Reasoning about Actions and Change (RAC) has historically played a pivotal role in solving foundational AI problems, such as the frame problem. It has driven advancements in AI fields, such as non-monotonic and commonsense reasoning. RAC remains crucial for AI systems that operate in dynamic environments, engage in interactive scenarios, or rely on commonsense reasoning. Despite substantial advances made by Large Language Models (LLMs) in various AI domains, their performance in RAC remains underexplored. To address this gap, we introduce a new diagnostic benchmark, $\textbf{ActionReasoningBench}$, which encompasses 8 domains and includes questions for up to 19 action sequences. This benchmark rigorously evaluates LLMs across six key RAC dimensions: $\textit{Fluent Tracking}$, $\textit{State Tracking}$, $\textit{Action Executability}$, $\textit{Effects of Actions}$, $\textit{Numerical RAC}$, and $\textit{Composite Questions}$. LLMs demonstrate average accuracy rates of 73.55%, 65.63%, 58.73%, and 62.38% on the former four dimensions, which are frequently discussed in RAC literature. However, the performance on the latter two dimensions, which introduce complex and novel reasoning questions, the average performance of LLMs is lowered to 33.16% and 51.19%, respectively, reflecting a 17.9% performance decline. We also introduce new ramification constraints to capture the indirect effects of actions, providing deeper insights into RAC challenges. Our evaluation of state-of-the-art LLMs, including both open-source and commercial models, reveals challenges across all RAC dimensions, particularly in handling ramifications, with GPT-4o failing to solve any question and o1-preview achieving a score of only 18.4%.

This position paper argues that post-deployment monitoring in clinical AI is underdeveloped and proposes statistically valid and label-efficient testing frameworks as a principled foundation for ensuring reliability and safety in real-world deployment. A recent review found that only 9\% of FDA-registered AI-based healthcare tools include a post-deployment surveillance plan. Existing monitoring approaches are often manual, sporadic, and reactive, making them ill-suited for the dynamic environments in which clinical models operate. We contend that post-deployment monitoring should be grounded in label-efficient and statistically valid testing frameworks, offering a principled alternative to current practices. We use the term "statistically valid" to refer to methods that provide explicit guarantees on error rates (e.g., Type I/II error), enable formal inference under pre-defined assumptions, and support reproducibility—features that align with regulatory requirements. Specifically, we propose that the detection of changes in the data and model performance degradation should be framed as distinct statistical hypothesis testing problems. Grounding monitoring in statistical rigor ensures a reproducible and scientifically sound basis for maintaining the reliability of clinical AI systems. Importantly, it also opens new research directions for the technical community---spanning theory, methods, and tools for statistically principled detection, attribution, and mitigation of post-deployment model failures in real-world settings.