new

Get trending papers in your email inbox!

Subscribe

Daily Papers

byAK and the research community

Jun 15

Auditing Multimodal LLM Raters: Central Tendency Bias in Clinical Ordinal Scoring

Multimodal large language models (LLMs) are increasingly explored as automated evaluators in clinical settings, yet their scoring behavior on ordinal clinical scales remains poorly understood. We benchmark three frontier LLM families against supervised deep learning models for scoring Clock Drawing Test (CDT) images on two public datasets using the Shulman rubric. While fully fine-tuned Vision Transformers achieve the best calibration (MAE 0.52, within-1 accuracy 91%), zero-shot LLMs remain competitive on tolerance-based agreement (GPT-5 MAE 0.67, within-1 accuracy 92%) despite higher absolute error. However, per-score analysis reveals that all three LLM families exhibit a pronounced central tendency effect (systematic endpoint compression): predictions are systematically compressed toward the middle of the scale, with over-prediction at the low end (score 0 to 1) and under-prediction at the high end (score 5 to 4). This effect disproportionately affects the clinically critical extremes where accurate scoring most impacts screening decisions for cognitive impairment. Targeted ablations show that neither few-shot exemplars spanning the full score range nor removing clinical terminology from the prompt eliminates the effect. Our findings extend the LLM-as-a-judge bias literature from NLP evaluation to clinical assessment, and highlight the need for calibration-aware evaluation and post-hoc calibration before deploying LLM-based raters in high-stakes screening workflows.

Co-ReAct: Rubrics as Step-Level Collaborators for ReAct Agents

ReAct-style agents for search-intensive, multi-step reasoning tasks rely largely on their own internal judgment to decide what evidence to seek, which reasoning or action step to take next, and when to stop, often producing shallow, redundant, or poorly targeted trajectories. Prior work has explored rubrics as external quality signals, but existing uses are mostly evaluative rather than action-guiding: rubrics typically serve as training-time rewards or post-hoc evaluators of completed outputs, and in deep-research settings they are often coarse-grained and report-level rather than step-level. We introduce Co-ReAct, a rubric-guided action-selection framework that uses rubrics as step-level guidance during inference. At each decision step, Co-ReAct injects a rubric into the agent's context to guide the next Reason-or-Act decision, specifying what the agent should target in evidence seeking, search, reasoning, or self-evaluation. To make this guidance reliable, we train a dedicated rubric generator with GRPO. Unlike prior pairwise or binary preference formulations, our objective optimizes a list-wise Spearman rank-correlation reward against multi-judge expert consensus rankings, encouraging rubrics that are discriminative rather than merely plausible. On DeepResearchBench and SQA-CS-V2, Co-ReAct consistently improves over ReAct and representative test-time compute baselines across search agents built on both 8B/14B open-source and frontier closed-source base models. The trained rubric generator can also serve as a drop-in component that improves these baselines without changing their underlying decision mechanisms. Our code is publicly available at https://github.com/ZBWpro/Co-ReAct.

  • 7 authors
·
May 21

Evolving Diagnostic Agents in a Virtual Clinical Environment

In this paper, we present a framework for training large language models (LLMs) as diagnostic agents with reinforcement learning, enabling them to manage multi-turn diagnostic processes, adaptively select examinations, and commit to final diagnoses. Unlike instruction-tuned models trained on static case summaries, our method acquires diagnostic strategies through interactive exploration and outcome-based feedback. Our contributions are fourfold: (i) We present DiagGym, a diagnostics world model trained with electronic health records that emits examination outcomes conditioned on patient history and recommended examination, serving as a virtual clinical environment for realistic diagnosis training and evaluation; (ii) We train DiagAgent via end-to-end, multi-turn reinforcement learning to learn diagnostic policies that optimize both information yield and diagnostic accuracy; (iii) We introduce DiagBench, a diagnostic benchmark comprising 750 cases with physician-validated examination recommendations and 99 cases annotated with 973 physician-written rubrics on diagnosis process; (iv) we demonstrate superior performance across diverse diagnostic settings. DiagAgent significantly outperforms 10 state-of-the-art LLMs, including DeepSeek-v3 and GPT-4o, as well as two prompt-engineered agents. In single-turn settings, DiagAgent achieves 9.34% higher diagnostic accuracy and 44.03% improvement in examination recommendation hit ratio. In end-to-end settings, it delivers 15.12% increase in diagnostic accuracy and 23.09% boost in examination recommendation F1 score. In rubric-based evaluation, it surpasses the next-best model, Claude-sonnet-4, by 7.1% in weighted rubric score. These findings indicate that learning policies in interactive clinical environments confers dynamic and clinically meaningful diagnostic management abilities unattainable through passive training alone.

Case-Specific Rubrics for Clinical AI Evaluation: Methodology, Validation, and LLM-Clinician Agreement Across 823 Encounters

Objective. Clinical AI documentation systems require evaluation methodologies that are clinically valid, economically viable, and sensitive to iterative changes. Methods requiring expert review per scoring instance are too slow and expensive for safe, iterative deployment. We present a case-specific, clinician-authored rubric methodology for clinical AI evaluation and examine whether LLM-generated rubrics can approximate clinician agreement. Materials and Methods. Twenty clinicians authored 1,646 rubrics for 823 clinical cases (736 real-world, 87 synthetic) across primary care, psychiatry, oncology, and behavioral health. Each rubric was validated by confirming that an LLM-based scoring agent consistently scored clinician-preferred outputs higher than rejected ones. Seven versions of an EHR-embedded AI agent for clinicians were evaluated across all cases. Results. Clinician-authored rubrics discriminated effectively between high- and low-quality outputs (median score gap: 82.9%) with high scoring stability (median range: 0.00%). Median scores improved from 84% to 95%. In later experiments, clinician-LLM ranking agreement (tau: 0.42-0.46) matched or exceeded clinician-clinician agreement (tau: 0.38-0.43), attributable to both ceiling compression and LLM rubric improvement. Discussion. This convergence supports incorporating LLM rubrics alongside clinician-authored ones. At roughly 1,000 times lower cost, LLM rubrics enable substantially greater evaluation coverage, while continued clinical authorship grounds evaluation in expert judgment. Ceiling compression poses a methodological challenge for future inter-rater agreement studies. Conclusion. Case-specific rubrics offer a path for clinical AI evaluation that preserves expert judgment while enabling automation at three orders lower cost. Clinician-authored rubrics establish the baseline against which LLM rubrics are validated.

  • 9 authors
·
Apr 26

Rethinking Rubric Generation for Improving LLM Judge and Reward Modeling for Open-ended Tasks

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.

  • 9 authors
·
Feb 4