AusClinBench: a deterministically scored benchmark of large language models against current Australian clinical policy

Multiple-choice medical benchmarks are increasingly saturated, and recent rubric-based evaluations such as HealthBench have shown that open-ended clinical performance is far from solved - its "Hard" subset top score remains 32%. We present a small, deliberately difficult evaluation dataset of five clinician-authored clinical scenarios spanning four specialties (anaesthesia, internal/family medicine, emergency medicine, and obstetrics), each accompanied by an atomic, weighted, MECE rubric (25-62 criteria per task; 184 criteria total) authored from a clinician-drafted golden answer. We evaluate three frontier models: GPT 5.4, Claude Opus 4.7, and Gemini 3.1 Pro. Mean rubric pass rates were 0.47 (Claude), 0.38 (GPT), and 0.37 (Gemini). The central finding is an inversion of clinical priority: the highest-weighted (weight-5, critical) criteria passed at only 32.4-41.7%, while low-stakes weight-1 criteria passed at 80-90%. 55 of 108 critical (weight-5) criteria (51%) were satisfied by no model. Three LLM autoraters reproduced expert met/not-met labels on 92.8-94.6% of 552 graded criteria. We position this as a methods-and-preliminary-findings contribution: the five tasks demonstrate a scalable, defensible pipeline ready to develop into a large-scale benchmark.

Large language models are increasingly used for medical guidance, but women's health remains under-evaluated in benchmark design. We present the Women's Health Benchmark (WHBench), a targeted evaluation suite of 47 expert-crafted scenarios across 10 women's health topics, designed to expose clinically meaningful failure modes including outdated guidelines, unsafe omissions, dosing errors, and equity-related blind spots. We evaluate 22 models using a 23-criterion rubric spanning clinical accuracy, completeness, safety, communication quality, instruction following, equity, uncertainty handling, and guideline adherence, with safety-weighted penalties and server-side score recalculation. Across 3,102 attempted responses (3,100 scored), no model mean performance exceeds 75 percent; the best model reaches 72.1 percent. Even top models show low fully correct rates and substantial variation in harm rates. Inter-rater reliability is moderate at the response label level but high for model ranking, supporting WHBench utility for comparative system evaluation while highlighting the need for expert oversight in clinical deployment. WHBench provides a public, failure-mode-aware benchmark to track safer and more equitable progress in womens health AI.

Large language model (LLM) assistants are being deployed to clinicians across health systems, and judgments about their readiness rest largely on benchmark scores, most of them derived from examination questions or curated cases. A benchmark predicts performance in deployment only to the extent that its items resemble real use, yet whether benchmarks reflect the work these systems receive has rarely been measured. Here we analyze 127,833 queries sent by 6,342 physicians, advanced practice providers and nurses in 35 specialties to an institutional assistant during an eight-month roll-out. We characterize each query with RCQ-Map, a clinician-validated framework grounded in taxonomies of clinical questions and of LLM evaluation, which records its task, intent, answerability, missing information and potential harm. Documentation and administration (36.2%) and knowledge retrieval (28.9%) made up nearly two-thirds of use, and diagnosis 3.7%; more than a third of queries could not be answered well as posed. Applying RCQ-Map to 58 public benchmarks drawn from major evaluation suites and frontier model reports, which we assemble into the Clinical AI Benchmark Atlas, showed that the median benchmark contained no documentation requests and shared 31% of the task mix of real use, less than an even spread across task categories would. Benchmarks in suites designed to resemble clinical practice were individually no closer to real use than those used in frontier model reports. Benchmark scores therefore say little about how clinical AI performs on most of the work it is actually given, and evaluation should be matched to real clinical use.