Interaction-Limited Safe Continuous-Time RL for Dynamical Medical Treatment

Medical treatment recommendation poses several challenges to reinforcement learning (RL): patient physiology evolves in continuous time, measurements and interventions are performed at irregular intervals, and treatment effects vary substantially across individuals. Existing RL formulations and simulated environments, however, are based on discrete-time MDPs with fixed decision intervals. Thus, it remains difficult to evaluate whether RL methods can handle time-interval-dependent disease progression, personalized treatment response, and safety between consecutive measurement points. To address this gap, we introduce MedGym, a benchmark environment for dynamic treatment recommendation. MedGym models longitudinal patient evolution in a continuous-time framework and constructs a configurable medical RL benchmark from clinical data by using Physics-Informed Neural Networks. The resulting benchmark enables direct comparison between discrete-time and continuous-time methods under irregular treatment timing and patient-specific dynamics. Furthermore, MedGym supports evaluation from clinically important perspectives, such as personalization and trajectory-level safety. By providing a standardized and configurable benchmark for continuous-time dynamic treatment, MedGym enables more realistic and informative evaluation of medical RL methods.

Safe reinforcement learning (RL) typically asks $\textit{what}$ an agent should do. We ask $\textit{when}$ it needs to act, and show that a single policy can jointly learn control inputs and communication-efficient timing decisions under a pointwise Lyapunov safety shield. We focus on stabilization around a known equilibrium, where CARE-based LQR backups, Lyapunov certificates, and classical Lyapunov-STC are well defined, enabling clean comparison against analytical baselines. A run-time assurance (RTA) layer overrides the policy via a one-step-ahead Lyapunov prediction and a precomputed LQR backup, providing a strictly stronger guarantee than constrained MDP methods that enforce safety only in expectation. On an inverted pendulum, cart--pole, and planar quadrotor, the learned policy achieves $1.91\times$, $1.45\times$, and $3.51\times$ higher mean inter-sample interval (MSI) than a Lyapunov-triggered baseline; a fixed LQR controller at the same average rate is unstable on all three plants, showing that adaptive timing, not a lower average rate, makes sparsity safe. A CARE-derived Lyapunov reward transfers across environments without redesign, with a single weight $w_c$ controlling the stability--communication tradeoff; ablations confirm the RTA shield is essential, with its removal reducing MSI by $1.27$--$1.84\times$ and degrading state norms. A preference-conditioned extension recovers the full tradeoff frontier from one model at $\tfrac{2}{11}$ of training compute, and SAC experiments show the results are algorithm-agnostic across discrete and continuous domains. A 12-state 3D quadrotor case study extends the framework to higher-dimensional systems where classical STC is intractable, and robustness to $\pm30\%$ mass variation and disturbances shows graceful degradation, with the RTA absorbing what the learned policy cannot.

Safe exploration remains a fundamental challenge in reinforcement learning (RL), limiting the deployment of RL agents in the real world. We propose Sampling-Based Safe Reinforcement Learning (SBSRL), a model-based RL algorithm that maintains safety throughout the learning process by enforcing constraints jointly across a finite set of dynamics samples. This formulation approximates an intractable worst-case optimization over uncertain dynamics and enables practical safety guarantees in continuous domains. We further introduce an exploration strategy based on constraining epistemic uncertainty, eliminating the need for explicit exploration bonuses. Under regularity conditions, we derive high-probability guarantees of safety throughout learning and a finite-time sample complexity bound for recovering a near-optimal policy. Empirically, SBSRL achieves safe and efficient exploration both in simulation and in real robotic hardware, and readily extends to practical deep-ensemble implementations that scale to high-dimensional continuous control problems.