Evaluating Medical LLMs by Levels of Autonomy: A Survey Moving from Benchmarks to Applications

Abstract

Medical Large language models achieve strong scores on standard benchmarks; however, the transfer of those results to safe and reliable performance in clinical workflows remains a challenge. This survey reframes evaluation through a levels-of-autonomy lens (L0-L3), spanning informational tools, information transformation and aggregation, decision support, and supervised agents. We align existing benchmarks and metrics with the actions permitted at each level and their associated risks, making the evaluation targets explicit. This motivates a level-conditioned blueprint for selecting metrics, assembling evidence, and reporting claims, alongside directions that link evaluation to oversight. By centering autonomy, the survey moves the field beyond score-based claims toward credible, risk-aware evidence for real clinical use.