Skill-Augmented AI Agents for Medical Research Analysis: An Exploratory Multi-Model Human Evaluation in an NSCLC Transcriptomic Biomarker Task

Background: Agent skills are increasingly deployed as modular, reusable capability units in AI agent systems. Medical research agent skills require safeguards beyond general-purpose evaluation, including scientific integrity, methodological validity, reproducibility, and boundary safety. This study developed and preliminarily evaluated a domain-specific audit framework for medical research agent skills, with a focus on reliability against expert review. Methods: We developed MedSkillAudit (skill-auditor@1.0), a layered framework assessing skill release readiness before deployment. We evaluated 75 skills across five medical research categories (15 per category). Two experts independently assigned a quality score (0-100), an ordinal release disposition (Production Ready / Limited Release / Beta Only / Reject), and a high-risk failure flag. System-expert agreement was quantified using ICC(2,1) and linearly weighted Cohen's kappa, benchmarked against the human inter-rater baseline. Results: The mean consensus quality score was 72.4 (SD = 13.0); 57.3% of skills fell below the Limited Release threshold. MedSkillAudit achieved ICC(2,1) = 0.449 (95% CI: 0.250-0.610), exceeding the human inter-rater ICC of 0.300. System-consensus score divergence (SD = 9.5) was smaller than inter-expert divergence (SD = 12.4), with no directional bias (Wilcoxon p = 0.613). Protocol Design showed the strongest category-level agreement (ICC = 0.551); Academic Writing showed a negative ICC (-0.567), reflecting a structural rubric-expert mismatch. Conclusions: Domain-specific pre-deployment audit may provide a practical foundation for governing medical research agent skills, complementing general-purpose quality checks with structured audit workflows tailored to scientific use cases.

Large language models (LLMs) are increasingly being explored for clinical decision support, but their reliability in complex oncology treatment planning remains unclear. We evaluated agentic LLM systems for breast cancer treatment recommendation generation using 72 real clinical cases across stages I to IV and 1,147 case-specific rubrics generated through Asymmetric Information Rubric Generation (AIRG), in which the rubric generator had access to real clinical decisions unavailable to the evaluated models. Seven pipelines were compared, including single-LLM baselines, tool-augmented systems, and multi-agent architectures with fact checking and autonomous subagent spawning. The best-performing configuration, Claude Opus 4.8 with the D&C+SA pipeline, achieved a global score of 0.594 $\pm$ 0.025. Tool use and increased agent autonomy had mixed effects, improving performance in some settings but degrading it in others. Performance varied by clinical domain and disease stage, and oncologist-led error analysis revealed persistent clinically relevant failures, including incorrect or missing recommendations, flawed justifications, citation errors, outdated claims, and overconfidence. These findings suggest that agentic LLM systems can generate clinically relevant breast cancer recommendations, but remain insufficient for unsupervised clinical use.

Introduction. Clinical and Translational Science Award (CTSA) programs must document their scholars' research impact, but assembling each scholar's record by hand takes staff an estimated 15 hours and does not scale to a full cohort. An artificial intelligence (AI) agent could serve as a tool to gather scholar data across platforms and disciplines. Methods. We built a human-in-the-loop AI agent that assembles a dossier of sourced evidence for each scholar and drafts one-sentence Translational Science Benefits Model (TSBM) impact summaries for staff review. We evaluated it in the impact-reporting workflow of one CTSA hub across 10 career-development (KL2/K12) scholars. Two evaluation staff independently coded all 507 findings as accept, edit, or reject; the primary measure was the unanimous usable rate, defined as the share both accepted or edited. Results. Both reviewers accepted or edited 81.7% of the agent's findings. Reviewers each spent a median of 14 minutes per scholar, replacing an estimated 15 hours of manual assembly. Inter-rater agreement was moderate (Cohen's kappa 0.43 on the usable-versus-reject decision). A profile discovery study found the agent's recall close to human search. The agent's impact evidence spanned all four TSBM domains, and about a third of the reviewed findings fell in non-scholarly categories that routine processes tend to miss. Reviewers rated synthesis accuracy 4.5 and usefulness 4.8 on a 5-point scale. Conclusions. A human-in-the-loop AI agent can serve as the first-pass author of a scholar's impact record, shifting staff from collecting and writing to reviewing, and making cohort-scale impact reporting feasible.