Evaluating Large Language Models in Dynamic Clinical Decision-Making with Standardized Patient Cases
Mirrored from arXiv — NLP / Computation & Language for archival readability. Support the source by reading on the original site.
Computer Science > Computation and Language
Title:Evaluating Large Language Models in Dynamic Clinical Decision-Making with Standardized Patient Cases
Abstract:Large language models (LLMs) are increasingly proposed as clinical agents, yet static, single-turn benchmarks cannot capture how a model dynamically delivers care across an encounter: gathering information, planning treatment, and adapting longitudinal management across successive patient states. Medical education has long addressed an analogous challenge through standardized patients (SPs): trained actors who consistently portray clinical cases, enabling realistic practice and objective, scripted assessment. Here we introduce MedSP1000, an SP-derived interactive benchmark for clinical-agent evaluation, including 1,638 SP cases with 24,602 trajectory-level peer-reviewed rubrics. MedSP1000 converts peer-reviewed SP teaching cases into executable scenarios with defined SP case scripts, clinical environment contexts, and human-validated structured rubric. In each simulation evaluation run, a clinical agent interacts in closed loop with a patient agent and an environment controller, and its behaviour is scored throughout the encounter against expert criteria specified in the original materials. Applying MedSP1000 to a range of general-purpose and medically specialized LLMs, we find that performance on static benchmarks does not reliably translate to such educational scenarios. The best-performing model, GPT-5.5, completes only 60.4% of expert-defined rubric items, whereas the strongest medically specialized model reaches 40.0%; increasing test-time compute produces no measurable gain. These results suggest that current LLMs, including agentic systems tuned for medicine, are not yet reliable enough to be safely integrated into actual clinical practice. More broadly, MedSP1000 shows how process-level, SP-style evaluation can reveal clinically relevant failure modes that single-turn benchmarks miss.
| Subjects: | Computation and Language (cs.CL) |
| Cite as: | arXiv:2606.05112 [cs.CL] |
| (or arXiv:2606.05112v1 [cs.CL] for this version) | |
| https://doi.org/10.48550/arXiv.2606.05112
arXiv-issued DOI via DataCite (pending registration)
|
Access Paper:
- View PDF
- TeX Source
References & Citations
Bookmark
Bibliographic and Citation Tools
Code, Data and Media Associated with this Article
Demos
Recommenders and Search Tools
arXivLabs: experimental projects with community collaborators
arXivLabs is a framework that allows collaborators to develop and share new arXiv features directly on our website.
Both individuals and organizations that work with arXivLabs have embraced and accepted our values of openness, community, excellence, and user data privacy. arXiv is committed to these values and only works with partners that adhere to them.
Have an idea for a project that will add value for arXiv's community? Learn more about arXivLabs.
More from arXiv — NLP / Computation & Language
-
GRPO, Dr. GRPO, and DAPO Are Three Operations on One Number: The Group-Standard-Deviation Identity
Jul 2
-
Testing Frontier Large Language Models' Physics Literacy in Parallel Physical Worlds
Jul 2
-
EPC: A Standardized Protocol for Measuring Evaluator Preference Dynamics in LLM Agent Systems
Jul 2
-
Mapping the Evaluation Frontier: An Empirical Survey of the Bias-Reliability Tradeoff Across Eleven Evaluator-Agent Conditions
Jul 2
Discussion (0)
Sign in to join the discussion. Free account, 30 seconds — email code or GitHub.
Sign in →No comments yet. Sign in and be the first to say something.