ConRub-Med: Reinforcement Learning with Consensus Rubrics for Open-Ended Medical Question Answering

Large Language Models (LLMs) have shown strong promise in healthcare applications. Yet deploying general-purpose models in real-world settings remains difficult due to data privacy constraints, inference costs, and limited suitability for edge or on-device use. These challenges motivate the development of smaller, more efficient models that require robust post-training strategies to ensure reliable medical reasoning. In this work, we investigate Group Relative Policy Optimization (GRPO) for post-training LLMs on heart-focused medical question answering with rubric-based supervision derived from RaR-Medicine. We propose a Variance-Aware Reward Framework that extends the Explicit Aggregation and Implicit Aggregation strategies of Rubrics as Rewards by replacing weighted binary criterion aggregation and single overall Likert-style scoring with continuous analytical reward functions derived from criterion-level rubric outcomes. This formulation provides richer optimization signals for feedback that is sparse, multi-criteria, and difficult to verify automatically, and enables more stable on-policy reinforcement learning. On a held-out heart-related subset of HealthBench, our best GRPO variant improves accuracy from 0.362 to 0.502 and F1 from 0.532 to 0.668 relative to the Qwen3-14B base model, while remaining competitive with GPT-OSS-120B (0.508 accuracy, 0.674 F1). Our findings show that carefully designed rubric-based rewards provide a practical strategy for improving heart-focused medical question answering in LLMs, with potential to extend to other rubric-based tasks.

Rubric-based reinforcement learning extends RL beyond tasks with exact answers or rule-based verifiers by scoring responses against instance-specific criteria. However, this makes reward computation expensive: training requires repeated rubric judging, often with proprietary APIs or local generative LLM judges with 7B parameters or more. We study whether smaller language models can serve as efficient and reliable rubric-based judges. To make this question measurable, we construct PointRubric and RaR-Science-Static, two pointwise rubric-based evaluation datasets with instance-specific criteria and itemwise satisfaction labels. We compare three ways of extracting criterion-level judgments from small models: Generative verdicts, Yes/No Logprob margins, and Probe judges. Across both datasets, the Qwen3-1.7B Probe judge achieves the strongest criterion-level agreement among these methods, outperforming Generative and Logprob judges. Used as a GRPO reward model, it trains a policy from 0.232 to 0.643 on RaR-Science rubric score, compared with 0.594 for an 8B Generative judge baseline, while the baseline requires 10.7$\times$ more reward-judge time. Task and domain transfer experiments further suggest that Probe judges preserve criterion-level reward structure across settings.

Reinforcement learning against rubrics, lists of criteria graded by an LLM judge, has become a standard way to post-train language models on tasks with no deterministic answer. The rubric, however, is a fixed proxy for quality, never a complete description of it, and a policy trained against it long enough will learn to exploit the difference. We measure this directly. Training Qwen3-8B with Group Relative Policy Optimization (GRPO) on medical and science rubrics and grading out-of-distribution (OOD) benchmarks with both the training judge and a stronger gold judge, we find that the two scores diverge during training. The training judge's score keeps climbing while the gold judge's score peaks and then falls, by 3 points on HealthBench-Hard and by 22 points on ResearchQA. A judge with a fixed bias would shift the gold curve by a constant, not send it down while the training score rises, so the divergence is reward hacking, not judge noise. We propose Rubric Dropout, a one-line fix borrowed from neuron dropout. At every step, we randomly drop a subset of the rubric's criteria before computing the reward, so the policy never optimizes the same rubric twice. The dropped subset is shared across each rollout group, so GRPO's group-relative advantages stay comparable, and evaluation always uses the full rubric. Comparing no dropout against dropout at 30% and 50% on both benchmark pairs, dropout raises the OOD gold score at every matched checkpoint (+1 to +2 points on HealthBench-Hard, +6 to +7 points on ResearchQA), lowers the two hacking measures we track, and costs nothing in domain. Sweeping the dropout fraction shows a broad 30-50% sweet spot, while the natural alternative, reweighting criteria by how useful they are to training, performs worse than no intervention at all in our setting.