Researchers propose Neurosymbolic Alignment, a training-time framework that couples a 7B clinical LLM with an HGNN-based Physiological World Model to improve safety in generative clinical reasoning. The method uses structured physiological knowledge from an 847K-node biomedical knowledge graph to score candidate responses and drive iterative on-policy ORPO updates.

  • Improves Clinical Safety Benchmark (CSS) from 69.5% to 90.8%, a gain of 21.3 percentage points over standard ORPO.
  • Reduces physician-evaluated harmful recommendation rate (HR) from 14.1% to 5.1% on the blinded subset.
  • Increases Drug Interaction Detection (DID) score from 72.8% to 91.6%.
  • Exceeds GPT-4 (5-shot) on all safety metrics despite having 10x fewer parameters.
  • Outperforms an inference-time self-correction pipeline (SFT+SelfCorrect) by 11.4 percentage points in CSS.

The authors conclude that training-time physiological grounding produces measurable and independently verifiable safety improvements in open-weight clinical LLMs, though external validation on real clinical data is needed to confirm transferability to deployment settings.