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Jul 3

MATRIX: Multi-Agent simulaTion fRamework for safe Interactions and conteXtual clinical conversational evaluation

Despite the growing use of large language models (LLMs) in clinical dialogue systems, existing evaluations focus on task completion or fluency, offering little insight into the behavioral and risk management requirements essential for safety-critical systems. This paper presents MATRIX (Multi-Agent simulaTion fRamework for safe Interactions and conteXtual clinical conversational evaluation), a structured, extensible framework for safety-oriented evaluation of clinical dialogue agents. MATRIX integrates three components: (1) a safety-aligned taxonomy of clinical scenarios, expected system behaviors and failure modes derived through structured safety engineering methods; (2) BehvJudge, an LLM-based evaluator for detecting safety-relevant dialogue failures, validated against expert clinician annotations; and (3) PatBot, a simulated patient agent capable of producing diverse, scenario-conditioned responses, evaluated for realism and behavioral fidelity with human factors expertise, and a patient-preference study. Across three experiments, we show that MATRIX enables systematic, scalable safety evaluation. BehvJudge with Gemini 2.5-Pro achieves expert-level hazard detection (F1 0.96, sensitivity 0.999), outperforming clinicians in a blinded assessment of 240 dialogues. We also conducted one of the first realism analyses of LLM-based patient simulation, showing that PatBot reliably simulates realistic patient behavior in quantitative and qualitative evaluations. Using MATRIX, we demonstrate its effectiveness in benchmarking five LLM agents across 2,100 simulated dialogues spanning 14 hazard scenarios and 10 clinical domains. MATRIX is the first framework to unify structured safety engineering with scalable, validated conversational AI evaluation, enabling regulator-aligned safety auditing. We release all evaluation tools, prompts, structured scenarios, and datasets.

  • 12 authors
·
Aug 25, 2025

Beyond Overall Accuracy: A Psychometric Deep Dive into the Topic-Specific Medical Capabilities of 80 Large Language Models

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.

  • 4 authors
·
Sep 28, 2025

MedSkillAudit: A Domain-Specific Audit Framework for Medical Research Agent Skills

Background: Agent skills are increasingly deployed as modular, reusable capability units in AI agent systems. Medical research agent skills require safeguards beyond general-purpose evaluation, including scientific integrity, methodological validity, reproducibility, and boundary safety. This study developed and preliminarily evaluated a domain-specific audit framework for medical research agent skills, with a focus on reliability against expert review. Methods: We developed MedSkillAudit (skill-auditor@1.0), a layered framework assessing skill release readiness before deployment. We evaluated 75 skills across five medical research categories (15 per category). Two experts independently assigned a quality score (0-100), an ordinal release disposition (Production Ready / Limited Release / Beta Only / Reject), and a high-risk failure flag. System-expert agreement was quantified using ICC(2,1) and linearly weighted Cohen's kappa, benchmarked against the human inter-rater baseline. Results: The mean consensus quality score was 72.4 (SD = 13.0); 57.3% of skills fell below the Limited Release threshold. MedSkillAudit achieved ICC(2,1) = 0.449 (95% CI: 0.250-0.610), exceeding the human inter-rater ICC of 0.300. System-consensus score divergence (SD = 9.5) was smaller than inter-expert divergence (SD = 12.4), with no directional bias (Wilcoxon p = 0.613). Protocol Design showed the strongest category-level agreement (ICC = 0.551); Academic Writing showed a negative ICC (-0.567), reflecting a structural rubric-expert mismatch. Conclusions: Domain-specific pre-deployment audit may provide a practical foundation for governing medical research agent skills, complementing general-purpose quality checks with structured audit workflows tailored to scientific use cases.

AIPOCH-AI AIPOCH
·
Apr 21 2

AI-Assisted Competency Assessment from Egocentric Video in Simulation-Based Nursing Education

Assessing learner competency in clinical simulation requires expert observation that is time-intensive, difficult to scale, and subject to inter-rater variability. Vision-language models have emerged as a promising tool for understanding complex visual behavior. In this work, we investigate whether visual observations can provide educationally meaningful signals for competency assessment through a three-stage framework that (1) extracts action timelines from egocentric nursing simulation video using frozen visual encoders and few-shot learning, (2) derives sequence-level features and per-session recognition metrics, and (3) relates these to instructor-rated competency. Across 22 densely annotated sessions (3.8 hours, 493 actions), a frozen DINOv2 backbone with HMM Viterbi decoding achieves 57.4% MOF in leave-one-out 1-shot recognition. Surprisingly, we observe a negative trend between recognition accuracy and competency (rho = -0.524, p = 0.012 for mIoU), robust to six confound controls: more competent students produce diverse, harder-to-classify workflows, while simple sequence features show no such relationship. Per-item analysis identifies patient safety protocols and team communication as the expected behaviors most reflected in this pattern, and process model comparisons reveal that higher-competency students exhibit more protocol-consistent action transitions. These findings suggest that recognition accuracy may complement predicted action timelines as a pedagogically informative signal in automated competency assessment.

  • 7 authors
·
May 15

GAPS: A Clinically Grounded, Automated Benchmark for Evaluating AI Clinicians

Current benchmarks for AI clinician systems, often based on multiple-choice exams or manual rubrics, fail to capture the depth, robustness, and safety required for real-world clinical practice. To address this, we introduce the GAPS framework, a multidimensional paradigm for evaluating Grounding (cognitive depth), Adequacy (answer completeness), Perturbation (robustness), and Safety. Critically, we developed a fully automated, guideline-anchored pipeline to construct a GAPS-aligned benchmark end-to-end, overcoming the scalability and subjectivity limitations of prior work. Our pipeline assembles an evidence neighborhood, creates dual graph and tree representations, and automatically generates questions across G-levels. Rubrics are synthesized by a DeepResearch agent that mimics GRADE-consistent, PICO-driven evidence review in a ReAct loop. Scoring is performed by an ensemble of large language model (LLM) judges. Validation confirmed our automated questions are high-quality and align with clinician judgment. Evaluating state-of-the-art models on the benchmark revealed key failure modes: performance degrades sharply with increased reasoning depth (G-axis), models struggle with answer completeness (A-axis), and they are highly vulnerable to adversarial perturbations (P-axis) as well as certain safety issues (S-axis). This automated, clinically-grounded approach provides a reproducible and scalable method for rigorously evaluating AI clinician systems and guiding their development toward safer, more reliable clinical practice.

  • 41 authors
·
Oct 15, 2025

GPT as Knowledge Worker: A Zero-Shot Evaluation of (AI)CPA Capabilities

The global economy is increasingly dependent on knowledge workers to meet the needs of public and private organizations. While there is no single definition of knowledge work, organizations and industry groups still attempt to measure individuals' capability to engage in it. The most comprehensive assessment of capability readiness for professional knowledge workers is the Uniform CPA Examination developed by the American Institute of Certified Public Accountants (AICPA). In this paper, we experimentally evaluate OpenAI's `text-davinci-003` and prior versions of GPT on both a sample Regulation (REG) exam and an assessment of over 200 multiple-choice questions based on the AICPA Blueprints for legal, financial, accounting, technology, and ethical tasks. First, we find that `text-davinci-003` achieves a correct rate of 14.4% on a sample REG exam section, significantly underperforming human capabilities on quantitative reasoning in zero-shot prompts. Second, `text-davinci-003` appears to be approaching human-level performance on the Remembering & Understanding and Application skill levels in the Exam absent calculation. For best prompt and parameters, the model answers 57.6% of questions correctly, significantly better than the 25% guessing rate, and its top two answers are correct 82.1% of the time, indicating strong non-entailment. Finally, we find that recent generations of GPT-3 demonstrate material improvements on this assessment, rising from 30% for `text-davinci-001` to 57% for `text-davinci-003`. These findings strongly suggest that large language models have the potential to transform the quality and efficiency of future knowledge work.

  • 4 authors
·
Jan 11, 2023

Toward a traceable, explainable, and fairJD/Resume recommendation system

In the last few decades, companies are interested to adopt an online automated recruitment process in an international recruitment environment. The problem is that the recruitment of employees through the manual procedure is a time and money consuming process. As a result, processing a significant number of applications through conventional methods can lead to the recruitment of clumsy individuals. Different JD/Resume matching model architectures have been proposed and reveal a high accuracy level in selecting relevant candidatesfor the required job positions. However, the development of an automatic recruitment system is still one of the main challenges. The reason is that the development of a fully automated recruitment system is a difficult task and poses different challenges. For example, providing a detailed matching explanation for the targeted stakeholders is needed to ensure a transparent recommendation. There are several knowledge bases that represent skills and competencies (e.g, ESCO, O*NET) that are used to identify the candidate and the required job skills for a matching purpose. Besides, modernpre-trained language models are fine-tuned for this context such as identifying lines where a specific feature was introduced. Typically, pre-trained language models use transfer-based machine learning models to be fine-tuned for a specific field. In this proposal, our aim is to explore how modern language models (based on transformers) can be combined with knowledge bases and ontologies to enhance the JD/Resume matching process. Our system aims at using knowledge bases and features to support the explainability of the JD/Resume matching. Finally, given that multiple software components, datasets, ontology, andmachine learning models will be explored, we aim at proposing a fair, ex-plainable, and traceable architecture for a Resume/JD matching purpose.

  • 3 authors
·
Feb 2, 2022

Capabilities of GPT-4 on Medical Challenge Problems

Large language models (LLMs) have demonstrated remarkable capabilities in natural language understanding and generation across various domains, including medicine. We present a comprehensive evaluation of GPT-4, a state-of-the-art LLM, on medical competency examinations and benchmark datasets. GPT-4 is a general-purpose model that is not specialized for medical problems through training or engineered to solve clinical tasks. Our analysis covers two sets of official practice materials for the USMLE, a three-step examination program used to assess clinical competency and grant licensure in the United States. We also evaluate performance on the MultiMedQA suite of benchmark datasets. Beyond measuring model performance, experiments were conducted to investigate the influence of test questions containing both text and images on model performance, probe for memorization of content during training, and study probability calibration, which is of critical importance in high-stakes applications like medicine. Our results show that GPT-4, without any specialized prompt crafting, exceeds the passing score on USMLE by over 20 points and outperforms earlier general-purpose models (GPT-3.5) as well as models specifically fine-tuned on medical knowledge (Med-PaLM, a prompt-tuned version of Flan-PaLM 540B). In addition, GPT-4 is significantly better calibrated than GPT-3.5, demonstrating a much-improved ability to predict the likelihood that its answers are correct. We also explore the behavior of the model qualitatively through a case study that shows the ability of GPT-4 to explain medical reasoning, personalize explanations to students, and interactively craft new counterfactual scenarios around a medical case. Implications of the findings are discussed for potential uses of GPT-4 in medical education, assessment, and clinical practice, with appropriate attention to challenges of accuracy and safety.

  • 5 authors
·
Mar 20, 2023

Do Large Language Models Align with Core Mental Health Counseling Competencies?

The rapid evolution of Large Language Models (LLMs) offers promising potential to alleviate the global scarcity of mental health professionals. However, LLMs' alignment with essential mental health counseling competencies remains understudied. We introduce CounselingBench, a novel NCMHCE-based benchmark evaluating LLMs across five key mental health counseling competencies. Testing 22 general-purpose and medical-finetuned LLMs, we find frontier models exceed minimum thresholds but fall short of expert-level performance, with significant variations: they excel in Intake, Assessment & Diagnosis yet struggle with Core Counseling Attributes and Professional Practice & Ethics. Medical LLMs surprisingly underperform generalist models accuracy-wise, while at the same time producing slightly higher-quality justifications but making more context-related errors. Our findings highlight the complexities of developing AI systems for mental health counseling, particularly for competencies requiring empathy and contextual understanding. We found that frontier LLMs perform at a level exceeding the minimal required level of aptitude for all key mental health counseling competencies, but fall short of expert-level performance, and that current medical LLMs do not significantly improve upon generalist models in mental health counseling competencies. This underscores the critical need for specialized, mental health counseling-specific fine-tuned LLMs that rigorously aligns with core competencies combined with appropriate human supervision before any responsible real-world deployment can be considered.

  • 11 authors
·
Oct 29, 2024

FINESSE-Bench: A Hierarchical Benchmark Suite for Financial Domain Knowledge and Technical Analysis in Large Language Models

Large language models (LLMs) are increasingly being applied to financial analysis, reporting, investment decision support, risk management, compliance, and professional training. However, robust evaluation of their domain competence in finance remains incomplete. Widely used open benchmarks such as FinQA, ConvFinQA, and TAT-QA have played an important role in advancing financial question answering and numerical reasoning, but they focus primarily on question answering over financial reports and do not provide an explicit hierarchy of professional difficulty. Broader resources, including FinanceBench, PIXIU, FinBen, and FLaME, expand the coverage of financial tasks, yet the problem of evaluating the transition from foundational knowledge to expert-level financial reasoning remains open. In this work, we present FINESSE-Bench, a suite of eight specialized benchmarks comprising 3,993 questions for hierarchical evaluation of financial competencies in LLMs. FINESSE-Bench combines exam-oriented datasets inspired by professional certifications (CFA-like Levels 1-3, CMT-like Level 2, and CFTe-like Level 1), applied trading task collections, and a Russian-language olympiad benchmark. This design enables evaluation of domain breadth, performance degradation as difficulty increases, the ability to solve computational tasks, and model behavior in specialized financial domains. We also describe a unified evaluation protocol covering multiple-choice questions, numerical answers, and short open-ended responses, together with an automated scoring scheme for freeform answers based on the LLM-as-judge paradigm. FINESSE-Bench is intended both as a complement to existing open financial benchmarks and as a tool for more substantive evaluation of professionally relevant financial competencies in large language models.

  • 7 authors
·
May 13 2

HealthQA-BR: A System-Wide Benchmark Reveals Critical Knowledge Gaps in Large Language Models

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.

  • 1 authors
·
Jun 16, 2025