# Do Clinical Question Answering Systems Really Need Specialised Medical Fine Tuning?

arXiv: https://arxiv.org/abs/2601.12812 · HTML: https://mlsanity.com/paper/2601.12812/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 16 of its 25 references that are in the map.
- First posted on arXiv 19 Jan 2026.

## Builds on (most cited first, 16 of 16)

- [Self-Consistency Improves Chain of Thought Reasoning in Language Models](https://mlsanity.com/paper/2203.11171/) (2022)
- [Locating and Editing Factual Associations in GPT](https://mlsanity.com/paper/2202.05262/) (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)
- [PubMedQA: A Dataset for Biomedical Research Question Answering](https://mlsanity.com/paper/1909.06146/) (2019)
- [Domain-Specific Language Model Pretraining for Biomedical Natural Language Processing](https://mlsanity.com/paper/2007.15779/) (2020)
- [BioGPT: Generative Pre-trained Transformer for Biomedical Text Generation and Mining](https://mlsanity.com/paper/2210.10341/) (2022)
- [Large language models in healthcare and medical domain: A review](https://mlsanity.com/paper/2401.06775/) (2023)
- [A Corpus with Multi-Level Annotations of Patients, Interventions and Outcomes to Support Language Processing for Medical Literature](https://mlsanity.com/paper/1806.04185/) (2018)
- [Has this Fact been Edited? Detecting Knowledge Edits in Language Models](https://mlsanity.com/paper/2405.02765/) (2024)
- [Benchmarking Large Language Models for Cryptanalysis and Side-Channel Vulnerabilities](https://mlsanity.com/paper/2505.24621/) (2025)
- [Instruction Tuning and CoT Prompting for Contextual Medical QA with LLMs](https://mlsanity.com/paper/2506.12182/) (2025)
- [SHIELD: Classifier-Guided Prompting for Robust and Safer LVLMs](https://mlsanity.com/paper/2510.13190/) (2025)
- [We Think, Therefore We Align LLMs to Helpful, Harmless and Honest Before They Go Wrong](https://mlsanity.com/paper/2509.22510/) (2025)
- [Truth, Trust, and Trouble: Medical AI on the Edge](https://mlsanity.com/paper/2507.02983/) (2025)
- [Fairness Evaluation and Inference Level Mitigation in LLMs](https://mlsanity.com/paper/2510.18914/) (2025)

## Abstract (arXiv)

Clinical Question-Answering (CQA) industry systems are increasingly rely on Large Language Models (LLMs), yet their deployment is often guided by the assumption that domain-specific fine-tuning is essential. Although specialised medical LLMs such as BioBERT, BioGPT, and PubMedBERT remain popular, they face practical limitations including narrow coverage, high retraining costs, and limited adaptability. Efforts based on Supervised Fine-Tuning (SFT) have attempted to address these assumptions but continue to reinforce what we term the SPECIALISATION FALLACY-the belief that specialised medical LLMs are inherently superior for CQA. To address this assumption, we introduce MEDASSESS-X, a deployment-industry-oriented CQA framework that applies alignment at inference time rather than through SFT. MEDASSESS-X uses lightweight steering vectors to guide model activations toward medically consistent reasoning without updating model weights or requiring domain-specific retraining. This inference-time alignment layer stabilises CQA performance across both general-purpose and specialised medical LLMs, thereby resolving the SPECIALISATION FALLACY. Empirically, MEDASSESS-X delivers consistent gains across all LLM families, improving Accuracy by up to +6%, Factual Consistency by +7%, and reducing Safety Error Rate by as much as 50%.