A collective capability boundary in frontier large language models on guideline-conformant and case-specific oncology decision-making
Zhang ShengJinming LiWangyang ChenZhiwei BaoYu YoSean Wang
Sep 2026
Artificial Intelligence
Abstract
Large language models (LLMs) achieve high scores on medical knowledge examinations, yet real-world oncology is not a knowledge test--it is a sequence of guideline-pathway choices, escalation judgments, and commitments under uncertainty. Existing benchmarks largely measure factual recall, leaving open whether frontier LLMs share decision-path blind spots that combining models cannot fix. We built the Oncology Decision Boundary Benchmark (ODBB)--2,005 oncology decision points across NCCN guidelines and colorectal cancer cases--and evaluated nine frontier LLMs (four closed-source, five open-weight families) released between June 2025 and April 2026. A fully deterministic scorer (zero LLM inference) classified outputs into 14 failure types, independently validated by two oncologists (Cohen's weighted $\kappa$ = 0.939 and 0.790) on a 225-item stratified sample. Treating the nine as a pooled super-model, 42.1% (Wilson 95% CI 40.0--44.3%) of all items--35.7% of the 1,586 NCCN items and 66.4% of the 419 colorectal-cancer cases--were answered correctly by none, with failures concentrated in choosing between guideline pathways before reasoning within any: a consistent blind spot in clinical meta-judgment that likely requires architectural intervention rather than more training data. Two models tuned for decisiveness (GPT-5.5, Gemini 3.1 Pro Preview) made unsafe commitments three to five times more often than the seven cautious models without scoring higher. In 3--9% of items, models stated the correct next clinical step yet did not commit to it--failures of decision, not knowledge. Model quality is no longer the primary bottleneck for clinical LLM deployment; the binding constraint is the assumption that any single model can be the sole basis for a clinical decision. Progress requires architectures that detect when a model reaches its competence boundary and route the decision to a clinician.
GAOKAO-Bench is introduced, an intuitive benchmark that employs questions from the Chinese GAOKAO examination as test samples, including both subjective and objective questions that contribute a robust evaluation benchmark for future large language models and offers valuable insights into the advantages and limitations of such models.
Xiaotian Zhang, Chun-yan Li, Yi Zong et al.· arXiv.org· 216 citations· ⚡17
Various recent Artificial Intelligence (AI) system failures, some of which have made the global headlines, have highlighted issues in these systems. These failures have resulted in calls for more ethical AI systems that better take into account their effects on various stakeholders. However, implementing AI ethics into practice is still an on-going challenge. High-level guidelines for doing so exist, devised by governments and private organizations alike, but lack practicality for developers. To address this issue, in this paper, we present a method for implementing AI ethics. The method, ECCOLA, has been iteratively developed using a cyclical action design research approach. The method aims at making the high-level AI ethics principles more practical, making it possible for developers to more easily implement them in practice.
Ville Vakkuri, Kai-Kristian Kemell, P. Abrahamsson· EUROMICRO Conference on Soft...· 64 citations· ⚡6
This paper designs Markov decision processes (MDPs) for different combinatorial problems and proposes to train conditional GFlowNets to sample from the solution space and demonstrates that GFlowNet policies can efficiently find high-quality solutions.
Dinghuai Zhang, H. Dai, Esmeralda S. Whitammer et al.· Advances in Neural Informati...· 59 citations· ⚡8
Progress in the field of artificial intelligence has been accelerating rapidly in the past two decades. Various autonomous systems from purely digital ones to autonomous vehicles are being developed and deployed out on the field. As these systems exert a growing impact on society, ethics in relation to artificial intelligence and autonomous systems have recently seen growing attention among the academia. However, the current literature on the topic has focused almost exclusively on theory and more specifically on conceptualization in the area. To widen the body of knowledge in the area, we conduct an empirical study on the current state of practice in artificial intelligence ethics. We do so by means of a multiple case study of five case companies, the results of which indicate a gap between research and practice in the area. Based on our findings we propose ways to tackle the gap.
Ville Vakkuri, Kai-Kristian Kemell, Joni Kultanen et al.· arXiv.org· 56 citations· ⚡6
The growing influence and decision-making capacities of Autonomous systems and Artificial Intelligence in our lives force us to consider the values embedded in these systems. But how ethics should be implemented into these systems? In this study, the solution is seen on philosophical conceptualization as a framework to form practical implementation model for ethics of AI. To take the first steps on conceptualization main concepts used on the field needs to be identified. A keyword based Systematic Mapping Study (SMS) on the keywords used in AI and ethics was conducted to help in identifying, defying and comparing main concepts used in current AI ethics discourse. Out of 1062 papers retrieved SMS discovered 37 re-occurring keywords in 83 academic papers. We suggest that the focus on finding keywords is the first step in guiding and providing direction for future research in the AI ethics field.
Ville Vakkuri, P. Abrahamsson· International Conference on...· 39 citations· ⚡2
Artificial Intelligence (AI) systems exert a growing influence on our society. As they become more ubiquitous, their potential negative impacts also become evident through various real-world incidents. Following such early incidents, academic and public discussion on AI ethics has highlighted the need for implementing ethics in AI system development. However, little currently exists in the way of frameworks for understanding the practical implementation of AI ethics. In this paper, we discuss a research framework for implementing AI ethics in industrial settings. The framework presents a starting point for empirical studies into AI ethics but is still being developed further based on its practical utilization.
Ville Vakkuri, Kai-Kristian Kemell, P. Abrahamsson· Conference on Technology Eth...· 27 citations· ⚡3
