GSEM: Graph-based Self-Evolving Memory for Experience Augmented Clinical Reasoning

Clinical decision-making is inherently experience-driven: physicians progressively refine their reasoning by synthesizing patient history, multimodal observations, and prior diagnostic experiences across interactions. In contrast, current multimodal large language model (MLLM)-based medical AI agents largely operate as stateless inference systems, generating decisions independently for each interaction without retaining or internalizing experiential knowledge. This discrepancy limits their ability to progressively improve reasoning reliability through usage and adapt to longitudinal patient contexts in real-world clinical workflows. In this study, we propose Medical Structured Multimodal Memory (MSM-Mem), an agentic memory framework that enables medical AI agents to evolve through accumulated clinical experiences. MSM-Mem organizes heterogeneous clinical experiences into semantic, episodic, and visual memory and incrementally updates them during inference, allowing the agent to retrieve prior experiences to inform current reasoning and progressively refine decision-making over time. Evaluations on MoE-LLaVA backbones demonstrate consistent performance improve- ments with further gains observed through continued usage. In general, MSM-Mem offers a viable pathway toward medical AI agents capable of evolving their reasoning competence in a manner analogous to the way clinicians learn from practice over time.

Medical agent systems are increasingly expected to support interactive clinical decision making rather than only static question answering. In such settings, effective agents must reuse prior experience across evolving cases, yet existing memory mechanisms often retain raw historical traces that are redundant, noisy, and difficult to govern. More importantly, they rarely distinguish which memories are truly useful for future reasoning. This limits their ability to accumulate compact and reliable experience for long-horizon clinical reasoning. To close this gap, we propose SkeMex, a post-deployment self-evolution framework that improves medical agents through a skill-based memory without updating model weights. SkeMex distills informative interaction trajectories into structured skills that encode reusable procedural knowledge, and organizes them into a multi-branch repository spanning general, task-specific, and action-level experience. To determine which memories should be reused and retained, SkeMex estimates context-dependent utility from environment feedback and uses it to guide value-aware retrieval and repository governance. A closed-loop ``Read--Write--Assess--Govern" lifecycle further supports continual evolution by writing new skills, updating utilities, promoting useful memories, and removing harmful entries. Experiments across diverse clinical tasks show that SkeMex consistently outperforms representative memory-based agents in both offline and online settings. It also generalizes across model backbones and supports transferable skill memory. All data and code will be released publicly.

Large language model (LLM) driven multi-agent systems have shown promise in complex clinical reasoning, yet existing approaches rely on static strategies and lack persistent clinical memory, preventing self-evolving from prior diagnostic successes and failures. We present EMR, a self-evolving medical multi-agent system via Experience Mining and Reuse. EMR introduces a hierarchical clinical experience library that organizes accumulated knowledge into three levels: clinical principles, diagnostic patterns, and representative cases. During inference, EMR emulates multidisciplinary consultation: a planner agent coordinates domain-specific department agents for specialized reasoning, while a summary agent synthesizes their analyses into a final decision. Critically, EMR automatically extracts correct diagnostic insights and failure-related warnings from multi-agent reasoning trajectories, incrementally updating the experience library to guide future cases. Experiments on medical reasoning benchmarks demonstrate that EMR consistently outperforms state-of-the-art medical multi-agent baselines. Further analysis reveals that the hierarchical experience enables cross-specialty generalization and transfer across diverse LLM backbones, offering a scalable and in