A bilingual AI audiologist built through rubric-guided playbook induction outperforms human audiologists in a blinded evaluation of simulated cases

Objective. Clinical AI documentation systems require evaluation methodologies that are clinically valid, economically viable, and sensitive to iterative changes. Methods requiring expert review per scoring instance are too slow and expensive for safe, iterative deployment. We present a case-specific, clinician-authored rubric methodology for clinical AI evaluation and examine whether LLM-generated rubrics can approximate clinician agreement. Materials and Methods. Twenty clinicians authored 1,646 rubrics for 823 clinical cases (736 real-world, 87 synthetic) across primary care, psychiatry, oncology, and behavioral health. Each rubric was validated by confirming that an LLM-based scoring agent consistently scored clinician-preferred outputs higher than rejected ones. Seven versions of an EHR-embedded AI agent for clinicians were evaluated across all cases. Results. Clinician-authored rubrics discriminated effectively between high- and low-quality outputs (median score gap: 82.9%) with high scoring stability (median range: 0.00%). Median scores improved from 84% to 95%. In later experiments, clinician-LLM ranking agreement (tau: 0.42-0.46) matched or exceeded clinician-clinician agreement (tau: 0.38-0.43), attributable to both ceiling compression and LLM rubric improvement. Discussion. This convergence supports incorporating LLM rubrics alongside clinician-authored ones. At roughly 1,000 times lower cost, LLM rubrics enable substantially greater evaluation coverage, while continued clinical authorship grounds evaluation in expert judgment. Ceiling compression poses a methodological challenge for future inter-rater agreement studies. Conclusion. Case-specific rubrics offer a path for clinical AI evaluation that preserves expert judgment while enabling automation at three orders lower cost. Clinician-authored rubrics establish the baseline against which LLM rubrics are validated.

English-only benchmarks expose only a narrow slice of voice-agent behavior. We introduce $τ$-Multilingual, extending $τ$-Voice to Spanish, Brazilian Portuguese, Hindi, Korean, and Mandarin with native-speaker review and evaluation of generated language and spoken output. Across 4,500 full-duplex calls and five voice configurations, Spanish, Portuguese, and Hindi remain within 3.2 task-completion points of English, but Korean and Mandarin fall by 14.7 and 8.4 points. The failure modes also vary: Korean systems miss more responses, Mandarin systems interrupt more often, and both struggle with tools and entities. Grok leads task completion but scores lowest on generation quality, motivating separate task, interaction, and generation reporting. We release language packs, validated judges, and tools for community-built multilingual voice-agent evaluation.

Large language models (LLMs) may support counseling training, yet evidence from Japanese-language interactions and automated quality ratings remains limited. We examined 18 fixed Japanese-language counseling transcripts generated through artificial intelligence (AI)-to-AI interactions under three counselor conditions: GPT-minimal (GPT-4-turbo with a minimal role instruction), GPT-SMDP (GPT-4-turbo with the Structured Multi-step Dialogue Prompt [SMDP]), and Claude-SMDP (Claude-3-Opus with SMDP). Fifteen counseling experts rated transcripts on four adapted global scales from the Motivational Interviewing Treatment Integrity coding manual and an overall-quality item; three newer LLMs independently rated the same transcripts in three iterations. In this fixed stimulus set, SMDP-condition dialogues received higher expert ratings for cultivating change talk, partnership, empathy, and overall quality than GPT-minimal dialogues; the two SMDP counselor models did not differ. LLM ratings were reproducible but generally more lenient than expert-reference ratings, particularly for softening sustain talk and overall quality. Simulated-client naturalness was below the scale midpoint. These findings provide an expert-referenced benchmark for Japanese-language AI counseling simulations and show that reproducible LLM ratings should not be treated as calibrated counseling-quality evidence without expert validation. This study does not test clinical effectiveness or human-client outcomes.