arXiv AI

Locally Deployable Small Language Models for Emergency Department Decision Support: A Systematic Benchmark of Fine-Tuning Strategies

arXiv:2608. 10273v1 Announce Type: cross Abstract: Deploying large language models (LLMs) for decision support in emergency departments (EDs) faces two major challenges: privacy risks of transmitting patient data to closed-source commercial LLMs and the lack of systematic evaluation of fine-tuning strategies for locally deployable open-source small language models (SLMs).

arXiv AI
Jun 17

First, do NOHARM: towards clinically safe large language models

arXiv:2512. 01241v3 Announce Type: replace-cross Abstract: Large language models (LLMs) are routinely used by physicians and patients for medical advice, yet their clinical safety profiles remain poorly characterized.

By David Wu, Fateme Nateghi Haredasht, Saloni Kumar Maharaj, Priyank Jain, Jessica Tran, Matthew Gwiazdon, Arjun Rustagi, Jenelle Jindal, Jacob M. Koshy, Vinay Kadiyala, Anup Agarwal, Bassman Tappuni, Brianna French, Sirus Jesudasen, Christopher V. Cosgriff, Rebanta Chakraborty, Jillian Caldwell, Susan Ziolkowski, David J. Iberri, Robert Diep, Rahul S. Dalal, Kira L. Newman, Kristin Galetta, J. Carl Pallais, Nancy Wei, Kathleen M. Buchheit, David I. Hong, Vartan Pahalyants, Ernest Y. Lee, Allen Shih, Tamara B. Kaplan, Vishnu Ravi, Sarita Khemani, Thomas A. Buckley, April S. Liang, Daniel Shirvani, Advait Patil, Nicholas Marshall, Kanav Chopra, Joel Koh, Adi Badhwar, Anastasia Perez, Austin J. Schoeffler, Mahbuba Tusty, Chase M. Walton, Liam G. McCoy, David J. H. Wu, Yingjie Weng, Sumant Ranji, Kevin Schulman, Nigam H. Shah, Jason Hom, Arnold Milstein, Arjun K. Manrai, Adam Rodman, Jonathan H. Chen, Ethan Goh
arXiv AI
Jul 15

First, do NOHARM: a medical safety benchmark and randomized study of physician and AI teaming on clinical consultations

arXiv:2512. 01241v4 Announce Type: replace-cross Abstract: Large language models (LLMs) and medical AI tools are routinely used by physicians and patients for medical advice, yet their clinical safety profiles remain poorly characterized.

By David Wu, Fateme Nateghi Haredasht, Saloni Kumar Maharaj, Priyank Jain, Jessica Tran, Matthew Gwiazdon, Arjun Rustagi, Jenelle Jindal, Jacob M. Koshy, Vinay Kadiyala, Anup Agarwal, Bassman Tappuni, Brianna French, Sirus Jesudasen, Christopher V. Cosgriff, Rebanta Chakraborty, Jillian Caldwell, Susan Ziolkowski, David J. Iberri, Robert Diep, Rahul S. Dalal, Kira L. Newman, Kristin Galetta, J. Carl Pallais, Nancy Wei, Kathleen M. Buchheit, David I. Hong, Vartan Pahalyants, Ernest Y. Lee, Allen Shih, Tamara B. Kaplan, Vishnu Ravi, Sarita Khemani, Thomas A. Buckley, April S. Liang, Daniel Shirvani, Advait Patil, Nicholas Marshall, Kanav Chopra, Joel Koh, Adi Badhwar, Anastasia Perez, Austin J. Schoeffler, Mahbuba Tusty, Chase M. Walton, Liam G. McCoy, David J. H. Wu, Yingjie Weng, Sumant Ranji, Kevin Schulman, Nigam H. Shah, Jason Hom, Arnold Milstein, Arjun K. Manrai, Adam Rodman, Jonathan H. Chen, Ethan Goh
arXiv Computation and Language
Sep 22

LLMs Anchor on Chief Complaint and Fail to Integrate Evidence in Sequential Clinical Triage

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 AI
2d ago

Counterfactual Auditing of Bias in Open-Source Large Language Models for Clinical Triage

The study evaluates counterfactual bias in ten open‑source large language models (LLMs) for pediatric Emergency Severity Index (ESI) prediction. By creating paired clinical vignettes that differ only in demographic or socioeconomic variables, the authors measure shifts in acuity assignment, finding that counterfactual sensitivity varies widely across model families and sizes. A fine‑tuned Qwen2.5‑7B model exhibited the lowest sensitivity, while larger or medical‑domain models sometimes showed greater shifts, highlighting the need for fairness assessment before clinical deployment.

By Manar Aljohani, Brandon Ho, Kenneth McKinley, Dennis Ren, Xuan Wang
arXiv AI
Jul 28

OpenAIs HealthBench in Action: Evaluating an LLM-Based Medical Assistant on Realistic Clinical Queries

arXiv:2509. 02594v3 Announce Type: replace-cross Abstract: Evaluating large language models (LLMs) on their ability to generate high-quality, accurate, situationally aware answers to clinical questions requires going beyond conventional benchmarks to assess how these systems behave in complex, high-stakes clinical scenarios.

By Sandhanakrishnan Ravichandran, Shivesh Kumar, Rogerio Corga Da Silva, Miguel Romano, Reinhard Berkels, Michiel van der Heijden, Olivier Fail, Valentine Emmanuel Gnanapragasam
arXiv Machine Learning
Sep 25

Language Specificity vs. Domain Diversity: Benchmarking Transformers for Bangla Medical NER

This study benchmarks transformer models for Bangla medical named entity recognition (NER), comparing BanglaBERT, multilingual BERT (mBERT), XLM‑RoBERTa, and GPT‑4o mini under zero‑shot and few‑shot prompting. Across a full test set of 3,179 samples, fine‑tuned XLM‑RoBERTa achieves a new state‑of‑the‑art F1‑score of 0.5959, while BanglaBERT lags with 0.4937, suggesting that domain diversity outweighs language specificity. The analysis shows high performance on Medicine and Specialist entities (F1 > 0.83) but lower accuracy on Symptoms (F1 0.4367), and demonstrates that fine‑tuned transformers outperform prompt‑only approaches by a factor of 3.76.

By Rakib Abdullah, Md. Maruful Islam Maruf
arXiv AI
3d ago

Sense and Sensitivity: Benchmarking LLM Clinical Triage Recommendations with Physician Experts

The paper introduces a benchmark of over 6,000 clinical triage scenarios, 7,000 physician annotations, and 225,000 large language model (LLM) responses to assess how LLMs perform under realistic variations in clinical text. The study finds that LLMs tend to recommend unnecessary care more often than physicians, especially when the input text is perturbed, and that LLM recommendations are more sensitive to gender and tone changes than human recommendations. These findings underscore the importance of deployment‑oriented evaluations that reflect expert physician behavior.

By Abinitha Gourabathina, Haoran Zhang, Yuexing Hao, Walter Gerych, Marzyeh Ghassemi
arXiv AI
Sep 15

A primer on evaluation methods for large language models in healthcare

arXiv:2609.14819v1 Announce Type: cross Abstract: Large language models (LLMs) have a growing range of applications in medicine, and their evaluation is critical for ensuring they provide benefit and...

By Suzannah E McKinney, Phuc Vu, Samuel A Justice, Christopher Humphries, Alyssa Pradhan, Timothy J Keyes, Bernardo C Bizzo, Keith J Dreyer, Sarah F Mercaldo, James M Hillis