Medical large language models are typically evaluated on idealized patient cases that do not reflect how real patients communicate. We introduce VeriSim, a patient simulation framework that injects controllable noise along six clinically grounded communication dimensions while substantially preserving each patient’s medical record. Truth adherence is supported by a verifier that extracts atomic claims from each candidate utterance and judges them against a UMLS-grounded vector index built with BioLORD embeddings, using the retrieved atoms’ structured clinical metadata (e.g., drug class, anatomical site, treats-condition relations) rather than surface-text similarity alone. Across seven open-weight LLMs, realistic noise reduces diagnostic accuracy by 15-25 percentage points and increases conversation length by 34-55%; the 7-8B models degrade 1.4x more than 70B+ models. A board-certified physician and a licensed nurse rate VeriSim’s conversations highly on truth, realism, clinical utility, and noise fidelity (inter-annotator agreement >=0.80 across all dimensions), and an LLM-as-judge closely tracks their ratings, enabling scalable evaluation.

Hallucinations—generating responses inconsistent with the visual input—remain a critical limitation of large vision-language models (LVLMs), especially in open-ended tasks such as image captioning and visual reasoning. In this work, we probe the layer-wise generation dynamics that drive hallucinations and propose a training-free mitigation strategy. Employing the Logit Lens, we examine how LVLMs construct next-token distributions across decoder layers, uncovering a pronounced commitment-depth gap: truthful tokens accumulate probability mass on their final candidates earlier than hallucinatory ones. Drawing on this discovery, we introduce Context Embedding injection (CEI), a lightweight method that harnesses the hidden state of the last input token—the context embedding—as a grounding signal to maintain visual fidelity throughout decoding and curb hallucinations. Evaluated on the CHAIR, AMBER, and MMHal-Bench benchmarks (with a maximum token length of 512), CEI outperforms state-of-the-art baselines across three LVLMs, with its dynamic variant yielding the lowest overall hallucination rates. By integrating novel mechanistic insights with a scalable intervention, this work advances the mitigation of hallucinations in LVLMs. Data and code are available at https://github.com/mehrdadfazli/CEI.