Nishant Mishra

Benjamin Warner, Ratna Sagari Grandhi, Max Kieffer et al.

Evaluating large language models (LLMs) for medical applications remains challenging due to benchmark saturation, limited data accessibility, and insufficient coverage of relevant tasks. Existing suites have either saturated, heavily depend on restricted datasets, or lack comprehensive model coverage. We introduce Medmarks, a fully open-source evaluation suite with 30 benchmarks spanning question answering, information extraction, medical calculations, and open-ended clinical reasoning. We perform a systematic evaluation of 61 models across 71 configurations using verifiable metrics and LLM-as-a-Judge. Our results show that frontier reasoning models (Gemini 3 Pro Preview, GPT-5.1, & GPT-5.2) achieve the highest performance across both benchmarks, most frontier proprietary models are significantly more token efficient than open-weight alternatives, medically fine-tuned models outperform their generalist counterparts, and that models are susceptible to answer-order bias (particularly smaller models and Grok 4). A subset of our evals (Medmarks-T) can be directly used as reinforcement learning environments to post-train LLMs for medical reasoning. Code is available at https://github.com/MedARC-AI/Medmarks

Nishant Mishra, Gaurav Sahu, Iacer Calixto et al.

Generating high-quality summaries for chat dialogs often requires large labeled datasets. We propose a method to efficiently use unlabeled data for extractive summarization of customer-agent dialogs. In our method, we frame summarization as a question-answering problem and use state-of-the-art large language models (LLMs) to generate pseudo-labels for a dialog. We then use these pseudo-labels to fine-tune a chat summarization model, effectively transferring knowledge from the large LLM into a smaller specialized model. We demonstrate our method on the \tweetsumm dataset, and show that using 10% of the original labelled data set we can achieve 65.9/57.0/61.0 ROUGE-1/-2/-L, whereas the current state-of-the-art trained on the entire training data set obtains 65.16/55.81/64.37 ROUGE-1/-2/-L. In other words, in the worst case (i.e., ROUGE-L) we still effectively retain 94.7% of the performance while using only 10% of the data.

Michele Miranda, Xinlan Yan, Nishant Mishra et al.

Protecting patient privacy in clinical narratives is essential for enabling secondary use of healthcare data under regulations such as GDPR and HIPAA. While manual de-identification remains the gold standard, it is costly and slow, motivating the need for automated methods that combine privacy guarantees with high utility. Most automated text de-identification pipelines employed named entity recognition (NER) to identify protected entities for redaction. Although methods based on differential privacy (DP) provide formal privacy guarantees, more recently also large language models (LLMs) are increasingly used for text de-identification in the clinical domain. In this work, we present the first comparative study of DP, NER, and LLMs for Dutch clinical text de-identification. We investigate these methods separately as well as hybrid strategies that apply NER or LLM preprocessing prior to DP, and assess performance in terms of privacy leakage and extrinsic evaluation (entity and relation classification). We show that DP mechanisms alone degrade utility substantially, but combining them with linguistic preprocessing, especially LLM-based redaction, significantly improves the privacy-utility trade-off.

Giovanni Cinà, Daniel Fernandez-Llaneza, Ludovico Deponte et al.

Feature attribution methods have become a staple method to disentangle the complex behavior of black box models. Despite their success, some scholars have argued that such methods suffer from a serious flaw: they do not allow a reliable interpretation in terms of human concepts. Simply put, visualizing an array of feature contributions is not enough for humans to conclude something about a model's internal representations, and confirmation bias can trick users into false beliefs about model behavior. We argue that a structured approach is required to test whether our hypotheses on the model are confirmed by the feature attributions. This is what we call the "semantic match" between human concepts and (sub-symbolic) explanations. Building on the conceptual framework put forward in Cinà et al. [2023], we propose a structured approach to evaluate semantic match in practice. We showcase the procedure in a suite of experiments spanning tabular and image data, and show how the assessment of semantic match can give insight into both desirable (e.g., focusing on an object relevant for prediction) and undesirable model behaviors (e.g., focusing on a spurious correlation). We couple our experimental results with an analysis on the metrics to measure semantic match, and argue that this approach constitutes the first step towards resolving the issue of confirmation bias in XAI.

Nishant Mishra, Wilker Aziz, Iacer Calixto

Progress in biomedical Named Entity Recognition (NER) and Entity Linking (EL) is currently hindered by a fragmented data landscape, a lack of resources for building explainable models, and the limitations of semantically-blind evaluation metrics. To address these challenges, we present MedPath, a large-scale and multi-domain biomedical EL dataset that builds upon nine existing expert-annotated EL datasets. In MedPath, all entities are 1) normalized using the latest version of the Unified Medical Language System (UMLS), 2) augmented with mappings to 62 other biomedical vocabularies and, crucially, 3) enriched with full ontological paths -- i.e., from general to specific -- in up to 11 biomedical vocabularies. MedPath directly enables new research frontiers in biomedical NLP, facilitating training and evaluation of semantic-rich and interpretable EL systems, and the development of the next generation of interoperable and explainable clinical NLP models.

Arijit Maji, Raghvendra Kumar, Akash Ghosh et al.

We introduce DRISHTIKON, a first-of-its-kind multimodal and multilingual benchmark centered exclusively on Indian culture, designed to evaluate the cultural understanding of generative AI systems. Unlike existing benchmarks with a generic or global scope, DRISHTIKON offers deep, fine-grained coverage across India's diverse regions, spanning 15 languages, covering all states and union territories, and incorporating over 64,000 aligned text-image pairs. The dataset captures rich cultural themes including festivals, attire, cuisines, art forms, and historical heritage amongst many more. We evaluate a wide range of vision-language models (VLMs), including open-source small and large models, proprietary systems, reasoning-specialized VLMs, and Indic-focused models, across zero-shot and chain-of-thought settings. Our results expose key limitations in current models' ability to reason over culturally grounded, multimodal inputs, particularly for low-resource languages and less-documented traditions. DRISHTIKON fills a vital gap in inclusive AI research, offering a robust testbed to advance culturally aware, multimodally competent language technologies.

Rachel M. Murphy, Nishant Mishra, Nicolette F. de Keizer et al.

In this study, we establish a benchmark for adverse drug event (ADE) detection in Dutch clinical free-text documents using several transformer models, clinical scenarios, and fit-for-purpose performance measures. We trained a Bidirectional Long Short-Term Memory (Bi-LSTM) model and four transformer-based Dutch and/or multilingual encoder models (BERTje, RobBERT, MedRoBERTa(.)nl, and NuNER) for the tasks of named entity recognition (NER) and relation classification (RC) using 102 richly annotated Dutch ICU clinical progress notes. Anonymized free-text clinical progress notes of patients admitted to the intensive care unit (ICU) of one academic hospital and discharge letters of patients admitted to Internal Medicine wards of two non-academic hospitals were reused. We evaluated our ADE RC models internally using the gold standard (two-step task) and predicted entities (end-to-end task). In addition, all models were externally validated for detecting ADEs at the document level. We report both micro- and macro-averaged F1 scores, given the dataset imbalance in ADEs. Although differences for the ADE RC task between the models were small, MedRoBERTa(.)nl was the best performing model with a macro-averaged F1 score of 0.63 using the gold standard and 0.62 using predicted entities. The MedRoBERTa(.)nl models also performed the best in our external validation and achieved a recall of between 0.67 to 0.74 using predicted entities, meaning between 67 to 74% of discharge letters with ADEs were detected. Our benchmark study presents a robust and clinically meaningful approach for evaluating language models for ADE detection in clinical free-text documents. Our study highlights the need to use appropriate performance measures fit for the task of ADE detection in clinical free-text documents and envisioned future clinical use.