Clinical prediction can saturate for two different reasons: a fitted learner may fail to extract available information, or the recorded variables may impose a population frontier. We separate these quantities through the \emph{learner gap} and the \emph{measurement-channel ceiling}. Optimal balanced accuracy is characterized by total-variation separation, yielding architecture invariance, a sharp partial-identification result under replacement contamination, a cross-fitted ceiling estimator, and exact conditions for multimodal decision improvement. We add two finite-sample diagnostics, namely a label-permutation optimism floor and an underfit curve, and validate the audit on three real cohorts: UCI readmission ($n=99{,}343$), BRFSS diabetes ($n=253{,}680$), and NHANES HbA1c ($n=10{,}219$). Well-tuned gradient boosting nearly reaches the estimated frontier in UCI and BRFSS, whereas deliberately or practically deficient learners retain large gaps. NHANES yields a null difference between questionnaire and measured marginal frontiers but a significant joint complementarity gain, refining the simplistic claim that an objective modality must dominate. Across all cohorts, modest AUROC gains coexist with substantially larger Bayes decision-flip rates, and several architectures estimate similar frontiers while their achieved balanced accuracy differs sharply. A PRISMA-guided synthesis of 104 clinical tasks then shows that the same channel-level regularities recur across more than 18 disease categories: a broad but non-universal structured-clinical region, diminishing same-channel gains across model families, and higher performance when measurement channels change. The framework converts saturation from an empirical observation into an auditable decision: improve the learner when headroom remains; improve measurement when it does not.
Yarin Udi, Tom Sharon-Shahak, Roee Masad +1cs.CV cs.LG
Medical world models commonly learn from multimodal recordings synchronized onto a fixed-rate grid. This preprocessing resamples each native stream onto a shared time axis. Each stream has an observation clock that governs when observations are emitted or updated. When this clock depends on the latent or acquisition state, it is endogenous. In such settings, synchronization may not be neutral and can erase task-relevant evidence before the model sees the data. We introduce a four-regime taxonomy that characterizes where the evidence needed to distinguish a target event or state survives. The relevant witness may remain in the sampled values, in grid-cell update patterns, in native timing, or only in an external acquisition channel. EndoClock operationalizes this taxonomy as a conservative pretraining audit. It reports the lowest witness-bearing representation supported by the available evidence, or unresolved when no regime can be established. We illustrate this failure in echocardiography, where B-mode video write-outs cease during pulsed-wave Doppler acquisition while the corresponding measurement events remain recorded only in an external acquisition log. This work is a preliminary failure alert and executable audit. Its practical message is to preserve the native observation process long enough to determine whether synchronization has erased information required by the intended task.