Training language models in simulation for psychiatric intake
Samuel Schmidgall, Tim Strother, Alex Bijamov, Min Woo Sun, Anil Palepu, Akshay Goel, Ulysse Marteau-Ferey, Théo Moutakanni 等 56 位作者
AI 速览：作者报告，在模拟环境中进行多轮强化学习训练，可提升语言模型在结构化精神科接诊中的表现，包括病史采集、鉴别诊断和初始管理计划。
In psychiatric practice, the clinical intake interview remains a primary diagnostic instrument, requiring the clinician to establish rapport while disentangling complex, overlapping presentations. Here, we show that multi-turn reinforcement learning (RL) in simulation environments improves language model performance on structured text-based psychiatric intake, spanning history-taking, differential diagnosis, and initial management planning. In a randomized, double-blind crossover study ($N = 60$ matched scenario pairs, 120 encounters) comparing the RL-trained agent against its identically prompted base model, 32 board-certified psychiatrists role-played standardized patients while a separate panel of 15 independent, board-certified psychiatrists scored the de-identified transcripts. The trained agent outperformed the base model in 76.7% of matched scenario pairs ($p < 0.0001$), with gains on an adapted clinical-examination rubric ($d_z = 0.77$, $p < 0.0001$), patient-centered communication (82.0% vs. 65.2%, $p < 0.001$), and differential diagnosis appropriateness (68.3% vs. 33.3%, $p < 0.001$). Across 127 psychiatrist-validated simulated intake scenarios, the trained agent nearly doubled its base model's clinical rubric score (0.706 vs. 0.379; composite reward 0.564 vs. 0.294, $p < 0.0001$). To systematically probe conversational safety, we established two Delphi-consensus taxonomies, of clinical safety risks and relational competencies, from which 256 challenging adversarial presentations were derived; we find that training in simulation environments more than halved under-triage of acute safety risks (12.9% vs. 30.5%, $p < 0.0001$). Simulation environments thus provide a controlled testbed for training and stress-testing psychiatric conversational agents, with gains that transferred to psychiatrist-enacted encounters, though residual gaps require safeguards and clinician oversight.
Girish Narayanswamy, Maxwell A. Xu, A. Ali Heydari, Samy Abdel-Ghaffar, Marius Guerard, Kara Vaillancourt, Zhihan Zhang, Jake Garrison 等 40 位作者
While ubiquitous wearable sensors capture a wealth of behavioral and physiological information, effectively transforming these signals into personalized health insights is challenging. Specifically, converting low-level sensor data into representations capable of characterizing higher-level states is difficult due to high phenotypic diversity and variation in individual baseline health, physiology, and lifestyle factors. Moreover, collecting wearable data paired with health outcome annotations is laborious and expensive, and retrospective annotation remains practically unfeasible, contributing to a scarcity of data with high-quality labels. To overcome these limitations, we propose a foundation model for wearable health that is pretrained on more than one trillion minutes of unlabeled sensor signals drawn from a large cohort of five million participants. We demonstrate that the joint scaling of model capacity and pretraining data volume leads to systematic improvements in performance, as evaluated on a diverse set of 35 health prediction tasks, spanning cardiovascular, metabolic, sleep, and mental health, as well as lifestyle choices and demographic factors. We find that this population scale representation unlocks label-efficient few-shot learning and generative capabilities for robust daily metric estimation. To further leverage this learned representation, we deploy a classroom of LLM agents to autonomously search the space of downstream predictive heads built on the model embeddings, showing broad performance improvements that increase with LLM model capacity. Finally, we show how integrating these downstream predictors into a Personal Health Agent can support model responses that are more relevant, contextually aware, and safe, and we validate this via 1,860 ratings from a cohort of clinicians.
An AI Co-Data-Scientist for Prioritizing Candidate Biomarkers from Wearable Sensor Data
Yubin Kim, Salman Rahman, Samuel Schmidgall, Chunjong Park, A. Ali Heydari, Ahmed A. Metwally, Hong Yu, Xin Liu 等 36 位作者
AI 速览：CoDaS是一个在人类监督下整合多智能体假设生成、确定性统计分析、对抗性验证与文献解读的AI联合数据科学家，用于从可穿戴设备数据中优先筛选与心理健康和代谢终点相关的候选生物标志物关联。
Wearable devices generate continuous physiological and behavioral data, but converting these signals into clinically reviewable biomarker hypotheses remains labor-intensive. We introduce CoDaS, an AI co-data-scientist that integrates multi-agent hypothesis generation, deterministic statistical analysis, adversarial validation and literature-grounded interpretation under human oversight. Across three wearable cohorts comprising 9,279 participant-observations, CoDaS prioritized candidate associations for mental-health and metabolic endpoints after internal checks for replication, stability, robustness and leakage. The system identified related circadian-instability signals associated with depression, including sleep-duration variability in DWB ($ρ$ = 0.252, $p$ < 0.001) and sleep-onset variability in GLOBEM ($ρ$ = 0.126, $p$ < 0.001), and derived a wearable cardiovascular-fitness index associated with insulin resistance (steps/resting heart rate; $ρ$ = -0.374, $p$ < 0.001). Adding these features to demographic models produced modest gains ($ΔR^2$ = 0.040 for depression, 0.021 for insulin resistance). In a 12-clinician review totaling approximately 25 active hours, clinician validity judgments aligned with CoDaS confidence tiers ($ρ$ = 0.67, $p$ = 0.005), whereas added clinical value and confidence to act were rated lower. CoDaS supports traceable, hypothesis-generating prioritization of wearable candidate biomarkers.
Rory Sayres, Kejia Chen, Ayush Jain, Matthew Thompson, Jonathan Richina, Xiang Yin, Jimmy Hu, Fan Zhang 等 22 位作者
Patient-managed Personal Health Records (PHRs) promises to empower patients to better understand their health; but information in the record is complex, potentially hindering insights. In this study, we assess the potential of large language models (LLMs, Gemini 3.0 Flash) to provide helpful answers to user health queries, when provided clinical data from PHRs as context. A total of 2,257 user queries were drawn from 3 different distributions to represent patient questions: shorter web search queries, longer questions derived from templates of chatbot conversations, and questions patients asked to their healthcare team (patient calls). Queries were matched with de-identified PHRs (from a pool of 1,945). Gemini responses were generated (1) without PHR context; (2) with a basic summary of demographics, conditions, and medications; (3) with full, extensive clinical notes. For evaluation, we leveraged an existing rating framework (SHARP), and developed a new framework for specific error modes when interpreting PHRs. Evaluation was performed using autoraters for the full set, and with clinician ratings for a subset (n=95), with both sets of raters knowing the full PHR context. We see significant improvements in the helpfulness of answers to all question types with PHR data (p < 0.001, paired t-test). We also observe potential gains in safety, accuracy, relevance and personalization of answers. Our PHR evaluation framework further identifies gaps in LLM understanding of particular aspects of complex PHRs, such as temporal disorientation, and rare but meaningful confabulations. These results suggest potential for PHR data to help people with a wide range of user needs; and provide a framework for monitoring for gaps in LLM answers based on PHR context. This study motivates further work to assess and realize potential benefits to users from understanding their health records.
Joseph Breda, Fadi Yousif, Beszel Hawkins, Marinela Cotoi, Miao Liu, Ray Luo, Po-Hsuan Cameron Chen, Mike Schaekermann 等 33 位作者
Language models excel at diagnostic assessments on curated medical case-studies and vignettes, performing on par with, or better than, clinical professionals. However, existing studies focus on complex scenarios with rich context making it difficult to draw conclusions about how these systems perform for patients reporting symptoms in everyday life. We deployed SymptomAI, a set of conversational AI agents for end-to-end patient interviewing and differential diagnosis (DDx), via the Fitbit app in a study that randomized participants (N=13,917) to interact with five AI agents. This corpus captures diverse communication and a realistic distribution of illnesses from a real world population. A subset of 1,228 participants reported a clinician-provided diagnosis, and 517 of these were further evaluated by a panel of clinicians during over 250 hours of annotation. SymptomAI DDx were significantly more accurate (OR = 2.56, p < 0.001) than those from independent clinicians given the same dialogue in a blinded randomized comparison. Moreover, agentic strategies which conduct a dedicated symptom interview that elicit additional symptom information before providing a diagnosis, perform substantially better than baseline, user-guided conversations (p < 0.001). An auxiliary analysis on 1,509 conversations from a general US population panel validated that these results generalize beyond wearable device users. We used SymptomAI diagnoses as labels for all 13,917 participants to analyze over 500,000 days of wearable metrics across nearly 400 unique conditions. We identified strong associations between acute infections and physiological shifts (e.g., OR > 7 for influenza). While limited by self-reported ground truth, these results demonstrate the benefits of a dedicated and complete symptom interview compared to a user-guided symptom discussion, which is the default of most consumer LLMs.
Yubin Kim, Ken Gu, Chanwoo Park, Chunjong Park, Samuel Schmidgall, A. Ali Heydari, Yao Yan, Zhihan Zhang 等 20 位作者
Agents, language model-based systems capable of reasoning, planning, and acting are widely adopted in real-world tasks, yet how their performance changes as these systems scale across key dimensions remains underexplored. We introduce quantitative scaling principles for agent systems as a predictive model, capturing how performance varies with coordination, model capability, and measurable system and task factors. Across 260 configurations spanning six agentic benchmarks, five canonical architectures (Single-Agent and four Multi-Agent: Independent, Centralized, Decentralized, Hybrid), and three LLM families, we perform controlled evaluations, standardizing tools, prompts, and compute to isolate architectural effects. The resulting model achieves a cross-validated R^2=0.373 across all six benchmarks (R^2=0.413 with a task-grounded capability metric). We identify a robust capability-saturation effect and additional patterns: (1) a coordination yields diminishing returns once single-agent baselines exceed certain performance; (2) tool-heavy tasks appear to incur multi-agent overhead; and (3) architectures without centralized verification tend to propagate errors more than those with centralized coordination. Relative performance change compared to single-agent baseline ranges from +80.8% on decomposable financial reasoning to -70.0% on sequential planning, demonstrating that architecture-task alignment determines collaborative success. The framework identifies the best-performing architecture for 87% of held-out configurations and shows consistent relative architecture preferences on unseen frontier models. Agent effectiveness depends on alignment between coordination and task structure, and that mismatched coordination degrades the performance.
Research Protocol for the Google Health Digital Well-being Study
Daniel McDuff, Andrew Barakat, Ari Winbush, Allen Jiang, Felicia Cordeiro, Ryann Crowley, Lauren E. Kahn, John Hernandez 等 9 位作者
AI 速览：本文提出一项数字福祉（DWB）研究方案，旨在以更大、更具代表性的样本和更好的核心构念测量，回答数字设备使用如何影响健康与福祉。
The impact of digital device use on health and well-being is a pressing question to which individuals, families, schools, policy makers, legislators, and digital designers are all demanding answers. However, the scientific literature on this topic to date is marred by small and/or unrepresentative samples, poor measurement of core constructs (e.g., device use, smartphone addiction), and a limited ability to address the psychological and behavioral mechanisms that may underlie the relationships between device use and well-being. A number of recent authoritative reviews have made urgent calls for future research projects to address these limitations. The critical role of research is to identify which patterns of use are associated with benefits versus risks, and who is more vulnerable to harmful versus beneficial outcomes, so that we can pursue evidence-based product design, education, and regulation aimed at maximizing benefits and minimizing risks of smartphones and other digital devices. We describe a protocol for a Digital Well-Being (DWB) study to help answer these questions.