Large language models (LLMs) show significant potential in healthcare, prompting numerous benchmarks to evaluate their capabilities. However, concerns persist regarding the reliability of these benchmarks, which often lack clinical fidelity, robust data management, and safety-oriented evaluation metrics. To address these shortcomings, we introduce MedCheck, the first lifecycle-oriented assessment framework specifically designed for medical benchmarks. Our framework deconstructs benchmark development into five stages from design to governance, and provides a comprehensive checklist of 46 medically-tailored criteria. Using MedCheck, we conducted an in-depth empirical evaluation of 56 medical LLM benchmarks. Our analysis uncovers widespread, systemic issues, including a profound disconnect from clinical practice, a crisis of data integrity due to unmitigated contamination risks, and a systematic neglect of safety-critical evaluation dimensions like model robustness and uncertainty awareness. Based on these findings, MedCheck is both a diagnostic tool for existing benchmarks and an actionable guideline for a more standardized, reliable, and transparent approach to evaluating AI in healthcare.

Reinforcement Learning (RL) is the dominant paradigm for training Large Language Model (LLM) agents on long-horizon tasks. However, sparse and delayed rewards often lead to trajectory neglect, in which agents lose focus on the task goal and interaction history at intermediate steps. Prior work has explored step-level supervision using Shannon-entropy–based uncertainty signals, which conflate inherent state complexity with agent confidence and therefore provide unreliable estimates of decision reliability. To address this issue, we propose normalized entropy, which measures confidence deviations relative to an agent’s average behavior under a given state, thereby strengthening the association between low-quality actions and trajectory neglect. Building on this insight, we introduce Selective Trajectory-Aware Policy Optimization (STAPO), a hierarchical group-based RL framework. STAPO leverages normalized entropy to locate outlier steps associated with trajectory neglect and optimizes them via a joint mechanism of trajectory-aware reward and trajectory-independent penalty, enhancing trajectory awareness while preserving training stability. Extensive experiments on ALFWorld, WebShop, and Search-Augmented QA demonstrate that STAPO achieves state-of-the-art performance while substantially alleviating trajectory neglect, validating its effectiveness and robustness for agentic tasks.

Medical Multimodal Large Language Models (Med-MLLMs) require egocentric clinical intent understanding for real-world deployment, yet existing benchmarks fail to evaluate this critical capability. We introduce MedGaze-Bench, the first benchmark leveraging clinician gaze as a Cognitive Cursor to assess intent understanding across surgery, emergency simulation, and diagnostic interpretation. Our benchmark addresses three fundamental challenges: visual homogeneity of anatomical structures, strict temporal-causal dependencies in clinical workflows, and implicit adherence to safety protocols. We propose a Three-Dimensional Clinical Intent Framework evaluating: (1) Spatial Intent—discriminating precise targets amid visual noise, (2) Temporal Intent—inferring causal rationale through retrospective and prospective reasoning, and (3) Standard Intent—verifying protocol compliance through safety checks. Beyond accuracy metrics, we introduce Trap QA mechanisms to stress-test clinical reliability by penalizing hallucinations and cognitive sycophancy. Experiments reveal current MLLMs struggle with egocentric intent due to over-reliance on global features, leading to fabricated observations and uncritical acceptance of invalid instructions.

Large language models (LLMs) exhibit substantial variability in performance and computational cost across tasks and queries, motivating routing systems that select models to meet user-specific cost–performance trade-offs. However, existing routers generalize poorly in cold-start scenarios where in-domain training data is unavailable. We address this limitation with a multi-level task-profile–guided data synthesis framework that constructs a hierarchical task taxonomy and produces diverse question–answer pairs to approximate the test-time query distribution. Building on this, we introduce TRouter, a task-type–aware router approach that models query-conditioned cost and performance via latent task-type variables, with prior regularization derived from the synthesized task taxonomy. This design enhances TRouter’s routing utility under both cold-start and in-domain settings. Across multiple benchmarks, we show that our synthesis framework alleviates cold-start issues and that TRouter delivers effective LLM routing.

The significant breakthroughs of Medical Multi-Modal Large Language Models (Med-MLLMs) renovate modern healthcare with robust information synthesis and medical decision support. However, these models are often evaluated on benchmarks that are unsuitable for the Med-MLLMs due to the intricate nature of the real-world diagnostic frameworks, which encompass diverse medical specialties and involve complex clinical decisions. Thus, a clinically representative benchmark is highly desirable for credible Med-MLLMs evaluation. To this end, we introduce Asclepius, a novel Med-MLLM benchmark that comprehensively assesses Med-MLLMs in terms of: distinct medical specialties (cardiovascular, gastroenterology, etc.) and different diagnostic capacities (perception, disease analysis, etc.). Grounded in 3 proposed core principles, Asclepius ensures a comprehensive evaluation by encompassing 15 medical specialties, stratifying into 3 main categories and 8 sub-categories of clinical tasks, and exempting overlap with the existing VQA dataset. We further provide an in-depth analysis of 6 Med-MLLMs and compare them with 3 human specialists, providing insights into their competencies and limitations in various medical contexts. Our work not only advances the understanding of Med-MLLMs’ capabilities but also sets a precedent for future evaluations and the safe deployment of these models in clinical environments.