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

Abstract

Automating the calculation of clinical risk scores offers a significant opportunity to reduce physician administrative burden and enhance patient care. The current standard for evaluating this capability is MedCalc-Bench, a large-scale dataset constructed using LLM-based feature extraction and rule-based aggregation. However, treating such model-generated benchmarks as static oracles risks enshrining historical model errors as evaluation gold standards, a problem dangerously amplified when these datasets serve as reward signals for Reinforcement Learning (RL). In this work, we propose viewing benchmarks for complex tasks such as clinical score computation as ''in-progress living documents'' that should be periodically re-evaluated as the processes for creating them improve. We introduce a systematic, physician-in-the-loop pipeline that leverages advanced agentic verifiers to audit and relabel MedCalc-Bench, utilizing automated triage to reserve scarce clinician attention for the most contentious instances. Our audit reveals that a notable fraction of original labels diverge from medical ground truth due to extraction errors, calculator logic mismatches, and clinical ambiguity. To study whether this label noise meaningfully impacts downstream RL training, we fine-tune a Qwen3-8B model via Group Relative Policy Optimization (GRPO) and demonstrate that training on corrected labels yields an 8.7% absolute improvement in accuracy over the original baseline -- validating that label noise materially affects model evaluation. These findings underscore that in safety-critical domains, rigorous benchmark maintenance is a prerequisite for genuine model alignment.

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