Scalable Stewardship of an LLM-Assisted Clinical Benchmark with Physician Oversight

Abstract

We examine the reliability of a widely used clinical AI benchmark whose reference labels were partially generated by LLMs, and find that a substantial fraction are clinically misaligned. We introduce a phased stewardship procedure to amplify the positive impact of physician experts' feedback and then demonstrate, via a controlled RL experiment, how uncaught label bias can materially affect downstream LLM evaluation and alignment. Our results demonstrate that partially LLM-generated labels can embed systemic errors that distort not only evaluation but also downstream model alignment. By adopting a hybrid oversight system, we can prioritize scarce expert feedback to maintain benchmarks as living, clinically-grounded documents. Ensuring this alignment is a prerequisite for the safe deployment of LLMs in high-stakes medical decision support.

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