Do Clinical Question Answering Systems Really Need Specialised Medical Fine Tuning?
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| Main Authors: | , , , , , , , |
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| Format: | Preprint |
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2026
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| _version_ | 1866917209742245888 |
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| author | Ray, Sushant Kumar Kashyap, Gautam Siddharth Tripathi, Sahil Joshi, Nipun Govindarajan, Vijay Ali, Rafiq Gao, Jiechao Naseem, Usman |
| author_facet | Ray, Sushant Kumar Kashyap, Gautam Siddharth Tripathi, Sahil Joshi, Nipun Govindarajan, Vijay Ali, Rafiq Gao, Jiechao Naseem, Usman |
| contents | Clinical Question-Answering (CQA) industry systems are increasingly rely on Large Language Models (LLMs), yet their deployment is often guided by the assumption that domain-specific fine-tuning is essential. Although specialised medical LLMs such as BioBERT, BioGPT, and PubMedBERT remain popular, they face practical limitations including narrow coverage, high retraining costs, and limited adaptability. Efforts based on Supervised Fine-Tuning (SFT) have attempted to address these assumptions but continue to reinforce what we term the SPECIALISATION FALLACY-the belief that specialised medical LLMs are inherently superior for CQA. To address this assumption, we introduce MEDASSESS-X, a deployment-industry-oriented CQA framework that applies alignment at inference time rather than through SFT. MEDASSESS-X uses lightweight steering vectors to guide model activations toward medically consistent reasoning without updating model weights or requiring domain-specific retraining. This inference-time alignment layer stabilises CQA performance across both general-purpose and specialised medical LLMs, thereby resolving the SPECIALISATION FALLACY. Empirically, MEDASSESS-X delivers consistent gains across all LLM families, improving Accuracy by up to +6%, Factual Consistency by +7%, and reducing Safety Error Rate by as much as 50%. |
| format | Preprint |
| id |
arxiv_https___arxiv_org_abs_2601_12812 |
| institution | arXiv |
| publishDate | 2026 |
| record_format | arxiv |
| spellingShingle | Do Clinical Question Answering Systems Really Need Specialised Medical Fine Tuning? Ray, Sushant Kumar Kashyap, Gautam Siddharth Tripathi, Sahil Joshi, Nipun Govindarajan, Vijay Ali, Rafiq Gao, Jiechao Naseem, Usman Computation and Language Clinical Question-Answering (CQA) industry systems are increasingly rely on Large Language Models (LLMs), yet their deployment is often guided by the assumption that domain-specific fine-tuning is essential. Although specialised medical LLMs such as BioBERT, BioGPT, and PubMedBERT remain popular, they face practical limitations including narrow coverage, high retraining costs, and limited adaptability. Efforts based on Supervised Fine-Tuning (SFT) have attempted to address these assumptions but continue to reinforce what we term the SPECIALISATION FALLACY-the belief that specialised medical LLMs are inherently superior for CQA. To address this assumption, we introduce MEDASSESS-X, a deployment-industry-oriented CQA framework that applies alignment at inference time rather than through SFT. MEDASSESS-X uses lightweight steering vectors to guide model activations toward medically consistent reasoning without updating model weights or requiring domain-specific retraining. This inference-time alignment layer stabilises CQA performance across both general-purpose and specialised medical LLMs, thereby resolving the SPECIALISATION FALLACY. Empirically, MEDASSESS-X delivers consistent gains across all LLM families, improving Accuracy by up to +6%, Factual Consistency by +7%, and reducing Safety Error Rate by as much as 50%. |
| title | Do Clinical Question Answering Systems Really Need Specialised Medical Fine Tuning? |
| topic | Computation and Language |
| url | https://arxiv.org/abs/2601.12812 |