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.
Tianyi Niu, Justin Chen, Genta Indra Winata Capital One, Shi-Xiong Zhang CapitalOne, Supriyo Chakraborty Capital One, Sambit Sahu CapitalOne, Yue Zhang, Elias Stengel-Eskin University of Texas at Austin 等 9 位作者
Large Language Model (LLM) routers dynamically select optimal models for given inputs. Existing approaches typically assume access to ground-truth labeled data, which is often unavailable in practice, especially when user request distributions are heterogeneous and unknown. We introduce Routing with Generated Data (RGD), a challenging setting in which routers are trained exclusively on generated queries and answers produced from high-level task descriptions by generator LLMs. We evaluate query-answer routers (using both queries and labels) and query-only routers across four diverse benchmarks and 12 models, finding that query-answer routers degrade faster than query-only routers as generator quality decreases. Our analysis reveals two crucial characteristics of effective generators: they must accurately respond to their own questions, and their questions must produce sufficient performance differentiation among the model pool. We then show how filtering for these characteristics can improve the quality of generated data. We further propose CASCAL, a novel query-only router that estimates model correctness through consensus voting and identifies model-specific skill niches via hierarchical clustering. CASCAL is substantially more robust to generator quality, outperforming the best query-answer router by 4.6% absolute accuracy when trained on weak generator data.
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cs.CL
Proceedings of the 64th Annual Meeting of the Association for Computational Linguistics (Volume 1: Long Papers) · 2026 · 正式发表
Jaewoo Lee, Archiki Prasad, Justin Chen, Zaid Khan, Elias Stengel-Eskin University of Texas at Austin, Mohit Bansal University of North Carolina at Chapel Hill
Information-seeking is a core capability for AI agents, requiring them to gather and reason over tool-generated information across long trajectories. However, such multi-step information-seeking tasks remain challenging for agents backed by language models. While process reward models (PRMs) can guide agents by ranking candidate steps at test-time, existing PRMs, designed for short reasoning with binary judgment, cannot capture richer dimensions of information-seeking steps, such as tool interactions and reasoning over tool outputs, nor handle the rapidly growing context in long-horizon tasks. To address these limitations, we introduce PRInTS, a generative PRM trained with dual capabilities: (1) dense scoring based on the PRM’s reasoning across multiple step quality dimensions (e.g., interpretation of tool outputs, tool call informativeness) and (2) trajectory summarization that compresses the growing context while preserving essential information for step evaluation. Extensive evaluations across FRAMES, GAIA (levels 1-3), and WebWalkerQA (easy-hard) benchmarks on multiple models, with ablations, reveal that best-of-n sampling with PRInTS enhances information-seeking in open-source models as well as specialized agents, matching or surpassing frontier models with a much smaller backbone agent and outperforming other strong reward modeling baselines.
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cs.CL · cs.AI
Proceedings of the 64th Annual Meeting of the Association for Computational Linguistics (Volume 1: Long Papers) · 2026 · 正式发表
Andrew Sellergren, Sahar Kazemzadeh, Tiam Jaroensri, Atilla Kiraly, Madeleine Traverse, Timo Kohlberger, Shawn Xu, Fayaz Jamil 等 81 位作者
Artificial intelligence (AI) has significant potential in healthcare applications, but its training and deployment faces challenges due to healthcare's diverse data, complex tasks, and the need to preserve privacy. Foundation models that perform well on medical tasks and require less task-specific tuning data are critical to accelerate the development of healthcare AI applications. We introduce MedGemma, a collection of medical vision-language foundation models based on Gemma 3 4B and 27B. MedGemma demonstrates advanced medical understanding and reasoning on images and text, significantly exceeding the performance of similar-sized generative models and approaching the performance of task-specific models, while maintaining the general capabilities of the Gemma 3 base models. For out-of-distribution tasks, MedGemma achieves 2.6-10% improvement on medical multimodal question answering, 15.5-18.1% improvement on chest X-ray finding classification, and 10.8% improvement on agentic evaluations compared to the base models. Fine-tuning MedGemma further improves performance in subdomains, reducing errors in electronic health record information retrieval by 50% and reaching comparable performance to existing specialized state-of-the-art methods for pneumothorax classification and histopathology patch classification. We additionally introduce MedSigLIP, a medically-tuned vision encoder derived from SigLIP. MedSigLIP powers the visual understanding capabilities of MedGemma and as an encoder achieves comparable or better performance than specialized medical image encoders. Taken together, the MedGemma collection provides a strong foundation of medical image and text capabilities, with potential to significantly accelerate medical research and development of downstream applications. The MedGemma collection, including tutorials and model weights, can be found at https://goo.gle/medgemma.