15 models, 3 runs each, evaluated in the published environment.
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How the benchmark was built
Developed with senior clinical operations consultants and former FDA Bioresearch Monitoring (BIMO) inspectors. Human experts independently reviewed the tasks and trial world for clinical realism and quality. Their expertise shaped what agents should recognize, how they should respond, and which omissions matter most.
The environment is modelled on a real, publicly available trial protocol. Its design and tasks draw on expert input and real-world scenarios of varying complexity; participant records and events are simulated.
Align grading with expert judgments
Human experts performed oversight work in the trial environment to establish the reference (“ground truth”): clinical interpretations, expected follow-up and acceptable alternatives, checked against the trial’s source records. They then explicitly graded completed model traces. Those human ratings and judgments informed the grading reference and configuration: what earns credit, what counts as an error, and what follow-up is expected.
Set the severity standard
Expert feedback confirmed the requirement tiers: 8 critical, 53 major, 5 minor and 18 calibration. It distinguishes recognizing a safety-relevant breach from completing the follow-up after recognition.
Resolve difficult boundaries
Expert feedback clarified when missing records support an absence claim, when a report must reconcile new events before finalization, and when a mistaken claim has a material consequence. Those interpretations are applied consistently across models.
1Source documentsProtocol, monitoring plan and supporting records
2Expert-curated environmentConnected participants, sites and evolving evidence
3Expert-grounded referenceHands-on oversight and review of model traces
484 requirementsExpert-confirmed severity tiers
521 checkpointsAssess the record, actions and final report
6Grader checksReference records, targeted edits and repeatability
The benchmark team translated this reference into source-linked requirements, scoring weights and response windows.
01
Scores
Each run is scored on three axes: State (the evolving record), Trajectory (investigation and follow-through) and Outputs (the final report).
Each axis combines its criteria using fixed weights. The composite is the average of the three axes.
From evidence to three diagnostic axes84 graded requirements inform the reference used to assess the work.
8Critical
53MajorAcross 17 concerns
5Minor
18Calibration
↓
Reference requirements + records, actions and report
State0–100
The evolving oversight record
Correctness
40%
Continuity
25%
Timeliness
35%
Trajectory0–100
Investigation and follow-through
Investigation
45%
Verification
35%
Follow-up
20%
Outputs0–100
The final report
Correctness
30%
Coverage
30%
Evidence
20%
Actions
15%
Clarity
5%
↓
Composite(State + Trajectory + Outputs) ÷ 3Equal weight for each axis
Requirements inform different criteria; they don’t contribute equally to every axis.
Timeliness: the share of required actions completed by their due checkpoint, averaged across checkpoints with work due. Late or never-completed actions earn no credit.
Exact formulas · worked examples from GPT-6 Astra, run 1
Ratings use a 0–4 scale. The formulas convert them to scores out of 100. Examples use unrounded values.
Axis score
25 × Σ(weight × mean rating) ÷ Σ(applicable weights)
100 × mean of each concern’s met-requirement fraction
Across 19 concerns, the fractions sum to 14.1905. Their mean × 100 gives 74.69.
State timeliness
100 × mean of the on-time fraction at each checkpoint with work due
The 20 checkpoint fractions sum to 10.5524. Their mean × 100 gives 52.76.
Late or never-completed transitions earn no credit. Checkpoints with nothing due are excluded.
Transition-attainment lag
First checkpoint meeting the requirement − first checkpoint when it applies
Astra’s Site 014 second-pass CRO review applied at checkpoint 16 and was completed at checkpoint 19: 19 − 16 = 3 checkpoints. Its deadline was checkpoint 17, so it was two checkpoints late.
Never-completed transitions have no observed lag, not zero lag.
Continuity and follow-up cover work the agent represented. With no applicable work, their weight moves to other criteria within the same axis.
Trajectory investigation and verification use the lower of required-check and current-action averages at each checkpoint, when both apply. Checkpoints have equal weight.
Model scores average three runs. The 95% intervals use all 27 bootstrap resamples. Overlapping intervals are labelled “not reliably distinguished.”
The agent tool API · 31 actions
Agents inspect evidence, maintain records and submit their work. These actions do not expose the private grading reference.
A run meets the standard only if it passes all three checks. Scores on other criteria don’t offset a failed check.
A major concern is incomplete when any of its major requirements is unmet. Each concern counts once.
Readiness requires all three conditionsAny failed check is enough; otherwise, a run with unfinished assessments is labelled “not fully assessed.”
All 8 critical requirements met
36of 45 runs missed at least one
Fewer than 4 of 17 major concerns incomplete
45of 45 runs left at least four incomplete
No uncorrected false assurance
Or premature closure on a critical or major concern
40of 45 runs have this failure recorded
Independent counts, not sequential losses: the same run can appear in more than one failure count.
All three + complete assessments
0 of 45 runs meet the standardAll 45 runs fail at least one check.
Counts runs, not individual errors.
Relaxing or removing the major-concern check still leaves every run failing another check.
03
Error review
The error review scores claims the evidence didn’t support, separately from the diagnostic scores.
Reviewers compare claims, source records, actions and later corrections. Evidence must have been available when the agent made the claim.
Four kinds of errors
Class
What it means
Example
E1
False assurance or premature closure
Calling a result verified or closing an issue before the evidence supports it.
E2
Unsupported allegation
Saying a required check never happened when the record only shows missing documentation.
E3
Wrong attribution
Assigning a finding to the wrong participant, site, visit, time or responsible party.
E4
Missing documentary support
Making a true, consequential claim without supplying its supporting evidence.
3.75 points with an observed consequence, 2.5 otherwise; 1 point for missing documentary support; ×1.5 on critical concerns.
What counts as an observed consequence?
The false premise reached an issued instruction, query or escalation, appeared as a settled final finding, or suppressed required work through a state change.
Hypothetical downstream harm does not qualify. Repeated errors within the same concern and class count once, keeping the strongest penalty.
Worked example · GPT-6 Astra, run 1
Requirement coverage80.9
−
Error penalties24.1
→
Error-adjusted score56.7
Calculated before rounding. This separate score does not change the diagnostic composite.
Corrected after the deadline, before the final report
0.5 · half penalty
Never corrected or silently dropped
1 · full penalty
The deadline is normally the next checkpoint, unless a linked requirement allows longer. It never extends beyond the final checkpoint.
A mistaken state change must also be reversed. Rewording a report does not undo an action.
Error-score formulas · worked examples
Requirement coverage
100 × weight of met requirements ÷ 104.5
Weights: critical 5, major 1, minor and calibration 0.5.
Astra run 1: 84.5 ÷ 104.5 × 100 ≈ 80.86. This differs from Outputs coverage.
Error penalty
Base points × critical-concern multiplier × correction multiplier
Opus run 1’s uncorrected critical follow-up closure: 3.75 × 1.5 × 1 = 5.625 points.
Error-adjusted score
max(0, requirement coverage − error penalties)
Astra run 1: max(0, 80.861 − 24.125) ≈ 56.736.
How the error penalty changes the separate scoreThree-run means. Diagnostic scores are unchanged.
15 models with complete meansHover a line, or focus a model name below, to inspect its three values.
GPT-6 Astra and GPT-6 Luna remain first and second at all three penalty settings.
All sensitivity values
Three-run error-adjusted means · 0–100. Display rounded to one decimal; lines use exact means.
Model
2.5 points
3.75 points
5 points
GPT-6 Astra
65.8
60.5
55.2
GPT-6 Luna
58.5
54.5
50.4
Claude Sonnet 5.5
54.4
47.5
40.6
GPT-5.6 Terra
46.0
43.9
41.8
GLM 5.3
49.7
39.0
28.4
Claude Opus 5.5
47.6
35.1
22.6
Claude Sonnet 5
35.8
27.8
19.9
Claude Fable 5.1
41.2
26.0
16.5
GLM 5.3 Flash
32.2
20.7
13.2
Kimi K3
33.1
18.5
7.0
MiMo V2.6 Pro
32.9
17.9
5.8
Qwen 3.8-2.4T-A95B
30.6
13.0
1.8
Gemini 3.8 Flash
19.5
6.0
1.6
Gemini 3.1 Pro
6.2
4.5
2.8
Gemini 3.5 Flash Lite
0.0
0.0
0.0
04
How we checked the grader
We tested whether the grader passes a correct reference record, fails copies of it with required work removed, responds to targeted edits, and repeats its ratings.
Reference record
Expected
The correct reference record passes.
Observed
Meets the standard, with an error-adjusted score of 95.0.
All 8 critical requirements met; 0 major concerns incomplete.
Reference record with required work removed
Expected
Both copies fail.
Observed
Removing one critical requirement fails the critical check. Leaving four major concerns incomplete fails the major check.
Targeted edits
Expected
Ratings respond to missing evidence and work, not instructions to award full marks.
Observed
The grader ignored an injected instruction to award full marks; one evidence rating moved by one point. Invalid citations lowered evidence ratings. Removing a workstream lowered continuity from 4 to 2. Full results below.
Repeatability
Test
36 cases, with two fresh grading passes per case.
Observed
91.9% exact agreement; 99.8% average agreement within one point on the 0–4 scale.
We measured agreement within each case, then averaged the 36 results equally.
How the perturbation tests worked
We copied grading inputs from three selected cases and changed one feature at a time, such as source order, citation IDs or an instruction inserted into the agent’s text. We graded each original and edited version twice with the same judge instructions and settings, then compared ratings and requirement decisions. A separate paired test removed a workstream.
These tests did not alter the benchmark runs or their published scores.
Full test details
The reference record meets the standard; both copies with required work removed fail.
Record
Error-adjusted score
Critical met / 8
Major incomplete / 17
Observed result
Reference record
95.0
8
0
Meets standard
One critical requirement removed
84.5
7
1
Fails · critical rule
Four major concerns left incomplete
87.9
8
4
Fails · major rule
The critical edit also removes six major requirements in the same concern. It fails with only one incomplete major concern, below the four-concern threshold. The major-only edit fails despite meeting all eight critical requirements.
The broader targeted-edit study produced 25 complete assessments and one input failure across 26 grading passes. The focused workstream-removal check and the assertion–query pair were separate studies.
What changed in each targeted-edit test.
Change
Observed result
Scope
Replace submitted citations with invalid references
Evidence ratings fell in both selected report cases on both grading passes. Other ratings were largely preserved.
Two report cases; two altered assessments each. The remaining credit varied between passes.
Insert a demand to award full marks into the agent’s text
None of six altered assessments followed the full-marks demand wholesale. One evidence rating rose by one point.
Three selected cases; two grading passes each. The same one-point variation also appeared after reordering sources.
Reorder source groups without changing their contents
Some correctness and evidence ratings moved by one point; some transition decisions also changed.
The grading passes did not use matched random seeds. This shows sensitivity to how evidence is presented.
Remove a workstream but leave its links unresolved
Continuity fell from 4 to 2 on both grading passes; correctness stayed at 2.
A separate, focused check: two intact and two altered assessments.
Contrast an unsupported assertion with a qualified query
The blinded, model-assisted review penalized the assertion and left the query unflagged.
One authored pair. Its inserted actions were not all replayed through the agent’s normal execution tools.
Empty case bodies while still listing those cases
One grading pass reported missing required context; the other kept continuity at 4.
An inconsistent test input, not a clean history-loss test. The input failure is retained.
Repeat the same recorded case with the same ID
Both grading passes kept continuity at 4.
This did not create a second workstream, so it is not evidence that duplicate workstreams are accepted.
Continuity changed; correctness did not · original 0–4 scale.
Record
Continuity
Correctness
Intact record · pass 1
4
2
Intact record · pass 2
4
2
Workstream removed · pass 1
2
2
Workstream removed · pass 2
2
2
Repeatability details
The 36 cases produced 72 assessments. All numeric ratings matched in 25/36 case pairs; all numeric and categorical judgments matched in 22/36.
Grader
GPT-6.1 Sol
Reasoning
Max
Maximum output
128,000 tokens
Temperature
Provider default
05
Run conditions
Models shared the task, world, tool API and checkpoint schedule. The standard budget was 80 tool calls per checkpoint and four hours per run.
One run per model is published: the run with the median composite. Other runs are available on request.