ClinConsensus: A Physician-Calibrated Benchmark for Evaluating Clinical Rubric Coverage in Chinese Medical LLMs

Abstract

Open-ended medical LLM evaluation remains weakly grounded in physician-calibrated coverage of clinically relevant response criteria, especially in localized clinical settings. We introduce \textsc{ClinConsensus}, a Chinese medical benchmark of 2{,}500 expert-curated cases spanning 36 specialties, 12 task themes, multiple difficulty levels, and lay-facing versus professional-facing settings. Each case is paired with 30 case-specific binary rubric criteria. To evaluate whether responses satisfy enough physician-authored criteria, we propose \emph{Clinician-Anchored Coverage Score} (CACS), a physician-calibrated threshold metric instantiated at \(k=10\), and develop a dual-judge framework combining a GPT-5.1 grader with a physician-supervised Qwen3-8B judge. Evaluating 11 frontier LLMs, we find a persistent coverage gap: Rubric Accuracy ranges from 39.6\% to 52.1\%, whereas CACS@10 ranges from 17.8\% to 32.9\%, leaving a 19.2--21.9 point gap across models. Stratified analyses further reveal substantial variation across reasoning, evidence use, structured extraction, medication instructions, follow-up, and dialogue register. These results suggest that medical LLM evaluation should measure thresholded, rubric-grounded clinical coverage rather than average partial correctness.