Grounding Clinical AI Competency in Human Cognition Through the Clinical World Model and Skill-Mix Framework

We present Multi-Agent Reasoning and Coordination (MARC), an open-source framework that replaces monolithic LLM prompting with deterministic multi-agent orchestration for clinical reasoning. MARC coordinates role-specialized agents for extraction, reasoning, answer generation, and evaluation, with explicit context passing and traceable intermediate outputs, enabling stage-wise failure attribution. We additionally introduce a Decomposer module that generates task-specific agent prompts from a plain-language description, eliminating manual prompt engineering. The framework supports both API-based and local CPU-compatible deployments and is entirely configurable via YAML, without code modifications. MARC is designed to be model-agnostic, interpretable, and accessible to clinical domain experts without programming expertise. The full framework is available at https://github.com/Penn-RAIL/MARC-v1.

Medical AI remains organized around isolated models, whereas care requires accountable capabilities that persist across time. We define clinical AI skills and propose the Clinical Harness, a runtime governance architecture that registers, orchestrates, constrains and monitors them. Using osteoporosis as an exemplar, we show how knowledge-driven, data-driven and physics-enhanced skills can support lifecycle care and provide a governed substrate for future medical agents.

Current AI evaluation frameworks focus primarily on technical performance, including accuracy, robustness, reasoning ability, and policy compliance. These measures remain essential, but they are not sufficient for systems that interact directly with users through natural language. Human-facing AI systems are increasingly used as advisors, coaches, tutors, and companions. In these roles, their responses can shape how users reason, interpret emotions, form beliefs, calibrate trust, and make decisions. The relevant unit of evaluation is therefore not only the model, but the human-AI interaction. This paper introduces psychological competence as a missing dimension in AI evaluation. We define psychological competence as the capacity of a human-facing AI system to support user cognition, emotional interpretation, and behavioral decision-making in ways that are appropriate to the user, context, and purpose of the interaction. This includes interaction properties such as framing, tone, perceived authority, responsiveness, uncertainty handling, and conversational guidance. Existing evaluation approaches capture parts of this problem but rarely assess these psychological effects directly. Drawing on behavioral science and human-AI interaction research, we outline a conceptual framework for psychological competence and its core domains. Rather than proposing a specific benchmark, we define the construct, clarify its boundaries, and describe how it may be assessed through scenario-based probes, structured human evaluation, and model-assisted evaluation methods. We argue that psychological competence should become a core consideration for model providers, deploying organizations, researchers, and regulators concerned with the real-world effects of human-facing AI systems.