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; https://www.medevidencebench.org.cn/), 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.

翻译：暂无翻译