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arxiv: 2606.08071 · v1 · pith:RK6JCOPDnew · submitted 2026-06-06 · 💻 cs.CL

SurgiQ: A Large-Scale Multi-Domain Benchmark for Evaluating Surgical Understanding in Large Language Models

Pith reviewed 2026-06-27 19:35 UTC · model grok-4.3

classification 💻 cs.CL
keywords surgical benchmarkLLM evaluationmultiple choice questionsprocedural reasoningmedical AIsurgerylarge language modelsbenchmark construction
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The pith

SurgiQ benchmark shows LLMs reach at most 68.1 percent accuracy on surgical questions, with general models ahead of biomedical ones.

A machine-rendered reading of the paper's core claim, the machinery that carries it, and where it could break.

The paper builds SurgiQ as a collection of 13,055 four-option questions drawn from surgical textbooks, papers, and exams across six domains. The questions come in four formats that test case-based reasoning, management choices, negation, and selection among operative options. When thirty-five open-weight models are scored under one protocol, the strongest reaches 68.1 percent while many smaller models stay near the 25 percent random level. General-purpose models outperform most biomedical-specialized ones, indicating that current medical fine-tuning leaves gaps in procedural surgical coverage.

Core claim

SurgiQ is a text-only benchmark of 13,055 questions spanning six surgical domains and four formats that require procedural reasoning, trade-off decisions, and negation handling. Evaluation under a unified log-likelihood protocol finds the best model at 68.1 percent accuracy, smaller models near random baseline, and general-purpose models such as Qwen2.5 ahead of most biomedical models, showing that medical specialization has not yet produced broad surgical coverage and that models remain prone to confident errors on plausible distractors.

What carries the argument

The SurgiQ benchmark, built by a multi-stage generation, verification, and expert-audit process from surgical sources, which supplies the questions used to measure surgical understanding.

If this is right

  • Smaller models remain near the 25 percent random baseline.
  • General-purpose models outperform most biomedical models on these questions.
  • Even strong models make confident mistakes on clinically plausible distractors.
  • Current medical specialization does not yet deliver broad surgical coverage.

Where Pith is reading between the lines

These are editorial extensions of the paper, not claims the author makes directly.

  • Models may improve more from exposure to procedural decision sequences than from additional medical text fine-tuning.
  • The same source-grounded construction method could be used to test understanding in other hands-on fields such as emergency procedures.
  • Future work could add video or image inputs to check whether text-only scores understate or overstate real surgical capability.

Load-bearing premise

The pipeline that turns textbook and exam material into questions produces items that measure genuine surgical understanding without introducing systematic factual errors or biases.

What would settle it

If practicing surgeons score below 70 percent on the full set or if any model reaches 90 percent accuracy after ordinary medical training, the benchmark would fail to isolate surgical understanding.

Figures

Figures reproduced from arXiv: 2606.08071 by Ayah Al-Naji, Cesare Stefanini, Edoardo Fazzari, Hamdan Alhadhrami, Preslav Nakov, Saif AlKindi.

Figure 1
Figure 1. Figure 1: Overview of the SurgiQ benchmark, illus [PITH_FULL_IMAGE:figures/full_fig_p001_1.png] view at source ↗
Figure 2
Figure 2. Figure 2: Examples of SurgiQ questions across four for [PITH_FULL_IMAGE:figures/full_fig_p003_2.png] view at source ↗
Figure 3
Figure 3. Figure 3: Overview of the SurgiQ construction pipeline. [PITH_FULL_IMAGE:figures/full_fig_p004_3.png] view at source ↗
Figure 4
Figure 4. Figure 4: Zero-shot prompt template used for model [PITH_FULL_IMAGE:figures/full_fig_p005_4.png] view at source ↗
Figure 5
Figure 5. Figure 5: Reliability diagram showing model calibra [PITH_FULL_IMAGE:figures/full_fig_p007_5.png] view at source ↗
Figure 6
Figure 6. Figure 6: Zero-shot and few-shot performance on SurgiQ. Domain Mean (%) Std. Neurosurgery 53.08 13.20 Robotic Surgery 52.67 12.97 General Surgery 52.57 13.77 Critical Care / Emergency 52.45 12.63 Laparoscopic Surgery 52.03 12.49 Orthopedic Surgery 49.23 11.24 [PITH_FULL_IMAGE:figures/full_fig_p008_6.png] view at source ↗
read the original abstract

Reliable evaluation of large language models in surgery remains underdeveloped. Broad medical benchmarks test clinical knowledge, while surgery requires procedural reasoning, management trade-offs, negation handling, and selection among plausible operative decisions. We present SurgiQ, a text-only, source-grounded benchmark of 13,055 four-option multiple-choice questions spanning six surgical domains and four question formats: case-based, reasoning, best-option, and negative. SurgiQ is constructed from surgical textbooks, open-access papers, and examination material using a multi-stage generation, verification, and expert-audit pipeline. We evaluate 35 open-weight LLMs under a unified log-likelihood protocol. Our results show substantial remaining headroom: smaller models often remain near the 25\% random baseline, while the best model reaches 68.1\% accuracy. General-purpose models, especially Qwen2.5, outperform most biomedical models, suggesting that current medical specialization does not yet provide sufficiently broad surgical coverage. Calibration and error analysis further show that even strong models make confident mistakes on clinically plausible distractors, motivating more reliable and broader surgical LLM evaluation.

Editorial analysis

A structured set of objections, weighed in public.

Desk editor's note, referee report, simulated authors' rebuttal, and a circularity audit. Tearing a paper down is the easy half of reading it; the pith above is the substance, this is the friction.

Referee Report

2 major / 1 minor

Summary. The paper introduces SurgiQ, a text-only benchmark of 13,055 four-option multiple-choice questions spanning six surgical domains and four formats (case-based, reasoning, best-option, negative). Questions are sourced from textbooks, open-access papers, and examination material via a multi-stage generation/verification/expert-audit pipeline. The authors evaluate 35 open-weight LLMs under a unified log-likelihood protocol, reporting that the best model reaches 68.1% accuracy while smaller models hover near the 25% random baseline, with general-purpose models (especially Qwen2.5) outperforming most biomedical models; they also provide calibration and error analysis showing confident mistakes on plausible distractors.

Significance. If the benchmark questions are shown to be valid and free of systematic construction artifacts, the work would be a useful contribution to domain-specific LLM evaluation by quantifying headroom in surgical reasoning and highlighting limitations of current medical fine-tuning. The scale, multi-domain coverage, and unified evaluation protocol are positive features.

major comments (2)
  1. [Benchmark Construction] Benchmark construction (multi-stage pipeline description): No quantitative metrics are reported on the expert-audit stage, such as question rejection rate, inter-rater agreement, or incidence of factual errors identified during audit. This is load-bearing for the central claims, because the headline results (68.1% peak accuracy and the general-purpose vs. biomedical model comparison) require that performance gaps reflect differences in surgical understanding rather than artifacts from question generation or distractor selection.
  2. [Experiments] Experiments and error analysis: The claim that even strong models make 'confident mistakes on clinically plausible distractors' is presented without supporting details on how distractor plausibility was verified or quantified during construction; this weakens interpretation of the calibration results and the motivation for broader surgical evaluation.
minor comments (1)
  1. [Results] Results section: Model comparison tables would benefit from explicit reporting of the number of questions per domain/format to allow readers to assess whether domain imbalance affects the aggregate accuracy figures.

Simulated Author's Rebuttal

2 responses · 0 unresolved

We thank the referee for the constructive feedback. The comments correctly identify areas where additional quantitative details on the construction pipeline would strengthen the paper's claims about benchmark validity. We address each point below and will revise the manuscript accordingly.

read point-by-point responses
  1. Referee: [Benchmark Construction] Benchmark construction (multi-stage pipeline description): No quantitative metrics are reported on the expert-audit stage, such as question rejection rate, inter-rater agreement, or incidence of factual errors identified during audit. This is load-bearing for the central claims, because the headline results (68.1% peak accuracy and the general-purpose vs. biomedical model comparison) require that performance gaps reflect differences in surgical understanding rather than artifacts from question generation or distractor selection.

    Authors: We agree that the absence of quantitative metrics on the expert-audit stage limits the strength of the validity argument. In the revised manuscript we will add the question rejection rate during audit, inter-rater agreement statistics (including any available Cohen's kappa or percentage agreement), and the count of factual errors identified and corrected. These will be placed in the benchmark construction section with a brief description of the audit protocol. revision: yes

  2. Referee: [Experiments] Experiments and error analysis: The claim that even strong models make 'confident mistakes on clinically plausible distractors' is presented without supporting details on how distractor plausibility was verified or quantified during construction; this weakens interpretation of the calibration results and the motivation for broader surgical evaluation.

    Authors: We accept that the current text does not sufficiently detail how distractor plausibility was verified. The revised version will expand the relevant section to describe the expert criteria used to judge clinical plausibility, any quantification performed during the multi-stage pipeline, and representative examples of distractors that were retained or revised. revision: yes

Circularity Check

0 steps flagged

No circularity: purely empirical benchmark with no derivations or self-referential fits

full rationale

The paper presents SurgiQ as a constructed benchmark evaluated on 35 LLMs via log-likelihood. No equations, parameter fitting, predictions, or first-principles derivations appear in the abstract or described pipeline. Construction relies on external sources (textbooks, papers, exams) plus expert audit, but this is a one-way data-generation process with no reduction of outputs to inputs by definition or self-citation. Results (e.g., 68.1% max accuracy, general-purpose models outperforming biomedical ones) are direct empirical measurements, not forced by any internal loop. Self-citations, if present, are not load-bearing for the central claims.

Axiom & Free-Parameter Ledger

0 free parameters · 1 axioms · 0 invented entities

The central contribution rests on the unverified assumption that the source-grounded multi-stage pipeline yields high-quality, unbiased questions that measure genuine surgical understanding.

axioms (1)
  • domain assumption The multi-stage generation, verification, and expert-audit pipeline from surgical textbooks, papers, and exams produces questions that accurately reflect surgical understanding.
    Invoked to justify benchmark validity in the abstract.

pith-pipeline@v0.9.1-grok · 5749 in / 1210 out tokens · 22734 ms · 2026-06-27T19:35:46.126782+00:00 · methodology

discussion (0)

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