MedArena: Comparing LLMs for Medicine-in-the-Wild Clinician Preferences

Large language models (LLMs) are increasingly considered for use in clinical consultation tasks, yet most medical evaluations remain static, single-turn, or narrowly outcome-based, limiting their ability to reflect the sequential, uncertain, and interactive nature of real-world care. Here, we propose AIPatient Arena, an EHRs-grounded evaluation framework for assessing the clinical utility of LLMs across eight dimensions of clinical competence. The framework integrates EHR data into patient-specific knowledge graphs, enabling multi-turn physician-patient interactions. We applied AIPatient Arena on a primary cohort of 437 patients and two out-of-distribution validation cohorts of 119 and 67 patients. We observe that LLMs performed well in medical interview questioning skills (QS; mean scores, 4.43-4.99/5), ethical and professional conduct (ET; 4.38-4.93/5), and clarity and transparency of clinical explanations (EX; 3.80-4.72/5). Performance was moderate in information integration (II; 3.19-4.21/5) and medication safety and justification (MS; 3.13-3.78/5), but persistent weaknesses were observed in handling of ambiguous patient responses (HR; 2.57-3.32/5), information coverage (IC; 2.08-3.02/5), and diagnostic accuracy and reasoning (Dx; 2.63-3.55/5). Process-based evaluation revealed recurrent interaction failures, including repetitive questioning, omission of past medical history, and inadequate handling of uncertainty. Richer conversational context improved diagnostic reasoning but yielded limited gains in treatment planning. These findings indicate that final-answer accuracy alone is insufficient for evaluating clinical readiness and highlight the importance of assessing how models gather, interpret, and communicate information throughout a consultation. AIPatient Arena provides an EHR-grounded framework for workflow-oriented pre-deployment evaluation of medical LLMs.

Background: Expert-annotated benchmarks for non-English open-response clinical questions are scarce. LLM-as-a-judge systems may scale evaluation but require validation. Objective: To introduce MedQADE, a standardized German open-response clinical benchmark with physician reference annotations, and evaluate LLM-as-a-judge alignment, self- and intra-family bias, and abstention. Methods: The benchmark contains 3,800 question-answer sets with answers from five student LLMs and annotations from 10 physicians. All 10 rated the 200-question core; two primary raters assessed each of 3,600 extension questions, with the tenth resolving disagreements. Nine LLM evaluators assessed all sets. We assessed physician reliability, student-model accuracy, evaluator alignment, bias, and abstention. Results: Physicians showed moderate-to-substantial agreement on answer correctness (unweighted mean pairwise Cohen's kappa = 0.612) but limited agreement on question difficulty (Krippendorff's alpha = 0.208 using squared numeric-score distances). Student-model accuracy was 17.8%-66.0% and generally decreased with physician-rated difficulty. Gemini 3 Flash approached the leave-one-out physician reference (kappa = 0.694 vs 0.709). Four of five models rated their own responses more favorably than out-of-family evaluators; five of six intra-family comparisons were positive. Physician abstention increased with perceived difficulty. Seven of nine LLM evaluators abstained in no more than 0.51% of evaluations; the two strongest evaluators assigned definitive labels to every response. Conclusions: Strong LLM evaluators approached physician agreement, but evaluator bias and low observed abstention warrant physician validation and further assessment of selective deferral before fully automated evaluation. These results do not establish clinical safety.

While Large Language Models (LLMs) excel on standardized medical exams, high scores often fail to translate to high-quality responses for real-world medical queries. Current evaluations rely heavily on multiple-choice questions, failing to capture the unstructured, ambiguous, and long-tail complexities inherent in genuine user inquiries. To bridge this gap, we introduce QuarkMedBench, an ecologically valid benchmark tailored for real-world medical LLM assessment. We compiled a massive dataset spanning Clinical Care, Wellness Health, and Professional Inquiry, comprising 20,821 single-turn queries and 3,853 multi-turn sessions. To objectively evaluate open-ended answers, we propose an automated scoring framework that integrates multi-model consensus with evidence-based retrieval to dynamically generate 220,617 fine-grained scoring rubrics (~9.8 per query). During evaluation, hierarchical weighting and safety constraints structurally quantify medical accuracy, key-point coverage, and risk interception, effectively mitigating the high costs and subjectivity of human grading. Experimental results demonstrate that the generated rubrics achieve a 91.8% concordance rate with clinical expert blind audits, establishing highly dependable medical reliability. Crucially, baseline evaluations on this benchmark reveal significant performance disparities among state-of-the-art models when navigating real-world clinical nuances, highlighting the limitations of conventional exam-based metrics. Ultimately, QuarkMedBench establishes a rigorous, reproducible yardstick for measuring LLM performance on complex health issues, while its framework inherently supports dynamic knowledge updates to prevent benchmark obsolescence.