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.

Insertion Language Models: Sequence Generation with Arbitrary-Position Insertions

Autoregressive models (ARMs), which predict subsequent tokens one-by-one ``from left to right,'' have achieved significant success across a wide range of sequence generation tasks. However, they struggle to accurately represent sequences that require satisfying sophisticated constraints or whose sequential dependencies are better addressed by out-of-order generation. Masked Diffusion Models (MDMs) address some of these limitations, but the process of unmasking multiple tokens simultaneously in MDMs can introduce incoherences, and MDMs cannot handle arbitrary infilling constraints when the number of tokens to be filled in is not known in advance. In this work, we introduce Insertion Language Models (ILMs), which learn to insert tokens at arbitrary positions in a sequence -- that is, they select jointly both the position and the vocabulary element to be inserted. By inserting tokens one at a time, ILMs can represent strong dependencies between tokens, and their ability to generate sequences in arbitrary order allows them to accurately model sequences where token dependencies do not follow a left-to-right sequential structure. To train ILMs, we propose a tailored network parameterization and use a simple denoising objective. Our empirical evaluation demonstrates that ILMs outperform both ARMs and MDMs on common planning tasks. Furthermore, we show that ILMs outperform MDMs and perform on par with ARMs in an unconditional text generation task while offering greater flexibility than MDMs in arbitrary-length text infilling.

Solving the Inverse Alignment Problem for Efficient RLHF

Collecting high-quality preference datasets for reinforcement learning from human feedback (RLHF) is resource-intensive and challenging. As a result, researchers often train reward models on extensive offline datasets which aggregate diverse generation sources and scoring/alignment policies. We hypothesize that this aggregation has an averaging effect on reward model scores, which limits signal and impairs the alignment process. Inspired by the field of inverse RL, we define the 'inverse alignment problem' in language model training, where our objective is to optimize the critic's reward for a fixed actor and a fixed offline preference dataset. We hypothesize that solving the inverse alignment problem will improve reward model quality by providing clearer feedback on the policy's current behavior. To that end, we investigate whether repeatedly fine-tuning a reward model on subsets of the offline preference dataset aligned with a periodically frozen policy during RLHF improves upon vanilla RLHF. Our empirical results demonstrate that this approach facilitates superior alignment and faster convergence compared to using an unaligned or out-of-distribution reward model relative to the LLM policy.