BRIDGE: benchmarking large language models for understanding real-world clinical practice texts

Large language models (LLMs) are evolving rapidly and hold great promise for medical applications, yet benchmarking on real-world clinical data such as electronic health records remains limited. Most existing benchmarks rely on medical examination-style questions or PubMed-derived text, failing to capture the complexity of clinical practice, while others target specific application scenarios with limited generalizability. Here we present BRIDGE, a comprehensive multilingual benchmark comprising 87 tasks sourced from 59 real-world clinical data sources across 9 languages. It covers eight task types spanning the patient care continuum, including triage, information extraction, diagnosis, prognosis and billing coding, and involves 14 clinical specialties. We systematically evaluated 95 LLMs (including DeepSeek-R1, GPT-4o, Gemini and Qwen3) under multiple inference strategies. Results reveal substantial performance variation across model sizes, languages, natural language processing tasks and clinical specialties. Open-source LLMs can match proprietary models, while medically fine-tuned models built on older backbones often lag behind updated general-purpose LLMs. BRIDGE and its continuously updated leaderboard provide foundational resources and important references for evaluating and developing LLMs for real-world clinical text understanding.