Krithik Vishwanath

Krithik Vishwanath, Mrigayu Ghosh, Anton Alyakin et al.

Specialized clinical AI assistants are rapidly entering medical practice, often framed as safer or more reliable than general-purpose large language models (LLMs). Yet, unlike frontier models, these clinical tools are rarely subjected to independent, quantitative evaluation, creating a critical evidence gap despite their growing influence on diagnosis, triage, and guideline interpretation. We assessed two widely deployed clinical AI systems (OpenEvidence and UpToDate Expert AI) against three state-of-the-art generalist LLMs (GPT-5, Gemini 3 Pro, and Claude Sonnet 4.5) using a 1,000-item mini-benchmark combining MedQA (medical knowledge) and HealthBench (clinician-alignment) tasks. Generalist models consistently outperformed clinical tools, with GPT-5 achieving the highest scores, while OpenEvidence and UpToDate demonstrated deficits in completeness, communication quality, context awareness, and systems-based safety reasoning. These findings reveal that tools marketed for clinical decision support may often lag behind frontier LLMs, underscoring the urgent need for transparent, independent evaluation before deployment in patient-facing workflows.

Krithik Vishwanath, Anton Alyakin, Mrigayu Ghosh et al.

The Congress of Neurological Surgeons Self-Assessment for Neurological Surgeons (CNS-SANS) questions are widely used by neurosurgical residents to prepare for written board examinations. Recently, these questions have also served as benchmarks for evaluating large language models' (LLMs) neurosurgical knowledge. This study aims to assess the performance of state-of-the-art LLMs on neurosurgery board-like questions and to evaluate their robustness to the inclusion of distractor statements. A comprehensive evaluation was conducted using 28 large language models. These models were tested on 2,904 neurosurgery board examination questions derived from the CNS-SANS. Additionally, the study introduced a distraction framework to assess the fragility of these models. The framework incorporated simple, irrelevant distractor statements containing polysemous words with clinical meanings used in non-clinical contexts to determine the extent to which such distractions degrade model performance on standard medical benchmarks. 6 of the 28 tested LLMs achieved board-passing outcomes, with the top-performing models scoring over 15.7% above the passing threshold. When exposed to distractions, accuracy across various model architectures was significantly reduced-by as much as 20.4%-with one model failing that had previously passed. Both general-purpose and medical open-source models experienced greater performance declines compared to proprietary variants when subjected to the added distractors. While current LLMs demonstrate an impressive ability to answer neurosurgery board-like exam questions, their performance is markedly vulnerable to extraneous, distracting information. These findings underscore the critical need for developing novel mitigation strategies aimed at bolstering LLM resilience against in-text distractions, particularly for safe and effective clinical deployment.

Krithik Vishwanath, Anton Alyakin, Daniel Alexander Alber et al.

Large language models (LLMs) have the potential to transform medicine, but real-world clinical scenarios contain extraneous information that can hinder performance. The rise of assistive technologies like ambient dictation, which automatically generates draft notes from live patient encounters, has the potential to introduce additional noise making it crucial to assess the ability of LLM's to filter relevant data. To investigate this, we developed MedDistractQA, a benchmark using USMLE-style questions embedded with simulated real-world distractions. Our findings show that distracting statements (polysemous words with clinical meanings used in a non-clinical context or references to unrelated health conditions) can reduce LLM accuracy by up to 17.9%. Commonly proposed solutions to improve model performance such as retrieval-augmented generation (RAG) and medical fine-tuning did not change this effect and in some cases introduced their own confounders and further degraded performance. Our findings suggest that LLMs natively lack the logical mechanisms necessary to distinguish relevant from irrelevant clinical information, posing challenges for real-world applications. MedDistractQA and our results highlights the need for robust mitigation strategies to enhance LLM resilience to extraneous information.

Krithik Vishwanath, Jaden Stryker, Anton Alyakin et al.

Language models (LMs) have demonstrated expert-level reasoning and recall abilities in medicine. However, computational costs and privacy concerns are mounting barriers to wide-scale implementation. To address these significant limitations, we introduce a parsimonious adaptation of phi-3-mini, MedMobile, a 3.8 billion parameter LM capable of running on a mobile device, for medical applications. We perform a careful set of pipeline additions and demonstrate that chain of thought, ensembling, and fine-tuning lead to the greatest performance gains, while unexpectedly retrieval augmented generation fails to demonstrate significant improvements. We evaluate the efficiency of our pipeline on the MultiMedQA and MedBullets. We demonstrate that MedMobile scores 75.7% on the MedQA (USMLE), surpassing the passing mark for licensed physicians (~60%) and rivaling scores of models 100 times its size. Across the entirety of the MultiMedQA, MedMobile achieves SOTA performance for models with less than 5B parameters and represents the smallest model to pass the MedQA (USMLE). MedMobile holds promise to democratize access to language models in medicine, bolstering lower compute needs and fast inference speeds. With the ability to combat the biggest barriers to entry for language models in medicine, we hope that MedMobile is a critical step forward in developing clinically relevant language models.