Preferred, Not Safer: Pairwise Preference Is a Poor Proxy for Clinical Safety
We evaluate whether clinician pairwise preferences provide a reliable signal of clinical safety in large language model (LLM) evaluation using expert feedback from MOOVE (Massive Open Online Validation and Evaluation), a clinician-led platform collecting blinded pairwise preferences alongside multi-criterion rubric ratings. Clinicians assign scores on a discrete $[-2, +2]$ scale, where negative values indicate clinically unsafe or misleading content. Using 26{,}804 pairwise judgments across outputs from 13 LLMs, contributed by more than 736 clinicians across 28+ countries, we find that clinician preference is a poor proxy for safety-critical performance. Models ranking highly under pairwi...
| Authors | Fay Elhassan, David Sasu, Alexandra Kulinkina et al. |
|---|---|
| Primary category | cs.CL |
| Published | 25 May 2026 |
| Last updated at source | 28 September 2026 |
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