LAMP: Extracting Locally Linear Decision Surfaces from LLM World Models

We introduce \textbf{LAMP} (\textbf{L}inear \textbf{A}ttribution \textbf{M}apping \textbf{P}robe), a method that shines light onto a black-box language model's decision surface and studies how reliably a model maps its stated reasons to its predictions through a locally linear model approximating the decision surface. LAMP treats the model's own self-reported explanations as a coordinate system and fits a locally linear surrogate that links those weights to the model's output. By doing so, it reveals which stated factors steer the model's decisions, and by how much. We apply LAMP to three tasks: \textit{sentiment analysis}, \textit{controversial-topic detection}, and \textit{safety-prompt auditing}. Across these tasks, LAMP reveals that many LLMs exhibit locally linear decision landscapes. In addition, these surfaces correlate with human judgments on explanation quality and, on a clinical case-file data set, aligns with expert assessments. Since LAMP operates without requiring access to model gradients, logits, or internal activations, it serves as a practical and lightweight framework for auditing proprietary language models, and enabling assessment of whether a model behaves consistently with the explanations it provides.

Assessing the Usability of GutGPT: A Simulation Study of an AI Clinical Decision Support System for Gastrointestinal Bleeding Risk

Applications of large language models (LLMs) like ChatGPT have potential to enhance clinical decision support through conversational interfaces. However, challenges of human-algorithmic interaction and clinician trust are poorly understood. GutGPT, a LLM for gastrointestinal (GI) bleeding risk prediction and management guidance, was deployed in clinical simulation scenarios alongside the electronic health record (EHR) with emergency medicine physicians, internal medicine physicians, and medical students to evaluate its effect on physician acceptance and trust in AI clinical decision support systems (AI-CDSS). GutGPT provides risk predictions from a validated machine learning model and evidence-based answers by querying extracted clinical guidelines. Participants were randomized to GutGPT and an interactive dashboard, or the interactive dashboard and a search engine. Surveys and educational assessments taken before and after measured technology acceptance and content mastery. Preliminary results showed mixed effects on acceptance after using GutGPT compared to the dashboard or search engine but appeared to improve content mastery based on simulation performance. Overall, this study demonstrates LLMs like GutGPT could enhance effective AI-CDSS if implemented optimally and paired with interactive interfaces.