Small Language Models for Emergency Departments Decision Support: A Benchmark Study
Bibliographic record
Abstract
Large language models (LLMs) have become increasingly popular in medical domains to assist physicians with a variety of clinical and operational tasks. Given the fast-paced and high-stakes environment of emergency departments (EDs), small language models (SLMs), characterized by a reduction in parameter count compared to LLMs, offer significant potential due to their inherent reasoning capability and efficient performance. This enables SLMs to support physicians by providing timely and accurate information synthesis, thereby improving clinical decision-making and workflow efficiency. In this paper, we present a comprehensive benchmark designed to identify SLMs suited for ED decision support, taking into account both specialized medical expertise and broad general problem-solving capabilities. In our evaluations, we focus on SLMs that have been trained on a mixture of general-domain and medical corpora. A key motivation for emphasizing SLMs is the practical hardware limitations, operational cost constraints, and privacy concerns in the typical real-world deployments. Our benchmark datasets include MedMCQA, MedQA-4Options, and PubMedQA, with the medical abstracts dataset emulating tasks aligned with real ED physicians’ daily tasks. Experimental results reveal that general-domain SLMs surprisingly outperform their medically fine-tuned counterparts across these diverse benchmarks for ED. This indicates that for ED, specialized medical fine-tuning of the model may not be required.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".