ClinConsensus: A Consensus-Based Benchmark for Evaluating Chinese Medical LLMs across Difficulty Levels

Abstract

Large language models (LLMs) are increasingly applied to health management, showing promise across disease prevention, clinical decision-making, and long-term care. However, existing medical benchmarks remain largely static and task-isolated, failing to capture the openness, longitudinal structure, and safety-critical complexity of real-world clinical workflows. We introduce ClinConsensus, a Chinese medical benchmark curated, validated, and quality-controlled by clinical experts. ClinConsensus comprises 2500 open-ended cases spanning the full continuum of care--from prevention and intervention to long-term follow-up--covering 36 medical specialties, 12 common clinical task types, and progressively increasing levels of complexity. To enable reliable evaluation of such complex scenarios, we adopt a rubric-based grading protocol and propose the Clinically Applicable Consistency Score (CACS@k). We further introduce a dual-judge evaluation framework, combining a high-capability LLM-as-judge with a distilled, locally deployable judge model trained via supervised fine-tuning, enabling scalable and reproducible evaluation aligned with physician judgment. Using ClinConsensus, we conduct a comprehensive assessment of several leading LLMs and reveal substantial heterogeneity across task themes, care stages, and medical specialties. While top-performing models achieve comparable overall scores, they differ markedly in reasoning, evidence use, and longitudinal follow-up capabilities, and clinically actionable treatment planning remains a key bottleneck. We release ClinConsensus as an extensible benchmark to support the development and evaluation of medical LLMs that are robust, clinically grounded, and ready for real-world deployment.