The portability paradox of foundation models for clinical decision support

Yakdan et al. demonstrate that foundation models (FMs) trained to predict cervical spondylotic myelopathy from electronic health record data outperform traditional models on internal datasets but lose their advantage during external validation. This suggests that the feature-dense patterns learned by FMs may reduce their portability across settings, particularly for rare outcomes. As FMs approach clinical deployment, local validation, subgroup analysis, and attention to implementation burden are essential to inform health system planning and stewardship.