# Benchmarking Clinical Decision Pathway Adherence in Large Language Models

arXiv: https://arxiv.org/abs/2608.26592 · HTML: https://mlsanity.com/paper/2608.26592/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 14 of its 37 references that are in the map.
- First posted on arXiv 27 Aug 2026.

## Builds on (most cited first, 14 of 14)

- [Judging LLM-as-a-Judge with MT-Bench and Chatbot Arena](https://mlsanity.com/paper/2306.05685/) (2023)
- [BERTScore: Evaluating Text Generation with BERT](https://mlsanity.com/paper/1904.09675/) (2019)
- [G-Eval: NLG Evaluation using GPT-4 with Better Human Alignment](https://mlsanity.com/paper/2303.16634/) (2023)
- [gpt-oss-120b & gpt-oss-20b Model Card](https://mlsanity.com/paper/2508.10925/) (2025)
- [What Disease does this Patient Have? A Large-scale Open Domain Question Answering Dataset from Medical Exams](https://mlsanity.com/paper/2009.13081/) (2020)
- [LLMs Get Lost In Multi-Turn Conversation](https://mlsanity.com/paper/2505.06120/) (2025)
- [MedAgents: Large Language Models as Collaborators for Zero-shot Medical Reasoning](https://mlsanity.com/paper/2311.10537/) (2023)
- [HuatuoGPT-o1, Towards Medical Complex Reasoning with LLMs](https://mlsanity.com/paper/2412.18925/) (2024)
- [Learning with a Wasserstein Loss](https://mlsanity.com/paper/1506.05439/) (2015)
- [PaddleOCR-VL-1.5: Towards a Multi-Task 0.9B VLM for Robust In-the-Wild Document Parsing](https://mlsanity.com/paper/2601.21957/) (2026)
- [MedicalAgentsBench for Complex Medical Reasoning: Comparing Internalized Reasoning Models versus Externalized Agent-based Frameworks](https://mlsanity.com/paper/2503.07459/) (2025)
- [Scaling Algorithms for Unbalanced Transport Problems](https://mlsanity.com/paper/1607.05816/) (2016)
- [CliMedBench: A Large-Scale Chinese Benchmark for Evaluating Medical Large Language Models in Clinical Scenarios](https://mlsanity.com/paper/2410.03502/) (2024)
- [A Decade-Scale Benchmark Evaluating LLMs' Clinical Practice Guidelines Detection and Adherence in Multi-turn Conversations](https://mlsanity.com/paper/2603.25196/) (2026)

## Built on by (most cited first, 1 of 1)

- [More Reasoning Is Not Always Better: Executing Clinical Guidelines with LLMs and Rules](https://mlsanity.com/paper/2610.15912/) (2026)

## Abstract (arXiv)

Following clinical decision pathways (CDPs) defined by clinical practice guidelines is essential for safe and reliable medical decision-making. However, existing medical large language model (LLM) benchmarks mainly evaluate final-answer accuracy, providing limited evaluation of models' ability to adhere to guidelines. To address this gap, we introduce MEGA-CDP, a benchmark for evaluating whether medical LLMs can generate guideline-adherent CDPs using provided guidelines as references. MEGA-CDP is constructed from 2,274 English and Chinese clinical practice guidelines through a guideline-to-case pipeline, yielding 42,353 clinical cases with explicit reference CDPs. It supports both single-turn vignette and multi-turn interactive settings, and introduces a CDP-oriented evaluation framework for measuring pathway consistency. Experiments on 16 representative LLMs show that reliable clinical decision support remains challenging for current models, demonstrating the need for CDP-oriented evaluation and the value of MEGA-CDP for advancing guideline adherence in medical LLMs.