arXiv:2611.12904v1 Announce Type: new Abstract: Large language models (LLMs) are increasingly being deployed in clinical documentation workflows, where clinicians review and edit their outputs before use. In principle, these clinician edits represent a scalable source of supervision for model training. In practice, not all edits represent actionable feedback: for instance, on data drawn from real-world deployment of an AI clinical documentation product, our review suggests that over 45% of edited outputs contain user-added information that is not directly supported by the inputs to the model. Naively fine-tuning on such edits risks teaching the model to hallucinate. In this paper, we develop a method to address this challenge. Given that real clinician edits on deployed documentation tools are not publicly available, we first develop a taxonomy of clinician-editing behaviors, informed by data from a deployed AI clinical documentation product. Then, we develop a method for generating semi-synthetic clinician-edit data, informed by our taxonomy, on a discharge-summary generation task based on MIMIC-III, a public dataset. Finally, we introduce simple filtering methods for identifying actionable edits, with accuracy evaluated by expert review. We show empirically, on our semi-synthetic dataset, that naive fine-tuning on raw edited output increases ungrounded content, while our approach of progressively filtering toward grounded edits enables improvement on clinician-alignment metrics while retaining faithfulness to the input context.
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