Adapting general-purpose LLMs into domain-specialized dense retrievers typically requires large-scale training on mixed-domain data. We show that merging independently trained domain-specialized experts consistently exceeds this approach across four decoder-only LLM families (0.6B–7B), four merging methods, and twelve medical and general retrieval tasks from MTEB, suggesting that parameter-space composition captures complementary domain strengths that large-scale mixed-domain training averages out. To further maximize expert quality, we introduce Synthesize-Train-Merge (STM), a modular framework that synthesizes hard negatives with a top-tier LLM and fine-tunes domain-specialized experts via LoRA before merging them, without continual pre-training. Synthesized hard negatives yield the largest gains for smaller models, and STM achieves strong performance on biomedical retrieval tasks while maintaining competitive general-domain results across all four backbone families.

Medical guidelines encode rich, evidence-based decision logic, yet the specific decision artifact a clinician needs is hard to locate within a guideline, let alone across guidelines covering plausible diseases and treatments. While guideline passages have supported end-to-end question answering, flowcharts remain largely underused in decision support despite their ability to encode actionable clinical pathways. We therefore introduce Case2Flow, a task designed to retrieve the most relevant guideline flowchart for a given patient case from a collection of guideline documents. To support it, we construct FlowAtlas, a curated corpus of 202 flowcharts extracted from 2,080 medical guidelines, together with a pipeline that synthesises 1,911 aligned case-flowchart pairs. Our evaluation of multimodal retrieval methods reveals systematic failure modes, including overreliance on keywords and spurious token-patch matches induced by uninformative background regions in flowcharts. Motivated by this, we propose CRISP, a training-free scoring method that sharpens late-interaction retrieval by suppressing uninformative patches, discounting ambiguous token matches, and incorporating bidirectional query-image alignment. CRISP improves Recall@1 by up to 18.71 percentage points, while a blinded physician assessment on published case narratives provides preliminary feasibility evidence beyond synthetic queries.

Large Language Models (LLMs) hold significant potential for improving healthcare applications, with biomedically adapted models promising enhanced performance on medical tasks. However, the effectiveness of biomedical domain adaptation for clinical tasks remains uncertain. In this study, we conduct a direct comparison of 12 biomedically adapted models and their general-domain base counterparts across six clinical tasks. Our results reveal that 11 out of 12 biomedical models exhibit performance declines, challenging prior findings that reported positive effects of biomedical adaptation. Notably, previous positive results primarily relied on multiple-choice evaluations, which may not reflect performance in real-world clinical applications. To promote reproducibility and further research, we open-source our evaluation pipeline, providing a resource for the development of models with practical benefits in healthcare settings.

While increasing patients’ access to medical documents improves medical care, this benefit is limited by varying health literacy levels and complex medical terminology. Large language models (LLMs) offer solutions by simplifying medical information. However, evaluating LLMs for safe and patient-friendly text generation is difficult due to the lack of standardized evaluation resources. To fill this gap, we developed MeDiSumQA. MeDiSumQA is a dataset created from MIMIC-IV discharge summaries through an automated pipeline combining LLM-based question-answer generation with manual quality checks. We use this dataset to evaluate various LLMs on patient-oriented question-answering. Our findings reveal that general-purpose LLMs frequently surpass biomedical-adapted models, while automated metrics correlate with human judgment. By releasing MeDiSumQA on PhysioNet, we aim to advance the development of LLMs to enhance patient understanding and ultimately improve care outcomes.