analiza aiqbench
This study reveals critical gaps in clinical LLM evaluation by demonstrating that high answer accuracy does not ensure counterfactual consistency or demographic robustness. The research highlights significant risks of stereotype generation and instability when models are perturbed with minimal clinical changes or demographic prefixes, urging the development of more rigorous safety screening protocols beyond simple accuracy metrics.
Beyond Accuracy: Counterfactual Fragility and Demographic Bias in Clinical Evaluation of LLMs
arXiv:2609.32807v1 Announce Type: new Abstract: Clinical LLM evaluation often emphasizes answer accuracy; however, accuracy alone does not test counterfactual consistency or demographic robustness. We evaluated six LLMs on 150 MedQA USMLE questions using two automated perturbation tests to assess their performance. The counterfactual validity (CFV) test asked each model to make a minimal, plausible clinical change that would make a different answer correct. The demographic robustness test added six demographic prefixes to the same vignette and compared the answers and explanations with a no demographic baseline. Of the 900 CFV attempts, 228 (25.3 %) were valid and 672 were invalid. Across 5,400 demographic comparisons, 1,097 answers were changed (20.3%). Automated judging identified 3,128 stereotype evidence flags, including 1,932 in the broad Other category. MedGemma 27B achieved the highest accuracy (87.1%) and CFV (63.3%), lowest answer change rate (16.0%), and low mean Explanation Demographic Dissonance (EDD) score (0.169). However, its accuracy still exceeded its CFV, indicating that correct answers do not guarantee reliable performance on the counterfactual validity task. OpenBioLLM had the highest answer change rate and EDD, whereas GLM had the highest stereotype flag rate. These findings show that accuracy, CFV, answer stability, EDD, and stereotype evidence capture different evaluation aspects. Because all judgments were automated and no clinician validation was available, the results support safety screening but do not establish clinical deployability of the model.
Abstract:Clinical LLM evaluation often emphasizes answer accuracy; however, accuracy alone does not test counterfactual consistency or demographic robustness. We evaluated six LLMs on 150 MedQA USMLE questions using two automated perturbation tests to assess their performance. The counterfactual validity (CFV) test asked each model to make a minimal, plausible clinical change that would make a different answer correct. The demographic robustness test added six demographic prefixes to the same vignette and compared the answers and explanations with a no demographic baseline. Of the 900 CFV attempts, 228 (25.3 %) were valid and 672 were invalid. Across 5,400 demographic comparisons, 1,097 answers were changed (20.3%). Automated judging identified 3,128 stereotype evidence flags, including 1,932 in the broad Other category. MedGemma 27B achieved the highest accuracy (87.1%) and CFV (63.3%), lowest answer change rate (16.0%), and low mean Explanation Demographic Dissonance (EDD) score (0.169). However, its accuracy still exceeded its CFV, indicating that correct answers do not guarantee reliable performance on the counterfactual validity task. OpenBioLLM had the highest answer change rate and EDD, whereas GLM had the highest stereotype flag rate. These findings show that accuracy, CFV, answer stability, EDD, and stereotype evidence capture different evaluation aspects. Because all judgments were automated and no clinician validation was available, the results support safety screening but do not establish clinical deployability of the model.
Artificial Intelligence (cs.AI)
arXiv:2609.32807 [cs.AI]
(or arXiv:2609.32807v1 [cs.AI] for this version)
https://doi.org/10.48550/arXiv.2609.32807 Focus to learn more arXiv-issued DOI via DataCite (pending registration)
arXivLabs is a framework that allows collaborators to develop and share new arXiv features directly on our website.
Both individuals and organizations that work with arXivLabs have embraced and accepted our values of openness, community, excellence, and user data privacy. arXiv is committed to these values and only works with partners that adhere to them.
Have an idea for a project that will add value for arXiv's community? Learn more about arXivLabs.
Text integral sub licența deschisă a publicației · 315 cuvinte
Subiecte conexe
AI in healthcare: applications and best practices
Databricks · 24 iul. 2026
MamaBench: Benchmarking LLM Robustness in Maternal and Child Health Diagnosis through Counterfactual Clinical Perturbation
arXiv · 21 iul. 2026
Evaluating Intersectional Fairness across Clinical Machine Learning Use Cases using Fairlogue and the All of Us Research Program
arXiv · 17 iun. 2026
SDoH-Aware Narrative Anchoring Bias in Medical LLMs for Trustworthy Clinical Decision Support
arXiv · 25 aug. 2026