LLM Doesn't Know What It Doesn't Know: Detecting Epistemic Blind Spots via Cross-Model Attribution Divergence on Clinical Tabular Data

Reliable Large Language Models (LLMs) should abstain when confidence is insufficient. However, prior studies often treat refusal as a generic "I don't know'', failing to distinguish input-level ambiguity (data uncertainty) from capability limitations (model uncertainty). This lack of distinction limits downstream action decisions like requesting clarification or invoking external tools. In this work, we introduce UA-Bench, a benchmark of over 3,500 questions drawn from six datasets spanning knowledge-intensive and reasoning-intensive tasks, designed to evaluate explicit uncertainty attribution. An evaluation of 18 frontier LLMs shows that even state-of-the-art models struggle to reliably discriminate between data uncertainty and model uncertainty, and that high answer accuracy does not necessarily imply strong uncertainty attribution ability. To narrow this gap, we propose a lightweight data synthesis and reinforcement learning strategy. Experiments on both Qwen3-4B-Instruct-2507 and Qwen3-8B in thinking mode show that the proposed method improves uncertainty attribution while preserving answer accuracy. Our code and data are publicly available now.

Large Language Models (LLMs) have achieved strong performance in medical question answering and clinical reasoning tasks. However, their reliability under uncertainty remains poorly understood which raises critical concerns for deployment in high-stakes clinical settings. In such environments, incorrect predictions are inherently risky, but confident incorrect predictions can be particularly harmful as they may mislead clinical decision-making. In this paper, we conduct a systematic behavioral analysis of LLMs under clinical information uncertainty. We propose an evaluation framework based on the MedMCQA dataset consisting of two complementary uncertainty settings. First, we introduce linguistic uncertainty cues through prompt modifications to simulate ambiguous clinical contexts. Second, we construct an answer removal setting, wherein the correct option is deliberately excluded mandating the model to recognize insufficient information and abstain. We analyze both model accuracy and confidence behavior using multiple calibration metrics including calibration gap, Expected Calibration Error (ECE), and Unsafe Confident Error Rate (UCER) across 500 medical questions. Our results reveal a consistent failure mode, i.e., although accuracy degrades under increasing uncertainty, model confidence remains misaligned with accuracy. This leads to a substantial increase in unsafe confident errors, indicating that model confidence remains largely insensitive to clinically meaningful information loss. Furthermore, we observe significant variation across models in their ability to abstain when the correct answer is unavailable, with some models persistently producing high confidence hallucinated answers. These findings expose critical limitations in the epistemic reliability of current LLMs and highlight the need for uncertainty aware evaluation methods prior to their deployment in clinical workflows.

Large Language Models (LLMs) are frequently confident, eloquent, and well versed. A natural question arises: do they know what they don't know? To answer this question, we borrow the concept of epistemic honesty and develop a novel metric to systematically evaluate whether an LLM appropriately acknowledges the boundaries of its knowledge. In this work, we introduce the Epistemic Honesty Quotient (EHQ), which reports three observable sub-scores across two operational axes (epistemic restraint and substantive-answer calibration), and construct EHQ-3000, a 3,000-question benchmark spanning Fabricated Entity, Post-Cutoff Event, Hyper-Niche True, and Context-Conditioned Questions. From a frozen registry of 21 model API routes, 15 completed the protocol after endpoint and eligibility checks; 14 entered the confirmatory analysis because severe provider-side truncation made one route's score indeterminate. The study reveals substantial variation across models, including a difference that can not be explained by their capability to extract explicitly available information. Composite EHQ ranges from 0.31 to 0.81 across the analysed panel, despite near-ceiling performance on the document-grounded capability probe. The two restraint criteria overlap strongly under the present category composition, whereas substantive-answer calibration varies across models and does not reliably co-vary with restraint; however, the small panel leaves substantial uncertainty. Thus, EHQ reveals behavioral differences that are not visible to conventional correctness-based assessment, while also showing why dataset composition, provider behavior, and confidence elicitation must remain part of the interpretation.