Current benchmarks for evaluating large language models (LLMs) in medical calculation are largely based on simplified settings, where each patient case corresponds to a single calculator and the required tool is explicitly specified in the query. However, real clinical scenarios often require multiple calculators for joint evaluation, nested-calculator calculation, and fuzzy queries that do not directly specify the target calculator. To this end, we propose a new medical calculation benchmark, MedCalc-Pro, which covers three progressively challenging task settings: single-calculator, multi-calculator, and nested-calculator calculation settings. MedCalc-Pro contains 2,268 real-world clinical cases, covering 77 medical calculators across 14 clinical departments. Meanwhile, to address the limited performance of existing frameworks and methods in complex clinical scenarios, we further propose a more generalizable agent framework that supports multi-calculator selection and nested-calculator calling, while suppressing parameter error propagation through structured validation and evidence audit. We conduct systematic comparisons across open-source, closed-source, and medical-specialized LLMs, and the results show that our framework achieves the best performance across all three task settings. This work provides a new benchmark and method for evaluating and applying LLMs in challenging medical calculation scenarios. The dataset and code are publicly available at https://github.com/easymoney7774/MedCalc-Pro.

Large language models (LLMs) have been widely adopted in healthcare, yet they still encounter significant challenges in complex clinical decision-making scenarios. Existing benchmarks primarily assess LLM performance in single-course settings and lack systematic evaluation in multi-course scenarios, where a patient’s condition evolves over time. To address this gap, we propose ClinicalMC, a benchmark for multi-course clinical decision-making. It includes 1,275 Chinese and 5,804 English samples across four stages from admission to discharge. These stages cover triage, first-course examination/diagnosis/treatment, subsequent multi-course examination/assessment/treatment, and final diagnosis. In ClinicalMC, patients in the English dataset undergo an average of 5.11 clinical courses, whereas those in the Chinese dataset undergo 3.42. To assess LLM performance, we construct a multi-agent evaluation framework that includes patient, examiner, and doctor agents. Based on the benchmark and framework, we design two experimental settings—a single-turn static setting and a multi-turn dynamic setting—and assess three categories of LLMs: 1) closed-source LLMs like GPT-4o-mini; 2) open-source LLMs like DeepSeek-V3, and 3) medical LLMs like HuatuoGPT-o1. Through extensive evaluation, we aim to better understand LLM performance in the medical domain and support its effective deployment in healthcare.