A Multi-Agent LLM Framework for Rating the Quality of Surgical Feedback

Reliable evaluation of large language models in surgery remains underdeveloped. Broad medical benchmarks test clinical knowledge, while surgery requires procedural reasoning, management trade-offs, negation handling, and selection among plausible operative decisions. We present SurgiQ, a text-only, source-grounded benchmark of 13,055 four-option multiple-choice questions spanning six surgical domains and four question formats: case-based, reasoning, best-option, and negative. SurgiQ is constructed from surgical textbooks, open-access papers, and examination material using a multi-stage generation, verification, and expert-audit pipeline. We evaluate 35 open-weight LLMs under a unified log-likelihood protocol. Our results show substantial remaining headroom: smaller models often remain near the 25% random baseline, while the best model reaches 68.1% accuracy. General-purpose models, especially Qwen2.5, outperform most biomedical models, suggesting that current medical specialization does not yet provide sufficiently broad surgical coverage. Calibration and error analysis further show that even strong models make confident mistakes on clinically plausible distractors, motivating more reliable and broader surgical LLM evaluation.

Large language models (LLMs) have been widely applied to automated essay scoring (AES) and automated feedback generation (AFG). However, existing studies rely primarily on prompt engineering or supervised fine-tuning, while systematic research on reinforcement learning (RL) post-training and automated evaluation of feedback quality remains limited. We propose RLAES, a unified LLM framework that jointly optimizes essay scoring and feedback generation through RL. To make feedback quality measurable, interpretable, and usable for training, we introduce Rubric-based Feedback Evaluation (RFE), an essay-grounded feedback evaluation framework comprising 166 fine-grained binary rubric items and an LLM-as-judge. Building on RFE, we propose Adaptive Gated Feedback Optimization (AGFO), which activates rubric-based feedback rewards on demand during RL, reducing evaluation overhead while improving feedback quality. We also propose Adjacent Contrastive Reasoning (ACR) to improve ordinal score calibration by explicitly contrasting adjacent score levels. Experimental results show that the RFE framework captures essay-feedback consistency, exhibits strong pairwise discriminative power, and closely aligns with expert preferences. On the ASAP benchmark, RLAES-AGFO achieves the best scoring performance among LLM-based methods (QWK = 0.803), while maintaining feedback quality comparable to GPT-5.5 and avoiding the feedback degradation observed under score-only RL. Code and datasets are publicly available at https://github.com/hellomuyi/RLAES.

As Large Language Models (LLMs) advance toward open-ended autonomous agents, the mechanisms used to evaluate and guide their behavior must evolve accordingly. This work introduces the rubric as a unifying framework capturing this evolution, characterizing rubrics as a dynamic response to successive LLM paradigm shifts that recurs across otherwise independent efforts in evaluation, reinforcement learning, and safety alignment. We define rubrics as explicit criteria sets that transform complex quality judgments into structured and actionable standards, and demonstrate that their recurrence across these research threads is not coincidental. We systematically organize existing rubric designs, examine their construction and optimization, and analyze their role across evaluation and training. Rubrics manifest at three progressively deeper levels: at the evaluative level, they decompose holistic judgments into verifiable dimensions; at the training level, they serve as dense feedback signals providing process-level guidance where scalar rewards fall short; at the intrinsic level, they emerge dynamically from model behaviors, driving self-improvement. We further assess rubric reliability across generation quality, execution fidelity, theoretical constraints, and security threats, before surveying rubric-based benchmarks across diverse domains. By rendering assessment transparent and decomposable, rubrics translate human value expectations into machine-learnable signals, serving as the enduring bridge between human intentions and machine behavior.