Title:Route, Don't Fix: Regime-Dependent Decoding Correction and a Trajectory-Gated Router for Reliable Clinical LLM Answer Selection

Abstract:Large language models (LLMs) are often deemed unsafe for clinical question answering because of their tendency to hallucinate. Retrieval augmentation, fine-tuning, and external verifiers require new infrastructure that clinical governance must approve and may add latency or extra model calls. Inference-time correction uses the model's internal logit signals, but a fixed transformation need not suit every question. A corrector that improves accuracy by about ten percentage points on a truthfulness stress test yields negligible gains on clinical multiple-choice benchmarks, where instruction tuning concentrates output probability on one answer and leaves low terminal entropy. We introduce ALTAS, which reads terminal entropy and late-layer linearity ($R^2$) from one forward pass to choose per question between greedy decoding and late-layer trajectory correction. No classifier, probe, or head is trained; the router operates on candidate-answer logits and adds 6.5% latency overhead. Applied to every question, the correction improves TruthfulQA over greedy at 3B and 8B by 11.4 and 10.0 percentage points, respectively ($p<10^{-10}$). Gated per question, ALTAS retains gains of 8.3 to 9.5 percentage points while keeping MedQA, PubMedQA, and MedHallu within a one-percentage-point do-no-harm band, with no statistically significant differences from greedy. The method passes verification sweeps over frozen thresholds, the scoring rule, and the domain label.

Bookmark

Bibliographic and Citation Tools

Code, Data and Media Associated with this Article

Demos

Recommenders and Search Tools