Daily Papers

TokaMind is a multi-modal transformer (MMT) foundation model pre-trained on tokamak plasma diagnostics data from MAST, where it was shown to outperform CNN-based approaches on fusion benchmarks. We investigate whether its learned representations generalize to physically distinct but structurally analogous domains. Through systematic experimentation across four domains-industrial bearing degradation, NASA CMAPSS turbofan degradation, and two independent power grid PMU datasets-we identify four transfer-favoring characteristics that help explain where TokaMind's pretrained representations are most effective. Power grid synchrophasor data matches this target-domain profile most directly, while industrial degradation datasets demonstrate that TokaMind can still yield useful performance under partial alignment, especially when task design and feature construction expose physically meaningful degradation structure. On the GESL/PNNL 500-event benchmark with provider-aware evaluation, TokaMind achieves test F1 = 0.837 pm 0.040 (3~seeds) for severe event classification. Our central finding, however, is not the aggregate score: classification difficulty is structurally determined by provider-level grid topology, not model capacity. In the single-window early-warning regime, TokaMind outperforms a CNN baseline (F1~0.889 vs.~0.878)--a reversal that disappears as more event windows are provided. Furthermore, Critical Slowing Down (CSD) indicators, used as a confidence gate rather than a classification label, improve F1 from 0.696 to 0.750 at 63% coverage-outperforming the CNN baseline (0.636) at any coverage level. These results establish the first cross-domain validation of TokaMind outside nuclear fusion and propose a transferability framework and revised evaluation protocol for multi-source PMU datasets.

Safety evaluation and red-teaming of large language models remain predominantly text-centric, and existing frameworks lack the infrastructure to systematically test whether alignment generalizes to audio, image, and video inputs. We present MUSE (Multimodal Unified Safety Evaluation), an open-source, run-centric platform that integrates automatic cross-modal payload generation, three multi-turn attack algorithms (Crescendo, PAIR, Violent Durian), provider-agnostic model routing, and an LLM judge with a five-level safety taxonomy into a single browser-based system. A dual-metric framework distinguishes hard Attack Success Rate (Compliance only) from soft ASR (including Partial Compliance), capturing partial information leakage that binary metrics miss. To probe whether alignment generalizes across modality boundaries, we introduce Inter-Turn Modality Switching (ITMS), which augments multi-turn attacks with per-turn modality rotation. Experiments across six multimodal LLMs from four providers show that multi-turn strategies can achieve up to 90-100% ASR against models with near-perfect single-turn refusal. ITMS does not uniformly raise final ASR on already-saturated baselines, but accelerates convergence by destabilizing early-turn defenses, and ablation reveals that the direction of modality effects is model-family-specific rather than universal, underscoring the need for provider-aware cross-modal safety testing.

With the growth of social media and large language models, content moderation has become crucial. Many existing datasets lack adequate representation of different groups, resulting in unreliable assessments. To tackle this, we propose a socio-culturally aware evaluation framework for LLM-driven content moderation and introduce a scalable method for creating diverse datasets using persona-based generation. Our analysis reveals that these datasets provide broader perspectives and pose greater challenges for LLMs than diversity-focused generation methods without personas. This challenge is especially pronounced in smaller LLMs, emphasizing the difficulties they encounter in moderating such diverse content.

Turn-taking modeling is fundamental to spoken dialogue systems, yet its evaluation remains fragmented and often limited to binary boundary detection under narrow interaction settings. Such protocols hinder systematic comparison and obscure model weaknesses across conversational conditions. We present CoDeTT, a context-aware decision benchmark for turn-taking evaluation. CoDeTT formulates turn-taking as a structured decision problem and constructs a multi-scenario dataset with fine-grained decision categories and controlled context variations. Under a unified evaluation protocol, we assess representative existing models and observe substantial performance disparities across decision types and interaction scenarios. CoDeTT provides a standardized benchmark for systematic and context-aware evaluation of turn-taking systems. The benchmark dataset and evaluation toolkit are available at https://github.com/YingaoWang-casia/CoDeTT.github.io.

The proliferation of memes on social media necessitates the capabilities of multimodal Large Language Models (mLLMs) to effectively understand multimodal harmfulness. Existing evaluation approaches predominantly focus on mLLMs' detection accuracy for binary classification tasks, which often fail to reflect the in-depth interpretive nuance of harmfulness across diverse contexts. In this paper, we propose MemeArena, an agent-based arena-style evaluation framework that provides a context-aware and unbiased assessment for mLLMs' understanding of multimodal harmfulness. Specifically, MemeArena simulates diverse interpretive contexts to formulate evaluation tasks that elicit perspective-specific analyses from mLLMs. By integrating varied viewpoints and reaching consensus among evaluators, it enables fair and unbiased comparisons of mLLMs' abilities to interpret multimodal harmfulness. Extensive experiments demonstrate that our framework effectively reduces the evaluation biases of judge agents, with judgment results closely aligning with human preferences, offering valuable insights into reliable and comprehensive mLLM evaluations in multimodal harmfulness understanding. Our code and data are publicly available at https://github.com/Lbotirx/MemeArena.

Instruction-based garment editing enables precise image modifications via natural language, with broad applications in fashion design and customization. Unlike general editing tasks, it requires understanding garment-specific semantics and attribute dependencies. However, progress is limited by the scarcity of high-quality instruction-image pairs, as manual annotation is costly and hard to scale. While MLLMs have shown promise in automated data synthesis, their application to garment editing is constrained by imprecise instruction modeling and a lack of fashion-specific supervisory signals. To address these challenges, we present an automated pipeline for constructing a garment editing dataset. We first define six editing instruction categories aligned with real-world fashion workflows to guide the generation of balanced and diverse instruction-image triplets. Second, we introduce Fashion Edit Score, a semantic-aware evaluation metric that captures semantic dependencies between garment attributes and provides reliable supervision during construction. Using this pipeline, we construct a total of 52,257 candidate triplets and retain 20,596 high-quality triplets to build EditGarment, the first instruction-based dataset tailored to standalone garment editing. The project page is https://yindq99.github.io/EditGarment-project/.

Visual explanations are often plausible but not structurally faithful. We introduce CAMBench-QR, a structure-aware benchmark that leverages the canonical geometry of QR codes (finder patterns, timing lines, module grid) to test whether CAM methods place saliency on requisite substructures while avoiding background. CAMBench-QR synthesizes QR/non-QR data with exact masks and controlled distortions, and reports structure-aware metrics (Finder/Timing Mass Ratios, Background Leakage, coverage AUCs, Distance-to-Structure) alongside causal occlusion, insertion/deletion faithfulness, robustness, and latency. We benchmark representative, efficient CAMs (LayerCAM, EigenGrad-CAM, XGrad-CAM) under two practical regimes of zero-shot and last-block fine-tuning. The benchmark, metrics, and training recipes provide a simple, reproducible yardstick for structure-aware evaluation of visual explanations. Hence we propose that CAMBENCH-QR can be used as a litmus test of whether visual explanations are truly structure-aware.

Text-based explainable recommendation aims to generate natural-language explanations that justify item recommendations, to improve user trust and system transparency. Although recent advances leverage LLMs to produce fluent outputs, a critical question remains underexplored: are these explanations factually consistent with the available evidence? We introduce a comprehensive framework for evaluating the factual consistency of text-based explainable recommenders. We design a prompting-based pipeline that uses LLMs to extract atomic explanatory statements from reviews, thereby constructing a ground truth that isolates and focuses on their factual content. Applying this pipeline to five categories from the Amazon Reviews dataset, we create augmented benchmarks for fine-grained evaluation of explanation quality. We further propose statement-level alignment metrics that combine LLM- and NLI-based approaches to assess both factual consistency and relevance of generated explanations. Across extensive experiments on six state-of-the-art explainable recommendation models, we uncover a critical gap: while models achieve high semantic similarity scores (BERTScore F1: 0.81-0.90), all our factuality metrics reveal alarmingly low performance (LLM-based statement-level precision: 4.38%-32.88%). These findings underscore the need for factuality-aware evaluation in explainable recommendation and provide a foundation for developing more trustworthy explanation systems.

Accurate prediction of RNA secondary structure underpins transcriptome annotation, mechanistic analysis of non-coding RNAs, and RNA therapeutic design. Recent gains from deep learning and RNA foundation models are difficult to interpret because current benchmarks may overestimate generalization across RNA families. We present the Comprehensive Hierarchical Annotation of Non-coding RNA Groups (CHANRG), a benchmark of 170{,}083 structurally non-redundant RNAs curated from more than 10 million sequences in Rfam~15.0 using structure-aware deduplication, genome-aware split design and multiscale structural evaluation. Across 29 predictors, foundation-model methods achieved the highest held-out accuracy but lost most of that advantage out of distribution, whereas structured decoders and direct neural predictors remained markedly more robust. This gap persisted after controlling for sequence length and reflected both loss of structural coverage and incorrect higher-order wiring. Together, CHANRG and a padding-free, symmetry-aware evaluation stack provide a stricter and batch-invariant framework for developing RNA structure predictors with demonstrable out-of-distribution robustness.

Several neural-based metrics have been recently proposed to evaluate machine translation quality. However, all of them resort to point estimates, which provide limited information at segment level. This is made worse as they are trained on noisy, biased and scarce human judgements, often resulting in unreliable quality predictions. In this paper, we introduce uncertainty-aware MT evaluation and analyze the trustworthiness of the predicted quality. We combine the COMET framework with two uncertainty estimation methods, Monte Carlo dropout and deep ensembles, to obtain quality scores along with confidence intervals. We compare the performance of our uncertainty-aware MT evaluation methods across multiple language pairs from the QT21 dataset and the WMT20 metrics task, augmented with MQM annotations. We experiment with varying numbers of references and further discuss the usefulness of uncertainty-aware quality estimation (without references) to flag possibly critical translation mistakes.

We introduce Syntax-Aware Fill-In-the-Middle (SAFIM), a new benchmark for evaluating Large Language Models (LLMs) on the code Fill-in-the-Middle (FIM) task. This benchmark focuses on syntax-aware completions of program structures such as code blocks and conditional expressions, and includes 17,720 examples from multiple programming languages, sourced from recent code submissions after April 2022 to minimize data contamination. SAFIM provides a robust framework with various prompt designs and novel syntax-aware post-processing techniques, facilitating accurate and fair comparisons across LLMs. Our comprehensive evaluation of 15 LLMs shows that FIM pretraining not only enhances FIM proficiency but also improves Left-to-Right (L2R) inference using LLMs. Our findings challenge conventional beliefs and suggest that pretraining methods and data quality have more impact than model size. SAFIM thus serves as a foundational platform for future research in effective pretraining strategies for code LLMs. The evaluation toolkit and dataset are available at https://github.com/gonglinyuan/safim, and the leaderboard is available at https://safimbenchmark.com.

Test-time scaling has emerged as a transformative paradigm for enhancing the performance of large reasoning models, enabling dynamic allocation of computational resources during inference. However, as the landscape of reasoning models rapidly expands, a critical question remains: how can we systematically compare and evaluate the test-time scaling capabilities across different models? In this paper, we introduce ARISE (Adaptive Resolution-aware Scaling Evaluation), a novel metric specifically designed to assess the test-time scaling effectiveness of large reasoning models. Unlike existing evaluation approaches, ARISE incorporates two key innovations: (1) sample-level awareness that effectively penalizes negative scaling behaviors where increased computation leads to performance degradation, and (2) a dynamic sampling mechanism that mitigates the impact of accuracy fluctuations and token count instability on the final assessment. We conduct comprehensive experiments evaluating state-of-the-art reasoning models across diverse domains including mathematical reasoning, code generation, and agentic tasks. Our results demonstrate that ARISE provides a reliable and fine-grained measurement of test-time scaling capabilities, revealing significant variations in scaling efficiency across models. Notably, our evaluation identifies Claude Opus as exhibiting superior scaling characteristics compared to other contemporary reasoning models.

Evaluating anomaly detection algorithms in time series data is critical as inaccuracies can lead to flawed decision-making in various domains where real-time analytics and data-driven strategies are essential. Traditional performance metrics assume iid data and fail to capture the complex temporal dynamics and specific characteristics of time series anomalies, such as early and delayed detections. We introduce Proximity-Aware Time series anomaly Evaluation (PATE), a novel evaluation metric that incorporates the temporal relationship between prediction and anomaly intervals. PATE uses proximity-based weighting considering buffer zones around anomaly intervals, enabling a more detailed and informed assessment of a detection. Using these weights, PATE computes a weighted version of the area under the Precision and Recall curve. Our experiments with synthetic and real-world datasets show the superiority of PATE in providing more sensible and accurate evaluations than other evaluation metrics. We also tested several state-of-the-art anomaly detectors across various benchmark datasets using the PATE evaluation scheme. The results show that a common metric like Point-Adjusted F1 Score fails to characterize the detection performances well, and that PATE is able to provide a more fair model comparison. By introducing PATE, we redefine the understanding of model efficacy that steers future studies toward developing more effective and accurate detection models.

Automated code review (CR) is a key application for Large Language Models (LLMs), but progress is hampered by a "reality gap": existing benchmarks evaluate models on isolated sub-tasks using simplified, context-poor data. This fails to reflect the holistic context-rich nature of real-world CR. To bridge this gap, we introduce CodeFuse-CR-Bench, the first comprehensiveness-aware benchmark for repository-level CR evaluation. CodeFuse-CR-Bench comprises 601 high-quality instances from 70 Python projects covering nine Pull-Request (PR) problem domains, where each instance provides rich, multi-faceted context including the associated issue, PR details, and repository state, enabling end-to-end evaluation. Beyond superficial metrics, we also propose a novel evaluation framework that combines rule-based checks for location and syntax with model-based judgments of review quality. We present the first large-scale assessment of state-of-the-art LLMs on this comprehensive CR task. Our results establish crucial baselines and reveal that (1) no single LLM dominates all aspects of CR; (2) Gemini 2.5 Pro achieves the highest comprehensive performance; and (3) different LLMs exhibit varying robustness to redundant context. These findings highlight the necessity of holistic, multi-dimensional evaluation and provide actionable insights for advancing truly intelligent yet practical CR assistants.

Mainstream large vision-language models (LVLMs) inherently encode cultural biases, highlighting the need for diverse multimodal datasets. To address this gap, we introduce Pearl, a large-scale Arabic multimodal dataset and benchmark explicitly designed for cultural understanding. Constructed through advanced agentic workflows and extensive human-in-the-loop annotations by 45 annotators from across the Arab world, Pearl comprises over K multimodal examples spanning ten culturally significant domains covering all Arab countries. We further provide two robust evaluation benchmarks Pearl and Pearl-Lite along with a specialized subset Pearl-X explicitly developed to assess nuanced cultural variations. Comprehensive evaluations on state-of-the-art open and proprietary LVLMs demonstrate that reasoning-centric instruction alignment substantially improves models' cultural grounding compared to conventional scaling methods. Pearl establishes a foundational resource for advancing culturally-informed multimodal modeling research. All datasets and benchmarks are publicly available.

This paper presents a novel approach to fine-tuning the Qwen2-1.5B model for Arabic language processing using Quantized Low-Rank Adaptation (QLoRA) on a system with only 4GB VRAM. We detail the process of adapting this large language model to the Arabic domain, using diverse datasets including Bactrian, OpenAssistant, and Wikipedia Arabic corpora. Our methodology involves custom data preprocessing, model configuration, and training optimization techniques such as gradient accumulation and mixed-precision training. We address specific challenges in Arabic NLP, including morphological complexity, dialectal variations, and diacritical mark handling. Experimental results over 10,000 training steps show significant performance improvements, with the final loss converging to 0.1083. We provide comprehensive analysis of GPU memory usage, training dynamics, and model evaluation across various Arabic language tasks, including text classification, question answering, and dialect identification. The fine-tuned model demonstrates robustness to input perturbations and improved handling of Arabic-specific linguistic phenomena. This research contributes to multilingual AI by demonstrating a resource-efficient approach for creating specialized language models, potentially democratizing access to advanced NLP technologies for diverse linguistic communities. Our work paves the way for future research in low-resource language adaptation and efficient fine-tuning of large language models.

In this paper, we introduce SalsaNext for the uncertainty-aware semantic segmentation of a full 3D LiDAR point cloud in real-time. SalsaNext is the next version of SalsaNet [1] which has an encoder-decoder architecture where the encoder unit has a set of ResNet blocks and the decoder part combines upsampled features from the residual blocks. In contrast to SalsaNet, we introduce a new context module, replace the ResNet encoder blocks with a new residual dilated convolution stack with gradually increasing receptive fields and add the pixel-shuffle layer in the decoder. Additionally, we switch from stride convolution to average pooling and also apply central dropout treatment. To directly optimize the Jaccard index, we further combine the weighted cross-entropy loss with Lovasz-Softmax loss [2]. We finally inject a Bayesian treatment to compute the epistemic and aleatoric uncertainties for each point in the cloud. We provide a thorough quantitative evaluation on the Semantic-KITTI dataset [3], which demonstrates that the proposed SalsaNext outperforms other state-of-the-art semantic segmentation networks and ranks first on the Semantic-KITTI leaderboard. We also release our source code https://github.com/TiagoCortinhal/SalsaNext.

Tasks in the aerospace industry heavily rely on searching and reusing large volumes of technical documents, yet there is no public information retrieval (IR) benchmark that reflects the terminology- and query-intent characteristics of this domain. To address this gap, this paper proposes the STELLA (Self-Reflective TErminoLogy-Aware Framework for BuiLding an Aerospace Information Retrieval Benchmark) framework. Using this framework, we introduce the STELLA benchmark, an aerospace-specific IR evaluation set constructed from NASA Technical Reports Server (NTRS) documents via a systematic pipeline that comprises document layout detection, passage chunking, terminology dictionary construction, synthetic query generation, and cross-lingual extension. The framework generates two types of queries: the Terminology Concordant Query (TCQ), which includes the terminology verbatim to evaluate lexical matching, and the Terminology Agnostic Query (TAQ), which utilizes the terminology's description to assess semantic matching. This enables a disentangled evaluation of the lexical and semantic matching capabilities of embedding models. In addition, we combine Chain-of-Density (CoD) and the Self-Reflection method with query generation to improve quality and implement a hybrid cross-lingual extension that reflects real user querying practices. Evaluation of seven embedding models on the STELLA benchmark shows that large decoder-based embedding models exhibit the strongest semantic understanding, while lexical matching methods such as BM25 remain highly competitive in domains where exact lexical matching technical term is crucial. The STELLA benchmark provides a reproducible foundation for reliable performance evaluation and improvement of embedding models in aerospace-domain IR tasks. The STELLA benchmark can be found in https://huggingface.co/datasets/telepix/STELLA.

Feature attribution methods identify which features of an input most influence a model's output. Most widely-used feature attribution methods (such as SHAP, LIME, and Grad-CAM) are "class-dependent" methods in that they generate a feature attribution vector as a function of class. In this work, we demonstrate that class-dependent methods can "leak" information about the selected class, making that class appear more likely than it is. Thus, an end user runs the risk of drawing false conclusions when interpreting an explanation generated by a class-dependent method. In contrast, we introduce "distribution-aware" methods, which favor explanations that keep the label's distribution close to its distribution given all features of the input. We introduce SHAP-KL and FastSHAP-KL, two baseline distribution-aware methods that compute Shapley values. Finally, we perform a comprehensive evaluation of seven class-dependent and three distribution-aware methods on three clinical datasets of different high-dimensional data types: images, biosignals, and text.

Predicting flows that occur both through and around porous bodies is challenging due to coupled physics across fluid and porous regions and the need to generalize across diverse geometries and boundary conditions. We address this problem using two Physics Informed learning approaches: Physics Informed PointNets (PIPN) and Physics Informed Geometry Aware Neural Operator (P-IGANO). We enforce the incompressible Navier Stokes equations in the free-flow region and a Darcy Forchheimer extension in the porous region within a unified loss and condition the networks on geometry and material parameters. Datasets are generated with OpenFOAM on 2D ducts containing porous obstacles and on 3D windbreak scenarios with tree canopies and buildings. We first verify the pipeline via the method of manufactured solutions, then assess generalization to unseen shapes, and for PI-GANO, to variable boundary conditions and parameter settings. The results show consistently low velocity and pressure errors in both seen and unseen cases, with accurate reproduction of the wake structures. Performance degrades primarily near sharp interfaces and in regions with large gradients. Overall, the study provides a first systematic evaluation of PIPN/PI-GANO for simultaneous through-and-around porous flows and shows their potential to accelerate design studies without retraining per geometry.

Vision Transformer (ViT) models have made breakthroughs in image embedding extraction, which provide state-of-the-art performance in tasks such as zero-shot image classification. However, the models suffer from a high computational burden. In this paper, we propose a novel speed-up method for ViT models called Attention-aware Token Filtering (ATF). ATF consists of two main ideas: a novel token filtering module and a filtering strategy. The token filtering module is introduced between a tokenizer and a transformer encoder of the ViT model, without modifying or fine-tuning of the transformer encoder. The module filters out tokens inputted to the encoder so that it keeps tokens in regions of specific object types dynamically and keeps tokens in regions that statically receive high attention in the transformer encoder. This filtering strategy maintains task accuracy while filtering out tokens inputted to the transformer encoder. Evaluation results on retrieval tasks show that ATF provides 2.8times speed-up to a ViT model, SigLIP, while maintaining the retrieval recall rate.

Classical OCR pipelines decompose document reading into detection, segmentation, and recognition stages, which makes them sensitive to localization errors and difficult to extend to interactive querying. This work investigates whether a single compact model can jointly perform text recognition and spatial grounding on both handwritten and printed documents. We introduce PILOT, a 155M-parameter prompt-conditioned generative model that formulates document OCR as unified sequence generation. A lightweight depthwise-separable CNN encodes the page, and a Transformer decoder autoregressively emits a single stream of subword and quantized absolute-coordinate tokens on a 10\,px grid, enabling full-page OCR, region-conditioned reading, and query-by-string spotting within the same architecture. A three-stage curriculum, progressing from plain transcription to joint text-and-box generation and finally to prompt-controlled extraction, stabilizes training and improves spatial grounding. Experiments on IAM, RIMES~2009, SROIE~2019, and the heterogeneous MAURDOR benchmark show that PILOT achieves competitive or superior performance in text recognition and line-level detection compared with traditional OCR systems, recent end-to-end HTR models, and compact vision--language models, while remaining substantially smaller than billion-scale multimodal models. Additional evaluations on fine-grained OCR and query-by-string spotting further confirm that a unified text--layout decoder can provide accurate and efficient promptable OCR in a compact setting. To support reproducibility, we release the synthetic SROIE generator, the 500k annotated IDL/PDFA pages, the harmonized line-level annotations for IAM, RIMES~2009, and MAURDOR, and the source code at https://github.com/hamdilaziz/PILOT.

Evaluating Generative 3D models remains challenging due to misalignment between automated metrics and human perception of quality. Current benchmarks rely on image-based metrics that ignore 3D structure or geometric measures that fail to capture perceptual appeal and real-world utility. To address this gap, we present 3D Arena, an open platform for evaluating image-to-3D generation models through large-scale human preference collection using pairwise comparisons. Since launching in June 2024, the platform has collected 123,243 votes from 8,096 users across 19 state-of-the-art models, establishing the largest human preference evaluation for Generative 3D. We contribute the iso3d dataset of 100 evaluation prompts and demonstrate quality control achieving 99.75% user authenticity through statistical fraud detection. Our ELO-based ranking system provides reliable model assessment, with the platform becoming an established evaluation resource. Through analysis of this preference data, we present insights into human preference patterns. Our findings reveal preferences for visual presentation features, with Gaussian splat outputs achieving a 16.6 ELO advantage over meshes and textured models receiving a 144.1 ELO advantage over untextured models. We provide recommendations for improving evaluation methods, including multi-criteria assessment, task-oriented evaluation, and format-aware comparison. The platform's community engagement establishes 3D Arena as a benchmark for the field while advancing understanding of human-centered evaluation in Generative 3D.

In this paper, we propose an improved quantitative evaluation framework for Generative Adversarial Networks (GANs) on generating domain-specific images, where we improve conventional evaluation methods on two levels: the feature representation and the evaluation metric. Unlike most existing evaluation frameworks which transfer the representation of ImageNet inception model to map images onto the feature space, our framework uses a specialized encoder to acquire fine-grained domain-specific representation. Moreover, for datasets with multiple classes, we propose Class-Aware Frechet Distance (CAFD), which employs a Gaussian mixture model on the feature space to better fit the multi-manifold feature distribution. Experiments and analysis on both the feature level and the image level were conducted to demonstrate improvements of our proposed framework over the recently proposed state-of-the-art FID method. To our best knowledge, we are the first to provide counter examples where FID gives inconsistent results with human judgments. It is shown in the experiments that our framework is able to overcome the shortness of FID and improves robustness. Code will be made available.

We introduce PhysGaia, a novel physics-aware benchmark for Dynamic Novel View Synthesis (DyNVS) that encompasses both structured objects and unstructured physical phenomena. While existing datasets primarily focus on photorealistic appearance, PhysGaia is specifically designed to support physics-consistent dynamic reconstruction. Our benchmark features complex scenarios with rich multi-body interactions, where objects realistically collide and exchange forces. Furthermore, it incorporates a diverse range of materials, including liquid, gas, textile, and rheological substance, moving beyond the rigid-body assumptions prevalent in prior work. To ensure physical fidelity, all scenes in PhysGaia are generated using material-specific physics solvers that strictly adhere to fundamental physical laws. We provide comprehensive ground-truth information, including 3D particle trajectories and physical parameters (e.g., viscosity), enabling the quantitative evaluation of physical modeling. To facilitate research adoption, we also provide integration pipelines for recent 4D Gaussian Splatting models along with our dataset and their results. By addressing the critical shortage of physics-aware benchmarks, PhysGaia can significantly advance research in dynamic view synthesis, physics-based scene understanding, and the integration of deep learning with physical simulation, ultimately enabling more faithful reconstruction and interpretation of complex dynamic scenes.

Building on the success of deep learning models in cardiovascular structure segmentation, increasing attention has been focused on improving generalization and robustness, particularly in small, annotated datasets. Despite recent advancements, current approaches often face challenges such as overfitting and accuracy limitations, largely due to their reliance on large datasets and narrow optimization techniques. This paper introduces the UU-Mamba model, an extension of the U-Mamba architecture, designed to address these challenges in both cardiac and vascular segmentation. By incorporating Sharpness-Aware Minimization (SAM), the model enhances generalization by targeting flatter minima in the loss landscape. Additionally, we propose an uncertainty-aware loss function that combines region-based, distribution-based, and pixel-based components to improve segmentation accuracy by capturing both local and global features. While the UU-Mamba model has already demonstrated great performance, further testing is required to fully assess its generalization and robustness. We expand our evaluation by conducting new trials on the ImageCAS (coronary artery) and Aorta (aortic branches and zones) datasets, which present more complex segmentation challenges than the ACDC dataset (left and right ventricles) used in our previous work, showcasing the model's adaptability and resilience. We confirm UU-Mamba's superior performance over leading models such as TransUNet, Swin-Unet, nnUNet, and nnFormer. Moreover, we provide a more comprehensive evaluation of the model's robustness and segmentation accuracy, as demonstrated by extensive experiments.

The process mining community has recently recognized the potential of large language models (LLMs) for tackling various process mining tasks. Initial studies report the capability of LLMs to support process analysis and even, to some extent, that they are able to reason about how processes work. This latter property suggests that LLMs could also be used to tackle process mining tasks that benefit from an understanding of process behavior. Examples of such tasks include (semantic) anomaly detection and next activity prediction, which both involve considerations of the meaning of activities and their inter-relations. In this paper, we investigate the capabilities of LLMs to tackle such semantics-aware process mining tasks. Furthermore, whereas most works on the intersection of LLMs and process mining only focus on testing these models out of the box, we provide a more principled investigation of the utility of LLMs for process mining, including their ability to obtain process mining knowledge post-hoc by means of in-context learning and supervised fine-tuning. Concretely, we define three process mining tasks that benefit from an understanding of process semantics and provide extensive benchmarking datasets for each of them. Our evaluation experiments reveal that (1) LLMs fail to solve challenging process mining tasks out of the box and when provided only a handful of in-context examples, (2) but they yield strong performance when fine-tuned for these tasks, consistently surpassing smaller, encoder-based language models.

In this work we address the problem of argument search. The purpose of argument search is the distillation of pro and contra arguments for requested topics from large text corpora. In previous works, the usual approach is to use a standard search engine to extract text parts which are relevant to the given topic and subsequently use an argument recognition algorithm to select arguments from them. The main challenge in the argument recognition task, which is also known as argument mining, is that often sentences containing arguments are structurally similar to purely informative sentences without any stance about the topic. In fact, they only differ semantically. Most approaches use topic or search term information only for the first search step and therefore assume that arguments can be classified independently of a topic. We argue that topic information is crucial for argument mining, since the topic defines the semantic context of an argument. Precisely, we propose different models for the classification of arguments, which take information about a topic of an argument into account. Moreover, to enrich the context of a topic and to let models understand the context of the potential argument better, we integrate information from different external sources such as Knowledge Graphs or pre-trained NLP models. Our evaluation shows that considering topic information, especially in connection with external information, provides a significant performance boost for the argument mining task.

Efficiently serving Large Language Models (LLMs) requires selecting an optimal parallel execution plan, balancing computation, memory, and communication overhead. However, determining the best strategy is challenging due to varying parallelism techniques (data, pipeline, tensor) and workload characteristics (e.g., compute-intensive tasks with long prompts vs. memory-intensive tasks with long generation). We propose APEX, an LLM serving system simulator that efficiently identifies optimal parallel execution plans by considering key factors of LLM serving systems, such as memory usage, batching behavior, etc. APEX performs dynamism-aware simulation to model iteration-level batching, and leverages LLMs' repetitive structure to reduce design space, scaling efficiently to trillion-scale models. APEX abstracts the key components of LLM serving systems, including the model, batching module, quantization formats, and device clusters, enabling the simulator to be general and extensible. Simulating on a CPU, APEX evaluates execution plans for various device clusters, covering diverse LLMs and workloads. APEX finds plans up to 3.37x faster than heuristics, and also plans that reduce energy consumption by up to 45% compared to latency-optimal plans. APEX performs comprehensive evaluations, reporting key system metrics like time per output token and time to first token, which can help service providers meet SLOs. APEX identifies an optimal plan within 15 minutes on a CPU, making it 71x faster and 1234x more cost-effective than cloud-based GPU deployment. APEX can be accessed at https://github.com/microsoft/apex_plus

Feed-forward 3D reconstruction has advanced rapidly, but current models remain unreliable in UAV photogrammetric acquisition. We argue that this failure is caused not only by appearance-domain shift, but also by UAV-specific camera-geometry variations, especially oblique views and HFOV-height ambiguity. Existing UAV datasets mainly emphasize scene diversity and provide limited coverage of camera configurations, which restricts robustness evaluation and UAV-domain adaptation. To address this gap, we introduce UAVFF3D, a geometry-aware real-synthetic benchmark for feed-forward UAV 3D reconstruction. UAVFF3D contains more than 170k real UAV images and more than 370k synthetic images rendered from high-quality textured 3D models, covering diverse HFOVs, flight altitudes, viewing directions, and acquisition patterns. It also includes a controlled HFOV-height test subset for diagnosing projection-geometry ambiguity. We further propose an evaluation protocol that jointly assesses camera-geometry estimation and dense scene reconstruction under a shared global alignment, avoiding the bias caused by separate camera and geometry alignments. Experiments on representative feed-forward reconstruction models show that UAVFF3D-based domain adaptation consistently improves camera and geometry estimation, reducing Ray Error by up to 84.2%, Pose ATE by up to 76.0%, and Chamfer Distance by up to 41.1%. In oblique scenes, adaptation reduces the oblique-nadir rotation gap by up to 90.7%. Under HFOV-height ambiguity, it improves robustness across HFOV-height configurations and yields more stable performance across HFOV settings. Incorporating camera priors further improves reconstruction under UAV-specific acquisition geometries. The dataset and evaluation code are available at https://github.com/yanxian-ll/UAVFF3D .

Predicting and reasoning how a video would make a human feel is crucial for developing socially intelligent systems. Although Multimodal Large Language Models (MLLMs) have shown impressive video understanding capabilities, they tend to focus more on the semantic content of videos, often overlooking emotional stimuli. Hence, most existing MLLMs fall short in estimating viewers' emotional reactions and providing plausible explanations. To address this issue, we propose StimuVAR, a spatiotemporal Stimuli-aware framework for Video Affective Reasoning (VAR) with MLLMs. StimuVAR incorporates a two-level stimuli-aware mechanism: frame-level awareness and token-level awareness. Frame-level awareness involves sampling video frames with events that are most likely to evoke viewers' emotions. Token-level awareness performs tube selection in the token space to make the MLLM concentrate on emotion-triggered spatiotemporal regions. Furthermore, we create VAR instruction data to perform affective training, steering MLLMs' reasoning strengths towards emotional focus and thereby enhancing their affective reasoning ability. To thoroughly assess the effectiveness of VAR, we provide a comprehensive evaluation protocol with extensive metrics. StimuVAR is the first MLLM-based method for viewer-centered VAR. Experiments demonstrate its superiority in understanding viewers' emotional responses to videos and providing coherent and insightful explanations.

Large language models (LLMs) are increasingly applied in mental health support systems, where reliable recognition of high-risk states such as suicidal ideation and self-harm is safety-critical. However, existing evaluations primarily rely on aggregate performance metrics, which often obscure risk-specific failure modes and provide limited insight into model behavior in realistic, multi-turn interactions. We present MHDash, an open-source platform designed to support the development, evaluation, and auditing of AI systems for mental health applications. MHDash integrates data collection, structured annotation, multi-turn dialogue generation, and baseline evaluation into a unified pipeline. The platform supports annotations across multiple dimensions, including Concern Type, Risk Level, and Dialogue Intent, enabling fine-grained and risk-aware analysis. Our results reveal several key findings: (i) simple baselines and advanced LLM APIs exhibit comparable overall accuracy yet diverge significantly on high-risk cases; (ii) some LLMs maintain consistent ordinal severity ranking while failing absolute risk classification, whereas others achieve reasonable aggregate scores but suffer from high false negative rates on severe categories; and (iii) performance gaps are amplified in multi-turn dialogues, where risk signals emerge gradually. These observations demonstrate that conventional benchmarks are insufficient for safety-critical mental health settings. By releasing MHDash as an open platform, we aim to promote reproducible research, transparent evaluation, and safety-aligned development of AI systems for mental health support.

In the last decade new ways of shopping online have increased the possibility of buying products and services more easily and faster than ever. In this new context, personality is a key determinant in the decision making of the consumer when shopping. The two main reasons are: firstly, a person's buying choices are influenced by psychological factors like impulsiveness, and secondly, some consumers may be more susceptible to making impulse purchases than others. To the best of our knowledge, the impact of personality factors on advertisements has been largely neglected at the level of recommender systems. This work proposes a highly innovative research which uses a personality perspective to determine the unique associations among the consumer's buying tendency and advert recommendations. As a matter of fact, the lack of a publicly available benchmark for computational advertising do not allow both the exploration of this intriguing research direction and the evaluation of state-of-the-art algorithms. We present the ADS Dataset, a publicly available benchmark for computational advertising enriched with Big-Five users' personality factors and 1,200 personal users' pictures. The proposed benchmark allows two main tasks: rating prediction over 300 real advertisements (i.e., Rich Media Ads, Image Ads, Text Ads) and click-through rate prediction. Moreover, this work carries out experiments, reviews various evaluation criteria used in the literature, and provides a library for each one of them within one integrated toolbox.

Recent advances in diffusion models have improved controllable streetscape generation and supported downstream perception and planning tasks. However, challenges remain in accurately modeling driving scenes and generating long videos. To alleviate these issues, we propose DreamForge, an advanced diffusion-based autoregressive video generation model tailored for 3D-controllable long-term generation. To enhance the lane and foreground generation, we introduce perspective guidance and integrate object-wise position encoding to incorporate local 3D correlation and improve foreground object modeling. We also propose motion-aware temporal attention to capture motion cues and appearance changes in videos. By leveraging motion frames and an autoregressive generation paradigm,we can autoregressively generate long videos (over 200 frames) using a model trained in short sequences, achieving superior quality compared to the baseline in 16-frame video evaluations. Finally, we integrate our method with the realistic simulator DriveArena to provide more reliable open-loop and closed-loop evaluations for vision-based driving agents. Project Page: https://pjlab-adg.github.io/DriveArena/dreamforge.

Large language model (LLM) agents rely on reusable skills to solve complex tasks. However, existing skill creation approaches treat skills as isolated and static artifacts, limiting their reusability, reliability, and long-term improvement. We propose MUSE-Autoskill Agent (Memory-Utilizing Skill Evolution), a skill-centric agent framework that lets agents continuously improve their task-solving capability by creating, reusing, and refining skills under a unified lifecycle (creation, memory, management, evaluation, and refinement). Our framework enables agents to create skills on demand, store and reuse them across tasks, organize and select them efficiently, and evaluate them through unit tests and runtime feedback for continuous refinement. We further introduce skill-level memory that accumulates experience for each skill across tasks, enabling more effective reuse and adaptation over time. Experiments on SkillsBench provide initial evidence that lifecycle-managed skills can improve task success, efficiency, reuse, and cross-agent transfer, highlighting the importance of treating skills as long-lived, experience-aware, and testable assets.

Retrieval-Augmented Generation (RAG) systems are increasingly vital for navigating the ever-expanding body of scientific literature, particularly in high-stakes domains such as chemistry. Despite the promise of RAG, foundational design choices -- such as how documents are segmented and represented -- remain underexplored in domain-specific contexts. This study presents the first large-scale, systematic evaluation of chunking strategies and embedding models tailored to chemistry-focused RAG systems. We investigate 25 chunking configurations across five method families and evaluate 48 embedding models on three chemistry-specific benchmarks, including the newly introduced QuestChemRetrieval dataset. Our results reveal that recursive token-based chunking (specifically R100-0) consistently outperforms other approaches, offering strong performance with minimal resource overhead. We also find that retrieval-optimized embeddings -- such as Nomic and Intfloat E5 variants -- substantially outperform domain-specialized models like SciBERT. By releasing our datasets, evaluation framework, and empirical benchmarks, we provide actionable guidelines for building effective and efficient chemistry-aware RAG systems.

Large language models (LLMs) have advanced significantly in code generation, yet their ability to follow complex programming instructions with layered and diverse constraints remains underexplored. Existing benchmarks often prioritize functional correctness, overlooking the nuanced requirements found in real-world development. We introduce MultiCodeIF, a comprehensive benchmark designed to evaluate instruction-following in code generation across multiple dimensions: constraint type, hierarchical levels, and iterative refinement. Built upon a structured taxonomy of 9 categories and 27 constraint types, MultiCodeIF enables granular assessment of both functional and non-functional instruction adherence. Using an automated pipeline, ConstraGen, we synthesize and evolve 2,021 code tasks sourced from 14 programming languages, supporting multi-turn evaluation through feedback-driven task variants. Empirical evaluation of six state-of-the-art LLMs uncovers substantial performance disparities. The top-performing model, Claude-3-7-Sonnet, achieves 63.0% average constraint satisfaction, while smaller models like Qwen3-1.7B fall to 44.8%. Models perform well on explicit constraints, but struggle with implicit or abstract constraints. Tasks with multiple hierarchical constraints significantly reduce model success rates, from 54.5% in single-level to just 18.8% in multi-level scenarios. However, structured feedback enables progressive improvement: average constraint satisfaction rises from 63.0% to 83.4% over four iterative refinement rounds. MultiCodeIF provides a scalable, constraint-aware, and feedback-sensitive framework to benchmark LLMs under realistic code generation scenarios, bridging the gap between synthetic evaluations and real-world instruction complexity. The full benchmark dataset, evaluation pipeline, and source code are available at https://github.com/SYSUSELab/MultiCodeIF.

Large language models (LLMs) are increasingly deployed in settings where reasoning, such as multi-step problem solving and chain-of-thought, is essential. Yet, current evaluation practices overwhelmingly report single-run accuracy while ignoring the intrinsic uncertainty that naturally arises from stochastic decoding. This omission creates a blind spot because practitioners cannot reliably assess whether a method's reported performance is stable, reproducible, or cost-consistent. We introduce ReasonBENCH, the first benchmark designed to quantify the underlying instability in LLM reasoning. ReasonBENCH provides (i) a modular evaluation library that standardizes reasoning frameworks, models, and tasks, (ii) a multi-run protocol that reports statistically reliable metrics for both quality and cost, and (iii) a public leaderboard to encourage variance-aware reporting. Across tasks from different domains, we find that the vast majority of reasoning strategies and models exhibit high instability. Notably, even strategies with similar average performance can display confidence intervals up to four times wider, and the top-performing methods often incur higher and less stable costs. Such instability compromises reproducibility across runs and, consequently, the reliability of reported performance. To better understand these dynamics, we further analyze the impact of prompts, model families, and scale on the trade-off between solve rate and stability. Our results highlight reproducibility as a critical dimension for reliable LLM reasoning and provide a foundation for future reasoning methods and uncertainty quantification techniques. ReasonBENCH is publicly available at https://github.com/au-clan/ReasonBench .

Recent deployments of large language models (LLMs) as autonomous trading agents raise questions about whether financial decision-making competence generalizes beyond specific market patterns and how it should be trained and evaluated in noisy markets lacking ground truth. We propose a structured framework for training and evaluating such models. Central to our approach is a curated, multiple-choice question (MCQ) dataset derived from classic textbooks and historical markets, verified by an AI committee, enriched with structured reasoning traces, and augmented to reduce shortcut learning. To evaluate whether performance on isolated MCQs generalizes to real-world trading, we introduce a two-stage protocol combining test-set evaluation with an MCQ-based chronological trading simulation. Extensive evaluations across market regimes provide statistically robust evidence that open models trained with our framework exhibit competitive, risk-aware behavior over time, outperform open-source baselines, and approach frontier-model performance at smaller scale. We release the dataset and evaluation framework to support further research.

Weight pruning is widely advocated for deploying Large Language Models on resource-constrained IoT and edge devices, yet its impact on model fairness remains poorly understood. We conduct a controlled empirical study of three instruction-tuned models (Gemma-2-9b-it, Mistral-7B-Instruct-v0.3, Phi-3.5-mini-instruct) across three pruning methods (Random, Magnitude, Wanda) at four sparsity levels (10-70%) on 12,148 BBQ bias benchmark items with 5 random seeds, totaling 2,368,860 inference records. Our results reveal a Smart Pruning Paradox: activation-aware pruning (Wanda) preserves perplexity nearly perfectly (just 3.5% increase at 50% sparsity for Mistral-7B), yet produces the highest bias amplification, with Stereotype Reliance Score increasing 83.7% and 47-59% of previously unbiased items developing new stereotypical behaviors at 70% sparsity. Random pruning destroys language capability entirely (perplexity exceeding 10^4 and reaching 10^8) but produces only random-chance bias. We further show that unstructured pruning provides zero storage savings and zero inference latency reduction on real edge hardware, undermining the primary motivation for its use in IoT deployment. Of 180 dense-vs-pruned comparisons, 141 (78.3%) are significant (p < 0.05) with mean |h| = 0.305. Published quantization studies report up to 21% of responses flipping between biased and unbiased states; our pruning results show transition rates nearly three times higher (47-59%), suggesting pruning poses a categorically greater risk to alignment than quantization. These findings demonstrate that perplexity-based evaluation provides false assurance of behavioral equivalence, and that IoT deployment pipelines require bias-aware validation before deploying pruned models at the edge.

This paper introduces Bhasha-Rupantarika, a light and efficient multilingual translation system tailored through algorithm-hardware codesign for resource-limited settings. The method investigates model deployment at sub-octet precision levels (FP8, INT8, INT4, and FP4), with experimental results indicating a 4.1x reduction in model size (FP4) and a 4.2x speedup in inference speed, which correlates with an increased throughput of 66 tokens/s (improvement by 4.8x). This underscores the importance of ultra-low precision quantization for real-time deployment in IoT devices using FPGA accelerators, achieving performance on par with expectations. Our evaluation covers bidirectional translation between Indian and international languages, showcasing its adaptability in low-resource linguistic contexts. The FPGA deployment demonstrated a 1.96x reduction in LUTs and a 1.65x decrease in FFs, resulting in a 2.2x enhancement in throughput compared to OPU and a 4.6x enhancement compared to HPTA. Overall, the evaluation provides a viable solution based on quantisation-aware translation along with hardware efficiency suitable for deployable multilingual AI systems. The entire codes [https://github.com/mukullokhande99/Bhasha-Rupantarika/] and dataset for reproducibility are publicly available, facilitating rapid integration and further development by researchers.

The rapid proliferation of Large Language Models (LLMs) and diverse specialized benchmarks necessitates a shift from fragmented, task-specific metrics to a holistic, competitive ranking system that effectively aggregates performance across multiple ability dimensions. Primarily using static scoring, current evaluation methods are fundamentally limited. They struggle to determine the proper mix ratio across diverse benchmarks, and critically, they fail to capture a model's dynamic competitive fitness or its vulnerability when confronted with sequential, high-stakes tasks. To address this, we introduce the novel Competitive Swiss-System Dynamics (CSD) framework. CSD simulates a multi-round, sequential contest where models are dynamically paired across a curated sequence of benchmarks based on their accumulated win-loss record. And Monte Carlo Simulation (N=100,000 iterations) is used to approximate the statistically robust Expected Win Score (E[S_m]), which eliminates the noise of random pairing and early-round luck. Furthermore, we implement a Failure Sensitivity Analysis by parameterizing the per-round elimination quantity (T_k), which allows us to profile models based on their risk appetite--distinguishing between robust generalists and aggressive specialists. We demonstrate that CSD provides a more nuanced and context-aware ranking than traditional aggregate scoring and static pairwise models, representing a vital step towards risk-informed, next-generation LLM evaluation.

We introduce AbBiBench (Antibody Binding Benchmarking), a benchmarking framework for antibody binding affinity maturation and design. Unlike previous strategies that evaluate antibodies in isolation, typically by comparing them to natural sequences with metrics such as amino acid recovery rate or structural RMSD, AbBiBench instead treats the antibody-antigen (Ab-Ag) complex as the fundamental unit. It evaluates an antibody design's binding potential by measuring how well a protein model scores the full Ab-Ag complex. We first curate, standardize, and share more than 184,500 experimental measurements of antibody mutants across 14 antibodies and 9 antigens-including influenza, lysozyme, HER2, VEGF, integrin, Ang2, and SARS-CoV-2-covering both heavy-chain and light-chain mutations. Using these datasets, we systematically compare 15 protein models including masked language models, autoregressive language models, inverse folding models, diffusion-based generative models, and geometric graph models by comparing the correlation between model likelihood and experimental affinity values. Additionally, to demonstrate AbBiBench's generative utility, we apply it to antibody F045-092 in order to introduce binding to influenza H1N1. We sample new antibody variants with the top-performing models, rank them by the structural integrity and biophysical properties of the Ab-Ag complex, and assess them with in vitro ELISA binding assays. Our findings show that structure-conditioned inverse folding models outperform others in both affinity correlation and generation tasks. Overall, AbBiBench provides a unified, biologically grounded evaluation framework to facilitate the development of more effective, function-aware antibody design models.

LLM serving systems typically treat user prompts as monolithic inputs, optimizing inference through decoding tricks or inter-query batching. However, many real-world prompts contain latent semantic parallelism--decomposable structures where subtasks can be executed independently to reduce latency while preserving meaning. We introduce PARALLELPROMPT, the first benchmark for measuring intra-query parallelism in natural user prompts. Our dataset comprises over 37,000 real-world prompts from public LLM chat logs, each annotated with a structured schema capturing task templates, shared context, and iteration inputs. These schemas are extracted using LLM-assisted prompting with rule-based multilingual validation. To evaluate the benefits of decomposition, we provide an execution suite that benchmarks serial vs. parallel strategies, measuring latency, structural adherence, and semantic fidelity. Our results show that intra-query parallelism can be successfully parsed in over 75% of curated datasets, unlocking up to 5x speedups on tasks like translation, comprehension, and comparative analysis, with minimal quality degradation. By releasing this benchmark, curation pipeline, and evaluation suite, we provide the first standardized testbed for studying structure-aware execution in LLM serving pipelines.

Multimodal agents have demonstrated strong performance in general GUI interactions, but their application in automotive systems has been largely unexplored. In-vehicle GUIs present distinct challenges: drivers' limited attention, strict safety requirements, and complex location-based interaction patterns. To address these challenges, we introduce Automotive-ENV, the first high-fidelity benchmark and interaction environment tailored for vehicle GUIs. This platform defines 185 parameterized tasks spanning explicit control, implicit intent understanding, and safety-aware tasks, and provides structured multimodal observations with precise programmatic checks for reproducible evaluation. Building on this benchmark, we propose ASURADA, a geo-aware multimodal agent that integrates GPS-informed context to dynamically adjust actions based on location, environmental conditions, and regional driving norms. Experiments show that geo-aware information significantly improves success on safety-aware tasks, highlighting the importance of location-based context in automotive environments. We will release Automotive-ENV, complete with all tasks and benchmarking tools, to further the development of safe and adaptive in-vehicle agents.

Benchmarks are necessary for healthcare evaluation, but are not sufficient for predicting deployment performance. Our position is that the evaluation--deployment gap arises not because of poorly designed benchmarks, but from implicit assumptions about how users interact with models that cannot be surfaced from benchmarks alone. To make this precise, we propose a classification of assumptions into two categories: task, which can be tested from conversation data alone, and outcome, which requires outcome data and behavioral studies for testing. Critically, outcome assumptions depend on human behavior, something that even well-designed benchmarks cannot directly observe. To demonstrate the operationality of this framework, we retrospectively analyze a healthcare RCT as a case study and find that the gap naturally separates into task and outcome gaps of roughly equal size. To address this, we make two contributions: first, we propose BenchmarkCards, an artifact that documents assumptions, and second, we propose staged evaluation, a procedure that systematically tests assumptions and evaluates performance.

The proliferation of Large Language Models (LLMs) presents transformative potential for healthcare, yet practical deployment is hindered by the absence of frameworks that assess real-world clinical utility. Existing benchmarks test static knowledge, failing to capture the dynamic, application-oriented capabilities required in clinical practice. To bridge this gap, we introduce a Medical LLM Benchmark MLB, a comprehensive benchmark evaluating LLMs on both foundational knowledge and scenario-based reasoning. MLB is structured around five core dimensions: Medical Knowledge (MedKQA), Safety and Ethics (MedSE), Medical Record Understanding (MedRU), Smart Services (SmartServ), and Smart Healthcare (SmartCare). The benchmark integrates 22 datasets (17 newly curated) from diverse Chinese clinical sources, covering 64 clinical specialties. Its design features a rigorous curation pipeline involving 300 licensed physicians. Besides, we provide a scalable evaluation methodology, centered on a specialized judge model trained via Supervised Fine-Tuning (SFT) on expert annotations. Our comprehensive evaluation of 10 leading models reveals a critical translational gap: while the top-ranked model, Kimi-K2-Instruct (77.3% accuracy overall), excels in structured tasks like information extraction (87.8% accuracy in MedRU), performance plummets in patient-facing scenarios (61.3% in SmartServ). Moreover, the exceptional safety score (90.6% in MedSE) of the much smaller Baichuan-M2-32B highlights that targeted training is equally critical. Our specialized judge model, trained via SFT on a 19k expert-annotated medical dataset, achieves 92.1% accuracy, an F1-score of 94.37%, and a Cohen's Kappa of 81.3% for human-AI consistency, validating a reproducible and expert-aligned evaluation protocol. MLB thus provides a rigorous framework to guide the development of clinically viable LLMs.

The rapid development of Large Language Models (LLMs) for healthcare applications has spurred calls for holistic evaluation beyond frequently-cited benchmarks like USMLE, to better reflect real-world performance. While real-world assessments are valuable indicators of utility, they often lag behind the pace of LLM evolution, likely rendering findings obsolete upon deployment. This temporal disconnect necessitates a comprehensive upfront evaluation that can guide model selection for specific clinical applications. We introduce MEDIC, a framework assessing LLMs across five critical dimensions of clinical competence: medical reasoning, ethics and bias, data and language understanding, in-context learning, and clinical safety. MEDIC features a novel cross-examination framework quantifying LLM performance across areas like coverage and hallucination detection, without requiring reference outputs. We apply MEDIC to evaluate LLMs on medical question-answering, safety, summarization, note generation, and other tasks. Our results show performance disparities across model sizes, baseline vs medically finetuned models, and have implications on model selection for applications requiring specific model strengths, such as low hallucination or lower cost of inference. MEDIC's multifaceted evaluation reveals these performance trade-offs, bridging the gap between theoretical capabilities and practical implementation in healthcare settings, ensuring that the most promising models are identified and adapted for diverse healthcare applications.

The deployment of Large Language Models (LLMs) in high-stakes clinical settings demands rigorous and reliable evaluation. However, existing medical benchmarks remain static, suffering from two critical limitations: (1) data contamination, where test sets inadvertently leak into training corpora, leading to inflated performance estimates; and (2) temporal misalignment, failing to capture the rapid evolution of medical knowledge. Furthermore, current evaluation metrics for open-ended clinical reasoning often rely on either shallow lexical overlap (e.g., ROUGE) or subjective LLM-as-a-Judge scoring, both inadequate for verifying clinical correctness. To bridge these gaps, we introduce LiveMedBench, a continuously updated, contamination-free, and rubric-based benchmark that weekly harvests real-world clinical cases from online medical communities, ensuring strict temporal separation from model training data. We propose a Multi-Agent Clinical Curation Framework that filters raw data noise and validates clinical integrity against evidence-based medical principles. For evaluation, we develop an Automated Rubric-based Evaluation Framework that decomposes physician responses into granular, case-specific criteria, achieving substantially stronger alignment with expert physicians than LLM-as-a-Judge. To date, LiveMedBench comprises 2,756 real-world cases spanning 38 medical specialties and multiple languages, paired with 16,702 unique evaluation criteria. Extensive evaluation of 38 LLMs reveals that even the best-performing model achieves only 39.2%, and 84% of models exhibit performance degradation on post-cutoff cases, confirming pervasive data contamination risks. Error analysis further identifies contextual application-not factual knowledge-as the dominant bottleneck, with 35-48% of failures stemming from the inability to tailor medical knowledge to patient-specific constraints.

Large language models (LLMs) have emerged as powerful tools for analyzing complex datasets. Recent studies demonstrate their potential to generate useful, personalized responses when provided with patient-specific health information that encompasses lifestyle, biomarkers, and context. As LLM-driven health applications are increasingly adopted, rigorous and efficient one-sided evaluation methodologies are crucial to ensure response quality across multiple dimensions, including accuracy, personalization and safety. Current evaluation practices for open-ended text responses heavily rely on human experts. This approach introduces human factors and is often cost-prohibitive, labor-intensive, and hinders scalability, especially in complex domains like healthcare where response assessment necessitates domain expertise and considers multifaceted patient data. In this work, we introduce Adaptive Precise Boolean rubrics: an evaluation framework that streamlines human and automated evaluation of open-ended questions by identifying gaps in model responses using a minimal set of targeted rubrics questions. Our approach is based on recent work in more general evaluation settings that contrasts a smaller set of complex evaluation targets with a larger set of more precise, granular targets answerable with simple boolean responses. We validate this approach in metabolic health, a domain encompassing diabetes, cardiovascular disease, and obesity. Our results demonstrate that Adaptive Precise Boolean rubrics yield higher inter-rater agreement among expert and non-expert human evaluators, and in automated assessments, compared to traditional Likert scales, while requiring approximately half the evaluation time of Likert-based methods. This enhanced efficiency, particularly in automated evaluation and non-expert contributions, paves the way for more extensive and cost-effective evaluation of LLMs in health.

Large language models (LLMs) have shown great promise in the medical domain, achieving strong performance on several benchmarks. However, they continue to underperform in real-world medical scenarios, which often demand stronger context-awareness, i.e., the ability to recognize missing or critical details (e.g., user identity, medical history, risk factors) and provide safe, helpful, and contextually appropriate responses. To address this issue, we propose Multifaceted Self-Refinement (MuSeR), a data-driven approach that enhances LLMs' context-awareness along three key facets (decision-making, communication, and safety) through self-evaluation and refinement. Specifically, we first design a attribute-conditioned query generator that simulates diverse real-world user contexts by varying attributes such as role, geographic region, intent, and degree of information ambiguity. An LLM then responds to these queries, self-evaluates its answers along three key facets, and refines its responses to better align with the requirements of each facet. Finally, the queries and refined responses are used for supervised fine-tuning to reinforce the model's context-awareness ability. Evaluation results on the latest HealthBench dataset demonstrate that our method significantly improves LLM performance across multiple aspects, with particularly notable gains in the context-awareness axis. Furthermore, by incorporating knowledge distillation with the proposed method, the performance of a smaller backbone LLM (e.g., Qwen3-32B) surpasses its teacher model, achieving a new SOTA across all open-source LLMs on HealthBench (63.8%) and its hard subset (43.1%). Code and dataset will be released at https://muser-llm.github.io.

The advancement in healthcare has shifted focus toward patient-centric approaches, particularly in self-care and patient education, facilitated by access to Electronic Health Records (EHR). However, medical jargon in EHRs poses significant challenges in patient comprehension. To address this, we introduce a new task of automatically generating lay definitions, aiming to simplify complex medical terms into patient-friendly lay language. We first created the README dataset, an extensive collection of over 50,000 unique (medical term, lay definition) pairs and 300,000 mentions, each offering context-aware lay definitions manually annotated by domain experts. We have also engineered a data-centric Human-AI pipeline that synergizes data filtering, augmentation, and selection to improve data quality. We then used README as the training data for models and leveraged a Retrieval-Augmented Generation method to reduce hallucinations and improve the quality of model outputs. Our extensive automatic and human evaluations demonstrate that open-source mobile-friendly models, when fine-tuned with high-quality data, are capable of matching or even surpassing the performance of state-of-the-art closed-source large language models like ChatGPT. This research represents a significant stride in closing the knowledge gap in patient education and advancing patient-centric healthcare solutions.

Medical care follows complex clinical pathways that extend beyond isolated physician-patient encounters, emphasizing decision-making and transitions between different stages. Current benchmarks focusing on static exams or isolated dialogues inadequately evaluate large language models (LLMs) in dynamic clinical scenarios. We introduce CP-Env, a controllable agentic hospital environment designed to evaluate LLMs across end-to-end clinical pathways. CP-Env simulates a hospital ecosystem with patient and physician agents, constructing scenarios ranging from triage and specialist consultation to diagnostic testing and multidisciplinary team meetings for agent interaction. Following real hospital adaptive flow of healthcare, it enables branching, long-horizon task execution. We propose a three-tiered evaluation framework encompassing Clinical Efficacy, Process Competency, and Professional Ethics. Results reveal that most models struggle with pathway complexity, exhibiting hallucinations and losing critical diagnostic details. Interestingly, excessive reasoning steps can sometimes prove counterproductive, while top models tend to exhibit reduced tool dependency through internalized knowledge. CP-Env advances medical AI agents development through comprehensive end-to-end clinical evaluation. We provide the benchmark and evaluation tools for further research and development at https://github.com/SPIRAL-MED/CP_ENV.

The successes of foundation models such as ChatGPT and AlphaFold have spurred significant interest in building similar models for electronic medical records (EMRs) to improve patient care and hospital operations. However, recent hype has obscured critical gaps in our understanding of these models' capabilities. We review over 80 foundation models trained on non-imaging EMR data (i.e. clinical text and/or structured data) and create a taxonomy delineating their architectures, training data, and potential use cases. We find that most models are trained on small, narrowly-scoped clinical datasets (e.g. MIMIC-III) or broad, public biomedical corpora (e.g. PubMed) and are evaluated on tasks that do not provide meaningful insights on their usefulness to health systems. In light of these findings, we propose an improved evaluation framework for measuring the benefits of clinical foundation models that is more closely grounded to metrics that matter in healthcare.

With the growing use of language models (LMs) in clinical environments, there is an immediate need to evaluate the accuracy and safety of LM-generated medical text. Currently, such evaluation relies solely on manual physician review. However, detecting errors in LM-generated text is challenging because 1) manual review is costly and 2) expert-composed reference outputs are often unavailable in real-world settings. While the "LM-as-judge" paradigm (a LM evaluating another LM) offers scalable evaluation, even frontier LMs can miss subtle but clinically significant errors. To address these challenges, we propose MedVAL, a self-supervised framework that leverages synthetic data to train evaluator LMs to assess whether LM-generated medical outputs are factually consistent with inputs, without requiring physician labels or reference outputs. To evaluate LM performance, we introduce MedVAL-Bench, a dataset containing 840 outputs annotated by physicians, following a physician-defined taxonomy of risk levels and error categories. Across 6 diverse medical tasks and 10 state-of-the-art LMs spanning open-source, proprietary, and medically adapted models, MedVAL fine-tuning significantly improves (p < 0.001) alignment with physicians on both seen and unseen tasks, increasing average F1 scores from 66% to 83%, with per-sample safety classification scores up to 86%. MedVAL improves the performance of even the best-performing proprietary LM (GPT-4o) by 8%. To support a scalable, risk-aware pathway towards clinical integration, we open-source the 1) codebase ( https://github.com/StanfordMIMI/MedVAL ), 2) MedVAL-Bench ( https://huggingface.co/datasets/stanfordmimi/MedVAL-Bench ), and 3) MedVAL-4B ( https://huggingface.co/stanfordmimi/MedVAL-4B ), the best-performing open-source LM. Our research provides the first evidence of LMs approaching expert-level validation ability for medical text.

This position paper emphasizes the critical gap in the evaluation of Explainable AI (XAI) due to the lack of standardized and reliable metrics, which diminishes its practical value, trustworthiness, and ability to meet regulatory requirements. Current evaluation methods are often fragmented, subjective, and biased, making them prone to manipulation and complicating the assessment of complex models. A central issue is the absence of a ground truth for explanations, complicating comparisons across various XAI approaches. To address these challenges, we advocate for widespread research into developing robust, context-sensitive evaluation metrics. These metrics should be resistant to manipulation, relevant to each use case, and based on human judgment and real-world applicability. We also recommend creating domain-specific evaluation benchmarks that align with the user and regulatory needs of sectors such as healthcare and finance. By encouraging collaboration among academia, industry, and regulators, we can create standards that balance flexibility and consistency, ensuring XAI explanations are meaningful, trustworthy, and compliant with evolving regulations.

Large language models (LLMs) hold immense promise to serve complex health information needs but also have the potential to introduce harm and exacerbate health disparities. Reliably evaluating equity-related model failures is a critical step toward developing systems that promote health equity. In this work, we present resources and methodologies for surfacing biases with potential to precipitate equity-related harms in long-form, LLM-generated answers to medical questions and then conduct an empirical case study with Med-PaLM 2, resulting in the largest human evaluation study in this area to date. Our contributions include a multifactorial framework for human assessment of LLM-generated answers for biases, and EquityMedQA, a collection of seven newly-released datasets comprising both manually-curated and LLM-generated questions enriched for adversarial queries. Both our human assessment framework and dataset design process are grounded in an iterative participatory approach and review of possible biases in Med-PaLM 2 answers to adversarial queries. Through our empirical study, we find that the use of a collection of datasets curated through a variety of methodologies, coupled with a thorough evaluation protocol that leverages multiple assessment rubric designs and diverse rater groups, surfaces biases that may be missed via narrower evaluation approaches. Our experience underscores the importance of using diverse assessment methodologies and involving raters of varying backgrounds and expertise. We emphasize that while our framework can identify specific forms of bias, it is not sufficient to holistically assess whether the deployment of an AI system promotes equitable health outcomes. We hope the broader community leverages and builds on these tools and methods towards realizing a shared goal of LLMs that promote accessible and equitable healthcare for all.

Recent advances have made long-form report-generating systems widely available. This has prompted evaluation frameworks that use LLM-as-judge protocols and claim verification, along with meta-evaluation frameworks that seek to validate these methods. Many of the meta-evaluations estimate an evaluation quality's by comparing its assessments against human pairwise preferences. Prior work, however, suggests that human pairwise preference may be overly simplistic and can fail to capture nuances of expert expectations. We conduct a case study in meta-evaluation for long-form QA benchmarks using ScholarQA-CS2, a benchmark designed for assessing retrieval-augmented deep-research QA in the scientific domain. We comprehensively validate the benchmark through human pairwise preference judgments, then critically examine the strengths, weaknesses, and confounders of this approach. We show that pairwise preference rankings are best suited for system-level evaluation, while explicit metric-wise annotations and expert annotators are critical for reliable metric-level assessment, with subjectivity remaining a key challenge. Based on our findings, we offer practical guidelines for designing future meta-evaluations that better align evaluation methods, annotator expertise, and reporting practices. By surfacing these methodological challenges, we aim to advance evaluation standards for deep-research systems.

The scaling laws and extraordinary performance of large foundation models motivate the development and utilization of such models in biomedicine. However, despite early promising results on some biomedical benchmarks, there are still major challenges that need to be addressed before these models can be used in real-world clinics. Frontier general-domain models such as GPT-4V still have significant performance gaps in multimodal biomedical applications. More importantly, less-acknowledged pragmatic issues, including accessibility, model cost, and tedious manual evaluation make it hard for clinicians to use state-of-the-art large models directly on private patient data. Here, we explore training open-source small multimodal models (SMMs) to bridge competency gaps for unmet clinical needs in radiology. To maximize data efficiency, we adopt a modular approach by incorporating state-of-the-art pre-trained models for image and text modalities, and focusing on training a lightweight adapter to ground each modality to the text embedding space, as exemplified by LLaVA-Med. For training, we assemble a large dataset of over 697 thousand radiology image-text pairs. For evaluation, we propose CheXprompt, a GPT-4-based metric for factuality evaluation, and demonstrate its parity with expert evaluation. For best practice, we conduct a systematic ablation study on various choices in data engineering and multimodal training. The resulting LlaVA-Rad (7B) model attains state-of-the-art results on standard radiology tasks such as report generation and cross-modal retrieval, even outperforming much larger models such as GPT-4V and Med-PaLM M (84B). The inference of LlaVA-Rad is fast and can be performed on a single V100 GPU in private settings, offering a promising state-of-the-art tool for real-world clinical applications.

The evaluation of Large Language Models (LLMs) in healthcare has been dominated by physician-centric, English-language benchmarks, creating a dangerous illusion of competence that ignores the interprofessional nature of patient care. To provide a more holistic and realistic assessment, we introduce HealthQA-BR, the first large-scale, system-wide benchmark for Portuguese-speaking healthcare. Comprising 5,632 questions from Brazil's national licensing and residency exams, it uniquely assesses knowledge not only in medicine and its specialties but also in nursing, dentistry, psychology, social work, and other allied health professions. We conducted a rigorous zero-shot evaluation of over 20 leading LLMs. Our results reveal that while state-of-the-art models like GPT 4.1 achieve high overall accuracy (86.6%), this top-line score masks alarming, previously unmeasured deficiencies. A granular analysis shows performance plummets from near-perfect in specialties like Ophthalmology (98.7%) to barely passing in Neurosurgery (60.0%) and, most notably, Social Work (68.4%). This "spiky" knowledge profile is a systemic issue observed across all models, demonstrating that high-level scores are insufficient for safety validation. By publicly releasing HealthQA-BR and our evaluation suite, we provide a crucial tool to move beyond single-score evaluations and toward a more honest, granular audit of AI readiness for the entire healthcare team.

Large language models offer transformative potential for healthcare, yet their responsible and equitable development depends critically on a deeper understanding of how training data characteristics influence model behavior, including the potential for bias. Current practices in dataset curation and bias assessment often lack the necessary transparency, creating an urgent need for comprehensive evaluation frameworks to foster trust and guide improvements. In this study, we present an in-depth analysis of potential downstream biases in clinical language models, with a focus on differential opioid prescription tendencies across diverse demographic groups, such as ethnicity, gender, and age. As part of this investigation, we introduce HC4: Healthcare Comprehensive Commons Corpus, a novel and extensively curated pretraining dataset exceeding 89 billion tokens. Our evaluation leverages both established general benchmarks and a novel, healthcare-specific methodology, offering crucial insights to support fairness and safety in clinical AI applications.

Healthcare systems continuously generate vast amounts of electronic health records (EHRs), commonly stored in the Fast Healthcare Interoperability Resources (FHIR) standard. Despite the wealth of information in these records, their complexity and volume make it difficult for users to retrieve and interpret crucial health insights. Recent advances in Large Language Models (LLMs) offer a solution, enabling semantic question answering (QA) over medical data, allowing users to interact with their health records more effectively. However, ensuring privacy and compliance requires edge and private deployments of LLMs. This paper proposes a novel approach to semantic QA over EHRs by first identifying the most relevant FHIR resources for a user query (Task1) and subsequently answering the query based on these resources (Task2). We explore the performance of privately hosted, fine-tuned LLMs, evaluating them against benchmark models such as GPT-4 and GPT-4o. Our results demonstrate that fine-tuned LLMs, while 250x smaller in size, outperform GPT-4 family models by 0.55% in F1 score on Task1 and 42% on Meteor Task in Task2. Additionally, we examine advanced aspects of LLM usage, including sequential fine-tuning, model self-evaluation (narcissistic evaluation), and the impact of training data size on performance. The models and datasets are available here: https://huggingface.co/genloop

Although large language models (LLMs) demonstrate expert-level medical knowledge, aligning their open-ended outputs with fine-grained clinician preferences remains challenging. Existing methods often rely on coarse objectives or unreliable automated judges that are weakly grounded in professional guidelines. We propose a two-stage framework to address this gap. First, we introduce HealthRubrics, a dataset of 7,034 physician-verified preference examples in which clinicians refine LLM-drafted rubrics to meet rigorous medical standards. Second, we distill these rubrics into HealthPrinciples: 119 broadly reusable, clinically grounded principles organized by clinical dimensions, enabling scalable supervision beyond manual annotation. We use HealthPrinciples for (1) offline alignment by synthesizing rubrics for unlabeled queries and (2) an inference-time tool for guided self-revision. A 30B parameter model that activates only 3B parameters at inference trained with our framework achieves 33.4% on HealthBench-Hard, outperforming much larger models including Deepseek-R1 and o3, establishing a resource-efficient baseline for clinical alignment.

Large visual language models (VLMs) have shown strong multi-modal medical reasoning ability, but most operate as end-to-end black boxes, diverging from clinicians' evidence-based, staged workflows and hindering clinical accountability. Complementarily, expert visual grounding models can accurately localize regions of interest (ROIs), providing explicit, reliable evidence that improves both reasoning accuracy and trust. In this paper, we introduce CARE, advancing Clinical Accountability in multi-modal medical Reasoning with an Evidence-grounded agentic framework. Unlike existing approaches that couple grounding and reasoning within a single generalist model, CARE decomposes the task into coordinated sub-modules to reduce shortcut learning and hallucination: a compact VLM proposes relevant medical entities; an expert entity-referring segmentation model produces pixel-level ROI evidence; and a grounded VLM reasons over the full image augmented by ROI hints. The VLMs are optimized with reinforcement learning with verifiable rewards to align answers with supporting evidence. Furthermore, a VLM coordinator plans tool invocation and reviews evidence-answer consistency, providing agentic control and final verification. Evaluated on standard medical VQA benchmarks, our CARE-Flow (coordinator-free) improves average accuracy by 10.9% over the same size (10B) state-of-the-art (SOTA). With dynamic planning and answer review, our CARE-Coord yields a further gain, outperforming the heavily pre-trained SOTA by 5.2%. Our experiments demonstrate that an agentic framework that emulates clinical workflows, incorporating decoupled specialized models and explicit evidence, yields more accurate and accountable medical AI. Project page: https://xypb.github.io/CARE-Project-Page/

Public health reasoning requires population level inference grounded in scientific evidence, expert consensus, and safety constraints. However, it remains underexplored as a structured machine learning problem with limited supervised signals and benchmarks. We introduce GlobalHealthAtlas, a large scale multilingual dataset of 280,210 instances spanning 15 public health domains and 17 languages. We further propose a large language model (LLM) assisted construction and quality control pipeline with retrieval, deduplication, evidence grounding checks, and label validation to improve consistency at scale. Finally, we present a domain aligned evaluator distilled from high confidence judgments of diverse LLMs to assess outputs along six dimensions: Accuracy, Reasoning, Completeness, Consensus Alignment, Terminology Norms, and Insightfulness. Together, these contributions enable reproducible training and evaluation of LLMs for safety critical public health reasoning beyond conventional QA benchmarks. We publicly release project codebase, evaluator, and model at:: https://github.com/Jan8217/GlobalHealthAtlas, https://huggingface.co/aerovane0/GlobalHealthAtlas_Public_Evaluator and https://huggingface.co/aerovane0/GlobalHealthAtlas_Public_Model

Large Language Models (LLMs) are increasingly used for clinical decision support, where hallucinations and unsafe suggestions may pose direct risks to patient safety. These risks are particularly challenging as they often manifest as subtle clinical errors that evade detection by generic metrics, while expert-authored fine-grained rubrics remain costly to construct and difficult to scale. In this paper, we propose a retrieval-augmented multi-agent framework designed to automate the generation of instance-specific evaluation rubrics. Our approach grounds evaluation in authoritative medical evidence by decomposing retrieved content into atomic facts and synthesizing them with user interaction constraints to form verifiable, fine-grained evaluation criteria. Evaluated on HealthBench, our framework achieves a Clinical Intent Alignment (CIA) score of 60.12%, a statistically significant improvement over the GPT-4o baseline (55.16%). In discriminative tests, our rubrics yield a mean score delta (μ_Δ = 8.658) and an AUROC of 0.977, nearly doubling the quality separation achieved by GPT-4o baseline (4.972). Beyond evaluation, our rubrics effectively guide response refinement, improving quality by 9.2% (from 59.0% to 68.2%). This provides a scalable and transparent foundation for both evaluating and improving medical LLMs. The code is available at https://anonymous.4open.science/r/Automated-Rubric-Generation-AF3C/.

The accelerating development of general medical artificial intelligence (GMAI), powered by multimodal large language models (MLLMs), offers transformative potential for addressing persistent healthcare challenges, including workforce deficits and escalating costs. The parallel development of systematic evaluation benchmarks emerges as a critical imperative to enable performance assessment and provide technological guidance. Meanwhile, as an invaluable knowledge source, the potential of medical textbooks for benchmark development remains underexploited. Here, we present MedBookVQA, a systematic and comprehensive multimodal benchmark derived from open-access medical textbooks. To curate this benchmark, we propose a standardized pipeline for automated extraction of medical figures while contextually aligning them with corresponding medical narratives. Based on this curated data, we generate 5,000 clinically relevant questions spanning modality recognition, disease classification, anatomical identification, symptom diagnosis, and surgical procedures. A multi-tier annotation system categorizes queries through hierarchical taxonomies encompassing medical imaging modalities (42 categories), body anatomies (125 structures), and clinical specialties (31 departments), enabling nuanced analysis across medical subdomains. We evaluate a wide array of MLLMs, including proprietary, open-sourced, medical, and reasoning models, revealing significant performance disparities across task types and model categories. Our findings highlight critical capability gaps in current GMAI systems while establishing textbook-derived multimodal benchmarks as essential evaluation tools. MedBookVQA establishes textbook-derived benchmarking as a critical paradigm for advancing clinical AI, exposing limitations in GMAI systems while providing anatomically structured performance metrics across specialties.

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.

Fake news detection becomes particularly challenging in real-time scenarios, where emerging events often lack sufficient supporting evidence. Existing approaches often rely heavily on external evidence and therefore struggle to generalize under evidence scarcity. To address this issue, we propose Evaluation-Aware Selection of Experts (EASE), a novel framework for real-time fake news detection that dynamically adapts its decision-making process according to the assessed sufficiency of available evidence. EASE introduces a sequential evaluation mechanism comprising three independent perspectives: (1) Evidence-based evaluation, which assesses evidence and incorporates it into decision-making only when the evidence is sufficiently supportive; (2) Reasoning-based evaluation, which leverages the world knowledge of large language models (LLMs) and applies them only when their reliability is adequately established; and (3) Sentiment-based fallback, which integrates sentiment cues when neither evidence nor reasoning is reliable. To enhance the accuracy of evaluation processes, EASE employs instruction tuning with pseudo labels to guide each evaluator in justifying its perspective-specific knowledge through interpretable reasoning. Furthermore, the expert modules integrate the evaluators' justified assessments with the news content to enable evaluation-aware decision-making, thereby enhancing overall detection accuracy. Moreover, we introduce RealTimeNews-25, a new benchmark comprising recent news for evaluating model generalization on emerging news with limited evidence. Extensive experiments demonstrate that EASE not only achieves state-of-the-art performance across multiple benchmarks, but also significantly improves generalization to real-time news. The code and dataset are available: https://github.com/wgyhhhh/EASE.

Patient recruitment is challenging for clinical trials. We introduce TrialGPT, an end-to-end framework for zero-shot patient-to-trial matching with large language models. TrialGPT comprises three modules: it first performs large-scale filtering to retrieve candidate trials (TrialGPT-Retrieval); then predicts criterion-level patient eligibility (TrialGPT-Matching); and finally generates trial-level scores (TrialGPT-Ranking). We evaluate TrialGPT on three cohorts of 183 synthetic patients with over 75,000 trial annotations. TrialGPT-Retrieval can recall over 90% of relevant trials using less than 6% of the initial collection. Manual evaluations on 1,015 patient-criterion pairs show that TrialGPT-Matching achieves an accuracy of 87.3% with faithful explanations, close to the expert performance. The TrialGPT-Ranking scores are highly correlated with human judgments and outperform the best-competing models by 43.8% in ranking and excluding trials. Furthermore, our user study reveals that TrialGPT can reduce the screening time by 42.6% in patient recruitment. Overall, these results have demonstrated promising opportunities for patient-to-trial matching with TrialGPT.

Ensuring the accuracy of responses provided by large language models (LLMs) is crucial, particularly in clinical settings where incorrect information may directly impact patient health. To address this challenge, we construct K-QA, a dataset containing 1,212 patient questions originating from real-world conversations held on K Health (an AI-driven clinical platform). We employ a panel of in-house physicians to answer and manually decompose a subset of K-QA into self-contained statements. Additionally, we formulate two NLI-based evaluation metrics approximating recall and precision: (1) comprehensiveness, measuring the percentage of essential clinical information in the generated answer and (2) hallucination rate, measuring the number of statements from the physician-curated response contradicted by the LLM answer. Finally, we use K-QA along with these metrics to evaluate several state-of-the-art models, as well as the effect of in-context learning and medically-oriented augmented retrieval schemes developed by the authors. Our findings indicate that in-context learning improves the comprehensiveness of the models, and augmented retrieval is effective in reducing hallucinations. We make K-QA available to to the community to spur research into medically accurate NLP applications.

Radiological imaging is central to diagnosis, treatment planning, and clinical decision-making. Vision-language foundation models have spurred interest in automated radiology report generation (RRG), but safe deployment requires reliable clinical evaluation of generated reports. Existing metrics often rely on surface-level similarity or behave as black boxes, lacking interpretability. We introduce ICARE (Interpretable and Clinically-grounded Agent-based Report Evaluation), an interpretable evaluation framework leveraging large language model agents and dynamic multiple-choice question answering (MCQA). Two agents, each with either the ground-truth or generated report, generate clinically meaningful questions and quiz each other. Agreement on answers captures preservation and consistency of findings, serving as interpretable proxies for clinical precision and recall. By linking scores to question-answer pairs, ICARE enables transparent, and interpretable assessment. Clinician studies show ICARE aligns significantly more with expert judgment than prior metrics. Perturbation analyses confirm sensitivity to clinical content and reproducibility, while model comparisons reveal interpretable error patterns.

Language models can distinguish between testing and deployment phases -- a capability known as evaluation awareness. This has significant safety and policy implications, potentially undermining the reliability of evaluations that are central to AI governance frameworks and voluntary industry commitments. In this paper, we study evaluation awareness in Llama-3.3-70B-Instruct. We show that linear probes can separate real-world evaluation and deployment prompts, suggesting that current models internally represent this distinction. We also find that current safety evaluations are correctly classified by the probes, suggesting that they already appear artificial or inauthentic to models. Our findings underscore the importance of ensuring trustworthy evaluations and understanding deceptive capabilities. More broadly, our work showcases how model internals may be leveraged to support blackbox methods in safety audits, especially for future models more competent at evaluation awareness and deception.

Limited access to mental healthcare, extended wait times, and increasing capabilities of Large Language Models (LLMs) has led individuals to turn to LLMs for fulfilling their mental health needs. However, examining the multi-turn mental health conversation capabilities of LLMs remains under-explored. Existing evaluation frameworks typically focus on diagnostic accuracy and win-rates and often overlook alignment with patient-specific goals, values, and personalities required for meaningful conversations. To address this, we introduce MedAgent, a novel framework for synthetically generating realistic, multi-turn mental health sensemaking conversations and use it to create the Mental Health Sensemaking Dialogue (MHSD) dataset, comprising over 2,200 patient-LLM conversations. Additionally, we present MultiSenseEval, a holistic framework to evaluate the multi-turn conversation abilities of LLMs in healthcare settings using human-centric criteria. Our findings reveal that frontier reasoning models yield below-par performance for patient-centric communication and struggle at advanced diagnostic capabilities with average score of 31%. Additionally, we observed variation in model performance based on patient's persona and performance drop with increasing turns in the conversation. Our work provides a comprehensive synthetic data generation framework, a dataset and evaluation framework for assessing LLMs in multi-turn mental health conversations.

Large Language Models (LLMs) are increasingly used in healthcare, yet ensuring their safety and trustworthiness remains a barrier to deployment. Conversational medical assistants must avoid unsafe compliance without over-refusing benign queries. We present an iterative post-deployment alignment framework that applies Kahneman-Tversky Optimization (KTO) and Direct Preference Optimization (DPO) to refine models against domain-specific safety signals. Using the CARES-18K benchmark for adversarial robustness, we evaluate four LLMs (Llama-3B/8B, Meditron-8B, Mistral-7B) across multiple cycles. Our results show up to 42% improvement in safety-related metrics for harmful query detection, alongside interesting trade-offs against erroneous refusals, thereby exposing architecture-dependent calibration biases. We also perform ablation studies to identify when self-evaluation is reliable and when external or finetuned judges are necessary to maximize performance gains. Our findings underscore the importance of adopting best practices that balance patient safety, user trust, and clinical utility in the design of conversational medical assistants.

Language model users often issue queries that lack specification, where the context under which a query was issued -- such as the user's identity, the query's intent, and the criteria for a response to be useful -- is not explicit. For instance, a good response to a subjective query like "What book should I read next?" would depend on the user's preferences, and a good response to an open-ended query like "How do antibiotics work against bacteria?" would depend on the user's expertise. This makes evaluation of responses to such queries an ill-posed task, as evaluators may make arbitrary judgments about the response quality. To remedy this, we present contextualized evaluations, a protocol that synthetically constructs context surrounding an underspecified query and provides it during evaluation. We find that the presence of context can 1) alter conclusions drawn from evaluation, even flipping win rates between model pairs, 2) nudge evaluators to make fewer judgments based on surface-level criteria, like style, and 3) provide new insights about model behavior across diverse contexts. Specifically, our procedure uncovers an implicit bias towards WEIRD contexts in models' "default" responses and we find that models are not equally sensitive to following different contexts, even when they are provided in prompts.

Recent advances in medical large language models (LLMs), multimodal models, and agents demand evaluation frameworks that reflect real clinical workflows and safety constraints. We present MedBench v4, a nationwide, cloud-based benchmarking infrastructure comprising over 700,000 expert-curated tasks spanning 24 primary and 91 secondary specialties, with dedicated tracks for LLMs, multimodal models, and agents. Items undergo multi-stage refinement and multi-round review by clinicians from more than 500 institutions, and open-ended responses are scored by an LLM-as-a-judge calibrated to human ratings. We evaluate 15 frontier models. Base LLMs reach a mean overall score of 54.1/100 (best: Claude Sonnet 4.5, 62.5/100), but safety and ethics remain low (18.4/100). Multimodal models perform worse overall (mean 47.5/100; best: GPT-5, 54.9/100), with solid perception yet weaker cross-modal reasoning. Agents built on the same backbones substantially improve end-to-end performance (mean 79.8/100), with Claude Sonnet 4.5-based agents achieving up to 85.3/100 overall and 88.9/100 on safety tasks. MedBench v4 thus reveals persisting gaps in multimodal reasoning and safety for base models, while showing that governance-aware agentic orchestration can markedly enhance benchmarked clinical readiness without sacrificing capability. By aligning tasks with Chinese clinical guidelines and regulatory priorities, the platform offers a practical reference for hospitals, developers, and policymakers auditing medical AI.

Clinical decision-making increasingly relies on timely and context-aware access to patient information within Electronic Health Records (EHRs), yet most existing natural language question-answering (QA) systems are evaluated solely on benchmark datasets, limiting their practical relevance. To overcome this limitation, we introduce EHRNavigator, a multi-agent framework that harnesses AI agents to perform patient-level question answering across heterogeneous and multimodal EHR data. We assessed its performance using both public benchmark and institutional datasets under realistic hospital conditions characterized by diverse schemas, temporal reasoning demands, and multimodal evidence integration. Through quantitative evaluation and clinician-validated chart review, EHRNavigator demonstrated strong generalization, achieving 86% accuracy on real-world cases while maintaining clinically acceptable response times. Overall, these findings confirm that EHRNavigator effectively bridges the gap between benchmark evaluation and clinical deployment, offering a robust, adaptive, and efficient solution for real-world EHR question answering.

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

Large language models (LLMs) have shown remarkable progress in encoding clinical knowledge and responding to complex medical queries with appropriate clinical reasoning. However, their applicability in subspecialist or complex medical settings remains underexplored. In this work, we probe the performance of AMIE, a research conversational diagnostic AI system, in the subspecialist domain of breast oncology care without specific fine-tuning to this challenging domain. To perform this evaluation, we curated a set of 50 synthetic breast cancer vignettes representing a range of treatment-naive and treatment-refractory cases and mirroring the key information available to a multidisciplinary tumor board for decision-making (openly released with this work). We developed a detailed clinical rubric for evaluating management plans, including axes such as the quality of case summarization, safety of the proposed care plan, and recommendations for chemotherapy, radiotherapy, surgery and hormonal therapy. To improve performance, we enhanced AMIE with the inference-time ability to perform web search retrieval to gather relevant and up-to-date clinical knowledge and refine its responses with a multi-stage self-critique pipeline. We compare response quality of AMIE with internal medicine trainees, oncology fellows, and general oncology attendings under both automated and specialist clinician evaluations. In our evaluations, AMIE outperformed trainees and fellows demonstrating the potential of the system in this challenging and important domain. We further demonstrate through qualitative examples, how systems such as AMIE might facilitate conversational interactions to assist clinicians in their decision making. However, AMIE's performance was overall inferior to attending oncologists suggesting that further research is needed prior to consideration of prospective uses.

Unstructured clinical notes contain essential patient information but are challenging for physicians to search and interpret efficiently. Although large language models (LLMs) have shown promise in question answering (QA), most existing systems lack transparency, usability, and alignment with clinical workflows. This work introduces an interactive QA system that enables physicians to query clinical notes via text or voice and receive extractive answers highlighted directly in the note for traceability. The system was built using OpenAI models with zero-shot prompting and evaluated across multiple metrics, including exact string match, word overlap, SentenceTransformer similarity, and BERTScore. Results show that while exact match scores ranged from 47 to 62 percent, semantic similarity scores exceeded 87 percent, indicating strong contextual alignment even when wording varied. To assess usability, the system was also evaluated using simulated clinical personas. Seven diverse physician and nurse personas interacted with the system across scenario-based tasks and provided structured feedback. The evaluations highlighted strengths in intuitive design and answer accessibility, alongside opportunities for enhancing explanation clarity.

This paper introduces a novel, entity-aware metric, termed as Radiological Report (Text) Evaluation (RaTEScore), to assess the quality of medical reports generated by AI models. RaTEScore emphasizes crucial medical entities such as diagnostic outcomes and anatomical details, and is robust against complex medical synonyms and sensitive to negation expressions. Technically, we developed a comprehensive medical NER dataset, RaTE-NER, and trained an NER model specifically for this purpose. This model enables the decomposition of complex radiological reports into constituent medical entities. The metric itself is derived by comparing the similarity of entity embeddings, obtained from a language model, based on their types and relevance to clinical significance. Our evaluations demonstrate that RaTEScore aligns more closely with human preference than existing metrics, validated both on established public benchmarks and our newly proposed RaTE-Eval benchmark.

Large language models (LLMs) are increasingly applied to outpatient referral tasks across healthcare systems. However, there is a lack of standardized evaluation criteria to assess their effectiveness, particularly in dynamic, interactive scenarios. In this study, we systematically examine the capabilities and limitations of LLMs in managing tasks within Intelligent Outpatient Referral (IOR) systems and propose a comprehensive evaluation framework specifically designed for such systems. This framework comprises two core tasks: static evaluation, which focuses on evaluating the ability of predefined outpatient referrals, and dynamic evaluation, which evaluates capabilities of refining outpatient referral recommendations through iterative dialogues. Our findings suggest that LLMs offer limited advantages over BERT-like models, but show promise in asking effective questions during interactive dialogues.

We introduce PhysicianBench, a benchmark for evaluating LLM agents on physician tasks grounded in real clinical setting within electronic health record (EHR) environments. Existing medical agent benchmarks primarily focus on static knowledge recall, single-step atomic actions, or action intent without verifiable execution against the environment. As a result, they fail to capture the long-horizon, composite workflows that characterize real clinical systems. PhysicianBench comprises 100 long-horizon tasks adapted from real consultation cases between primary care and subspecialty physicians, with each task independently reviewed by a separate panel of physicians. Tasks are instantiated in an EHR environment with real patient records and accessed through the same standard APIs used by commercial EHR vendors. Tasks span 21 specialties (e.g., cardiology, endocrinology, oncology, psychiatry) and diverse workflow types (e.g., diagnosis interpretation, medication prescribing, treatment planning), requiring an average of 27 tool calls per task. Solving each task requires retrieving data across encounters, reasoning over heterogeneous clinical information, executing consequential clinical actions, and producing clinical documentation. Each task is decomposed into structured checkpoints (670 in total across the benchmark) capturing distinct stages of completion graded by task-specific scripts with execution-grounded verification. Across 13 proprietary and open-source LLM agents, the best-performing model achieves only 46% success rate (pass@1), while open-source models reach at most 19%, revealing a substantial gap between current agent capabilities and the demands of real-world clinical workflows. PhysicianBench provides a realistic and execution-grounded benchmark for measuring progress toward autonomous clinical agents.

Clinical trial matching is the task of identifying trials for which patients may be potentially eligible. Typically, this task is labor-intensive and requires detailed verification of patient electronic health records (EHRs) against the stringent inclusion and exclusion criteria of clinical trials. This process is manual, time-intensive, and challenging to scale up, resulting in many patients missing out on potential therapeutic options. Recent advancements in Large Language Models (LLMs) have made automating patient-trial matching possible, as shown in multiple concurrent research studies. However, the current approaches are confined to constrained, often synthetic datasets that do not adequately mirror the complexities encountered in real-world medical data. In this study, we present the first, end-to-end large-scale empirical evaluation of clinical trial matching using real-world EHRs. Our study showcases the capability of LLMs to accurately match patients with appropriate clinical trials. We perform experiments with proprietary LLMs, including GPT-4 and GPT-3.5, as well as our custom fine-tuned model called OncoLLM and show that OncoLLM, despite its significantly smaller size, not only outperforms GPT-3.5 but also matches the performance of qualified medical doctors. All experiments were carried out on real-world EHRs that include clinical notes and available clinical trials from a single cancer center in the United States.

Hospitals and healthcare systems rely on operational decisions that determine patient flow, cost, and quality of care. Despite strong performance on medical knowledge and conversational benchmarks, foundation models trained on general text may lack the specialized knowledge required for these operational decisions. We introduce Lang1, a family of models (100M-7B parameters) pretrained on a specialized corpus blending 80B clinical tokens from NYU Langone Health's EHRs and 627B tokens from the internet. To rigorously evaluate Lang1 in real-world settings, we developed the REalistic Medical Evaluation (ReMedE), a benchmark derived from 668,331 EHR notes that evaluates five critical tasks: 30-day readmission prediction, 30-day mortality prediction, length of stay, comorbidity coding, and predicting insurance claims denial. In zero-shot settings, both general-purpose and specialized models underperform on four of five tasks (36.6%-71.7% AUROC), with mortality prediction being an exception. After finetuning, Lang1-1B outperforms finetuned generalist models up to 70x larger and zero-shot models up to 671x larger, improving AUROC by 3.64%-6.75% and 1.66%-23.66% respectively. We also observed cross-task scaling with joint finetuning on multiple tasks leading to improvement on other tasks. Lang1-1B effectively transfers to out-of-distribution settings, including other clinical tasks and an external health system. Our findings suggest that predictive capabilities for hospital operations require explicit supervised finetuning, and that this finetuning process is made more efficient by in-domain pretraining on EHR. Our findings support the emerging view that specialized LLMs can compete with generalist models in specialized tasks, and show that effective healthcare systems AI requires the combination of in-domain pretraining, supervised finetuning, and real-world evaluation beyond proxy benchmarks.

In psychotherapy, therapeutic outcome assessment, or treatment outcome evaluation, is essential for enhancing mental health care by systematically evaluating therapeutic processes and outcomes. Existing large language model approaches often focus on therapist-centered, single-session evaluations, neglecting the client's subjective experience and longitudinal progress across multiple sessions. To address these limitations, we propose IPAEval, a client-Informed Psychological Assessment-based Evaluation framework that automates treatment outcome evaluations from the client's perspective using clinical interviews. IPAEval integrates cross-session client-contextual assessment and session-focused client-dynamics assessment to provide a comprehensive understanding of therapeutic progress. Experiments on our newly developed TheraPhase dataset demonstrate that IPAEval effectively tracks symptom severity and treatment outcomes over multiple sessions, outperforming previous single-session models and validating the benefits of items-aware reasoning mechanisms.

The potential of Multimodal Large Language Models (MLLMs) in domain of medical imaging raise the demands of systematic and rigorous evaluation frameworks that are aligned with the real-world medical imaging practice. Existing practices that report single or coarse-grained metrics are lack the granularity required for specialized clinical support and fail to assess the reliability of reasoning mechanisms. To address this, we propose a paradigm shift toward multidimensional, fine-grained and in-depth evaluation. Based on a two-stage systematic construction pipeline designed for this paradigm, we instantiate it with MedRCube. We benchmark 33 MLLMs, Lingshu-32B achieve top-tier performance. Crucially, MedRCube exposes a series of pronounced insights inaccessible under prior evaluation settings. Furthermore, we introduce a credibility evaluation subset to quantify reasoning credibility, uncover a highly significant positive association between shortcut behavior and diagnostic task performance, raising concerns for clinically trustworthy deployment. The resources of this work can be found at https://github.com/F1mc/MedRCube.

The meaningful use of electronic health records (EHR) continues to progress in the digital era with clinical decision support systems augmented by artificial intelligence. A priority in improving provider experience is to overcome information overload and reduce the cognitive burden so fewer medical errors and cognitive biases are introduced during patient care. One major type of medical error is diagnostic error due to systematic or predictable errors in judgment that rely on heuristics. The potential for clinical natural language processing (cNLP) to model diagnostic reasoning in humans with forward reasoning from data to diagnosis and potentially reduce the cognitive burden and medical error has not been investigated. Existing tasks to advance the science in cNLP have largely focused on information extraction and named entity recognition through classification tasks. We introduce a novel suite of tasks coined as Diagnostic Reasoning Benchmarks, DR.BENCH, as a new benchmark for developing and evaluating cNLP models with clinical diagnostic reasoning ability. The suite includes six tasks from ten publicly available datasets addressing clinical text understanding, medical knowledge reasoning, and diagnosis generation. DR.BENCH is the first clinical suite of tasks designed to be a natural language generation framework to evaluate pre-trained language models. Experiments with state-of-the-art pre-trained generative language models using large general domain models and models that were continually trained on a medical corpus demonstrate opportunities for improvement when evaluated in DR. BENCH. We share DR. BENCH as a publicly available GitLab repository with a systematic approach to load and evaluate models for the cNLP community.

In this study, we aimed to determine if fine-tuned large language models (LLMs) can generate accurate, personalized impressions for whole-body PET reports. Twelve language models were trained on a corpus of PET reports using the teacher-forcing algorithm, with the report findings as input and the clinical impressions as reference. An extra input token encodes the reading physician's identity, allowing models to learn physician-specific reporting styles. Our corpus comprised 37,370 retrospective PET reports collected from our institution between 2010 and 2022. To identify the best LLM, 30 evaluation metrics were benchmarked against quality scores from two nuclear medicine (NM) physicians, with the most aligned metrics selecting the model for expert evaluation. In a subset of data, model-generated impressions and original clinical impressions were assessed by three NM physicians according to 6 quality dimensions (3-point scale) and an overall utility score (5-point scale). Each physician reviewed 12 of their own reports and 12 reports from other physicians. Bootstrap resampling was used for statistical analysis. Of all evaluation metrics, domain-adapted BARTScore and PEGASUSScore showed the highest Spearman's rank correlations (0.568 and 0.563) with physician preferences. Based on these metrics, the fine-tuned PEGASUS model was selected as the top LLM. When physicians reviewed PEGASUS-generated impressions in their own style, 89% were considered clinically acceptable, with a mean utility score of 4.08 out of 5. Physicians rated these personalized impressions as comparable in overall utility to the impressions dictated by other physicians (4.03, P=0.41). In conclusion, personalized impressions generated by PEGASUS were clinically useful, highlighting its potential to expedite PET reporting.

Background: Clinical documentation represents a significant burden for healthcare providers, with physicians spending up to 2 hours daily on administrative tasks. Recent advances in large language models (LLMs) offer promising solutions, but privacy concerns and computational requirements limit their adoption in healthcare settings. Objective: To develop and evaluate a privacy-preserving, on-device medical transcription system using a fine-tuned Llama 3.2 1B model capable of generating structured medical notes from medical transcriptions while maintaining complete data sovereignty entirely in the browser. Methods: We fine-tuned a Llama 3.2 1B model using Parameter-Efficient Fine-Tuning (PEFT) with LoRA on 1,500 synthetic medical transcription-to-structured note pairs. The model was evaluated against the base Llama 3.2 1B on two datasets: 100 endocrinology transcripts and 140 modified ACI benchmark cases. Evaluation employed both statistical metrics (ROUGE, BERTScore, BLEURT) and LLM-as-judge assessments across multiple clinical quality dimensions. Results: The fine-tuned OnDevice model demonstrated substantial improvements over the base model. On the ACI benchmark, ROUGE-1 scores increased from 0.346 to 0.496, while BERTScore F1 improved from 0.832 to 0.866. Clinical quality assessments showed marked reduction in major hallucinations (from 85 to 35 cases) and enhanced factual correctness (2.81 to 3.54 on 5-point scale). Similar improvements were observed on the internal evaluation dataset, with composite scores increasing from 3.13 to 4.43 (+41.5%). Conclusions: Fine-tuning compact LLMs for medical transcription yields clinically meaningful improvements while enabling complete on-device browser deployment. This approach addresses key barriers to AI adoption in healthcare: privacy preservation, cost reduction, and accessibility for resource-constrained environments.

Manual curation of evaluation datasets is struggling to keep up with the rapidly expanding capabilities and deployment scenarios of language models. Towards scalable model profiling, we introduce and validate a framework for evaluating LLMs, called Adaptive Evaluations. Adaptive evaluations use scaffolded language models (evaluator agents) to search through a target model's behavior on a domain dataset and create difficult questions (tasks) that can discover and probe the model's failure modes. We find that frontier models lack consistency when adaptively probed with our framework on a diverse suite of datasets and tasks, including but not limited to legal reasoning, forecasting, and online harassment. Generated questions pass human validity checks and often transfer to other models with different capability profiles, demonstrating that adaptive evaluations can also be used to create difficult domain-specific datasets.

The large language model (LLM)-as-judge paradigm has been used to meet the demand for a cheap, reliable, and fast evaluation of model outputs during AI system development and post-deployment monitoring. While judge models -- LLMs finetuned to specialize in assessing and critiquing model outputs -- have been touted as general purpose evaluators, they are typically evaluated only on non-contextual scenarios, such as instruction following. The omission of contextual settings -- those where external information is used as context to generate an output -- is surprising given the increasing prevalence of retrieval-augmented generation (RAG) and summarization use cases. Contextual assessment is uniquely challenging, as evaluation often depends on practitioner priorities, leading to conditional evaluation criteria (e.g., comparing responses based on factuality and then considering completeness if they are equally factual). To address the gap, we propose ContextualJudgeBench, a judge benchmark with 2,000 challenging response pairs across eight splits inspired by real-world contextual evaluation scenarios. We build our benchmark with a multi-pronged data construction pipeline that leverages both existing human annotations and model-based perturbations. Our comprehensive study across 11 judge models and 9 general purpose models, reveals that the contextual information and its assessment criteria present a significant challenge to even state-of-the-art models. For example, OpenAI's o1, the best-performing model, barely reaches 55% consistent accuracy.

Recent text-to-video (T2V) technology advancements, as demonstrated by models such as Gen2, Pika, and Sora, have significantly broadened its applicability and popularity. Despite these strides, evaluating these models poses substantial challenges. Primarily, due to the limitations inherent in automatic metrics, manual evaluation is often considered a superior method for assessing T2V generation. However, existing manual evaluation protocols face reproducibility, reliability, and practicality issues. To address these challenges, this paper introduces the Text-to-Video Human Evaluation (T2VHE) protocol, a comprehensive and standardized protocol for T2V models. The T2VHE protocol includes well-defined metrics, thorough annotator training, and an effective dynamic evaluation module. Experimental results demonstrate that this protocol not only ensures high-quality annotations but can also reduce evaluation costs by nearly 50%. We will open-source the entire setup of the T2VHE protocol, including the complete protocol workflow, the dynamic evaluation component details, and the annotation interface code. This will help communities establish more sophisticated human assessment protocols.

Online medical service provides patients convenient access to doctors, but effectively ranking doctors based on specific medical needs remains challenging. Current ranking approaches typically lack the interpretability crucial for patient trust and informed decision-making. Additionally, the scarcity of standardized benchmarks and labeled data for supervised learning impedes progress in expertise-aware doctor ranking. To address these challenges, we propose an explainable ranking framework for doctor ranking powered by large language models in a zero-shot setting. Our framework dynamically generates disease-specific ranking criteria to guide the large language model in assessing doctor relevance with transparency and consistency. It further enhances interpretability by generating step-by-step rationales for its ranking decisions, improving the overall explainability of the information retrieval process. To support rigorous evaluation, we built and released DrRank, a novel expertise-driven dataset comprising 38 disease-treatment pairs and 4,325 doctor profiles. On this benchmark, our framework significantly outperforms the strongest baseline by +6.45 NDCG@10. Comprehensive analyses also show our framework is fair across disease types, patient gender, and geographic regions. Furthermore, verification by medical experts confirms the reliability and interpretability of our approach, reinforcing its potential for trustworthy, real-world doctor recommendation. To demonstrate its broader applicability, we validate our framework on two datasets from BEIR benchmark, where it again achieves superior performance. The code and associated data are available at: https://github.com/YangLab-BUPT/DrRank.

As the performance of large language models (LLMs) continues to advance, their adoption is expanding across a wide range of domains, including the medical field. The integration of LLMs into medical applications raises critical safety concerns, particularly due to their use by users with diverse roles, e.g. patients and clinicians, and the potential for model's outputs to directly affect human health. Despite the domain-specific capabilities of medical LLMs, prior safety evaluations have largely focused only on general safety benchmarks. In this paper, we introduce a safety evaluation protocol tailored to the medical domain in both patient user and clinician user perspectives, alongside general safety assessments and quantitatively analyze the safety of medical LLMs. We bridge a gap in the literature by building the PatientSafetyBench containing 466 samples over 5 critical categories to measure safety from the perspective of the patient. We apply our red-teaming protocols on the MediPhi model collection as a case study. To our knowledge, this is the first work to define safety evaluation criteria for medical LLMs through targeted red-teaming taking three different points of view - patient, clinician, and general user - establishing a foundation for safer deployment in medical domains.

The Model Context Protocol has emerged as a transformative standard for connecting large language models to external data sources and tools, rapidly gaining adoption across major AI providers and development platforms. However, existing benchmarks are overly simplistic and fail to capture real application challenges such as long-horizon reasoning and large, unfamiliar tool spaces. To address this critical gap, we introduce MCP-Universe, the first comprehensive benchmark specifically designed to evaluate LLMs in realistic and hard tasks through interaction with real-world MCP servers. Our benchmark encompasses 6 core domains spanning 11 different MCP servers: Location Navigation, Repository Management, Financial Analysis, 3D Design, Browser Automation, and Web Searching. To ensure rigorous evaluation, we implement execution-based evaluators, including format evaluators for agent format compliance, static evaluators for time-invariant content matching, and dynamic evaluators that automatically retrieve real-time ground truth for temporally sensitive tasks. Through extensive evaluation of leading LLMs, we find that even SOTA models such as GPT-5 (43.72%), Grok-4 (33.33%) and Claude-4.0-Sonnet (29.44%) exhibit significant performance limitations. In addition, our benchmark poses a significant long-context challenge for LLM agents, as the number of input tokens increases rapidly with the number of interaction steps. Moreover, it introduces an unknown-tools challenge, as LLM agents often lack familiarity with the precise usage of the MCP servers. Notably, enterprise-level agents like Cursor cannot achieve better performance than standard ReAct frameworks. Beyond evaluation, we open-source our extensible evaluation framework with UI support, enabling researchers and practitioners to seamlessly integrate new agents and MCP servers while fostering innovation in the rapidly evolving MCP ecosystem.

Most medical multimodal benchmarks focus on static tasks such as image question answering, report generation, and plain-language rewriting. Patient education is more demanding: systems must identify relevant evidence across images, show patients where to look, explain findings in accessible language, and handle confusion or distress. Yet most patient education work remains text-only, even though combined image-and-text explanations may better support understanding. We introduce MedImageEdu, a benchmark for multi-turn, evidence-grounded radiology patient education. Each case provides a radiology report with report text and case images. A DoctorAgent interacts with a PatientAgent, conditioned on a hidden profile that captures factors such as education level, health literacy, and personality. When a patient question would benefit from visual support, the DoctorAgent can issue drawing instructions grounded in the report, case images, and the current question to a benchmark-provided drawing tool. The tool returns image(s), after which the DoctorAgent produces a final multimodal response consisting of the image(s) and a grounded plain-language explanation. MedImageEdu contains 150 cases from three sources and evaluates both the consultation process and the final multimodal response along five dimensions: Consultation, Safety and Scope, Language Quality, Drawing Quality, and Image-Text Response Quality. Across representative open- and closed-source vision-language model agents, we find three consistent gaps: fluent language often outpaces faithful visual grounding, safety is the weakest dimension across disease categories, and emotionally tense interactions are harder than low education or low health literacy. MedImageEdu provides a controlled testbed for assessing whether multimodal agents can teach from evidence rather than merely answer from text.

While large language models (LLMs) achieve near-perfect scores on medical licensing exams, these evaluations inadequately reflect the complexity and diversity of real-world clinical practice. We introduce MedHELM, an extensible evaluation framework for assessing LLM performance for medical tasks with three key contributions. First, a clinician-validated taxonomy spanning 5 categories, 22 subcategories, and 121 tasks developed with 29 clinicians. Second, a comprehensive benchmark suite comprising 35 benchmarks (17 existing, 18 newly formulated) providing complete coverage of all categories and subcategories in the taxonomy. Third, a systematic comparison of LLMs with improved evaluation methods (using an LLM-jury) and a cost-performance analysis. Evaluation of 9 frontier LLMs, using the 35 benchmarks, revealed significant performance variation. Advanced reasoning models (DeepSeek R1: 66% win-rate; o3-mini: 64% win-rate) demonstrated superior performance, though Claude 3.5 Sonnet achieved comparable results at 40% lower estimated computational cost. On a normalized accuracy scale (0-1), most models performed strongly in Clinical Note Generation (0.73-0.85) and Patient Communication & Education (0.78-0.83), moderately in Medical Research Assistance (0.65-0.75), and generally lower in Clinical Decision Support (0.56-0.72) and Administration & Workflow (0.53-0.63). Our LLM-jury evaluation method achieved good agreement with clinician ratings (ICC = 0.47), surpassing both average clinician-clinician agreement (ICC = 0.43) and automated baselines including ROUGE-L (0.36) and BERTScore-F1 (0.44). Claude 3.5 Sonnet achieved comparable performance to top models at lower estimated cost. These findings highlight the importance of real-world, task-specific evaluation for medical use of LLMs and provides an open source framework to enable this.

Evaluating large language models (LLMs) for medical applications remains challenging due to benchmark saturation, limited data accessibility, and insufficient coverage of relevant tasks. Existing suites have either saturated, heavily depend on restricted datasets, or lack comprehensive model coverage. We introduce Medmarks, a fully open-source evaluation suite with 30 benchmarks spanning question answering, information extraction, medical calculations, and open-ended clinical reasoning. We perform a systematic evaluation of 61 models across 71 configurations using verifiable metrics and LLM-as-a-Judge. Our results show that frontier reasoning models (Gemini 3 Pro Preview, GPT-5.1, & GPT-5.2) achieve the highest performance across both benchmarks, most frontier proprietary models are significantly more token efficient than open-weight alternatives, medically fine-tuned models outperform their generalist counterparts, and that models are susceptible to answer-order bias (particularly smaller models and Grok 4). A subset of our evals (Medmarks-T) can be directly used as reinforcement learning environments to post-train LLMs for medical reasoning. Code is available at https://github.com/MedARC-AI/Medmarks

Finetuning specialized generative evaluators has emerged as a popular paradigm to meet the increasing demand for scalable evaluation during both training and test-time. However, recent work has largely focused on applying new methodology, such as reinforcement learning (RL), to training evaluators, shying away from large-scale, data-driven development. In this work, we focus on data scaling, curating a set of 2.5M samples spanning five unique evaluation tasks (pairwise, step-level, reference-free and reference-based verification, and single rating) and multiple domains focused on reasoning evaluation. With our data, we train Foundational Automatic Reasoning Evaluators (FARE), a family of 8B and 20B (with 3.6B active) parameter evaluators, with a simple iterative rejection-sampling supervised finetuning (SFT) approach. FARE-8B challenges larger specialized RL-trained evaluators and FARE-20B sets the new standard for open-source evaluators, surpassing specialized 70B+ evaluators. Beyond static benchmarks, we evaluate FARE in real-world tasks: As inference-time rerankers, FARE-20B achieves near-oracle performance on MATH. As verifiers in RL training, FARE improves the downstream RL-trained model performance by up to 14.1% vs. string-matching verifiers. When initialized from FARE, a continually-finetuned FARE-Code outperforms gpt-oss-20B by 65% on evaluating test-case quality.

As Large Language Models (LLMs) are increasingly proposed for high-stakes medical applications, there has emerged a critical need for reliable and accurate evaluation methodologies. Traditional accuracy metrics fail inadequately as they neither capture question characteristics nor offer topic-specific insights. To address this gap, we introduce MedIRT, a rigorous evaluation framework grounded in Item Response Theory (IRT), the gold standard in high-stakes educational testing. Unlike previous research relying on archival data, we prospectively gathered fresh responses from 80 diverse LLMs on a balanced, 1,100-question USMLE-aligned benchmark. Using one unidimensional two-parameter logistic IRT model per topic, we estimate LLM's latent model ability jointly with question difficulty and discrimination, yielding more stable and nuanced performance rankings than accuracy alone. Notably, we identify distinctive ``spiky'' ability profiles, where overall rankings can be misleading due to highly specialized model abilities. While GPT-5 was the top performer in a majority of domains (8 of 11), it was outperformed in Social Science and Communication by Claude-3-opus, demonstrating that even an overall 23rd-ranked model can hold the top spot for specific competencies. Furthermore, we demonstrate IRT's utility in auditing benchmarks by identifying flawed questions. We synthesize these findings into a practical decision-support framework that integrates our multi-factor competency profiles with operational metrics. This work establishes a robust, psychometrically grounded methodology essential for the safe, effective, and trustworthy deployment of LLMs in healthcare.

Radiology reports convey detailed clinical observations and capture diagnostic reasoning that evolves over time. However, existing evaluation methods are limited to single-report settings and rely on coarse metrics that fail to capture fine-grained clinical semantics and temporal dependencies. We introduce LUNGUAGE,a benchmark dataset for structured radiology report generation that supports both single-report evaluation and longitudinal patient-level assessment across multiple studies. It contains 1,473 annotated chest X-ray reports, each reviewed by experts, and 80 of them contain longitudinal annotations to capture disease progression and inter-study intervals, also reviewed by experts. Using this benchmark, we develop a two-stage framework that transforms generated reports into fine-grained, schema-aligned structured representations, enabling longitudinal interpretation. We also propose LUNGUAGESCORE, an interpretable metric that compares structured outputs at the entity, relation, and attribute level while modeling temporal consistency across patient timelines. These contributions establish the first benchmark dataset, structuring framework, and evaluation metric for sequential radiology reporting, with empirical results demonstrating that LUNGUAGESCORE effectively supports structured report evaluation. The code is available at: https://github.com/SuperSupermoon/Lunguage

Long-form clinical videos are central to visual evidence-based decision-making, with growing importance for applications such as surgical robotics and related settings. However, current multimodal large language models typically process videos with passive sampling or weakly grounded inspection, which limits their ability to iteratively locate, verify, and justify predictions with temporally targeted evidence. To close this gap, we propose MedScope, a tool-using clinical video reasoning model that performs coarse-to-fine evidence seeking over long-form procedures. By interleaving intermediate reasoning with targeted tool calls and verification on retrieved observations, MedScope produces more accurate and trustworthy predictions that are explicitly grounded in temporally localized visual evidence. To address the lack of high-fidelity supervision, we build ClinVideoSuite, an evidence-centric, fine-grained clinical video suite. We then optimize MedScope with Grounding-Aware Group Relative Policy Optimization (GA-GRPO), which directly reinforces tool use with grounding-aligned rewards and evidence-weighted advantages. On full and fine-grained video understanding benchmarks, MedScope achieves state-of-the-art performance in both in-domain and out-of-domain evaluations. Our approach illuminates a path toward medical AI agents that can genuinely "think with videos" through tool-integrated reasoning. We will release our code, models, and data.

Reliable evaluation is essential for developing and deploying large language models, yet in practice it often requires substantial manual effort: practitioners must identify appropriate benchmarks, reproduce heterogeneous evaluation codebases, configure dataset schema mappings, and interpret aggregated metrics. To address these challenges, we present One-Eval, an agentic evaluation system that converts natural-language evaluation requests into executable, traceable, and customizable evaluation workflows. One-Eval integrates (i) NL2Bench for intent structuring and personalized benchmark planning, (ii) BenchResolve for benchmark resolution, automatic dataset acquisition, and schema normalization to ensure executability, and (iii) Metrics \& Reporting for task-aware metric selection and decision-oriented reporting beyond scalar scores. The system further incorporates human-in-the-loop checkpoints for review, editing, and rollback, while preserving sample evidence trails for debugging and auditability. Experiments show that One-Eval can execute end-to-end evaluations from diverse natural-language requests with minimal user effort, supporting more efficient and reproducible evaluation in industrial settings. Our framework is publicly available at https://github.com/OpenDCAI/One-Eval.

At the heart of medicine lies the physician-patient dialogue, where skillful history-taking paves the way for accurate diagnosis, effective management, and enduring trust. Artificial Intelligence (AI) systems capable of diagnostic dialogue could increase accessibility, consistency, and quality of care. However, approximating clinicians' expertise is an outstanding grand challenge. Here, we introduce AMIE (Articulate Medical Intelligence Explorer), a Large Language Model (LLM) based AI system optimized for diagnostic dialogue. AMIE uses a novel self-play based simulated environment with automated feedback mechanisms for scaling learning across diverse disease conditions, specialties, and contexts. We designed a framework for evaluating clinically-meaningful axes of performance including history-taking, diagnostic accuracy, management reasoning, communication skills, and empathy. We compared AMIE's performance to that of primary care physicians (PCPs) in a randomized, double-blind crossover study of text-based consultations with validated patient actors in the style of an Objective Structured Clinical Examination (OSCE). The study included 149 case scenarios from clinical providers in Canada, the UK, and India, 20 PCPs for comparison with AMIE, and evaluations by specialist physicians and patient actors. AMIE demonstrated greater diagnostic accuracy and superior performance on 28 of 32 axes according to specialist physicians and 24 of 26 axes according to patient actors. Our research has several limitations and should be interpreted with appropriate caution. Clinicians were limited to unfamiliar synchronous text-chat which permits large-scale LLM-patient interactions but is not representative of usual clinical practice. While further research is required before AMIE could be translated to real-world settings, the results represent a milestone towards conversational diagnostic AI.

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

Clinical decision support systems (CDSS) require scrutable, auditable pipelines that enable rigorous, reproducible validation. Yet current LLM-based CDSS remain largely opaque. Most "open" models are open-weight only, releasing parameters while withholding the data provenance, curation procedures, and generation pipelines that determine model behavior. Fully Open (FO) models, which expose the complete training stack end-to-end, do not currently exist in medicine. We introduce Fully Open Meditron, the first fully open pipeline for building LLM-CDSS, comprising a clinician-audited training corpus, a reproducible data construction and training framework, and a use-aligned evaluation protocol. The corpus unifies eight public medical QA datasets into a normalized conversational format and expands coverage with three clinician-vetted synthetic extensions: exam-style QA, guideline-grounded QA derived from 46,469 clinical practice guidelines, and clinical vignettes. The pipeline enforces system-wide decontamination, gold-label resampling of teacher generations, and end-to-end validation by a four-physician panel. We evaluate using an LLM-as-a-judge protocol over expert-written clinical vignettes, calibrated against 204 human raters. We apply the recipe to five FO base models (Apertus-70B/8B-Instruct, OLMo-2-32B-SFT, EuroLLM-22B/9B-Instruct). All MeditronFO variants are preferred over their bases. Apertus-70B-MeditronFO improves +6.6 points over its base (47.2% to 53.8%) on aggregate medical benchmarks, establishing a new FO SoTA. Gemma-3-27B-MeditronFO is preferred over MedGemma in 58.6% of LLM-as-a-judge comparisons and outperforms it on HealthBench (58% vs 55.9%). These results show that fully open pipelines can achieve state-of-the-art domain-specific performance without sacrificing auditability or reproducibility.

Large Language Models (LLMs) have demonstrated considerable potential in general practice. However, existing benchmarks and evaluation frameworks primarily depend on exam-style or simplified question-answer formats, lacking a competency-based structure aligned with the real-world clinical responsibilities encountered in general practice. Consequently, the extent to which LLMs can reliably fulfill the duties of general practitioners (GPs) remains uncertain. In this work, we propose a novel evaluation framework to assess the capability of LLMs to function as GPs. Based on this framework, we introduce a general practice benchmark (GPBench), whose data are meticulously annotated by domain experts in accordance with routine clinical practice standards. We evaluate ten state-of-the-art LLMs and analyze their competencies. Our findings indicate that current LLMs are not yet ready for deployment in such settings without human oversight, and further optimization specifically tailored to the daily responsibilities of GPs is essential.

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.

Current medical language models, adapted from large language models (LLMs), typically predict ICD code-based diagnosis from electronic health records (EHRs) because these labels are readily available. However, ICD codes do not capture the nuanced, context-rich reasoning clinicians use for diagnosis. Clinicians synthesize diverse patient data and reference clinical practice guidelines (CPGs) to make evidence-based decisions. This misalignment limits the clinical utility of existing models. We introduce GARMLE-G, a Generation-Augmented Retrieval framework that grounds medical language model outputs in authoritative CPGs. Unlike conventional Retrieval-Augmented Generation based approaches, GARMLE-G enables hallucination-free outputs by directly retrieving authoritative guideline content without relying on model-generated text. It (1) integrates LLM predictions with EHR data to create semantically rich queries, (2) retrieves relevant CPG knowledge snippets via embedding similarity, and (3) fuses guideline content with model output to generate clinically aligned recommendations. A prototype system for hypertension diagnosis was developed and evaluated on multiple metrics, demonstrating superior retrieval precision, semantic relevance, and clinical guideline adherence compared to RAG-based baselines, while maintaining a lightweight architecture suitable for localized healthcare deployment. This work provides a scalable, low-cost, and hallucination-free method for grounding medical language models in evidence-based clinical practice, with strong potential for broader clinical deployment.

Discharge summaries in Electronic Health Records (EHRs) are crucial for clinical decision-making, but their length and complexity make information extraction challenging, especially when dealing with accumulated summaries across multiple patient admissions. Large Language Models (LLMs) show promise in addressing this challenge by efficiently analyzing vast and complex data. Existing benchmarks, however, fall short in properly evaluating LLMs' capabilities in this context, as they typically focus on single-note information or limited topics, failing to reflect the real-world inquiries required by clinicians. To bridge this gap, we introduce EHRNoteQA, a novel benchmark built on the MIMIC-IV EHR, comprising 962 different QA pairs each linked to distinct patients' discharge summaries. Every QA pair is initially generated using GPT-4 and then manually reviewed and refined by three clinicians to ensure clinical relevance. EHRNoteQA includes questions that require information across multiple discharge summaries and covers eight diverse topics, mirroring the complexity and diversity of real clinical inquiries. We offer EHRNoteQA in two formats: open-ended and multi-choice question answering, and propose a reliable evaluation method for each. We evaluate 27 LLMs using EHRNoteQA and examine various factors affecting the model performance (e.g., the length and number of discharge summaries). Furthermore, to validate EHRNoteQA as a reliable proxy for expert evaluations in clinical practice, we measure the correlation between the LLM performance on EHRNoteQA, and the LLM performance manually evaluated by clinicians. Results show that LLM performance on EHRNoteQA have higher correlation with clinician-evaluated performance (Spearman: 0.78, Kendall: 0.62) compared to other benchmarks, demonstrating its practical relevance in evaluating LLMs in clinical settings.

Curated datasets for healthcare are often limited due to the need of human annotations from experts. In this paper, we present MedEval, a multi-level, multi-task, and multi-domain medical benchmark to facilitate the development of language models for healthcare. MedEval is comprehensive and consists of data from several healthcare systems and spans 35 human body regions from 8 examination modalities. With 22,779 collected sentences and 21,228 reports, we provide expert annotations at multiple levels, offering a granular potential usage of the data and supporting a wide range of tasks. Moreover, we systematically evaluated 10 generic and domain-specific language models under zero-shot and finetuning settings, from domain-adapted baselines in healthcare to general-purposed state-of-the-art large language models (e.g., ChatGPT). Our evaluations reveal varying effectiveness of the two categories of language models across different tasks, from which we notice the importance of instruction tuning for few-shot usage of large language models. Our investigation paves the way toward benchmarking language models for healthcare and provides valuable insights into the strengths and limitations of adopting large language models in medical domains, informing their practical applications and future advancements.

Recent advances in large language models have enabled their application to a range of healthcare tasks. However, aligning LLMs with the nuanced demands of medical ethics, especially under complex real world scenarios, remains underexplored. In this work, we present MedES, a dynamic, scenario-centric benchmark specifically constructed from 260 authoritative Chinese medical, ethical, and legal sources to reflect the challenges in clinical decision-making. To facilitate model alignment, we introduce a guardian-in-the-loop framework that leverages a dedicated automated evaluator (trained on expert-labeled data and achieving over 97% accuracy within our domain) to generate targeted prompts and provide structured ethical feedback. Using this pipeline, we align a 7B-parameter LLM through supervised fine-tuning and domain-specific preference optimization. Experimental results, conducted entirely within the Chinese medical ethics context, demonstrate that our aligned model outperforms notably larger baselines on core ethical tasks, with observed improvements in both quality and composite evaluation metrics. Our work offers a practical and adaptable framework for aligning LLMs with medical ethics in the Chinese healthcare domain, and suggests that similar alignment pipelines may be instantiated in other legal and cultural environments through modular replacement of the underlying normative corpus.

Large language models have exhibited exceptional performance on various Natural Language Processing (NLP) tasks, leveraging techniques such as the pre-training, and instruction fine-tuning. Despite these advances, their effectiveness in medical applications is limited, due to challenges such as factual inaccuracies, reasoning abilities, and lack grounding in real-world experience. In this study, we present ClinicalGPT, a language model explicitly designed and optimized for clinical scenarios. By incorporating extensive and diverse real-world data, such as medical records, domain-specific knowledge, and multi-round dialogue consultations in the training process, ClinicalGPT is better prepared to handle multiple clinical task. Furthermore, we introduce a comprehensive evaluation framework that includes medical knowledge question-answering, medical exams, patient consultations, and diagnostic analysis of medical records. Our results demonstrate that ClinicalGPT significantly outperforms other models in these tasks, highlighting the effectiveness of our approach in adapting large language models to the critical domain of healthcare.

Integrating language models (LMs) in healthcare systems holds great promise for improving medical workflows and decision-making. However, a critical barrier to their real-world adoption is the lack of reliable evaluation of their trustworthiness, especially in multilingual healthcare settings. Existing LMs are predominantly trained in high-resource languages, making them ill-equipped to handle the complexity and diversity of healthcare queries in mid- and low-resource languages, posing significant challenges for deploying them in global healthcare contexts where linguistic diversity is key. In this work, we present CLINIC, a Comprehensive Multilingual Benchmark to evaluate the trustworthiness of language models in healthcare. CLINIC systematically benchmarks LMs across five key dimensions of trustworthiness: truthfulness, fairness, safety, robustness, and privacy, operationalized through 18 diverse tasks, spanning 15 languages (covering all the major continents), and encompassing a wide array of critical healthcare topics like disease conditions, preventive actions, diagnostic tests, treatments, surgeries, and medications. Our extensive evaluation reveals that LMs struggle with factual correctness, demonstrate bias across demographic and linguistic groups, and are susceptible to privacy breaches and adversarial attacks. By highlighting these shortcomings, CLINIC lays the foundation for enhancing the global reach and safety of LMs in healthcare across diverse languages.

Clinical evidence, derived from rigorous research and data analysis, provides healthcare professionals with reliable scientific foundations for informed decision-making. Integrating clinical evidence into real-time practice is challenging due to the enormous workload, complex professional processes, and time constraints. This highlights the need for tools that automate evidence synthesis to support more efficient and accurate decision making in clinical settings. This study introduces Quicker, an evidence-based clinical decision support system powered by large language models (LLMs), designed to automate evidence synthesis and generate clinical recommendations modeled after standard clinical guideline development processes. Quicker implements a fully automated chain that covers all phases, from questions to clinical recommendations, and further enables customized decision-making through integrated tools and interactive user interfaces. To evaluate Quicker's capabilities, we developed the Q2CRBench-3 benchmark dataset, based on clinical guideline development records for three different diseases. Experimental results highlighted Quicker's strong performance, with fine-grained question decomposition tailored to user preferences, retrieval sensitivities comparable to human experts, and literature screening performance approaching comprehensive inclusion of relevant studies. In addition, Quicker-assisted evidence assessment effectively supported human reviewers, while Quicker's recommendations were more comprehensive and logically coherent than those of clinicians. In system-level testing, collaboration between a single reviewer and Quicker reduced the time required for recommendation development to 20-40 minutes. In general, our findings affirm the potential of Quicker to help physicians make quicker and more reliable evidence-based clinical decisions.

Real-world clinical decision-making grapples with integrating information from diverse data modalities, including medical text, 2D/3D images, and video, leading to inefficiencies and potential diagnostic oversights. While generalist vision-language models (VLMs) offer promise, their medical development faces challenges of opaque pipelines, data scarcity, and architectural inflexibility. Here we present Hulu-Med, a transparent medical VLM that unifies understanding across all these modalities. Built upon a unified patch-based vision encoder and an LLM decoder, Hulu-Med was progressively trained on 16.7 million (M) samples to scale from 2D to 3D and video comprehension. The medical-aware token reduction enables efficient training, requiring only 4,000 to 40,000 GPU hours for 7B to 32B parameter variants. Extensive evaluation across 30 benchmarks exhibits state-of-the-art performance, surpassing leading open-source models and competing with proprietary systems in tasks spanning visual question-answering, medical report generation, and complex reasoning in multilingual and rare disease scenarios. By open-sourcing our complete pipeline, we establish that high-performance medical VLM can be achieved transparently, providing a foundational tool for accessible and impactful clinical AI. Code is released on https://github.com/ZJUI-AI4H/Hulu-Med{https://github.com/ZJUI-AI4H/Hulu-Med}.

Automatic evaluation with large language models, commonly known as LLM-as-a-judge, is now standard across reasoning and alignment tasks. Despite evaluating many samples in deployment, these evaluators typically (i) treat each case independently, missing the opportunity to accumulate experience, and (ii) rely on a single fixed prompt for all cases, neglecting the need for sample-specific evaluation criteria. We introduce Learning While Evaluating (LWE), a framework that allows evaluators to improve sequentially at inference time without requiring training or validation sets. LWE maintains an evolving meta-prompt that (i) produces sample-specific evaluation instructions and (ii) refines itself through self-generated feedback. Furthermore, we propose Selective LWE, which updates the meta-prompt only on self-inconsistent cases, focusing computation where it matters most. This selective approach retains the benefits of sequential learning while being far more cost-effective. Across two pairwise comparison benchmarks, Selective LWE outperforms strong baselines, empirically demonstrating that evaluators can improve during sequential testing with a simple selective update, learning most from the cases they struggle with.

Despite the potential of Large Language Models (LLMs) in medicine, they may generate responses lacking supporting evidence or based on hallucinated evidence. While Retrieval Augment Generation (RAG) is popular to address this issue, few studies implemented and evaluated RAG in downstream domain-specific applications. We developed a RAG pipeline with 70,000 ophthalmology-specific documents that retrieve relevant documents to augment LLMs during inference time. In a case study on long-form consumer health questions, we systematically evaluated the responses including over 500 references of LLMs with and without RAG on 100 questions with 10 healthcare professionals. The evaluation focuses on factuality of evidence, selection and ranking of evidence, attribution of evidence, and answer accuracy and completeness. LLMs without RAG provided 252 references in total. Of which, 45.3% hallucinated, 34.1% consisted of minor errors, and 20.6% were correct. In contrast, LLMs with RAG significantly improved accuracy (54.5% being correct) and reduced error rates (18.8% with minor hallucinations and 26.7% with errors). 62.5% of the top 10 documents retrieved by RAG were selected as the top references in the LLM response, with an average ranking of 4.9. The use of RAG also improved evidence attribution (increasing from 1.85 to 2.49 on a 5-point scale, P<0.001), albeit with slight decreases in accuracy (from 3.52 to 3.23, P=0.03) and completeness (from 3.47 to 3.27, P=0.17). The results demonstrate that LLMs frequently exhibited hallucinated and erroneous evidence in the responses, raising concerns for downstream applications in the medical domain. RAG substantially reduced the proportion of such evidence but encountered challenges.