Toward System One Clinical Intelligence: Parameter-Efficient Fine-Tuning and Counterfactual Explainability of Decision Foundation Models

arXiv:2610.15029v1 Announce Type: cross Abstract: Automated disease classification from patient-reported symptoms requires balancing the speed of lightweight discriminative models against the contextual understanding and latency costs of autoregressive large language models (LLMs). Decision foundation models offer an alternative by mapping representations directly to candidate classes without free-form text generation. We adapt Clef-Flash, a 9-billion-parameter decision model built on a Qwen3.5 backbone, for 24-class disease classification on the Symptom2Disease benchmark. Using 4-bit quantize

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