The study evaluates four open language models (8–27 billion parameters) on the Spanish MIR residency exam, covering 1,552 questions across eight editions. The largest models could rank within the top 600–3,000 candidates and had 41–43 specialties still open, yet abstaining never improved performance because even low‑confidence answers were more often correct than the 25% break‑even threshold. Medical fine‑tuning lowered overconfidence but also reduced accuracy, did not improve the correlation between confidence and correctness, and removing or swapping the provided images did not affect accuracy.
By Miguel Fernandez-de-Retana, Unai Zulaika, Ruben Sanchez-Corcuera, Aritz Bilbao-Jayo, Aitor Almeida
Large language model assistants are being deployed to clinicians, but their readiness is judged mainly by benchmark scores that are based on examination questions or curated cases. This study analyzed 127,833 queries from 6,342 healthcare professionals across 35 specialties, finding that most requests were for documentation, administration, and knowledge retrieval, with a significant portion of queries unanswerable. When compared to 58 public benchmarks, the median benchmark lacked documentation requests and only shared 31% of the real task mix, indicating that current benchmarks poorly reflect actual clinical use.
By Krithik Vishwanath, Haitong Lin, Anton Alyakin, Jin Vivian Lee, D. Brock Hewitt, Jie J. Yao, William Robert Small, Hammad A. Khan, Cordelia Orillac, Aakaash Varma, Brandon Ye, Daniel Alexander Alber, Gustavo Stolovitzky, Batia Wiesenfeld, Oded Nov, Wei Wu, Kang Zhang, Yindalon Aphinyanaphongs, Tim Requarth, Eric Karl Oermann, The International Digital Twin Consortium in Healthcare, Medicine
The paper introduces Clinical System One (CS1), a 4‑billion‑parameter decision model that rapidly produces typed judgments from clinical records. Trained on 12.4 million Q&A pairs from 3.6 million patients, CS1 can answer multiple questions in a single forward pass, providing probability estimates for uncertain cases. In evaluations on 963,408 held‑out patients and 21 external datasets, CS1 outperformed larger open models and, when paired with a language‑model agent, efficiently identified trial‑eligible patients with far fewer tokens.
By Andrew Zhang, Trinh T. L. Vuong, Sophia J. Wagner, Dongmin Bang, Tong Ding, Yuchang Su, Mary Cipperman, Christina S. Chen, Judith Lefkes, Ramin Kahidi, Ming Y. Lu, Caiwei Tian, Tianhao Luo, Jingnan Ma, Rowland Pettit, Long Phi Le, Faisal Mahmood
The paper introduces PrecepTron, a 32‑billion‑parameter language model fine‑tuned with low‑rank adaptation to evaluate clinical reasoning in large language models (LLMs) at a physician level. It also releases GRAND‑ROUNDS, a benchmark of 9,217 scored responses from 160 clinicians across seven studies. Using PrecepTron, the authors replicate key findings from major medical AI studies and explore new questions about LLM diagnostic accuracy, demonstrating that fine‑tuned models can provide consistent, scalable physician‑level scoring.
By Thomas A. Buckley, Zahir Kanjee, Peter G. Brodeur, Byron Crowe, Anthony M. Pettinato, Aashna P. Shah, Adrian D. Haimovich, Liam G. McCoy, Daniel Restrepo, Jason A. Freed, Ethan Goh, Jonathan H. Chen, Laura Zwaan, Katherine E. Goodman, Daniel J. Morgan, Raja-Elie E. Abdulnour, Adam Rodman, Arjun K. Manrai
arXiv:2606. 28960v1 Announce Type: new Abstract: Physicians now pose millions of clinical questions to AI tools each week, yet these tools are evaluated largely on hypothetical or exam-style questions, not those actually asked in practice.
By Jean Feng, Vishal Patel, Patrick Heagerty, Yifan Mai, Venkatesh Sivaraman, Patrick Vossler, Jialin Ouyang, Anupam B. Jena
The study compared 13 decision models with 15 generative large language model configurations on 1,273 four‑option MedQA questions. Decision models achieved 67.71%–89.08% accuracy, while generative models ranged from 78.32%–96.86%. Mercury Decide offered the lowest cost per 1,000 questions and Clef Omni the fastest median request time, but decision models still showed higher error rates for high‑confidence predictions and varied probability repeatability.
By Oscar Freyer, Daniel Glauert, Moritz Hofmann, Max Ostermann, Stephen Gilbert, Jakob Nikolas Kather
The study evaluates large language models (LLMs) on unprocessed electronic medical record data for clinical registry abstraction, focusing on the American College of Cardiology National Cardiovascular Data Registry. In a pilot at one academic center, the LLM identified candidate data sources for each registry question, which abstractors used to define question‑specific document sets. In a subsequent validation at a second center, the LLM answered 157 registry questions with an overall mean accuracy of 91.5%, but accuracy dropped from 96% for simple medication or event flag questions to 62% for event timing questions, reflecting increasing ambiguity and required clinical reasoning.
By James Matheson, Betsy Castillo, Andrew Y. Shin, David Scheinker
arXiv:2606. 15735v1 Announce Type: cross Abstract: Discharge summaries are crucial clinical documents containing the context of a patient's overall hospital stay, and are routinely reviewed by medical experts for patient readmission, ongoing care, and diagnostic decision-making.
By Jiyoun Kim, Muhan Yeo, Eunhye Jang, Jeewon Yang, Hangyul Yoon, Su Ji Lee, Hee Jo Han, Hee-Jae Jung, Doyun Kwon, Jun young Lee, Jaehun Lee, Jung-Oh Lee, Sunjun Kweon, Jong Hak Moon, Daseul Kim, Minjae Cho, Edward Choi
The study introduces MedQADE, a German open‑response clinical benchmark with 3,800 question‑answer pairs and physician reference annotations. It evaluates large language models (LLMs) as judges, finding that while some LLMs (e.g., Gemini 3 Flash) achieve physician‑level agreement on correctness, they exhibit self‑bias and low abstention rates. Physicians showed moderate agreement on correctness but limited agreement on difficulty, and their abstention increased with perceived difficulty.
By William Philipp, Finn Fassbender, Daniel Fister, Thorsten Langer, Martje G. Pauly, Rebecca Herzog, Markus A. Hobert, Theresa Paulus, Alexander Baumann, Chi Wang Ip, Lukas L. Goede, Johanna Reimer, Sebastian L\"ons, Ronald B\"ock, Sebastian Fudickar
arXiv:2607. 02175v1 Announce Type: new Abstract: Multiple-choice medical benchmarks are increasingly saturated, and recent rubric-based evaluations such as HealthBench have shown that open-ended clinical performance is far from solved - its "Hard" subset top score remains 32%.
By Samiha A. Ismail, Fan X. Chen, Ali Merali
The paper introduces three interpretable metrics—Explanation Stability Index (ESI), Causal Faithfulness Score (CFS), and Perturbation Stability Score (PSS)—to assess the faithfulness of large language models (LLMs) in clinical decision support. Evaluating six LLMs on 150 MedQA-USMLE questions, the study finds that only 23.3% of cited clinical concepts are causally necessary, and that correct answers often have lower CFS than incorrect ones, with answer consistency negatively predicting faithfulness. These findings suggest that accuracy, consistency, and consensus are incomplete safety signals for clinical decision-making support.
By Bharath Kumar Bolla, Chaitali Deb Purkayastha, Vishnu Surya Reddy Nandi
arXiv:2409. 07314v3 Announce Type: replace-cross Abstract: While Large Language Models (LLMs) achieve superhuman performance on standardized medical licensing exams, these static benchmarks have become saturated and increasingly disconnected from the functional requirements of clinical workflows.
By Praveenkumar Kanithi, Cl\'ement Christophe, Marco AF Pimentel, Tathagata Raha, Prateek Munjal, Nada Saadi, Hamza A Javed, Svetlana Maslenkova, Nasir Hayat, Ronnie Rajan, Shadab Khan