论文库

General-purpose generative AI (GenAI) models are being rapidly adopted in healthcare, but they are challenging to assess with traditional evaluation frameworks. These conceptual, methodological, and practical challenges parallel decades of work in evaluating clinician and health system quality and safety. We describe the adaptation of methods from several fields, combined with emerging technical approaches, into a structured, multi-method evaluation framework designed to give well-rounded assessments of GenAI in health at scale. The approach first anchors evaluation to Critical User Journeys (CUJs) to help prioritize out of a large choice space, and maps these to a phased AI system lifecycle (base model development, product development, and post-deployment monitoring), since evaluation at each stage requires different methodological approaches. In this context, the approach then integrates three distinct evaluation methods (closed-question benchmarks, LLM-as-a-judge autoraters, and expert human review) across three core domains: accuracy, safety, and usefulness. Taken together, this approach provides a strategic framework for bridging the gap between benchmarking results and performance in the real world with the goal of supporting decision-making and accountability across development, procurement, and deployment for product teams, health systems, and regulators.

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.