Blinded physician evaluation has been considered by many to be the gold standard for assessing clinical reasoning in large language models (LLMs). This is difficult to scale; thus, prior studies typically rely on small physician panels, often from a single institution or specialty, which both limits the scientific questions investigated and makes it unclear whether findings would be reproduced with a different set of evaluators. To more rigorously and scalably study clinical reasoning in AI models, here we introduce PrecepTron, an LLM fine-tuned for physician-level evaluation of open-ended responses. PrecepTron was trained using low-rank adaptation (LoRA) of a 32-billion-parameter model on a small number of physician examples. We also release GRAND-ROUNDS, a new large-scale physician-annotated benchmark of 9,217 scores by 11 physicians across seven studies. We show that frontier LLMs in typical"LLM-as-a-judge"approaches often disagree with physicians and with each other, but fine-tuning PrecepTron on a small number of cases enables physician-level consistent scoring across tasks. We use PrecepTron to reproduce headline findings from five influential studies assessing LLMs for clinical care in JAMA, Science, and Nature Medicine without new human grading. Using PrecepTron, we then pose new questions about how LLMs reason in medicine that would have been infeasible with human grading alone, including measuring the diagnostic accuracy of frontier LLMs when clinical cases are provided piecemeal, even token by token. Together, PrecepTron and GRAND-ROUNDS provide a foundation for reproducible, large-scale study of how LLMs reason in medicine. All code, data, and labels are made freely available for researchers.
Thomas A. Buckley, Zahir Kanjee, Peter G. Brodeur et al.· 0 citations
Heterogeneous multi-robot service systems must assign requests to compatible robots, construct feasible schedules, and adapt as new tasks arrive online. Historical data can help anticipate future demand, but relying too heavily on inaccurate predictions can degrade performance under distribution shifts. We develop a prediction-aware adaptive rollout framework for heterogeneous multi-robot task assignment with scheduled and real-time requests. The problem is formulated as a finite-horizon stochastic dynamic program incorporating robot-task compatibility, ordered service requirements, routing constraints, service windows, and end-of-horizon return requirements. The proposed policy evaluates current assignments using sampled future request scenarios while restricting immediate commitments to requests already observed. To enable online use, the framework combines pruned candidate controls, wait actions, and an interaction-aware base policy for efficient future-cost estimation. Robustness to forecast error is provided by adaptively reweighting predicted requests based on recent prediction mismatch and selectively re-optimizing assigned but unstarted requests. We also introduce a historical-data-driven procedure for selecting the heterogeneous fleet composition before deployment. In a case study using real nursing-task requests from hospital inpatient floors, the proposed approach achieves near-complete service and reduces serviced-request wait times relative to reactive, token-passing, prediction-positioning, and myopic greedy baselines, with the largest improvements in tail-delay metrics.
Daniel Garces, Sara Castro, Adrian D. Haimovich et al.· 0 citations
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