The paper identifies a new problem in clinical natural language processing called the clinical lost‑in‑the‑middle (CLitM) effect, where large language models perform poorly on information located near the center of long electronic health record (EHR) documents. Using the MedAlign dataset, the authors quantify a 21.9‑percentage‑point accuracy gap across 2,196 instruction‑response pairs and six models, showing that most critical facts lie in the CLitM trough. They propose Query‑Conditioned Clinical Suppression (QCCS), a lightweight context‑selection gate that outperforms traditional retrieval methods (BM25, dense retrieval, cross‑encoder reranking) on a held‑out set of 83 instructions, achieving up to 25.3% accuracy for middle‑position queries.
whyItMatters":"The study demonstrates that standard retrieval strategies fail to reliably surface central clinical information, and that a query‑aligned selection mechanism can substantially improve model performance on critical EHR data."
By Sanjay Basu
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
MedFabric is a new benchmark for detecting word‑level medical fabrications, comprising 646 fabricated statements each paired with a ground‑truth passage that shares the same LLM authorship and nearly identical wording. The study shows that current detectors perform poorly—expert clinicians achieve only 53.3% macro‑F1 and no detector family surpasses 60% without gold evidence—highlighting that detection hinges on evidence correctness rather than subtlety of fabrication. The authors demonstrate that a retrieval‑confidence gate can substantially improve performance, raising macro‑F1 from 61% to 74%.
By Tung Sum Thomas Kwok, Qian Qian, Xiaofeng Lin, Dongxu Zhang, Jun Han, Zhichao Yang, Davin Hill, Tamer Soliman, Sanjit Singh Batra, Robert Tillman, Guang Cheng
arXiv:2607. 28788v1 Announce Type: new Abstract: Clinical diagnosis at hospital admission must be made rapidly from limited, incomplete evidence.
By Jiahui Li, Ruili Fang, Zishuai Liu, Yutong Guo, Nan Yang, Wenzhan Song, Jin Lu, Fei Dou
The study evaluates large language models (LLMs) on sequential emergency department triage, where acuity labels are predicted from progressively longer nurse‑patient conversations. Six LLMs were tested at five checkpoints on simulated and physician‑authored dialogues, showing a decline from moderate‑to‑substantial agreement on full records to only fair‑to‑moderate agreement at each checkpoint. The models consistently anchor on chief complaint exchanges and fail to integrate later evidence, yielding low agreement with clinicians (QWK 0.295 vs. 0.887‑0.929) and concentrating predictions on ESI‑2 and ESI‑3.
whyItMatters":"The findings reveal that LLMs, despite strong offline performance, cannot reliably handle the sequential nature of real‑time triage, highlighting a critical gap for safe deployment in emergency settings."
By Dipankar Srirag, Haokai Zhao, Ashutosh Kumar, Eleanor Hopper, Michael Dalton, Quoc Dung Nguyen, Aditya Joshi, Salil S. Kanhere, Padmanesan Narasimhan
arXiv:2608.29582v1 Announce Type: cross
Abstract: Current evaluations of large language models (LLMs) primarily focus on factual knowledge retrieval, overlooking the fundamental challenge of navigati...
By Yi Yu, Bo Wang, Chong Feng, Ge Shi, Xia Liu, Ziyi Yang, Xuewen Shi
arXiv:2607. 26929v1 Announce Type: cross Abstract: The same diagnostic result can support or challenge one causal claim yet fail to address another when the claims concern different populations, outcomes, estimands, pathways, or identifying assumptions.
By Weiyi Kong, Zhuoran Li
The paper investigates how memory systems can answer a current query correctly yet fail to retain distinctions needed for later updates. Using a paired‑history audit, the authors evaluate 24 history pairs across six synthetic mechanisms and two model backends, achieving perfect reveal accuracy on DeepSeek and high accuracy on GLM. Record‑level audits reveal specific failures in structured reveal memories and frontier late‑reference adequacy, and the authors test a label‑equivariant repair that only partially restores correctness.
By Guangzhe Zhang
M4Bench is a benchmark comprising 28 clinical derivation tasks across 15 families on MIMIC‑IV and eICU datasets, designed to evaluate whether AI coding agents can reproduce complex procedural specifications for electronic health record (EHR) variable derivation. The study shows that incorporating specification completeness into agent skills yields the largest performance gains, with modest additional benefits from delivery format and schema familiarity. The benchmark, along with tasks, skills, evaluation code, and sanitized evidence, is released as open source for clinician‑reviewable use.
arXiv:2606. 05970v1 Announce Type: cross Abstract: Large language models are increasingly used for structured extraction from clinical free-text notes, but the sensitivity of their output to upstream configuration choices is less understood than their accuracy on fixed benchmarks.
By Martin Murin
M4Bench is a benchmark comprising 28 clinical derivation tasks across 15 families on MIMIC‑IV and eICU, designed to evaluate whether AI coding agents can reproduce complex procedural specifications for electronic health record (EHR) variable derivation. The study tests agents with and without clinician‑reviewed skill sets, finding that specification completeness drives most performance gains, while generic context or skill format contribute little. The benchmark includes tasks, skills, evaluation code, and sanitized evidence, all released as open‑source.
By Hannes Ill, Rafi Al Attrach, Rajna Fani, Ahram Han, Ryohei Yamamoto, Marlene Louisa Moerig, Dukyong Yoon, Leo Anthony Celi
arXiv:2606. 03157v1 Announce Type: new Abstract: Large language models (LLMs) have been widely adopted in healthcare, yet they still encounter significant challenges in complex clinical decision-making scenarios.
By Ruihui Hou, Siyi Zhu, Ziyue Huai, Guangya Yu, Yongqi Fan, Chunming Wang, Tong Ruan