Acoustic foundation models, fine-tuned for Automatic Speech Recognition (ASR), suffer from performance degradation in wild acoustic test settings when deployed in real-world scenarios. Stabilizing online Test-Time Adaptation (TTA) under these conditions remains an open and unexplored question. Existing wild vision TTA methods often fail to handle speech data effectively due to the unique characteristics of high-entropy speech frames, which are unreliably filtered out even when containing crucial semantic content. Furthermore, unlike static vision data, speech signals follow short-term consistency, requiring specialized adaptation strategies. In this work, we propose a novel wild acoustic TTA method tailored for ASR fine-tuned acoustic foundation models. Our method, Confidence-Enhanced Adaptation, performs frame-level adaptation using a confidence-aware weight scheme to avoid filtering out essential information in high-entropy frames. Additionally, we apply consistency regularization during test-time optimization to leverage the inherent short-term consistency of speech signals. Our experiments on both synthetic and real-world datasets demonstrate that our approach outperforms existing baselines under various wild acoustic test settings, including Gaussian noise, environmental sounds, accent variations, and sung speech.

Traditional applications of natural language processing (NLP) in healthcare have predominantly focused on patient-centered services, enhancing patient interactions and care delivery, such as through medical dialogue systems. However, the potential of NLP to benefit inexperienced doctors, particularly in areas such as communicative medical coaching, remains largely unexplored. We introduce “ChatCoach”, a human-AI cooperative framework designed to assist medical learners in practicing their communication skills during patient consultations. ChatCoach differentiates itself from conventional dialogue systems by offering a simulated environment where medical learners can practice dialogues with a patient agent, while a coach agent provides immediate, structured feedback. This is facilitated by our proposed Generalized Chain-of-Thought (GCoT) approach, which fosters the generation of structured feedback and enhances the utilization of external knowledge sources. Additionally, we have developed a dataset specifically for evaluating Large Language Models (LLMs) within the ChatCoach framework on communicative medical coaching tasks. Our empirical results validate the effectiveness of ChatCoach.