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When Metrics Disagree: Automatic Similarity vs. LLM-as-a-Judge for Clinical Dialogue Evaluation
Authors:
Bian Sun,
Zhenjian Wang,
Orvill de la Torre,
Zirui Wang
Abstract:
As Large Language Models (LLMs) are increasingly integrated into healthcare to address complex inquiries, ensuring their reliability remains a critical challenge. Recent studies have highlighted that generic LLMs often struggle in clinical contexts, occasionally producing misleading guidance. To mitigate these risks, this research focuses on the domain-specific adaptation of \textbf{Llama-2-7B} us…
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As Large Language Models (LLMs) are increasingly integrated into healthcare to address complex inquiries, ensuring their reliability remains a critical challenge. Recent studies have highlighted that generic LLMs often struggle in clinical contexts, occasionally producing misleading guidance. To mitigate these risks, this research focuses on the domain-specific adaptation of \textbf{Llama-2-7B} using the \textbf{Low-Rank Adaptation (LoRA)} technique. By injecting trainable low-rank matrices into the Transformer layers, we efficiently adapted the model using authentic patient-physician transcripts while preserving the foundational knowledge of the base model. Our objective was to enhance precision and contextual relevance in responding to medical queries by capturing the specialized nuances of clinical discourse.
Due to the resource-intensive nature of large-scale human validation, the model's performance was evaluated through a dual-track framework: \textbf{Track A} utilized traditional lexical similarity metrics (e.g., BLEU, ROUGE), while \textbf{Track B} employed an "LLM-as-a-Judge" paradigm using GPT-4 for semantic assessment. Our results demonstrate that while the LoRA-enhanced model achieved significant improvements across all quantitative lexical dimensions, a profound disagreement surfaced in the GPT-4 evaluation, which marginally favored the baseline model's conversational flow. This metric divergence underscores a pivotal finding: traditional automated scores may not fully reflect clinical utility. Consequently, we propose that while automated metrics and LLM judges serve as valuable developmental proxies, rigorous validation by human medical experts remains an indispensable requirement for the safe deployment of LLMs in healthcare settings.
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Submitted 31 March, 2026; v1 submitted 27 February, 2026;
originally announced March 2026.
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Code Simulation as a Proxy for High-order Tasks in Large Language Models
Authors:
Emanuele La Malfa,
Christoph Weinhuber,
Orazio Torre,
Fangru Lin,
X. Angelo Huang,
Samuele Marro,
Anthony Cohn,
Nigel Shadbolt,
Michael Wooldridge
Abstract:
Many reasoning, planning, and problem-solving tasks share an intrinsic algorithmic nature: correctly simulating each step is a sufficient condition to solve them correctly. We collect pairs of naturalistic and synthetic reasoning tasks to assess the capabilities of Large Language Models (LLM). While naturalistic tasks often require careful human handcrafting, we show that synthetic data is, in man…
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Many reasoning, planning, and problem-solving tasks share an intrinsic algorithmic nature: correctly simulating each step is a sufficient condition to solve them correctly. We collect pairs of naturalistic and synthetic reasoning tasks to assess the capabilities of Large Language Models (LLM). While naturalistic tasks often require careful human handcrafting, we show that synthetic data is, in many cases, a good proxy that is much easier to collect at scale. We leverage common constructs in programming as the counterpart of the building blocks of naturalistic reasoning tasks, such as straight-line programs, code that contains critical paths, and approximate and redundant instructions. We further assess the capabilities of LLMs on sorting problems and repeated operations via sorting algorithms and nested loops. Our synthetic datasets further reveal that while the most powerful LLMs exhibit relatively strong execution capabilities, the process is fragile: it is negatively affected by memorisation and seems to rely heavily on pattern recognition. Our contribution builds upon synthetically testing the reasoning capabilities of LLMs as a scalable complement to handcrafted human-annotated problems.
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Submitted 4 July, 2025; v1 submitted 5 February, 2025;
originally announced February 2025.
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Code Simulation Challenges for Large Language Models
Authors:
Emanuele La Malfa,
Christoph Weinhuber,
Orazio Torre,
Fangru Lin,
Samuele Marro,
Anthony Cohn,
Nigel Shadbolt,
Michael Wooldridge
Abstract:
Many reasoning, planning, and problem-solving tasks share an intrinsic algorithmic nature: correctly simulating each step is a sufficient condition to solve them correctly. This work studies to what extent Large Language Models (LLMs) can simulate coding and algorithmic tasks to provide insights into general capabilities in such algorithmic reasoning tasks. We introduce benchmarks for straight-lin…
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Many reasoning, planning, and problem-solving tasks share an intrinsic algorithmic nature: correctly simulating each step is a sufficient condition to solve them correctly. This work studies to what extent Large Language Models (LLMs) can simulate coding and algorithmic tasks to provide insights into general capabilities in such algorithmic reasoning tasks. We introduce benchmarks for straight-line programs, code that contains critical paths, and approximate and redundant instructions. We further assess the simulation capabilities of LLMs with sorting algorithms and nested loops and show that a routine's computational complexity directly affects an LLM's ability to simulate its execution. While the most powerful LLMs exhibit relatively strong simulation capabilities, the process is fragile, seems to rely heavily on pattern recognition, and is affected by memorisation. We propose a novel off-the-shelf prompting method, Chain of Simulation (CoSm), which instructs LLMs to simulate code execution line by line/follow the computation pattern of compilers. CoSm efficiently helps LLMs reduce memorisation and shallow pattern recognition while improving simulation performance. We consider the success of CoSm in code simulation to be inspirational for other general routine simulation reasoning tasks.
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Submitted 12 June, 2024; v1 submitted 17 January, 2024;
originally announced January 2024.