Mastering medical knowledge is crucial for medical-specific LLMs. However, despite the existence of medical benchmarks like MedQA, a unified framework that fully leverages existing knowledge bases to evaluate LLMs' mastery of medical knowledge is still lacking. We propose PretexEval, a novel framework that dynamically generates reliable and diverse test samples to evaluate LLMs for any given medical knowledge base. We notice that test samples produced directly from knowledge bases by templates or LLMs may introduce factual errors and also lack diversity. To address these issues, our framework employs predicate equivalence transformations to produce a series of variants for any given medical knowledge point. Finally, these produced predicate variants are converted into textual language, resulting in a series of reliable and diverse test samples. Here, we use our proposed framework to systematically investigate the mastery of medical factual knowledge of 12 well-known LLMs, based on two knowledge bases that are crucial for clinical diagnosis and treatment. The evaluation results illustrate that current LLMs still exhibit significant deficiencies in fully mastering medical knowledge, despite achieving considerable success on some famous public benchmarks. These new findings provide valuable insights for developing medical-specific LLMs, highlighting that current LLMs urgently need to strengthen their comprehensive and in-depth mastery of medical knowledge before being applied to real-world medical scenarios.

Large language models (LLMs) have demonstrated remarkable performance on various medical benchmarks, but their capabilities across different cognitive levels remain underexplored. Inspired by Bloom's Taxonomy, we propose a multi-cognitive-level evaluation framework for assessing LLMs in the medical domain in this study. The framework integrates existing medical datasets and introduces tasks targeting three cognitive levels: preliminary knowledge grasp, comprehensive knowledge application, and scenario-based problem solving. Using this framework, we systematically evaluate state-of-the-art general and medical LLMs from six prominent families: Llama, Qwen, Gemma, Phi, GPT, and DeepSeek. Our findings reveal a significant performance decline as cognitive complexity increases across evaluated models, with model size playing a more critical role in performance at higher cognitive levels. Our study highlights the need to enhance LLMs' medical capabilities at higher cognitive levels and provides insights for developing LLMs suited to real-world medical applications.

Large Language Models (LLMs) are expected to possess comprehensive medical knowledge to support real-world clinical applications. While domain-specific fine-tuning effectively injects medical knowledge into LLMs, it often causes catastrophic forgetting of previously acquired knowledge and instruction-following capabilities. In this paper, we investigate this issue and reveal a pattern of proximity-dependent forgetting: knowledge that is semantically or topically close to the injected content is more likely to be forgotten, while unrelated knowledge shows minimal degradation. Moreover, we observe that existing mitigation techniques fail to address this type of forgetting effectively. Motivated by this observation and inspired by human learning mechanisms, we proposeInternAL (\Internal Knowledge Augmentation Learning), a novel approach that leverages LLMs' own internal knowledge to mitigate forgetting. InternAL first probes internal knowledge closely related to the injection by prompting the model with questions derived from the injected knowledge. This knowledge is then used to augment the original injection dataset, guiding the model to retain related prior knowledge during training. Experimental results on multiple LLMs (LLaMA, Qwen) demonstrate that InternAL significantly mitigates proximity-related forgetting while maintaining strong knowledge injection performance. Our findings provide new insights into the nature of catastrophic forgetting in medical knowledge injection and highlight a promising direction for robust domain adaptation in LLMs. Code and datasets are available at https://github.com/THUMLP/InternAL.