When Cases Get Rare: A Retrieval Benchmark for Off-Guideline Clinical Question Answering

Across medical specialties, clinical practice is anchored in evidence-based guidelines that codify best studied diagnostic and treatment pathways. These pathways routinely fall short for the long tail of real-world care not covered by guidelines. Most medical large language models (LLMs), however, are trained to encode common, guideline-focused medical knowledge in their parameters. Current evaluations test models primarily on recalling and reasoning with this memorized content, often in multiple-choice settings. Given the fundamental importance of evidence-based reasoning in medicine, it is neither feasible nor reliable to depend on memorization in practice. To address this gap, we introduce OGCaReBench, a free-form retrieval-focused benchmark aimed at evaluating LLMs at answering clinical questions that require going beyond typical guidelines. Extracted from published medical case reports and validated by medical experts, OGCaReBench contains long-form clinical questions requiring free-text answers, providing a systematic framework for assessing open-ended medical reasoning in rare, case-based scenarios. Our experiments reveal that even the best-performing baseline (GPT-5.2) correctly answers only 56% of our benchmark with specialized models only reaching 42%. Augmenting models with retrieved medical articles improves this performance to up to 82% (using GPT-5.2) highlighting the importance of evidence-grounding for real-world medical reasoning tasks. This work thus establishes a foundation for benchmarking and advancing both general-purpose and medical LLMs to produce reliable answers in challenging clinical contexts.

Data Efficient Evaluation of Large Language Models and Text-to-Image Models via Adaptive Sampling

Evaluating LLMs and text-to-image models is a computationally intensive task often overlooked. Efficient evaluation is crucial for understanding the diverse capabilities of these models and enabling comparisons across a growing number of new models and benchmarks. To address this, we introduce SubLIME, a data-efficient evaluation framework that employs adaptive sampling techniques, such as clustering and quality-based methods, to create representative subsets of benchmarks. Our approach ensures statistically aligned model rankings compared to full datasets, evidenced by high Pearson correlation coefficients. Empirical analysis across six NLP benchmarks reveals that: (1) quality-based sampling consistently achieves strong correlations (0.85 to 0.95) with full datasets at a 10\% sampling rate such as Quality SE and Quality CPD (2) clustering methods excel in specific benchmarks such as MMLU (3) no single method universally outperforms others across all metrics. Extending this framework, we leverage the HEIM leaderboard to cover 25 text-to-image models on 17 different benchmarks. SubLIME dynamically selects the optimal technique for each benchmark, significantly reducing evaluation costs while preserving ranking integrity and score distribution. Notably, a minimal sampling rate of 1% proves effective for benchmarks like MMLU. Additionally, we demonstrate that employing difficulty-based sampling to target more challenging benchmark segments enhances model differentiation with broader score distributions. We also combine semantic search, tool use, and GPT-4 review to identify redundancy across benchmarks within specific LLM categories, such as coding benchmarks. This allows us to further reduce the number of samples needed to maintain targeted rank preservation. Overall, SubLIME offers a versatile and cost-effective solution for the robust evaluation of LLMs and text-to-image models.