Prasanna Desikan

Harshit Rajgarhia, Shuubham Ojha, Asif Shaik et al.

We present MedMosaic, a medical audio question-answering dataset designed to benchmark language and audio reasoning models under realistic clinical constraints. Medical audio data is difficult to collect due to privacy regulations and high annotation costs arising from domain expertise. Thus, existing benchmarks tend to underrepresent complex medical audio scenarios. To address these challenges, MedMosaic features a diverse range of medical audio types, including condition-related physiological sounds, carefully constructed synthetic voices to mimic speech with artifacts as well as real short and long length clinical conversations to model varying context lengths. The dataset also features a total of 46,701 question-answer pairs, spanning categories such as multiple-choice, sequential multi-turn, and open-ended question-answers, enabling systematic evaluation of multi-hop reasoning and answer generation capabilities. Benchmarking 13 audio and multimodal reasoning models reveals that reasoning remains challenging for all evaluated systems, with substantial performance variation across question types. In particular, even state-of-the-art model like Gemini-2.5-pro can only achieve 68.1% accuracy approximately. These findings underscore persistent limitations in medical reasoning and highlight the need for more robust, domain-specific multimodal reasoning models.

Ananya Mantravadi, Harshit Rajgarhia, Prasanna Desikan et al.

Clinical protocol-execution tasks -- checking a lab value, applying a threshold, placing a correctly structured FHIR order -- are natural candidates for RL from world feedback: once clinical SMEs encode decision logic into a verifier, that verifier grades unlimited rollouts without per-episode annotation. But applying RL requires a sound feedback channel and sufficient base capability. We audit MedAgentBench v1/v2, find a 41.7\% silent-finish ceiling that makes inaction the RL dominant strategy, and construct \textbf{MedAgentBench-v3 (MAB-v3)} (508 tasks, 8.9\% ceiling). Training Qwen3-8B exposes two structural barriers: a \emph{capability ceiling} (10/20 task types have 0\% base performance, zero gradient) and a \emph{format-knowledge barrier} (3/20 types require exact clinical codes undiscoverable by exploration). Pure RL reaches 18.2\% pass@1 vs.\ 34.1\% for rule-based SFT; the 15.9~pp gap is attributable entirely to these barriers. A decision/format-knowledge/lookup taxonomy predicts RL learnability and prescribes the fix: SFT to inject codes, RL to learn conditionals.

Mayur Sanap, Prasanna Desikan, Edgar Lobaton

Respiratory acoustic foundation models (FMs) are benchmarked exclusively on smartphone recordings, yet clinical deployment increasingly targets body-coupled (BC) wearables whose sensors attenuate high-frequency content through tissue and bone, leaving FM reliability uncharacterised. We introduce BCoughBench, evaluating five FMs (OPERA-CT/CE/GT, HeAR, M2D+Resp) on nine classification tasks (AUROC, sensitivity at 95% specificity, Expected Calibration Error) and three age regression tasks (MAE vs. a mean-predictor baseline) across five EBEN-simulated BC sensor conditions on five labeled cough datasets. Mean AUROC declines from 0.785 (smartphone) to 0.689-0.723, degrading most under temple vibration pickup ($Δ$ = -0.096) and least under the soft in-ear ($Δ$ = -0.062). No FM meets the clinical sensitivity threshold (Se@Sp95 $\geq$ 0.20) on most disease tasks under any BC sensor. Sex classification on the CIDRZ cohort collapses (AUROC 0.954 to 0.596-0.628, $Δ$ = -0.341) while COVID detection is nearly unaffected ($Δ$ = -0.004). Age regression is robust, improving under the forehead accelerometer on CoughVID (MAE 9.61 to 8.97 yr); HeAR leads on regression and demographic tasks, M2D+Resp on disease and characteristic tasks. BCoughBench provides a reproducible framework for FM evaluation under wearable conditions.

Akshat Dasula, Prasanna Desikan, Jaideep Srivastava

Large language models (LLMs) are increasingly applied to structured clinical data, yet whether they can recognize the limits of their own knowledge on such tasks remains unexplored. We study this question through the lens of cross-model attribution divergence with the goal of reducing epistemic uncertainty for structured tasks, comparing Qwen 2.5 7B and XGBoost on a prediction task via attribution divergence analysis. We report four findings. First, LLM verbalized confidence is epistemically vacuous, it outputs a near-constant (0.856-0.937) regardless of whether accuracy is 49% or 75.3%, tracking prompt format rather than prediction quality. Second, the LLM exhibits an inverse difficulty effect: accuracy drops to 64.8% when XGBoost is 99% correct, but matches XGBoost (73.8% vs. 73.1%) when it is moderately uncertain. Third, few-shot examples and SHAP-derived feature evidence are orthogonal, super-additive interventions: they reduce the Attribution Disagreement Score (ADS) from 1.54 to 0.38 and improve accuracy from 49% to 75.3% without training. Fourth, a cross-model calibrator that determined LLM reliability using attribution divergence signals reduces expected calibration error from 0.254 to 0.080, replacing uninformative verbalized confidence with patient-specific reliability estimates, without accessing model internals or requiring repeated inference. We frame these findings as a cold start problem for LLMs on structured data and outline a path toward genuine epistemic self-awareness.

Mayur Sanap, Prasanna Desikan, Edgar Lobaton

Respiratory acoustic foundation models (FMs) excel at cough classification, yet their ability to predict continuous health quantities from cough audio remains largely unexplored, despite the clinical value of passive age, BMI, and disease probability estimation in settings where physical measurements are unavailable. We introduce the multi-model, multi-target cough regression benchmark evaluating five FMs (OPERA-CT, OPERA-CE, OPERA-GT, HeAR, M2D+Resp) across six targets on three datasets under subject-disjoint protocols, comparing linear, MLP-small, and full MLP regression heads. MLP-small beats the mean-predictor baseline on all tasks and linear probing in 23 of 30 model x task cases, with full MLP overfitting on small clinical data but recovering on larger sets, revealing a dataset size x head-capacity trade-off. HeAR leads within-dataset age regression on Coswara (9.12 yr MAE); its CIDRZ result is excluded from headline claims owing to possible HeAR-CIDRZ pretraining overlap. OPERA-GT is favored over OPERA-CT on age in all three datasets, with the CIDRZ margin within seed variance, extending a generative-pretraining advantage from breath to cough. HeAR and M2D+Resp reach near-full performance at N = 50 samples while OPERA models require N = 400. Cross-dataset transfer is strongly asymmetric as large diverse data generalises to small clinical populations (CoughVID to CIDRZ: -0.17 yr) but not vice versa (CIDRZ to Coswara: +2.43 yr, +26.6%).

Prasanna Desikan, Harshit Rajgarhia, Shivali Dalmia et al.

AI models are increasingly deployed in live clinical environments where they must perform reliably across complex, high-stakes workflows that standard training and validation datasets were never designed to capture. Evaluating these systems requires benchmarks: structured combinations of tasks, datasets, and metrics that enable reproducible, comparable measurement of what a model can do. The central challenge in healthcare AI is not performance alone, but the absence of systematic methods to measure reliability, safety, and clinical relevance under real-world conditions. Most existing benchmarks test what a model knows; too few test whether it can perform reliably and without failing across the full complexity of real clinical tasks. Current benchmarks have accumulated through ad hoc dataset construction optimized for narrow task performance: frontier models achieve near-perfect scores on medical licensing examinations, but when evaluated across real clinical tasks, performance degrades sharply, scoring 0.74--0.85 on documentation, 0.61--0.76 on clinical decision support, and only 0.53--0.63 on administrative and workflow tasks \cite{medhelm}. High benchmark scores give a false sense of deployment readiness, and the gap between performance and utility widens precisely as AI systems take on more consequential clinical roles. Without a principled framework for benchmark design, the field cannot determine whether poor clinical performance reflects model limitations or failures in how performance is being measured.

Shivali Dalmia, Ananya Mantravadi, Prasanna Desikan

The work in this paper evaluates zero-shot and few-shot large language models (LLMs) for safety-critical clinical action extraction using the CLIP discharge-note dataset, with particular emphasis on transitions of care and post-discharge patient safety. To manage the complexity of clinical documentation, we introduce a two-stage extraction framework that decomposes discharge notes, that are written in narrative form, into fine-grained, explicitly actionable clinical tasks through a staged prompting strategy. Our contributions include a systematic assessment of generative LLMs for clinical action extraction, a detailed comparison between general-purpose LLMs and task-specific supervised BERT-based models, and an analysis of annotation inconsistencies across different action categories. We show that contemporary LLMs achieve performance comparable to or exceeding supervised models on binary actionability detection, while supervised baselines retain a meaningful advantage on fine-grained multi-label category classification, despite the absence of task-specific fine-tuning and under strict data-privacy constraints. Qualitative error analysis reveals that many failures stem from misalignment between model reasoning and dataset annotation conventions, particularly in cases involving implicit clinical actions and rigid structural labeling rules. These results indicate that reported performance reflects model limitations due to lack of clinical reasoning, that is not captured by plain annotations. Labels without rationales make it impossible to distinguish clinical reasoning failures from annotation convention mismatches. Advancing clinical NLP requires reasoning-annotated datasets that document why specific spans are actionable, not merely which spans were labeled, enabling proper evaluation of model clinical understanding.