Retrieval-Augmented Generation Based Nurse Observation Extraction

Conversational nurse-patient transcripts contain actionable observations, but converting these transcripts into structured representations at scale remains challenging. Documentation burden is substantial, with prior studies showing clinicians spend large portions of their workday on documentation and related desk work rather than direct patient care. MEDIQA-SYNUR focuses on observation extraction from conversational nurse-patient transcripts, requiring systems to normalize these narratives into a predefined schema with value-type constraints. We propose a modular retrieval-augmented generation (RAG) pipeline that uses the training set as an exemplar corpus, combines schema-constrained prompting (full schema vs. pruned candidate schema), deterministic schema-based postprocessing, and a second-pass audit, with two LLM backbones: Llama-4-Scout-17B-16E-Instruct and GPT-5.2 with corresponding embedding models for RAG. Our best configuration uses GPT-5.2 with full schema, RAG, and a second-pass auditing, achieving 80.36% F1 score. Overall, our results show that RAG consistently improves performance, while the optimal degree of schema constraint depends on the model, and second-pass auditing yields modest additional gains by correcting residual schema-adherence errors.

Retrieval-augmented generation (RAG) is a widely used approach for grounding large language models (LLMs) in external knowledge. However, configuring a pipeline is an expensive hyperparameter optimization problem over many interacting choices, from chunking and embedding model to reranking and generation. Existing optimizers, from greedy search to Bayesian optimization, reduce each trial to an aggregate score and search without modeling why a configuration performed as it did, even though the retrieved chunks already provide evidence about whether each failure occurred during retrieval or after it. We introduce Agentic AutoRAG, an LLM-agent optimizer for multi-objective RAG hyperparameter optimization with retrieval-versus-generation failure attribution. It proposes configurations scored on a frozen exam from the corpus: after each trial a Diagnoser attributes each failed question to retrieval or generation, and a Proposer, grounded in a knowledge base of model rankings and pricing, selects the next configuration, weighing accuracy against cost to trace a Pareto frontier. On three multi-hop QA benchmarks it reaches higher LLM-judge accuracy than every baseline we compare, and within its first 10 trials it matches or beats the statistical baselines' full 30-trial judge accuracy. In its cost-aware mode on a real-world healthcare corpus it reaches a median exam accuracy of 77%, above the strongest baseline's 71.5%, at about 58% of that baseline's cost per query, and it matches that 71.5% at about 22% of the cost.

As real-world datasets become more complex and heterogeneous, supervised learning is often bottlenecked by input representation design. Modeling multimodal data, such as time-series, free text, and structured records, often requires non-trivial domain expertise. We propose an agentic pipeline to streamline this process. First, an LLM analyzes a small but diverse subset of text-serialized input examples in-context to synthesize a global rubric, which acts as a programmatic specification for extracting and organizing evidence. This rubric is then used to transform naive text-serializations of inputs into a more standardized format for downstream models. We also describe local rubrics, which are task-conditioned interpretive summaries generated by an LLM. Across 15 clinical tasks from the EHRSHOT benchmark, our rubric approaches significantly outperform count-feature models, naive LLM baselines, and a clinical foundation model pretrained on orders of magnitude more data. Beyond performance, rubrics offer operational advantages such as being easy to audit, cost-effectiveness at scale, and facilitating tabular representations.