision logic and uses it to generate factual and counterfactual question-answering data. Theses data teach models both guideline-supported decisions and how decisions change under different patient conditions. Post-training a medical LLM on the generated data yields MedGuideX. Across four clinical reasoning benchmarks, MedGuideX achieves a 10.28% relative improvement in average accuracy. Physician evaluation further shows that MedGuideX better recovers clinician authored reasoning steps and produces physician-preferred rationales in faithfulness, validity, completeness, and clarity. Overall, our results show that executable decision logic from CPGs can be transformed into scalable supervision for building reliable medical LLMs.

Yuhao Shen, Lang Cao, Simo Du +4

University of Illinois Urbana-Champaign · 2The Chinese University of Hong Kong, Shenzhen · 3Albert Einstein College of Medicine

Healthcare Clinical Decision Support Clinical Reasoning Medical LLMs

May 25, 2026cs.CL

The Daily Dose: Workflow-Integrated Large Language Model Automation for Clinical Summarization and Trial Identification in Radiation Oncology

Objective: To describe the design and early clinical evaluation of The Daily Dose (TDD), an LLM-driven, automated clinical summarization and clinical-trial identification system integrated into routine radiation oncology practice. Design: Mixed-methods evaluation using a cross-sectional, anonymous clinician survey administered after 1 month of system deployment. Exposure: Daily automated delivery of physician-specific email summaries generated using RadOnc-GPT, including patient schedules, concise EHR-derived clinical-status summaries, and automated identification of potentially relevant clinical trials for new or consult visits. Main Outcomes and Measures: Primary outcomes included self-reported usability, satisfaction, perceived usefulness, perceived impact on workflow, time savings, and intention for continued use. Internal consistency reliability was assessed using Cronbach's

α

. Results: Among 55 respondents, 52 (94.5%) worked in radiation oncology, and 38 (69.1%) were attending physicians. Most participants (83.6%) reported using TDD daily or several times per week. Mean (SD) scores were 3.89 (1.04) for usability and satisfaction, 3.43 (1.24) for perceived usefulness, and 3.80 (1.17) for impact and future use (5-point Likert scale). Overall satisfaction was positively associated with perceived time savings (

p < .001

). Participants reported variable time savings, with 27% estimating

\geq 10

minutes saved per day. The questionnaire demonstrated excellent internal consistency (overall Cronbach's

α

= 0.97).

Jason Holmes, Federico Mastroleo, Mariana Borras-Osorio +17

Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States · Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy · Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy +2

Healthcare Clinical Decision Support Text Summarization Workflow Automation Oncology Medical LLMs

May 25, 2026cs.AI

Uncertainty Reasoning with Large Language Models for Explainable Disease Diagnosis

Clinical decision-making requires reasoning over incomplete, imprecise, and linguistically expressed patient narratives. While large language models (LLMs) excel at extracting latent information from natural language, they lack the verifiability and interpretability essential for trustworthy medical AI. We propose a neuro-symbolic reasoning framework that aligns LLMs with formal logic to enable explainable and formally verifiable medical diagnosis. Patient descriptions and clinical guidelines are embedded into a neural knowledge base, where LLMs extract structured medical entities, temporal relations, and fuzzy symptom patterns, which are decoded into a symbolic knowledge base expressed in fuzzy logic and declarative rules. We perform two-stage reasoning: (1) inductive symbolic generalization to capture diagnostic patterns from encoded narratives, and (2) inference verification via a logic programming engine to derive and validate diagnoses consistent with clinical standards. Each symptom is treated as a fuzzy predicate with probabilistic weights, and inference paths are auditable, adjustable, and compatible with physician feedback. Unlike purely statistical methods, our system supports iterative refinement: misalignment between LLM-generated diagnoses and ground truth can be traced, explained, and corrected through formal rules. By combining logic-based transparency, LLM adaptability, and probabilistic robustness, the framework enables human-aligned healthcare inference with strong generalization and verifiable, step-by-step reasoning chains. We validate our framework on public benchmarks, demonstrating effective reconciliation of symbolic reasoning and LLMs with real-world clinical narratives. Results show performance comparable to state-of-the-art LLMs, while additionally providing interpretable reasoning paths and formally verifiable diagnostic conclusions.

Xiaoyang Fan, Yufan Cai, Zhe Hou +1

National University of Singapore · Griffith University

Clinical Decision Support Clinical Reasoning Neuro-Symbolic Reasoning Medical LLMs

May 25, 2026cs.AI

Towards end-to-end LLM-based censoring-aware survival analysis

Objective: Survival analysis is central to medical prediction, yet large language models (LLMs) are rarely used as end-to-end survival models because censoring prevents straightforward supervised fine-tuning. Here we present LLMSurvival, a framework that enables censoring-aware survival analysis with unmodified LLMs operating directly on tabular clinical data. Materials and Methods: LLMSurvival reformulates time-to-event prediction as pairwise ranking among comparable subjects, and derives test-time risk by aggregating comparisons against anchor individuals from the training cohort. Results: Across two clinical tasks (ICU mortality prediction in MIMIC-IV and fragility fracture prediction in a NewYork-Presbyterian/Weill Cornell Medicine cohort), LLMSurvival improves overall concordance over Cox proportional hazards modeling by 3.1% for ICU mortality and 0.5% for fracture risk, 2.1% on average for ICU mortality and 2.8% for fracture risk over three established deep learning survival models. Discussion: The results show that survival modeling with censoring can be made compatible with LLM fine-tuning through comparison-based reformulation. The framework demonstrates high portability and superior performance over expert curated scores like SAPS-II and FRAX scores across diverse clinical context. Furthermore, the framework supports local deployment, as compact, publicly available base models provide sufficient performance. Conclusion: The LLMSurvival framework serves as a proof of concept for an integrated, censoring-conscious approach to survival analysis via LLMs.

Yishu Wei, Hexin Dong, Yi Lin +3

Department of Population Health Science, Weill Cornell Medicine, New York, 10065, US · Department of Medicine, Weill Cornell Medicine, New York, 10065, US

Survival Analysis Mortality Prediction Medical LLMs

May 23, 2026cs.CL

HiMed: Incentivizing Hindi Reasoning in Medical LLMs

Medical large language models hold promise for reducing healthcare disparities, yet Hindi remains severely underrepresented. While medical LLMs excel in high-resource languages, their performance degrades sharply in Hindi, particularly on Indian systems of medicine. We argue that robust cross-lingual medical transfer requires Hindi reasoning. To this end, we introduce HiMed, a Hindi reasoning medical corpus and benchmark suite covering both Western and Indian medicine. We further propose HiMed-8B, a Hindi-form medical reasoning LLM, through the design of decaying scaffolding reward. Extensive experiments demonstrate improvement in Hindi medical reasoning performance and reduction in the English--Hindi accuracy gap. Ablation studies validate the contribution of each training stage and reward component. All data and code are available on GitHub: https://github.com/FreedomIntelligence/HiMed.

Dingfeng Jiang, Han Yan, Chenze Ma +12

1The Chinese University of Hong Kong, Shenzhen · 2Indian Institute of Technology (Banaras Hindu University) Varanasi · 3Tongji University +4

Multilingual Language Models Healthcare RL for Language Model Reasoning Medical Reasoning Medical LLMs

May 22, 2026cs.CL

When Symptoms Are Not Enough: Evidence-Weighting Patterns in Large Language Model Psychiatric Screening

As demand for mental health care outpaces clinician-delivered assessment, scalable screening tools are increasingly needed. Large language models (LLMs) may identify psychiatric risk from patient narratives, but their reliability across diagnoses, demographic subgroups, and evidence-use patterns remains uncertain. We introduce a SCID-anchored benchmark of 555 semi-structured experiential interviews paired with diagnostic reference labels for anxiety disorder, major depressive disorder, post-traumatic stress disorder, and any current mental health disorder. Using zero-shot task-specific prompting, we evaluated five state-of-the-art LLMs and examined whether false-negative errors reflected missed psychiatric evidence or differential weighting of symptom, functional-impairment, and protective-context cues. Performance varied across tasks and models, with accuracy ranging from 0.49 to 0.86 and Matthews correlation coefficients from 0.16 to 0.38. GPT-4.1 Mini and GPT-5 Mini showed the most consistent disorder-specific accuracy. Subgroup analyses found higher depression-classification accuracy among male than female participants, no consistent age-related pattern, and modest non-uniform variation across race strata. Evidence-integration analyses showed that false-negative anxiety and PTSD classifications often contained explicit symptom evidence but were accompanied by preserved functioning, coping ability, or social support. Functional-impairment evidence shifted model outputs toward positive classifications, whereas protective-context evidence shifted outputs away. These findings suggest that LLMs may support scalable psychiatric screening, but their tendency to discount symptom evidence in the presence of preserved functioning or protective context requires careful validation before clinical deployment.

Jianfeng Zhu, Megan Korhummel, Ruoming Jin +1

Departments of Computer Science1 and Psychological Science2 Kent State University Kent, OH USA

Medical Diagnosis Mental Health Demographic Bias in Language Models Clinical Language Model Evaluation Medical LLMs