arXiv AI August 28, 2026 By Jin Mu, Guanhua Chen

Making Clinical Language Models Auditable: Concept-Guided Fine-Tuning for Robust Prediction

The paper introduces CAST, a concept-guided artifact suppression tuning framework that uses sparse autoencoders to identify and suppress note-specific artifacts in clinical language models. CAST labels latent features with an LLM-assisted pipeline and ICD‑10 constraints, then fine‑tunes the model while providing post‑hoc per‑concept attributions for auditability. In experiments on MIMIC‑IV discharge‑note mortality prediction, CAST outperforms standard fine‑tuned encoders and competes with strong LLM baselines while offering a feature‑level audit trail of clinical concepts and suppressed artifacts.

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