# Assessing and Mitigating Medical Knowledge Drift and Conflicts in Large Language Models

arXiv: https://arxiv.org/abs/2505.07968 · HTML: https://mlsanity.com/paper/2505.07968/

## Key facts

- Cited by 4 papers in the map (data through 14 Oct 2026).
- Builds on 20 of its 45 references that are in the map.
- First posted on arXiv 12 May 2025.

## Builds on (most cited first, 20 of 20)

- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [Training language models to follow instructions with human feedback](https://mlsanity.com/paper/2203.02155/) (2022)
- [Proximal Policy Optimization Algorithms](https://mlsanity.com/paper/1707.06347/) (2017)
- [LLaMA: Open and Efficient Foundation Language Models](https://mlsanity.com/paper/2302.13971/) (2023)
- [Retrieval-Augmented Generation for Knowledge-Intensive NLP Tasks](https://mlsanity.com/paper/2005.11401/) (2020)
- [Sentence-BERT: Sentence Embeddings using Siamese BERT-Networks](https://mlsanity.com/paper/1908.10084/) (2019)
- [Direct Preference Optimization: Your Language Model is Secretly a Reward Model](https://mlsanity.com/paper/2305.18290/) (2023)
- [Qwen2.5 Technical Report](https://mlsanity.com/paper/2412.15115/) (2024)
- [Scaling Instruction-Finetuned Language Models](https://mlsanity.com/paper/2210.11416/) (2022)
- [Gemma 2: Improving Open Language Models at a Practical Size](https://mlsanity.com/paper/2408.00118/) (2024)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [Mixtral of Experts](https://mlsanity.com/paper/2401.04088/) (2024)
- [MiniLM: Deep Self-Attention Distillation for Task-Agnostic Compression of Pre-Trained Transformers](https://mlsanity.com/paper/2002.10957/) (2020)
- [Adaptive Chameleon or Stubborn Sloth: Revealing the Behavior of Large Language Models in Knowledge Conflicts](https://mlsanity.com/paper/2305.13300/) (2023)
- [Knowledge Conflicts for LLMs: A Survey](https://mlsanity.com/paper/2403.08319/) (2024)
- [Can large language models reason about medical questions?](https://mlsanity.com/paper/2207.08143/) (2022)
- [Rich Knowledge Sources Bring Complex Knowledge Conflicts: Recalibrating Models to Reflect Conflicting Evidence](https://mlsanity.com/paper/2210.13701/) (2022)
- [Med42-v2: A Suite of Clinical LLMs](https://mlsanity.com/paper/2408.06142/) (2024)
- [Large Language Models to Identify Social Determinants of Health in Electronic Health Records](https://mlsanity.com/paper/2308.06354/) (2023)
- [Superficial Self-Improved Reasoners Benefit from Model Merging](https://mlsanity.com/paper/2503.02103/) (2025)

## Built on by (most cited first, 4 of 4)

- [Large Language Models Lack Temporal Awareness of Medical Knowledge](https://mlsanity.com/paper/2605.13045/) (2026)
- [CRAFT: Causal Responsibility and Failure Tracing in Medical Vision Language Models](https://mlsanity.com/paper/2609.38810/) (2026)
- [RAGe: A Retrieval-Augmented Generation Evaluation Framework](https://mlsanity.com/paper/2605.27445/) (2026)
- [Suppressing Pressure, Amplifying Evidence: Self-Guided Attention Steering to Mitigate Sycophancy and Stubbornness](https://mlsanity.com/paper/2610.04329/) (2026)

## Abstract (arXiv)

Large Language Models (LLMs) have great potential in the field of health care, yet they face great challenges in adapting to rapidly evolving medical knowledge. This can lead to outdated or contradictory treatment suggestions. This study investigated how LLMs respond to evolving clinical guidelines, focusing on concept drift and internal inconsistencies. We developed the DriftMedQA benchmark to simulate guideline evolution and assessed the temporal reliability of various LLMs. Our evaluation of seven state-of-the-art models across 4,290 scenarios demonstrated difficulties in rejecting outdated recommendations and frequently endorsing conflicting guidance. Additionally, we explored two mitigation strategies: Retrieval-Augmented Generation and preference fine-tuning via Direct Preference Optimization. While each method improved model performance, their combination led to the most consistent and reliable results. These findings underscore the need to improve LLM robustness to temporal shifts to ensure more dependable applications in clinical practice. The dataset is available at https://huggingface.co/datasets/RDBH/DriftMed.