An evidence-traceable benchmark of clinical reasoning in large language models
2026-11-10 04:28:57
Zhiqun Zhao (Advanced Medical Research Institute and Key Laboratory for Experimental Teratology of the Ministry of Education, Cheeloo College of Medicine, Shandong University, Jinan, China), Xiaodong Yang (Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China), Bruce Gu (Shandong Computer Science Center, National Supercomputer Center in Jinan, Jinan, China, Qilu University of Technology, Shandong Academy of Sciences, Jinan, China), Ming Li (Department of Rheumatology and Immunology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China), Yi Fu (Information Network Management Office, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China), Song Li (Department of Medical Oncology, Qilu Hospital, Shandong University, Jinan, China), Qi Mei (Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China), Zhi Liu (Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China), Kai Zhang (Department of Breast Surgery, General Surgery, Qilu Hospital, Shandong University, Jinan, China), Kexue Fu (Shandong Computer Science Center, National Supercomputer Center in Jinan, Jinan, China, Qilu University of Technology, Shandong Academy of Sciences, Jinan, China), Jing Wu (Department of Central Laboratory, Public Health Clinical Center Affiliated to Shandong University, Shandong University, Jinan, China), Xiaofei Lu (Department of Breast Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, China), Yule Li (Advanced Medical Research Institute and Key Laboratory for Experimental Teratology of the Ministry of Education, Cheeloo College of Medicine, Shandong University, Jinan, China), Zheng Wang (Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China), Haiquan Lu (Advanced Medical Research Institute and Key Laboratory for Experimental Teratology of the Ministry of Education, Cheeloo College of Medicine, Shandong University, Jinan, China), Xiaoming Wu (Shandong Computer Science Center, National Supercomputer Center in Jinan, Jinan, China, Qilu University of Technology, Shandong Academy of Sciences, Jinan, China)
Benchmark scores for medical large language models (LLMs) are difficult to interpret when scoring criteria cannot be traced to clinical evidence. Here we developed Med Evidence Bench (MEB; this https URL), comprising 1,536 physician-constructed items across three levels: guideline knowledge, standardized clinical scenarios and real-world laboratory scenarios. Each criterion stating a medical claim is linked to a versioned source-text span. Across ten LLMs, the Evidence Trace Score (ETS) was 0.975-0.997 for guideline knowledge, 0.292-0.658 for standardized scenarios and 0.182-0.447 for real-world scenarios, and rankings varied across levels. For real-world scenarios, scores for identifying clinical information (mean, 0.770) exceeded those for matching evidence (0.165) or formulating recommendations (0.160). On 1,296 criterion-level judgments, automated grading agreed with the majority vote of three physicians (macro-F1, 0.930; 95% confidence interval, 0.915-0.945), although agreement was lower for evidence application. These findings from Chinese-language materials indicate that guideline recall does not ensure patient-specific evidence use and do not establish clinical effectiveness.
