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Aligning LLMs to Ask Good Questions a Case Study in Clinical Reasoning (arxiv.org)
1 point by Anon84 on Aug 7, 2025 | hide | past | pdf | discuss on HN

In plain words: Good questions are broken into traits like clarity and relevance, then the model is trained to prefer follow-ups that score well on those traits. In clinical cases, this cut diagnostic errors by 56.6% versus the strongest instruction-tuned chat models.

Abstract · ALFA: Aligning LLMs to Ask Good Questions A Case Study in Clinical Reasoning

Large language models (LLMs) often fail to ask effective questions under uncertainty, making them unreliable in domains where proactive information-gathering is essential for decision-making. We present ALignment via Fine-grained Attributes, (ALFA) a framework that improves LLM question-asking by (i) decomposing the notion of a "good" question into a set of theory-grounded attributes (e.g., clarity, relevance), (ii) controllably synthesizing attribute-specific question variations, and (iii) aligning models via preference-based optimization to explicitly learn to ask better questions along these fine-grained attributes. Focusing on clinical reasoning as a case study, we introduce the MediQ-AskDocs dataset, composed of 17k real-world clinical interactions augmented with 80k attribute-specific preference pairs of follow-up questions, as well as a novel expert-annotated interactive healthcare QA task to evaluate question-asking abilities. Models aligned with ALFA reduce diagnostic errors by 56.6% on MediQ-AskDocs compared to SoTA instruction-tuned LLMs, with a question-level win-rate of 64.4% and strong generalizability. Our findings suggest that explicitly guiding question-asking with structured, fine-grained attributes offers a scalable path to improve LLMs, especially in expert application domains.

Shuyue Stella Li, Jimin Mun, Faeze Brahman, Pedram Hosseini, Bryceton G. Thomas, Jessica M. Sin, Bing Ren, Jonathan S. Ilgen, Yulia Tsvetkov, Maarten Sap
arXiv:2502.14860 · cs.CL · submitted Feb 20, 2025 · updated Aug 11, 2025
abstract · pdf · html · 29 pages, 8 figures, 12 tables

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