LLM-as-a-Fuzzy-Judge: Fine-Tuning Large Language Models as a Clinical Evaluation Judge with Fuzzy Logic

Clinical communication skills are critical in medical education, and practicing and assessing clinical communication skills on a scale is challenging. Although LLM-powered clinical scenario simulations have shown promise in enhancing medical students' clinical practice, providing automated and scalable clinical evaluation that follows nuanced physician judgment is difficult. This paper combines fuzzy logic and Large Language Model (LLM) and proposes LLM-as-a-Fuzzy-Judge to address the challenge of aligning the automated evaluation of medical students' clinical skills with subjective physicians' preferences. LLM-as-a-Fuzzy-Judge is an approach that LLM is fine-tuned to evaluate medical students' utterances within student-AI patient conversation scripts based on human annotations from four fuzzy sets, including Professionalism, Medical Relevance, Ethical Behavior, and Contextual Distraction. The methodology of this paper started from data collection from the LLM-powered medical education system, data annotation based on multidimensional fuzzy sets, followed by prompt engineering and the supervised fine-tuning (SFT) of the pre-trained LLMs using these human annotations. The results show that the LLM-as-a-Fuzzy-Judge achieves over 80\% accuracy, with major criteria items over 90\%, effectively leveraging fuzzy logic and LLM as a solution to deliver interpretable, human-aligned assessment. This work suggests the viability of leveraging fuzzy logic and LLM to align with human preferences, advances automated evaluation in medical education, and supports more robust assessment and judgment practices. The GitHub repository of this work is available at https://github.com/2sigmaEdTech/LLMAsAJudge

Jailbreak Detection in Clinical Training LLMs Using Feature-Based Predictive Models

Jailbreaking in Large Language Models (LLMs) threatens their safe use in sensitive domains like education by allowing users to bypass ethical safeguards. This study focuses on detecting jailbreaks in 2-Sigma, a clinical education platform that simulates patient interactions using LLMs. We annotated over 2,300 prompts across 158 conversations using four linguistic variables shown to correlate strongly with jailbreak behavior. The extracted features were used to train several predictive models, including Decision Trees, Fuzzy Logic-based classifiers, Boosting methods, and Logistic Regression. Results show that feature-based predictive models consistently outperformed Prompt Engineering, with the Fuzzy Decision Tree achieving the best overall performance. Our findings demonstrate that linguistic-feature-based models are effective and explainable alternatives for jailbreak detection. We suggest future work explore hybrid frameworks that integrate prompt-based flexibility with rule-based robustness for real-time, spectrum-based jailbreak monitoring in educational LLMs.