Organizations: Institute of Medical Education, Health Science Center, Peking University, Beijing, China · School of Public Health, Peking University, Haidian District, Beijing, China · Peking University Health Science Center-Chaoxing Joint Laboratory for Digital and Smart Medical, Peking University, Beijing, China · Graduate School of Education, Peking University, Haidian District, Beijing, China
The rapid proliferation of large language models (LLMs) in healthcare creates an urgent need for scalable and psychometrically sound evaluation methods. Conventional static benchmarks are costly to administer repeatedly, vulnerable to data contamination, and lack calibrated measurement properties for fine-grained performance tracking. We propose and validate a computerized adaptive testing (CAT) framework grounded in item response theory (IRT) for efficient assessment of standardized medical knowledge in LLMs. The study comprises a two-phase design: a Monte Carlo simulation to identify optimal CAT configurations and an empirical evaluation of 38 LLMs using a human-calibrated medical item bank. Each model completed both the full item bank and an adaptive test that dynamically selected items based on real-time ability estimates and terminated upon reaching a predefined reliability threshold (standard error <= 0.3). Results show that CAT-derived proficiency estimates achieved a near-perfect correlation with full-bank estimates (r = 0.988) while using only 1.3 percent of the items. Evaluation time was reduced from several hours to minutes per model, with substantial reductions in token usage and computational cost, while preserving inter-model performance rankings. This work establishes a psychometric framework for rapid, low-cost benchmarking of foundational medical knowledge in LLMs. The proposed adaptive methodology is intended as a standardized pre-screening and continuous monitoring tool and is not a substitute for real-world clinical validation or safety-oriented prospective studies.
Computerized Adaptive Testing (CAT) has proven effective for efficient LLM evaluation on multiple-choice benchmarks, but modern LLM evaluation increasingly relies on generation tasks where outputs are scored continuously rather than marked correct/incorrect. We present a principled extension of IRT-based adaptive testing to continuous bounded scores (ROUGE, BLEU, LLM-as-a-Judge) by replacing the Bernoulli response distribution with a heteroskedastic normal distribution. Building on this, we introduce an uncertainty aware ranker with adaptive stopping criteria that achieves reliable model ranking while testing as few items and as cheaply as possible. We validate our method on five benchmarks spanning n-gram-based, embedding-based, and LLM-as-judge metrics. Our method improves ranking correlation by 0.13 τ over random sampling and has 99% accuracy on confident predictions while using 2% of the items after a one-time calibration step.
Esma Balkır, Alice Pernthaller, Marco Basaldella +2
Trismik · Leverhulme Centre for the Future of Intelligence, University of Cambridge · Universitat Politècnica de València +1
Evaluating large language models (LLMs) typically requires thousands of benchmark items, making the process expensive, slow, and increasingly impractical at scale. Existing evaluation protocols rely on average accuracy over fixed item sets, treating all items as equally informative despite substantial variation in difficulty and discrimination. We introduce ATLAS, an adaptive testing framework based on Item Response Theory (IRT) that estimates model ability using Fisher information-guided item selection. ATLAS reduces the number of required items by up to 90% while maintaining measurement precision. For instance, it matches whole-bank ability estimates using only 41 items (0.157 MAE) on HellaSwag (5,600 items). We further reconstruct accuracy from ATLAS's ability estimates and find that reconstructed accuracies closely match raw accuracies across all five benchmarks, indicating that ability θ preserves the global performance structure. At the same time, θ provides finer discrimination within accuracy-equivalent models: among more than 3,000 evaluated models, 23-31% shift by more than 10 rank positions, and models with identical accuracies receive meaningfully different ability estimates. Code and calibrated item banks are available at https://github.com/Peiyu-Georgia-Li/ATLAS.git.
Large language models (LLMs) in medicine are mainly evaluated using multiple-choice question answering (MCQA), which can overestimate real clinical ability due to guessing strategies and answer biases. To address these limitations, we introduce an expanded and more challenging benchmark based on Polish medical exams, adding over 15,000 questions, two new domains, and four structural modifications that reduce MCQA-specific artifacts and better test reasoning. We evaluate 21 LLMs and show that evaluation design strongly affects results. Under our harder setup, the best model (Qwen3.5-122B) drops by 28.4 and 31 pp on English and Polish exams, respectively. Despite low evidence of data contamination, standard MCQA scores do not reliably reflect true medical competence. To facilitate further research, we make our benchmark publicly available.
Antoni Lasik, Jakub Pokrywka, Łukasz Grzybowski +7
NASK National Research Institute · Adam Mickiewicz University · ARAAI Poland +4