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Jul 29

Multi-OphthaLingua: A Multilingual Benchmark for Assessing and Debiasing LLM Ophthalmological QA in LMICs

Current ophthalmology clinical workflows are plagued by over-referrals, long waits, and complex and heterogeneous medical records. Large language models (LLMs) present a promising solution to automate various procedures such as triaging, preliminary tests like visual acuity assessment, and report summaries. However, LLMs have demonstrated significantly varied performance across different languages in natural language question-answering tasks, potentially exacerbating healthcare disparities in Low and Middle-Income Countries (LMICs). This study introduces the first multilingual ophthalmological question-answering benchmark with manually curated questions parallel across languages, allowing for direct cross-lingual comparisons. Our evaluation of 6 popular LLMs across 7 different languages reveals substantial bias across different languages, highlighting risks for clinical deployment of LLMs in LMICs. Existing debiasing methods such as Translation Chain-of-Thought or Retrieval-augmented generation (RAG) by themselves fall short of closing this performance gap, often failing to improve performance across all languages and lacking specificity for the medical domain. To address this issue, We propose CLARA (Cross-Lingual Reflective Agentic system), a novel inference time de-biasing method leveraging retrieval augmented generation and self-verification. Our approach not only improves performance across all languages but also significantly reduces the multilingual bias gap, facilitating equitable LLM application across the globe.

Any Large Language Model Can Be a Reliable Judge: Debiasing with a Reasoning-based Bias Detector

LLM-as-a-Judge has emerged as a promising tool for automatically evaluating generated outputs, but its reliability is often undermined by potential biases in judgment. Existing efforts to mitigate these biases face key limitations: in-context learning-based methods fail to address rooted biases due to the evaluator's limited capacity for self-reflection, whereas fine-tuning is not applicable to all evaluator types, especially closed-source models. To address this challenge, we introduce the Reasoning-based Bias Detector (RBD), which is a plug-in module that identifies biased evaluations and generates structured reasoning to guide evaluator self-correction. Rather than modifying the evaluator itself, RBD operates externally and engages in an iterative process of bias detection and feedback-driven revision. To support its development, we design a complete pipeline consisting of biased dataset construction, supervision collection, distilled reasoning-based fine-tuning of RBD, and integration with LLM evaluators. We fine-tune four sizes of RBD models, ranging from 1.5B to 14B, and observe consistent performance improvements across all scales. Experimental results on 4 bias types--verbosity, position, bandwagon, and sentiment--evaluated using 8 LLM evaluators demonstrate RBD's strong effectiveness. For example, the RBD-8B model improves evaluation accuracy by an average of 18.5% and consistency by 10.9%, and surpasses prompting-based baselines and fine-tuned judges by 12.8% and 17.2%, respectively. These results highlight RBD's effectiveness and scalability. Additional experiments further demonstrate its strong generalization across biases and domains, as well as its efficiency.

Mitigating Deceptive Alignment via Self-Monitoring

Modern large language models rely on chain-of-thought (CoT) reasoning to achieve impressive performance, yet the same mechanism can amplify deceptive alignment, situations in which a model appears aligned while covertly pursuing misaligned goals. Existing safety pipelines treat deception as a black-box output to be filtered post-hoc, leaving the model free to scheme during its internal reasoning. We ask: Can deception be intercepted while the model is thinking? We answer this question, the first framework that embeds a Self-Monitor inside the CoT process itself, named CoT Monitor+. During generation, the model produces (i) ordinary reasoning steps and (ii) an internal self-evaluation signal trained to flag and suppress misaligned strategies. The signal is used as an auxiliary reward in reinforcement learning, creating a feedback loop that rewards honest reasoning and discourages hidden goals. To study deceptive alignment systematically, we introduce DeceptionBench, a five-category benchmark that probes covert alignment-faking, sycophancy, etc. We evaluate various LLMs and show that unrestricted CoT roughly aggravates the deceptive tendency. In contrast, CoT Monitor+ cuts deceptive behaviors by 43.8% on average while preserving task accuracy. Further, when the self-monitor signal replaces an external weak judge in RL fine-tuning, models exhibit substantially fewer obfuscated thoughts and retain transparency. Our project website can be found at cot-monitor-plus.github.io