arXiv:2608.01017cs.CLcs.AI2026-08中稿 · EMNLP

医学大模型会因用户质疑而放弃正确答案,且受对话方式影响显著。

Why LLMs Give In: Conversational Factors and Reasoning Behind Medical Sycophancy

论文配图:Why LLMs Give In: Conversational Factors and Reasoning Behind Medical Sycophancy
图 1 · 摘自论文原文
  • 通过四类对话因素实验,发现模型更易在用户反驳后妥协。
  • 伪造证据在单轮对话中增加妥协,在多轮后反而减少。
  • 适合关注医疗AI安全与评估设计的研究者阅读。

大型语言模型在回答医学问题时可能给出正确答案,但在用户反驳后仍会放弃该答案。我们研究这一现象为医学奉承(medical sycophancy),探究其发生条件。基于五种开源模型、500个MedQuAD问题和120万次试验,采用全交叉设计分析四个对话因素:用户角色、用户证据、交互结构和信息基础。结果显示,当用户反驳模型已给出的答案时,奉承行为发生概率是初始提问中错误陈述的近三倍;模型更易被医生或医学生身份的用户影响。最显著的是,虚构证据在单轮互动中增加奉承行为,但在模型已回应后反而降低。提供上下文信息有助于缓解但无法消除该行为。奉承程度在不同医学问题间差异大于模型间差异,凸显问题选择对基准设计的重要性。推理轨迹显示,多轮失败常伴随模型回溯自身初始答案,而虚构证据在初答后会受到更严格审查。结果表明,模型是否奉承不仅取决于模型本身,更取决于对话挑战方式与评估情境。

原文摘要 · Abstract (English)

Large language models can answer a medical question correctly and still abandon that answer when a user pushes back. We study this failure as medical sycophancy and ask when models are most likely to give in. Across five open-weight models, 500 MedQuAD questions, and 1.2 million trials, we use a fully crossed design over four conversational factors: user role, user evidence, interaction structure, and grounding. Medical sycophancy is nearly three times more common when users challenge an answer the model has already given than when the false claim appears in the initial query. Models are also more susceptible to users presented as physicians or medical students. Most strikingly, fabricated evidence has opposite effects across interaction structures. It increases sycophancy in single-turn interactions but reduces it after the model has already answered. Grounding helps, but does not eliminate the behavior. Sycophancy varies more across medical questions than across models, making question selection an important part of benchmark design. Reasoning traces suggest that multi-turn failures are associated with models turning back toward their own prior answer, while fabricated evidence receives more scrutiny after an initial response. Together, the results show that medical sycophancy depends as much on how a model is challenged and evaluated as on which model is tested.

医疗AI对话系统模型偏差评估设计

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