Evidence map›Paper›PMID 40655536›Full record

ArticleJAMIA open2025

A study of calibration as a measurement of trustworthiness of large language models in biomedical natural language processing.

Rodrigo de Oliveira, Matthew Garber, James M Gwinnutt, Emaan Rashidi, Jwu-Hsuan Shantina Hwang, William Gilmour, Jay Nanavati, Khaldoun Zine El Abidine, Christina DeFilippo Mack

Abstract read
In one paragraph

Article in JAMIA open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Review
  2. Article
  3. Article
  4. Development and External Validation of a Large Language Model-Based Clinical Decision-Support System for Colonoscopy Surveillance Intervals.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2026
    Article
  5. Article
  6. Will large language models transform clinical prediction?Diagnostic and prognostic research · 2025
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Rodrigo de OliveiraIQVIA - Real World Solutions, London, W2 1AF, United Kingdom.ORCID https://orcid.org/0009-0008-4812-8106
Matthew GarberIQVIA - Real World Solutions, Boston, MA, 02210, United States.ORCID https://orcid.org/0009-0005-9863-6465
James M GwinnuttIQVIA - Real World Solutions, Reading, RG1 3JH, United Kingdom.ORCID https://orcid.org/0000-0002-1435-8797
Emaan RashidiIQVIA - Real World Solutions, Baltimore, MD, 21201, United States.
Jwu-Hsuan Shantina HwangIQVIA - Real World Solutions, Boston, MA, 02210, United States.
William GilmourIQVIA - Real World Solutions, Cambridge, CB4 0WW, United Kingdom.
Jay NanavatiIQVIA - Real World Solutions, London, W2 1AF, United Kingdom.
Khaldoun Zine El AbidineIQVIA - Real World Solutions, Ottawa, ON, K1P 5J6, Canada.
Christina DeFilippo MackIQVIA - Real World Solutions, Research Triangle Park, NC, 27703, United States.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Objectives: To assess the calibration of 9 large language models (LLMs) within biomedical natural language processing (BioNLP) tasks, furthering understanding of trustworthiness and reliability in real-world settings. Materials and Methods: For each LLM, we collected responses and corresponding confidence scores for all 13 datasets (grouped into 6 tasks) of the Biomedical Language Understanding & Reasoning Benchmark (BLURB). Confidence scores were assigned using 3 strategies: Verbal, Self-consistency, and Hybrid. For evaluation, we introduced Flex-ECE (Flexible Expected Calibration Error), a novel adaptation of ECE that accounts for partial correctness in model responses, allowing for a more realistic assessment of calibration in language-based settings. Two post-hoc calibration techniques-isotonic regression and histogram binning-were evaluated. Results: Across tasks, mean calibration ranged from 23.9% (Population-Intervention-Comparison-Outcome extraction) to 46.6% (Relation Extraction). Across LLMs, Medicine-Llama3-8B had the best mean overall calibration (29.8%), and Flan-T5-XXL had the highest ranking on 5/13 datasets. Across strategies, Self-consistency (mean: 27.3%) had better calibration than Verbal (mean: 42.0%) and Hybrid (mean: 44.2%). Post-hoc methods substantially improved calibration, with best mean calibrated Flex-ECEs ranging from 0.1% to 4.1%. Discussion: The poor out-of-the-box calibration of LLMs poses a risk to trustworthy deployment of such models in real-world BioNLP applications. Calibration can be improved post-hoc and is a recommended practice. Non-binary metrics for LLM evaluation such as Flex-ECE provide a more realistic assessment of trustworthiness of LLMs, and indeed any model that can be partially right/wrong. Conclusion: This study shows that out-of-the-box calibration of LLMs is very poor, but traditional post-hoc calibration techniques are useful to calibrate LLMs.

Indexed as

Biomedical Language Understanding & Reasoning Benchmark (BLURB)calibrationlarge language models (LLMs)natural language processing (NLP)trustworthiness

Identifiers

PMID40655536
PMCPMC12249208

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.