# To Adapt or not to Adapt, Rethinking the Value of Medical Knowledge-Aware Large Language Models

arXiv: https://arxiv.org/abs/2604.06854 · HTML: https://mlsanity.com/paper/2604.06854/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 12 of its 47 references that are in the map.
- First posted on arXiv 8 Apr 2026.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)

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

- [Llama 2: Open Foundation and Fine-Tuned Chat Models](https://mlsanity.com/paper/2307.09288/) (2023)
- [Qwen2.5 Technical Report](https://mlsanity.com/paper/2412.15115/) (2024)
- [Mistral 7B](https://mlsanity.com/paper/2310.06825/) (2023)
- [Magpie: Alignment Data Synthesis from Scratch by Prompting Aligned LLMs with Nothing](https://mlsanity.com/paper/2406.08464/) (2024)
- [BioMistral: A Collection of Open-Source Pretrained Large Language Models for Medical Domains](https://mlsanity.com/paper/2402.10373/) (2024)
- [MEDITRON-70B: Scaling Medical Pretraining for Large Language Models](https://mlsanity.com/paper/2311.16079/) (2023)
- [Clinical Camel: An Open Expert-Level Medical Language Model with Dialogue-Based Knowledge Encoding](https://mlsanity.com/paper/2305.12031/) (2023)
- [Answer, Assemble, Ace: Understanding How LMs Answer Multiple Choice Questions](https://mlsanity.com/paper/2407.15018/) (2024)
- [Biomedical Large Languages Models Seem not to be Superior to Generalist Models on Unseen Medical Data](https://mlsanity.com/paper/2408.13833/) (2024)
- [Efficiently Democratizing Medical LLMs for 50 Languages via a Mixture of Language Family Experts](https://mlsanity.com/paper/2410.10626/) (2024)
- [None of the Others: a General Technique to Distinguish Reasoning from Memorization in Multiple-Choice LLM Evaluation Benchmarks](https://mlsanity.com/paper/2502.12896/) (2025)
- [Large Language Models in Healthcare](https://mlsanity.com/paper/2503.04748/) (2025)

## Built on by (most cited first, 1 of 1)

- [MIRA-Ev:A Benchmark for Granular Evidence Detection and Relational Reasoning in Clinical Exams](https://mlsanity.com/paper/2607.19201/) (2026)

## Abstract (arXiv)

BACKGROUND: Recent studies have shown that domain-adapted large language models (LLMs) do not consistently outperform general-purpose counterparts on standard medical benchmarks, raising questions about the need for specialized clinical adaptation. METHODS: We systematically compare general and clinical LLMs on a diverse set of multiple choice clinical question answering tasks in English and Spanish. We introduce a perturbation based evaluation benchmark that probes model robustness, instruction following, and sensitivity to adversarial variations. Our evaluation includes, one-step and two-step question transformations, multi prompt testing and instruction guided assessment. We analyze a range of state-of-the-art clinical models and their general-purpose counterparts, focusing on Llama 3.1-based models. Additionally, we introduce Marmoka, a family of lightweight 8B-parameter clinical LLMs for English and Spanish, developed via continual domain-adaptive pretraining on medical corpora and instructions. RESULTS: The experiments show that clinical LLMs do not consistently outperform their general purpose counterparts on English clinical tasks, even under the proposed perturbation based benchmark. However, for the Spanish subsets the proposed Marmoka models obtain better results compared to Llama. CONCLUSIONS: Our results show that, under current short-form MCQA benchmarks, clinical LLMs offer only marginal and unstable improvements over general-purpose models in English, suggesting that existing evaluation frameworks may be insufficient to capture genuine medical expertise. We further find that both general and clinical models exhibit substantial limitations in instruction following and strict output formatting. Finally, we demonstrate that robust medical LLMs can be successfully developed for low-resource languages such as Spanish, as evidenced by the Marmoka models.