# VeriSim: A Configurable Framework for Stress-Testing Medical AI Under Patient Communication Noise

arXiv: https://arxiv.org/abs/2604.10441 · HTML: https://mlsanity.com/paper/2604.10441/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 15 of its 42 references that are in the map.
- First posted on arXiv 12 Apr 2026.

## Builds on (most cited first, 15 of 15)

- [The Llama 3 Herd of Models](https://mlsanity.com/paper/2407.21783/) (2024)
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- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [What Disease does this Patient Have? A Large-scale Open Domain Question Answering Dataset from Medical Exams](https://mlsanity.com/paper/2009.13081/) (2020)
- [PubMedQA: A Dataset for Biomedical Research Question Answering](https://mlsanity.com/paper/1909.06146/) (2019)
- [CTRL: A Conditional Transformer Language Model for Controllable Generation](https://mlsanity.com/paper/1909.05858/) (2019)
- [ChatDoctor: A Medical Chat Model Fine-Tuned on a Large Language Model Meta-AI (LLaMA) Using Medical Domain Knowledge](https://mlsanity.com/paper/2303.14070/) (2023)
- [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)
- [AgentClinic: a multimodal agent benchmark to evaluate AI in simulated clinical environments](https://mlsanity.com/paper/2405.07960/) (2024)
- [DDXPlus: A New Dataset For Automatic Medical Diagnosis](https://mlsanity.com/paper/2205.09148/) (2022)
- [Automatic Interactive Evaluation for Large Language Models with State Aware Patient Simulator](https://mlsanity.com/paper/2403.08495/) (2024)
- [PatientSim: A Persona-Driven Simulator for Realistic Doctor-Patient Interactions](https://mlsanity.com/paper/2505.17818/) (2025)
- [LLMs Can Simulate Standardized Patients via Agent Coevolution](https://mlsanity.com/paper/2412.11716/) (2024)

## Abstract (arXiv)

Medical large language models are typically evaluated on idealized patient cases that do not reflect how real patients communicate. We introduce VeriSim, a patient simulation framework that injects controllable noise along six clinically grounded communication dimensions while substantially preserving each patient's medical record. Truth adherence is supported by a verifier that extracts atomic claims from each candidate utterance and judges them against a UMLS-grounded vector index built with BioLORD embeddings, using the retrieved atoms' structured clinical metadata (e.g., drug class, anatomical site, treats-condition relations) rather than surface-text similarity alone. Across seven open-weight LLMs, realistic noise reduces diagnostic accuracy by 15-25 percentage points and increases conversation length by 34-55%; the 7-8B models degrade 1.4x more than 70B+ models. A board-certified physician and a licensed nurse rate VeriSim's conversations highly on truth, realism, clinical utility, and noise fidelity (inter-annotator agreement >= 0.80 across all dimensions), and an LLM-as-judge closely tracks their ratings, enabling scalable evaluation. We release VeriSim as an open-source framework for rigorous stress-testing of clinical AI: https://github.com/mohitmarvania/VeriSim