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在模拟环境中训练语言模型用于精神科接诊

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。登录阅读完整解读 →

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.

First, do NOHARM: a medical safety benchmark and randomized study of physician and AI teaming on clinical consultations

David Wu, Fateme Nateghi Haredasht, Saloni Kumar Maharaj, Priyank Jain, Jessica Tran, Matthew Gwiazdon, Arjun Rustagi, Jenelle Jindal 等 57 位作者

Large language models (LLMs) and medical AI tools are routinely used by physicians and patients for medical advice, yet their clinical safety profiles remain poorly characterized. We present NOHARM (Numerous Options Harm Assessment for Risk in Medicine), a 1,100-task benchmark of primary care-to-specialist consultation cases to measure the frequency and severity of potentially harmful errors from LLM-generated medical consultation recommendations. NOHARM covers 10 specialties, with 12,747 expert annotations for 4,249 clinical management options. Across 20 notable LLMs and 4 widely used retrieval-augmented generation (RAG) clinical AI tools, direct application of recommendations carried potential for severe harm in up to 24.6% of cases, with errors of omission accounting for more than 80% of severe errors. Harm potential was not uniform across systems, with clinical AI tools outperforming generalist LLMs, and multi-agent AI teaming further improving performance in generalist models. In a randomized study of 101 U.S.-licensed generalist physicians, AI assistance improved physician performance compared to conventional resources. However, AI-assisted physicians frequently omitted valuable AI-generated recommendations and still scored lower than many AI systems alone. Had those recommendations been incorporated, combined human-AI responses would have outperformed both the human and AI system as used, suggesting complementary strengths and unrealized potential in human-AI teaming. Collectively, these results show that despite strong performance on medical knowledge benchmarks, widely used AI tools can produce medical consultation advice with the potential for severe harm, and highlight the need for explicit measurement of clinical safety. The benchmark and leaderboard are publicly available to support ongoing evaluation and improvement of AI systems used for clinical care.

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