Clinical Decision-Making

Follow this topic Ask about this topic

Momentum

17 papers in the last four weeks, up 325% on the four weeks before. 0.2% of all new papers.

Jul 13Week of Sep 28

Latest papers 78

May 15, 2026cs.LG

Imitation learning for clinical decision support in pediatric ECMO

Pediatric critical care is a dynamic, high-stakes process involving constant monitoring and adjustments in life-saving treatments. Modeling these interventions is crucial for effective decision support. To address the challenges of high complexity and data scarcity in pediatric Extracorporeal Membrane Oxygenation (ECMO), we frame clinical decision-making as learning to act from trajectories, i.e., imitation learning that learns action models from observational data, with a key feature that actions are not directly observed. We consider TabPFN, a recent transformer-based approach for tabular data, and traditional baselines including XGBoost and Multi-Layer Perceptrons(MLPs) on real-world pediatric ECMO data to learn the action models. We find that the TabPFN-based approach consistently outperforms these classical baselines, supporting its use as a strong clinician-behavior baseline for pediatric ECMO decision support.

Fateme Golivand, Michael Skinner, Saurabh Mathur +5

University of Texas at Dallas · Technische Universität Darmstadt · Swarthmore College +1

Latent Action Learning Clinical Decision Support Clinical Decision-Making Imitation Learning

May 15, 2026cs.CL

Few-Shot Large Language Models for Actionable Triage Categorization of Online Patient Inquiries

Online patient inquiries are often informal, incomplete, and written before professional assessment, yet they must still be routed to an appropriate level of clinical follow-up. We study this as a four-class actionable triage task -- self-care, schedule-visit, urgent-clinician-review, or emergency-referral, and ask whether prompted large language models (LLMs) can support such routing under low-resource labeling conditions. Using the public HealthCareMagic-100K corpus, we construct a 300-example human calibrated gold evaluation set, a 700-example auto-labeled silver training set, and a 40-example few-shot pool. We compare Term Frequency-Inverse Document Frequency (TF-IDF) and Bidirectional Encoder Representations from Transformers for Biomedical Text Mining (BioBERT) baselines train on silver labels against six prompted LLMs under 0-shot, 4-shot, and 12-shot conditions respectively. Accordingly, we evaluate with macro-

F_1

alongside safety-aware metrics, including emergency-recall, under-triage rate, and severe under-triage rate. The strongest LLM (Claude Haiku 4.5, 12-shot) reaches macro-

F_1

0.475, exceeding the best supervised baseline (BioBERT, 0.378) on point estimate, with overlapping confidence intervals. Few-shot prompting and two-model agreement help in label-dependent ways: self-care agreement is reliable, urgent-clinician-review is not. We conclude that LLMs can support triage prioritization and selective human review, but not autonomous deployment.

Liqi Zhou, Jiafu Li

Healthcare Clinical Triage Few-Shot Prompting Clinical Decision-Making Classification Clinical Language Model Evaluation+1

May 14, 2026cs.LG

RxEval: A Prescription-Level Benchmark for Evaluating LLM Medication Recommendation

Inpatient medication recommendation requires clinicians to repeatedly select specific medications, doses, and routes as a patient's condition evolves. Existing benchmarks formulate this task as admission-level prediction over coarse drug codes with multi-hot diagnostic and procedure code inputs, failing to capture the per-timepoint, information-rich nature of real prescribing. We propose RxEval, a prescription-level benchmark that evaluates LLM prescribing capability by multiple-choice questions: each question presents a detailed patient profile and time-ordered clinical trajectory, requiring selection of specific medication-dose-route triples from real prescriptions and patient-specific distractors generated via reasoning-chain perturbation. RxEval comprises 1,547 questions spanning 584 patients, 18 diagnostic categories, and 969 unique medications. Evaluation of 16 LLMs shows that RxEval is both challenging and discriminative: F1 ranges from 45.18 to 77.10 across models, and the best Exact Match is only 46.10%. Error analysis reveals that even frontier models may overlook stated patient information and fail to derive clinical conclusions.

Shuhao Chen, Weisen Jiang, Changmiao Wang +4

The Hong Kong University of Science and Technology · Southern University of Science and Technology · The Chinese University of Hong Kong +2

Healthcare Clinical Decision Support Clinical Decision-Making Large Language Model-Based Recommendation Clinical Language Model Evaluation

May 13, 2026cs.AI

Modeling Bounded Rationality in Drug Shortage Pharmacists Using Attention-Guided Dynamic Decomposition

Hospital pharmacists make high-stakes decisions to mitigate drug shortages under uncertainty, time pressure, and patient risk. Interviews revealed that pharmacists focus attention on a small subset of drugs, limiting cognitive effort to the most urgent cases. Motivated by these findings, we formalize a bounded-rational, attention-guided decision framework that dynamically decomposes drugs into a subset for high-cost reasoning and a complementary subset for low-cost monitoring. We develop two agents: an Expert Agent that applies attention weights derived from pharmacist interviews, and a Learner Agent that adapts attention allocation over time through experience. Across simulated scenarios spanning short to long horizons, we show that attention-guided planning supports stable decision-making without complete state reasoning. These results suggest that a primary decision is not what action to take, but where to allocate cognitive effort, and that attention-guided, satisficing strategies can reduce problem complexity while maintaining stable performance.

Yaniv Eliyahu Amiri, Noah Chicoine, Jacqueline Griffin +1

Khoury College of Computer Sciences, Northeastern University, Boston, MA, USA · Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA · Department of Psychology, Northeastern University, Boston, MA, USA

Computational Cognitive Modeling Clinical Decision-Making Model-Based Planning Bounded Rationality Decision-Making under Uncertainty

May 13, 2026cs.AI

RealICU: Do LLM Agents Understand Long-Context ICU Data? A Benchmark Beyond Behavior Imitation

Intensive care units (ICU) generate long, dense and evolving streams of clinical information, where physicians must repeatedly reassess patient states under time pressure, underscoring a clear need for reliable AI decision support. Existing ICU benchmarks typically treat historical clinician actions as ground truth. However, these actions are made under incomplete information and limited temporal context of the underlying patient state, and may therefore be suboptimal, making it difficult to assess the true reasoning capabilities of AI systems. We introduce RealICU, a hindsight-annotated benchmark for evaluating large language models (LLMs) under realistic ICU conditions, where labels are created after senior physicians review the full patient trajectory. We formulate four physician-motivated tasks: assess Patient Status, Acute Problems, Recommended Actions, and Red Flag actions that risk unsafe outcomes. We partition each trajectory with 30-min windows and release two datasets: RealICU-Gold with 930-window annotations from 94 MIMIC-IV patients, and RealICU-Scale with 11,862 windows extended by Oracle, a physician-validated LLM hindsight labeler. Existing LLMs including memory-augmented ones performed poorly on RealICU, exposing two failure modes: a recall-safety tradeoff for clinical recommendations, and an anchoring bias to early interpretations of the patient. We further introduce ICU-Evo to study structured-memory agents that improves long-horizon reasoning but does not fully eliminate safety failures. Together, RealICU provides a clinically grounded testbed for measuring and improving AI sequential decision-support in high-stakes care. Project page: https://chengzhi-leo.github.io/RealICU-Bench/

Chengzhi Shen, Weixiang Shen, Tobias Susetzky +8

Cherise · Technical University of Munich (TUM) · TUM University Hospital +8

Healthcare Clinical Decision-Making Clinical Reasoning Clinical Language Model Evaluation Memory-Augmented Language Model Agents

May 10, 2026cs.AI

EpiGraph: Building Generalists for Evidence-Intensive Epilepsy Reasoning in the Wild

Epilepsy diagnosis and treatment require evidence-intensive reasoning across heterogeneous clinical knowledge, including biosignal patterns, genetic mechanisms, pharmacogenomics, treatment strategies, and patient outcomes. In this work, we present \textsc{EpiGraph}, a large-scale epilepsy knowledge graph and benchmark for evaluating knowledge-augmented clinical reasoning. \textsc{EpiGraph} integrates 48,166 peer-reviewed papers and seven clinical resources into a heterogeneous graph containing 24,324 entities and 32,009 evidence-grounded triplets across five clinical layers. Built upon this graph, \textsc{EpiBench} defines five clinically motivated tasks spanning clinical decision-making, EEG report generation, pharmacogenomic precision medicine, treatment recommendation, and deep research planning. We evaluate six LLMs under both standard and Graph-RAG settings. Results show that integrating \textsc{EpiGraph} consistently improves performance across all tasks, with the largest gains observed in pharmacogenomic reasoning (+30--41%). Our findings demonstrate that structured epilepsy knowledge substantially enhances evidence-grounded clinical reasoning and provides a practical benchmark framework for evaluating knowledge-augmented LLMs in real-world neurological settings. Our code is available at: https://github.com/LabRAI/EEG-KG.

Yuyang Dai, Zheng Chen, Jathurshan Pradeepkumar +4

Florida State University · The University of Osaka · University of Illinois Urbana-Champaign

KG Construction Retrieval-Augmented Generation Clinical Decision-Making Clinical Reasoning Biomedical KGs

May 10, 2026cs.AI

Towards Conversational Medical AI with Eyes, Ears and a Voice

The practice of medicine relies not only upon skillful dialogue but also on the nuanced exchange and interpretation of rich auditory and visual cues between doctors and patients. Building on the low-latency voice and video processing capabilities of Gemini, we introduce AI co-clinician, a first-of-its-kind conversational AI system utilizing continuous streams of audio-visual data from live patient conversations to inform real-time clinical decisions. Its dual-agent architecture balances deep clinical reasoning with the low latency required for natural dialogue. To assess this system, we implemented a video-based interface emulating telemedicine consultations. We crafted 20 standardized outpatient scenarios requiring proactive real-time auditory and visual reasoning and designed "TelePACES" evaluation criteria alongside case-specific rubrics. In a randomized, interface-blinded, crossover simulation study (n = 120 encounters) with 10 internal medicine residents as patient actors, we compared AI co-clinician with primary care physicians (PCPs), GPT-Realtime, and a baseline agent. AI co-clinician approached PCPs in key TelePACES dimensions, including management plans and differential diagnosis, while significantly outperforming GPT-Realtime across all general criteria. While our agent demonstrated parity with PCPs in case-specific triage measures, physicians maintained superior overall performance in case-specific assessments. Although AI co-clinician marks a significant advance in real-time telemedical AI, gaps remain in physical examination and disease-specific reasoning. Our work shows that text-only approaches fail to capture the true challenges of medical consultation and suggests that high-stakes real-time diagnostic AI is most safely advanced in collaborative, triadic models where AI can be a supportive co-clinician for doctors and patients.

Meet Shah, Jason Gusdorf, Anil Palepu +50

Audio-Visual Understanding Healthcare Clinical Decision-Making Clinical Reasoning Conversational Agents Human-AI Collaboration

May 6, 2026cs.LG

Feature importance analysis for patient management decisions

The objective of this paper is to understand what characteristics and features of clinical data influence physician's decision about ordering laboratory tests or prescribing medications the most. We conduct our analysis on data and decisions extracted from electronic health records of 4486 post-surgical cardiac patients. The summary statistics for 335 different lab order decisions and 407 medication decisions are reported. We show that in many cases, physician's lab-order and medication decisions can be well predicted from a small subset of all features.

Michal Valko, Milos Hauskrecht

Department of Computer Science, University of Pittsburgh, Pittsburgh, PA

Feature Attribution Healthcare Clinical Decision-Making

May 6, 2026cs.LG

Evidence-based anomaly detection in clinical domains

Anomaly detection methods can be very useful in identifying interesting or concerning events. In this work, we develop and examine new probabilistic anomaly detection methods that let us evaluate management decisions for a specific patient and identify those decisions that are highly unusual with respect to patients with the same or similar condition. The statistics used in this detection are derived from probabilistic models such as Bayesian networks that are learned from a database of past patient cases. We apply our methods to the problem of identifying unusual patient-management decisions in post-surgical cardiac patients.

Milos Hauskrecht, Michal Valko, Branislav Kveton +2

Computer Science Department; 2 Intelligent Systems Program; 3 Department of Biomedical Informatics, University of Pittsburgh, PA · Intelligent Systems Program; 3 Department of Biomedical Informatics, University of Pittsburgh, PA

Clinical Decision Support Clinical Decision-Making Anomaly Detection

May 6, 2026cs.CL

Ask Before You Diagnose: Safe-Psych, a Sequential Evaluation Benchmark for LLMs in Psychiatry

Large language models (LLMs) are increasingly used for decision support in healthcare, but clinical evidence is often incomplete or evolving. When the available information is insufficient to support a reliable answer, models should request clarification or abstain rather than provide unsupported responses. Existing medical benchmarks, however, typically assume that complete information is available upfront. We introduce Safe-Psych, a sequential benchmark for evaluating how LLMs handle evolving diagnostic uncertainty in clinical psychiatry. Safe-Psych contains over 1,000 real-world psychiatric clinical notes segmented to simulate incremental evidence disclosure, with psychiatrist-derived action labels at each stage: DIAGNOSE, CLARIFY, or ABSTAIN. We evaluate multiple state-of-the-art LLMs in full-information and sequential settings. Our findings show that capability does not ensure calibration: even strong models struggle under incomplete clinical information, with under-abstention exceeding 60% for most models and safety-aware prompting reducing premature commitment only by shifting errors toward excessive abstention. In sequential evaluation, models frequently diagnose before sufficient evidence is available and rarely seek clarification unless explicitly prompted; these premature diagnoses are less accurate than on-time diagnoses. Overall, Safe-Psych reveals a limitation across the evaluated models: recognizing when clinical evidence is incomplete and additional information is needed. We release Safe-Psych to support research on improving LLM safety in healthcare.

Oriana Presacan, Andreea Grama, Larisa Irimină +6

National University of Science and Technology Politehnica Bucharest · Psychiatric Hospital Doctor Gheorghe Preda · Oslo Metropolitan University +3

Selective Prediction Healthcare Medical Diagnosis Mental Health Clinical Decision-Making LLM Safety Evaluation+1

May 5, 2026cs.CL

EQUITRIAGE: A Fairness Audit of Gender Bias in LLM-Based Emergency Department Triage

Emergency department triage assigns patients an acuity score that determines treatment priority, and clinical evidence documents persistent gender disparities in human acuity assessment. As hospitals pilot large language models (LLMs) as triage decision support, a critical question is whether these models reproduce or mitigate known biases. We present EQUITRIAGE, a fairness audit of LLM-based ESI assignment evaluating five models (Gemini-3-Flash, Nemotron-3-Super, DeepSeek-V3.1, Mistral-Small-3.2, GPT-4.1-Nano) across 374,275 evaluations on 18,714 MIMIC-IV-ED vignettes under four prompt strategies. Of 9,368 originals, 9,346 are paired with a gender-swapped counterfactual. All five models produced flip rates above a pre-registered 5% threshold (9.9% to 43.8%). Two showed directional female undertriage (DeepSeek F/M 2.15:1, Gemini 1.34:1); two were near-parity; one had high sensitivity with weak male-direction asymmetry. DeepSeek's directional bias coexisted with a low outcome-linked calibration gap (0.013 against MIMIC-IV admission), a Chouldechova-style dissociation between within-group calibration and between-pair counterfactual invariance. Demographic blinding reduced Gemini's flip rate to 0.5%; an age-preserving blind variant left DeepSeek with residual F/M 1.25, implicating age as a residual channel. Chain-of-thought prompting degraded accuracy for all five models. A two-model ablation reveals opposite underlying mechanisms for the same directional phenotype: in Gemini the signal is emergent in the combined name+gender swap, while in DeepSeek the gender token alone carries it. EQUITRIAGE shows that group parity, counterfactual invariance, and gender calibration are distinct fairness properties, that intervention effectiveness is model-dependent, and that per-model counterfactual auditing should precede clinical deployment.

Richard J. Young, Alice M. Matthews

University of Nevada, Las Vegas, Lee Business School, Las Vegas, NV, USA · DeepNeuro AI, Las Vegas, NV, USA · Concorde Career Colleges, Dept. of Cardiovascular and Medical Diagnostic Sonography

Gender Bias in Language Models Clinical Triage Social Bias in Language Models Clinical Decision-Making Language Model Calibration Language Model Bias Evaluation+1

Apr 29, 2026cs.CY

Algorithmic Authority and the Clinical Standard of Care

The integration of artificial intelligence into clinical medicine creates a fundamental tension between algorithmic probabilistic reasoning and the experiential intuition of expert physicians; applying Lawrence Lessig's \enquote{Code is Law} framework, I argue that the architecture of clinical AI systems already functions as de facto medical regulation, reshaping liability and the standard of care. Reframing AI \enquote{hallucination} as structurally analogous to well-documented human cognitive failures such as confirmation bias and premature diagnostic closure, I show that both failure modes demand a unified governance response. I therefore propose a dialectical standard of care that treats the integrated AI-physician dyad as the singular responsible diagnostic entity, mandating the synthesis of algorithmic precision with human interpretive authority within robust data governance and patient privacy frameworks.

Aizierjiang Aiersilan

The George Washington University

AI Accountability Healthcare Clinical Decision-Making AI Governance Human-AI Decision Making Human Oversight of AI

Apr 28, 2026q-bio.NC

Single-turn emergency psychiatric triage across 15 frontier AI chatbots

People increasingly turn to general-purpose AI chatbots for advice about emotional and mental health problems, but the ability of these systems to recognize and appropriately triage psychiatric emergencies remains under-characterized. We evaluated psychiatric triage performance in 15 frontier AI chatbots using 112 clinical vignettes spanning four urgency levels, from routine care to immediate emergency assessment. In each trial (1680 total), a chatbot received a single user message conveying all triage-relevant information from one vignette and recommended a timeframe for care. The primary outcome was emergency under-triage; secondary outcomes included triage accuracy and the direction of errors. Vignettes and user messages were generated using a clinician-verified LLM pipeline. Across 415 emergency trials, 23 were under-triaged (5.5%; 95% CI 1.8-15.9). Overall accuracy, averaged across urgency levels, ranged from 42.0% to 71.8% across chatbots and was lowest for intermediate cases (19.6%; 95% CI 11.7-28.1). Every chatbot showed a net over-triage bias; overall, 763 of 786 incorrect assignments (97.1%) were more urgent than the prespecified triage level. The error pattern was similar when predictions were assessed against clinician ratings: 35 of 430 trials involving vignettes rated as emergencies by at least 75% of clinicians were under-triaged (8.1%). AI chatbots recognized most psychiatric emergencies but still missed clinically important cases and frequently over-triaged less urgent presentations. Further evaluations should examine how triage performance changes when clinically relevant information must be elicited through conversation.

Veith Weilnhammer, Lennart Luettgau, Christopher Summerfield +5

Max Planck UCL Centre for Computational Psychiatry and Ageing Research, London, UK · UK AI Security Institute · Department of Experimental Psychology, University of Oxford, Oxford, UK +2

Healthcare Clinical Triage Mental Health Clinical Decision-Making Clinical Language Model Evaluation

Apr 23, 2026cs.RO

A Bayesian Reasoning Framework for Robotic Systems in Autonomous Casualty Triage

Autonomous robots deployed in mass casualty incidents (MCI) face the challenge of making critical decisions based on incomplete and noisy perceptual data. We present an autonomous robotic system for casualty assessment that fuses outputs from multiple vision-based algorithms, estimating signs of severe hemorrhage, visible trauma, or physical alertness, into a coherent triage assessment. At the core of our system is a Bayesian network, constructed from expert-defined rules, which enables probabilistic reasoning about a casualty's condition even with missing or conflicting sensory inputs. The system, evaluated during the DARPA Triage Challenge (DTC) in realistic MCI scenarios involving 11 and 9 casualties, demonstrated a nearly three-fold improvement in physiological assessment accuracy (from 15% to 42% and 19% to 46%) compared to a vision-only baseline. More importantly, overall triage accuracy increased from 14% to 53%, while the diagnostic coverage of the system expanded from 31% to 95% of cases. These results demonstrate that integrating expert-guided probabilistic reasoning with advanced vision-based sensing can significantly enhance the reliability and decision-making capabilities of autonomous systems in critical real-world applications.

Szymon Rusiecki, Cecilia Morales, Pia Störy +3

AGH University of Krakow, Krak´ow, Poland · Carnegie Mellon University, Pittsburgh, PA, USA · Osnabrück University, Osnabrück, Germany +1

Robotics Clinical Decision-Making

Apr 1, 2026cs.CL

CARE: Privacy-Compliant Agentic Reasoning with Evidence Discordance

Large language model (LLM) systems are increasingly used to support high-stakes decision-making, but they typically perform worse when the available evidence is internally inconsistent. Such a scenario exists in real-world healthcare settings, with patient-reported symptoms contradicting medical signs. To study this problem, we introduce MIMIC-DOS, a dataset for short-horizon organ dysfunction worsening prediction in the intensive care unit (ICU) setting. We derive this dataset from the widely recognized MIMIC-IV, a publicly available electronic health record dataset, and construct it exclusively from cases in which discordance between signs and symptoms exists. This setting poses a substantial challenge for existing LLM-based approaches, with single-pass LLMs and agentic pipelines often struggling to reconcile such conflicting signals. To address this problem, we propose CARE: a multi-stage privacy-compliant agentic reasoning framework in which a proprietary LLM provides guidance by generating structured categories and transitions without accessing sensitive patient data, while a local LLM uses these categories and transitions to support evidence acquisition and final decision-making. Empirically, under controlled retrospective evaluation on MIMIC-DOS, CARE achieves the best overall performance across key metrics among the evaluated LLMs and agentic workflows, showing that it can more robustly handle conflicting clinical evidence while preserving privacy.

Haochen Liu, Weien Li, Rui Song +6

University of Cambridge · McGill University · MBZUAI - Mohamed bin Zayed University of Artificial Intelligence +2

Privacy-Preserving Language Models Healthcare Clinical Decision-Making Multi-LLM Collaboration Clinical Risk Prediction

Dec 8, 2025cs.LG

CLARITY: Medical World Model for Guiding Treatment Decisions by Modeling Context-Aware Disease Trajectories in Latent Space

Clinical decision-making in oncology requires predicting dynamic disease evolution, a task current static AI predictors cannot perform. While world models (WMs) offer a paradigm for generative prediction, existing medical applications remain limited. Existing methods often rely on stochastic diffusion models, focusing on visual reconstruction rather than causal, physiological transitions. Furthermore, in medical domain, models like MeWM typically ignore patient-specific temporal and clinical contexts and lack a feedback mechanism to link predictions to treatment decisions. To address these gaps, we introduce CLARITY, a medical world model that forecasts disease evolution directly within a structured latent space. It explicitly integrates time intervals (temporal context) and patient-specific data (clinical context) to model treatment-conditioned progression as a smooth, interpretable trajectory, and thus generate physiologically faithful, individualized treatment plans. Finally, CLARITY introduces a novel prediction-to-decision framework, translating latent rollouts into transparent, actionable recommendations. CLARITY demonstrates state-of-the-art performance in treatment planning. On the MU-Glioma-Post dataset, our approach outperforms recent MeWM by 12%, and significantly surpasses all other medical-specific large language models.

Tianxingjian Ding, Yuanhao Zou, Chen Chen +2

Institute of Artificial Intelligence, University of Central Florida

Healthcare Clinical Decision Support Clinical Decision-Making Oncology Latent World Models

Nov 3, 2025cs.MA

An Explanation-oriented Inquiry Dialogue Game for Expert Collaborative Recommendations

This work presents a requirement analysis for collaborative dialogues among medical experts and an inquiry dialogue game based on this analysis for incorporating explainability into multiagent system design. The game allows experts with different knowledge bases to collaboratively make recommendations while generating rich traces of the reasoning process through combining explanation-based illocutionary forces in an inquiry dialogue. The dialogue game was implemented as a prototype web-application and evaluated against the specification through a formative user study. The user study confirms that the dialogue game meets the needs for collaboration among medical experts. It also provides insights on the real-life value of dialogue-based communication tools for the medical community.

Qurat-ul-ain Shaheen, Katarzyna Budzynska, Carles Sierra

IIIA, CSIC, Barcelona, Spain · Software Competence Centre Hagenberg, Hagenberg, Austria · Laboratory of The New Ethos, Faculty of Administration and Social Sciences, Warsaw University of Technology, Warsaw, Poland

Explainable Artificial Intelligence Healthcare Multi-Agent Collaboration Clinical Decision-Making Multi-Agent Communication

Date pendingcs.AI

Timely Clinical Diagnosis through Active Test Selection

There is growing interest in using machine learning (ML) to support clinical diagnosis, but most approaches rely on static, fully observed datasets and fail to reflect the sequential, resource-aware reasoning clinicians use in practice. Diagnosis remains complex and error prone, especially in high-pressure or resource-limited settings, underscoring the need for frameworks that help clinicians make timely and cost-effective decisions. We propose ACTMED (Adaptive Clinical Test selection via Model-based Experimental Design), a diagnostic framework that integrates Bayesian Experimental Design (BED) with large language models (LLMs) to better emulate real-world diagnostic reasoning. At each step, ACTMED selects the test expected to yield the greatest reduction in diagnostic uncertainty for a given patient. LLMs act as flexible simulators, generating plausible patient state distributions and supporting belief updates without requiring structured, task-specific training data. Clinicians can remain in the loop; reviewing test suggestions, interpreting intermediate outputs, and applying clinical judgment throughout. We evaluate ACTMED on real-world datasets and show it can optimize test selection to improve diagnostic accuracy, interpretability, and resource use. This represents a step toward transparent, adaptive, and clinician-aligned diagnostic systems that generalize across settings with reduced reliance on domain-specific data.

Silas Ruhrberg Estévez, Nicolás Astorga, Mihaela van der Schaar

University of Cambridge Cambridge, UK

Clinical Decision Support Clinical Decision-Making Clinical Reasoning