As medical LLMs transition to clinical deployment, assessing their ethical reasoning capability becomes critical. While achieving high accuracy on knowledge benchmarks, LLMs lack validated assessment for navigating ethical trade-offs in clinical decision-making where multiple valid solutions exist. Existing benchmarks lack systematic approaches to incorporate recognized philosophical frameworks and expert validation for ethical reasoning assessment. We introduce PrinciplismQA, a philosophy-grounded approach to assessing LLM clinical medical ethics alignment. Grounded in Principlism, our approach provides a systematic methodology for incorporating clinical ethics philosophy into LLM assessment design. PrinciplismQA comprises 3,648 expert-validated questions spanning knowledge assessment and clinical reasoning. Our expert-calibrated pipeline enables reproducible evaluation and models ethical biases. Evaluating recent models reveals significant ethical reasoning gaps despite high knowledge accuracy, demonstrating that knowledge-oriented training does not ensure clinical ethical alignment. PrinciplismQA provides a validated tool for assessing clinical AI deployment readiness.

Large Language Models (LLMs) provide a possibility to make a great breakthrough in medicine. The establishment of a standardized medical benchmark becomes a fundamental cornerstone to measure progression. However, medical environments in different regions have their local characteristics, e.g., the ubiquity and significance of traditional Chinese medicine within China. Therefore, merely translating English-based medical evaluation may result in contextual incongruities to a local region. To solve the issue, we propose a localized medical benchmark called CMB, a Comprehensive Medical Benchmark in Chinese, designed and rooted entirely within the native Chinese linguistic and cultural framework. While traditional Chinese medicine is integral to this evaluation, it does not constitute its entirety. Using this benchmark, we have evaluated several prominent large-scale LLMs, including ChatGPT, GPT-4, dedicated Chinese LLMs, and LLMs specialized in the medical domain. We hope this benchmark provide first-hand experience in existing LLMs for medicine and also facilitate the widespread adoption and enhancement of medical LLMs within China. Our data and code are publicly available at https://github.com/FreedomIntelligence/CMB.

In this paper, we present HuatuoGPT, a Large Language Model (LLM) for medical consultation. The core recipe of HuatuoGPT is to leverage both distilled data from **ChatGPT** and real-world data from **doctors** in the supervised fine-tuning stage. This is not only because purely using **ChatGPT**-distilled data might cause ‘model collapse’, but also because real-world data from **doctors** would be complementary to **ChatGPT**-distilled data. The responses from ChatGPT are usually detailed, well-presented, fluent, and instruction-followed, but it cannot perform like a doctor in many aspects, e.g. for interactive diagnosis. Therefore, the extra doctors’ data could tame a distilled language model to perform like doctors. To synergize the strengths of both data sources, we introduce RLMF (Reinforcement Learning from Mixed Feedback) where a reward model is trained to align the language model with the merits that both sources (ChatGPT and doctors) bring. Experimental results (in GPT-4 evaluation, human evaluation, and medical benchmark datasets) demonstrate that HuatuoGPT achieves state-of-the-art results in performing medical consultation among open-source LLMs. It is worth noting that by using additional real-world data and RLMF, the distilled language model (i.e., HuatuoGPT) outperforms its teacher model (i.e., ChatGPT) in most cases.