# Measuring Stability Beyond Accuracy in Small Open-Source Medical Large Language Models for Pediatric Endocrinology

arXiv: https://arxiv.org/abs/2601.11567 · HTML: https://mlsanity.com/paper/2601.11567/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 12 of its 29 references that are in the map.
- First posted on arXiv 26 Dec 2025.

## Builds on (most cited first, 12 of 12)

- [The Llama 3 Herd of Models](https://mlsanity.com/paper/2407.21783/) (2024)
- [BLOOM: A 176B-Parameter Open-Access Multilingual Language Model](https://mlsanity.com/paper/2211.05100/) (2022)
- [LLM Evaluators Recognize and Favor Their Own Generations](https://mlsanity.com/paper/2404.13076/) (2024)
- [HuatuoGPT-o1, Towards Medical Complex Reasoning with LLMs](https://mlsanity.com/paper/2412.18925/) (2024)
- [Self-Preference Bias in LLM-as-a-Judge](https://mlsanity.com/paper/2410.21819/) (2024)
- [Pride and Prejudice: LLM Amplifies Self-Bias in Self-Refinement](https://mlsanity.com/paper/2402.11436/) (2024)
- [ClinicalGPT: Large Language Models Finetuned with Diverse Medical Data and Comprehensive Evaluation](https://mlsanity.com/paper/2306.09968/) (2023)
- [Can multiple-choice questions really be useful in detecting the abilities of LLMs?](https://mlsanity.com/paper/2403.17752/) (2024)
- [Exploring the Impact of Temperature on Large Language Models:Hot or Cold?](https://mlsanity.com/paper/2506.07295/) (2025)
- [Polaris: A Safety-focused LLM Constellation Architecture for Healthcare](https://mlsanity.com/paper/2403.13313/) (2024)
- [A Study on Large Language Models' Limitations in Multiple-Choice Question Answering](https://mlsanity.com/paper/2401.07955/) (2024)
- [Accuracy and Consistency of LLMs in the Registered Dietitian Exam: The Impact of Prompt Engineering and Knowledge Retrieval](https://mlsanity.com/paper/2408.02964/) (2024)

## Abstract (arXiv)

Small open-source medical large language models (LLMs) offer promising opportunities for low-resource deployment and broader accessibility. However, their evaluation is often limited to accuracy on medical multiple choice question (MCQ) benchmarks, and lacks evaluation of consistency, robustness, or reasoning behavior. We use MCQ coupled to human evaluation and clinical review to assess six small open-source medical LLMs (HuatuoGPT-o1 (Chen 2024), Diabetica-7B, Diabetica-o1 (Wei 2024), Meditron3-8B (Sallinen2025), MedFound-7B (Liu 2025), and ClinicaGPT-base-zh (Wang 2023)) in pediatric endocrinology. In deterministic settings, we examine the effect of prompt variation on models' output and self-assessment bias. In stochastic settings, we evaluate output variability and investigate the relationship between consistency and correctness. HuatuoGPT-o1-8B achieved the highest performance. The results show that high consistency across the model response is not an indicator of correctness, although HuatuoGPT-o1-8B showed the highest consistency rate. When tasked with selecting correct reasoning, both HuatuoGPT-o1-8B and Diabetica-o1 exhibit self-assessment bias and dependency on the order of the candidate explanations. Expert review of incorrect reasoning rationales identified a mix of clinically acceptable responses and clinical oversight. We further show that system-level perturbations, such as differences in CUDA builds, can yield statistically significant shifts in model output despite stable accuracy. This work demonstrates that small, semantically negligible prompt perturbations lead to divergent outputs, raising concerns about reproducibility of LLM-based evaluations and highlights the output variability under different stochastic regimes, emphasizing the need of a broader diagnostic framework to understand potential pitfalls in real-world clinical decision support scenarios.