Cross-Model Consistency of AI-Generated Exercise Prescriptions: A Repeated Generation Study Across Three Large Language Models

Run-level pass rate overstates retry-free coverage by up to 17.8 percentage points -- and the gap is largest precisely for mid-performing systems. We investigate this accuracy--stability relationship in large language model (LLM) evaluation for deterministic text-conditioned generation, using programming tasks as a concrete testbed. Standard code-generation benchmarks emphasize single-run accuracy or eventual success under repeated sampling, but many deployment settings also require stability: consistent outcomes across repeated invocations under the same task description. We present a repeated-run evaluation protocol with metrics for run-level accuracy, retry-free coverage, and per-problem variability. On a recency-based benchmark of 100 LeetCode-style problems, we evaluate 16 models from five provider families under two prompt templates with five repeated runs per problem, yielding 16,000 evaluation instances. Although run-level pass rate and perfect stability rate are strongly correlated (r=0.985), pass rate consistently exceeds retry-free coverage -- a gap that reaches 17.8 percentage points and reverses model rankings even among closely matched systems. Prompt effects are model-dependent rather than uniformly beneficial. These results suggest that repeated-run stability analysis is a necessary complement to conventional accuracy reporting for deterministic text-conditioned generation tasks.

Large language models are increasingly deployed in agentic pipelines that depend on the model evaluating its own outputs without external verification. The reliability of these pipelines depends on an implicit assumption: that the model applies relevant concepts the same way when it generates an output and later evaluates that output. We propose a new measure, generator-evaluator self-consistency, to test this assumption directly and apply it to 10 frontier models across 491 concepts. We find, first, that there is substantial variation in self-consistency. Second, we find that in a clinical setting with physician-validated mistakes (Proniakin et al., 2025), across models, those with higher self-consistency are linked to greater vulnerability to mistakes. Thus, even when models consistently apply concepts they may not be safe to deploy. This is evidence of a consistency dilemma in LLMs: self-consistency is operationally useful, but models that are more consistent are also more prone to mistakes.

Large language models are increasingly deployed to simulate patients for clinical training, research, and mental health tools, yet population-level validity remains largely untested. We introduce PsychBench, the first epidemiological audit of LLM patient simulation: 28,800 profiles from four frontier models (GPT-4o-mini, DeepSeek-V3, Gemini-3-Flash, GLM-4.7) evaluated against NHANES and NESARC-III baselines across 120 intersectional cohorts. The central finding is a coherence-fidelity dissociation: models produce clinically plausible individuals while misrepresenting the populations they are drawn from. Variance compression ranges from 14 percent (GLM-4.7) to 62 percent (DeepSeek-V3), eliminating the distributional tails of clinical reality. Despite test-retest correlations above r = 0.90, 36.66 percent of cases cross diagnostic thresholds between runs. Symptom correlation matrices diverge across demographic groups beyond split-half noise, with transgender populations diverging three to five times more than racial differences. Calibration bias is systematic and asymmetric. Models overestimate depression severity for most groups by 3.6 to 6.1 points (Cohen d = 1.13 to 1.91), consistent with training on clinical corpora with elevated base rates. For transgender women the direction inverts: models capture only 8 to 46 percent of documented minority stress elevation, yielding a -5.42 residual (d = -1.55). Models also attribute irritability to Black men and fatigue to women beyond matched controls, encoding racialized and gendered assumptions. Patterns replicate across US and Chinese architectures, indicating failures tied to current training paradigms rather than isolated implementations. For most users, LLM mental health tools risk pathologizing ordinary distress; for transgender users, algorithmic erasure of genuine need. The patients look right. They do not represent real populations.