Continually Self-Improving Language Models for Bariatric Surgery Question--Answering

TL;DR

This paper introduces bRAGgen, an adaptive, self-updating language model for bariatric surgery question-answering, which integrates real-time evidence to improve accuracy and relevance, addressing healthcare disparities.

Contribution

The paper presents bRAGgen, a novel retrieval-augmented model with dynamic updating for domain-specific medical QA, and introduces bRAGq, a new benchmark dataset for bariatric surgery.

Findings

bRAGgen outperforms state-of-the-art models in clinical accuracy.

The model maintains current, evidence-based responses.

bRAGq is the first large-scale benchmark for MBS-related questions.

Abstract

While bariatric and metabolic surgery (MBS) is considered the gold standard treatment for severe and morbid obesity, its therapeutic efficacy hinges upon active and longitudinal engagement with multidisciplinary providers, including surgeons, dietitians/nutritionists, psychologists, and endocrinologists. This engagement spans the entire patient journey, from preoperative preparation to long-term postoperative management. However, this process is often hindered by numerous healthcare disparities, such as logistical and access barriers, which impair easy patient access to timely, evidence-based, clinician-endorsed information. To address these gaps, we introduce bRAGgen, a novel adaptive retrieval-augmented generation (RAG)-based model that autonomously integrates real-time medical evidence when response confidence dips below dynamic thresholds. This self-updating architecture ensures that responses remain current and accurate, reducing the risk of misinformation. Additionally, we present bRAGq, a curated dataset of 1,302 bariatric surgery--related questions, validated by an expert bariatric surgeon. bRAGq constitutes the first large-scale, domain-specific benchmark for comprehensive MBS care. In a two-phase evaluation, bRAGgen is benchmarked against state-of-the-art models using both large language model (LLM)--based metrics and expert surgeon review. Across all evaluation dimensions, bRAGgen demonstrates substantially superior performance in generating clinically accurate and relevant responses.