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arXiv AI By Xiaomeng Xiong, Marcus Walker, Yanlin Jiang

LLMs as Judges and Examinees for Medical Item Difficulty Prediction

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The paper investigates using open‑weight large language models (LLMs) as both judges and simulated examinees to predict medical exam item difficulty from text alone. LLMs provided absolute difficulty ratings, pairwise comparisons, and response‑based signals such as correctness and option probabilities, which were combined with baseline features to improve predictions. The best models achieved Spearman correlations of .447 on USMLE and .494 on PANCE, surpassing prior shared‑task systems and matching proprietary models, demonstrating that LLM signals capture difficulty information beyond traditional text representations.

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