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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.

A Roadmap to Pluralistic Alignment

Taylor Sorensen, Jared Moore, Jillian Fisher, Mitchell Gordon, Niloofar Mireshghallah, Christopher Michael Rytting, Andre Ye, Liwei Jiang 等 12 位作者

With increased power and prevalence of AI systems, it is ever more critical that AI systems are designed to serve all, i.e., people with diverse values and perspectives. However, aligning models to serve pluralistic human values remains an open research question. In this piece, we propose a roadmap to pluralistic alignment, specifically using language models as a test bed. We identify and formalize three possible ways to define and operationalize pluralism in AI systems: 1) Overton pluralistic models that present a spectrum of reasonable responses; 2) Steerably pluralistic models that can steer to reflect certain perspectives; and 3) Distributionally pluralistic models that are well-calibrated to a given population in distribution. We also formalize and discuss three possible classes of pluralistic benchmarks: 1) Multi-objective benchmarks, 2) Trade-off steerable benchmarks, which incentivize models to steer to arbitrary trade-offs, and 3) Jury-pluralistic benchmarks which explicitly model diverse human ratings. We use this framework to argue that current alignment techniques may be fundamentally limited for pluralistic AI; indeed, we highlight empirical evidence, both from our own experiments and from other work, that standard alignment procedures might reduce distributional pluralism in models, motivating the need for further research on pluralistic alignment.

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