Dialogue to Question Generation for Evidence-based Medical Guideline Agent Development

Across medical specialties, clinical practice is anchored in evidence-based guidelines that codify best studied diagnostic and treatment pathways. These pathways routinely fall short for the long tail of real-world care not covered by guidelines. Most medical large language models (LLMs), however, are trained to encode common, guideline-focused medical knowledge in their parameters. Current evaluations test models primarily on recalling and reasoning with this memorized content, often in multiple-choice settings. Given the fundamental importance of evidence-based reasoning in medicine, it is neither feasible nor reliable to depend on memorization in practice. To address this gap, we introduce OGCaReBench, a free-form retrieval-focused benchmark aimed at evaluating LLMs at answering clinical questions that require going beyond typical guidelines. Extracted from published medical case reports and validated by medical experts, OGCaReBench contains long-form clinical questions requiring free-text answers, providing a systematic framework for assessing open-ended medical reasoning in rare, case-based scenarios. Our experiments reveal that even the best-performing baseline (GPT-5.2) correctly answers only 56% of our benchmark with specialized models only reaching 42%. Augmenting models with retrieved medical articles improves this performance to up to 82% (using GPT-5.2) highlighting the importance of evidence-grounding for real-world medical reasoning tasks. This work thus establishes a foundation for benchmarking and advancing both general-purpose and medical LLMs to produce reliable answers in challenging clinical contexts.

Recent advances in deep research systems enable large language models to retrieve, synthesize, and reason over large-scale external knowledge. In medicine, developing clinical guidelines critically depends on such deep evidence integration. However, existing benchmarks fail to evaluate this capability in realistic workflows requiring multi-step evidence integration and expert-level judgment. To address this gap, we introduce MedProbeBench, the first benchmark leveraging high-quality clinical guidelines as expert-level references. Medical guidelines, with their rigorous standards in neutrality and verifiability, represent the pinnacle of medical expertise and pose substantial challenges for deep research agents. For evaluation, we propose MedProbe-Eval, a comprehensive evaluation framework featuring: (1) Holistic Rubrics with 1,200+ task-adaptive rubric criteria for comprehensive quality assessment, and (2) Fine-grained Evidence Verification for rigorous validation of evidence precision, grounded in 5,130+ atomic claims. Evaluation of 17 LLMs and deep research agents reveals critical gaps in evidence integration and guideline generation, underscoring the substantial distance between current capabilities and expert-level clinical guideline development. Project: https://github.com/uni-medical/MedProbeBench

Clinical decision-making requires synthesizing heterogeneous evidence, including patient histories, clinical guidelines, and trajectories of comparable cases. While large language models (LLMs) offer strong reasoning capabilities, they remain prone to hallucinations and struggle to integrate long, structured medical documents. We present MED-COPILOT, an interactive clinical decision-support system designed for clinicians and medical trainees, which combines guideline-grounded GraphRAG retrieval with hybrid semantic-keyword similar-patient retrieval to support transparent and evidence-aware clinical reasoning. The system builds a structured knowledge graph from WHO and NICE guidelines, applies community-level summarization for efficient retrieval, and maintains a 36,000-case similar-patient database derived from SOAP-normalized MIMIC-IV notes and Synthea-generated records. We evaluate our framework on clinical note completion and medical question answering, and demonstrate that it consistently outperforms parametric LLM baselines and standard RAG, improving both generation fidelity and clinical reasoning accuracy. The full system is available at https://huggingface.co/spaces/Cryo3978/Med_GraphRAG , enabling users to inspect retrieved evidence, visualize token-level similarity contributions, and conduct guided follow-up analysis. Our results demonstrate a practical and interpretable approach to integrating structured guideline knowledge with patient-level analogical evidence for clinical LLMs.