# A Proposed Rubric for Evaluating Expressed Clinical Reasoning in Large Language Model Responses

arXiv: https://arxiv.org/abs/2609.37788 · HTML: https://mlsanity.com/paper/2609.37788/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 16 of its 54 references that are in the map.
- First posted on arXiv 29 Sep 2026.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)

## Builds on (most cited first, 16 of 16)

- [Language Models Don't Always Say What They Think: Unfaithful Explanations in Chain-of-Thought Prompting](https://mlsanity.com/paper/2305.04388/) (2023)
- [HealthBench: Evaluating Large Language Models Towards Improved Human Health](https://mlsanity.com/paper/2505.08775/) (2025)
- [Reliability without Validity: A Systematic, Large-Scale Evaluation of LLM-as-a-Judge Models Across Agreement, Consistency, and Bias](https://mlsanity.com/paper/2606.19544/) (2026)
- [FaithCoT-Bench: Benchmarking Instance-Level Faithfulness of Chain-of-Thought Reasoning](https://mlsanity.com/paper/2510.04040/) (2025)
- [ER-Reason: A Benchmark Dataset for LLM Clinical Reasoning in the Emergency Room](https://mlsanity.com/paper/2505.22919/) (2025)
- [EchoBench: Benchmarking Sycophancy in Medical Large Vision-Language Models](https://mlsanity.com/paper/2509.20146/) (2025)
- [C2-Faith: Benchmarking LLM Judges for Causal and Coverage Faithfulness in Chain-of-Thought Reasoning](https://mlsanity.com/paper/2603.05167/) (2026)
- [All Claims Are Equal, but Some Claims Are More Equal Than Others: Importance-Sensitive Factuality Evaluation of LLM Generations](https://mlsanity.com/paper/2510.07083/) (2025)
- [OpenAIs HealthBench in Action: Evaluating an LLM-Based Medical Assistant on Realistic Clinical Queries](https://mlsanity.com/paper/2509.02594/) (2025)
- [Beyond Precision: Importance-Aware Recall for Factuality Evaluation in Long-Form LLM Generation](https://mlsanity.com/paper/2604.03141/) (2026)
- [Possible or Definite? A Benchmark for Evaluating Diagnostic Uncertainty Preservation in Clinical Text](https://mlsanity.com/paper/2606.18471/) (2026)
- [Evaluation of Causal Reasoning for Large Language Models in Contextualized Clinical Scenarios of Laboratory Test Interpretation](https://mlsanity.com/paper/2509.16372/) (2025)
- [MamaBench: Benchmarking LLM Robustness in Maternal and Child Health Diagnosis through Counterfactual Clinical Perturbation](https://mlsanity.com/paper/2607.14385/) (2026)
- [Two-Level Meta-Rubrics for Evaluating Open-Ended Generation: GAMUT, a Benchmark for Factual Completeness](https://mlsanity.com/paper/2607.19322/) (2026)
- [H-DDx: A Hierarchical Evaluation Framework for Differential Diagnosis](https://mlsanity.com/paper/2510.03700/) (2025)
- [Evaluating and Improving LLM Self-Modeling](https://mlsanity.com/paper/2608.30980/) (2026)

## Abstract (arXiv)

We propose a rubric for assessing expressed clinical reasoning in model responses, drawing on three bodies of work: medical education assessment frameworks (ART, SCT, Key Feature Problems and OSCE); clinical LLM benchmarks (MedR-Bench, HealthBench, TIMER-Bench, DR. BENCH, PrIME-LLM and PatientSafeBench); and general LLM reasoning evaluation research, including the Factuality-Validity-Coherence-Utility taxonomy, FaithCoT-Bench and C2-Faith. We use groundedness as a clinically oriented adaptation of the taxonomy's factuality category. The rubric brings these concepts together in a multidimensional framework for scoring free-text responses to gold-standard clinical vignettes. It includes provisional behavioural anchors, applicability rules and a separate flag for case-specific safety-critical errors. General-domain frameworks inform its design but are not treated as validated clinical instruments. The rubric does not replace case-specific reference criteria or the task-specific metrics of existing benchmarks. It has not yet been tested for inter-rater reliability, construct validity or clinical utility. Its immediate purpose is to make evaluation decisions explicit and open to scrutiny before empirical testing.