# TriageRA-CCF: Source-Side Clinical Confidence and Coverage Signals for Adaptive Rank Budgeting in Medical LLMs

arXiv: https://arxiv.org/abs/2606.29375 · HTML: https://mlsanity.com/paper/2606.29375/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 19 of its 25 references that are in the map.
- First posted on arXiv 28 Jun 2026.

## Builds on (most cited first, 19 of 19)

- [The Llama 3 Herd of Models](https://mlsanity.com/paper/2407.21783/) (2024)
- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [On Calibration of Modern Neural Networks](https://mlsanity.com/paper/1706.04599/) (2017)
- [Outrageously Large Neural Networks: The Sparsely-Gated Mixture-of-Experts Layer](https://mlsanity.com/paper/1701.06538/) (2017)
- [Switch Transformers: Scaling to Trillion Parameter Models with Simple and Efficient Sparsity](https://mlsanity.com/paper/2101.03961/) (2021)
- [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)
- [DoRA: Weight-Decomposed Low-Rank Adaptation](https://mlsanity.com/paper/2402.09353/) (2024)
- [MedMCQA : A Large-scale Multi-Subject Multi-Choice Dataset for Medical domain Question Answering](https://mlsanity.com/paper/2203.14371/) (2022)
- [Towards Expert-Level Medical Question Answering with Large Language Models](https://mlsanity.com/paper/2305.09617/) (2023)
- [LoraHub: Efficient Cross-Task Generalization via Dynamic LoRA Composition](https://mlsanity.com/paper/2307.13269/) (2023)
- [AdaLoRA: Adaptive Budget Allocation for Parameter-Efficient Fine-Tuning](https://mlsanity.com/paper/2303.10512/) (2023)
- [DyLoRA: Parameter Efficient Tuning of Pre-trained Models using Dynamic Search-Free Low-Rank Adaptation](https://mlsanity.com/paper/2210.07558/) (2022)
- [MixLoRA: Enhancing Large Language Models Fine-Tuning with LoRA-based Mixture of Experts](https://mlsanity.com/paper/2404.15159/) (2024)
- [CMB: A Comprehensive Medical Benchmark in Chinese](https://mlsanity.com/paper/2308.08833/) (2023)
- [When MOE Meets LLMs: Parameter Efficient Fine-tuning for Multi-task Medical Applications](https://mlsanity.com/paper/2310.18339/) (2023)
- [MoELoRA: Contrastive Learning Guided Mixture of Experts on Parameter-Efficient Fine-Tuning for Large Language Models](https://mlsanity.com/paper/2402.12851/) (2024)
- [IncreLoRA: Incremental Parameter Allocation Method for Parameter-Efficient Fine-tuning](https://mlsanity.com/paper/2308.12043/) (2023)
- [MING-MOE: Enhancing Medical Multi-Task Learning in Large Language Models with Sparse Mixture of Low-Rank Adapter Experts](https://mlsanity.com/paper/2404.09027/) (2024)

## Abstract (arXiv)

Medical large language models are commonly adapted with a fixed low-rank budget, even though medical questions differ substantially in confidence, clinical coverage, and cross-domain difficulty. We study adaptive rank budgeting for parameter-efficient medical question answering: for each question, the adapter decides whether to activate a small, medium, or large subset of LoRA rank channels. The central challenge is that a naive adaptive budget router can collapse to unstable choices or spend capacity without improving shifted benchmarks. We propose TriageRA-CCF, a source-side teacher for adaptive rank-budgeted LoRA. It combines three signals computed only from source training data: base-model answer confidence, metadata-cell clinical coverage, and a counterfactual close-miss proxy. These signals supervise a straight-through budget router over active ranks {2,4,8}, together with budget-cost, entropy, and rank-balance regularization. Under a matched CMB-source training protocol, TriageRA-CCF achieves the best average accuracy among LoRA, DoRA, and MoELoRA baselines on both Qwen3-8B and Llama3.1-8B. The gains are modest and non-uniform across benchmarks: +0.21 average points over the strongest external baseline on Qwen3-8B and +0.16 on Llama3.1-8B. Component ablations show that confidence, coverage, and counterfactual signals all provide useful budget supervision, but their combination is not monotonically best on every backbone.