Medical large language models and agents show strong single-encounter question answering and evidence interpretation but struggle to accumulate and govern experience across encounters. We present HealthJev, an open-source agent separating shared safety rules and medical knowledge from a private longitudinal memory and distilling lessons from completed cases. To filter out erroneous lessons before they affect future behaviour, we self-train JevGate, a lightweight System-One model that decides which lessons enter memory; each decision takes a median of 86 milliseconds and about 1,000 input tokens, sustaining experience accumulation at negligible run-time overhead. On a longitudinal benchmark of 90-day simulated daily interactions for 20 users built from real MIMIC-IV trajectories, HealthJev outperformed a memory-free ReAct agent and three memory-augmented frameworks, with all paired comparisons significant. Across six tasks spanning clinical records, medical imaging, genomics and clinical text, HealthJev improved every task with a mean gain of 13.3 percentage points over the base condition, surpassing all baselines. The frozen library transferred to six further backbones with macro-average gains of 6.8 to 15.1 percentage points, and one task's library brought gains on other tasks. These results indicate that governed, self-evolving memory supports longitudinal personal health management beyond single encounters. HealthJev is publicly available at https://github.com/HC-Guo/Self-Evolving_HealthJev.
Large language models (LLMs) are advancing in multimodal understanding and reasoning, accelerating medical model development. Traditional Chinese medicine (TCM) uses evidence from the four examinations to determine disease location and nature, differentiate syndromes and guide treatment. This diagnostic process constitutes a complete chain of reasoning. We present Fu-TCM, a multimodal TCM LLM trained on data retained after cleaning and filtering an initial collection of approximately 7.12 million examples derived from classical texts, textbooks, medical images, clinical cases and publicly available datasets. The model was further optimized using Bianzheng-Grounded Policy Optimization (BGPO), which explicitly targets syndrome differentiation through rewards for response format, intermediate TCM reasoning fields and final syndrome predictions. Fu-TCM-27B led all six benchmarks spanning TCM reasoning, text and vision, achieving a macro-average accuracy of 81.01% and surpassing the strongest reference model with complete results across all six benchmarks by 7.13 percentage points. Its largest margin was 11.90 points on Fu-bianzheng. Case-level analyses further showed a positive association between intermediate-field accuracy and final syndrome-selection accuracy in most evaluated models. These findings suggest that TCM syndrome differentiation may be computationally learnable and that structured reasoning supervision can improve performance across TCM tasks.
Ziheng Li, Liu Kang, Feng Xiao, Luxi Xing Alibaba Group, Qingyi Si JD.com, Zhuoran Li Beijing University of Posts and Telecommunications, Weikang Gong Fudan University, Deqing Yang Fudan University 等 10 位作者
Group Relative Policy Optimization (GRPO) has emerged as a promising critic-free reinforcement learning paradigm for reasoning tasks. However, standard GRPO employs a coarse-grained credit assignment mechanism that propagates group-level rewards uniformly to to every token in a sequence, neglecting the varying contribution of individual reasoning steps. We address this limitation by introducing Outcome-grounded Advantage Reshaping (OAR), a fine-grained credit assignment mechanism that redistributes advantages based on how much each token influences the model’s final answer. We instantiate OAR via two complementary strategies: (1) OAR-P, which estimates outcome sensitivity through counterfactual token perturbations, serving as a high-fidelity attribution signal; (2) OAR-G, which uses an input-gradient sensitivity proxy to approximate the influence signal with a single backward pass. These importance signals are integrated with a conservative Bi-Level advantage reshaping scheme that suppresses low-impact tokens and boosts pivotal ones while preserving the overall advantage mass. Empirical results on extensive mathematical reasoning benchmarks demonstrate that while OAR-P sets the performance upper bound, OAR-G achieves comparable gains with negligible computational overhead, both significantly outperforming a strong GRPO baseline, pushing the boundaries of critic-free LLM reasoning.
尚无 AI 解读，展示原文摘要
cs.CL
Proceedings of the 64th Annual Meeting of the Association for Computational Linguistics (Volume 1: Long Papers) · 2026 · 正式发表