Thanni Adewuyi, Anuoluwa Sotome, Samuel Okoko +6cs.CL cs.LG
Large language models achieve strong scores on medical benchmarks, yet these benchmarks evaluate each question in isolation, providing no measure of whether a system can distinguish clinically similar presentations requiring different interventions. We introduce MamaBench, the first counterfactual benchmark for maternal and paediatric AI: 434 expert-authored clinical narratives in 217 pairs across 371 pathologies, evaluated via the Bias Trap Rate (BTR), the conditional probability that a model fails the counterfactual given success on the base case. We propose Evidence-Anchored RAG (EA-RAG), a three-stage retrieval method that replaces aggregate similarity with an evidence coverage objective through clinical parameter extraction, coverage auditing, and contrastive sub-queries. Across eight configurations of four frontier LLMs, base accuracy overstates robust accuracy by 16-28 percentage points in every model. EA-RAG achieves 20.3% BTR and 65.0% robust accuracy on Claude Sonnet 4.6, a 5.5 percentage point BTR reduction without degrading base accuracy. The residual 20% BTR confirms that counterfactual robustness in clinical AI remains an open challenge. Keywords: counterfactual evaluation, clinical AI, maternal healthcare, retrieval-augmented generation, diagnostic robustness
Large Vision-Language Models (LVLMs) show strong visualization interpretation, yet it is unclear whether their responses reflect genuine reasoning over visual evidence or factual priors learned during training. Current evaluations mix these two sources, obscuring when correct visual interpretation is overridden by memorized facts. We present a framework that isolates visual correctness from factual correctness, revealing validity limitations in existing visualization literacy assessments. Across three experiments with 15 state-of-the-art LVLMs: (1) several models reach human-level performance on standard tests (VLAT), but this may reflect factual recall rather than visual understanding, while randomized-data tests (reVLAT) underestimate literacy when correct visual interpretation is superseded by factual priors. (2) Using our Counterfactual Visualization Literacy Assessment Test (CVLAT) with capability-normalized arbitration metrics, we classify models by the sign of their visual-factual reliance index (VFRI), revealing a visualization-oriented majority and a factual knowledge-oriented minority, though several near-zero cases warrant caution. A human baseline (N=30) on the same counterfactual items confirms that people overwhelmingly follow the chart under conflict, providing a human reference point. (3) Prompt-based intervention can shift prioritization, but its effectiveness is highly model-dependent and direction-asymmetric, and high chart-reading capability does not predict prompt-controllability. Overall, high visualization accuracy is not sufficient evidence of faithful visual reasoning: reliable integration into visual analytics requires evaluating not only visualization literacy but also how models arbitrate between visual evidence and factual priors when the two diverge. Benchmark and code: https://github.com/JaeyoungKim-HCIL/CVLAT