Clinical Language Model Evaluation

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Overview

Clinical language model evaluation asks whether models can answer medical questions, interpret records, support conversations, and assist with decisions without causing harm. Researchers use exam-style benchmarks, clinician-authored rubrics, electronic health records, simulated consultations, and tests that vary language, missing information, patient behavior, or evidence; they also compare expert ratings with automated judges. Evaluation increasingly measures safety, omissions, evidence grounding, uncertainty, consistency, and workflow performance alongside accuracy. A central challenge is that strong scores on static tests or plausible reasoning may not transfer to dynamic, incomplete clinical encounters, while automated judges can disagree with clinicians and require validation.

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419 papers49 papers in the last four weeks, up 2% on the four weeks before. 0.3% of all new papers.

Apr 23, 2026

Reliability Auditing for Downstream LLM tasks in Psychiatry: LLM-Generated Hospitalization Risk Scores

Large language models (LLMs) are increasingly utilized in clinical reasoning and risk assessment. However, their interpretive reliability in critical and indeterminate domains such as psychiatry remains unclear. Prior work has identified algorithmic biases and prompt sensitivity in these systems, raising concerns about how contextual information may influence model outputs, but there remains no systematic way to assess these, especially in the psychiatric domain. We propose an approach for reliability auditing downstream LLM tasks by structuring evaluation around the impact of prompt design and the inclusion of medically insignificant inputs on predicted hospitalization risk scores, which is often the first downstream AI clinical-decision-making task. In our audit, a cohort of synthetic patient profiles (n = 50) is generated, each consisting of 15 clinically relevant features and up to 50 clinically insignificant features, across four prompt reframings (neutral, logical, human impact, clinical judgment). We audit four LLMs (Gemini 2.5 Flash, LLaMa 3.3 70b, Claude Sonnet 4.6, GPT-4o mini), and our results show that including medically insignificant variables resulted in a statistically significant increase in the absolute mean predicted hospitalization risk and output variability across all models and prompts, indicating reduced predictive stability as contextual noise increased. Clinically insignificant features had an effect on instability across many model-prompt conditions, and prompt variations independently affected the trajectory of instability in a model-dependent manner. These findings quantify how LLM-based psychiatric risk assessments are sensitive to non-clinical information, highlighting the need for systematic evaluations of attributional stability and uncertainty behavior like this before clinical deployments.

Shevya Panda, Shinjini Bose, Ananya Joshi

Johns Hopkins University Baltimore, USA

Prompt SensitivityLLM AuditingMental HealthClinical Language Model EvaluationClinical Risk Prediction
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Apr 23, 2026

Evaluating Patient Safety Risks in Generative AI: Development and Validation of a FMECA Framework for Generated Clinical Content

Objectives: Large language models (LLMs) are increasingly used for clinical text summarization, yet structured methods to assess associated patient safety risks remain limited. Failure Mode, Effects, and Criticality Analysis (FMECA) provides a proactive framework for systematic risk identification but has not been adapted to LLM-generated clinical content. This study aimed to develop and validate a novel FMECA framework for the prospective assessment of patient safety risks in LLM-generated clinical summaries. Materials and Methods: An interdisciplinary expert panel (n = 8) developed a taxonomy of failure modes through literature review and brainstorming. Standard FMECA dimensions (occurrence, severity, detectability) were adapted into 5-point ordinal scales. The framework was applied to 36 discharge summaries from four patients, generated by an open LLM (GPT-OSS 120B) using real-world clinical data from the Geneva University Hospitals. Reviewers independently annotated the summaries across two rounds. Inter-rater reliability was assessed at failure mode, severity and detectability score levels. Usability and content validity were evaluated using an adapted System Usability Scale and structured feedback. Results: The final framework comprised 14 failure modes organized into categories. Inter-rater agreement improved between rounds, reaching moderate-to-substantial agreement for failure mode identification and good agreement for severity and detectability scoring. Usability was rated as good (mean SUS: 79.2/100), with high evaluator confidence. Discussion and Conclusion: This study presents the first FMECA-based framework for systematic patient safety risk assessment of LLM-generated clinical summaries. The framework provides a structured and reproducible method for identifying clinically relevant risks caused by these summaries.

Lydie Bednarczyk, Jamil Zaghir, Julien Ehrsam +11

Division of Medical Information Sciences, Diagnostic Department, Geneva University Hospitals (HUG), Geneva, Switzerland. · Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland. · Pharmacy, Geneva University Hospital (HUG), and Institute of Pharmaceutical Sciences of Western Switzerland, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland. +3

Clinical Language Model EvaluationMedical LLMs
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Apr 23, 2026

When Correct Beliefs Collapse: Epistemic Resilience of LLMs under Clinical Pressure

Despite strong medical benchmark accuracy, LLMs can exhibit severe multi-turn sycophancy in clinical dialogue, abandoning initial correct diagnosis under escalating pressure. We propose Med-Stress, a targeted stress test framework that evaluates belief stability under escalating pressure. Across nine frontier large language models (LLMs), we find a clear dissociation between medical knowledge and robustness: high initial diagnostic capability does not imply high belief stability, yielding large knowledge-robustness gaps for several LLMs. To mitigate this failure mode, we propose a lightweight inference-time defense, RBED (Role-Based Epistemic Defense), and R-FT (Resilience-oriented Fine-Tuning), a training-time approach that internalizes evidence-based resistance to pressure. Experiments show that R-FT nearly eliminates belief change and substantially improves robustness.

Boyu Xiao, Xiuqi Tian, Xuwen Song +4

Research Center for Social Computing and Interactive Robotics, Harbin Institute of Technology, China

LLM SycophancyHealthcareLLM ReliabilityClinical Language Model EvaluationLanguage Model RobustnessMedical LLMs+1
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Apr 22, 2026

Serialisation Strategy Matters: How FHIR Data Format Affects LLM Medication Reconciliation

Medication reconciliation at clinical handoffs is a high-stakes, error-prone process. Large language models are increasingly proposed to assist with this task using FHIR-structured patient records, but a fundamental and largely unstudied variable is how the FHIR data is serialised before being passed to the model. We present the first systematic comparison of four FHIR serialisation strategies (Raw JSON, Markdown Table, Clinical Narrative, and Chronological Timeline) across five open-weight models (Phi-3.5-mini, Mistral-7B, BioMistral-7B, Llama-3.1-8B, Llama-3.3-70B) on a controlled benchmark of 200 synthetic patients, totalling 4,000 inference runs. We find that serialisation strategy has a large, statistically significant effect on performance for models up to 8B parameters: Clinical Narrative outperforms Raw JSON by up to 19 F1 points for Mistral-7B (r = 0.617, p < 10^{-10}). This advantage reverses at 70B, where Raw JSON achieves the best mean F1 of 0.9956. In all 20 model and strategy combinations, mean precision exceeds mean recall: omission is the dominant failure mode, with models more often missing an active medication than fabricating one, which changes how clinical safety auditing priorities should be set. Smaller models plateau at roughly 7-10 concurrent active medications, leaving polypharmacy patients, the patients most at risk from reconciliation errors, systematically underserved. BioMistral-7B, a domain-pretrained model without instruction tuning, produces zero usable output in all conditions, showing that domain pretraining alone is not sufficient for structured extraction. These results offer practical, evidence-based format recommendations for clinical LLM deployment: Clinical Narrative for models up to 8B, Raw JSON for 70B and above. The complete pipeline is reproducible on open-source tools running on an AWS g6e.xlarge instance (NVIDIA L40S, 48 GB VRAM).

Sanjoy Pator

Independent Researcher

HealthcareLLM Information ExtractionClinical Language Model EvaluationMedical LLMs
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Apr 22, 2026

Can "AI" Be a Doctor? A Study of Empathy, Readability, and Alignment in Clinical LLMs

Large Language Models (LLMs) are increasingly deployed in healthcare, yet their communicative alignment with clinical standards remains insufficiently quantified. We conduct a multidimensional evaluation of general-purpose and domain-specialized LLMs across structured medical explanations and real-world physician-patient interactions, analyzing semantic fidelity, readability, and affective resonance. Baseline models amplify affective polarity relative to physicians (Very Negative: 43.14-45.10% vs. 37.25%) and, in larger architectures such as GPT-5 and Claude, produce substantially higher linguistic complexity (FKGL up to 16.91-17.60 vs. 11.47-12.50 in physician-authored responses). Empathy-oriented prompting reduces extreme negativity and lowers grade-level complexity (up to -6.87 FKGL points for GPT-5) but does not significantly increase semantic fidelity. Collaborative rewriting yields the strongest overall alignment. Rephrase configurations achieve the highest semantic similarity to physician answers (up to mean = 0.93) while consistently improving readability and reducing affective extremity. Dual stakeholder evaluation shows that no model surpasses physicians on epistemic criteria, whereas patients consistently prefer rewritten variants for clarity and emotional tone. These findings suggest that LLMs function most effectively as collaborative communication enhancers rather than replacements for clinical expertise.

Mariano Barone, Francesco Di Serio, Roberto Moio +4

Department of Electrical Engineering and Information Technology, University of Naples Federico II, Via Claudio 21, Naples, 80125, Italy. · Department of Translational Medical Sciences, University of Campania ”Luigi Vanvitelli”, Via Leonardo Bianchi, Naples, 80131, Italy. · Department of Computer Science, McCormick School of Engineering and Applied Science, Northwestern University, 2309 Sheridan Rd, Evanston, 60201, IL, United States.

HealthcareLLM PromptingClinical Language Model EvaluationMedical LLMs
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Apr 22, 2026

Graph2Counsel: Clinically Grounded Synthetic Counseling Dialogue Generation from Client Psychological Graphs

Rising demand for mental health support has increased interest in using Large Language Models (LLMs) for counseling, but adapting them to this safety-critical domain is hindered by limited real-world data due to privacy constraints. Synthetic datasets provide a promising alternative, but existing approaches often rely on unstructured or semi-structured text inputs and overlook structural dependencies between a client's cognitive, emotional, and behavioral states, leading to psychologically inconsistent and less realistic interactions. We introduce Graph2Counsel, a framework for generating synthetic counseling sessions grounded in Client Psychological Graphs (CPGs) that encode relationships among clients' thoughts, emotions, and behaviors. Graph2Counsel uses a structured prompting pipeline guided by counselor strategies and CPG, and explores prompting strategies including CoT and Multi-Agent Feedback. It produces 760 sessions from 76 CPGs across diverse client profiles. In expert evaluation, our dataset outperforms prior datasets on specificity, counselor competence, authenticity, conversational flow, and safety (Krippendorff's αα = 0.70). Fine-tuning an open-source model on this dataset improves performance on several metrics on CounselingBench and CounselBench, while matching baselines on others. We further introduce Therapy-Eval, a multi-turn evaluation framework, and demonstrate the effectiveness of our fine-tuned model in realistic therapeutic conversations. We make our code, data and fine-tuned model public.

Aishik Mandal, Hiba Arnaout, Clarissa W. Ong +5

UKP Lab, Department of Computer Science and Hessian Center for AI (hessian.AI), Technische Universität Darmstadt · Zuse School · National Research Center for Applied Cybersecurity ATHENE +4

Mental Health CounselingMental HealthSynthetic Data GenerationConditional GenerationSynthetic Data EvaluationSynthetic Data Generation for Language Models+3
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Apr 21, 2026

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

This study compared repeated generation consistency of exercise prescription outputs across three large language models (LLMs), specifically GPT-4.1, Claude Sonnet 4.6, and Gemini 2.5 Flash, under temperature=0 conditions. Each model generated prescriptions for six clinical scenarios 20 times, yielding 360 total outputs analyzed across four dimensions: semantic similarity, output reproducibility, FITT classification, and safety expression. Mean semantic similarity was highest for GPT-4.1 (0.955), followed by Gemini 2.5 Flash (0.950) and Claude Sonnet 4.6 (0.903), with significant inter-model differences confirmed (H = 458.41, p < .001). Critically, these scores reflected fundamentally different generative behaviors: GPT-4.1 produced entirely unique outputs (100%) with stable semantic content, while Gemini 2.5 Flash showed pronounced output repetition (27.5% unique outputs), indicating that its high similarity score derived from text duplication rather than consistent reasoning. Identical decoding settings thus yielded fundamentally different consistency profiles, a distinction that single-output evaluations cannot capture. Safety expression reached ceiling levels across all models, confirming its limited utility as a differentiating metric. These results indicate that model selection constitutes a clinical rather than merely technical decision, and that output behavior under repeated generation conditions should be treated as a core criterion for reliable deployment of LLM-based exercise prescription systems.

Kihyuk Lee

Data Convergence Team, Office of Hospital Information, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

LLM EvaluationClinical Language Model EvaluationMedical LLMs
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Apr 20, 2026

MedProbeBench: Systematic Benchmarking at Deep Evidence Integration for Expert-level Medical Guideline

Recent advances in deep research systems enable large language models to retrieve, synthesize, and reason over large-scale external knowledge. In medicine, developing clinical guidelines critically depends on such deep evidence integration. However, existing benchmarks fail to evaluate this capability in realistic workflows requiring multi-step evidence integration and expert-level judgment. To address this gap, we introduce MedProbeBench, the first benchmark leveraging high-quality clinical guidelines as expert-level references. Medical guidelines, with their rigorous standards in neutrality and verifiability, represent the pinnacle of medical expertise and pose substantial challenges for deep research agents. For evaluation, we propose MedProbe-Eval, a comprehensive evaluation framework featuring: (1) Holistic Rubrics with 1,200+ task-adaptive rubric criteria for comprehensive quality assessment, and (2) Fine-grained Evidence Verification for rigorous validation of evidence precision, grounded in 5,130+ atomic claims. Evaluation of 17 LLMs and deep research agents reveals critical gaps in evidence integration and guideline generation, underscoring the substantial distance between current capabilities and expert-level clinical guideline development. Project: https://github.com/uni-medical/MedProbeBench

Jiyao Liu, Jianghan Shen, Sida Song +19

Fudan University, Shanghai, China · Shanghai Artificial Intelligence Laboratory, Shanghai, China · Nanjing University, Nanjing, China +1

HealthcareAI Agent BenchmarksEvidence-Grounded GenerationClinical Language Model Evaluation
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Apr 20, 2026

First, Do No Harm (With LLMs): Mitigating Racial Bias via Agentic Workflows

Large language models (LLMs) are increasingly used in clinical settings, raising concerns about racial bias in both generated medical text and clinical reasoning. Existing studies have identified bias in medical LLMs, but many focus on single models and give less attention to mitigation. This study uses the EU AI Act as a governance lens to evaluate five widely used LLMs across two tasks, namely synthetic patient-case generation and differential diagnosis ranking. Using race-stratified epidemiological distributions in the United States and expert differential diagnosis lists as benchmarks, we apply structured prompt templates and a two-part evaluation design to examine implicit and explicit racial bias. All models deviated from observed racial distributions in the synthetic case generation task, with GPT-4.1 showing the smallest overall deviation. In the differential diagnosis task, DeepSeek V3 produced the strongest overall results across the reported metrics. When embedded in an agentic workflow, DeepSeek V3 showed an improvement of 0.0348 in mean p-value, 0.1166 in median p-value, and 0.0949 in mean difference relative to the standalone model, although improvement was not uniform across every metric. These findings support multi-metric bias evaluation for AI systems used in medical settings and suggest that retrieval-based agentic workflows may reduce some forms of explicit bias in benchmarked diagnostic tasks. Detailed prompt templates, experimental datasets, and code pipelines are available on our GitHub.

Sihao Xing, Zaur Gouliev

School of Enterprise Computing and Digital Transformation Technological University Dublin · School of Information and Communication Studies University College Dublin

HealthcareSocial Bias in Language ModelsMedical DiagnosisLanguage Model Bias EvaluationClinical Language Model EvaluationMedical LLMs
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Apr 20, 2026

MHSafeEval: Role-Aware Interaction-Level Evaluation of Mental Health Safety in Large Language Models

Large language models (LLMs) are increasingly explored as scalable tools for mental health counseling, yet evaluating their safety remains challenging due to the interactional and context-dependent nature of clinical harm. Existing evaluation frameworks predominantly assess isolated responses using coarse-grained taxonomies or static datasets, limiting their ability to diagnose how harms emerge and accumulate over multi-turn counseling interactions. In this work, we introduce R-MHSafe, a role-aware mental health safety taxonomy that characterizes clinically significant harm in terms of the interactional roles an AI counselor adopts, including perpetrator, instigator, facilitator, or enabler, combined with clinically grounded harm categories. Then, we propose MHSafeEval, a closed-loop, agent-based evaluation framework that formulates safety assessment as trajectory-level discovery of harm through adversarial multi-turn interactions, guided by role-aware modeling. Using R-MHSafe and MHSafeEval, we conduct a large-scale evaluation across state-of-the-art LLMs. Our results reveal substantial role-dependent and cumulative safety failures that are systematically missed by existing static benchmarks, and show that our framework significantly improves failure-mode coverage and diagnostic granularity.

Suhyun Lee, Palakorn Achananuparp, Neemesh Yadav +2

Department of Artificial Intelligence, Hanyang University, Seoul, Republic of Korea · School of Computing and Information Systems, Singapore Management University, Singapore

Mental Health CounselingLLM EvaluationMental HealthLLM Safety EvaluationClinical Language Model Evaluation
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Apr 19, 2026

PsychBench: Auditing Epidemiological Fidelity in Large Language Model Mental Health Simulations

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.

Patrick Keough

Independent Researcher Bremerton, Washington, USA

HealthcareLLM AuditingMental HealthLanguage Model CalibrationDemographic Bias in Language ModelsClinical Language Model Evaluation+1
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Apr 19, 2026

Calibrated? Not for Everyone: How Sexual Orientation and Religious Markers Distort LLM Accuracy and Confidence in Medical QA

Safe clinical deployment of Large Language Models (LLMs) requires not only high accuracy but also robust uncertainty calibration to ensure models defer to clinicians when appropriate. Our paper investigates how social descriptors of a patient (specifically sexual orientation and religious affiliation) distort these uncertainty signals and model accuracy. Evaluating nine general-purpose and biomedical LLMs on 2,364 medical questions and their counterfactual variants, we demonstrate that identity markers cause a "calibration crisis". "Homosexual" markers consistently trigger performance drops, and intersectional identities produce idiosyncratic, non-additive harms to calibration. Moreover, a clinician-validated case study in an open-ended generation setting confirms that these failures are not an artifact of the multiple-choice format. Our results demonstrate that the presence of social identity cues does not merely shift predictions; it affects the reliability of confidence signals, posing a significant risk to equitable care and safe deployment in confidence-based clinical workflows.

Alberto Testoni, Iacer Calixto

Department of Medical Informatics, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands. · Amsterdam Public Health, Methodology, Amsterdam, The Netherlands.

Intersectional Bias in Language ModelsHealthcareSocial Bias in Language ModelsLanguage Model CalibrationLLM ReliabilityMedical QA+2
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Apr 19, 2026

MedPRMBench: A Fine-grained Benchmark for Process Reward Models in Medical Reasoning

Medical reasoning can reach a plausible answer while overlooking an unsafe or unsupported intermediate step. Process-Level Reward Models (PRMs) can verify such steps, yet existing PRM benchmarks largely target mathematics rather than patient-specific clinical errors. We introduce MedPRMBench, a step-level medical reasoning benchmark with 14 clinical error types, including five new and two clinically re-scoped types, and rule-defined severity grades. Built from seven medical QA sources via structured error construction and review by 86 physicians from Grade-A tertiary hospitals, it provides 6{,}500 evaluation questions, 13{,}000 reasoning chains, and 113{,}910 step labels, plus a leakage-clean 6{,}870-question training split. The best of 20 prompted critics reaches only 75.4% PRMScore, and critics differ sharply in error-type profiles and operating points. A Qwen3-8B PRM trained on the split reaches 86.6% PRMScore and 89.0% strict first-error localization; in matched ablations, physician review raises error recall by 6.55 points and cuts clean-chain false alarms from 5.6% to 2.1%. The training signal replicates across model families; without further training, the PRM transfers to ProcessBench and PRMBench, exceeding six of nine math-trained PRMs on each.

Xiang Zheng, Lingyan Wu, Weiqi Zhai +4

Alibaba Group, China

HealthcareProcess Reward ModelsMedical ReasoningClinical Language Model Evaluation
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Apr 18, 2026

Evaluating Multimodal LLMs for Inpatient Diagnosis: Real-World Performance, Safety, and Cost Across Ten Frontier Models

Background: Large language models (LLMs) are increasingly proposed for diagnostic support, but few evaluations use real-world multimodal inpatient data, particularly in low and middle-income country (LMIC) public hospitals. Methods: We conducted VALID, a retrospective evaluation of 539 multimodal inpatient cases from a tertiary public hospital in South Africa. Inputs included radiology imaging (CT, MRI, CXR) and reports, laboratory results, clinical notes, and vital signs. Expert panels adjudicated 300 cases (balanced and discordant subsets) to establish ground truth diagnoses, differentials, and reasoning. Ten multimodal LLMs generated zero-shot outputs. A calibrated three-model LLM Jury scored all outputs and routine ward diagnoses across diagnostic accuracy, differential quality, reasoning, and patient safety (>10,000 evaluations). Primary outcomes were composite scores (S3S_3, S4S_4) and win rates. Results: (i) LLM performance was tightly clustered (<15% variation) despite large cost differences; low-cost models performed comparably to top models. (ii) All LLMs significantly outperformed routine ward diagnoses on average diagnostic and safety scores. (iii) Top performance was achieved by GPT-5.1, followed by Gemini models. (vi) Adding radiology reports improved performance by 6%. (v) Diagnostic and reasoning scores were highly correlated (ρ=0.85ρ= 0.85). (vi) Output rates varied (65-100%) due to input constraints. Results were robust across subsets and evaluation design. Conclusions: Across a real-world LMIC dataset, multimodal LLMs showed similar diagnostic performance despite large cost differences and outperformed routine care on average safety metrics. Affordability, robustness, and deployment constraints may outweigh marginal performance differences in LMIC settings.

Bruce A. Bassett, Amy Rouillard, Sitwala Mundia +8

School of Computer Science and Applied Mathematics, University of the Witwatersrand, Johannesburg, South Africa · Wits MIND Institute, University of the Witwatersrand, Johannesburg, South Africa · Grai Labs, Cape Town, South Africa +3

Language Model Safety EvaluationHealthcareMedical DiagnosisClinical Language Model EvaluationMultimodal Model EvaluationMedical LLMs
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Apr 18, 2026

HealthCraft: A Reinforcement Learning Safety Environment for Emergency Medicine

Frontier language models are being deployed into clinical workflows faster than the infrastructure to evaluate them safely. Static medical-QA benchmarks miss the failure modes that matter in emergency medicine: trajectory-level safety collapse, tool misuse, and capitulation under sustained clinical pressure. We present HealthCraft, the first public reinforcement-learning environment that rewards trajectory-level safety under realistic emergency-medicine conditions, adapted from Corecraft. It is built on a FHIR R4 world state with 14 entity types and 3,987 seed entities, exposes 24 MCP tools, and defines a dual-layer rubric that zeroes reward whenever any safety-critical criterion is violated. We release 195 tasks across six categories, graded against 2,255 binary criteria (515 safety-critical); a post-hoc 10-task negative-class slate extends this to 205 tasks and 2,337 criteria. V8 results on two frontier models show Claude Opus 4.6 at Pass@1 24.8% [21.5-28.4] and GPT-5.4 at 12.6% [10.2-15.6], with safety-failure rates of 27.5% and 34.0%. On multi-step workflows - the closest proxy to real emergency care - performance collapses to near zero (Claude 1.0%, GPT-5.4 0.0%) despite partial competence on individual steps. Six infrastructure bugs fixed between pilots v2 and v8 re-ordered which model "looks stronger," evidence that infrastructure fidelity is part of the measurement. A deterministic LLM-judge overlay bounds evaluator noise, and a 60-run negative-class smoke pilot shows the reward signal is not drop-in training-safe: restraint criteria pass at 0.929 prevalence, a gameability an eval harness can tolerate but a training reward cannot. We scaffold coupling to a Megatron+SGLang+GRPO loop per Corecraft Section 5.2 and leave training-reward ablations as future work. Environment, tasks, rubrics, and harness are released under Apache 2.0.

Brandon Dent

GOATnote Inc.

HealthcareAI Agent BenchmarksLLM Safety EvaluationAI Agent Safety BenchmarksClinical Language Model EvaluationLLM Agent Safety
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Apr 16, 2026

Blinded Multi-Rater Comparative Evaluation of a Large Language Model and Clinician-Authored Responses in CGM-Informed Diabetes Counseling

Continuous glucose monitoring (CGM) is central to diabetes care, but explaining CGM patterns clearly and empathetically remains time-intensive. Evidence for retrieval-grounded large language model (LLM) systems in CGM-informed counseling remains limited. To evaluate whether a retrieval-grounded LLM-based conversational agent (CA) could support patient understanding of CGM data and preparation for routine diabetes consultations. We developed a retrieval-grounded LLM-based CA for CGM interpretation and diabetes counseling support. The system generated plain-language responses while avoiding individualized therapeutic advice. Twelve CGM-informed cases were constructed from publicly available datasets. Between Oct 2025 and Feb 2026, 6 senior UK diabetes clinicians each reviewed 2 assigned cases and answered 24 questions. In a blinded multi-rater evaluation, each CA-generated and clinician-authored response was independently rated by 3 clinicians on 6 quality dimensions. Safety flags and perceived source labels were also recorded. Primary analyses used linear mixed-effects models. A total of 288 unique responses (144 CA and 144 clinician) generated 864 ratings. The CA received higher quality scores than clinician responses (mean 4.37 vs 3.58), with an estimated mean difference of 0.782 points (95% CI 0.692-0.872; P<.001). The largest differences were for empathy (1.062, 95% CI 0.948-1.177) and actionability (0.992, 95% CI 0.877-1.106). Safety flag distributions were similar, with major concerns rare in both groups (3/432, 0.7% each). Retrieval-grounded LLM systems may have value as adjunct tools for CGM review, patient education, and preconsultation preparation. However, these findings do not support autonomous therapeutic decision-making or unsupervised real-world use.

Zhijun Guo, Alvina Lai, Emmanouil Korakas +6

Institute of Health Informatics, University College London, London, United Kingdom · University College London Hospitals NHS Foundation Trust, London, United Kingdom · Dartford and Gravesham NHS Foundation Trust, Dartford, United Kingdom +1

Clinical Decision SupportRAG EvaluationClinical Language Model EvaluationMedical LLMsContinuous Glucose Monitoring
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Apr 16, 2026

Can LLMs Accurately Score Medical Diagnoses and Clinical Reasoning?

Evaluating medical AI systems using expert clinician panels is costly and slow, motivating the use of large language models (LLMs) as alternative adjudicators. Here, we evaluate an LLM Jury, composed of three frontier AI models, for scoring 3334 diagnoses on 300 real-world low- and middle-income country (LMIC) hospital cases. Both LLM- and clinician-generated diagnoses are scored against expert panel diagnoses across four dimensions: diagnosis, differential diagnosis, clinical reasoning, and negative treatment risk. The LLM Jury scores are compared with expert and independent re-scoring panel scores to assess error metrics, inter-rater agreement, severe-risk errors, and the effect of post hoc calibration using isotonic regression. In our data, we find that: (i) the uncalibrated LLM Jury scores preserve ordinal agreement with the expert clinician panel scores, but are systematically lower; (ii) the probability of severe-risk errors is lower for the LLM Jury than the human expert re-score panels; (iii) the LLM Jury combined with LLM diagnoses can be used to identify diagnoses at high risk of error, enabling targeted expert review and improved panel efficiency; (iv) the calibrated LLM Jury scores and rankings of diagnosing agents show excellent agreement with those of the primary expert panels; (v) LLM Jury models show no self-preference bias, they did not score diagnoses generated by their own underlying model or models from the same vendor more (or less) favourably than those generated by other models. Together, these results provide evidence that a calibrated LLM Jury is a trustworthy and reliable proxy for expert clinician evaluation in medical AI benchmarking. Confirming these findings in other clinical settings is an important direction for future work.

Amy Rouillard, Sitwala Mundia, Linda Camara +8

aWits MIND Institute, University of the Witwatersrand, Johannesburg, South Africa · fSchool of Computer Science and Applied Mathematics, University of the Witwatersrand, Johannesburg, South Africa · bGrai Labs, Cape Town, South Africa +3

LLM-as-a-JudgeHealthcareClinical ReasoningClinical Language Model Evaluation
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Apr 16, 2026

Beyond Literal Summarization: Redefining Hallucination for Medical SOAP Note Evaluation

Evaluating large language models (LLMs) for clinical documentation tasks such as SOAP note generation remains challenging. Unlike standard summarization, these tasks require clinical abstraction, normalization of colloquial language, and medically grounded inference. However, prevailing evaluation methods including automated metrics and LLM as judge frameworks rely on lexical faithfulness, often labeling any information not explicitly present in the transcript as hallucination. We show that such approaches systematically misclassify clinically valid outputs as errors, inflating hallucination rates and distorting model assessment. Our analysis reveals that many flagged hallucinations correspond to legitimate clinical transformations, including synonym mapping, abstraction of examination findings, diagnostic inference, and guideline consistent care planning. By aligning evaluation criteria with clinical reasoning through calibrated prompting and retrieval grounded in medical ontologies we observe a significant shift in outcomes. Under a lexical evaluation regime, the mean hallucination rate is 35%, heavily penalizing valid reasoning. With inference aware evaluation, this drops to 9%, with remaining cases reflecting genuine safety concerns. These findings suggest that current evaluation practices over penalize valid clinical reasoning and may measure artifacts of evaluation design rather than true errors, underscoring the need for clinically informed evaluation in high context domains like medicine.

Bhavik Vachhani, Kush Shrisvastava, Pranshu Nema +1

Augnito Research

Medical Report GenerationClinical ReasoningLLM Hallucination DetectionClinical Language Model Evaluation
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Apr 16, 2026

Continued Pretraining of FinBERT on Finnish Histopathological Reports: Train-Time Signals and Proxy Downstream Correlations

In Natural Language Processing (NLP) classification tasks where a lack of labeled data is an issue, continued pretraining (CPT) of transformer models on unlabeled data is an established approach. In this paper, we have two aims. (1) We describe our observations from continued pretraining of the Finnish BERT transformer model (FinBERT) on a Finnish histopathological dataset (below, the Histopathology data). (2) Since the Histopathology data has no classification labels, we gather public Finnish datasets as proxy data to analyze whether the signals observed in (1) are associated with downstream classification gains. We observe that CPT train-time loss curves differ strongly by domain, and that, in an exploratory analysis, certain CPT-derived features correlate with proxy classification improvement. In particular, this report contributes to the limited literature on NLP for Finnish healthcare data.

Rami Luisto, Liisa Petäinen, Tommi Grönholm +5

Faculty of Information Technology, University of Jyväskylä, Jyväskylä, Finland. · Digital Workforce Services, Helsinki, Finland. · Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland. +2

HealthcareDomain-Adaptive PretrainingContinued PretrainingClinical Language Model EvaluationClinical NLP
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Apr 15, 2026

A Multi-Domain Red Teaming Framework for Safety, Robustness, and Fairness Evaluation of Medical Large Language Models

Large language models (LLMs) are increasingly deployed across healthcare, yet existing benchmarks fail to capture model behavior under adversarial or ethically complex conditions common in clinical practice. We developed a multi-domain red teaming framework evaluating eleven contemporary LLMs across 690 clinically grounded scenarios spanning nine domains and over 150 subcategories. Scenarios incorporated adversarial transformations, and responses were assessed using a seven-dimension rubric with LLM-assisted scoring and human-in-the-loop validation. Results revealed substantial performance variance, with mean scores ranging from 0.791 to 0.984. Critically, several high-performing systems produced complete failures in individual safety-critical scenarios, demonstrating that aggregate accuracy masks clinically meaningful risk. The highest-performing systems (X-BAI, GPT-5, Claude Opus 4.1) achieved scores above 0.97 with low variance, while performance varied significantly across domains. Equity-related tasks showed 10-20% error amplification with demographic modifications, and human reviewers identified clinically relevant failures missed by automated evaluation. Our findings demonstrate that performance variance and worst-case failures provide more clinically meaningful reliability indicators than mean accuracy alone, and that hybrid evaluation approaches combining automation with clinician oversight are essential for credible safety assessment.

Andrei Marian Feier, Veysel Kocaman, Yigit Gul +6

John Snow Labs Inc.

LLM SafetyLLM Safety EvaluationLLM EvaluationClinical Language Model EvaluationMedical LLMs
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Apr 13, 2026

When AI Tells You What You Want to Hear: Sycophantic Behavior of Large Language Models in Dementia Care Settings

Large language models (LLMs) are increasingly used in clinical and care settings. This exploratory study investigates whether LLMs exhibit sycophantic behavior - adapting their responses to social expectation signals rather than maintaining professional quality - in the context of dementia care. Five prompts with systematically increasing confirmatory and authority-related framing (P1 neutral to P5 authority-signaled implementation support) were submitted to four LLMs (GPT-5, Claude Sonnet 4.6, Gemini 3.1 Pro, Mistral Large), each repeated five times (N = 100 responses). Responses were evaluated using an LLM-as-a-Judge methodology against seven nursing-ethical quality criteria (K1-K7) and a tone scale (0-3). All models showed significant negative Spearman correlations between prompt level and response quality (rho ranging from -0.543 to -0.734, all p < 0.01). Mistral Large exhibited the most pronounced effect (rho = -0.734), with mean scores dropping from 6.0/7 at P1 to 0.2/7 at P5. The findings suggest that LLMs pose context-sensitive risks in high-stakes care environments and that prompt framing significantly shapes response quality - a dimension that has received insufficient attention in healthcare AI deployment.

Christian Kolb

Dementia CareLLM SycophancyLLM ReliabilityHealthcareClinical Language Model Evaluation
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Apr 13, 2026

Consistency of AI-Generated Exercise Prescriptions: A Repeated Generation Study Using a Large Language Model

Background: Large language models (LLMs) have been explored as tools for generating personalized exercise prescriptions, yet the consistency of outputs under identical conditions remains insufficiently examined. Objective: This study evaluated the intra-model consistency of LLM-generated exercise prescriptions using a repeated generation design. Methods: Six clinical scenarios were used to generate exercise prescriptions using Gemini 2.5 Flash (20 outputs per scenario; total n = 120). Consistency was assessed across three dimensions: (1) semantic consistency using SBERT-based cosine similarity, (2) structural consistency based on the FITT principle using an AI-as-a-judge approach, and (3) safety expression consistency, including inclusion rates and sentence-level quantification. Results: Semantic similarity was high across scenarios (mean cosine similarity: 0.879-0.939), with greater consistency in clinically constrained cases. Frequency showed consistent patterns, whereas variability was observed in quantitative components, particularly exercise intensity. Unclassifiable intensity expressions were observed in 10-25% of resistance training outputs. Safety-related expressions were included in 100% of outputs; however, safety sentence counts varied significantly across scenarios (H=86.18, p less than 0.001), with clinical cases generating more safety expressions than healthy adult cases. Conclusions: LLM-generated exercise prescriptions demonstrated high semantic consistency but showed variability in key quantitative components. Reliability depends substantially on prompt structure, and additional structural constraints and expert validation are needed before clinical deployment.

Kihyuk Lee

Data Convergence Team, Office of Hospital Information, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

Self-Consistency in Language ModelsMedical LLMsClinical Language Model Evaluation
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Apr 13, 2026

How Robust Are Large Language Models for Clinical Numeracy? An Empirical Study on Numerical Reasoning Abilities in Clinical Contexts

Large Language Models (LLMs) are increasingly being explored for clinical question answering and decision support, yet safe deployment critically requires reliable handling of patient measurements in heterogeneous clinical notes. Existing evaluations of LLMs for clinical numerical reasoning provide limited operation-level coverage, restricted primarily to arithmetic computation, and rarely assess the robustness of numerical understanding across clinical note formats. We introduce ClinicNumRobBench, a benchmark of 1,624 context-question instances with ground-truth answers that evaluates four main types of clinical numeracy: value retrieval, arithmetic computation, relational comparison, and aggregation. To stress-test robustness, ClinicNumRobBench presents longitudinal MIMIC-IV vital-sign records in three semantically equivalent representations, including a real-world note-style variant derived from the Open Patients dataset, and instantiates queries using 42 question templates. Experiments on 17 LLMs show that value retrieval is generally strong, with most models exceeding 85% accuracy, while relational comparison and aggregation remain challenging, with some models scoring below 15%. Fine-tuning on medical data can reduce numeracy relative to base models by over 30%, and performance drops under note-style variation indicate LLM sensitivity to format. ClinicNumRobBench offers a rigorous testbed for clinically reliable numerical reasoning. Code and data URL are available on https://github.com/MinhVuong2000/ClinicNumRobBench.

Minh-Vuong Nguyen, Fatemeh Shiri, Zhuang Li +1

School of Computing Technologies, RMIT University, Australia

Numerical Reasoning in Language ModelsClinical Language Model EvaluationLanguage Model RobustnessMedical LLMsClinical Reasoning
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Apr 12, 2026

Evaluating Small Open LLMs for Medical Question Answering: A Practical Framework

Incorporating large language models (LLMs) in medical question answering demands more than high average accuracy: a model that returns substantively different answers each time it is queried is not a reliable medical tool. Online health communities such as Reddit have become a primary source of medical information for millions of users, yet they remain highly susceptible to misinformation; deploying LLMs as assistants in these settings amplifies the need for output consistency alongside correctness. We present a practical, open-source evaluation framework for assessing small, locally-deployable open-weight LLMs on medical question answering, treating reproducibility as a first-class metric alongside lexical and semantic accuracy. Our pipeline computes eight quality metrics, including BERTScore, ROUGE-L, and an LLM-as-judge rubric, together with two within-model reproducibility metrics derived from repeated inference (N=10 runs per question). Evaluating three models (Llama 3.1 8B, Gemma 3 12B, MedGemma 1.5 4B) on 50 MedQuAD questions (N=1,500 total responses) reveals that despite low-temperature generation (T=0.2), self-agreement across runs reaches at most 0.20, while 87-97% of all outputs per model are unique -- a safety gap that single-pass benchmarks entirely miss. The clinically fine-tuned MedGemma 1.5 4B underperforms the larger general-purpose models on both quality and reproducibility; however, because MedGemma is also the smallest model, this comparison confounds domain fine-tuning with model scale. We describe the methodology in sufficient detail for practitioners to replicate or extend the evaluation for their own model-selection workflows. All code and data pipelines are available at https://github.com/aviad-buskila/llm_medical_reproducibility.

Avi-ad Avraam Buskila

Department of Information Science and Applied Artificial Intelligence, Bar-Ilan University, Ramat-Gan, Israel

LLM EvaluationLLM ReliabilityClinical Language Model EvaluationMedical LLMsBiomedical QA
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Apr 12, 2026

VeriSim: A Configurable Framework for Stress-Testing Medical AI Under Patient Communication Noise

Medical large language models are typically evaluated on idealized patient cases that do not reflect how real patients communicate. We introduce VeriSim, a patient simulation framework that injects controllable noise along six clinically grounded communication dimensions while substantially preserving each patient's medical record. Truth adherence is supported by a verifier that extracts atomic claims from each candidate utterance and judges them against a UMLS-grounded vector index built with BioLORD embeddings, using the retrieved atoms' structured clinical metadata (e.g., drug class, anatomical site, treats-condition relations) rather than surface-text similarity alone. Across seven open-weight LLMs, realistic noise reduces diagnostic accuracy by 15-25 percentage points and increases conversation length by 34-55%; the 7-8B models degrade 1.4x more than 70B+ models. A board-certified physician and a licensed nurse rate VeriSim's conversations highly on truth, realism, clinical utility, and noise fidelity (inter-annotator agreement >= 0.80 across all dimensions), and an LLM-as-judge closely tracks their ratings, enabling scalable evaluation. We release VeriSim as an open-source framework for rigorous stress-testing of clinical AI: https://github.com/mohitmarvania/VeriSim

Sina Mansouri, Mohit Marvania, Vibhavari Ashok Shihorkar +5

Department of Computer Science, George Mason University · Department of Health Administration and Policy, College of Public Health, George Mason University · Department of Science, George Mason University

HealthcareLLM ReliabilityClinical Language Model EvaluationLanguage Model RobustnessMedical LLMs
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Apr 11, 2026

Comparative Analysis of Large Language Models in Healthcare

Background: Large Language Models (LLMs) are transforming artificial intelligence applications in healthcare due to their ability to understand, generate, and summarize complex medical text. They offer valuable support to clinicians, researchers, and patients, yet their deployment in high-stakes clinical environments raises critical concerns regarding accuracy, reliability, and patient safety. Despite substantial attention in recent years, standardized benchmarking of LLMs for medical applications has been limited. Objective: This study addresses the need for a standardized comparative evaluation of LLMs in medical settings. Method: We evaluate multiple models, including ChatGPT, LLaMA, Grok, Gemini, and ChatDoctor, on core medical tasks such as patient note summarization and medical question answering, using the open-access datasets, MedMCQA, PubMedQA, and Asclepius, and assess performance through a combination of linguistic and task-specific metrics. Results: The results indicate that domain-specific models, such as ChatDoctor, excel in contextual reliability, producing medically accurate and semantically aligned text, whereas general-purpose models like Grok and LLaMA perform better in structured question-answering tasks, demonstrating higher quantitative accuracy. This highlights the complementary strengths of domain-specific and general-purpose LLMs depending on the medical task. Conclusion: Our findings suggest that LLMs can meaningfully support medical professionals and enhance clinical decision-making; however, their safe and effective deployment requires adherence to ethical standards, contextual accuracy, and human oversight in relevant cases. These results underscore the importance of task-specific evaluation and cautious integration of LLMs into healthcare workflows.

Subin Santhosh, Farwa Abbas, Hussain Ahmad +1

Adelaide University, Australia · South Australian Health and Medical Research Institute, Australia

Medical LLMsClinical Language Model EvaluationMedical QAText Summarization
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Apr 10, 2026

Do LLMs Reliably Identify Correct Information Units in Aphasic Discourse?

Correct Information Units (CIUs) are central to discourse assessment in aphasia because they quantify communicative informativeness rather than linguistic form alone. However, CIU scoring is time intensive and requires trained raters. This study examined whether instruction-tuned large language models (LLMs) can reliably perform token-level CIU classification from aphasic discourse transcripts. Sixteen picture-description transcripts elicited with the Cat Rescue stimulus were annotated for CIU status according to Nicholas and Brookshire (1993). The sample spanned four severity strata: control, mild, moderate, and severe aphasia. Four publicly available instruction-tuned LLMs were benchmarked under zero-shot and two few-shot prompting conditions across five stratified random seeds. Performance was evaluated against consensus human labels using accuracy, precision, recall, F1, and Cohen's kappa. Zero-shot prompting was insufficient across models. In contrast, few-shot prompting yielded substantial gains and produced competitive performance for three viable models. Mean few-shot F1 scores ranged from 0.776 to 0.817 across Llama-3.1-8B, Qwen2.5-7B, and Mistral-7B, with no significant differences between fixed global and per-chunk local example selection. Phi-3-mini was unstable and did not yield reliable performance. Viable models showed high recall but lower precision, suggesting systematic over-classification of tokens as CIUs. Performance also varied by discourse severity, with the weakest results in more severe aphasia. Few-shot LLM prompting can support automated CIU identification without gradient-based task training, but agreement with human annotation remains insufficient for fully autonomous use. These findings support LLM-based CIU scoring as a promising human-in-the-loop component of discourse assessment systems.

Jason M Pittman, Yesenia Medina-Santos, Anton Phillips +1

Department of Speech, Language and Hearing Sciences · Program in Neuroscience

Clinical Language Model Evaluation
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Apr 9, 2026

MedConceal: A Benchmark for Clinical Hidden-Concern Reasoning Under Partial Observability

Patient-clinician communication is an asymmetric-information problem: patients often do not disclose fears, misconceptions, or practical barriers unless clinicians elicit them skillfully. Effective medical dialogue therefore requires reasoning under partial observability: clinicians must elicit latent concerns, confirm them through interaction, and respond in ways that guide patients toward appropriate care. However, existing medical dialogue benchmarks largely sidestep this challenge by exposing hidden patient state, collapsing elicitation into extraction, or evaluating responses without modeling what remains hidden. We present MedConceal, a benchmark with an interactive patient simulator for evaluating hidden-concern reasoning in medical dialogue, comprising 300 curated cases and 600 clinician-LLM interactions. Built from clinician-answered online health discussions, each case pairing clinician-visible context with simulator-internal hidden concerns derived from prior literature and structured using an expert-developed taxonomy. The simulator withholds these concerns from the dialogue agent, tracks whether they have been revealed and addressed via theory-grounded turn-level communication signals, and is clinician-reviewed for clinical plausibility. This enables process-aware evaluation of both task success and the interaction process that leads to it. We study two abilities: confirmation, surfacing hidden concerns through multi-turn dialogue, and intervention, addressing the primary concern and guiding the patient toward a target plan. Results show that no single system dominates: frontier models lead on different confirmation metrics, while human clinicians (N=159) remain strongest on intervention success. Together, these results identify hidden-concern reasoning under partial observability as a key unresolved challenge for medical dialogue systems.

Yikun Han, Joey Chan, Jingyuan Chen +3

University of Illinois Urbana-Champaign · NYC Health + Hospitals/Jacobi

Clinical Language Model EvaluationClinical ReasoningMulti-Turn Dialogue Evaluation
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Apr 9, 2026

ProMedical: Hierarchical Fine-Grained Criteria Modeling for Medical LLM Alignment via Explicit Injection

Aligning Large Language Models (LLMs) with high-stakes medical standards remains a significant challenge, primarily due to the dissonance between coarse-grained preference signals and the complex, multi-dimensional nature of clinical protocols. To bridge this gap, we introduce ProMedical, a unified alignment framework grounded in fine-grained clinical criteria. We first construct ProMedical-Preference-50k, a dataset generated via a human-in-the-loop pipeline that augments medical instructions with rigorous, physician-derived rubrics. Leveraging this corpus, we propose the Explicit Criteria Injection paradigm to train a multi-dimensional reward model. Unlike traditional scalar reward models, our approach explicitly disentangles safety constraints from general proficiency, enabling precise guidance during reinforcement learning. To rigorously validate this framework, we establish ProMedical-Bench, a held-out evaluation suite anchored by double-blind expert adjudication. Empirical evaluations demonstrate that optimizing the Qwen3-8B base model via ProMedical-RM-guided GRPO yields substantial gains, improving overall accuracy by 22.3% and safety compliance by 21.7%, effectively rivaling proprietary frontier models. Furthermore, the aligned policy generalizes robustly to external benchmarks, demonstrating performance comparable to state-of-the-art models on UltraMedical. We publicly release our datasets, reward models, and benchmarks to facilitate reproducible research in safety-aware medical alignment.

He Geng, Yangmin Huang, Lixian Lai +5

Xunfei Healthcare Technology Co., Ltd.

LLM AlignmentMedical LLMsMulti-Objective Language Model AlignmentReward ModelingClinical Language Model Evaluation
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Apr 9, 2026

LLM-Based Data Generation and Clinical Skills Evaluation for Low-Resource French OSCEs

Objective Structured Clinical Examinations (OSCEs) are the standard method for assessing medical students' clinical and communication skills through structured patient interviews. In France, however, the organization of training sessions is limited by human and logistical constraints, restricting students' access to repeated practice and structured feedback. Recent advances in Natural Language Processing (NLP) and Large Language Models (LLMs) now offer the opportunity to automatically evaluate such medical interviews, thereby alleviating the need for human examiners during training. Yet, real French OSCE annotated transcripts remain extremely scarce, limiting reproducible research and reliable benchmarking. To address these challenges, we investigate the use of LLMs for both generating and evaluating French OSCE dialogues in a low-resource context. We introduce a controlled pipeline that produces synthetic doctor-patient interview transcripts guided by scenario-specific evaluation criteria, combining ideal and perturbed performances to simulate varying student skill levels. The resulting dialogues are automatically silver-labeled through an LLM-assisted framework supporting adjustable evaluation strictness. Benchmarking multiple open-source and proprietary LLMs shows that mid-size models (≤\le32B parameters) achieve accuracies comparable to GPT-4o (∼\sim90%) on synthetic data, highlighting the feasibility of locally deployable, privacy-preserving evaluation systems for medical education.

Tian Huang, Tom Bourgeade, Irina Illina

Université de Lorraine, CNRS, Inria, LORIA, F-54000 Nancy, France

Educational AssessmentClinical Language Model EvaluationSynthetic Data Generation for Language ModelsText Generation
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