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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May 1, 2026cs.CR

When RAG Chatbots Expose Their Backend: An Anonymized Case Study of Privacy and Security Risks in Patient-Facing Medical AI

Background: Patient-facing medical chatbots based on retrieval-augmented generation (RAG) are increasingly promoted to deliver accessible, grounded health information. AI-assisted development lowers the barrier to building them, but they still demand rigorous security, privacy, and governance controls. Objective: To report an anonymized, non-destructive security assessment of a publicly accessible patient-facing medical RAG chatbot and identify governance lessons for safe deployment of generative AI in health. Methods: We used a two-stage strategy. First, Claude Opus 4.6 supported exploratory prompt-based testing and structured vulnerability hypotheses. Second, candidate findings were manually verified using Chrome Developer Tools, inspecting browser-visible network traffic, payloads, API schemas, configuration objects, and stored interaction data. Results: The LLM-assisted phase identified a critical vulnerability: sensitive system and RAG configuration appeared exposed through client-server communication rather than restricted server-side. Manual verification confirmed that ordinary browser inspection allowed collection of the system prompt, model and embedding configuration, retrieval parameters, backend endpoints, API schema, document and chunk metadata, knowledge-base content, and the 1,000 most recent patient-chatbot conversations. The deployment also contradicted its privacy assurances: full conversation records, including health-related queries, were retrievable without authentication. Conclusions: Serious privacy and security failures in patient-facing RAG chatbots can be identified with standard browser tools, without specialist skills or authentication; independent review should be a prerequisite for deployment. Commercial LLMs accelerated this assessment, including under a false developer persona; assistance available to auditors is equally available to adversaries.

Alfredo Madrid-García, Miguel Rujas

Escuela Técnica Superior de Ingenieros de Telecomunicación Universidad Politécnica de Madrid Avenida Complutense, 30, Madrid, 28040, Spain

Healthcare LLM Auditing RAG Security Medical LLMs

May 1, 2026cs.CY

DIYHealth Suite: Dataset, Model, and Benchmark for Health Management at Home

Generative AI is reshaping healthcare, yet most existing advances rely on hospital-grade devices, which limits their accessibility and potential for health management outside clinical settings. With the proliferation of portable devices and telemedicine, healthcare is shifting toward home-based Diagnosis-It-Yourself (DIY) care. Despite this promise, several distinctive challenges remain: (i) home-collected data are heterogeneous, exacerbated by the absence of standardized large-scale datasets; (ii) models require adaptation to variable task demands and evolving individual conditions; (iii) the broad spectrum of home care tasks lacks a unified benchmark for systematic evaluation. In this paper, we present DIYHealth Suite, a comprehensive framework designed to address these challenges through a tailored dataset, model, and benchmark. We first curate DIYHealth-900K, a large-scale multimodal dataset capturing diverse real-world home care scenarios. Building on this, we propose DIYHealthGPT, an adaptive foundation model for home-based health management, powered by the novel Hybrid Hyper Low-Rank Adaptation technique. Finally, we establish DIYHealthBench, the first benchmark to evaluate foundation models on home care tasks. Extensive experiments demonstrate that DIYHealthGPT delivers state-of-the-art performance over both general-purpose and medical-specific baselines on 11 home care tasks in both open-QA and closed-QA settings, laying the groundwork for the next generation of personalized health management at home.

Changshuo Liu, Junran Wu, Zhongle Xie +9

School of Computing, National University of Singapore, Singapore

Healthcare Multimodal Large Language Models Medical LLMs Parameter-Efficient Fine-Tuning

May 1, 2026cs.LG

Healthcare AI GYM for Medical Agents

Clinical reasoning demands multi-step interactions -- gathering patient history, ordering tests, interpreting results, and making safe treatment decisions -- yet a unified training environment provides the breadth of clinical domains and specialized tools to train generalizable medical AI agents through reinforcement learning remains elusive. We present a comprehensive empirical study of multi-turn agentic RL for medical AI, built on \gym{}, a gymnasium-compatible environment spanning 10 clinical domains with 3.6K+ tasks, 135 domain-specific tools, and a knowledge base of 828K medical passages. Our analysis reveals that agentic multi-turn structure degrades into verbose single-turn monologues, characterized by monotonic length explosion and a simultaneous erosion of tool-use frequency. We characterize how this collapse, alongside distillation instability, stems from the misalignment of sparse terminal rewards with sequential clinical trajectories. We find that vanilla GRPO achieves strong final accuracy on some benchmarks but suffers from training instability, evidenced by significant oscillations in response length and prolonged convergence periods. To improve training efficiency and stability, we propose Turn-level Truncated On-Policy Distillation (TT-OPD), a self-distillation framework where a gradient-free EMA teacher leverages outcome-privileged information to provide dense, outcome-aware KL regularization at every conversation turn. TT-OPD achieves the best performance on 10 of 18 benchmarks with an average +3.9~pp improvement over the non-RL baseline with faster early convergence, controlled response length, and sustained multi-turn tool use.

Minbyul Jeong

Upstage AI

Healthcare On-Policy Distillation Medical LLMs RL for LLM Agents Agent Benchmarks RL for Tool Use

May 1, 2026cs.CL

RadLite: Multi-Task LoRA Fine-Tuning of Small Language Models for CPU-Deployable Radiology AI

Large language models (LLMs) show promise in radiology but their deployment is limited by computational requirements that preclude use in resource-constrained clinical environments. We investigate whether small language models (SLMs) of 3-4 billion parameters can achieve strong multi-task radiology performance through LoRA fine-tuning, enabling deployment on consumer-grade CPUs. We train Qwen2.5-3B-Instruct and Qwen3-4B on 162K samples spanning 9 radiology tasks - RADS classification across 10 systems, impression generation, temporal comparison, radiology NLI, NER, abnormality detection, N/M staging, and radiology Q&A - compiled from 12 public datasets. Both models are evaluated on up to 500 held-out test samples per task with standardized metrics. Our key findings are: (1) LoRA fine-tuning dramatically improves performance over zero-shot baselines (RADS accuracy +53%, NLI +60%, N-staging +89%); (2) the two models exhibit complementary strengths - Qwen2.5 excels at structured generation tasks while Qwen3 dominates extractive tasks; (3) a task-outed oracle ensemble combining both models achieves the best performance across all tasks; (4) few-shot prompting with fine-tuned models hurts performance, demonstrating that LoRA adaptation is more effective than in-context learning for specialized domains; and (5) models can be quantized to GGUF format (~1.8-2.4GB) for CPU deployment at 4-8 tokens/second on consumer hardware. Our work demonstrates that small, efficiently fine-tuned models - which we collectively call RadLite - can serve as practical multi-task radiology AI assistants deployable entirely on consumer hardware without GPU requirements. Code and models are available at https://github.com/RadioX-Labs/RadLite

Pankaj Gupta, Kartik Bose

Postgraduate Institute of Medical Education and Research, Chandigarh, India ∗Corresponding author: Additional Professor, Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India · Postgraduate Institute of Medical Education and Research, Chandigarh, India

LLM Fine-Tuning Small Language Models Clinical NLP Medical LLMs

Apr 30, 2026cs.AI

Modeling Clinical Concern Trajectories in Language Model Agents

Large language model (LLM) agents deployed in clinical settings often exhibit abrupt, threshold-driven behavior, offering little visibility into accumulating risk prior to escalation. In real-world care, however, clinicians act on gradually rising concern rather than instantaneous triggers. We study whether explicit state dynamics can expose such pre-escalation signals without delegating clinical authority to the agent. We introduce a lightweight agent architecture in which a memoryless clinical risk encoder is integrated over time using first- and second-order dynamics to produce a continuous escalation pressure signal. Across synthetic ward scenarios, stateless agents exhibit sharp escalation cliffs, while second-order dynamics produce smooth, anticipatory concern trajectories despite similar escalation timing. These trajectories surface sustained unease prior to escalation, enabling human-in-the-loop monitoring and more informed intervention. Our results suggest that explicit state dynamics can make LLM agents more clinically legible by revealing how long concern has been rising, not just when thresholds are crossed.

Sukesh Subaharan, Venkatesan VS, Murugadasan P +3

Coimbatore Medical College · Coimbatore, TN · India

LLM Interpretability AI Agent Monitoring Medical LLMs LLM Agent Reliability

Apr 30, 2026cs.CL

HealthBench Professional: Evaluating Large Language Models on Real Clinician Chats

Millions of clinicians use ChatGPT to support clinical care, but evaluations of the most common use cases in model-clinician conversations are limited. We introduce HealthBench Professional, an open benchmark for evaluating large language models on real tasks that clinicians bring to ChatGPT in the course of their work. The benchmark is organized around three common use cases central to clinical practice: care consult, writing and documentation, and medical research. Each example includes a physician-authored conversation with ChatGPT for Clinicians and is scored via rubrics written and iteratively adjudicated by three or more physicians across three phases. HealthBench Professional examples were carefully selected for quality, representativeness, and difficulty for OpenAI's current frontier models, to enable continued measurement of progress. Difficult examples for recent OpenAI models were enriched by roughly 3.5 times relative to the candidate pool of 15,079 examples. Additionally, about one-third of examples involve physicians conducting deliberate adversarial testing of models. As a strong baseline, we also collected human physician responses for all tasks (unbounded time, specialist-matched, web access). The best scoring system, GPT-5.4 in ChatGPT for Clinicians, outperforms base GPT-5.4, all other models, and human physicians. We hope HealthBench Professional provides the healthcare AI community a measure to track frontier model progress in real-world clinical tasks and build systems that clinicians can trust to improve care.

Rebecca Soskin Hicks, Mikhail Trofimov, Dominick Lim +13

OpenAI

Healthcare Clinical Decision Support Clinical Language Model Evaluation Language Model Robustness Medical LLMs

Apr 29, 2026cs.CL

Domain-Adapted Small Language Models for Reliable Clinical Triage

Accurate and consistent Emergency Severity Index (ESI) assignment remains a persistent challenge in emergency departments, where highly variable free-text triage documentation contributes to mistriage and workflow inefficiencies. This study evaluates whether open-source small language models (SLMs) can serve as reliable, privacy-preserving decision-support tools for clinical triage. We systematically compared multiple SLMs across diverse prompting pipelines and found that clinical vignettes, concise summaries of triage narratives, yielded the most accurate predictions. The SLM, Qwen2.5-7B, demonstrated the strongest balance of accuracy, stability, and computational efficiency. Through large-scale domain adaptation using expert-curated and silver-standard pediatric triage data, fine-tuned Qwen2.5-7B models substantially reduced discordance and clinically significant errors, outperforming all baseline SLMs and advanced proprietary large language models (LLMs, e.g., GPT-4o). These findings highlight the feasibility of institution-specific SLMs for reliable, privacy-preserving ESI decision support and underscore the importance of targeted fine-tuning over more complex inference strategies.

Manar Aljohani, Brandon Ho, Kenneth McKinley +2

Department of Computer Science, Virginia Tech, Blacksburg, VA, US · Children’s National Hospital, Washington DC, USA

Clinical Triage LLM Fine-Tuning Small Language Models Clinical Prediction Clinical Language Model Evaluation Medical LLMs

Apr 29, 2026cs.LG

Fidelity, Diversity, and Privacy: A Multi-Dimensional LLM Evaluation for Clinical Data Augmentation

The scarcity of high-quality annotated medical data, particularly in mental health, poses a significant bottleneck for training robust machine learning models. Privacy regulations restrict data sharing, making synthetic data generation a promising alternative. The use of Large Language Models (LLMs) in a data augmentation pipeline could be leveraged as an alternative in this field. In the proposed methodology, DeepSeek-R1, OpenBioLLM-Llama3 and Qwen 3.5 are used to generate synthetic mental health evaluation reports conditioned on specific International Classification of Diseases, Tenth Revision (ICD-10) codes. Because naive text generation can lead to mode collapse or privacy breaches (memorization), a comprehensive evaluation framework is introduced. The generated diagnostic texts are assessed across three dimensions: semantic fidelity, lexical diversity, and privacy/plagiarism. The results demonstrate that all models can generate clinically coherent, diverse, and privacy-safe synthetic reports, significantly expanding the available training data for clinical natural language processing tasks without compromising patient confidentiality.

Guillermo Iglesias, Gema Bello-Orgaz, María Navas-Loro +3

Departamento de Sistemas Informáticos, Escuela Técnica Superior de Ingeniería de Sistemas Informáticos, Universidad Politécnica de Madrid, Spain · Department of Psychiatry, University Hospital Rey Juan Carlos, Mostoles, Spain · Department of Psychiatry, University Hospital Jimenez Diaz Foundation, Madrid, Spain +5

Synthetic Data Augmentation Synthetic Data Generation Privacy Leakage in Language Models Medical LLMs Synthetic Data Evaluation

Apr 28, 2026cs.AI

MEMOR-E: In-Context and Fine-Tuned LLM Personalization for Alzheimer's Assistive Robotics

Alzheimer's disease is a neurodegenerative disorder marked by progressive declines in memory and language that reduce independence in daily life, motivating socially assistive robotic support. This paper presents MEMOR-E, a mobile quadruped robot with an interactive tablet interface that assists patients and caregivers through medication reminders, routine guidance, memory oriented interactions, and companionship. We evaluated the feasibility of fine tuning large language models (LLMs) to emulate stage consistent cognitive behavior and interpret responses across standard neuropsychological language tasks, using audio transcriptions from 235 Alzheimer's patients and synthetically generated healthy controls. We also report findings on using in context learning (ICL) in LLMs, where a second LLM produced domain and severity level cognitive error summaries. Our results show that MEMOR-E can generate stage aware, non diagnostic cognitive summaries that support personalized assistive interactions, while explainable AI mechanisms translate model outputs into transparent, human readable evidence to enable caregiver oversight and trustworthy human robot interaction.

Maissa Abir Smaili, Eren Sadikoglu, Ransalu Senanayake

Istanbul Medipol University Istanbul, Türkiye · Arizona State University Tempe, USA

Alzheimer's Disease LLM Personalization Assistive Robotics Medical LLMs

Apr 28, 2026cs.CL

Learning from Medical Entity Trees: An Entity-Centric Medical Data Engineering Framework for MLLMs

Multimodal Large Language Models (MLLMs) have shown transformative potential in medical applications, yet their performance is hindered by conventional data curation strategies that rely on coarse-grained partitioning by modality or department. Such fragmented approaches fail to capture the hierarchical and interconnected nature of clinical medical knowledge, limiting the models' ability to perform fine-grained recognition and complex reasoning. In this paper, we propose a novel Entity-Centric Medical Data Engineering framework. We automatically extract entities from authoritative medical literature to construct a Medical Entity Tree (MET), a hierarchical structure that systematically encodes diseases, anatomical structures, modalities, and symptoms into a unified knowledge repository. Building upon the MET, we propose an advanced data engine that includes: (1) node-guided retrieval to anchor raw data to specific medical concepts, (2) a two-stage hybrid filtering and alignment pipeline to ensure precise visual-semantic correspondence, and (3) knowledge-aware data synthesis to generate enriched captions and targeted reasoning VQA pairs, leveraging structural constraints. Extensive evaluations across six medical benchmarks demonstrate that our approach significantly enhances the medical capabilities of general-purpose MLLMs, improving their ability to handle complex clinical queries and achieve state-of-the-art performance in diverse medical contexts.

Jianghang Lin, Haihua Yang, Deli Yu +6

Key Laboratory of Multimedia Trusted Perception and Efficient Computing, Ministry of Education of China, Xiamen University, China · ByteDance · Northeastern University

Training Data Curation Multimodal QA Medical VLMs Knowledge Graphs Medical LLMs

Apr 27, 2026cs.CL

Learning Evidence of Depression Symptoms via Prompt Induction

Depression places substantial pressure on mental health services, and many people describe their experiences outside clinical settings in high-volume user-generated text (e.g., online forums and social media). Automatically identifying clinical symptom evidence in such text can therefore complement limited clinical capacity and scale to large populations. We address this need through sentence-level classification of 21 depression symptoms from the BDI-II questionnaire, using BDI-Sen, a dataset annotated for symptom relevance. This task is fine-grained and highly imbalanced, and we find that common LLM approaches (zero-shot, in-context learning, and fine-tuning) struggle to apply consistent relevance criteria for most symptoms. We propose Symptom Induction (SI), a novel approach which compresses labeled examples into short, interpretable guidelines that specify what counts as evidence for each symptom and uses these guidelines to condition classification. Across four LLM families and eight models, SI achieves the best overall weighted F1 on BDI-Sen, with especially large gains for infrequent symptoms. Cross-domain evaluation on an external dataset further shows that induced guidelines generalize across other diseases shared symptomatology (bipolar and eating disorders).

Eliseo Bao, Anxo Perez, David Otero +1

IRLab, CITIC, Universidade da Coruña A Coruña, Spain

Depression Detection Mental Health Clinical NLP Medical LLMs

Apr 27, 2026cs.CL

MultiDx: A Multi-Source Knowledge Integration Framework towards Diagnostic Reasoning

Diagnostic prediction and clinical reasoning are critical tasks in healthcare applications. While Large Language Models (LLMs) have shown strong capabilities in commonsense reasoning, they still struggle with diagnostic reasoning due to limited domain knowledge. Existing approaches often rely on internal model knowledge or static knowledge bases, resulting in knowledge insufficiency and limited adaptability, which hinder their capacity to perform diagnostic reasoning. Moreover, these methods focus solely on the accuracy of final predictions, overlooking alignment with standard clinical reasoning trajectories. To this end, we propose MultiDx, a two-stage diagnostic reasoning framework that performs differential diagnosis by analyzing evidence collected from multiple knowledge sources. Specifically, it first generates suspected diagnoses and reasoning paths by leveraging knowledge from web search, SOAP-formatted case, and clinical case database. Then it integrates multi-perspective evidence through matching, voting, and differential diagnosis to generate the final prediction.~Extensive experiments on two public benchmarks demonstrate the effectiveness of our approach.

Yimin Deng, Zhenxi Lin, Yejing Wang +9

Xi’an Jiaotong University · City University of Hong Kong · Tencent Jarvis Lab +1

Knowledge Augmentation for Language Models Medical Diagnosis Clinical Reasoning Clinical Prediction Differential Diagnosis Medical LLMs

Apr 25, 2026cs.CL

AI Safety Training Can be Clinically Harmful

Large language models are being deployed as mental health support agents at scale, yet only 16% of LLM-based chatbot interventions have undergone rigorous clinical efficacy testing, and simulations reveal psychological deterioration in over one-third of cases. We evaluate four generative models on 250 Prolonged Exposure (PE) therapy scenarios and 146 CBT cognitive restructuring exercises (plus 29 severity-escalated variants), scored by a three-judge LLM panel. All models scored near-perfectly on surface acknowledgment (~0.91-1.00) while therapeutic appropriateness collapsed to 0.22-0.33 at the highest severity for three of four models, with protocol fidelity reaching zero for two. Under CBT severity escalation, one model's task completeness dropped from 92% to 71% while the frontier model's safety-interference score fell from 0.99 to 0.61. We identify a systematic, modality-spanning failure: RLHF safety alignment disrupts the therapeutic mechanism of action by grounding patients during imaginal exposure, offering false reassurance, inserting crisis resources into controlled exercises, and refusing to challenge distorted cognitions mentioning self-harm in PE; and through task abandonment or safety-preamble insertion during CBT cognitive restructuring. These findings motivate a five-axis evaluation framework (protocol fidelity, hallucination risk, behavioral consistency, crisis safety, demographic robustness), mapped onto FDA SaMD and EU AI Act requirements. We argue that no AI mental health system should proceed to deployment without passing multi-axis evaluation across all five dimensions.

Suhas BN, Andrew M. Sherrill, Rosa I. Arriaga +2

College of Information Sciences and Technology, Penn State University, USA · Department of Psychiatry and Behavioral Sciences, Emory University, USA · School of Interactive Computing, Georgia Tech, USA +1

Mental Health Counseling LLM Alignment Healthcare Mental Health LLM Safety Evaluation Clinical Language Model Evaluation+2

Apr 25, 2026cs.CL

VeriLLMed: Interactive Visual Debugging of Medical Large Language Models with Knowledge Graphs

Large language models (LLMs) show promise in medical diagnosis, but real-world deployment remains challenging due to high-stakes clinical decisions and imperfect reasoning reliability. As a result, careful inspection of model behavior is essential for assessing whether diagnostic reasoning is reliable and clinically grounded. However, debugging medical LLMs remains difficult. First, developers often lack sufficient medical domain expertise to interpret model errors in clinically meaningful terms. Second, models can fail across a large and diverse set of instances involving different input types, tasks, and reasoning steps, making it challenging for developers to prioritize which errors deserve focused inspection. Third, developers struggle to identify recurring error patterns across cases, as existing debugging practices are largely instance-centric and rely on manual inspection of isolated failures. To address these challenges, we present VeriLLMed, a visual analytics system that integrates external biomedical knowledge to audit and debug medical LLM diagnostic reasoning. VeriLLMed transforms model outputs into comparable reasoning paths, constructs knowledge graph-grounded reference paths, and identifies three recurring classes of diagnosis errors: relation errors, branch errors, and missing errors. Case studies and expert evaluation demonstrate that VeriLLMed helps developers identify clinically implausible reasoning and generate actionable insights that can inform the improvement of medical LLMs.

Yurui Xiang, Xingyi Mao, Rui Sheng +7

Healthcare LLM Auditing Visual Analytics Medical LLMs LLM Reasoning

Apr 25, 2026cs.CL

Au-M-ol: A Unified Model for Medical Audio and Language Understanding

In this work, we present Au-M-ol, a novel multimodal architecture that extends Large Language Models (LLMs) with audio processing. It is designed to improve performance on clinically relevant tasks such as Automatic Speech Recognition (ASR). Au-M-ol has three main components: (1) an audio encoder that extracts rich acoustic features from medical speech, (2) an adaptation layer that maps audio features into the LLM input space, and (3) a pretrained LLM that performs transcription and clinical language understanding. This design allows the model to interpret spoken medical content directly, improving both accuracy and robustness. In experiments, Au-M-ol reduces Word Error Rate (WER) by 56% compared to state-of-the-art baselines on medical transcription tasks. The model also performs well in challenging conditions, including noisy environments, domain-specific terminology, and speaker variability. These results suggest that Au-M-ol is a strong candidate for real-world clinical applications, where reliable and context-aware audio understanding is essential.

Meizhu Liu, Nistha Mitra, Paul Li +3

Oracle AI Science · Neuramill

Speech Processing Audio Understanding Audio-Language Models Automatic Speech Recognition Medical LLMs

Apr 24, 2026cs.CL

DeepImagine: Learning Biomedical Reasoning via Successive Counterfactual Imagining

Predicting the outcomes of prospective clinical trials remains a major challenge for large language models. Prior work has shown that both traditional correlational predictors, such as random forests and logistic regression, and strong commercial LLMs achieve limited performance on this task. In this paper, we propose DeepImagine, a framework for teaching LLMs biomedical reasoning through successive counterfactual imagining. The central idea is to approximate hidden causal mechanisms of clinical trials by training models to infer how observed trial results would change under controlled perturbations of experimental conditions, such as dosage, outcome measures, study arms, geography, and other trial attributes. To support this objective, we construct both natural and approximate counterfactual pairs from real clinical trials with reported outcomes. For settings where strict counterfactual supervision is available, such as paired outcome measures or dose-ranging study arms within the same trial, we train models with supervised fine-tuning. For broader settings where only approximate counterfactual pairs can be retrieved, we optimize models with reinforcement learning using verifiable rewards based on downstream benchmark correctness. We further augment training with synthetic reasoning traces that provide causally plausible explanations for local counterfactual transitions. Using this pipeline, we train language models under 10B parameters, including Qwen3.5-9B, and evaluate them on clinical trial outcome prediction. We aim to show that DeepImagine consistently improves over untuned language models and traditional correlational baselines. Finally, we aim to show that the learned reasoning trajectories provide interpretable signals about how models represent trial-level mechanisms, suggesting a practical path toward more mechanistic and scientifically useful biomedical language models.

Youze Zheng, Jianyou Wang, Yuhan Chen +8

Laboratory for Emerging Intelligence, University of California, San Diego · University of Chicago · Elsevier +1

LLM Fine-Tuning Counterfactual Reasoning in Language Models Clinical Outcome Prediction Causal Reasoning in Language Models Counterfactual Reasoning Medical LLMs+1

Apr 23, 2026cs.CL

Lightweight Retrieval-Augmented Generation and Large Language Model-Based Modeling for Scalable Patient-Trial Matching

Patient-trial matching requires reasoning over long, heterogeneous electronic health records (EHRs) and complex eligibility criteria, posing significant challenges for scalability, generalization, and computational efficiency. Existing approaches either rely on full-document processing with large language models (LLMs), which is computationally expensive, or use traditional machine learning methods that struggle to capture unstructured clinical narratives. In this work, we propose a lightweight framework that combines retrieval-augmented generation and large language model-based modeling for scalable patient-trial matching. The framework explicitly separates two key components: retrieval-augmented generation is used to identify clinically relevant segments from long EHRs, reducing input complexity, while large language models are used to encode these selected segments into informative representations. These representations are further refined through dimensionality reduction and modeled using lightweight predictors, enabling efficient and scalable downstream classification. We evaluate the proposed approach on multiple public benchmarks (n2c2, SIGIR, TREC 2021/2022) and a real-world multimodal dataset from Mayo Clinic (MCPMD). Results show that retrieval-based information selection significantly reduces computational burden while preserving clinically meaningful signals. We further demonstrate that frozen LLMs provide strong representations for structured clinical data, whereas fine-tuning is essential for modeling unstructured clinical narratives. Importantly, the proposed lightweight pipeline achieves performance comparable to end-to-end LLM approaches with substantially lower computational cost.

Xiaodi Li, Yang Xiao, Munhwan Lee +7

Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, USA · Computer Science Department, University of Tulsa, Tulsa, OK, USA · Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, MN, USA +4

Retrieval-Augmented Generation Clinical NLP Medical LLMs

Apr 23, 2026cs.CY

Evaluating Patient Safety Risks in Generative AI: Development and Validation of a FMECA Framework for Generated Clinical Content

Objectives: Large language models (LLMs) are increasingly used for clinical text summarization, yet structured methods to assess associated patient safety risks remain limited. Failure Mode, Effects, and Criticality Analysis (FMECA) provides a proactive framework for systematic risk identification but has not been adapted to LLM-generated clinical content. This study aimed to develop and validate a novel FMECA framework for the prospective assessment of patient safety risks in LLM-generated clinical summaries. Materials and Methods: An interdisciplinary expert panel (n = 8) developed a taxonomy of failure modes through literature review and brainstorming. Standard FMECA dimensions (occurrence, severity, detectability) were adapted into 5-point ordinal scales. The framework was applied to 36 discharge summaries from four patients, generated by an open LLM (GPT-OSS 120B) using real-world clinical data from the Geneva University Hospitals. Reviewers independently annotated the summaries across two rounds. Inter-rater reliability was assessed at failure mode, severity and detectability score levels. Usability and content validity were evaluated using an adapted System Usability Scale and structured feedback. Results: The final framework comprised 14 failure modes organized into categories. Inter-rater agreement improved between rounds, reaching moderate-to-substantial agreement for failure mode identification and good agreement for severity and detectability scoring. Usability was rated as good (mean SUS: 79.2/100), with high evaluator confidence. Discussion and Conclusion: This study presents the first FMECA-based framework for systematic patient safety risk assessment of LLM-generated clinical summaries. The framework provides a structured and reproducible method for identifying clinically relevant risks caused by these summaries.

Lydie Bednarczyk, Jamil Zaghir, Julien Ehrsam +11

Division of Medical Information Sciences, Diagnostic Department, Geneva University Hospitals (HUG), Geneva, Switzerland. · Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland. · Pharmacy, Geneva University Hospital (HUG), and Institute of Pharmaceutical Sciences of Western Switzerland, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland. +3

Clinical Language Model Evaluation Medical LLMs

Apr 23, 2026cs.AI

When Correct Beliefs Collapse: Epistemic Resilience of LLMs under Clinical Pressure

Despite strong medical benchmark accuracy, LLMs can exhibit severe multi-turn sycophancy in clinical dialogue, abandoning initial correct diagnosis under escalating pressure. We propose \textbf{\textsc{Med-Stress}}, a targeted stress test framework that evaluates belief stability under escalating pressure. Across nine frontier large language models (LLMs), we find a clear dissociation between medical knowledge and robustness: high initial diagnostic capability does not imply high belief stability, yielding large knowledge-robustness gaps for several LLMs. To mitigate this failure mode, we propose a lightweight inference-time defense, \textbf{\texttt{RBED}} (\textbf{R}ole-\textbf{B}ased \textbf{E}pistemic \textbf{D}efense), and \textbf{\texttt{R-FT}} (\textbf{R}esilience-oriented \textbf{F}ine-\textbf{T}uning), a training-time approach that internalizes evidence-based resistance to pressure. Experiments show that \textbf{\texttt{R-FT}} nearly eliminates belief change and substantially improves robustness.

Boyu Xiao, Xiuqi Tian, Xuwen Song +4

Research Center for Social Computing and Interactive Robotics, Harbin Institute of Technology, China

LLM Sycophancy Healthcare LLM Reliability Clinical Language Model Evaluation Language Model Robustness Medical LLMs

Apr 22, 2026cs.CL

Serialisation Strategy Matters: How FHIR Data Format Affects LLM Medication Reconciliation

Medication reconciliation at clinical handoffs is a high-stakes, error-prone process. Large language models are increasingly proposed to assist with this task using FHIR-structured patient records, but a fundamental and largely unstudied variable is how the FHIR data is serialised before being passed to the model. We present the first systematic comparison of four FHIR serialisation strategies (Raw JSON, Markdown Table, Clinical Narrative, and Chronological Timeline) across five open-weight models (Phi-3.5-mini, Mistral-7B, BioMistral-7B, Llama-3.1-8B, Llama-3.3-70B) on a controlled benchmark of 200 synthetic patients, totalling 4,000 inference runs. We find that serialisation strategy has a large, statistically significant effect on performance for models up to 8B parameters: Clinical Narrative outperforms Raw JSON by up to 19 F1 points for Mistral-7B (r = 0.617, p < 10^{-10}). This advantage reverses at 70B, where Raw JSON achieves the best mean F1 of 0.9956. In all 20 model and strategy combinations, mean precision exceeds mean recall: omission is the dominant failure mode, with models more often missing an active medication than fabricating one, which changes how clinical safety auditing priorities should be set. Smaller models plateau at roughly 7-10 concurrent active medications, leaving polypharmacy patients, the patients most at risk from reconciliation errors, systematically underserved. BioMistral-7B, a domain-pretrained model without instruction tuning, produces zero usable output in all conditions, showing that domain pretraining alone is not sufficient for structured extraction. These results offer practical, evidence-based format recommendations for clinical LLM deployment: Clinical Narrative for models up to 8B, Raw JSON for 70B and above. The complete pipeline is reproducible on open-source tools running on an AWS g6e.xlarge instance (NVIDIA L40S, 48 GB VRAM).

Sanjoy Pator

Independent Researcher

Healthcare LLM Information Extraction Clinical Language Model Evaluation Medical LLMs

Apr 22, 2026cs.CL

Can "AI" Be a Doctor? A Study of Empathy, Readability, and Alignment in Clinical LLMs

Large Language Models (LLMs) are increasingly deployed in healthcare, yet their communicative alignment with clinical standards remains insufficiently quantified. We conduct a multidimensional evaluation of general-purpose and domain-specialized LLMs across structured medical explanations and real-world physician-patient interactions, analyzing semantic fidelity, readability, and affective resonance. Baseline models amplify affective polarity relative to physicians (Very Negative: 43.14-45.10% vs. 37.25%) and, in larger architectures such as GPT-5 and Claude, produce substantially higher linguistic complexity (FKGL up to 16.91-17.60 vs. 11.47-12.50 in physician-authored responses). Empathy-oriented prompting reduces extreme negativity and lowers grade-level complexity (up to -6.87 FKGL points for GPT-5) but does not significantly increase semantic fidelity. Collaborative rewriting yields the strongest overall alignment. Rephrase configurations achieve the highest semantic similarity to physician answers (up to mean = 0.93) while consistently improving readability and reducing affective extremity. Dual stakeholder evaluation shows that no model surpasses physicians on epistemic criteria, whereas patients consistently prefer rewritten variants for clarity and emotional tone. These findings suggest that LLMs function most effectively as collaborative communication enhancers rather than replacements for clinical expertise.

Mariano Barone, Francesco Di Serio, Roberto Moio +4

Department of Electrical Engineering and Information Technology, University of Naples Federico II, Via Claudio 21, Naples, 80125, Italy. · Department of Translational Medical Sciences, University of Campania ”Luigi Vanvitelli”, Via Leonardo Bianchi, Naples, 80131, Italy. · Department of Computer Science, McCormick School of Engineering and Applied Science, Northwestern University, 2309 Sheridan Rd, Evanston, 60201, IL, United States.

Healthcare LLM Prompting Clinical Language Model Evaluation Medical LLMs

Apr 22, 2026cs.CL

LLM StructCore: Schema-Guided Reasoning Condensation and Deterministic Compilation

Automatically filling Case Report Forms (CRFs) from clinical notes is challenging due to noisy language, strict output contracts, and the high cost of false positives. We describe our CL4Health 2026 submission for Dyspnea CRF filling (134 items) using a contract-driven two-stage design grounded in Schema-Guided Reasoning (SGR). The key task property is extreme sparsity: the majority of fields are unknown, and official scoring penalizes both empty values and unsupported predictions. We shift from a single-step "LLM predicts 134 fields" approach to a decomposition where (i) Stage 1 produces a stable SGR-style JSON summary with exactly 9 domain keys, and (ii) Stage 2 is a fully deterministic, 0-LLM compiler that parses the Stage 1 summary, canonicalizes item names, normalizes predictions to the official controlled vocabulary, applies evidence-gated false-positive filters, and expands the output into the required 134-item format. On the dev80 split, the best teacher configuration achieves macro-F1 0.6543 (EN) and 0.6905 (IT); on the hidden test200, the submitted English variant scores 0.63 on Codabench. The pipeline is language-agnostic: Italian results match or exceed English with no language-specific engineering.

Serhii Zabolotnii

Cherkasy State Business College2026 Cherkasy, Ukraine

Healthcare Clinical Information Extraction Medical LLMs LLM Reasoning

Apr 22, 2026cs.CL

Surrogate modeling for interpreting black-box LLMs in medical predictions

Large language models (LLMs), trained on vast datasets, encode extensive real-world knowledge within their parameters, yet their black-box nature obscures the mechanisms and extent of this encoding. Surrogate modeling, which uses simplified models to approximate complex systems, can offer a path toward better interpretability of black-box models. We propose a surrogate modeling framework that quantitatively explains LLM-encoded knowledge. For a specific hypothesis derived from domain knowledge, this framework approximates the latent LLM knowledge space using observable elements (input-output pairs) through extensive prompting across a comprehensive range of simulated scenarios. Through proof-of-concept experiments in medical predictions, we demonstrate our framework's effectiveness in revealing the extent to which LLMs "perceive" each input variable in relation to the output. Particularly, given concerns that LLMs may perpetuate inaccuracies and societal biases embedded in their training data, our experiments using this framework quantitatively revealed both associations that contradict established medical knowledge and the persistence of scientifically refuted racial assumptions within LLM-encoded knowledge. By disclosing these issues, our framework can act as a red-flag indicator to support the safe and reliable application of these models.

Changho Han, Songsoo Kim, Dong Won Kim +4

Medical Big Data Research Center, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea · Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea. · Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA 02139 +5

Surrogate Modeling LLM Interpretability Demographic Bias in Language Models Medical LLMs

Apr 21, 2026cs.LG

MoBayes: A Modular Bayesian Framework for Separating Reasoning from Language in Conversational Clinical Decision Support

Large language models (LLMs) are increasingly used for conversational clinical decision support, yet they conflate next token prediction with probabilistic decision making. We argue that this conflation reflects an architectural limitation: such systems lack explicit posterior tracking, controllable abstention thresholds, and auditable reasoning chains. We introduce MoBayes, a Modular Bayesian dialogue framework that separates reasoning from language. The LLM acts only as a language interface, parsing patient conversation into structured observations, while a Bayesian module performs probabilistic inference over these observations to update posteriors, select follow-up questions via expected-information-gain and determine when to stop or defer through calibrated decision thresholds. This design enables explicit posterior tracking, controllable selective decision-making, and replaceable population-specific statistical backends without retraining the language model. Across empirical and LLM-generated knowledge bases, MoBayes outperforms standalone frontier LLM doctors, including matched model-family comparisons where inexpensive sensor models paired with MoBayes exceed larger autonomous models at lower cost. The advantage persists under adversarial patient communication styles and across varying diagnostic scenarios. These results suggest that reliable conversational clinical decision support systems should separate probabilistic reasoning from language generation rather than scaling model size alone. Code is available at https://anonymous.4open.science/r/MoBayes/

Yusuf Kesmen, Fay Elhassan, Jiayi Ma +7

LiGHT, EPFL · University of Bern · CLAN, Aarhus University

Selective Prediction Clinical Decision Support Bayesian Inference Clinical Reasoning Medical LLMs

Apr 21, 2026cs.CL

Cross-Model Consistency of AI-Generated Exercise Prescriptions: A Repeated Generation Study Across Three Large Language Models

This study compared repeated generation consistency of exercise prescription outputs across three large language models (LLMs), specifically GPT-4.1, Claude Sonnet 4.6, and Gemini 2.5 Flash, under temperature=0 conditions. Each model generated prescriptions for six clinical scenarios 20 times, yielding 360 total outputs analyzed across four dimensions: semantic similarity, output reproducibility, FITT classification, and safety expression. Mean semantic similarity was highest for GPT-4.1 (0.955), followed by Gemini 2.5 Flash (0.950) and Claude Sonnet 4.6 (0.903), with significant inter-model differences confirmed (H = 458.41, p < .001). Critically, these scores reflected fundamentally different generative behaviors: GPT-4.1 produced entirely unique outputs (100%) with stable semantic content, while Gemini 2.5 Flash showed pronounced output repetition (27.5% unique outputs), indicating that its high similarity score derived from text duplication rather than consistent reasoning. Identical decoding settings thus yielded fundamentally different consistency profiles, a distinction that single-output evaluations cannot capture. Safety expression reached ceiling levels across all models, confirming its limited utility as a differentiating metric. These results indicate that model selection constitutes a clinical rather than merely technical decision, and that output behavior under repeated generation conditions should be treated as a core criterion for reliable deployment of LLM-based exercise prescription systems.

Kihyuk Lee

Data Convergence Team, Office of Hospital Information, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

LLM Evaluation Clinical Language Model Evaluation Medical LLMs

Apr 21, 2026cs.CL

Can Continual Pre-training Bridge the Performance Gap between General-purpose and Specialized Language Models in the Medical Domain?

This paper narrows the performance gap between small, specialized models and significantly larger general-purpose models through domain adaptation via continual pre-training and merging. We address the scarcity of specialized non-English data by constructing a high-quality German medical corpus (FineMed-de) from FineWeb2. This corpus is used to continually pre-train and merge three well-known LLMs (ranging from

7B

to

24B

parameters), creating the DeFineMed model family. A comprehensive evaluation confirms that specialization dramatically enhances

7B

model performance on German medical benchmarks. Furthermore, the pairwise win-rate analysis of the Qwen2.5-based models demonstrates an approximately

3.5

-fold increase in the win-rate against the much larger Mistral-Small-24B-Instruct through domain adaptation. This evidence positions specialized

7B

models as a competitive, resource-efficient solution for complex medical instruction-following tasks. While model merging successfully restores instruction-following abilities, a subsequent failure mode analysis reveals inherent trade-offs, including the introduction of language mixing and increased verbosity, highlighting the need for more targeted fine-tuning in future work. This research provides a robust, compliant methodology for developing specialized LLMs, serving as the foundation for practical use in German-speaking healthcare contexts.

Niclas Doll, Jasper Schulze Buschhoff, Shalaka Satheesh +3

Fraunhofer IAIS · Lamarr Institute

Domain-Adaptive Pretraining Domain Adaptation for LLMs Language Model Merging Medical LLMs

Apr 21, 2026cs.HC

Beyond Semantic Similarity: A Component-Wise Evaluation Framework for Medical Question Answering Systems with Health Equity Implications

The use of Large Language Models (LLMs) to support patients in addressing medical questions is becoming increasingly prevalent. However, most of the measures currently used to evaluate the performance of these models in this context only measure how closely a model's answers match semantically, and therefore do not provide a true indication of the model's medical accuracy or of the health equity risks associated with it. To address these shortcomings, we present a new evaluation framework for medical question answering called VB-Score (Verification-Based Score) that provides a separate evaluation of the four components of entity recognition, semantic similarity, factual consistency, and structured information completeness for medical question-answering models. We perform rigorous reviews of the performance of three well-known and widely used LLMs on 48 public health-related topics taken from high-quality, authoritative information sources. Based on our analyses, we discover a major discrepancy between the models' semantic and entity accuracy. Our assessments of the performance of all three models show that each of them has almost uniformly severe performance failures when evaluated against our criteria. Our findings indicate alarming performance disparities across various public health topics, with most of the models exhibiting 13.8% lower performance (compared to an overall average) for all the public health topics that relate to chronic conditions that occur in older and minority populations, which indicates the existence of what's known as condition-based algorithmic discrimination. Our findings also demonstrate that prompt engineering alone does not compensate for basic architectural limitations on how these models perform in extracting medical entities and raise the question of whether semantic evaluation alone is a sufficient measure of medical AI safety.

Abu Noman Md Sakib, Md. Main Oddin Chisty, Zijie Zhang

University of Texas at San Antonio, USA · Khulna University of Engineering and Technology, Bangladesh

LLM Answer Verification Healthcare Algorithmic Fairness Medical QA Language Model Bias Evaluation Medical LLMs

Apr 21, 2026cs.AI

Reinforcement Learning Improves LLM Accuracy and Reasoning in Disease Classification from Radiology Reports

Accurate disease classification from radiology reports is essential for many applications. While supervised fine-tuning (SFT) of lightweight LLMs improves accuracy, it can degrade reasoning. We propose a two-stage approach: SFT on disease labels followed by Group Relative Policy Optimization (GRPO) to refine predictions by optimizing accuracy and format without reasoning supervision. Across three radiologist-annotated datasets, SFT outperformed baselines and GRPO further improved classification and enhanced reasoning recall and comprehensiveness.

Yishu Wei, Yi Lin, Adam Flanders +2

Department of Population Health Sciences, Weill Cornell Medicine, New York, NY · Department of Radiology, Thomas Jefferson University, Philadelphia, PA · Department of Radiology, Weill Cornell Medicine, New York, NY

Healthcare Clinical Reasoning RL Fine-Tuning Medical LLMs

Apr 21, 2026cs.CL

LLMs for Cardiovascular Risk Prediction from Structured Clinical Data

Coronary artery disease (CAD) remains one of the leading causes of death globally, highlighting the need for reliable predictive systems to support early diagnosis and risk assessment. While traditional machine learning models perform well on structured clinical data, large language models (LLMs) present new possibilities to interpret medical information expressed in natural language. In this work, we develop a hybrid framework that bridges structured clinical data and natural-language representations for CAD prediction. Using a publicly available dataset of 1,190 patient records with 11 clinical attributes, structured variables are converted into interpretable feature representations and synthetic clinical narratives using LLMs. A validation pipeline performs reverse extraction of clinical variables and computes a consistency score with the original records, achieving an average fidelity of 94.61%. We then evaluate four conventional machine learning models and compare their performance with LLM-based classification under zero-shot and few-shot prompting settings. We use two LLMs here, GPT and Gemini. Experimental results show that Random Forest achieves the highest accuracy. Despite this advantage, LLM-based classification remains beneficial in real-world clinical settings. This is because LLMs operate directly on natural language patient descriptions, meaning that sensitive numerical patient data such as exact lab values, blood pressure readings, and diagnostic codes are kept private. Findings suggest that combining structured clinical data with LLM-generated narratives can enable new directions for hybrid clinical prediction systems.

Jeba Maliha, Md Rafiul Kabir

Central Michigan University, Mount Pleasant, MI, USA

Medical LLMs Clinical Risk Prediction

Apr 20, 2026cs.CY

First, Do No Harm (With LLMs): Mitigating Racial Bias via Agentic Workflows

Large language models (LLMs) are increasingly used in clinical settings, raising concerns about racial bias in both generated medical text and clinical reasoning. Existing studies have identified bias in medical LLMs, but many focus on single models and give less attention to mitigation. This study uses the EU AI Act as a governance lens to evaluate five widely used LLMs across two tasks, namely synthetic patient-case generation and differential diagnosis ranking. Using race-stratified epidemiological distributions in the United States and expert differential diagnosis lists as benchmarks, we apply structured prompt templates and a two-part evaluation design to examine implicit and explicit racial bias. All models deviated from observed racial distributions in the synthetic case generation task, with GPT-4.1 showing the smallest overall deviation. In the differential diagnosis task, DeepSeek V3 produced the strongest overall results across the reported metrics. When embedded in an agentic workflow, DeepSeek V3 showed an improvement of 0.0348 in mean p-value, 0.1166 in median p-value, and 0.0949 in mean difference relative to the standalone model, although improvement was not uniform across every metric. These findings support multi-metric bias evaluation for AI systems used in medical settings and suggest that retrieval-based agentic workflows may reduce some forms of explicit bias in benchmarked diagnostic tasks. Detailed prompt templates, experimental datasets, and code pipelines are available on our GitHub.

Sihao Xing, Zaur Gouliev

School of Enterprise Computing and Digital Transformation Technological University Dublin · School of Information and Communication Studies University College Dublin

Healthcare Social Bias in Language Models Medical Diagnosis Language Model Bias Evaluation Clinical Language Model Evaluation Medical LLMs