# Enabling Scalable Evaluation of Bias Patterns in Medical LLMs

arXiv: https://arxiv.org/abs/2410.14763 · HTML: https://mlsanity.com/paper/2410.14763/

## Key facts

- Cited by 5 papers in the map (data through 14 Oct 2026).
- Builds on 34 of its 60 references that are in the map.
- First posted on arXiv 18 Oct 2024.

## Builds on (most cited first, 30 of 34)

- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [The Llama 3 Herd of Models](https://mlsanity.com/paper/2407.21783/) (2024)
- [BART: Denoising Sequence-to-Sequence Pre-training for Natural Language Generation, Translation, and Comprehension](https://mlsanity.com/paper/1910.13461/) (2019)
- [BERTScore: Evaluating Text Generation with BERT](https://mlsanity.com/paper/1904.09675/) (2019)
- [Constitutional AI: Harmlessness from AI Feedback](https://mlsanity.com/paper/2212.08073/) (2022)
- [G-Eval: NLG Evaluation using GPT-4 with Better Human Alignment](https://mlsanity.com/paper/2303.16634/) (2023)
- [Retrieval-Augmented Generation for Large Language Models: A Survey](https://mlsanity.com/paper/2312.10997/) (2023)
- [Survey of Hallucination in Natural Language Generation](https://mlsanity.com/paper/2202.03629/) (2022)
- [BioBERT: a pre-trained biomedical language representation model for biomedical text mining](https://mlsanity.com/paper/1901.08746/) (2019)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [Red Teaming Language Models with Language Models](https://mlsanity.com/paper/2202.03286/) (2022)
- [Domain-Specific Language Model Pretraining for Biomedical Natural Language Processing](https://mlsanity.com/paper/2007.15779/) (2020)
- [Semantics derived automatically from language corpora contain human-like biases](https://mlsanity.com/paper/1608.07187/) (2016)
- [Large Language Models](https://mlsanity.com/paper/2307.05782/) (2023)
- [BARTScore: Evaluating Generated Text as Text Generation](https://mlsanity.com/paper/2106.11520/) (2021)
- [Bias and Fairness in Large Language Models: A Survey](https://mlsanity.com/paper/2309.00770/) (2023)
- [Dynabench: Rethinking Benchmarking in NLP](https://mlsanity.com/paper/2104.14337/) (2021)
- [GPTScore: Evaluate as You Desire](https://mlsanity.com/paper/2302.04166/) (2023)
- [MEDITRON-70B: Scaling Medical Pretraining for Large Language Models](https://mlsanity.com/paper/2311.16079/) (2023)
- [Adapted Large Language Models Can Outperform Medical Experts in Clinical Text Summarization](https://mlsanity.com/paper/2309.07430/) (2023)
- [Capabilities of Gemini Models in Medicine](https://mlsanity.com/paper/2404.18416/) (2024)
- [To Ship or Not to Ship: An Extensive Evaluation of Automatic Metrics for Machine Translation](https://mlsanity.com/paper/2107.10821/) (2021)
- [Towards Accurate Differential Diagnosis with Large Language Models](https://mlsanity.com/paper/2312.00164/) (2023)
- [BLEU is Not Suitable for the Evaluation of Text Simplification](https://mlsanity.com/paper/1810.05995/) (2018)
- [A Toolbox for Surfacing Health Equity Harms and Biases in Large Language Models](https://mlsanity.com/paper/2403.12025/) (2024)
- [Building a PubMed knowledge graph](https://mlsanity.com/paper/2005.04308/) (2020)
- [Knowledge Solver: Teaching LLMs to Search for Domain Knowledge from Knowledge Graphs](https://mlsanity.com/paper/2309.03118/) (2023)
- [Bias patterns in the application of LLMs for clinical decision support: A comprehensive study](https://mlsanity.com/paper/2404.15149/) (2024)
- [RefChecker: Reference-based Fine-grained Hallucination Checker and Benchmark for Large Language Models](https://mlsanity.com/paper/2405.14486/) (2024)
- [Healthcare Copilot: Eliciting the Power of General LLMs for Medical Consultation](https://mlsanity.com/paper/2402.13408/) (2024)

## Built on by (most cited first, 5 of 5)

- [FairMedQA: Benchmarking Bias in Large Language Models for Medical Question Answering](https://mlsanity.com/paper/2505.19562/) (2025)
- [ConTextual: Improving Clinical Text Summarization in LLMs with Context-preserving Token Filtering and Knowledge Graphs](https://mlsanity.com/paper/2504.16394/) (2025)
- [HyMaTE: A Hybrid Mamba and Transformer Model for EHR Representation Learning](https://mlsanity.com/paper/2509.24118/) (2025)
- [Toward Revealing Nuanced Biases in Medical LLMs](https://mlsanity.com/paper/2507.21176/) (2025)
- [Toward Better Assessment of LLMs' Performance in Clinical Error Detection](https://mlsanity.com/paper/2608.16643/) (2026)

## Abstract (arXiv)

Large language models (LLMs) have shown impressive potential in helping with numerous medical challenges. Deploying LLMs in high-stakes applications such as medicine, however, brings in many concerns. One major area of concern relates to biased behaviors of LLMs in medical applications, leading to unfair treatment of individuals. To pave the way for the responsible and impactful deployment of Med LLMs, rigorous evaluation is a key prerequisite. Due to the huge complexity and variability of different medical scenarios, existing work in this domain has primarily relied on using manually crafted datasets for bias evaluation. In this study, we present a new method to scale up such bias evaluations by automatically generating test cases based on rigorous medical evidence. We specifically target the challenges of a) domain-specificity of bias characterization, b) hallucinating while generating the test cases, and c) various dependencies between the health outcomes and sensitive attributes. To that end, we offer new methods to address these challenges integrated with our generative pipeline, using medical knowledge graphs, medical ontologies, and customized general LLM evaluation frameworks in our method. Through a series of extensive experiments, we show that the test cases generated by our proposed method can effectively reveal bias patterns in Med LLMs at larger and more flexible scales than human-crafted datasets. We publish a large bias evaluation dataset using our pipeline, which is dedicated to a few medical case studies. A live demo of our application for vignette generation is available at https://vignette.streamlit.app. Our code is also available at https://github.com/healthylaife/autofair.