Automated Rubrics for Reliable Evaluation of Medical Dialogue Systems

arXiv:2601.15161v2 Announce Type: replace-cross Abstract: Large Language Models (LLMs) are increasingly used for clinical decision support, where hallucinations and unsafe suggestions may pose direct risks to patient safety. These risks are hard to assess: subtle clinical errors are often missed by generic metrics and LLM judges using general criteria, while expert-authored fine-grained rubrics are expensive and difficult to scale. In this paper, we propose a retrieval-augmented multi-agent framework designed to automate the generation of instance-specific evaluation rubrics. Our approach grounds evaluation in authoritative medical evidence by decomposing retrieved content into atomic facts and synthesizing them with user interaction constraints to form verifiable, fine-grained evaluation criteria. Evaluated on HealthBench and LLMEval-Med datasets, our framework achieves Clinical Intent Alignment (CIA) scores of 50.20% and 31.90%, significantly outperforming the GPT-4o baseline and demonstrating robust cross-lingual generalization. In discriminative tests on HealthBench, our rubrics yield a 7.8% higher win rate than GPT-4o baseline with nearly double score $\Delta$, while ablation studies confirm its structural necessity. Beyond evaluation, our rubrics effectively guide response refinement, improving quality by 9.2%. This provides a scalable, cross-lingual foundation for both evaluating and improving medical LLMs. The code is available at https://github.com/AmbeChen/Automated-Rubric-Generation.