Improving Medical Calculation of LLMs with Embedded Coding

Tianshi Ming, Yingying Zhang, Xian Wu

Large Language Models (LLMs) perform well on medical examinations and question-answering benchmarks, but remain unreliable on medical calculation tasks that require exact numerical outputs. These calculations support high-stakes decisions such as medication dosing, organ-function assessment, and prognostic scoring, for which even small errors can have serious clinical consequences. We introduce MedCode, a framework that improves medical calculation by training LLMs to generate embedded executable code. Given a clinical context, the model identifies the relevant calculator, extracts its input variables, and produces a script that delegates arithmetic operations to a deterministic interpreter. Executing the script returns the calculated value together with an explanation and the appropriate unit. We construct supervised fine-tuning (SFT) and preference datasets from the MedCalc benchmark and additionally curate a dataset for calculation tasks in Intensive Care Unit (ICU) scenarios. We further propose weighted Direct Preference Optimization (wDPO), which adaptively emphasizes preference pairs that are difficult for the model to distinguish. Experiments with LLaMA3-8B, Qwen2.5-7B,…