Daily Papers

We present HealthBench, an open-source benchmark measuring the performance and safety of large language models in healthcare. HealthBench consists of 5,000 multi-turn conversations between a model and an individual user or healthcare professional. Responses are evaluated using conversation-specific rubrics created by 262 physicians. Unlike previous multiple-choice or short-answer benchmarks, HealthBench enables realistic, open-ended evaluation through 48,562 unique rubric criteria spanning several health contexts (e.g., emergencies, transforming clinical data, global health) and behavioral dimensions (e.g., accuracy, instruction following, communication). HealthBench performance over the last two years reflects steady initial progress (compare GPT-3.5 Turbo's 16% to GPT-4o's 32%) and more rapid recent improvements (o3 scores 60%). Smaller models have especially improved: GPT-4.1 nano outperforms GPT-4o and is 25 times cheaper. We additionally release two HealthBench variations: HealthBench Consensus, which includes 34 particularly important dimensions of model behavior validated via physician consensus, and HealthBench Hard, where the current top score is 32%. We hope that HealthBench grounds progress towards model development and applications that benefit human health.

General-purpose health benchmarks increasingly anchor claims about LLM medical performance, but they are not always resolved by clinical specialty, making domain-specific performance hard to isolate. Mental health is of acute public-health concern as millions of people turn to LLMs for psychological support, and most existing evaluations are bespoke academic benchmarks that are difficult to integrate into developer workflows. We introduce HealthBench-Psych and HealthBench-Psych-Hard. We screened HealthBench's 5,000 physician-rubric conversations for mental-health relevance with a transparent LLM-applied rubric, then validated the subset through two rounds of blinded clinician review with concealed known-exclude controls, yielding 610 conversations (12.2% of the corpus). Evaluating 20 frontier and open models under a cross-vendor panel of three LLM judges, we find a statistically tied frontier cluster, measurable refusal behavior in two models, and near-identical rankings across judges (τge 0.92). We release the subset, pipeline, model responses, grades, and analysis code as a reusable resource.

Most reported gains on agentic-LLM clinical benchmarks are often attributed to prompt engineering, yet our results suggest that larger improvements can come from architectural and engine-level design. We present MDIA, a Multi-agent Diagnostic Intelligence Agent implemented as a 7-node specialty-routed clinical reasoning graph, on the full HealthBench Professional benchmark (n = 525), on a non-fine-tuned LLM. MDIA achieves 0.6272 under OpenAI's GPT-5.4-2026-03-05, which is +3.72 pp above the performance of OpenAI's ChatGPT for Clinicians. The experimental work shows that performance lift is attributable to system architecture: specialty routing, multi-turn context preservation, drug-state safety gating, site-filtered search, length-aware synthesis, and engine-level reliability. These findings support the view that agentic clinical benchmark performance is shaped both by the underlying foundation model and the orchestration architecture. Nevertheless, we also noticed notable differences when using other models as a grader; in particular, when using Gemini 2.5 Pro, MDIA scored 0.6585, which suggests that the choice of grader is a source of variability. Robust evaluation of LLMs would therefore require assessment across several independent grader models.

Evaluating large language models (LLMs) on open-ended questions is difficult because response quality depends on the question's context. Binary scores and static rubrics fail to capture these context-dependent requirements. Existing methods define criteria at the dataset level or generate them in a single pass, which limits their ability to explore the evaluation space implied by each question. We introduce One-Question-One-World (Qworld), a method that generates question-specific evaluation criteria using a recursive expansion tree. Given a question, Qworld decomposes it into scenarios, perspectives, and fine-grained binary criteria through structured hierarchical and horizontal expansion. The resulting criteria specify what a high-quality answer must address for that question. On HealthBench, Qworld covers 89% of expert-authored criteria and generates 79% novel criteria validated by human experts. Experts rate Qworld criteria higher in insight and granularity than those produced by prior methods. When applied to 11 frontier LLMs on HealthBench and Humanity's Last Exam, Qworld reveals capability differences in dimensions such as long-term impact, equity, error handling, and interdisciplinary reasoning that coarse rubrics do not distinguish. By formulating criteria generation as structured coverage of question-implied evaluation axes, Qworld enables evaluation that adapts to each question rather than relying on fixed task-level criteria.

Many useful language-model tasks cannot be evaluated by exact outcome verification. Rubric-based reinforcement learning (RL) addresses this issue by scoring open-ended responses against explicit criteria. However, because the reward is assigned after the complete response, the training signal does not directly identify which individual decisions contributed to the final score. We propose a two-stage training framework that uses rubrics first as privileged teacher context for dense token-level supervision, then as rewards for further RL. In the first stage, rubric-privileged on-policy distillation (RP-OPD), a student without access to the rubric matches a rubric-aware teacher's next-token distributions at student-generated prefixes. In the second stage, RL directly optimizes the rubric reward and improves beyond the observed distillation plateau. We evaluate the framework on health and science tasks using open-weight models. Across HealthBench, ResearchQA, and RubricHub Science, we compare post-training methods and vary the amount of SFT or RP-OPD training before RL, finding that our two-stage framework achieves the highest scores among the methods evaluated. RP-OPD + RL shows limited signs of reward hacking on RubricHub Science, whereas the SFT + RL baseline increasingly receives high rewards for claims of rubric compliance without providing the required content. These findings support using rubrics to guide on-policy distillation before applying rubric-based RL.

As large language models (LLMs) advance in conversational and reasoning capabilities, their practical application in healthcare has become a critical research focus. However, there is a notable gap between the performance of medical LLMs on static benchmarks such as USMLE and their utility in real-world clinical decision-making. This discrepancy arises because traditional exams fail to capture the dynamic, interactive nature of medical consultations. To address this challenge, we introduce a novel dynamic verification framework that moves beyond static answer verifier, establishing a large-scale, high-fidelity interactive reinforcement learning system. Our framework comprises two key components: a Patient Simulator that creates realistic clinical environments using de-identified medical records, and a Clinical Rubrics Generator that dynamically produces multi-dimensional evaluation metrics. Building on this foundation, we develop Baichuan-M2, a 32B-parameter medical augmented reasoning model trained through a multi-stage reinforcement learning strategy with an improved Group Relative Policy Optimization (GRPO) algorithm. Evaluated on HealthBench, Baichuan-M2 outperforms all other open-source models and most advanced closed-source counterparts, achieving a score above 32 on the challenging HealthBench Hard benchmark-previously exceeded only by GPT-5. Our work demonstrates that robust dynamic verifier system is essential for aligning LLM capabilities with practical clinical applications, establishing a new Pareto front in the performance-parameter trade-off for medical AI deployment.

We present Federation of Agents (FoA), a distributed orchestration framework that transforms static multi-agent coordination into dynamic, capability-driven collaboration. FoA introduces Versioned Capability Vectors (VCVs): machine-readable profiles that make agent capabilities searchable through semantic embeddings, enabling agents to advertise their capabilities, cost, and limitations. Our aarchitecturecombines three key innovations: (1) semantic routing that matches tasks to agents over sharded HNSW indices while enforcing operational constraints through cost-biased optimization, (2) dynamic task decomposition where compatible agents collaboratively break down complex tasks into DAGs of subtasks through consensus-based merging, and (3) smart clustering that groups agents working on similar subtasks into collaborative channels for k-round refinement before synthesis. Built on top of MQTT,s publish-subscribe semantics for scalable message passing, FoA achieves sub-linear complexity through hierarchical capability matching and efficient index maintenance. Evaluation on HealthBench shows 13x improvements over single-model baselines, with clustering-enhanced laboration particularly effective for complex reasoning tasks requiring multiple perspectives. The system scales horizontally while maintaining consistent performance, demonstrating that semantic orchestration with structured collaboration can unlock the collective intelligence of heterogeneous federations of AI agents.

Open-ended evaluation is essential for deploying large language models in real-world settings. In studying HealthBench, we observe that using the model itself as a grader and generating rubric-based reward signals substantially improves reasoning performance. Remarkably, the trained model also becomes a stronger grader. Motivated by this, we introduce Self-Rewarding Rubric-Based Reinforcement Learning for Open-Ended Reasoning, a lightweight framework that enables faster and more resource-efficient training while surpassing baselines. Remarkably, on Qwen3-32B, training with just the 4000-sample HealthBench Easy subset is sufficient to obtain a model that exceeds GPT-5 on HealthBench Hard. Incorporating a small amount of teacher-graded data further enhances performance for less capable models.

Large Language Models (LLMs) are increasingly used for clinical decision support, where hallucinations and unsafe suggestions may pose direct risks to patient safety. These risks are particularly challenging as they often manifest as subtle clinical errors that evade detection by generic metrics, while expert-authored fine-grained rubrics remain costly to construct and difficult to scale. In this paper, we propose a retrieval-augmented multi-agent framework designed to automate the generation of instance-specific evaluation rubrics. Our approach grounds evaluation in authoritative medical evidence by decomposing retrieved content into atomic facts and synthesizing them with user interaction constraints to form verifiable, fine-grained evaluation criteria. Evaluated on HealthBench, our framework achieves a Clinical Intent Alignment (CIA) score of 60.12%, a statistically significant improvement over the GPT-4o baseline (55.16%). In discriminative tests, our rubrics yield a mean score delta (μ_Δ = 8.658) and an AUROC of 0.977, nearly doubling the quality separation achieved by GPT-4o baseline (4.972). Beyond evaluation, our rubrics effectively guide response refinement, improving quality by 9.2% (from 59.0% to 68.2%). This provides a scalable and transparent foundation for both evaluating and improving medical LLMs. The code is available at https://anonymous.4open.science/r/Automated-Rubric-Generation-AF3C/.

Brazil's Unified Health System (SUS) relies on official clinical guidelines that define diagnostic criteria, treatments, dosages, and monitoring procedures for over 200 million citizens. Yet current LLMs perform poorly on this guideline-specific knowledge, and no benchmark evaluates clinical recall grounded in Brazilian Portuguese protocols. We address this gap by adapting Qwen2.5-14B-Instruct to the Brazilian clinical domain. From 178 official guidelines (~5.4M tokens), we generate ~70M tokens of synthetic data in three formats -- rephrases, wiki-style articles, and question-answer pairs -- using four generator LLMs. We then apply continual pre-training followed by Group Relative Policy Optimization (GRPO). We introduce HealthBench-BR, with 1,780 balanced true/false clinical assertions, and PCDT-QA, with 890 open-ended clinical questions scored by an LLM judge. Our best model achieves 83.9% on HealthBench-BR and 85.4% on PCDT-QA, outperforming GPT-5.2, Claude Sonnet 4.6, Gemini 3.1 Pro, and Google AI Overview's web-grounded RAG despite having only 14B parameters. Ablations show that generator diversity and reinforcement learning are critical to these gains. We release all datasets, benchmarks, and model weights to support reproducible clinical NLP research for Brazilian Portuguese. Code, data, and model weights are available at https://github.com/hugoabonizio/clinical-protocols-br

The professionalism of a human doctor in outpatient service depends on two core abilities: the ability to make accurate medical decisions and the medical consultation skill to conduct strategic, empathetic patient inquiry. Existing Large Language Models (LLMs) have achieved remarkable accuracy on medical decision-making benchmarks. However, they often lack the ability to conduct the strategic and empathetic consultation, which is essential for real-world clinical scenarios. To address this gap, we propose Doctor-R1, an AI doctor agent trained to master both of the capabilities by ask high-yield questions and conduct strategic multi-turn inquiry to guide decision-making. Our framework introduces three key components: a multi-agent interactive environment, a two-tiered reward architecture that separately optimizes clinical decision-making and communicative inquiry skills, and an experience repository to ground policy learning in high-quality prior trajectories. We evaluate Doctor-R1 on OpenAI's HealthBench and MAQuE, assessed across multi-facet metrics, such as communication quality, user experience, and task accuracy. Remarkably, Doctor-R1 surpasses state-of-the-art open-source specialized LLMs by a substantial margin with higher parameter efficiency and outperforms powerful proprietary models. Furthermore, the human evaluations show a strong preference for Doctor-R1 to generate human-preferred clinical dialogue, demonstrating the effectiveness of the framework.

Large language models (LLMs) have shown great promise in the medical domain, achieving strong performance on several benchmarks. However, they continue to underperform in real-world medical scenarios, which often demand stronger context-awareness, i.e., the ability to recognize missing or critical details (e.g., user identity, medical history, risk factors) and provide safe, helpful, and contextually appropriate responses. To address this issue, we propose Multifaceted Self-Refinement (MuSeR), a data-driven approach that enhances LLMs' context-awareness along three key facets (decision-making, communication, and safety) through self-evaluation and refinement. Specifically, we first design a attribute-conditioned query generator that simulates diverse real-world user contexts by varying attributes such as role, geographic region, intent, and degree of information ambiguity. An LLM then responds to these queries, self-evaluates its answers along three key facets, and refines its responses to better align with the requirements of each facet. Finally, the queries and refined responses are used for supervised fine-tuning to reinforce the model's context-awareness ability. Evaluation results on the latest HealthBench dataset demonstrate that our method significantly improves LLM performance across multiple aspects, with particularly notable gains in the context-awareness axis. Furthermore, by incorporating knowledge distillation with the proposed method, the performance of a smaller backbone LLM (e.g., Qwen3-32B) surpasses its teacher model, achieving a new SOTA across all open-source LLMs on HealthBench (63.8%) and its hard subset (43.1%). Code and dataset will be released at https://muser-llm.github.io.

The integration of large language models (LLMs) into medical practice holds transformative potential, yet their real-world clinical utility remains limited by critical alignment challenges: (1) a disconnect between static evaluation benchmarks and dynamic clinical cognitive needs, (2) difficulties in adapting to evolving, multi-source medical standards, and (3) the inability of conventional reward models to capture nuanced, multi-dimensional medical quality criteria. To address these gaps, we propose MR-RML (Multidimensional Rubric-oriented Reward Model Learning) via GPRC (Geometric Projection Reference Constraints), a novel alignment framework that integrates medical standards into a structured "Dimensions-Scenarios-Disciplines" matrix to guide data generation and model optimization. MR-RML introduces three core innovations: (1) a "Dimensions-Scenarios-Disciplines" medical standard system that embeds domain standards into the full training pipeline; (2) an independent multi-dimensional reward model that decomposes evaluation criteria, shifting from real-time rubric-based scoring to internalized reward modeling for improved consistency and cost-efficiency; (3) geometric projection reference constraints that transform medical cognitive logic into mathematical regularization, aligning scoring gradients with clinical reasoning and enabling synthetic data-driven training. Through extensive evaluations on the authoritative medical benchmark Healthbench, our method yields substantial performance gains over the base LLM Qwen-32B (45% on the full subset and 85% on Hard subset, respectively). It achieves a SOTA among open-source LLMs with scores of 62.7 (full subset) and 44.7 (hard subset), while also outperforming the majority of closed-source models.

Large language models (LLMs) have achieved expert-level performance on standardized examinations, yet multiple-choice accuracy poorly reflects real-world clinical utility and safety. As patients and clinicians increasingly use LLMs for guidance on complex conditions such as pancreatic cancer, evaluation must extend beyond general medical knowledge. Existing frameworks, such as HealthBench, rely on simulated queries and lack disease-specific depth. Moreover, high rubric-based scores do not ensure factual correctness, underscoring the need to assess hallucinations. We developed a human-in-the-loop pipeline to create expert rubrics for de-identified patient questions from the Pancreatic Cancer Action Network (PanCAN). The resulting benchmark, PanCanBench, includes 3,130 question-specific criteria across 282 authentic patient questions. We evaluated 22 proprietary and open-source LLMs using an LLM-as-a-judge framework, measuring clinical completeness, factual accuracy, and web-search integration. Models showed substantial variation in rubric-based completeness, with scores ranging from 46.5% to 82.3%. Factual errors were common, with hallucination rates (the percentages of responses containing at least one factual error) ranging from 6.0% for Gemini-2.5 Pro and GPT-4o to 53.8% for Llama-3.1-8B. Importantly, newer reasoning-optimized models did not consistently improve factuality: although o3 achieved the highest rubric score, it produced inaccuracies more frequently than other GPT-family models. Web-search integration did not inherently guarantee better responses. The average score changed from 66.8% to 63.9% for Gemini-2.5 Pro and from 73.8% to 72.8% for GPT-5 when web search was enabled. Synthetic AI-generated rubrics inflated absolute scores by 17.9 points on average while generally maintaining similar relative ranking.

Large language model (LLM) judges are often used as rewards to train policies on objectives that deterministic verifiers cannot capture. However, these rewards are often collapsed to pass/fail ({0, 1}), which reports the verdict but not how well a response met each criterion. We model each pass/fail verdict as a score on an unreported scale, compared with one cutoff. A stretch of that scale moves every score proportionally toward or away from the cutoff, but never across it, so no verdict changes. A policy is therefore free to apply any stretch without changing anything the panel reports. Under a joint-Gaussian model, a third grade adds a second threshold and removes this affine stretch ambiguity. On MATH and SciBench outputs from one seven-criterion judge, all 14 constructed criterionwise stretches were invisible after binarization but visible with three grades. At n=1{,}024, a test given both population laws had at least 96.5% power at a 1.5times stress. Retaining grades closes one blind spot created by binarization, but verdicts alone remain insufficient as some changes are still indistinguishable from genuine improvement. These include arbitrary within-grade changes and fixed-covariance, loading-aligned mean shifts -- the signature of a sycophancy-shaped lift the panel reads as competence. The shared-factor reference approximation fit MATH and SciBench but not HealthBench, delineating its empirical scope. We recommend keeping at least three grades (for example, asking the judge whether each criterion is fully, partially, or not met and rewarding {0, 0.5, 1}), and externally validating gains along the remaining direction, which no finer scale removes.

Extending Reinforcement Learning with Verifiable Rewards (RLVR) to real-world tasks often requires balancing objective and subjective evaluation criteria. However, many such tasks lack a single, unambiguous ground truth-making it difficult to define reliable reward signals for post-training language models. While traditional preference-based methods offer a workaround, they rely on opaque reward functions that are difficult to interpret and prone to spurious correlations. We introduce Rubrics as Rewards (RaR), a framework that uses structured, checklist-style rubrics as interpretable reward signals for on-policy training with GRPO. Our best RaR method yields up to a 28% relative improvement on HealthBench-1k compared to simple Likert-based approaches, while matching or surpassing the performance of reward signals derived from expert-written references. By treating rubrics as structured reward signals, we show that RaR enables smaller-scale judge models to better align with human preferences and sustain robust performance across model scales.

We introduce Baichuan-M3, a medical-enhanced large language model engineered to shift the paradigm from passive question-answering to active, clinical-grade decision support. Addressing the limitations of existing systems in open-ended consultations, Baichuan-M3 utilizes a specialized training pipeline to model the systematic workflow of a physician. Key capabilities include: (i) proactive information acquisition to resolve ambiguity; (ii) long-horizon reasoning that unifies scattered evidence into coherent diagnoses; and (iii) adaptive hallucination suppression to ensure factual reliability. Empirical evaluations demonstrate that Baichuan-M3 achieves state-of-the-art results on HealthBench, the newly introduced HealthBench-Hallu and ScanBench, significantly outperforming GPT-5.2 in clinical inquiry, advisory and safety. The models are publicly available at https://huggingface.co/collections/baichuan-inc/baichuan-m3.

Domain adaptation aims to turn a general-purpose large language model (LLM) into an expert for a target domain. While the dominant SFT+RL pipeline offers a convenient cold start, it may reduce exploration diversity and introduces additional complexity through multi-stage optimization. These limitations motivate RL-only adaptation. However, pure on-policy RL suffers from a cold-start problem, while mixed-policy RL still falls short: informative tokens in teacher outputs are learned too slowly in early training, and stale teacher outputs can hinder later improvement. We identify these two failure modes as Gradient Starvation and Teacher-Distribution Anchoring. To address them, we propose One-stage Policy Optimization (OnePO), which treats teacher outputs as transient guidance for policy improvement. OnePO combines Adaptive Objective Evolution to strengthen learning on informative low-probability teacher tokens and Teacher Retirement to discard teacher outputs once the current policy can surpass them. On medical adaptation, OnePO achieves 67.2 on HealthBench (Total) with only 20K training samples, outperforming SFT+RL and pure RL by 2.7 and 7.4 points, respectively. We further scale OnePO to produce HuatuoGPT-3, an open-source medical LLM series whose 27B variant reaches 70.1 on HealthBench (Total) and 71.4 on HealthBench Professional, surpassing frontier models such as GPT-6 Astra. Models and code are available at https://github.com/FreedomIntelligence/HuatuoGPT-3.

Recent advances in Large Language Models (LLMs) have underscored the potential of Reinforcement Learning (RL) to facilitate the emergence of reasoning capabilities. Despite the encouraging results, a fundamental dilemma persists as RL improvement relies on learning from high-quality samples, yet the exploration for such samples remains bounded by the inherent limitations of LLMs. This, in effect, creates an undesirable cycle in which what cannot be explored cannot be learned. In this work, we propose Rubric-Scaffolded Reinforcement Learning (RuscaRL), a novel instructional scaffolding framework designed to break the exploration bottleneck for general LLM reasoning. Specifically, RuscaRL introduces checklist-style rubrics as (1) explicit scaffolding for exploration during rollout generation, where different rubrics are provided as external guidance within task instructions to steer diverse high-quality responses. This guidance is gradually decayed over time, encouraging the model to internalize the underlying reasoning patterns; (2) verifiable rewards for exploitation during model training, where we can obtain robust LLM-as-a-Judge scores using rubrics as references, enabling effective RL on general reasoning tasks. Extensive experiments demonstrate the superiority of the proposed RuscaRL across various benchmarks, effectively expanding reasoning boundaries under the best-of-N evaluation. Notably, RuscaRL significantly boosts Qwen-2.5-7B-Instruct from 23.6 to 50.3 on HealthBench-500, surpassing GPT-4.1. Furthermore, our fine-tuned variant on Qwen3-30B-A3B-Instruct achieves 61.1 on HealthBench-500, outperforming leading LLMs including OpenAI-o3.

Large Language Models (LLMs) have shown substantial advances through reinforcement learning (RL), particularly in domains where rewards can be programmatically verified, such as mathematics and code. In these areas, models benefit from a well-defined operational base guided by explicit rule-based objectives. However, this progress reveals a significant limitation: in open-ended domains where rewards are ambiguous, subjective, or context-dependent, such as creative writing, scientific reasoning, and notably medical consultation, robust reward functions are lacking, making these areas challenging for current RL strategies. To bridge this gap, we introduce ORBIT, an open-ended rubric-based incremental training framework specifically designed for high-stakes medical dialogue. ORBIT integrates syn- thetic dialogue generation with the dynamic creation of rubrics, employing these rubrics to direct an incremental RL process. In particular, this approach does not depend on external medical knowledge or manual rules, instead utilizing rubric-guided feedback to shape learning. When implemented on the Qwen3-4B-Instruct model, our method can greatly enhance its performance on the HealthBench-Hard benchmark from 7.0 to 27.2 using only 2k samples, thus achieving state-of-the-art results for models of this scale. Our analysis confirms that rubric-driven RL fos-ters consistent performance gains across diverse consultation scenarios, going beyond simple numerical improvements. These findings underscore rubric-based feedback as a scalable strategy for advancing LLMs in intricate, open-ended tasks.

Reinforcement Learning with Verifiable Rewards (RLVR) has driven substantial progress in reasoning-intensive domains like mathematics. However, optimizing open-ended generation remains challenging due to the lack of ground truth. While rubric-based evaluation offers a structured proxy for verification, existing methods suffer from scalability bottlenecks and coarse criteria, resulting in a supervision ceiling effect. To address this, we propose an automated Coarse-to-Fine Rubric Generation framework. By synergizing principle-guided synthesis, multi-model aggregation, and difficulty evolution, our approach produces comprehensive and highly discriminative criteria capable of capturing the subtle nuances. Based on this framework, we introduce RubricHub, a large-scale (sim110k) and multi-domain dataset. We validate its utility through a two-stage post-training pipeline comprising Rubric-based Rejection Sampling Fine-Tuning (RuFT) and Reinforcement Learning (RuRL). Experimental results demonstrate that RubricHub unlocks significant performance gains: our post-trained Qwen3-14B achieves state-of-the-art (SOTA) results on HealthBench (69.3), surpassing proprietary frontier models such as GPT-5. The code and data will be released soon.

Although large language models (LLMs) demonstrate expert-level medical knowledge, aligning their open-ended outputs with fine-grained clinician preferences remains challenging. Existing methods often rely on coarse objectives or unreliable automated judges that are weakly grounded in professional guidelines. We propose a two-stage framework to address this gap. First, we introduce HealthRubrics, a dataset of 7,034 physician-verified preference examples in which clinicians refine LLM-drafted rubrics to meet rigorous medical standards. Second, we distill these rubrics into HealthPrinciples: 119 broadly reusable, clinically grounded principles organized by clinical dimensions, enabling scalable supervision beyond manual annotation. We use HealthPrinciples for (1) offline alignment by synthesizing rubrics for unlabeled queries and (2) an inference-time tool for guided self-revision. A 30B parameter model that activates only 3B parameters at inference trained with our framework achieves 33.4% on HealthBench-Hard, outperforming much larger models including Deepseek-R1 and o3, establishing a resource-efficient baseline for clinical alignment.

Clinical decision support systems (CDSS) require scrutable, auditable pipelines that enable rigorous, reproducible validation. Yet current LLM-based CDSS remain largely opaque. Most "open" models are open-weight only, releasing parameters while withholding the data provenance, curation procedures, and generation pipelines that determine model behavior. Fully Open (FO) models, which expose the complete training stack end-to-end, do not currently exist in medicine. We introduce Fully Open Meditron, the first fully open pipeline for building LLM-CDSS, comprising a clinician-audited training corpus, a reproducible data construction and training framework, and a use-aligned evaluation protocol. The corpus unifies eight public medical QA datasets into a normalized conversational format and expands coverage with three clinician-vetted synthetic extensions: exam-style QA, guideline-grounded QA derived from 46,469 clinical practice guidelines, and clinical vignettes. The pipeline enforces system-wide decontamination, gold-label resampling of teacher generations, and end-to-end validation by a four-physician panel. We evaluate using an LLM-as-a-judge protocol over expert-written clinical vignettes, calibrated against 204 human raters. We apply the recipe to five FO base models (Apertus-70B/8B-Instruct, OLMo-2-32B-SFT, EuroLLM-22B/9B-Instruct). All MeditronFO variants are preferred over their bases. Apertus-70B-MeditronFO improves +6.6 points over its base (47.2% to 53.8%) on aggregate medical benchmarks, establishing a new FO SoTA. Gemma-3-27B-MeditronFO is preferred over MedGemma in 58.6% of LLM-as-a-judge comparisons and outperforms it on HealthBench (58% vs 55.9%). These results show that fully open pipelines can achieve state-of-the-art domain-specific performance without sacrificing auditability or reproducibility.

Premature closure, or committing to a conclusion before sufficient information is available, is a recognized contributor to diagnostic error but remains underexamined in large language models (LLMs). We define LLM premature closure as inappropriate commitment under uncertainty: providing an answer, recommendation, or clinical guidance when the safer response would be clarification, abstention, escalation, or refusal. We evaluated five frontier LLMs across structured and open-ended medical tasks. In MedQA (n = 500) and AfriMed-QA (n = 490) questions where the correct choice had been removed, models still selected an answer at high rates, with baseline false-action rates of 55-81% and 53-82%, respectively. In open-ended evaluation, models gave inappropriate answers on an average of 30% of 861 HealthBench questions and 78% of 191 physician-authored adversarial queries. Safety-oriented prompting reduced premature closure across models, but residual failure persisted, highlighting the need to evaluate whether medical LLMs know when not to answer.

Instance-specific rubrics are common in AI benchmarks where reliable evaluation requires specific expert knowledge. This approach is difficult to scale, prompting research into the generation of rubrics with large language models (LLMs). However, even when expert rubrics are available as references, it is unclear how to productively evaluate the quality of generated rubrics at scale. In this paper, we introduce a method for the evaluation of rubric generation, which we call Interventional Transfer (IT), based on the idea that two rubrics are similar if they move together when a response is perturbed to pass/fail one of them. In contrast to existing approaches for evaluation of rubric generation, we argue that different forms of interventional transfer can be used to evaluate the utility of generated rubrics for different tasks. For instance, we apply this approach in a case study on HealthBench, where we demonstrate an asymmetry in rubrics generated by Qwen3.8-27B, Deepseek-V4-Flash, and Opus-5, used to evaluate responses from GPT-5.6-Terra. Perturbations that degrade responses according to the generated/expert rubric transfer into lower scores on the corresponding expert/generated rubric, but perturbations that improve on one rubric do not reliably transfer into higher scores on the other. We argue that this finding has implications for the usage of LLM-generated rubrics for performance monitoring and hill-climbing. We contrast our approach with existing approaches for rubric evaluation, which do not surface the same asymmetry that we observe.

Where do learning signals come from when there is no ground truth in post-training? We propose turning exploration into supervision through Compute as Teacher (CaT), which converts the model's own exploration at inference-time into reference-free supervision by synthesizing a single reference from a group of parallel rollouts and then optimizing toward it. Concretely, the current policy produces a group of rollouts; a frozen anchor (the initial policy) reconciles omissions and contradictions to estimate a reference, turning extra inference-time compute into a teacher signal. We turn this into rewards in two regimes: (i) verifiable tasks use programmatic equivalence on final answers; (ii) non-verifiable tasks use self-proposed rubrics-binary, auditable criteria scored by an independent LLM judge, with reward given by the fraction satisfied. Unlike selection methods (best-of-N, majority, perplexity, or judge scores), synthesis may disagree with the majority and be correct even when all rollouts are wrong; performance scales with the number of rollouts. As a test-time procedure, CaT improves Gemma 3 4B, Qwen 3 4B, and Llama 3.1 8B (up to +27% on MATH-500; +12% on HealthBench). With reinforcement learning (CaT-RL), we obtain further gains (up to +33% and +30%), with the trained policy surpassing the initial teacher signal.

Specialized clinical AI assistants are rapidly entering medical practice, often framed as safer or more reliable than general-purpose large language models (LLMs). Yet, unlike frontier models, these clinical tools are rarely subjected to independent, quantitative evaluation, creating a critical evidence gap despite their growing influence on diagnosis, triage, and guideline interpretation. We assessed two widely deployed clinical AI systems (OpenEvidence and UpToDate Expert AI) against three state-of-the-art generalist LLMs (GPT-5, Gemini 3 Pro, and Claude Sonnet 4.5) using a 1,000-item mini-benchmark combining MedQA (medical knowledge) and HealthBench (clinician-alignment) tasks. Generalist models consistently outperformed clinical tools, with GPT-5 achieving the highest scores, while OpenEvidence and UpToDate demonstrated deficits in completeness, communication quality, context awareness, and systems-based safety reasoning. These findings reveal that tools marketed for clinical decision support may often lag behind frontier LLMs, underscoring the urgent need for transparent, independent evaluation before deployment in patient-facing workflows.

Large language models(LLMs) excel at text generation and knowledge question-answering tasks, but they are prone to generating hallucinated content, severely limiting their application in high-risk domains. Current hallucination detection methods based on uncertainty estimation and external knowledge retrieval suffer from the limitation that they still produce erroneous content at high confidence levels and rely heavily on retrieval efficiency and knowledge coverage. In contrast, probe methods that leverage the model's hidden-layer states offer real-time and lightweight advantages. However, traditional linear probes struggle to capture nonlinear structures in deep semantic spaces.To overcome these limitations, we propose a neural network-based framework for token-level hallucination detection. By freezing language model parameters, we employ lightweight MLP probes to perform nonlinear modeling of high-level hidden states. A multi-objective joint loss function is designed to enhance detection stability and semantic disambiguity. Additionally, we establish a layer position-probe performance response model, using Bayesian optimization to automatically search for optimal probe insertion layers and achieve superior training results.Experimental results on LongFact, HealthBench, and TriviaQA demonstrate that MLP probes significantly outperform state-of-the-art methods in accuracy, recall, and detection capability under low false-positive conditions.

Recently, rubrics have been used to guide LLM judges in capturing subjective, nuanced, multi-dimensional human preferences, and have been extended from evaluation to reward signals for reinforcement fine-tuning (RFT). However, rubric generation remains hard to control: rubrics often lack coverage, conflate dimensions, misalign preference direction, and contain redundant or highly correlated criteria, degrading judge accuracy and producing suboptimal rewards during RFT. We propose RRD, a principled framework for rubric refinement built on a recursive decompose-filter cycle. RRD decomposes coarse rubrics into fine-grained, discriminative criteria, expanding coverage while sharpening separation between responses. A complementary filtering mechanism removes misaligned and redundant rubrics, and a correlation-aware weighting scheme prevents over-representing highly correlated criteria, yielding rubric sets that are informative, comprehensive, and non-redundant. Empirically, RRD delivers large, consistent gains across both evaluation and training: it improves preference-judgment accuracy on JudgeBench and PPE for both GPT-4o and Llama3.1-405B judges, achieving top performance in all settings with up to +17.7 points on JudgeBench. When used as the reward source for RFT on WildChat, it yields substantially stronger and more stable learning signals, boosting reward by up to 160% (Qwen3-4B) and 60% (Llama3.1-8B) versus 10-20% for prior rubric baselines, with gains that transfer to HealthBench-Hard and BiGGen Bench. Overall, RRD establishes recursive rubric refinement as a scalable and interpretable foundation for LLM judging and reward modeling in open-ended domains.

Most existing large language models (LLMs) are expensive to adapt after deployment, especially when a task requires newly produced information or niche domain knowledge. Recent work has shown that, by manipulating and optimizing their context, LLMs can be tailored to downstream tasks without updating their weights. However, most existing methods remain closed-loop, relying solely on the model's intrinsic knowledge. In this paper, we equip these context optimizers with Wikipedia search and browser tools for active information seeking. We show that naively adding these tools to a standard sequential context optimization pipeline can actually degrade performance compared to baselines. However, when paired with a search-based training procedure that maintains and prunes multiple candidate contexts, active information seeking delivers consistent and substantial gains. We demonstrate these improvements across diverse domains, including low-resource translation (Flores+), health scenarios (HealthBench), and reasoning-heavy tasks (LiveCodeBench and Humanity's Last Exam). Furthermore, our method proves to be data-efficient, robust across different hyperparameters, and capable of generating effective textual contexts that generalize well across different models.

Reinforcement learning against rubrics, lists of criteria graded by an LLM judge, has become a standard way to post-train language models on tasks with no deterministic answer. The rubric, however, is a fixed proxy for quality, never a complete description of it, and a policy trained against it long enough will learn to exploit the difference. We measure this directly. Training Qwen3-8B with Group Relative Policy Optimization (GRPO) on medical and science rubrics and grading out-of-distribution (OOD) benchmarks with both the training judge and a stronger gold judge, we find that the two scores diverge during training. The training judge's score keeps climbing while the gold judge's score peaks and then falls, by 3 points on HealthBench-Hard and by 22 points on ResearchQA. A judge with a fixed bias would shift the gold curve by a constant, not send it down while the training score rises, so the divergence is reward hacking, not judge noise. We propose Rubric Dropout, a one-line fix borrowed from neuron dropout. At every step, we randomly drop a subset of the rubric's criteria before computing the reward, so the policy never optimizes the same rubric twice. The dropped subset is shared across each rollout group, so GRPO's group-relative advantages stay comparable, and evaluation always uses the full rubric. Comparing no dropout against dropout at 30% and 50% on both benchmark pairs, dropout raises the OOD gold score at every matched checkpoint (+1 to +2 points on HealthBench-Hard, +6 to +7 points on ResearchQA), lowers the two hacking measures we track, and costs nothing in domain. Sweeping the dropout fraction shows a broad 30-50% sweet spot, while the natural alternative, reweighting criteria by how useful they are to training, performs worse than no intervention at all in our setting.

Rubric-based reinforcement learning extends reward-driven optimization to open-ended tasks by assigning partial credit to individual response requirements. However, rubric judges can assign a high criterion score even when the information or action it requires is absent from the response, a failure mode we term Vacuous Credit. Such awards persist after the required information is removed and can reverse the sign of a response's GRPO advantage. To address this problem, we introduce MetaRubric, which alternates evidence-aware policy optimization with response-guided rubric adaptation. We construct counterfactual counterparts by changing one task-relevant fact in each prompt. During policy optimization, credit is assigned only when the response contains sufficient evidence to satisfy the required rubric criterion. After each policy-optimization stage, current policy responses guide revisions to original and counterfactual criteria while preserving the meaning of the original prompt's initial rubric as interpreted under each prompt's facts. We also adapt criterion weights at stage boundaries to better address observed policy errors. Across multiple backbones, MetaRubric improves PubMedQA accuracy by 6.00--20.40 percentage points over static-judge GRPO, with further gains on HealthBench-Hard and two multimodal medical benchmarks.

LLM-as-a-Judge frameworks are increasingly trusted to automate evaluation in place of human experts, yet their reliability in high-stakes medical contexts remains unproven. We stress-test this assumption for detecting incomplete patient-facing medical responses, evaluating three rubric granularities (General-Likert, Analytical-Rubric, Dynamic-Checklist) and three backbone models across two clinician-annotated datasets, including HealthBench, the largest publicly available benchmark for medical response evaluation. LLM Judges discriminate complete from incomplete responses at and slightly above near chance (AUC 0.49--0.66); at the threshold required to recall 90% of incomplete responses, clinicians must still review the vast majority of the dataset, offering no triage utility. Even when model and clinician verdicts agree, they rarely cite the same explanation; and when they diverge, false positives stem from over-flagging non-essential gaps while false negatives reflect outright detection failures. These results reveal that LLM Judges and clinicians apply fundamentally different completeness standards; a finding that undermines their use as autonomous evaluators or triage filters in clinical settings.

Physicians now pose millions of clinical questions to AI tools each week, yet these tools are evaluated largely on hypothetical or exam-style questions, not those actually asked in practice. We report a blinded evaluation built on 620 Real-world Point-Of-Care Queries (Real-POCQi) submitted to the OpenEvidence (OE) platform by physicians spanning 30 specialties, as well as 187 questions from HealthBench. 149 practicing physicians across 36 states made head-to-head comparisons between answers from three frontier general-purpose models (Claude Opus 4.8, Gemini 3.1 Pro, and GPT-5.5) and a specialized clinical tool (OE), with graders matched to each question's specialty. When comparing answers along five dimensions relevant to clinical decision support -- accuracy, clinical utility, source quality, verifiability, & completeness -- physicians scored the specialized tool highest on all axes; in the primary analysis on Real-POCQi, win differences (margins between win and loss rates) ranged from 25 to 39 percentage points (p<0.001). Results remained consistent in sensitivity analyses stratifying by citation display, answer length, OE-user status, and Real-POCQi versus HealthBench. In parallel, LLM judges were found to systematically differ from expert judges, though both generally agreed on the best model. These findings underscore two conclusions: (i) AI tool evaluations should reflect real-world query distributions and use expert judges that mirror the specialization defining modern medicine and (ii) the consistent advantage of the specialized tool over general-purpose models does not necessarily mean that the latter cannot serve similar purposes, but that targeted engineering and customization can yield meaningful gains in performance for its users. We release Real-POCQi as a public benchmark, as well as the prespecified statistical analysis for reproducing results of this study.