medical transcription teams

Abstract: LLM correctors of ASR output are judged by aggregate WER, which hides what they fix and what they break. We decompose every WER change exactly into repaired tokens, damaged tokens and insertions, and use this to ask what the source audio adds to a corrector. We compare correction with and without the audio, for the model's own draft and for the output of an independent recogniser, on three corpora. With Gemini 2.5 Flash, text-only correction of its own draft breaks 13-32% of already-correct transcripts; with the audio, 1-3%. Damage falls in both settings. Repair falls against the own draft and rises against the recogniser. On medical dictation, kept insertions cancel the gain in net WER. The open-weight Voxtral, which rarely edits, does not show this pattern. Prompts differ between the two arms, so the contrasts bound the effect of the audio and do not isolate it.

Abstract: Clinical note generation from doctor--patient dialogue is high-volume and hallucination-intolerant: a fabricated laboratory value can create patient-safety risk, not a quality regression. We ask whether an agentic \emph{verification} architecture, rather than generator scale, can make a small language model viable here. Holding a four-evaluator verification stack and refinement policy fixed and swapping only the generator between a 4B-parameter model with a QLoRA adapter and a frontier baseline, the small model reaches $0.984$ claim-level factual entailment against $0.992$ and comes within $3.3$ points on completeness, generating entirely on-device. Its deficit is confined to \emph{inter-section structural fidelity}---arrangement rather than clinical comprehension, and the axis on which it also falls furthest below the corpus's reference notes. Because that deficit is an explicit verifier decision rather than a silent quality difference, it becomes a routing policy: run the small model by default, escalate what the verifier rejects. Measured end to end, that it achieved a similiar verified-rate acceptance to the frontier-only acceptance in this test set ($99.6\%$ vs.\ $98.4\%$ over $250$ encounters) while routing $62$, documenting three quarters without a frontier \emph{generation} call. Ablating the loop separates architecture from scale: unrefined, the small model is accepted on $26.8\%$ of encounters and the frontier model on $74.8\%$, so verification does the most work where the generator is weakest. We also contribute section-scoped refinement, which preserves unflagged sections by construction rather than instruction, and find the baseline is not uniformly stronger---its provider refused two trauma-related transcripts the on-device model handled and certified, one facet of a provider dependency a served adapter does not carry.

Abstract: Recognition of domain-specific and low-frequency terms remains challenging for automatic speech recognition (ASR). Although contextual biasing can improve their recognition, directly providing a large terminology dictionary introduces many irrelevant biasing terms. Retrieval-based contextual biasing addresses this issue by selecting candidate terms from an external dictionary, but querying many recognized words requires numerous dictionary lookups and may yield poorly targeted candidates. We propose a training-free contextual ASR framework in which a pretrained speech large language model (SpeechLLM) jointly generates an ASR hypothesis and localizes error spans likely to involve domain-specific terms. Only the localized spans are used to retrieve phonologically similar terms from an external terminology dictionary. The same SpeechLLM then re-recognizes the audio conditioned on the first-pass hypothesis and the retrieved terms, without task-specific model training. To assess applicability across domains, we evaluate the framework on medical, air traffic control, and financial speech. The proposed method substantially reduces dictionary queries while improving the recall and ranking of relevant terminology candidates and second-pass ASR performance across all three domains.