Retrieval-Augmented Agentic Rubric Generation for Reliable Medical Response Evaluation

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 for automatically generating 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 fine-grained evaluation criteria. Evaluated on HealthBench and LLMEval-Med, our framework achieves Clinical Intent Alignment (CIA) scores of 50.20% and 31.90%, significantly outperforming the GPT-4o baseline and showing consistent improvements across English and Chinese medical benchmarks. In discriminative tests on HealthBench, our rubrics achieve a 7.8% point higher win rate than GPT-4o and increase the mean score difference from 4.972 to 8.658. Ablation studies further show that individual components contribute differently across datasets, with interaction-intent modeling providing the most consistent contribution to clinical-criterion coverage. Beyond evaluation, our rubrics guide response refinement, improving response quality by 9.2%. These results suggest that automated, knowledge-grounded rubric generation provides a scalable foundation for evaluating and improving medical LLMs. The code is available at https://anonymous.4open.science/r/Automated-Rubric-Generation-E716/.