arXiv:2601.12471v1 Announce Type: cross Abstract: Current evaluation of large language models (LLMs) overwhelmingly prioritizes accuracy; however, in real-world and safety-critical applications, the ability to abstain when uncertain is equally vital for trustworthy deployment. We introduce MedAbstain, a unified benchmark and evaluation protocol for abstention in medical multiple-choice question answering (MCQA) -- a discrete-choice setting that generalizes to agentic action selection -- integrating conformal prediction, adversarial question perturbations, and explicit abstention options. Our systematic evaluation of both open- and closed-source LLMs reveals that even state-of-the-art, high-accuracy models often fail to abstain with uncertain. Notably, providing explicit abstention options consistently increases model uncertainty and safer abstention, far more than input perturbations, while scaling model size or advanced prompting brings little improvement. These findings highlight the central role of abstention mechanisms for trustworthy LLM deployment and offer practical guidance for improving safety in high-stakes applications.

arXiv:2509.05818v2 Announce Type: replace Abstract: Patients must possess the knowledge necessary to actively participate in their care. We present NoteAid-Chatbot, a conversational AI that promotes patient understanding via a novel 'learning as conversation' framework, built on a multi-agent large language model (LLM) and reinforcement learning (RL) setup without human-labeled data. NoteAid-Chatbot was built on a lightweight LLaMA 3.2 3B model trained in two stages: initial supervised fine-tuning on conversational data synthetically generated using medical conversation strategies, followed by RL with rewards derived from patient understanding assessments in simulated hospital discharge scenarios. Our evaluation, which includes comprehensive human-aligned assessments and case studies, demonstrates that NoteAid-Chatbot exhibits key emergent behaviors critical for patient education, such as clarity, relevance, and structured dialogue, even though it received no explicit supervision for these attributes. Our results show that even simple Proximal Policy Optimization (PPO)-based reward modeling can successfully train lightweight, domain-specific chatbots to handle multi-turn interactions, incorporate diverse educational strategies, and meet nuanced communication objectives. Our Turing test demonstrates that NoteAid-Chatbot surpasses non-expert human. Although our current focus is on healthcare, the framework we present illustrates the feasibility and promise of applying low-cost, PPO-based RL to realistic, open-ended conversational domains, broadening the applicability of RL-based alignment methods.