ClinEdge: An Expert-Graded Benchmark of Real Patient Edge Cases Where Frontier Multimodal Models Fail

arXiv:2610.15239v1 Announce Type: new Abstract: Most benchmarks for large language models in medicine are built from licensing examinations and theoretical questions. The few that draw on real clinical data do so only in part, and rarely require a model to read a patient's own imaging. ClinEdge addresses this gap with 32 real, de-identified patient cases from active clinical practice, each evaluated across seven frontier systems for a total of 224 expert-graded evaluations. Each case pairs primary imaging with a short vignette, contains a feature known to defeat pattern-matched reasoning, and is scored against the patient's documented clinical course. The suite is built for depth rather than volume. Grading followed a two-stage expert process. First, a senior orthopaedic surgeon graded all 224 responses on a weighted rubric and a pass-or-fail verdict. Second, a panel of nineteen physicians, largely senior specialists at teaching medical colleges, independently reviewed every case and every one of the 224 grades. All seven production systems were evaluated through their public interfaces, and all 224 conversations are preserved as replayable links. Performance was poor across all systems, and the failures were shared: different vendors missed the same findings and converged on the same wrong plans. From the experts' notes we catalogue 18 recurring failure modes in five families. The models stop reading an image at the first finding. They give generic plans and lean toward over-treatment. They trust a misleading history over correct imaging. Their answers vary across systems and runs, and change with question format. Failing answers were delivered fluently and without any expressed uncertainty. Four cases are released in full; the remaining 28 are held out, and we invite frontier AI labs and healthcare AI companies to evaluate their models against them (research@futrbridge.com)