From Answers to Arguments: Toward Trustworthy Clinical Diagnostic Reasoning with Toulmin-Guided Curriculum Goal-Conditioned Learning

The integration of Large Language Models (LLMs) into clinical decision support is critically obstructed by their opaque and often unreliable reasoning. In the high-stakes domain of healthcare, correct answers alone are insufficient; clinical practice demands full transparency to ensure patient safety and enable professional accountability. A pervasive and dangerous weakness of current LLMs is their tendency to produce "correct answers through flawed reasoning." This issue is far more than a minor academic flaw; such process errors signal a fundamental lack of robust understanding, making the model prone to broader hallucinations and unpredictable failures when faced with real-world clinical complexity. In this paper, we establish a framework for trustworthy clinical argumentation by adapting the Toulmin model to the diagnostic process. We propose a novel training pipeline: Curriculum Goal-Conditioned Learning (CGCL), designed to progressively train LLM to generate diagnostic arguments that explicitly follow this Toulmin structure. CGCL's progressive three-stage curriculum systematically builds a solid clinical argument: (1) extracting facts and generating differential diagnoses; (2) justifying a core hypothesis while rebutting alternatives; and (3) synthesizing the analysis into a final, qualified conclusion. We validate CGCL using T-Eval, a quantitative framework measuring the integrity of the diagnosis reasoning. Experiments show that our method achieves diagnostic accuracy and reasoning quality comparable to resource-intensive Reinforcement Learning (RL) methods, while offering a more stable and efficient training pipeline.

PRISM: Festina Lente Proactivity -- Risk-Sensitive, Uncertainty-Aware Deliberation for Proactive Agents

Proactive agents must decide not only what to say but also whether and when to intervene. Many current systems rely on brittle heuristics or indiscriminate long reasoning, which offers little control over the benefit-burden tradeoff. We formulate the problem as cost-sensitive selective intervention and present PRISM, a novel framework that couples a decision-theoretic gate with a dual-process reasoning architecture. At inference time, the agent intervenes only when a calibrated probability of user acceptance exceeds a threshold derived from asymmetric costs of missed help and false alarms. Inspired by festina lente (Latin: "make haste slowly"), we gate by an acceptance-calibrated, cost-derived threshold and invoke a resource-intensive Slow mode with counterfactual checks only near the decision boundary, concentrating computation on ambiguous and high-stakes cases. Training uses gate-aligned, schema-locked distillation: a teacher running the full PRISM pipeline provides dense, executable supervision on unlabeled interaction traces, while the student learns a response policy that is explicitly decoupled from the intervention gate to enable tunable and auditable control. On ProactiveBench, PRISM reduces false alarms by 22.78% and improves F1 by 20.14% over strong baselines. These results show that principled decision-theoretic gating, paired with selective slow reasoning and aligned distillation, yields proactive agents that are precise, computationally efficient, and controllable. To facilitate reproducibility, we release our code, models, and resources at https://prism-festinalente.github.io/; all experiments use the open-source ProactiveBench benchmark.