Clinical Language Model Evaluation

Ask about this topic

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.

Latest papers

CardsList

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

Mar 14, 2026

Clinician input steers AI toward accurate and harmful recommendations

Large language models (LLMs) are entering clinical workflows, yet evaluations rarely assess how clinician reasoning shapes model behavior during clinical interactions. Using 61 curated NEJM Case Records, we tested how expert or misleading clinician reasoning influenced AI-generated differential diagnoses and next step recommendations across 21 reasoning variants from 8 proprietary and open-source models. After clinician exposure, LLM-clinician concordance increased: simulations with >=3 overlapping differential diagnoses rose from 65.8% to 93.5%, and those with >=3 overlapping next step recommendations from 20.3% to 53.8%. Expert context significantly improved correct final-diagnosis inclusion in all 21 models (mean +20.4 pp), reflecting both improved reasoning and passive content echoing, while adversarial context significantly degraded performance in 14 models (mean -5.4 pp). Expert context also significantly increased leading-diagnosis accuracy in all 21 models, whereas adversarial context significantly reduced it in 13. Multi-turn disagreement challenges revealed distinct model phenotypes, from highly conformist to dogmatic, with adversarial arguments remaining a vulnerability even in otherwise resilient models. Inference-time scaling reduced harmful echoing of clinician-introduced recommendations across WHO harm-severity tiers by 62.7% for mild, 57.9% for moderate, 76.3% for severe, and 83.5% for death-tier recommendations. Inference-time prompting recovered diagnostic accuracy lost to adversarial context while preserving expert-context benefits across GPT-5, Claude Sonnet 4.5, and Gemini 3 Flash, and sharply reduced highly consistent harmful echoing across severity tiers. These findings provide a foundation for evaluating clinician-AI collaboration and introduce interactive metrics and mitigation strategies essential to safety and robustness.

Ivan Lopez, Selin S. Everett, Bryan J. Bunning +10

Department of Biomedical Data Science, Stanford University, Stanford, CA, USA · Stanford University School of Medicine, Stanford, CA, USA · Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA +14

Medical LLMsClinical Language Model EvaluationLLM SycophancyAdversarial Robustness of Language ModelsLLM InferenceClinical Reasoning
AskPDF
Mar 14, 2026

Faithful or Just Plausible? Evaluating the Faithfulness of Closed-Source LLMs in Medical Reasoning

Closed-source large language models (LLMs), such as ChatGPT and Gemini, are increasingly consulted for medical advice, yet their explanations may appear plausible while failing to reflect the model's underlying reasoning process. This gap poses serious risks as patients and clinicians may trust coherent but misleading explanations. We conduct a systematic black-box evaluation of faithfulness in medical reasoning among three widely used closed-source LLMs. Our study consists of three perturbation-based probes: (1) causal ablation, testing whether stated chain-of-thought (CoT) reasoning causally influences predictions; (2) positional bias, examining whether models create post-hoc justifications for answers driven by input positioning; and (3) hint injection, testing susceptibility to external suggestions. We complement these quantitative probes with a small-scale human evaluation of model responses to patient-style medical queries to examine concordance between physician assessments of explanation faithfulness and layperson perceptions of trustworthiness. We find that CoT reasoning steps often do not causally drive predictions, and models readily incorporate external hints without acknowledgment. In contrast, positional biases showed minimal impact in this setting. These results underscore that faithfulness, not just accuracy, must be central in evaluating LLMs for medicine, to ensure both public protection and safe clinical deployment.

Halimat Afolabi, Zainab Afolabi, Elizabeth Friel +13

Stratified Precision, United Kingdom · Harvard Medical School, United States · Imperial College London, United Kingdom +3

Faithfulness of Language Model ExplanationsMedical LLMsCoT FaithfulnessClinical Language Model Evaluation
AskPDF
Mar 14, 2026

QuarkMedBench: A Real-World Scenario Driven Benchmark for Evaluating Large Language Models

While Large Language Models (LLMs) excel on standardized medical exams, high scores often fail to translate to high-quality responses for real-world medical queries. Current evaluations rely heavily on multiple-choice questions, failing to capture the unstructured, ambiguous, and long-tail complexities inherent in genuine user inquiries. To bridge this gap, we introduce QuarkMedBench, an ecologically valid benchmark tailored for real-world medical LLM assessment. We compiled a massive dataset spanning Clinical Care, Wellness Health, and Professional Inquiry, comprising 20,821 single-turn queries and 3,853 multi-turn sessions. To objectively evaluate open-ended answers, we propose an automated scoring framework that integrates multi-model consensus with evidence-based retrieval to dynamically generate 220,617 fine-grained scoring rubrics (~9.8 per query). During evaluation, hierarchical weighting and safety constraints structurally quantify medical accuracy, key-point coverage, and risk interception, effectively mitigating the high costs and subjectivity of human grading. Experimental results demonstrate that the generated rubrics achieve a 91.8% concordance rate with clinical expert blind audits, establishing highly dependable medical reliability. Crucially, baseline evaluations on this benchmark reveal significant performance disparities among state-of-the-art models when navigating real-world clinical nuances, highlighting the limitations of conventional exam-based metrics. Ultimately, QuarkMedBench establishes a rigorous, reproducible yardstick for measuring LLM performance on complex health issues, while its framework inherently supports dynamic knowledge updates to prevent benchmark obsolescence.

Yao Wu, Kangping Yin, Liang Dong +13

Quark Medical Team, Alibaba Group

LLM EvaluationClinical Language Model EvaluationMedical LLMsMedical QALLM Safety EvaluationLLM-as-a-Judge
AskPDF
Mar 13, 2026

MedArena: Comparing LLMs for Medicine-in-the-Wild Clinician Preferences

Large language models (LLMs) are increasingly central to clinician workflows, spanning clinical decision support, medical education, and patient communication. However, current evaluation methods for medical LLMs rely heavily on static, templated benchmarks that fail to capture the complexity and dynamics of real-world clinical practice, creating a dissonance between benchmark performance and clinical utility. To address these limitations, we present MedArena, an interactive evaluation platform that enables clinicians to directly test and compare leading LLMs using their own medical queries. Given a clinician-provided query, MedArena presents responses from two randomly selected models and asks the user to select the preferred response. Out of 1571 preferences collected across 12 LLMs up to November 1, 2025, Gemini 2.0 Flash Thinking, Gemini 2.5 Pro, and GPT-4o were the top three models by Bradley-Terry rating. Only one-third of clinician-submitted questions resembled factual recall tasks (e.g., MedQA), whereas the majority addressed topics such as treatment selection, clinical documentation, or patient communication, with ~20% involving multi-turn conversations. Additionally, clinicians cited depth and detail and clarity of presentation more often than raw factual accuracy when explaining their preferences, highlighting the importance of readability and clinical nuance. We also confirm that the model rankings remain stable even after controlling for style-related factors like response length and formatting. By grounding evaluation in real-world clinical questions and preferences, MedArena offers a scalable platform for measuring and improving the utility and efficacy of medical LLMs.

Eric Wu, Kevin Wu, Jason Hom +11

Department of Electrical Engineering, Stanford University, Stanford, CA, USA · Department of Biomedical Data Science, Stanford University, Stanford, CA, USA · Division of Hospital Medicine, Department of Medicine, Stanford School of Medicine, Stanford, CA, USA +8

Clinical Language Model EvaluationMedical LLMsHuman Preference EvaluationPairwise Comparison
AskPDF
Mar 13, 2026

Developing and evaluating a chatbot to support maternal health care

The ability to provide trustworthy maternal health information using phone-based chatbots can have a significant impact, particularly in low-resource settings where users have low health literacy and limited access to care. However, deploying such systems is technically challenging: user queries are short, underspecified, and code-mixed across languages, answers require regional context-specific grounding, and partial or missing symptom context makes safe routing decisions difficult. We present a chatbot for maternal health in India developed through a partnership between academic researchers, a health tech company, a public health nonprofit, and a hospital. The system combines (1) stage-aware triage, routing high-risk queries to expert templates, (2) hybrid retrieval over curated maternal/newborn guidelines, and (3) evidence-conditioned generation from an LLM. Our core contribution is an evaluation workflow for high-stakes deployment under limited expert supervision. Targeting both component-level and end-to-end testing, we introduce: (i) a labeled triage benchmark (N=150) achieving 86.7% emergency recall, explicitly reporting the missed-emergency vs. over-escalation trade-off; (ii) a synthetic multi-evidence retrieval benchmark (N=100) with chunk-level evidence labels; (iii) LLM-as-judge comparison on real queries (N=781) using clinician-codesigned criteria; and (iv) expert validation. Our findings show that trustworthy medical assistants in multilingual, noisy settings require defense-in-depth design paired with multi-method evaluation, rather than any single model and evaluation method choice.

Smriti Jha, Vidhi Jain, Jianyu Xu +8

Carnegie Mellon University · Population Council Institute · Sitaram Bhartia Institute of Science and Research +1

HealthcareMedical LLMsClinical TriageClinical Language Model EvaluationRAG Evaluation
AskPDF
Mar 12, 2026

Shattering the Shortcut: A Topology-Regularized Benchmark for Multi-hop Medical Reasoning in LLMs

While Large Language Models (LLMs) achieve expert-level performance on standard medical benchmarks through single-hop factual recall, they severely struggle with the complex, multi-hop diagnostic reasoning required in real-world clinical settings. A primary obstacle is "shortcut learning", where models exploit highly connected, generic hub nodes (e.g., "inflammation") in knowledge graphs to bypass authentic micro-pathological cascades. To address this, we introduce ShatterMed-QA, a bilingual benchmark of 10,558 multi-hop clinical questions designed to rigorously evaluate deep diagnostic reasoning. Our framework constructs a topology-regularized medical Knowledge Graph using a novel kk-Shattering algorithm, which physically prunes generic hubs to explicitly sever logical shortcuts. We synthesize the evaluation vignettes by applying implicit bridge entity masking and topology-driven hard negative sampling, forcing models to navigate biologically plausible distractors without relying on superficial elimination. Comprehensive evaluations of 21 LLMs reveal massive performance degradation on our multi-hop tasks, particularly among domain-specific models. Crucially, restoring the masked evidence via Retrieval-Augmented Generation (RAG) triggers near-universal performance recovery, validating ShatterMed-QA's structural fidelity and proving its efficacy in diagnosing the fundamental reasoning deficits of current medical AI. Explore the dataset, interactive examples, and full leaderboards at our project website: https://shattermed-qa-web.vercel.app/

Xing Zi, Xinying Zhou, Jinghao Xiao +2

University of Technology Sydney, Australia

Shortcut Learning in Language ModelsMulti-Hop QAMedical QAClinical Language Model Evaluation
AskPDF
Mar 12, 2026

Performance Evaluation of Open-Source Large Language Models for Assisting Pathology Report Writing in Japanese

The performance of large language models (LLMs) for supporting pathology report writing in Japanese remains unexplored. We evaluated seven open-source LLMs from three perspectives: (A) generation and information extraction of pathology diagnosis text following predefined formats, (B) correction of typographical errors in Japanese pathology reports, and (C) subjective evaluation of model-generated explanatory text by pathologists and clinicians. Thinking models and medical-specialized models showed advantages in structured reporting tasks that required reasoning and in typo correction. In contrast, preferences for explanatory outputs varied substantially across raters. Although the utility of LLMs differed by task, our findings suggest that open-source LLMs can be useful for assisting Japanese pathology report writing in limited but clinically relevant scenarios.

Masataka Kawai, Singo Sakashita, Shumpei Ishikawa +8

Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Japan · Department of Pathology, University of Yamanashi, Chuo, Japan · Division of Pathology, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Japan +3

Medical Report GenerationMedical LLMsClinical Language Model EvaluationLLM Information ExtractionGrammatical Error Correction
AskPDF
Mar 12, 2026

Evaluation format, not only model capability, shapes measured triage failure in consumer health AI

A recent Nature Medicine study reported that ChatGPT Health under-triages 51.6% of emergencies and concluded that consumer-facing AI triage poses safety risks. Its protocol, however, was an exam-style scaffold (forced A/B/C/D output, knowledge suppression, no clarifying questions) unlike how consumers use health chatbots. We ask how much of the headline error rate is a property of the measurement rather than of the models. In a first, mechanistic study, five frontier LLMs on a 17-scenario bank scored 6.4 points higher under naturalistic patient-style messages than under the constrained scaffold (p=0.015). In a second, faithful replication we ran the authors' own 60 released vignettes through six frontier models under four matched formats, with clinician validation of the rewrites and a blinded clinician audit of the LLM adjudicators. Here the direction reversed: free-text rewrites scored slightly below the exact prompt (78.7% vs 81.8%, p=0.020), removing only the answer scaffold changed little (80.6% vs 81.4%, p=0.81), and naturalistic input with a forced categorical answer beat both the exact prompt (84.4%, p=0.023) and free text (p=0.0001). On the four vignettes defining the original emergency rate, under-triage was 17% with the exact scaffold, 50% in free text, and 21% with a forced letter on the same message; every free-text "under-triage" was a same-day recommendation scored C rather than D, and 60% made escalation conditional on information the patient was asked to check, behavior a single-turn benchmark cannot score. The headline rate did not reproduce as a stable cross-model finding; much of it depends on output format and on mapping prose onto a four-point scale. Each format elicits a separate response, so the design measures format sensitivity, not format versus capability. Safety claims should report sensitivity to input wording, output format and adjudication.

David Fraile Navarro, Jialei Sheng, Farah Magrabi +1

Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia · NSW Health, Sydney, NSW, Australia

Language Model Safety EvaluationLLM Safety BenchmarksClinical Language Model EvaluationPrompt SensitivityClinical Triage
AskPDF
Mar 12, 2026

Stop Listening to Me! How Multi-turn Conversations Can Degrade LLM Reliability

Large language models (LLMs) excel on static benchmarks, but their performance across multi-turn conversations, which better reflect real-world usage, remains understudied. Addressing this gap is critical in high-stakes settings like healthcare, where patients and clinicians are turning to LLM chatbots to address their medical inquiries. Here, we introduce the "stick-or-switch" (SoS) framework, which partitions a question-answer space into multiple sequential presentations to model two safety-centric behaviors: conviction (i.e., sticking to a correct answer selection or abstention against incorrect suggestions) and flexibility (i.e., switching to a correct suggestion when it is introduced). Evaluating 17 LLMs across three clinical benchmarks, we observe a pervasive conversation tax, where partitioning an answer-space into sequential presentations reduces end-to-end accuracy and abstention against incorrect suggestions by an average of up to 30%, reaching 65% in certain models. We also observe blind switching, where models transition an initial abstention to incorrect and correct suggestions at near-identical rates reaching 50%. Finally, we show that increasing model scale mitigates some of these conversational inefficacies while exacerbating others, such as a higher propensity to adopt an incorrect suggestion from an initial abstention. Together our findings demonstrate that the general proficiency captured by static benchmarks do not translate over multi-turn dialogues.

Kevin H. Guo, Chao Yan, Avinash Baidya +5

Vanderbilt University · Vanderbilt University Medical Center · Intuit AI Research

LLM ReliabilityMulti-Turn Dialogue EvaluationClinical Language Model EvaluationKnowledge Conflicts in Language Models
AskPDF
Mar 11, 2026

Human-AI Co-reasoning for Clinical Diagnosis with Evidence-Integrated Language Agent

We present PULSE, a medical reasoning agent that combines a domain-tuned large language model with scientific literature retrieval to support diagnostic decision-making in complex real-world cases. To evaluate its capabilities, we curated a benchmark of 82 authentic endocrinology case reports encompassing a broad spectrum of disease types and incidence levels. In controlled experiments, we compared PULSE's performance against physicians with varying levels of expertise-from residents to senior specialists-and examined how AI assistance influenced human diagnostic reasoning. PULSE attained expert-competitive accuracy, outperforming residents and junior specialists while matching senior specialist performance at both Top@1 and Top@4 thresholds. Unlike physicians, whose accuracy declined with disease rarity, PULSE maintained stable performance across incidence tiers. The agent also exhibited adaptive reasoning, increasing output length with case difficulty in a manner analogous to the longer deliberation observed among expert clinicians. When used collaboratively, PULSE enabled physicians to correct initial errors and broaden diagnostic hypotheses, but also introduced risks of automation bias. The study explores both serial and concurrent collaboration workflows, revealing that PULSE offers robust support across common and rare presentations. These findings underscore both the promise and the limitations of language model-based agents in clinical diagnosis, and offer a framework for evaluating their role in real-world decision-making.

Zhongzhen Huang, Yan Ling, Hong Chen +7

Shanghai Jiao Tong University, Shanghai, China · Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai, China · Department of Endocrinology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China +3

Medical DiagnosisClinical Decision SupportHuman-AI Decision MakingMedical LLMsClinical Language Model Evaluation
AskPDF
Mar 11, 2026

WHBench: Evaluating Frontier LLMs with Expert-in-the-Loop Validation on Women's Health Topics

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.

Sneha Maurya, Spandana Govindgari, Girish Kumar +1

Columbia University · Akhara AI

Clinical Language Model EvaluationLLM Safety BenchmarksHealthcareClinical QALanguage Model Bias Evaluation
AskPDF
Mar 10, 2026

Disentangling Prompt Element Level Risk Factors for Hallucinations and Omissions in Mental Health LLM Responses

Mental health concerns are often expressed outside clinical settings, including in high-distress help seeking, where safety-critical guidance may be needed. Consumer health informatics systems increasingly incorporate large language models (LLMs) for mental health question answering, yet many evaluations underrepresent narrative, high-distress inquiries. We introduce UTCO (User, Topic, Context, Tone), a prompt construction framework that represents an inquiry as four controllable elements for systematic stress testing. Using 2,075 UTCO-generated prompts, we evaluated Llama 3.3 and annotated hallucinations (fabricated or incorrect clinical content) and omissions (missing clinically necessary or safety-critical guidance). Hallucinations occurred in 6.5% of responses and omissions in 13.2%, with omissions concentrated in crisis and suicidal ideation prompts. Across regression, element-specific matching, and similarity-matched comparisons, failures were most consistently associated with context and tone, while user-background indicators showed no systematic differences after balancing. These findings support evaluating omissions as a primary safety outcome and moving beyond static benchmark question sets.

Congning Ni, Sarvech Qadir, Bryan Steitz +14

Vanderbilt University Medical Center, Nashville, TN, USA · Vanderbilt University, Nashville, TN, USA · Lirio, Knoxville, TN, USA +1

Hallucination in Language ModelsLLM Safety EvaluationClinical Language Model EvaluationQuestion Answering
AskPDF
Mar 9, 2026

A prospective clinical feasibility study of a conversational diagnostic AI in an ambulatory primary care clinic

Large language model (LLM)-based AI systems have shown promise for patient-facing diagnostic and management conversations in simulated settings. Translating these systems into clinical practice requires assessment in real-world workflows with rigorous safety oversight. We report a prospective, single-arm feasibility study of an LLM-based conversational AI, the Articulate Medical Intelligence Explorer (AMIE), conducting clinical history taking and presentation of potential diagnoses for patients to discuss with their provider at urgent care appointments at a leading academic medical center. 100 adult patients completed an AMIE text-chat interaction up to 5 days before their appointment. We sought to assess the conversational safety and quality, patient and clinician experience, and clinical reasoning capabilities compared to primary care providers (PCPs). Human safety supervisors monitored all patient-AMIE interactions in real time and did not need to intervene to stop any consultations based on pre-defined criteria. Patients reported high satisfaction and their attitudes towards AI improved after interacting with AMIE (p < 0.001). PCPs found AMIE's output useful with a positive impact on preparedness. AMIE's differential diagnosis (DDx) included the final diagnosis, per chart review 8 weeks post-encounter, in 90% of cases, with 75% top-3 accuracy. Blinded assessment of AMIE and PCP DDx and management (Mx) plans suggested similar overall DDx and Mx plan quality, without significant differences for DDx (p = 0.6) and appropriateness and safety of Mx (p = 0.1 and 1.0, respectively). PCPs outperformed AMIE in the practicality (p = 0.003) and cost effectiveness (p = 0.004) of Mx. While further research is needed, this study demonstrates the initial feasibility, safety, and user acceptance of conversational AI in a real-world setting, representing crucial steps towards clinical translation.

Peter Brodeur, Jacob M. Koshy, Anil Palepu +45

HealthcareMedical LLMsClinical Language Model EvaluationClinical Decision SupportClinical ReasoningHuman-in-the-Loop AI
AskPDF
Mar 9, 2026

COACH meets QUORUM: A Framework and Pipeline for Aligning User, Expert and Developer Perspectives in LLM-generated Health Counselling

Systems that collect data on sleep, mood, and activities can provide valuable lifestyle counselling to populations affected by chronic disease and its consequences. Such systems are, however, challenging to develop; besides reliably extracting patterns from user-specific data, systems should also contextualise these patterns with validated medical knowledge to ensure the quality of counselling, and generate counselling that is relevant to a real user. We present QUORUM, a new evaluation framework that unifies these developer-, expert-, and user-centric perspectives, and show with a real case study that it meaningfully tracks convergence and divergence in stakeholder perspectives. We also present COACH, a Large Language Model-driven pipeline to generate personalised lifestyle counselling for our Healthy Chronos use case, a diary app for cancer patients and survivors. Applying our framework shows that overall, users, medical experts, and developers converge on the opinion that the generated counselling is relevant, of good quality, and reliable. However, stakeholders also diverge on the tone of the counselling, sensitivity to errors in pattern-extraction, and potential hallucinations. These findings highlight the importance of multi-stakeholder evaluation for consumer health language technologies and illustrate how a unified evaluation framework can support trustworthy, patient-centered NLP systems in real-world settings.

Yee Man Ng, Bram van Dijk, Pieter Beynen +5

Leiden University · Leiden University Medical Center · Healthy Chronos

Clinical Language Model EvaluationMedical LLMsPersonalized Language Models
AskPDF
Mar 6, 2026

Language Shapes Mental Health Evaluations in Large Language Models

Multilingual large language models (LLMs) are increasingly used in socially sensitive mental health contexts, including support chatbots, screening, and content moderation. This raises a reliability question: do semantically equivalent mental health inputs elicit comparable evaluations across languages, or systematic shifts consistent with language-associated social and cultural contexts? We examine this question in an English-Chinese setting with GPT-4o and Qwen3-32B using a two-level framework: construct-level evaluative orientation, measured by psychometric stigma instruments, and decision-level behavior, measured by binary stigma detection and four-class depression severity classification. Across instruments and models, Chinese prompts elicit higher stigma-related scores than English prompts. At the decision level, Chinese prompts reduce sensitivity to stigmatizing content and produce more conservative depression severity judgments, leading to more under-estimation errors. These findings show that prompt language can shift both evaluative orientation and downstream behavior in LLM-based mental health evaluation. They highlight the need to evaluate multilingual LLMs not only for aggregate performance, but also for whether they apply comparable evaluative standards across languages in socially sensitive domains.

Jiayi Xu, Xiyang Hu

University of North Carolina at Chapel Hill · Arizona State University

Cross-Lingual Consistency in Language ModelsMultilingual Language Model EvaluationClinical Language Model EvaluationDepression Severity Estimation
AskPDF
Mar 6, 2026

MedMT-Bench: Can LLMs Memorize and Understand Long Multi-Turn Conversations in Medical Scenarios?

Large Language Models (LLMs) have demonstrated impressive capabilities across various specialist domains and have been integrated into high-stakes areas such as medicine. However, as existing medical-related benchmarks rarely stress-test the long-context memory, interference robustness, and safety defense required in practice. To bridge this gap, we introduce MedMT-Bench, a challenging medical multi-turn instruction following benchmark that simulates the entire diagnosis and treatment process. We construct the benchmark via scene-by-scene data synthesis refined by manual expert editing, yielding 400 test cases that are highly consistent with real-world application scenarios. Each test case has an average of 22 rounds (maximum of 52 rounds), covering 5 types of difficult instruction following issues. For evaluation, we propose an LLM-as-judge protocol with instance-level rubrics and atomic test points, validated against expert annotations with a human-LLM agreement of 91.94%. We test 17 frontier models, all of which underperform on MedMT-Bench (overall accuracy below 60.00%), with the best model reaching 59.75%. MedMT-Bench can be an essential tool for driving future research towards safer and more reliable medical AI. The benchmark is available in https://openreview.net/attachment?id=aKyBCsPOHB&name=supplementary_material

Lin Yang, Yuancheng Yang, Xu Wang +2

ByteDance

Long-Context Language Model EvaluationClinical Language Model EvaluationMulti-Turn Dialogue EvaluationLLM Safety Benchmarks
AskPDF
Mar 4, 2026

Who Judges the Judge? Evaluating LLM-as-a-Judge for French Medical open-ended QA

Automatic evaluation of medical open-ended question answering (OEQA) remains challenging due to the need for expert annotations. We evaluate whether large language models (LLMs) can act as judges of semantic equivalence in French medical OEQA, comparing closed-access, general-purpose, and biomedical domain-adapted models. Our results show that LLM-based judgments are strongly influenced by the model that generated the answer, with agreement varying substantially across generators. Domain-adapted and large general-purpose models achieve the highest alignment with expert annotations. We further show that lightweight adaptation of a compact model using supervised fine-tuning (SFT) and Group Relative Policy Optimization (GRPO) substantially improves performance and reduces generator sensitivity, even with limited data. Overall, our findings highlight the need for generator-aware evaluation and suggest that carefully adapted small models can support scalable evaluation in low-resource medical settings.

Ikram Belmadani, Oumaima El Khettari, Pacôme Constant dit Beaufils +2

Aix-Marseille Univ., CNRS, LIS UMR 7020, 13000 Marseille, France · Nantes Univ., École Centrale Nantes, CNRS, LS2N, UMR 6004, 44000 Nantes, France · Nantes Université, CHU Nantes, PHU 11: Santé Publique, Clinique des données, INSERM, CIC 1413, 44000 Nantes, France +2

LLM-as-a-JudgeBias in LLM-as-a-JudgeClinical Language Model EvaluationMedical QA
AskPDF
Mar 4, 2026

Assessing the Effectiveness of LLMs in Delivering Cognitive Behavioral Therapy

As mental health issues continue to rise globally, there is an increasing demand for accessible and scalable therapeutic solutions. Many individuals currently seek support from Large Language Models (LLMs), even though these models have not been validated for use in counseling services. In this paper, we evaluate LLMs' ability to emulate professional therapists practicing Cognitive Behavioral Therapy (CBT). Using anonymized, transcribed role-play sessions between licensed therapists and clients, we compare two approaches: (1) a generation-only method and (2) a Retrieval-Augmented Generation (RAG) approach using CBT guidelines. We evaluate both proprietary and open-source models for linguistic quality, semantic coherence, and therapeutic fidelity using standard natural language generation (NLG) metrics, natural language inference (NLI), and automated scoring for skills assessment. Our results indicate that while LLMs can generate CBT-like dialogues, they are limited in their ability to convey empathy and maintain consistency.

Navdeep Singh Bedi, Ana-Maria Bucur, Noriko Kando +1

Università della Svizzera italiana, Switzerland · National Institute of Informatics, Japan

Clinical Language Model EvaluationMedical LLMsLarge Language Model-Based Role-Play Simulation
AskPDF
Mar 4, 2026

Benchmarking Motivational Interviewing Competence of Large Language Models

Motivational interviewing (MI) promotes behavioural change in substance use disorders. Its fidelity is measured using the Motivational Interviewing Treatment Integrity (MITI) framework. While large language models (LLMs) can potentially generate MI-consistent therapist responses, their competence using MITI is not well-researched, especially in real world clinical transcripts. We aim to benchmark MI competence of proprietary and open-source models compared to human therapists in real-world transcripts and assess distinguishability from human therapists. Methods: We shortlisted 3 proprietary and 7 open-source LLMs from LMArena, evaluated performance using MITI 4.2 framework on two datasets (96 handcrafted model transcripts, 34 real-world clinical transcripts). We generated parallel LLM-therapist utterances iteratively for each transcript while keeping client responses static, and ranked performance using a composite ranking system with MITI components and verbosity. We conducted a distinguishability experiment with two independent psychiatrists to identify human-vs-LLM responses. Results: All 10 tested LLMs had fair (MITI global scores >3.5) to good (MITI global scores >4) competence across MITI measures, and three best-performing models (gemma-3-27b-it, gemini-2.5-pro, grok-3) were tested on real-world transcripts. All showed good competence, with LLMs outperforming human-expert in Complex Reflection percentage (39% vs 96%) and Reflection-Question ratio (1.2 vs >2.8). In the distinguishability experiment, psychiatrists identified LLM responses with only 56% accuracy, with d-prime: 0.17 and 0.25 for gemini-2.5-pro and gemma-3-27b-it respectively. Conclusion: LLMs can achieve good MI proficiency in real-world clinical transcripts using MITI framework. These findings suggest that even open-source LLMs are viable candidates for expanding MI counselling sessions in low-resource settings.

Aishwariya Jha, Prakrithi Shivaprakash, Lekhansh Shukla +3

Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India. · Department of Computer Science and Engineering, Indian Institute of Technology (IIT) Kharagpur, India. · Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India.

Clinical Language Model EvaluationMedical LLMs
AskPDF
Mar 3, 2026

TrustMH-Bench: A Comprehensive Benchmark for Evaluating the Trustworthiness of Large Language Models in Mental Health

While Large Language Models (LLMs) demonstrate significant potential in providing accessible mental health support, their practical deployment raises critical trustworthiness concerns due to the domains high-stakes and safety-sensitive nature. Existing evaluation paradigms for general-purpose LLMs fail to capture mental health-specific requirements, highlighting an urgent need to prioritize and enhance their trustworthiness. To address this, we propose TrustMH-Bench, a holistic framework designed to systematically quantify the trustworthiness of mental health LLMs. By establishing a deep mapping from domain-specific norms to quantitative evaluation metrics, TrustMH-Bench evaluates models across eight core pillars: Reliability, Crisis Identification and Escalation, Safety, Fairness, Privacy, Robustness, Anti-sycophancy, and Ethics. We conduct extensive experiments across six general-purpose LLMs and six specialized mental health models. Experimental results indicate that the evaluated models underperform across various trustworthiness dimensions in mental health scenarios, revealing significant deficiencies. Notably, even generally powerful models (e.g., GPT-5.1) fail to maintain consistently high performance across all dimensions. Consequently, systematically improving the trustworthiness of LLMs has become a critical task. Our data and code are released.

Zixin Xiong, Ziteng Wang, Haotian Fan +2

Renmin University of China, China · Beijing University of Posts and Telecommunications, China · Hefei University of Technology, China

LLM Safety BenchmarksLLM ReliabilityClinical Language Model Evaluation
AskPDF
Mar 2, 2026

ClinConsensus: A Physician-Calibrated Benchmark for Evaluating Clinical Rubric Coverage in Chinese Medical LLMs

Open-ended medical LLM evaluation remains weakly grounded in physician-calibrated coverage of clinically relevant response criteria, especially in localized clinical settings. We introduce ClinConsensus, a Chinese medical benchmark of 2{,}500 expert-curated cases spanning 36 specialties, 12 task themes, multiple difficulty levels, and lay-facing versus professional-facing settings. Each case is paired with 30 case-specific binary rubric criteria. To evaluate whether responses satisfy enough physician-authored criteria, we propose Clinician-Anchored Coverage Score (CACS), a physician-calibrated threshold metric instantiated at k=10k=10, and develop a dual-judge framework combining a GPT-5.1 grader with a physician-supervised Qwen3-8B judge. Evaluating 11 frontier LLMs, we find a persistent coverage gap: Rubric Accuracy ranges from 39.6% to 52.1%, whereas CACS@10 ranges from 17.8% to 32.9%, leaving a 19.2--21.9 point gap across models. Stratified analyses further reveal substantial variation across reasoning, evidence use, structured extraction, medication instructions, follow-up, and dialogue register. These results suggest that medical LLM evaluation should measure thresholded, rubric-grounded clinical coverage rather than average partial correctness.

Xiang Zheng, Han Li, Wenjie Luo +15

Alibaba Group, China

Clinical Language Model EvaluationMedical LLMsRubric-Based Evaluation
AskPDF
Mar 2, 2026

Benchmarking LLM Summaries of Multimodal Clinical Time Series for Remote Monitoring

Large language models (LLMs) can generate fluent clinical summaries of remote therapeutic monitoring time series. However, it remains unclear whether these narratives faithfully capture clinically significant events, such as sustained abnormalities. Existing evaluation metrics primarily focus on semantic similarity and linguistic quality, leaving event-level correctness largely unmeasured. To address this gap, we introduce an event-based evaluation framework for multimodal time-series summarization using the Technology-Integrated Health Management (TIHM)-1.5 dementia monitoring dataset. Clinically grounded daily events are derived through rule-based abnormal thresholds and temporal persistence criteria. Model-generated summaries are then aligned with these structured facts. Our evaluation protocol measures abnormality recall, duration recall, measurement coverage, and hallucinated event mentions. We benchmark three approaches: zero-shot prompting, statistical prompting, and a vision-based pipeline that uses rendered time-series visualizations. The results reveal a striking decoupling between conventional metrics and clinical event fidelity. Models that achieve high semantic similarity scores often exhibit near-zero abnormality recall. In contrast, the vision-based approach demonstrates the strongest event alignment, achieving 45.7% abnormality recall and 100% duration recall. These findings underscore the importance of event-aware evaluation to ensure reliable clinical time-series summarization.

Aditya Shukla, Yining Yuan, Ben Tamo +7

Georgia Institute of Technology · Shepherd Center

Summarization EvaluationClinical Language Model EvaluationMultimodal Model Evaluation
AskPDF
Mar 2, 2026

PanCanBench: A Comprehensive Benchmark for Evaluating Large Language Models in Pancreatic Oncology

Large language models (LLMs) have achieved expert-level performance on standardized examinations, yet multiple-choice accuracy poorly reflects real-world clinical utility and safety. As patients and clinicians increasingly use LLMs for guidance on complex conditions such as pancreatic cancer, evaluation must extend beyond general medical knowledge. Existing frameworks, such as HealthBench, rely on simulated queries and lack disease-specific depth. Moreover, high rubric-based scores do not ensure factual correctness, underscoring the need to assess hallucinations. We developed a human-in-the-loop pipeline to create expert rubrics for de-identified patient questions from the Pancreatic Cancer Action Network (PanCAN). The resulting benchmark, PanCanBench, includes 3,130 question-specific criteria across 282 authentic patient questions. We evaluated 22 proprietary and open-source LLMs using an LLM-as-a-judge framework, measuring clinical completeness, factual accuracy, and web-search integration. Models showed substantial variation in rubric-based completeness, with scores ranging from 46.5% to 82.3%. Factual errors were common, with hallucination rates (the percentages of responses containing at least one factual error) ranging from 6.0% for Gemini-2.5 Pro and GPT-4o to 53.8% for Llama-3.1-8B. Importantly, newer reasoning-optimized models did not consistently improve factuality: although o3 achieved the highest rubric score, it produced inaccuracies more frequently than other GPT-family models. Web-search integration did not inherently guarantee better responses. The average score changed from 66.8% to 63.9% for Gemini-2.5 Pro and from 73.8% to 72.8% for GPT-5 when web search was enabled. Synthetic AI-generated rubrics inflated absolute scores by 17.9 points on average while generally maintaining similar relative ranking.

Yimin Zhao, Sheela R. Damle, Simone E. Dekker +13

Department of Biostatistics, University of Washington · Clinical Research Division, Fred Hutch Cancer Center · Division of Hematology and Oncology, Department of Medicine, University of Washington +5

Clinical Language Model EvaluationMedical QAOncology
AskPDF
Mar 1, 2026

Prompt Sensitivity and Answer Consistency of Small Open-Source Language Models for Clinical Question Answering in Low-Resource Healthcare

Small open-source language models are gaining attention for healthcare applications in low-resource settings where cloud infrastructure and GPU hardware may be unavailable. However, the reliability of these models under different phrasings of the same clinical question remains poorly understood. We evaluate five open-source models (Gemma 2 2B, Phi-3 Mini 3.8B, Llama 3.2 3B, Mistral 7B, and Meditron-7B, a domain-pretrained model without instruction tuning) across three clinical question answering datasets (MedQA, MedMCQA, and PubMedQA) using five prompt styles: original, formal, simplified, roleplay, and direct. Model behavior is evaluated using consistency scores, accuracy, and instruction-following failure rates. All experiments were conducted locally on consumer CPU hardware without fine-tuning. Consistency and accuracy were largely independent across models. Gemma 2 achieved the highest consistency (0.845-0.888) but the lowest accuracy (33.0-43.5%), while Llama 3.2 showed moderate consistency (0.774-0.807) alongside the highest accuracy (49.0-65.0%). Roleplay prompts consistently reduced accuracy across all models, with Phi-3 Mini dropping 21.5 percentage points on MedQA. Meditron-7B exhibited near-complete instruction-following failure on PubMedQA (99.0% UNKNOWN rate), indicating that domain pretraining alone is insufficient for structured clinical question answering. These findings show that high consistency does not imply correctness: models can be reliably wrong, a dangerous failure mode in clinical AI. Llama 3.2 demonstrated the strongest balance of accuracy and reliability for low-resource deployment. Safe clinical AI requires joint evaluation of consistency, accuracy, and instruction adherence.

Shravani Hariprasad

Independent Researcher

Clinical Language Model EvaluationPrompt SensitivitySmall Language ModelsClinical QAReasoning Consistency in Language ModelsInstruction Following
AskPDF
Feb 28, 2026

Leveraging Computerized Adaptive Testing for Cost-effective Evaluation of Large Language Models in Medical Benchmarking

The rapid proliferation of large language models (LLMs) in healthcare creates an urgent need for scalable and psychometrically sound evaluation methods. Conventional static benchmarks are costly to administer repeatedly, vulnerable to data contamination, and lack calibrated measurement properties for fine-grained performance tracking. We propose and validate a computerized adaptive testing (CAT) framework grounded in item response theory (IRT) for efficient assessment of standardized medical knowledge in LLMs. The study comprises a two-phase design: a Monte Carlo simulation to identify optimal CAT configurations and an empirical evaluation of 38 LLMs using a human-calibrated medical item bank. Each model completed both the full item bank and an adaptive test that dynamically selected items based on real-time ability estimates and terminated upon reaching a predefined reliability threshold (standard error <= 0.3). Results show that CAT-derived proficiency estimates achieved a near-perfect correlation with full-bank estimates (r = 0.988) while using only 1.3 percent of the items. Evaluation time was reduced from several hours to minutes per model, with substantial reductions in token usage and computational cost, while preserving inter-model performance rankings. This work establishes a psychometric framework for rapid, low-cost benchmarking of foundational medical knowledge in LLMs. The proposed adaptive methodology is intended as a standardized pre-screening and continuous monitoring tool and is not a substitute for real-world clinical validation or safety-oriented prospective studies.

Tianpeng Zheng, Zhehan Jiang, Jiayi Liu +1

Institute of Medical Education, Health Science Center, Peking University, Beijing, China · School of Public Health, Peking University, Haidian District, Beijing, China · Peking University Health Science Center-Chaoxing Joint Laboratory for Digital and Smart Medical, Peking University, Beijing, China +1

Computerized Adaptive TestingLLM EvaluationClinical Language Model EvaluationEducational Assessment
AskPDF
Feb 28, 2026

CURE: A Multimodal Benchmark for Clinical Understanding and Retrieval Evaluation

Multimodal large language models (MLLMs) demonstrate considerable potential in clinical diagnostics, a domain that inherently requires synthesizing complex visual and textual data alongside consulting authoritative medical literature. However, existing benchmarks primarily evaluate MLLMs in end-to-end answering scenarios. This limits the ability to disentangle a model's foundational multimodal reasoning from its proficiency in evidence retrieval and application. We introduce the Clinical Understanding and Retrieval Evaluation (CURE) benchmark. Comprising 500500 multimodal clinical cases mapped to physician-cited reference literature, CURE evaluates reasoning and retrieval under controlled evidence settings to disentangle their respective contributions. We evaluate state-of-the-art MLLMs across distinct evidence-gathering paradigms in both closed-ended and open-ended diagnosis tasks. Evaluations reveal a stark dichotomy: while advanced models demonstrate clinical reasoning proficiency when supplied with physician reference evidence (achieving up to 73.4%73.4\% accuracy on differential diagnosis), their performance substantially declines (as low as 25.4%25.4\%) when reliant on independent retrieval mechanisms. This disparity highlights the dual challenges of effectively integrating multimodal clinical evidence and retrieving precise supporting literature. CURE is publicly available at https://github.com/yanniangu/CURE.

Yannian Gu, Zhongzhen Huang, Linjie Mu +3

Shanghai Jiao Tong University, Shanghai, China · SenseTime Research, China · Shanghai Innovation Institute, Shanghai, China

Clinical Language Model EvaluationMultimodal Model EvaluationMultimodal ReasoningMedical DiagnosisInformation Retrieval
AskPDF
Feb 27, 2026

When Metrics Disagree: Automatic Similarity vs. LLM-as-a-Judge for Clinical Dialogue Evaluation

As Large Language Models (LLMs) are increasingly integrated into healthcare to address complex inquiries, ensuring their reliability remains a critical challenge. Recent studies have highlighted that generic LLMs often struggle in clinical contexts, occasionally producing misleading guidance. To mitigate these risks, this research focuses on the domain-specific adaptation of Llama-2-7B using the Low-Rank Adaptation (LoRA) technique. By injecting trainable low-rank matrices into the Transformer layers, we efficiently adapted the model using authentic patient-physician transcripts while preserving the foundational knowledge of the base model. Our objective was to enhance precision and contextual relevance in responding to medical queries by capturing the specialized nuances of clinical discourse. Due to the resource-intensive nature of large-scale human validation, the model's performance was evaluated through a dual-track framework: Track A utilized traditional lexical similarity metrics (e.g., BLEU, ROUGE), while Track B employed an "LLM-as-a-Judge" paradigm using GPT-4 for semantic assessment. Our results demonstrate that while the LoRA-enhanced model achieved significant improvements across all quantitative lexical dimensions, a profound disagreement surfaced in the GPT-4 evaluation, which marginally favored the baseline model's conversational flow. This metric divergence underscores a pivotal finding: traditional automated scores may not fully reflect clinical utility. Consequently, we propose that while automated metrics and LLM judges serve as valuable developmental proxies, rigorous validation by human medical experts remains an indispensable requirement for the safe deployment of LLMs in healthcare settings.

Bian Sun, Zhenjian Wang, Orvill de la Torre +1

Heinz College, Carnegie Mellon University · School of Computer Science, Carnegie Mellon University

Clinical Language Model EvaluationGenerative AI EvaluationDomain Adaptation for LLMsMedical QALLM-as-a-Judge
AskPDF
Feb 26, 2026

MediX-R1: Open Ended Medical Reinforcement Learning

We introduce MediX-R1, an open-ended Reinforcement Learning (RL) framework for medical multimodal large language models (MLLMs) that enables clinically grounded, free-form answers beyond multiple-choice formats. MediX-R1 fine-tunes a baseline vision-language backbone with Group Based RL and a composite reward tailored for medical reasoning: an LLM-based accuracy reward that judges semantic correctness with a strict YES/NO decision, a medical embedding-based semantic reward to capture paraphrases and terminology variants, and lightweight format and modality rewards that enforce interpretable reasoning and modality recognition. This multi-signal design provides stable, informative feedback for open-ended outputs where traditional verifiable or MCQ-only rewards fall short. To measure progress, we propose a unified evaluation framework for both text-only and image+text tasks that uses a Reference-based LLM-as-judge in place of brittle string-overlap metrics, capturing semantic correctness, reasoning, and contextual alignment. Despite using only ∼51\sim51K instruction examples, MediX-R1 achieves excellent results across standard medical LLM (text-only) and VLM (image + text) benchmarks, outperforming strong open-source baselines and delivering particularly large gains on open-ended clinical tasks. Our results demonstrate that open-ended RL with comprehensive reward signals and LLM-based evaluation is a practical path toward reliable medical reasoning in multimodal models. Our trained models, curated datasets and source code are available at https://medix.cvmbzuai.com

Sahal Shaji Mullappilly, Mohammed Irfan Kurpath, Omair Mohamed +5

Mohamed Bin Zayed University of Artificial Intelligence (MBZUAI) · Jubilee Mission Medical College and Research Institute · JJM Medical College

RL for VLMsMedical VLMsMedical QAClinical Language Model EvaluationMultimodal Reward Modeling
AskPDF
Feb 26, 2026

Toward Automatic Filling of Case Report Forms: A Case Study on Data from an Italian Emergency Department

Case Report Forms (CRFs) collect data about patients and are at the core of well-established practices to conduct research in clinical settings. With the recent progress of language technologies, there is an increasing interest in automatic CRF-filling from clinical notes, mostly based on the use of Large Language Models (LLMs). However, there is a general scarcity of annotated CRF data, both for training and testing LLMs, which limits the progress on this task. As a step in the direction of providing such data, we present a new dataset of clinical notes from an Italian Emergency Department annotated with respect to a pre-defined CRF containing 134 items to be filled. We provide an analysis of the data, define the CRF-filling task and metric for its evaluation, and report on pilot experiments where we use an open-source state-of-the-art LLM to automatically execute the task. Results of the case-study show that (i) CRF-filling from real clinical notes in Italian can be approached in a zero-shot setting; (ii) LLMs' results are affected by biases (e.g., a cautious behaviour favours "unknown" answers), which need to be corrected.

Gabriela Anna Kaczmarek, Pietro Ferrazzi, Lorenzo Porta +2

Fondazione Bruno Kessler, Povo, Trento, Italy · University of Padova, Padova, Italy · Emergency Medicine Unit, Fatebenefratelli Hospital, Milan, Italy +1

Clinical NLPClinical Information ExtractionMedical LLMsClinical Language Model Evaluation
AskPDF
Feb 26, 2026

ClinDet-Bench: Beyond Abstention, Evaluating Judgment Determinability of LLMs in Clinical Decision-Making

Clinical decisions are often required under incomplete information. Clinical experts must identify whether available information is sufficient for judgment, as both premature conclusion and unnecessary abstention can compromise patient safety. To evaluate this capability of large language models (LLMs), we developed ClinDet-Bench, a benchmark based on clinical scoring systems that decomposes incomplete-information scenarios into determinable and undeterminable conditions. Identifying determinability requires considering all hypotheses about missing information, including unlikely ones, and verifying whether the conclusion holds across them. We find that recent LLMs fail to identify determinability under incomplete information, producing both premature judgments and excessive abstention, despite correctly explaining the underlying scoring knowledge and performing well under complete information. These findings suggest that existing benchmarks are insufficient to evaluate the safety of LLMs in clinical settings. ClinDet-Bench provides a framework for evaluating determinability recognition, leading to appropriate abstention, with potential applicability to medicine and other high-stakes domains, and is publicly available.

Yusuke Watanabe, Yohei Kobashi, Takeshi Kojima +3

Kyoto University, Department of Biomedical Data Intelligence · Kyoto University, Department of Cardiovascular Medicine · The University of Tokyo

Clinical Language Model EvaluationLLM Safety BenchmarksLLM AbstentionClinical Decision-Making
AskPDF