Abstract
The advent of large language models (LLMs) has sparked interest among educators across various fields, particularly in medical education. However, general-purpose pretrained LLMs may perform inadequately on medical examination questions without domain adaptation. Full fine-tuning of a pretrained LLM requires substantial computing resources, making it impractical for resource-constrained settings. In this work, we investigate a Composition to Augment Language Models (CALM) framework for medical domain adaptation in answering real-world medical examination questions. Specifically, we fine-tune a small pretrained language model on an open-ended medical question-answering dataset to inject medical domain knowledge, and then develop MedCALM by composing this medical-specialized augmenting model with an anchor LLM. Experiments on real-world medical exam question datasets show that MedCALM outperforms the compared baselines. The results indicate that using a multi-head cross-attention module to connect two LLMs improves performance on multiple-choice question answering. In addition, the selection of connected layers significantly affects the effectiveness of composition between the anchor and augmenting models. Our experiments suggest that cross-attention between the last few layers of the two models achieves promising performance.
| Original language | English |
|---|---|
| Article number | 100638 |
| Journal | Computers and Education: Artificial Intelligence |
| Volume | 11 |
| DOIs | |
| Publication status | Published - Dec 2026 |
Keywords
- Augmenting model
- Domain adaptation
- LLM composition
- Medical question answering
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