Clinical Decision-Making

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Overview

Clinical decision-making is the process of choosing tests, diagnoses, treatments, and care plans from evidence that may be incomplete or uncertain, with consequences for patient outcomes and resource use. Approaches include clinical prediction models, causal and individualized treatment-effect methods, decision-focused optimization, and sequential policies that balance gathering more information against acting or deferring. Large language models and multi-agent systems are increasingly evaluated for interactive tasks such as history-taking, triage, longitudinal record review, and treatment planning, often with retrieval, uncertainty estimates, or clinician oversight. A central challenge is that strong diagnostic or benchmark scores do not ensure safe, stable, fair decisions in real workflows, especially when evidence is missing, patient context shifts, or the costs of errors differ.

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133 papers21 papers in the last four weeks, up 50% on the four weeks before. 0.1% of all new papers.

May 18, 2026

What Does the AI Doctor Value? Auditing Pluralism in the Clinical Ethics of Language Models

Medicine is inherently pluralistic. Principles such as autonomy, beneficence, nonmaleficence, and justice routinely conflict, and such ethical dilemmas often sharply divide reasonable physicians. Good clinical practice navigates these tensions in concert with each patient's values rather than imposing a single ethical stance. The ethical values that large language models bring to medical advice, however, have not been systematically examined. We present a framework for auditing value pluralism in medical AI, comprising a benchmark of clinician-verified dilemmas and an attribution method that recovers value priorities directly from decisions. The ecosystem of frontier models spans physician-level value heterogeneity, and models discuss competing values in their reasoning (Overton pluralism) before committing to a decision. However, individual model decisions are near-deterministic across repeated sampling and semantic variations, failing to reproduce the distributional pluralism of the physician panel. Across benchmark cases, these consistent decisions reflect committed, systematic value preferences. While most model priorities fall within the natural range of inter-physician variation, some significantly underweight patient autonomy. A single LLM deployed without regard for its value priorities could amplify those priorities at scale to every patient it serves. Without explicit efforts to balance ethical perspectives with one or multiple models, these tools risk replacing clinical pluralism with a deployment monoculture.

Payal Chandak, Victoria Alkin, David Wu +11

Moral Reasoning in Language ModelsHealthcareLLM AuditingClinical Decision-MakingClinical Language Model Evaluation
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May 15, 2026

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 LearningClinical Decision SupportClinical Decision-MakingImitation Learning
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May 15, 2026

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-F1F_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-F1F_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

HealthcareClinical TriageFew-Shot PromptingClinical Decision-MakingClassificationClinical Language Model Evaluation+2
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May 14, 2026

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

Medication RecommendationHealthcareClinical Decision SupportClinical Decision-MakingLarge Language Model-Based RecommendationClinical Language Model Evaluation
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May 13, 2026

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 ModelingClinical Decision-MakingModel-Based PlanningBounded RationalityDecision-Making under Uncertainty
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May 13, 2026

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

HealthcareClinical Decision-MakingClinical ReasoningClinical Language Model EvaluationMemory-Augmented Language Model Agents
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May 10, 2026

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 EpiGraph, a large-scale epilepsy knowledge graph and benchmark for evaluating knowledge-augmented clinical reasoning. 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, 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 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 ConstructionRetrieval-Augmented GenerationClinical Decision-MakingClinical ReasoningBiomedical KGs
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May 10, 2026

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 UnderstandingHealthcareClinical Decision-MakingClinical ReasoningConversational AgentsHuman-AI Collaboration
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May 6, 2026

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 AttributionHealthcareClinical Decision-Making
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May 6, 2026

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 SupportClinical Decision-MakingAnomaly Detection
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May 6, 2026

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 PredictionHealthcareMedical DiagnosisMental HealthClinical Decision-MakingLLM Safety Evaluation+1
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May 5, 2026

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 ModelsClinical TriageSocial Bias in Language ModelsClinical Decision-MakingLanguage Model CalibrationLanguage Model Bias Evaluation+1
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Apr 29, 2026

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 AccountabilityHealthcareClinical Decision-MakingAI GovernanceHuman-AI Decision MakingHuman Oversight of AI
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Apr 28, 2026

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

HealthcareClinical TriageMental HealthClinical Decision-MakingClinical Language Model Evaluation
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Apr 23, 2026

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

RoboticsClinical Decision-Making
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Apr 14, 2026

From Prediction to Intervention: The Evolution of AI in Biomedicine

Artificial intelligence has advanced rapidly in biomedicine through large-scale multimodal data integration, enabling increasingly accurate prediction of clinical outcomes and patient stratification. These systems, however, remain fundamentally observational: they learn statistical associations from historical data and operate within previously observed biological and clinical states, limiting their ability to generalize to novel therapies or unobserved interventions. We argue that AI in biomedicine is undergoing a structural transition. As biomedical decision-making increasingly depends on reasoning about intervention rather than extrapolation from past observations, predictive architectures become structurally insufficient. Systems that learn from historical data cannot, by construction, represent how biological systems evolve under perturbation, and therefore cannot reliably support decision-making in the presence of novel interventions. We introduce a conceptual framework distinguishing observational and interventional intelligence and define disease-level models as systems that explicitly represent the state, dynamics, and intervention response of biological processes. These models enable a shift from inference to simulation -- reasoning about what will happen under intervention rather than what is likely based on the past. This transition also implies a shift in where value is created: from data processing and prediction toward systems that support and define decision-making under intervention. It follows directly from the structure of biomedical decision-making and defines the next stage of AI in medicine. Systems that cannot model intervention will be structurally excluded from decision-making.

Andrew Feinberg, Aleksandr Sarachakov, Viktor Svekolkin +3

BostonGene Corporation, Waltham, MA, USA

Clinical Decision-MakingClinical Decision SupportClinical Prediction
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Apr 10, 2026

Beyond the Individual: Virtualizing Multi-Disciplinary Reasoning for Clinical Intake via Collaborative Agents

The initial outpatient consultation is critical for clinical decision-making, yet it is often conducted by a single physician under time pressure, making it prone to cognitive biases and incomplete evidence capture. Although the Multi-Disciplinary Team (MDT) reduces these risks, they are costly and difficult to scale to real-time intake. We propose Aegle, a synchronous virtual MDT framework that brings MDT-level reasoning to outpatient consultations via a graph-based multi-agent architecture. Aegle formalizes the consultation state using a structured SOAP representation, separating evidence collection from diagnostic reasoning to improve traceability and bias control. An orchestrator dynamically activates specialist agents, which perform decoupled parallel reasoning and are subsequently integrated by an aggregator into a coherent clinical note. Experiments on ClinicalBench and a real-world RAPID-IPN dataset across 24 departments and 53 metrics show that Aegle consistently outperforms state-of-the-art proprietary and open-source models in documentation quality and consultation capability, while also improving final diagnosis accuracy. Our code is available at https://github.com/HovChen/Aegle.

Huangwei Chen, Wu Li, Junhao Jia +7

Zhejiang Key Laboratory of Accessible Perception and Intelligent Systems, College of Computer Science and Technology, Zhejiang University · Hangzhou Pujian Medical Technology Co., Ltd, China · School of Computer Science and Technology, Hangzhou Dianzi University +1

Clinical ReasoningClinical Decision-MakingMulti-Agent CollaborationLLM Agent OrchestrationMedical Report Generation
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Apr 9, 2026

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

The competency of any intelligent agent is bounded by its formal account of the world in which it operates. Clinical AI lacks such an account. Existing frameworks address evaluation, regulation, or system design in isolation, without a shared model of the clinical world to connect them. We introduce the Clinical World Model, a framework that formalizes care as a tripartite interaction among Patient, Provider, and Ecosystem. To formalize how any agent, whether human or artificial, transforms information into clinical action, we develop parallel decision-making architectures for providers, patients, and AI agents, grounded in validated principles of clinical cognition. The Clinical AI Skill-Mix operationalizes competency through eight dimensions. Five define the clinical competency space (condition, phase, care setting, provider role, and task) and three specify how AI engages human reasoning (assigned authority, agent facing, and anchoring layer). The combinatorial product of these dimensions yields a space of billions of distinct competency coordinates. A central structural implication is that validation within one coordinate provides minimal evidence for performance in another, rendering the competency space irreducible. The framework supplies a common grammar through which clinical AI can be specified, evaluated, and bounded across stakeholders. By making this structure explicit, the Clinical World Model reframes the field's central question from whether AI works to in which competency coordinates reliability has been demonstrated, and for whom.

Seyed Amir Ahmad Safavi-Naini, Elahe Meftah, Josh Mohess +11

Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland · Department of Digital Medicine, Bern University Hospital, University of Bern, Bern, Switzerland · Division of Data-Driven and Digital Medicine (D3M), Icahn School of Medicine at Mount Sinai, New York, United States +9

Human-AI Decision MakingClinical Decision-Making
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Apr 8, 2026

MedDialBench: Benchmarking LLM Diagnostic Robustness under Parametric Adversarial Patient Behaviors

Interactive medical dialogue benchmarks have shown that LLM diagnostic accuracy degrades significantly when interacting with non-cooperative patients, yet existing approaches either apply adversarial behaviors without graded severity or case-specific grounding, or reduce patient non-cooperation to a single ungraded axis, and none analyze cross-dimension interactions. We introduce MedDialBench, a benchmark enabling controlled, dose-response characterization of how individual patient behavior dimensions affect LLM diagnostic robustness. It decomposes patient behavior into five dimensions -- Logic Consistency, Health Cognition, Expression Style, Disclosure, and Attitude -- each with graded severity levels and case-specific behavioral scripts. This controlled factorial design enables graded sensitivity analysis, dose-response profiling, and cross-dimension interaction detection. Evaluating five frontier LLMs across 7,225 dialogues (85 cases x 17 configurations x 5 models), we find a fundamental asymmetry: information pollution (fabricating symptoms) produces 1.7-3.4x larger accuracy drops than information deficit (withholding information), and fabricating is the only configuration achieving statistical significance across all five models (McNemar p < 0.05). Among six dimension combinations, fabricating is the sole driver of super-additive interaction: all three fabricating-involving pairs produce O/E ratios of 0.70-0.81 (35-44% of eligible cases fail under the combination despite succeeding under each dimension alone), while all non-fabricating pairs show purely additive effects (O/E ~ 1.0). Inquiry strategy moderates deficit but not pollution: exhaustive questioning recovers withheld information, but cannot compensate for fabricated inputs. Models exhibit distinct vulnerability profiles, with worst-case drops ranging from 38.8 to 54.1 percentage points.

Xiaotian Luo, Xun Jiang, Jiangcheng Wu

Shanda Group

Adversarial Robustness of Language ModelsMedical LLMsAdversarial RobustnessClinical Language Model EvaluationClinical Decision-Making
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Apr 8, 2026

GraphDx: A Cost-Aware Knowledge-Enhanced Multi-Agent Framework for Sequential Diagnosis

Sequential diagnosis requires balancing diagnostic accuracy against resource costs through iterative information gathering. Existing Large Language Model (LLM) approaches exhibit a critical knowledge-reasoning gap: despite encoding extensive medical knowledge, they struggle to reason systematically under cost constraints, often resorting to excessive testing. We propose GraphDx, a knowledge-enhanced framework with two core innovations. First, we design an automated pipeline that leverages LLMs to construct Medical Diagnosis Knowledge Graphs (MDKGs) with quantized typicality, action-centric topology, and dual-objective attributes for both diagnostic relevance and cost-sensitivity. Second, we introduce three collaborative agents (Perception, Reasoning, and Decision) where the Perception and Decision Agents handle language understanding and generation, while the Reasoning Agent performs deterministic evidence scoring and cost-aware planning on the MDKG. Experiments on MedQA and MIMIC-IV across three LLM backbones (DeepSeek-V3, Kimi-k2, Llama-3.3) show that GraphDx improves diagnostic success rates from 50--68% to 79--93% while reducing test costs by 20--54%, providing a robust, economical, and interpretable solution for automated clinical diagnosis.

Shaoting Tan, Ning Liu, Yuntao Du +7

Shandong University · Nankai University · East China Normal University +1

Clinical Decision-MakingMulti-Agent LLM SystemsBiomedical KGsCost-Sensitive Learning
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Apr 6, 2026

Uncertainty-Guided Latent Diagnostic Trajectory Learning for Sequential Clinical Diagnosis

Clinical diagnosis requires sequential evidence acquisition under uncertainty. However, most Large Language Model (LLM) based diagnostic systems assume fully observed patient information and therefore do not explicitly model how clinical evidence should be sequentially acquired over time. Even when diagnosis is formulated as a sequential decision process, it is still challenging to learn effective diagnostic trajectories. This is because the space of possible evidence-acquisition paths is relatively large, while clinical datasets rarely provide explicit supervision information for desirable diagnostic paths. To this end, we formulate sequential diagnosis as a Latent Diagnostic Trajectory Learning (LDTL) framework based on a planning LLM agent and a diagnostic LLM agent. For the diagnostic LLM agent, diagnostic action sequences are treated as latent paths and we introduce a posterior distribution that prioritizes trajectories providing more diagnostic information. The planning LLM agent is then trained to follow this distribution, encouraging coherent diagnostic trajectories that progressively reduce uncertainty. Experiments on the MIMIC-CDM benchmark demonstrate that our proposed LDTL framework outperforms existing baselines in diagnostic accuracy under a sequential clinical diagnosis setting, while requiring fewer diagnostic tests. Furthermore, ablation studies highlight the critical role of trajectory-level posterior alignment in achieving these improvements.

Xuyang Shen, Haoran Liu, Dongjin Song +1

University of Connecticut · Texas A&M University · NEC Laboratories America

Medical DiagnosisClinical Decision-MakingActive Information GatheringClinical ReasoningLatent Variable Models
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Apr 1, 2026

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 ModelsHealthcareClinical Decision-MakingMulti-LLM CollaborationClinical Risk Prediction
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Mar 27, 2026

ClinicalAgents: Multi-Agent Orchestration for Clinical Decision Making with Dual-Memory

While Large Language Models (LLMs) have demonstrated potential in healthcare, they often struggle with the complex, non-linear reasoning required for accurate clinical diagnosis. Existing methods typically rely on static, linear mappings from symptoms to diagnoses, failing to capture the iterative, hypothesis-driven reasoning inherent in human clinicians. To bridge this gap, we introduce ClinicalAgents, a novel multi-agent framework designed to simulate the cognitive workflow of expert clinicians. Unlike rigid sequential chains, ClinicalAgents employs a dynamic orchestration mechanism modeled as a Monte Carlo Tree Search (MCTS) process. This allows an orchestrator to iteratively generate hypotheses, actively verify evidence, and trigger backtracking when critical information is missing. The foundation of this framework is a Dual-Memory architecture: a mutable working memory that maintains the evolving patient state for context-aware reasoning, and a static experience memory that retrieves clinical guidelines and historical cases via an active feedback loop. Extensive experiments demonstrate that ClinicalAgents achieves the best performance among evaluated baselines, significantly enhancing both diagnostic accuracy and explainability compared to strong single-agent and multi-agent baselines. Our code is released at https://github.com/ZhuohanGe/ClinicalAgents-Code.

Zhuohan Ge, Haoyang Li, Yubo Wang +3

The Hong Kong Polytechnic University, Hong Kong SAR, China · The Hong Kong University of Science and Technology, Hong Kong SAR, China

Clinical Decision-MakingMulti-Agent LLM SystemsMedical DiagnosisClinical ReasoningMemory-Augmented Language Model AgentsLLM Agent Planning
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Mar 26, 2026

Rethinking Health Agents: From Siloed AI to Collaborative Decision Mediators

Large language model based health agents are increasingly used by health consumers and clinicians to interpret health information and guide health decisions. However, most AI systems in healthcare operate in siloed configurations, supporting individual users rather than the multi-stakeholder relationships central to healthcare. Such use can fragment understanding and exacerbate misalignment among patients, caregivers, and clinicians. We reframe AI not as a standalone assistant, but as a collaborator embedded within multi-party care interactions. Through a clinically validated fictional pediatric chronic kidney disease case study, we show that breakdowns in adherence stem from fragmented situational awareness and misaligned goals, and that siloed use of general-purpose AI tools does little to address these collaboration gaps. We propose a conceptual framework for designing AI collaborators that surface contextual information, reconcile mental models, and scaffold shared understanding while preserving human decision authority.

Ray-Yuan Chung, Xuhai Xu, Ari Pollack

University of Washington Seattle, WA, USA · Columbia University New York, NY, USA · Seattle Children’s Hospital Seattle, WA, USA

Human-AI CollaborationHealthcareHuman-AI Decision MakingHuman-Centered AIClinical Decision-Making
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Mar 25, 2026

Integrating Causal Machine Learning into Clinical Decision Support Systems: Insights from Literature and Practice

Current clinical decision support systems (CDSSs) typically base their predictions on correlation, not causation. In recent years, causal machine learning (ML) has emerged as a promising way to improve decision-making with CDSSs by offering interpretable, treatment-specific reasoning. However, existing research often emphasizes model development rather than designing clinician-facing interfaces. To address this gap, we investigated how CDSSs based on causal ML should be designed to effectively support collaborative clinical decision-making. Using a design science research methodology, we conducted a structured literature review and interviewed experienced physicians. From these, we derived eight empirically grounded design requirements, developed seven design principles, and proposed nine practical design features. Our results establish guidance for designing CDSSs that deliver causal insights, integrate seamlessly into clinical workflows, and support trust, usability, and human-AI collaboration. We also reveal tensions around automation, responsibility, and regulation, highlighting the need for an adaptive certification process for ML-based medical products.

Domenique Zipperling, Lukas Schmidt, Benedikt Hahn +2

University of Bayreuth and Fraunhofer FIT, Bayreuth, Germany · Technical University of Munich, Munich, Bavaria, Germany · Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, United States

Clinical Decision SupportClinical Decision-MakingHuman-AI Decision Making
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Mar 23, 2026

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

Clinical decision-making agents can benefit from reusing prior decision experience. However, many memory-augmented methods store experiences as independent records without explicit relational structure, which may introduce noisy retrieval, unreliable reuse, and in some cases even hurt performance compared to direct LLM inference. We propose GSEM (Graph-based Self-Evolving Memory), a clinical memory framework that organizes clinical experiences into a dual-layer memory graph, capturing both the decision structure within each experience and the relational dependencies across experiences, and supporting applicability-aware retrieval and online feedback-driven calibration of node quality and edge weights. Across MedR-Bench and MedAgentsBench with two LLM backbones, GSEM achieves the highest average accuracy among all baselines, reaching 70.90% and 69.24% with DeepSeek-V3.2 and Qwen3.5-35B, respectively. Code is available at https://github.com/xhan1022/gsem.

Xiao Han, Yuzheng Fan, Sendong Zhao +2

Research Center for Social Computing and Interactive Robotics, Harbin Institute of Technology, China

Memory-Augmented Language Model AgentsGraph-Based Agent MemoryClinical Decision-MakingClinical Reasoning
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Mar 23, 2026

Cerebra: A Multidisciplinary AI Board for Multimodal Dementia Characterization and Risk Assessment

Modern clinical practice increasingly depends on reasoning over heterogeneous, evolving, and incomplete patient data. Although recent advances in multimodal foundation models have improved performance on various clinical tasks, most existing models remain static, opaque, and poorly aligned with real-world clinical workflows. We present Cerebra, an interactive multi-agent AI team that coordinates specialized agents for EHR, clinical notes, and medical imaging analysis. These outputs are synthesized into a clinician-facing dashboard that combines visual analytics with a conversational interface, enabling clinicians to interrogate predictions and contextualize risk at the point of care. Cerebra supports privacy-preserving deployment by operating on structured representations and remains robust when modalities are incomplete. We evaluated Cerebra using a massive multi-institutional dataset spanning 3 million patients from four independent healthcare systems. Cerebra consistently outperformed both state-of-the-art single-modality models and large multimodal language model baselines. In dementia risk prediction, it achieved AUROCs up to 0.80, compared with 0.74 for the strongest single-modality model and 0.68 for language model baselines. For dementia diagnosis, it achieved an AUROC of 0.86, and for survival prediction, a C-index of 0.81. In a reader study with experienced physicians, Cerebra significantly improved expert performance, increasing accuracy by 17.5 percentage points in prospective dementia risk estimation. These results demonstrate Cerebra's potential for interpretable, robust decision support in clinical care.

Sheng Liu, Long Chen, Zeyun Zhao +16

Department of Biomedical Data Science, Stanford University · Department of Radiation Oncology, Stanford University · Center for Data Science, New York University +13

Clinical Risk PredictionClinical Decision-MakingMultimodal AgentsDementia Care
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Mar 17, 2026

Medical Reasoning with Large Language Models: A Survey and MR-Bench

Large language models (LLMs) have achieved strong performance on medical exam-style tasks, motivating growing interest in their deployment in real-world clinical settings. However, clinical decision-making is inherently safety-critical, context-dependent, and conducted under evolving evidence. In such situations, reliable LLM performance depends not on factual recall alone, but on robust medical reasoning. In this work, we present a comprehensive review of medical reasoning with LLMs. Grounded in cognitive theories of clinical reasoning, we conceptualize medical reasoning as an iterative process of abduction, deduction, and induction, and organize existing methods into seven major technical routes spanning training-based and training-free approaches. We further conduct a unified cross-benchmark evaluation of representative medical reasoning models under a consistent experimental setting, enabling a more systematic and comparable assessment of the empirical impact of existing methods. To better assess clinically grounded reasoning, we introduce MR-Bench, a benchmark derived from real-world hospital data. Evaluations on MR-Bench expose a pronounced gap between exam-level performance and accuracy on authentic clinical decision tasks. Overall, this survey provides a unified view of existing medical reasoning methods, benchmarks, and evaluation practices, and highlights key gaps between current model performance and the requirements of real-world clinical reasoning.

Xiaohan Ren, Chenxiao Fan, Wenyin Ma +4

School of Cyber Science and Technology, University of Science and Technology of China, Anhui, China · School of Artificial Intelligence and Data Science, University of Science and Technology of China, Anhui, China · Department of Infectious Disease, The First Affiliated Hospital of USTC, Anhui, China +2

Medical ReasoningClinical ReasoningClinical Language Model EvaluationClinical Decision-Making
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Mar 6, 2026

DERM-3R: A Resource-Efficient Multimodal Agents Framework for Dermatologic Diagnosis and Treatment in Real-World Clinical Settings

Skin diseases impose a substantial and growing global health burden. Modern dermatologic therapies control acute manifestations rapidly, but single-target treatment paradigms, recurrent disease courses, and neglected systemic comorbidities limit their long-term effectiveness. Traditional Chinese medicine (TCM) offers a complementary, holistic approach through syndrome differentiation and individualized treatment, yet its clinical practice is hindered by non-standardized knowledge, incomplete multimodal records, and the difficulty of scaling expert-driven reasoning. We propose DERM-3R, a resource-efficient multimodal agents framework that models TCM dermatologic diagnosis and treatment under limited data and computational resources. We decompose and redefine real-world dermatologic decision-making into three essential issues: fine-grained lesion recognition, multi-view lesion representation with specialist-level pathogenesis modeling, and holistic clinical reasoning for syndrome differentiation and treatment planning. DERM-3R comprises three collaborative agents, DERM-Rec, DERM-Rep, and DERM-Reason, each addressing one of these issues. Built on a lightweight multimodal large language model and fine-tuned by partial-parameter finetuning on 103 real-world TCM psoriasis cases, DERM-3R performs strongly across multiple dermatologic reasoning tasks. Automatic metrics, LLM-as-a-Judge assessments, and human doctors show that, despite extremely limited training data and parameter updates, DERM-3R matches or even surpasses hundred-billion-parameter general-purpose multimodal models such as GPT-5.1 and Gemini-3-Flash. Our results indicate that structured, domain-aware multi-agent modeling is an effective alternative to brute-force scaling for complex clinical tasks, offering a practical and scalable paradigm for multimodal AI in dermatology and integrative medicine.

Jirui Dai, Zhendong Wang, Chongjing Wang +7

Traditional Chinese MedicineDermatologyMultimodal AgentsClinical Decision-MakingMedical VLMsClinical Reasoning+1
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Mar 6, 2026

From Physician Expertise to Clinical Agents: Preserving, Standardizing, and Scaling Physicians' Medical Expertise with Lightweight LLM

Medicine is an empirical discipline refined through long-term observation and the messy, high-variance reality of clinical practice. Physicians build diagnostic and therapeutic competence through repeated cycles of application, reflection, and improvement, forming individualized methodologies. Yet outcomes vary widely, and master physicians' knowledge systems are slow to develop and hard to transmit at scale, contributing to the scarcity of high-quality clinical expertise. To address this, we propose Med-Shicheng, a general framework that enables large language models to systematically learn and transfer distinguished physicians' diagnostic-and-therapeutic philosophy and case-dependent adaptation rules in a standardized way. Built on Tianyi, Med-Shicheng consists of five stages. We target five National Masters of Chinese Medicine or distinguished TCM physicians, curate multi-source materials, and train a single model to internalize all five knowledge systems across seven tasks, including etiology-pathogenesis analysis, syndrome diagnosis, treatment principle selection, prescription generation, prescription explanation, symptom evolution with regimen adjustment, and clinical advice. Implemented on Qwen2.5-1.5B-Base, Med-Shicheng runs on resource-constrained GPUs while achieving performance comparable to DeepSeek-R1 and GPT-5. We also examine the reliability of LLM-as-a-judge versus physician evaluation: automated judging tracks overall trends but shows bias on fine-grained individualized distinctions, highlighting the need for physician involvement when ground truth is unavailable and for domain-adapted judge models.

Chanyong Luo, Jirui Dai, Zhendong Wang +14

the Infectious disease department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China · the Department of Computer Science, Johns Hopkins University, Baltimore, USA · the Gulou Hospital of Traditional Chinese Medicine of Beijing，Beijing, China +8

Traditional Chinese MedicineMedical LLMsClinical Decision-Making
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