arXiv subjects

Zonghai Yao

Publications and source records attributed to Zonghai Yao.

At least 19 recordsLinked to original sources

arXiv2026

SAGE: Sense-Aligned Multimodal Grounding Evaluation with Gloss-Augmented Reasoning

This paper introduces Sense-Aligned Grounding Evaluation (SAGE), a unified 10-candidate image-selection benchmark that reformulates VWSD, VerSe, and WikiDiverse into a shared term-centric protocol covering noun-, verb-, and entity-centered grounding. SAGE includes confusable hard negatives and a context-swapped VerSe diagnostic to probe target-term grounding beyond direct caption--image compatibility. We further propose Gloss-Augmented Reasoning (GAR), a training-free framework combining definition grounding with constraint-guided semantic verification. Experiments show that strong VWSD performance does not transfer uniformly across grounding settings. With Gemma3-12B, definition augmentation improves all three subsets, while constraint-guided reasoning improves VWSD and yields particularly strong gains on VerSe, but is less effective on WikiDiverse. Combining the two signals achieves the best macro-average performance, improving Hits@1 from 65.90 to 71.22. These results show that SAGE supports both unified evaluation and fine-grained analysis of explicit semantic reasoning across grounding settings.

cs.CL↗

arXiv2026

Measure First, Then Allocate: Calibrated Rollout Budgets for MCP Agents in Reinforcement Learning

Training tool-using language models requires costly interaction, yet identical rewards within a rollout group provide no group-relative learning signal. We use reward disagreement to guide harness evaluation and the allocation of rollouts for policy training in Model Context Protocol (MCP) environments. We first introduce Discord, which tests harness edits using exact paired inference and decision-preserving early stopping: only disagreeing paired outcomes favor one harness over another. This insight motivates prospective allocation in BRACE (Bank-calibrated Rollout Allocation under Correlated Episodes). BRACE combines historical task evidence, uncertainty in task success rates, and a correlated reward model to forecast mixed-reward groups before allocating generation budget. Controlled harness experiments favor Discord, while live MCP experiments expose a retention-cost trade-off. At three Qwen3-VL model scales, BRACE exceeds the strongest plotted baseline peaks with fewer new training rollouts; historical-bank collection is counted separately. It also leads the compared methods on BFCL and NESTFUL without further training. Ablations probe the bank, estimator, and allocation score; prospective evaluation checks forecast calibration. These results support forecasting reward contrast before generation.

cs.LG↗

arXiv2026

DischargeBench: Pre-Deployment Evaluation of LLM Discharge Educators through Persona-Grounded Patient Simulation

Effective discharge education is personalized: a clinician adapts the discharge plan to each patient's literacy, recall, and personality. Before large language models (LLMs) take on this role with real patients, they need to be evaluated in conversations with diverse patients, yet existing evaluations target static, artifact-generation, or question-answering tasks. We introduce **DischargeBench**, a pre-deployment benchmark in which a candidate LLM educator teaches a persona-grounded simulated patient in an open-ended, multi-turn conversation. We curate **MIMIC-IV-Ext-DischargeBench**, 320 cases across 16 ICD chapters, each paired with a patient persona that varies personality, education level, health literacy, and recall. Each conversation is scored on Conversation Quality, Topic Checklist Score (TCS), Simulated Comprehension Score (SCS), and a Claim-Level Safety Audit (CLSA) by an LLM judge validated against physician annotations. Across eight closed- and open-source LLMs, the best model scored only 0.70 on TCS and 0.72 on SCS, and distrustful and anxious patients lowered comprehension for every model. DischargeBench is intended as a screening step before human evaluation, not as evidence of readiness to educate patients.

cs.CL↗

arXiv2026

Iterative Critique-Refine Framework for Enhancing LLM Personalization

Personalized text generation requires models not only to produce coherent text but also to align with a target user's style, tone, and topical focus. Existing retrieval-augmented approaches such as LaMP and PGraphRAG enrich profiles with user and neighbor histories, but they stop at generation and often yield outputs that drift in tone, topic, or style. We present PerFine, a unified, training-free critique-refine framework that enhances personalization through iterative, profile-grounded feedback. In each iteration, an LLM generator produces a draft conditioned on the retrieved profile, and a critic LLM - also conditioned on the same profile - provides structured feedback on tone, vocabulary, sentence structure, and topicality. The generator then revises, while a novel knockout strategy retains the stronger draft across iterations. We further study additional inference-time strategies such as Best-of-N and Topic Extraction to balance quality and efficiency. Across Yelp, Goodreads, and Amazon datasets, PerFine consistently improves personalization over PGraphRAG, with G-Eval gains of +8.5-12%, steady improvements over 3-5 refinement iterations, and scalability with increasing critic size. These results highlight that post-hoc, profile-aware feedback offers a powerful paradigm for personalized LLM generation that is both training-free and model-agnostic.

cs.CL↗

arXiv2026

MultiViewDx: Evidence-Linked Multi-View Clinical Diagnosis

Medical multimodal large language models (MLLMs) can perform well on existing medical visual question answering (MedVQA) benchmarks, but their training data often does not match clinical diagnosis. Most supervision is organized around isolated images or short QA pairs, leaving two structures weakly specified: how evidence leads to a decision, and how views, series, modalities, and patient context from the same case are linked. We introduce MultiViewDx, a partly physician-validated multimodal instruction dataset for evidence-linked multi-view medical imaging diagnosis. MultiViewDx uses the clinical case as the supervision unit. It links imaging studies with patient context, normalizes heterogeneous reports into an evidence-linked workflow (evidence -> findings -> differential discussion -> diagnosis), and uses a unified image-text retriever to constrain instruction synthesis to source-supported evidence. It covers X-ray, CT, MRI, ultrasound, histopathology, and other clinical visual sources. We fine-tune MultiViewDx-8B-AN and evaluate it on both existing MedVQA benchmarks and real-world case-based diagnostic reasoning. Across four MedVQA benchmarks, it achieves the best average accuracy among compared systems (79.0%), outperforming HuatuoGPT-Vision-34B (66.7%) and Claude3-Opus (55.7%). Beyond MedVQA, on JAMA Clinical Challenge cases, it receives the strongest overall rating under a physician-designed rubric for key clinical points, diagnostic inference, and evidence grounding. Controlled ablations and clinician evaluation show that both case-level multi-view organization and evidence-linked reasoning targets contribute to the gain.

cs.CL↗

arXiv2026

MedQA-MM: Shortcuts Behind Medical Visual Reasoning

A benchmark score credits final answers, but not the route by which an item can be answered. In medical multimodal multiple-choice questions (MCQs), this distinction matters because a correct answer can be supported by the intended image finding or by benchmark-preserved cues in the wording of answers, non-visual clinical text, visible image text, artificial annotations, or device/context artifacts. We call the resulting score-level overinterpretation reasoning inflation. Here, a route is an observable input path that can support answer selection, not a claim about the model's hidden cognition. Across six medical multimodal MCQ datasets, we separate candidate cues from behavioral evidence through prompt- and image-side audits, modality ablations, and matched repairs that preserve the medical target and answer key. In a 13-configuration open-model panel, full-input accuracy is 62.63%, while text-only and options-only settings achieve 53.96% and 29.71%, respectively. Removing length-gap, absolute/conspicuous, and spatial/prepositional cues lowers accuracy by 6.58, 3.50, and 4.77 percentage points. We also construct MedQA-MM, a 1,000-item shortcut-mitigated subset, where text-only and options-only accuracy fall to 5.21% and 12.33%. This does not imply that models never use images; it shows that medical image-reasoning claims require route-level evidence.

cs.CV↗

arXiv2026

Enhancing LLMs for Identifying and Prioritizing Important Medical Jargons from Electronic Health Record Notes Utilizing Data Augmentation: A Comparative Study

OpenNotes gives patients access to their EHR notes, but dense medical jargon limits comprehension. We evaluate closed-source and open-source LLMs for extracting and prioritizing the jargon terms most relevant to individual patients, using 90 expert-annotated EHR notes. We test combinations of general vs. structured prompts, zero-shot vs. few-shot prompting, fine-tuning, and GPT-4o-based data augmentation, the last paired with a ranking technique to refine training in low-resource settings. To assess the effect of dataset size, we fine-tune on augmented datasets scaled from 10 to 9,995 examples. All settings are evaluated with 10-fold cross-validation, reporting F1 and Mean Reciprocal Rank (MRR) under two string-matching criteria (relaxed matching and Jaccard Index), followed by an error analysis of model outputs. Open-source models performed best when fine-tuned on the gold-standard dataset: under Jaccard-based matching, DeepSeek 8B achieved the top F1 (0.431, SD 0.046) and BioMistral 7B the top MRR (0.577, SD 0.109). Under relaxed matching, however, open-source models did not match closed-source performance even with augmentation or fine-tuning. Few-shot prompting offered no advantage over zero-shot in vanilla models; prompting style substantially affected results; fine-tuning on a small gold-standard set improved performance; and data augmentation matched or exceeded fine-tuning, though its benefit depended heavily on augmented-data quality. These findings show that prompting strategy, fine-tuning, and data augmentation each meaningfully improve LLM performance on patient-centered jargon extraction in low-resource clinical settings.

cs.CL↗

arXiv2026

Medical thinking with multiple images

Large language models perform well on many medical QA benchmarks, but real clinical reasoning often requires integrating evidence across multiple images rather than interpreting a single view. We introduce MedThinkVQA, an expert-annotated benchmark for thinking with multiple images, where models must interpret each image, combine cross-view evidence, and answer diagnostic questions with intermediate supervision and step-level evaluation. The dataset contains 8,067 cases, including 720 test cases, with an average of 6.62 images per case, substantially denser than prior work, whose expert-level benchmarks use at most 1.43 images per case. On the test set, the best closed-source models, Claude-4.6-Opus, Gemini-3-Pro, and GPT-5.2-xhigh, reach only 57.2%, 55.3%, and 54.9% accuracy, while GPT-5-mini and GPT-5-nano reach 39.7% and 30.8%. Strong open-source models lag behind, led by Qwen3.5-397B-A17B at 52.2% and Qwen3.5-27B at 50.6%. Further analysis identifies grounded multi-image reasoning as the main bottleneck: models often fail to extract, align, and compose evidence across views before higher-level inference can help. Providing expert single-image cues and cross-image summaries improves performance, whereas replacing them with self-generated intermediates reduces accuracy. Step-level analysis shows that over 70% of errors arise from image reading and cross-view integration. Scaling results further show that additional inference-time computation helps only when visual grounding is already reliable; when early evidence extraction is weak, longer reasoning yields limited or unstable gains and can amplify misread cues. These results suggest that the key challenge is not reasoning length alone, but reliable mechanisms for grounding, aligning, and composing distributed evidence across real-world multimodal clinical inputs.

cs.CV↗

arXiv2026

Rethinking Patient Education as Multi-turn Multi-modal Interaction

Most medical multimodal benchmarks focus on static tasks such as image question answering, report generation, and plain-language rewriting. Patient education is more demanding: systems must identify relevant evidence across images, show patients where to look, explain findings in accessible language, and handle confusion or distress. Yet most patient education work remains text-only, even though combined image-and-text explanations may better support understanding. We introduce MedImageEdu, a benchmark for multi-turn, evidence-grounded radiology patient education. Each case provides a radiology report with report text and case images. A DoctorAgent interacts with a PatientAgent, conditioned on a hidden profile that captures factors such as education level, health literacy, and personality. When a patient question would benefit from visual support, the DoctorAgent can issue drawing instructions grounded in the report, case images, and the current question to a benchmark-provided drawing tool. The tool returns image(s), after which the DoctorAgent produces a final multimodal response consisting of the image(s) and a grounded plain-language explanation. MedImageEdu contains 150 cases from three sources and evaluates both the consultation process and the final multimodal response along five dimensions: Consultation, Safety and Scope, Language Quality, Drawing Quality, and Image-Text Response Quality. Across representative open- and closed-source vision-language model agents, we find three consistent gaps: fluent language often outpaces faithful visual grounding, safety is the weakest dimension across disease categories, and emotionally tense interactions are harder than low education or low health literacy. MedImageEdu provides a controlled testbed for assessing whether multimodal agents can teach from evidence rather than merely answer from text.

cs.AI↗

arXiv2026

RiTeK: A Dataset for Large Language Models Complex Reasoning over Textual Knowledge Graphs in Medicine

Answering complex real-world questions in the medical domain often requires accurate retrieval from medical Textual Knowledge Graphs (medical TKGs), as the relational path information from TKGs could enhance the inference ability of Large Language Models (LLMs). However, the main bottlenecks lie in the scarcity of existing medical TKGs, the limited expressiveness of their topological structures, and the lack of comprehensive evaluations of current retrievers for medical TKGs. To address these challenges, we first develop a Dataset1 for LLMs Complex Reasoning over medical Textual Knowledge Graphs (RiTeK), covering a broad range of topological structures. Specifically, we synthesize realistic user queries integrating diverse topological structures, relational information, and complex textual descriptions. We conduct a rigorous medical expert evaluation process to assess and validate the quality of our synthesized queries. RiTeK also serves as a comprehensive benchmark dataset for evaluating the capabilities of retrieval systems built upon LLMs. By assessing 11 representative retrievers on this benchmark, we observe that existing methods struggle to perform well, revealing notable limitations in current LLM-driven retrieval approaches. These findings highlight the pressing need for more effective retrieval systems tailored for semi-structured data in the medical domain.

cs.CL↗

arXiv2026

ChatCLIDS: Simulating Persuasive AI Dialogues to Promote Closed-Loop Insulin Adoption in Type 1 Diabetes Care

Real-world adoption of closed-loop insulin delivery systems (CLIDS) in type 1 diabetes remains low, driven not by technical failure, but by diverse behavioral, psychosocial, and social barriers. We introduce ChatCLIDS, the first benchmark to rigorously evaluate LLM-driven persuasive dialogue for health behavior change. Our framework features a library of expert-validated virtual patients, each with clinically grounded, heterogeneous profiles and realistic adoption barriers, and simulates multi-turn interactions with nurse agents equipped with a diverse set of evidence-based persuasive strategies. ChatCLIDS uniquely supports longitudinal counseling and adversarial social influence scenarios, enabling robust, multi-dimensional evaluation. Our findings reveal that while larger and more reflective LLMs adapt strategies over time, all models struggle to overcome resistance, especially under realistic social pressure. These results highlight critical limitations of current LLMs for behavior change, and offer a high-fidelity, scalable testbed for advancing trustworthy persuasive AI in healthcare and beyond.

cs.AI↗

arXiv2026

Efficient and Effective Internal Memory Retrieval for LLM-Based Healthcare Prediction

Large language models (LLMs) hold significant promise for healthcare, yet their reliability in high-stakes clinical settings is often compromised by hallucinations and a lack of granular medical context. While Retrieval Augmented Generation (RAG) can mitigate these issues, standard supervised pipelines require computationally intensive searches over massive external knowledge bases, leading to high latency that is impractical for time-sensitive care. To address this, we introduce Keys to Knowledge (K2K), a novel framework that replaces external retrieval with internal, key-based knowledge access. By encoding essential clinical information directly into the model's parameter space, K2K enables rapid retrieval from internal key-value memory without inference-time overhead. We further enhance retrieval quality through activation-guided probe construction and cross-attention reranking. Experimental results demonstrate that K2K achieves state-of-the-art performance across four benchmark healthcare outcome prediction datasets.

cs.CL↗

arXiv2026

From Scores to Steps: Diagnosing and Improving LLM Performance in Evidence-Based Medical Calculations

Large language models (LLMs) have demonstrated promising performance on medical benchmarks; however, their ability to perform medical calculations, a crucial aspect of clinical decision-making, remains underexplored and poorly evaluated. Existing benchmarks often assess only the final answer with a wide numerical tolerance, overlooking systematic reasoning failures and potentially causing serious clinical misjudgments. In this work, we revisit medical calculation evaluation with a stronger focus on clinical trustworthiness. First, we clean and restructure the MedCalc-Bench dataset and propose a new step-by-step evaluation pipeline that independently assesses formula selection, entity extraction, and arithmetic computation. Under this granular framework, the accuracy of GPT-4o drops from 62.7% to 43.6%, revealing errors masked by prior evaluations. Second, we introduce an automatic error analysis framework that generates structured attribution for each failure mode. Human evaluation confirms its alignment with expert judgment, enabling scalable and explainable diagnostics. Finally, we propose a modular agentic pipeline, MedRaC, that combines retrieval-augmented generation and Python-based code execution. Without any fine-tuning, MedRaC improves the accuracy of different LLMs from 16.35% up to 53.19%. Our work highlights the limitations of current benchmark practices and proposes a more clinically faithful methodology. By enabling transparent and transferable reasoning evaluation, we move closer to making LLM-based systems trustworthy for real-world medical applications.

cs.CL↗

arXiv2026

Knowing When to Abstain: Medical LLMs Under Clinical Uncertainty

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.

cs.CL↗

arXiv2026

MedQA-CS: Objective Structured Clinical Examination (OSCE)-Style Benchmark for Evaluating LLM Clinical Skills

Artificial intelligence (AI) and large language models (LLMs) in healthcare require advanced clinical skills (CS), yet current benchmarks fail to evaluate these comprehensively. We introduce MedQA-CS, an AI-SCE framework inspired by medical education's Objective Structured Clinical Examinations (OSCEs), to address this gap. MedQA-CS evaluates LLMs through two instruction-following tasks, LLM-as-medical-student and LLM-as-CS-examiner, designed to reflect real clinical scenarios. Our contributions include developing MedQA-CS, a comprehensive evaluation framework with publicly available data and expert annotations, and providing the quantitative and qualitative assessment of LLMs as reliable judges in CS evaluation. Our experiments show that MedQA-CS is a more challenging benchmark for evaluating clinical skills than traditional multiple-choice QA benchmarks (e.g., MedQA). Combined with existing benchmarks, MedQA-CS enables a more comprehensive evaluation of LLMs' clinical capabilities for both open- and closed-source LLMs.

cs.AI↗

arXiv2025

PRIME: Planning and Retrieval-Integrated Memory for Enhanced Reasoning

Inspired by the dual-process theory of human cognition from \textit{Thinking, Fast and Slow}, we introduce \textbf{PRIME} (Planning and Retrieval-Integrated Memory for Enhanced Reasoning), a multi-agent reasoning framework that dynamically integrates \textbf{System 1} (fast, intuitive thinking) and \textbf{System 2} (slow, deliberate thinking). PRIME first employs a Quick Thinking Agent (System 1) to generate a rapid answer; if uncertainty is detected, it then triggers a structured System 2 reasoning pipeline composed of specialized agents for \textit{planning}, \textit{hypothesis generation}, \textit{retrieval}, \textit{information integration}, and \textit{decision-making}. This multi-agent design faithfully mimics human cognitive processes and enhances both efficiency and accuracy. Experimental results with LLaMA 3 models demonstrate that PRIME enables open-source LLMs to perform competitively with state-of-the-art closed-source models like GPT-4 and GPT-4o on benchmarks requiring multi-hop and knowledge-grounded reasoning. This research establishes PRIME as a scalable solution for improving LLMs in domains requiring complex, knowledge-intensive reasoning.

cs.AI↗

arXiv2025

Chatbot To Help Patients Understand Their Health

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.

cs.AI↗

arXiv2025

ChatThero: An LLM-Supported Chatbot for Behavior Change and Therapeutic Support in Addiction Recovery

Substance use disorders (SUDs) affect millions of people, and relapses are common, requiring multi-session treatments. Access to care is limited, which contributes to the challenge of recovery support. We present \textbf{ChatThero}, an innovative low-cost, multi-session, stressor-aware, and memory-persistent autonomous \emph{language agent} designed to facilitate long-term behavior change and therapeutic support in addiction recovery. Unlike existing work that mostly finetuned large language models (LLMs) on patient-therapist conversation data, ChatThero was trained in a multi-agent simulated environment that mirrors real therapy. We created anonymized patient profiles from recovery communities (e.g., Reddit). We classify patients as \texttt{easy}, \texttt{medium}, and \texttt{difficult}, three scales representing their resistance to recovery. We created an external environment by introducing stressors (e.g., social determinants of health) to simulate real-world situations. We dynamically inject clinically-grounded therapeutic strategies (motivational interview and cognitive behavioral therapy). Our evaluation, conducted by both human (blinded clinicians) and LLM-as-Judge, shows that ChatThero is superior in empathy and clinical relevance. We show that stressor simulation improves robustness of ChatThero. Explicit stressors increase relapse-like setbacks, matching real-world patterns. We evaluate ChatThero with behavioral change metrics. On a 1--5 scale, ChatThero raises \texttt{motivation} by $+1.71$ points (from $2.39$ to $4.10$) and \texttt{confidence} by $+1.67$ points (from $1.52$ to $3.19$), substantially outperforming GPT-5. On \texttt{difficult} patients, ChatThero reaches the success milestone with $26\%$ fewer turns than GPT-5.

cs.AI↗