Reliable and interpretable automated assessment of second-language (L2) speech remains a central challenge, as large speech-language models (SpeechLLMs) often struggle to align with the nuanced variability of human raters. To address this, we introduce a rubric-guided reasoning framework that explicitly encodes multi-aspect human assessment criteria: accuracy, fluency, and prosody, while calibrating model uncertainty to capture natural rating variability. We fine-tune the Qwen2-Audio-7B-Instruct model using multi-rater human judgments and develop an uncertainty-calibrated regression approach supported by conformal calibration for interpretable confidence intervals. Our Gaussian uncertainty modeling and conformal calibration approach achieves the strongest alignment with human ratings, outperforming regression and classification baselines. The model reliably assesses fluency and prosody while highlighting the inherent difficulty of assessing accuracy. Together, these results demonstrate that rubric-guided, uncertainty-calibrated reasoning offers a principled path toward trustworthy and explainable SpeechLLM-based speech assessment.

The current largest open-source generic automatic speech recognition (ASR) system for Dutch, Kaldi_NL, does not include a domain-specific healthcare jargon in the lexicon. Commercial alternatives (e.g., Google ASR system) are also not suitable for this purpose, not only because of the lexicon issue, but they do not safeguard privacy of sensitive data sufficiently and reliably. These reasons motivate that just a small amount of medical staff employs speech technology in the Netherlands. This paper proposes an innovative ASR training method developed within the Homo Medicinalis (HoMed) project. On the semantic level it specifically targets automatic transcription of doctor-patient consultation recordings with a focus on the use of medicines. In the first stage of HoMed, the Kaldi_NL language model (LM) is fine-tuned with lists of Dutch medical terms and transcriptions of Dutch online healthcare news bulletins. Despite the acoustic challenges and linguistic complexity of the domain, we reduced the word error rate (WER) by 5.2%. The proposed method could be employed for ASR domain adaptation to other domains with sensitive and special category data. These promising results allow us to apply this methodology on highly sensitive audiovisual recordings of patient consultations at the Netherlands Institute for Health Services Research (Nivel).