Benchmarking decision models against generative large language models on medical multiple-choice questions
TL;DR
Decision models offered resource advantages alongside lower peak accuracy; generative large language model configurations offered resource advantages alongside lower peak accuracy; selecting models for medical workflows requires considering probability quality and repeatability together with accuracy and the resources needed to detect and correct errors.
Abstract
Medical workflows often require selecting among predefined options. We compared 13 decision models with 15 generative large language model configurations, including different reasoning settings, using 1,273 four-option MedQA questions under text-only conditions. Accuracy ranged from 67.71% to 89.08% for decision models and from 78.32% to 96.86% for generative configurations. Among the tested configurations, Mercury Decide had the lowest mean final-attempt cost (USD 0.0069 per 1,000 questions), while Clef Omni had the shortest median request duration (0.291 seconds). Decision-model probabilities distinguished correct from incorrect answers, but error rates among answers assigned probabilities of at least 0.90 ranged from 1.71% to 12.77%. Answer agreement across three runs ranged from 92.30% to 100%, while probability repeatability varied. Decision models offered resource advantages alongside lower peak accuracy; selecting models for medical workflows requires considering probability quality and repeatability together with accuracy and the resources needed to detect and correct errors.
