PlainMedScale: A Corpus of Multi-Level Simplified Medical Texts in German and English

Medical Vision-Language Models (Med-VLMs) achieve strong expert-level performance, yet their ability to generate patient-accessible descriptions remains underexplored. With the 21st Century Cures Act now mandating immediate patient access to diagnostic imaging results, evaluating whether Med-VLMs can bridge this Expert-Lay Gap is both urgent and clinically consequential for patient education and shared decision-making. To this end, we introduce MedLayXPlain, the first large-scale multimodal benchmark and evaluation framework for Medical Lay Language Generation (MLLG). MedLayXPlain-122K provides 122,789 region-grounded samples across 8 imaging modalities from 12 publicly available source datasets, each comprising a medical image with paired expert and lay captions anchored in a three-level Unified Medical Language System (UMLS) ontology hierarchy spanning 7 semantic groups, 43 semantic types, and 2,411 medical concepts. Lay captions are constructed via Hierarchical Ontology-Verified Refinement (HOVER), a three-step pipeline combining patient-centric vocabulary mapping, LLM-based constrained rewriting, and cross-model visual verification to enforce semantic equivalence while preventing hallucination. We further introduce MedLayEval, a lightweight 3B evaluator distilled from a 27B verifier that scores expert-lay alignment across five clinically grounded attributes, addressing the poor correlation between standard NLG metrics and clinical judgment. Benchmarking 33 VLMs on MedLayXPlain-122K reveals a systematic Expert-Lay Gap: medical VLMs achieve strong expert captioning but suffer significant lay-register degradation, while general-purpose VLMs produce more accessible language yet lack clinical precision, confirming that neither current paradigm adequately serves patient-facing communication.

Medical Vision-Language Models (Med-VLMs) have achieved expert-level proficiency in interpreting diagnostic imaging. However, current models are predominantly trained on professional literature, limiting their ability to communicate findings in the lay register required for patient-centered care. While text-centric research has actively developed resources for simplifying medical jargon, there is a critical absence of large-scale multimodal benchmarks designed to facilitate lay-accessible medical image understanding. To bridge this resource gap, we introduce MedLayBench-V, the first large-scale multimodal benchmark dedicated to expert-lay semantic alignment. Unlike naive simplification approaches that risk hallucination, our dataset is constructed via a Structured Concept-Grounded Refinement (SCGR) pipeline. This method enforces strict semantic equivalence by integrating Unified Medical Language System (UMLS) Concept Unique Identifiers (CUIs) with micro-level entity constraints. MedLayBench-V provides a verified foundation for training and evaluating next-generation Med-VLMs capable of bridging the communication divide between clinical experts and patients.

Plain Language Summaries (PLS) aim to make research accessible to lay readers, but they are typically written in a one-size-fits-all style that ignores differences in readers' information needs and comprehension. In health contexts, this limitation is particularly important because misunderstanding scientific information can affect real-world decisions. Large language models (LLMs) offer new opportunities for personalizing PLS, but it remains unclear whether personalization helps, which strategies are most effective, and how to balance personalization with safety. We introduce ReLay, a dataset of 300 participant--PLS pairs from 50 lay participants in both static (expert-written) and interactive (LLM-personalized) settings. ReLay includes user characteristics, health information needs, information-seeking behavior, comprehension outcomes, interaction logs, and quality ratings. We use ReLay to evaluate five LLMs across two personalization methods. Personalization improves comprehension and perceived quality, but it also raises the risk of reinforcing user biases and introducing hallucinations, revealing a trade-off between personalization and safety. These findings highlight the need for personalization methods that are both effective and trustworthy for diverse lay audiences.