Clinical Language Model Evaluation

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37 papers in the last four weeks, up 118% on the four weeks before. 0.4% of all new papers.

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Sep 14, 2026cs.CL

K-Bench: a clinically calibrated benchmark for evaluating large language models in high-risk mental health conversations

People increasingly use large language models (LLMs) for mental health support, yet their safety in evolving, high-risk conversations remains poorly characterised. We developed K-Bench, a clinician-calibrated, protected benchmark evaluating 125 model configurations representing 33 base models from 14 providers across a fixed cohort of 200 multi-turn vignettes involving suicide, self-harm, domestic violence, substance misuse, and no-risk presentations. Synthetic patient conversations showed substantial distributional overlap with real human-AI conversations. A frozen GPT-4o judge achieved 94.2% exact agreement with clinician consensus across 6,751 eligible item comparisons from 151 clinician-rated transcripts. Leading models combined strong supportive conversation with combined-risk scores above 95, whereas risk exploration exposed substantial variation among lower-performing configurations. Therapeutic prompting produced configuration-specific gains concentrated among weaker models, while elevated reasoning produced no average improvement. K-Bench combines broader clinical coverage and configuration-scale comparison with a continuously updated public leaderboard whose operational test materials are protected from direct optimisation. The leaderboard is available at www.k-bench.ai.

Laura M. Vowels, Matthew J. Vowels, Shivali Sharma +9

School of Psychology, University of Roehampton, London, United Kingdom · Kivira Health, United Kingdom · University of Hertfordshire, Hatfield, United Kingdom +4

LLM Safety Benchmarks Mental Health Counseling Language Model Safety Evaluation LLM Safety Clinical Language Model Evaluation

Sep 14, 2026cs.AI

KnowBench: Effort Reduction as a Unified, Deployment-Grounded Benchmark for Clinical AI

Clinical AI systems are evaluated with instruments built for research settings (reference-based similarity metrics and expert rubric panels) that measure resemblance to an artifact rather than reduction of a burden. We introduce KnowBench, pioneered by Knowtex, whose unifying metric is Effort Reduction (ER): the proportion of system-generated clinical work product accepted by the responsible clinician under expert and safety review. ER is defined once and instantiated per task across the administrative workload clinical AI automates: visit notes, diagnosis and billing codes, orders, EHR chart summarization, patient after-visit summaries, and clinical decision support. In every instantiation the construction is identical: the clinician's review-and-attestation event is the ground truth, every accepted unit is work the system completed, and every correction is residual effort returned to the clinician. The primary contribution of this paper is the benchmark itself: the metric, its degenerate cases, and a reporting protocol under which ER claims are auditable and cross-system comparable. Alongside it we report an initial headline measurement from the documentation instantiation: over one million signed encounters across a production window exceeding six months and thirteen medical specialties, Knowtex's proprietary fine-tuned clinical foundation models operating inside a closed feedback architecture achieve an aggregate ER of 97.99%, with per-specialty aggregates spanning 96.8-98.9%. This release reports the protocol's checklist partially, and states which companion statistics are withheld; the benchmark is offered so that this figure, and every figure reported after it, can be held to the same standard.

Jocelyn Kang, Caroline Zhang

Knowtex Inc.

Benchmark Design Workflow Automation Clinical Language Model Evaluation

Sep 14, 2026cs.AI

Four Ledgers, Not One Score: Responsible Communication of LLM-Judge Calibration in Biomedical ML

Synthetic perturbations appear to offer inexpensive calibration data for LLM evaluators in biomedical ML, where expert review is scarce. Yet a planted mutation key is neither a detector output nor automatically human ground truth. We formalize four distinct ledgers: planted perturbations, independent detector outputs, source-linked human dispositions, and human-added discoveries. We then audit the evaluation design, scoring code, read paths, and current human records of a private synthetic Japanese care-handoff workflow. The factory stored 69 planted error cards across 47 targets. Final review covers 22 targets and contains 22 confirmed imported proposals, 9 rejected proposals, and 79 human-added cards; only 3 reviewed targets are double annotated. Passing imported plant keys to a generic detector scorer yields 22/(22+9)=0.710 and 22/(22+79)=0.218. A direct audit identity shows that these values are proposal-confirmation yield and submitted-ledger composition, not judge precision and recall, because no independent detector realization was preserved for the audited proposals in the available records. The audit also finds source-name collisions, row shadowing, forced severity, vacuous ratio defaults, and unsupported zero-support field weights. We contribute a provenance-aware claim audit, a storage contract, and a minimum calibration gate for responsibly communicating biomedical ML capability claims. This single-workflow forensic case is an existence proof of a failure mode, not an estimate of its prevalence: existing human work supports an exploratory audit of synthetic proposals, but not LLM-judge operating characteristics, clinical validity, corpus prevalence, or robust inter-annotator agreement.

Sidi Chang, Peiying Zhu

Blossom AI San Francisco, CA, USA

LLM-as-a-Judge LLM Auditing Language Model Calibration Clinical Language Model Evaluation Synthetic Data Evaluation

Sep 14, 2026cs.AI

When Rubrics Fail: Hallucinations Reveal Blind Spots in Medical AI Evaluation

Hallucinations can undermine clinician trust in LLMs, making it important that evaluation methods capture clinically relevant errors. Rubric-based evaluation has become the leading approach for assessing LLMs in medicine, but it is unclear whether rubric scores reflect such errors. We first study this in a controlled setting using MedHallu, finding that more specific rubrics better distinguish correct from hallucinated responses. To test this systematically, we develop a taxonomy of medical hallucination types and a clinician-validated error-injection pipeline that creates matched correct and error-injected responses. Across HealthBench, HealthBench Professional, and LiveMedBench, our clinically relevant hallucinations are missed by rubrics, often leaving scores unchanged. We find that rubrics are most effective when explicitly checking facts, and are less effective for additional or unexpected errors they do not anticipate. A preliminary retrieval-based factuality check recovers some of the rubric-blind errors, suggesting a complementary approach. These findings reveal systematic blind spots in current medical evaluation of LLMs and suggest that rubric scores alone are insufficient to establish clinical reliability, potentially undermining clinician trust and confidence in clinical deployment.

Griffin Farrow, Lily Sijia Li, Jack Johnson +4

University of Oxford

LLM Hallucination Detection Rubric-Based Evaluation Clinical Language Model Evaluation

Sep 14, 2026cs.AI

MedRoundsQA: A Persona and Difficulty Aware Evaluation for Multi-Turn Medical Consultations

Medical benchmarks are dominated by single-turn, multiple-choice clinical cases that poorly reflect real consultations. Practically, clinicians elicit evidence interactively and patient communication varies widely. We introduce MedRoundsQA, a multi-turn diagnostic benchmark derived from 1,387 board-exam cases across 17 specialties. Each case is converted into a structured 24-slot clinical record, and then instantiated as controlled doctor-patient dual-agent dialogues under varying patient personas, with the underlying clinical content held fixed. We further classify cases by difficulty using model-based uncertainty to enable easy-to-hard analysis. Evaluations of fifteen LLM doctor agents show that (i) moving from a single-turn diagnosis on the standardized records to multi-turn consultations causes large degradations of roughly 13-39 points; (ii) more turns reliably improves question relevance, but diagnostic accuracy exhibits diminishing returns and typically plateaus after 6-12 turns; and (iii) patient persona differences can shift diagnosis accuracy by about 7-8 points (lowest to highest education), highlighting equity risks that single-turn benchmarks miss.

Youssef Mohamed, Ahmed Heakl, Qinrong Cui +13

MBZUAI · Cairo University · Ain Shams University +2

Medical Diagnosis Multi-Turn Dialogue Evaluation Clinical Language Model Evaluation

Sep 13, 2026cs.CL

A primer on evaluation methods for large language models in healthcare

Large language models (LLMs) have a growing range of applications in medicine, and their evaluation is critical for ensuring they provide benefit and not harm. This evaluation can be more challenging than traditional machine learning for many reasons, including probabilistic and open-ended outputs, and behavior that shifts with prompt design and accumulated context. This review covers four key areas of LLM evaluation: principles of study design, statistical methods, capability evaluation and clinical context evaluation. Capability evaluation considers different benchmarks, including multiple-choice, agentic and multi-turn benchmarks, alongside operational metrics like token usage. Clinical context evaluation addresses establishing accuracy of free text outputs, such as human review and LLM-as-a-judge, and clinical trial approaches. Across sections, we describe underlying concepts and potential pitfalls, while emphasizing the importance of aligning evaluation methods with the research question. Together, this article aims to provide a pragmatic basis for designing and executing rigorous evaluations of healthcare LLMs.

Suzannah E McKinney, Phuc Vu, Samuel A Justice +7

Mass General Brigham AI, Mass General Brigham, Boston, MA, USA · Generative AI Laboratory, School of Informatics, University of Edinburgh, Edinburgh, UK · University of Edinburgh Centre for Cardiovascular Science, Edinburgh, UK +5

LLM Evaluation Clinical Language Model Evaluation Medical LLMs

Sep 12, 2026cs.AI

Towards a Deterministic Math Solver for Clinical Language Models

Large language models are unreliable at arithmetic, which is a problem for clinical calculators where a single numerical error changes the recommendation. The standard response is to hardcode each calculator as a validated function, one at a time. We test an alternative: the model does not calculate. Instead, it writes case-specific Python that a restricted local executor runs as a deterministic solver, and the model's task reduces to deciding how to use it. We evaluate this Program-Solve interface on MedCalc-Bench Verified (1,100 cases, 55 calculators) against direct model arithmetic and a hand-written 22-calculator library, using Qwen2.5-7B and Qwen2.5-32B-AWQ, after auditing the benchmark's formulas against current clinical guidelines and flagging 16 of 55 with version, use or coefficient concerns. With formulas and gold variables supplied and both routes reading the whole note, handing off to the solver is not a reliable advantage at 7B (75.31% against 72.02%, a paired +3.29 points with a 95% calculator-cluster interval of [-3.49, 10.38]) but is one at 32B (90.53% against 83.47%, +7.05 [0.47, 14.60], clear of zero). The hand-written library is exact on its 440 supported cases but abstains elsewhere (40.0% overall). Adding an executor thus helps some open-weight models more than others even under matched formula, variable and note access, and is not a substitute for verified formulas or reliable variable extraction either way.

Felipe Ocampo Osorio, Sebastián Andrés Cajas Ordoñez, Maximin Lange +5

MIT Critical Data · UNC Chapel-Hil · University of Pavia +1

Numerical Reasoning in Language Models LLM Reliability LLM Tool Use Clinical Language Model Evaluation LLM Code Generation

Sep 12, 2026cs.AI

Can LLMs Follow Medical Expert Logic? A Benchmark for Hierarchical Logical Consistency in Risk-of-Bias Assessment

Evidence-based medicine demands strict logical consistency, yet current evaluations of large language models (LLMs) prioritize superficial label matching over genuine reasoning. We introduce LogiMed-RoB, a benchmark grounded in Cochrane Risk of Bias (RoB) 2.0 expert logic, comprising 860 randomized controlled trials (RCTs) and 14,820 queries. It evaluates models under the Hierarchical Logical Consistency (HLC) framework across four dimensions: Atomic Consistency, Domain Consistency, Aggregation Consistency, and Evidential Faithfulness. Experiments on 10 state-of-the-art LLMs reveal a catastrophic Error Compounding Effect: despite the top model reaching 98.88% Atomic Consistency, its end-to-end consistency collapses to 45.13%, with several open-weight architectures plummeting to nearly 0%. We further uncover a systematic evidence-reasoning gap: even when models retrieve high-quality evidence, they fail to deduce correct outcomes in 18.63-40.05% of cases, while Blind Guess Rates reach 48.28%. LogiMed-RoB demonstrates that high outcome accuracy can conceal critical reasoning flaws, underscoring the necessity of white-box logical verification for clinical deployment.

Jiayu Huang, Zichen Tang, Qianhui Ling +2

Beijing University of Posts and Telecommunications · Hypertension Center, Beijing Anzhen Hospital, Capital Medical University

Reasoning Consistency in Language Models Clinical Language Model Evaluation LLM Reasoning

Sep 11, 2026cs.AI

Scaling Clinical Judgment to Evaluate Medical AI

Blinded physician evaluation has been considered by many to be the gold standard for assessing clinical reasoning in large language models (LLMs). This is difficult to scale; thus, prior studies typically rely on small physician panels, often from a single institution or specialty, which both limits the scientific questions investigated and makes it unclear whether findings would be reproduced with a different set of evaluators. To more rigorously and scalably study clinical reasoning in AI models, here we introduce PrecepTron, an LLM fine-tuned for physician-level evaluation of open-ended responses. PrecepTron was trained using low-rank adaptation (LoRA) of a 32-billion-parameter model on a small number of physician examples. We also release GRAND-ROUNDS, a new large-scale physician-annotated benchmark of 9,217 scored responses from 160 clinicians across seven studies. We show that frontier LLMs in typical "LLM-as-a-judge" approaches often disagree with physicians and with each other, but fine-tuning PrecepTron on a small number of cases enables physician-level consistent scoring across tasks. We use PrecepTron to reproduce headline findings from five influential studies assessing LLMs for clinical care in JAMA, Science, and Nature Medicine without new human grading. Using PrecepTron, we then pose new questions about how LLMs reason in medicine that would have been infeasible with human grading alone, including measuring the diagnostic accuracy of frontier LLMs when clinical cases are provided piecemeal, even token by token. Together, PrecepTron and GRAND-ROUNDS provide a foundation for reproducible, large-scale study of how LLMs reason in medicine. All code, data, and labels are made freely available for researchers.

Thomas A. Buckley, Zahir Kanjee, Peter G. Brodeur +15

Department of Biomedical Informatics, Harvard Medical School, Boston, MA · Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA · Stanford Division of Hospital Medicine, Stanford University, Stanford, CA +11

LLM-as-a-Judge LLM Fine-Tuning Clinical Reasoning Clinical Language Model Evaluation Medical LLMs

Sep 11, 2026cs.CL

The widening evaluation gap in medical large language model research 2023 to 2026

Large language models are superseded every few quarters; clinical evidence takes years. We asked whether medical research is keeping pace with the systems it evaluates. PubMed returned 11,628 records for January 2023 to June 2026 across fourteen clinical domains, growing 45-fold; 2.5% used a randomised, controlled or prospective design. Evaluation lag, from a study's newest named model release to its own publication, widened from 1.33 to 6.08 quarters. Because discontinued models age mechanically, we benchmarked this against a counterfactual holding model composition fixed: migration to newer systems offset only 56% of the drift (95% CI 50-65). Randomised trials evaluated models a median 4.6 quarters older than other designs (P = 3 x 10^-19), yet among studies naming a model still under development no design differed from any other; 62% of randomised trials evaluated a discontinued family. Rigour and currency are in tension, and that tension reflects model selection rather than research timelines.

Raad Bin Tareaf, Murad Al-Rajab, Samia Loucif

XU Exponential University of Applied Sciences, Data Science and Artificial Intelligence Cluster, Marlene-Dietrich-Allee 12B, 14482 Potsdam, Germany · College of Engineering, Abu Dhabi University, Abu Dhabi, United Arab Emirates · College of Technological Innovation, Zayed University, Abu Dhabi, United Arab Emirates

LLM Evaluation Clinical Language Model Evaluation Medical LLMs

Sep 9, 2026cs.CY

Emergency Department Revisit Quality Review Screening: Exploring Human Decision-Making and Artificial Intelligence Support

Background: Emergency Department (ED) return visits are commonly reviewed for quality assurance, but are often limited (e.g., to revisits within 48-72 hours) to increase actionable finding yield while minimizing chart review burden. Those limitations may lead to missed quality improvement opportunities. Methods: We conducted an exploratory, retrospective study of randomly selected ED visits to a multihospital health system having an ED revisit within 1-14 days to the same health system. Given only each visit's primary diagnosis, raters (2-3 clinicians and GPT-4 large language model [LLM]) assessed characteristics of the diagnosis pairs, including the "target": whether a pair warranted further assessment. Informed by rater response analyses, an algorithm leveraging an LLM-populated knowledge graph ("KGA") was created to automatically screen for potentially concerning pairs, then preliminarily assessed. Results: 99 diagnosis pairs were included. GPT-4 responses poorly correlated to clinician raters, rating nearly all (94%) pairs as warranting follow-up (4.4-13.3 times more than clinicians). However, prompt engineering was minimal. Among clinician raters, revisit medical gravity was consistently significantly associated with the target, while a differential diagnosis/complication composite was significantly associated on unadjusted, but not adjusted (though less powered) analysis. The KGA achieved 83-100% positive predictive value for at least one clinician rater determining further assessment was warranted based on the diagnosis pair. Conclusion: These results can inform next steps for improving screening with LLMs like ChatGPT. Further research is warranted to validate this preliminary work's finding that the KGA may enable enhancing the scope and yield of screening without substantially increasing reviewer workload.

Jonathan A. Handler, Marlene I. Robles-Granda, Jacob E. Mefford +5

Clinical Intelligence and Advanced Data Lab, OSF HealthCare, Peoria, IL · Digital Innovation Development, OSF HealthCare, Peoria, IL · OnCall, OSF HealthCare, Peoria, IL +7

Clinical Decision Support Clinical Decision-Making Human-AI Decision Making Clinical Language Model Evaluation Knowledge Graphs Clinical Risk Prediction

Sep 8, 2026cs.CL

Performance of Clinical AI System and Physicians and Frontier Language Models in primary care diagnostics

Clinical AI evaluation should encompass diagnosis and management after adaptive information gathering. We compared Doctorina, eight physicians and four standalone frontier language models in 150 synthetic Polish-language primary-care consultations. Doctorina achieved 82.0% Top-1 concordance versus 57.0% for physicians (difference, 25.0 percentage points; 95% confidence interval, 17.7-32.7) and 97.3% versus 85.0% primary-or-reference-differential concordance. Across 149 case pairs, normalized workup and treatment scores were 89.4 versus 66.9 and 83.7 versus 61.2. Doctorina had the highest diagnostic point estimates among all six groups; Kimi K3 ranked next, while Claude Opus 5 led the closely spaced management estimates of Opus, Doctorina and Kimi. A second Doctorina execution reproduced the advantages over physicians across all outcomes. Doctorina's advantage over physicians therefore extended from primary-diagnosis selection to higher-rated diagnostic workup and initial treatment after adaptive consultation.

Andy Nkansah, Hanna Plotnitskaya, Stanislau Salavei +6

1A.I. Doctor Medical Assist LTD, Limassol, Cyprus. · 2Family Medicine Specialist, Kraków, Poland.

Healthcare Medical Diagnosis Clinical Decision-Making Clinical Reasoning Clinical Language Model Evaluation

Sep 3, 2026cs.AI

LLM4CKD: Large Language Models for Early Stage Chronic Kidney Disease Screening

Early screening of chronic kidney disease (CKD) is critical for timely intervention, yet most machine learning (ML) and deep learning (DL) approaches require labeled data and model training, limiting their use in real-world screening settings. This study evaluates the effectiveness of large language models (LLMs) for CKD screening under zero-shot and few-shot in-context learning settings and compares them with traditional ML and DL methods. We propose a framework that uses clinically selected tabular features and structured prompt templates to enable LLM-based inference without task-specific training. LLM performance is evaluated across multiple prompt styles, feature configurations, and data settings, and compared with standard ML, DL, and tabular foundation model (TFM) baselines, and existing CKD screening tools. The results show that LLMs can achieve competitive performance using only a small number of examples, often matching or outperforming traditional approaches in low-data settings. However, their performance remains model-dependent and less stable as input complexity increases. In contrast, ML, DL, and TFM models show more consistent improvement with larger training data. Overall, the findings highlight a trade-off between data efficiency and stability, suggesting that LLMs may serve as a flexible complementary approach for CKD screening when labeled data are limited.

Muhammad Ashad Kabir, Sirajam Munira

School of Computing, Mathematics and Engineering Charles Sturt University NSW, Australia · Department of Computer Science Rensselaer Polytechnic Institute NY, USA

Medical Diagnosis In-Context Learning Clinical Language Model Evaluation Medical LLMs

Sep 2, 2026cs.CL

Counterfactual Fairness Audits of Multi-Step Clinical LLM Agents Require a Measured Per-Action Instability Floor

Counterfactual audits are the standard tool for checking whether a clinical agent treats demographically distinct but clinically identical patients differently. They report a flip rate: how often an action changes when only the patient descriptor changes. We show that this quantity is uninterpretable on its own. Re-running an identical condition ten times over sixteen vignettes (same narrative, same descriptor string, nothing varied) moved a clinical agent's action in 8.7% of outcome-vignette cells, and instability was heterogeneous across actions by a factor of eight, from 0.022 for ICU escalation to 0.179 for controlled-substance caution. No demographic contrast in our data was distinguishable from that floor. A second model gives a pooled floor of 6.7% and ranks the six actions almost identically (Spearman 0.94, exact p=0.017), so the floor is not one system's artefact. Majority-vote aggregation over five draws removes 39% of it and then flattens, and a null simulation attributes the residue to heterogeneous per-cell rates, so replication mitigates without eliminating. Any counterfactual fairness estimate reported without a per-action floor beside it therefore cannot be read as evidence of disparity. The measurements were taken with FairMedAgent, an evaluation harness for disparity in the actions of clinical LLM agents whose estimand, the within-range counterfactual flip rate, counts only flips between actions a published decision rule admits and a clinician has adjudicated. That estimand requires band adjudication, which is under way; no disparity result is claimed here. Each synthetic vignette runs a six-stage trajectory (five model-facing decisions around a deterministic environment step) under fixed-form conditions spanning race, sex, age, insurance, English proficiency, and their intersections. The harness, the floor protocol, and every analysis script are released.

Rohith Reddy Bellibaltu, Manpreet Singh, Deepak Parashar +1

Florida International University · Boston University, Boston, MA 02215 USA · Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India +1

Counterfactual Evaluation Algorithmic Fairness Counterfactual Fairness Clinical Language Model Evaluation LLM Agent Reliability

Sep 1, 2026cs.CL

Investigating Linear Probe Robustness to Linguistic Register, Medical Specialty, and Corpus Shifts in Medical QA

Linear classifiers trained on hidden states of a large language model (LLM), linear probes, can flag factual errors from a single forward pass. Geometrically, that implies that true and false statements separate along a stable direction in hidden state space, i.e., the truth direction. Prior work disagrees on whether this generalises across input shifts, but the disagreement is hard to interpret because cross-dataset probe transfer experiments confound several kinds of input change at once. We isolate three such variables in medical question-answering (QA): writing style (register), domain (medical specialty), and corpus (dataset). We build a benchmark using 500 MedQA entries, each rewritten into four styles (textbook, patient, clinical note, colloquial), annotated with clinical specialty, and grouped with two other exam corpora, MedMCQA and MMLU-medical, for cross-dataset evaluation. Probing four open-weight LLMs (2--8B), we find that the truth direction is largely robust to writing style (mean

Δ_\text{register} \approx 0.10

AUROC on held-out facts) and to medical specialty (

Δ_\text{specialty} \approx 0.03

), but degrades unevenly across corpora: by

0.12

AUROC on MMLU-medical and by

0.21

on MedMCQA, roughly twice the register gap. The register result replicates with a second generator and carries over to human-written patient questions. The truth direction is therefore largely stable within the medical domain but breaks under some corpus shifts, and question format does not explain the break, which suggests that the signal a linear probe recovers is partly bound to dataset structure rather than to medical knowledge alone.

Nishant Mishra, Ameen Abu-Hanna, Iacer Calixto

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

Clinical Language Model Evaluation Language Model Robustness Language Model Probing

Sep 1, 2026cs.CL

ClinTraceBench: Source-Verifiable Longitudinal Clinical Reasoning over EHR-Derived Dialogues

Clinical LLM assistants must reason over multi-visit patient trajectories, yet whether the compact history representations used to scale them---retrieval, structured timelines, LLM summaries, agentic memory---preserve the longitudinal signal clinical reasoning needs has not been measured. We introduce ClinTraceBench: 385 MIMIC-IV-derived verified dialogues with event-ID provenance, a nine-task taxonomy (T1--T9), and L0--L4 deterministic + L5 human-audit validation (98.92% agreement). We evaluate eight history representation strategies---a no-context floor, \textit{last-visit-only}, \textit{full-context}, BGE-M3 \textit{dense-retrieval}, two compression schemes, and two agentic-memory systems (\textit{Mem0}, \textit{A-Mem})---across four backbones (DeepSeek-V3, GPT-4o-mini, Haiku~~4.5, Sonnet~~4.6) on 6{,}271 questions: 32 cells, 200{,}672 predictions. Four findings: (SP4) a controlled T3 injection probe isolates compression-induced \textit{relation} loss---with the attribution sentence present \textit{before} construction, \textit{Mem0}, \textit{A-Mem} and \textit{llm-summary} still recover only 0--5.3% of the injected positives; (SP1) compressed strategies pay an aggregation tax on multi-visit trends and cross-patient comparisons; (SP2) the blind-to-full gap spans

+29.8

~pp (GPT-4o-mini) to

+62.7

~pp (Haiku); (SP3) abstention scales non-monotonically with context length. On the Pareto frontier Haiku dominates Sonnet under \textit{full-context} ($25.76 vs.\ $106.21), inverting the ``biggest backbone wins'' heuristic.

Huimin Wang, Zhengyi Zhao, Yutian Zhao

Shenzhen University · The Chinese University of Hong Kong · Dealism

Clinical QA Clinical Reasoning Clinical Language Model Evaluation LLM Context Management

Aug 31, 2026cs.CL

Toward Workflow-Aware Benchmarking for Healthcare NLP Agents

Large language model (LLM) agents are increasingly proposed for healthcare tasks such as clinical documentation, evidence retrieval, patient messaging, and care coordination. Yet many evaluations remain limited to static medical question answering or one-shot generation, under-representing longitudinal state, interruptions, and human handoffs. We introduce an episode-level evaluation protocol for healthcare NLP agents. The protocol separates evidence across model, agent, and simulated-workflow behavior; specifies a five-field episode schema; and defines annotation and scoring for state continuity, evidence traceability, and escalation decisions. It is instantiated as four task templates: documentation update, evidence retrieval, patient messaging, and triage handoff. The protocol does not claim to measure clinical outcomes or deployment value. Instead, it supplies a reproducible intermediate evaluation layer between static benchmarks and prospective workflow studies, with an explicit cost-sensitive treatment of missed versus unnecessary escalation.

Junyi Yao, Baichuan Li, Zihao Zheng +1

Washington University in St. Louis, USA · Southern Methodist University, USA

Benchmark Design LLM Agent Evaluation AI Agent Benchmarks Clinical Language Model Evaluation

Aug 31, 2026cs.CL

One note in three: a verified census of three deployed AI scribes, and the instrument that counted it

Ambient AI scribes draft clinical notes under the reassurance that a clinician signs every note. We audited three commercial AI scribes on the same 142 consultations: 565 notes from recorded UK primary-care and US ambulatory encounters plus authored scenarios. Twelve discovery passes proposed 13,678 candidate errors; the 5,898 clearing an importance filter went to an adversarial panel of two models from different families, each told to refute what it could, and 618 survived. One note in three (31.3% [27.0, 35.6]) carries a verified failure, concentrated in allergy and medication information, invented patient identity, and history written up as examination on telephone consultations that can contain none. No product was given a patient record; setting aside the two classes a record would have prefilled, invented identity and dates, the rate is 24.8% [20.8, 29.0]. One failure mode did not fit our scheme, drawn from published scribe-error taxonomies: a treatment the clinician retracts, recorded as delivered care. Two clinicians adjudicated blind, disjoint samples: a physician author upheld 20 of 21 findings (95.2% [77.3, 99.2]) and an independent clinician, not an author, 12 of 12 ([75.8, 100]); both judged every sampled refusal genuine. A failure rate depends on the instrument as much as the scribes. With model, evidence and settings fixed, the review instruction alone moves the share of candidates verified from 9.3% to 79.0%, and the reviewing family moves it too: alone at that instruction the gentler flags 54.8% of notes against 27.8%. Between 28% and 97% of sampled notes carry a failure depending on the standard. Published audits disagree among themselves by a margin instrument differences alone can produce: omission is 54-86% of their errors against our 23.1%. We release all 618 findings with transcript-side evidence, every prompt and model version, and the re-runnable pipeline.

Sebastian Fox, Luke Markham, Ryan Lail +1

Composo

Medical Report Generation Clinical Language Model Evaluation Language Model Auditing

Aug 31, 2026cs.CL

LLM Judges Verify Presence, Not Absence: Omission Blindness in AI Clinical Notes and What Recovers It

Ambient AI scribes draft clinical notes, and published audits find their dominant error is omission: information the encounter established that the note fails to record. The standard check is an LLM judge: a second model reads the note against the transcript and flags problems. We ask whether judges detect omissions. Public corpora cannot supply the answer key: their clinician reference notes and transcripts are materially discrepant. Our benchmark has 500 single-error note pairs from audited fact sheets, 298 with a named fact certainly absent and 202 added-or-altered controls. Across eight judge designs, paired discrimination (the flawed note below its clean twin, 0.5 a coin flip) reads 0.79-0.94 on added or altered content and 0.50-0.63 on omissions. On single notes, no design flags omissions reliably more often than perfect notes. Wording changes, voting and GEPA prompt optimisation move the operating point without creating usable detection. Restructuring the task recovers it: list the facts the transcript establishes, then check the note for each. Two methods reach it independently and trade off: a per-fact pipeline, and a GEPA-evolved prompt doing the same in one call. The pipeline's flags name the missing fact and its severity at 2.7% false alarms. The single call detects more (36.9% against 24.6%, p=0.002) at 6.2% false alarms and a tenth of the cost per note. A physician author validated 70 items and, where the two routes disagree, sided with the pipeline on 10 of 10 (p=0.002). A second clinician, not an author, graded the severity rubric blind and agrees to within a grade. On real vendor notes from a companion census no benchmark threshold transfers, but the re-calibrated single call detects more than the best of the eight at half its false-alarm rate. Omissions whose fact is restated elsewhere defeat both routes. We release the benchmark, prompts and judgements.

Sebastian Fox, Luke Markham, Ryan Lail +1

Composo

LLM-as-a-Judge Clinical Language Model Evaluation

Aug 31, 2026cs.CL

ECGQuest: Benchmarking and Fine-Tuning Language Models for Electrocardiography

Electrocardiogram (ECG) interpretation requires knowledge of cardiology, electrophysiology, clinical diagnosis, ECG waveforms, signal acquisition, and instrumentation. Existing language-model benchmarks, however, primarily assess broad medical knowledge or interpretation of individual ECG signals and images rather than the broader contextual knowledge required for ECG interpretation. We developed ECGQuest, a literature-grounded resource for evaluating and fine-tuning ECG-specific language models. A GPT-4o-based pipeline generated questions from 23 ECG references and Computing in Cardiology proceedings from 2003-2025. The final dataset contains 10,904 unique True/False questions paired with their negated forms (21,808 Q&A pairs). We evaluated three commercial and 20 open-source language models on a held-out test set in a zero-shot setting. Five open-source models with 7-14B parameters were fine-tuned using Low-Rank Adaptation, with BERT and BiomedBERT included as supervised encoder baselines. Generalization was assessed on ECG-related subsets of MedMCQA and MedQA converted to binary True/False questions using official answer keys. Zero-shot accuracy on ECGQuest ranged from 49.5% to 74.4%, with GPT-5 performing best. General-purpose models outperformed medically specialized models, several models showed strong True/False bias, and encoder baselines performed near chance. Fine-tuning improved all open-source models by 6.5-14.1%. Fine-tuned DeepSeek-R1-Distill-Qwen-14B reached 76.3% accuracy, while a five-model voting ensemble reached 78.5%. On MedMCQA and MedQA, fine-tuning mainly benefited weaker or class-biased models and did not consistently improve strong base models. ECGQuest provides a reproducible benchmark for contextual ECG knowledge and shows that parameter-efficient fine-tuning can make smaller language models competitive with substantially larger commercial models.

Mohammadsina Hassannia, Matthew A. Reyna, Reza Sameni

Department of Biomedical Informatics Emory University Atlanta, GA 30322, USA · Department of Biomedical Engineering Georgia Institute of Technology and Department of Biomedical Informatics Emory University Atlanta, GA 30332, USA

Electrocardiography LLM Fine-Tuning Medical QA Clinical Language Model Evaluation

Aug 31, 2026cs.CL

GPAgentBench-2K: Benchmarking Large Language Model Agents in Complex Clinical Action Space

Large Language Models (LLMs) show great potential as clinical agents, yet existing benchmarks reduce clinical workflows to static predictions or unconstrained Markov Decision Processes (MDPs) with coarse action sets. To address this, we introduce GPAgentBench-2K, the first Constrained MDP (CMDP) LLM-agent benchmark for primary-care clinical decision-making, constructed from expert-validated records of real-world GP encounters. Our environment models a full spectrum of six foundational clinical actions, imposes a topological workflow prior over the action space, and operationalizes safety-informed abstention as a first-class outcome. Evaluating 16 state-of-the-art LLMs reveals a significant performance degradation as the action space scales. Crucially, we uncover a clinical quality-safety gap: even frontier models with the highest diagnosis accuracy violate safety constraints in over half of high-risk cases. Finally, we establish a reference point using Constrained Group Relative Policy Optimization (C-GRPO), and show that while explicitly modeling constraints improves performance over unconstrained RL methods, it remains far from clinically acceptable safety.

Boqi Chen, Xudong Liu, Yunke Ao +2

ETH Zurich · MBZUAI · University of Toronto

Healthcare Constrained RL AI Agent Safety Benchmarks Clinical Language Model Evaluation Agent Benchmarks

Aug 30, 2026cs.LG

Error Detection for PET/CT Radiology Reports: Domain-Specific vs Large Language Models

Errors in radiology reports can adversely affect patient treatment, yet automated report quality assurance remains challenging because errors are often subtle and require domain expertise to detect. Although large language models (LLMs) have recently been proposed for radiology report verification, their ability to detect clinically meaningful errors beyond chest X-ray datasets remains under-explored. To this end, we present the first systematic evaluation of language models for PET/CT report error detection, comparing compact domain-specific models with SOTA open-weight LLMs. We collected 30,633 oncology FDG PET/CT reports from 23 radiologists over 10 years. We trained domain-specific BERT models to detect clinically motivated synthetic reporting errors and evaluated alongside zero-/few-shot Qwen3-32B, Gemma-3-27B and Llama-3.3-70B on a held-out benchmark of 11,500 reports. A 15M-parameter model achieved 94.4% balanced accuracy with a 5.8% false-positive rate, compared with 84.0% for the strongest prompted LLM. Task-specific adaptation of Llama-3.3-70B closed this performance gap (94.4%) but retained substantially greater computational requirements. Our results suggest that domain-specific training matters more than model scale for PET/CT report error detection, supporting compact models as an accurate and computationally efficient approach to automated radiology report quality assurance.

Hermione Warr, Harry Anthony, Lilli J Freischem +3

Department of Engineering Science, University of Oxford, UK · Department of Physics, University of Oxford, UK · Department of Oncology, University of Oxford, UK +1

LLM Evaluation PET/CT Imaging Clinical Language Model Evaluation Radiology Report Evaluation

Aug 13, 2026cs.IR

Do AI chatbots find what experts would? Effects of model, user role, and sample size on study retrieval for medical questions

Large language model (LLM) chatbots are increasingly used to answer clinical questions with citations to relevant studies, yet the quality of retrieved evidence and factors influencing study selection remain unclear. We evaluated three general-purpose LLM chatbots (Claude Sonnet 5, Gemini 3.1 Pro, and ChatGPT GPT-5.5) using 20 clinical questions adapted from 2026 Cochrane reviews. We simulated patient, clinician, and evidence-synthesis researcher roles and obtained four independent responses for each chatbot-role-question combination, yielding 720 responses (3 chatbots

\times

3 user roles

\times

4 repetitions

\times

20 review questions). Chatbots were asked to support their answers with primary clinical citations, which were benchmarked against the included and excluded study sets of the corresponding Cochrane reviews. On average, a single response retrieved 39.2%

\pm

29.8% of the corresponding Cochrane included-study set and 5.0%

\pm

9.4% of the excluded-study set. Recall of included studies varied significantly by model and user role. ChatGPT achieved higher recall than Claude or Gemini (63.1%

\pm

29.5% vs. 37.0%

\pm

23.8% vs. 17.3%

\pm

13.1%; blocked permutation test,

p=2.0\times10^{-5}

), and the researcher role yielded higher recall than the clinician or patient roles (42.8%

\pm

30.8% vs. 38.6%

\pm

28.9% vs. 36.1%

\pm

29.3%;

p=2.0\times10^{-5}

). Controlling for publication year, citations per year, and open-access status, sample size was the only significant predictor of retrieval: each doubling of sample size was associated with 50% higher odds of retrieval (odds ratio 1.50, 95% CI 1.24-1.81). These findings show that LLM chatbots can retrieve studies identified by expert reviewers, but retrieval varies substantially across models and user roles and favors larger clinical trials.

Qingfang Liu, Qiao Jin, Joe D. Menke +2

National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, MD, USA · National Library of Medicine, National Institutes of Health, Bethesda, MD, USA · School of Information Sciences, University of Illinois Urbana-Champaign, Champaign, IL, USA

Clinical QA Information Retrieval Biomedical IR Clinical Language Model Evaluation Evidence Retrieval

Aug 12, 2026cs.CL

A corpus-specific clinical RAG system matches or outperforms newer frontier LLMs on HealthBench

General-purpose large language models (LLMs) have recently been reported to match or exceed specialized clinical AI tools on medical benchmarks, but such comparisons draw on a narrow set of systems and on benchmarks developed largely in high-income settings. We evaluate VITA, a retrieval-augmented generation (RAG) system purpose-built for contextual knowledge retrieval in India and other low- and middle-income (LMIC) settings. VITA retrieves from a curated corpus of disease-specific guidelines, India-specific antimicrobial resistance data, national formulary constraints, and resource-limited care protocols; its architecture and corpus are proprietary, but the benchmark, the physician-written rubrics, and our full response and scoring outputs are public for independent verification. On 4,023 English-language HealthBench questions (80.5% of the benchmark), scored with a GPT-4.1 judge, VITA ranked first with 51.9% of possible rubric points, ahead of GPT-5.4 (46.1%), o4-mini (44.3%), Gemini 3.1 Pro (42.6%), and Claude Sonnet 4.6 (37.3%), and scored highest on 45.4% of questions. To test robustness to newer models and judge lineage, a 500-question subset was re-run against current-generation models (GPT-5.5, Claude Opus 4.8, Gemini 3.5 Pro, Grok 4.3) and graded by a neutral open-weight judge (DeepSeek-V4-Pro) sharing no lineage with any system tested. Here the gap narrowed to parity: VITA and GPT-5.5 were statistically indistinguishable on mean per-question score, while VITA led on points-weighted score and won the most questions. VITA's advantages in accuracy and completeness persisted under the neutral judge; its communication scores were lower. These results indicate that a purpose-built clinical RAG system remains competitive with frontier LLMs on an open benchmark, consistent with corpus specificity as a design variable that improves grounding at some cost to communication polish.

Praveen Reddy, Charuta Mandke, Suvrankar Datta +4

Retrieval-Augmented Generation LLM Grounding RAG Evaluation Clinical Language Model Evaluation Medical LLMs

Aug 12, 2026cs.CY

Quantifying the Relationship Between Clinical Safety and Environmental Impact in Therapeutic LLMs

The deployment of large language models (LLMs) in mental health contexts raises questions about the relationship between clinical safety and environmental cost. In this paper, we examine this relationship by combining K-Bench clinical safety scores with EcoLogits life-cycle assessment estimates across 47 supported model configurations. We evaluate model performance and environmental impact across four dimensions: energy use, carbon emissions, water consumption, and abiotic depletion. The results indicate a non-linear trade-off at the upper end of the safety distribution: a 2.61 percentage-point increase in clinical safety score corresponded to an approximately 60-fold increase in estimated energy use per million output tokens. Row-level analyses further suggest that additional test-time compute did not consistently improve clinical safety and, in some configurations, was associated with lower clinical safety scores. These findings suggest that relying solely on larger models or additional inference-time computation may be an inefficient strategy for improving safety in therapeutic AI systems. We discuss the implications for sustainable deployment and highlight dynamic model selection, including model cascading, as a potential approach for reducing environmental impact while preserving clinical performance in higher-risk cases.

Alireza A. Safaei, Laura M. Vowels, Matthew J. Vowels +2

University of Isfahan Isfahan, Iran · University of Roehampton London, UK · Kivira Health New York City, New York, U.S.A.

Energy-Efficient ML LLM Safety Evaluation Clinical Language Model Evaluation

Aug 10, 2026cs.CL

Locally Deployable Small Language Models for Emergency Department Decision Support: A Systematic Benchmark of Fine-Tuning Strategies

Deploying large language models (LLMs) for decision support in emergency departments (EDs) faces two major challenges: privacy risks of transmitting patient data to closed-source commercial LLMs and the lack of systematic evaluation of fine-tuning strategies for locally deployable open-source small language models (SLMs). We benchmarked eight open-source SLMs using zero-shot prompting, prefix tuning, Low-Rank Adaptation (LoRA), and full fine-tuning on three ED tasks: triage level prediction, specialist referral recommendation, and diagnosis prediction. Using 2,083 MIMIC-IV-ED cases and Claude Haiku 4.5 and Claude Sonnet 4.5 as baselines, we found that LoRA fine-tuned open-source SLMs outperform commercial baselines on triage level prediction and specialist referral recommendation, while diagnosis prediction remains challenging for open-source SLMs. Confusion matrix analysis further shows that fine-tuned open-source SLMs can detect highest-severity patients missed by the commercial baselines. These results demonstrate that locally deployable SLMs can achieve clinically competitive performance for ED decision support.

Qingfeng Zhang, Yuanxiong Guo, Yanmin Gong

The University of Texas at San Antonio, San Antonio, TX · Texas A&M University, Houston, TX

LLM Fine-Tuning Clinical Decision Support Small Language Models Clinical Language Model Evaluation Medical LLMs

Aug 10, 2026cs.CL

TAF-MED: Multi-Turn Safety Refusal Collapse in LLMs Under Declared Self-Treatment Intent

Large language models (LLMs) increasingly provide conversational health information that may influence treatment decisions, yet existing benchmarks do not isolate whether medication-safety boundaries persist across follow-ups after explicit self-treatment intent. We introduce TAF-MED, a physician-reviewed benchmark of 500 fixed three-turn scenarios, and evaluate eight LLMs across 4,000 conversations. A rubric-based automated judge labelled responses as SAFE, LEAKY, or UNSAFE, and two physicians independently annotated a model-balanced random subset of 400 conversations. We assessed unsafe guidance, collapse after a strictly SAFE initial response, and model-ranking stability. Overall, 71.6% of conversations contained an UNSAFE response, and 61.4% of those beginning with a strictly SAFE response later collapsed to UNSAFE; model-level collapse rates ranged from 24.4% to 96.2%. Four of 28 model pairs reversed order between initial unsafe and collapse rates. Automated labels achieved 94.3% agreement with the adjudicated physician reference (

κ= 0.895

). These findings show that first-turn safety is an incomplete proxy for conversational safety persistence and motivate evaluation across complete dialogue trajectories. We will release TAF-MED on Hugging Face to support reproducible research on multi-turn medical safety.

Waleed Jamil, Raphael Schmitt

1Independent Researcher, Edinburgh, United Kingdom · School of Computation, Information and Technology, Technical University of Munich, Germany · Institute of General Practice, Faculty of Medicine and Medical Center, University of Freiburg, Germany

LLM Safety Benchmarks LLM Safety Evaluation Clinical Language Model Evaluation Refusal Behavior in Language Models Medical LLMs

Aug 10, 2026cs.CL

An Agentic Generative Large Language Model for Treatment Planning of Colorectal Cancer

Treatment planning in precision oncology requires synthesizing heterogeneous patient information with rapidly evolving clinical guidelines to ensure guideline-concordant care. While large language models (LLMs) show promise in many diagnostic tasks, their adoption for high-stakes treatment planning is hindered by complex reasoning, adherence to timely clinical guidelines, and safety concerns. In this study, we present GatorOnco, an agentic LLM for colorectal cancer (CRC) treatment planning. GatorOnco is developed using a total of 282 billion tokens of biomedical text, including healthcare system-scale clinical text comprising 166 billion tokens from UF Health. We implemented a domain-adaptation method that integrates pre-training, model merging, a two-stage post-training approach, and agent-based reinforcement learning. An agentic retrieval-augmented generation (RAG) approach dynamically integrates time-sensitive clinical guidelines into the reasoning process. In a blind, randomized clinical evaluation conducted by five UF Health oncologists, GatorOnco significantly outperformed open-source LLMs (P < 0.01) and achieved expert-level performance comparable to UF Health oncologists. Compared with expert oncologists, GatorOnco received significantly higher ratings for readability (4.46 vs. 4.19, P < 0.01) and completeness (3.91 vs. 3.52, P < 0.01), while showing statistically comparable performance in correctness (4.09 vs. 4.11, P = 0.921), currency (4.04 vs. 3.98, P = 0.478), and safety (4.22 vs. 4.22, P = 0.999). These findings demonstrate that integrating agentic reasoning with large-scale domain adaptation can help bridge the gap for generative AI in high-stakes cancer treatment planning.

Mengxian Lyu, Cheng Peng, Tim Jang +18

Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA. · Division of Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA · University of Florida Health Cancer Institute, Gainesville, FL, USA +8

Clinical Decision-Making Domain Adaptation for LLMs Oncology Clinical Language Model Evaluation Medical LLMs

Aug 10, 2026cs.CL

When Confidence Fails: Overconfidence in LLMs under Uncertainty and Missing Clinical Information

Large Language Models (LLMs) have achieved strong performance in medical question answering and clinical reasoning tasks. However, their reliability under uncertainty remains poorly understood which raises critical concerns for deployment in high-stakes clinical settings. In such environments, incorrect predictions are inherently risky, but confident incorrect predictions can be particularly harmful as they may mislead clinical decision-making. In this paper, we conduct a systematic behavioral analysis of LLMs under clinical information uncertainty. We propose an evaluation framework based on the MedMCQA dataset consisting of two complementary uncertainty settings. First, we introduce linguistic uncertainty cues through prompt modifications to simulate ambiguous clinical contexts. Second, we construct an answer removal setting, wherein the correct option is deliberately excluded mandating the model to recognize insufficient information and abstain. We analyze both model accuracy and confidence behavior using multiple calibration metrics including calibration gap, Expected Calibration Error (ECE), and Unsafe Confident Error Rate (UCER) across 500 medical questions. Our results reveal a consistent failure mode, i.e., although accuracy degrades under increasing uncertainty, model confidence remains misaligned with accuracy. This leads to a substantial increase in unsafe confident errors, indicating that model confidence remains largely insensitive to clinically meaningful information loss. Furthermore, we observe significant variation across models in their ability to abstain when the correct answer is unavailable, with some models persistently producing high confidence hallucinated answers. These findings expose critical limitations in the epistemic reliability of current LLMs and highlight the need for uncertainty aware evaluation methods prior to their deployment in clinical workflows.

Maryam Tahermazandarani, Adnan Mahmood, Fahmida Islam +1

School of Computing, Macquarie University, Sydney, NSW 2109, Australia

Hallucination in Language Models LLM Uncertainty Estimation Clinical Language Model Evaluation Uncertainty Calibration LLM Abstention

Aug 5, 2026cs.CL

RESPClinBench: Benchmarking Multimodal Clinical Decision-Making and Longitudinal Disease Management in Respiratory Specialty Care

Background: Respiratory specialty care requires multimodal interpretation, longitudinal risk assessment, guideline-concordant intervention, and whole-course management, which are poorly represented by examination-oriented medical benchmarks. Objective: To develop RESPClinBench, a real-world scenario-based benchmark for respiratory clinical decision-making, and evaluate seven contemporary large language models across AECOPD-PIM and PNBIM. Methods: RESPClinBench cases were adapted from de-identified respiratory clinical data. Three attending-level respiratory physicians revised cases, reference answers, and atomic clinical-action points, while one senior respiratory specialist performed cross-review and final adjudication. AECOPD-PIM comprised 427 open-ended COPD cases, and PNBIM comprised 196 multimodal pulmonary nodule cases combining chest CT with structured clinical information. Seven models generated 4,361 responses through standardized API inference with temperature 0 and a maximum output length of 8192 tokens. An automated framework calculated the final score as the arithmetic mean of atomic-action recall and rubric-based LLM-as-a-Judge assessment. Results: Across 623 cases, the mean final score was 68.58. Qwen3.6-27B ranked first overall at 71.22, Qwen3.5-397B-A17B led PNBIM at 72.48, and Qwen3.6-27B led AECOPD-PIM at 71.11. Imaging hallucination and serious medical risk occurred in 31.85% and 8.16% of PNBIM responses; medication-safety risk and serious medical risk occurred in 26.93% and 1.44% of AECOPD-PIM responses. Conclusions: RESPClinBench identifies task-specific limitations in multimodal pulmonary nodule assessment and longitudinal COPD management. Combining explicit clinical-action coverage, holistic evaluation, and independent safety flags provides a clinically grounded basis for model selection and prospective validation.

Mouxiao Bian, Zhi Chen, Ruiyao Chen +8

Shanghai Artificial Intelligence Laboratory, Shanhai, China · Macau University of Science and Technology, Macau, China · First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China +1

LLM Safety Benchmarks Healthcare Clinical Decision-Making Clinical Language Model Evaluation Multimodal Model Evaluation