Paper Detail

When Quantization Preserves Accuracy but Not Evidence: Explanation-Aware Post-Training Quantization for Medical LLMs

Yeji Kim, Mi-Young Kim, Randy Goebel

arxiv Score 11.3

Published 2026-09-21 · First seen 2026-09-22

General AI

Abstract

Post-training quantization (PTQ) enables efficient deployment of large language models, and PTQ methods are usually optimized and evaluated with generic reconstruction, perplexity, or answer accuracy. But in explanation-critical domains, preserving only the final answer may be insufficient, since users may also inspect generated rationales to judge whether a prediction is trustworthy. We study this issue in medical multiple-choice question answering, where rationales should provide evidence that supports the selected answer. We propose an explanation-aware objective for transformation-based PTQ. Our method builds an offline faithfulness cache from full-precision teacher rationales and uses it during optimization to preserve answer-supporting evidence tokens and evidence-conditioned answer behavior. We instantiate it on OSTQuant under W4A4KV4 quantization and evaluate four 7B--8B medical and instruction-tuned LLMs on MedExQA, MedExpQA, and ChallengeClinicalQA. While a same-calibration OSTQuant baseline preserves task accuracy, it can substantially weaken answer-supporting rationales. Our objective is to preserve the full-precision model's answer-supporting behavior rather than improve gold-label accuracy, and our method better preserves the full-precision model's answer behavior and rationale-to-answer support. These results suggest that PTQ for explanation-critical settings should evaluate preservation of answer-supporting evidence, not only answer accuracy. Code and evaluation scripts are available at https://github.com/dut0817/EAQuant.

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BibTeX

@article{kim2026when,
  title = {When Quantization Preserves Accuracy but Not Evidence: Explanation-Aware Post-Training Quantization for Medical LLMs},
  author = {Yeji Kim and Mi-Young Kim and Randy Goebel},
  year = {2026},
  abstract = {Post-training quantization (PTQ) enables efficient deployment of large language models, and PTQ methods are usually optimized and evaluated with generic reconstruction, perplexity, or answer accuracy. But in explanation-critical domains, preserving only the final answer may be insufficient, since users may also inspect generated rationales to judge whether a prediction is trustworthy. We study this issue in medical multiple-choice question answering, where rationales should provide evidence that},
  url = {https://arxiv.org/abs/2609.24799},
  keywords = {cs.CL, cs.AI},
  eprint = {2609.24799},
  archiveprefix = {arXiv},
}

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