Healthcare

Public datasets of Chest X-Rays (CXRs) have long been a popular benchmark for developing machine learning (ML) computer vision models in healthcare. However, the reported strong average-case performance of these models do not necessarily reflect their actual utility when used in heterogeneous clinical settings, potentially masking weaker performance in medically significant scenarios. In this work we use clinical context to provide a more holistic evaluation of models for CXR diagnosis. In particular, we use discharge summaries, recorded prior to each CXR, to derive a ``pre-CXR'' probability of each CXR label, as a proxy for existing contextual knowledge available to clinicians when interpreting CXRs. We use this measure to probe model performance along two dimensions: First, using a stratified analysis, we show that models tend to have lower performance (as measured by AUROC and other metrics) among individuals with higher pre-CXR probability. Second, by controlling for pre-CXR probability via matching and re-weighting, we demonstrate that performance degrades when the correlation is broken between prior context and the current CXR label, suggesting that model performance is highly sensitive to the underlying distribution of clinical context. Specifically, cases with high pre-test probabilities present a fundamentally more difficult visual classification task, highlighting a gap in clinical utility when models are applied to high-risk cohorts.

In high-stakes domains such as healthcare, privacy concerns severely limit the use of real-world training data. Differentially private (DP) synthetic data offers a promising alternative with formal privacy guarantees, but achieving strong utility remains challenging for clinical note generation due to domain specificity and long-form text complexity. We present Term2Note, a method for synthesising full-length clinical notes under DP constraints. By structurally separating content and form, Term2Note generates section-wise note content conditioned on medical terms, with terms and notes privatised under separate DP constraints, and applies a DP quality maximiser to improve outputs. Experiments demonstrate that Term2Note produces synthetic notes with statistical properties closely aligned with real clinical notes, and that downstream models trained on these notes achieve performance comparable to those trained on real clinical data. Compared to existing DP text generation baselines, Term2Note substantially improves both fidelity and utility, without relying on label distribution assumptions, highlighting its effectiveness as a practical privacy-preserving alternative to real clinical notes.

Foundation models for healthcare require balancing robust generalization across heterogeneous clinical populations and disease settings with the architectural simplicity needed for deployment. We present a pre-trained model focused on demographic attributes that enhances feature utility across medical domains in a plug-and-play fashion. We introduce the General Demographic Pre-trained (GDP) model, designed to extract intrinsic representations of patient status based on age and sex, the two most ubiquitous clinical features. The composition of GDP was optimized by investigating various encoding methods and visit-reordering schemes. The model was pre-trained and transferability was validated by embedding the learned representations into diverse disease and geographic cohorts characterized by distinct demographic profiles. The optimal model configuration was subsequently validated against top-performing tabular foundation models (TabPFN, TabICL, and TabFM). Our findings demonstrate that concatenating GDP-derived embeddings with raw residual features consistently enhances predictive performance across classification tasks while elevating the relative importance of demographic attributes. The embedding transformation provides superior representational separability compared to the original data distribution, yielding competitive discrimination performance across metrics against all three general-purpose foundation models and tree-based algorithm. GDP has successfully served the purpose of a foundation model, which produce enriched representations that amplify the predictive insight of these features beyond their raw form. The generated embeddings can be directly concatenated with residual features, serving as an enhancement layer that maintains full compatibility with standard tabular classifiers.

Medical report understanding from real-world document images is essential for generating patient-facing explanations and enabling structured information exchange in clinical systems. Existing VLMs and LLMs have shown strong performance on document understanding, but structured understanding of medical reports remains insufficiently benchmarked. Therefore, we introduce MedRepBench, a benchmark with 1,925 de-identified Chinese medical report images spanning diverse departments, patient demographics, and acquisition formats. In MedRepBench, we mainly focus on report-grounded interpretation rather than evaluating diagnostic reasoning, treatment recommendation, or the integration of patient history. The interpretation is defined as structured extraction of report fields (e.g., item, value, unit, reference range, abnormal flag) plus a patient-facing explanation grounded strictly in the report content. The benchmark primarily evaluates end-to-end VLMs, and also includes a controlled text-only setting (high-quality OCR + LLM) to approximate an upper bound when character recognition errors are minimized. Our evaluation framework provides two complementary protocols: (1) an objective protocol measuring field-level recall of structured items, and (2) an automated subjective protocol that uses an LLM-based judge to score factuality, interpretability, and reasoning quality under a fixed prompt. Using the objective metric as a reward signal, we also provide a lightweight GRPO-based alignment baseline for a mid-sized VLM, which improves field-level recall by up to 6%. Finally, we analyze practical limitations of OCR+LLM pipelines, including layout-related errors and additional system latency, showing the need for robust end-to-end vision-based medical report understanding. The dataset and evaluation resources are publicly available on https://huggingface.co/datasets/MedRepBench/MedRepBench.

Interactive medical questioning is essential in clinical consultations, where physicians must actively gather necessary patient information. Yet existing medical Large Language Models (LLMs) predominantly follow a reactive paradigm, risking diagnostic errors by answering before seeking sufficient details. To bridge this gap, we propose ProMed, a reinforcement learning framework that transitions LLMs toward a proactive paradigm, enabling them to ask clinically valuable questions before decision-making. Central to ProMed is the Shapley Information Gain (SIG) reward, which quantifies a question's clinical utility as the amount of newly acquired information, while considering its contextual importance via Shapley values. We integrate SIG into a two-stage training pipeline: (1) SIG-Guided Model Initialization uses Monte Carlo Tree Search to construct high-reward interaction trajectories for supervision, and (2) SIG-Augmented Policy Optimization, with a novel SIG-guided Reward Distribution Mechanism that prioritizes informative questions for fine-grained optimization. Experiments on partial-information medical benchmarks show that ProMed significantly outperforms state-of-the-art methods by 6.29% on average and delivers a 54.45% gain over the reactive paradigm, and generalizes robustly to out-of-domain cases. Our codes are available at https://github.com/hxxding/ProMed.

Large language models (LLMs) are increasingly used to answer health-related questions and support healthcare workflows, yet evidence for their safety still relies heavily on static benchmarks that can rapidly become obsolete or be optimized against. Here we introduce a Dynamic, Automatic, and Systematic (DAS) red-teaming audit framework that continuously stress-tests LLMs for health across four safety-critical axes: robustness, privacy, bias/fairness, and hallucination/factual inaccuracies. Validated against board-certified clinicians with high concordance, a suite of adversarial agents autonomously mutates health-related test cases to uncover vulnerabilities in real time. Applying DAS to 15 proprietary and open-source LLMs revealed a profound gap between high static benchmark performance and low dynamic reliability--the "Benchmarking Gap". Despite median MedQA accuracy exceeding 80%, 94% of previously correct answers failed under dynamic robustness testing. This brittleness generalized to the realistic, open-ended HealthBench dataset, where top-tier models exhibited failure rates exceeding 70% and sharp shifts in model rankings across evaluations, suggesting that high scores on established static benchmarks may reflect superficial memorization. We observed similarly high failure rates across other domains: privacy leaks were elicited in 86% of scenarios, cognitive-bias priming altered recommendations in 81% of fairness tests, and hallucination rates exceeded 74% in widely used models. By converting LLM safety evaluation for health from a static checklist into a living adversarial audit, DAS provides a scalable framework for surfacing latent risks before such systems are deployed in consumer-facing health assistants, clinician-facing tools, and broader healthcare workflows. Code is available at https://github.com/JZPeterPan/DAS-Medical-Red-Teaming-Agents.

Millions of individuals' well-being are challenged by the harms of substance use. Harm reduction as a public health strategy provides non-judgemental, evidence-based information intended to improve health outcomes and reduce associated safety risks. Some large language models (LLMs) have demonstrated a high level of medical reasoning, promising to address the information needs of people who use drugs (PWUD). However, their performance in relevant tasks remains largely unexplored. We introduce HarmReduction, a benchmark designed to evaluate LLMs' accuracy and safety risks in harm reduction information provision. The benchmark dataset (HR-Basic) has 2,160 question-answer-evidence pairs. The scope covers three tasks: checking safety boundaries, providing quantitative values, and inferring polysubstance use risks. We build the Instruction and RAG schemes to evaluate model behaviours based on their inherent knowledge and the integration of domain knowledge. Our results indicate that state-of-the-art LLMs still struggle to provide accurate harm reduction information, and sometimes, present severe safety risks to PWUD. This work contributes an evaluation framework for LLMs to deliver harm reduction information to avoid introducing negative health outcomes through the use of LLMs.

Off-policy evaluation (OPE) methods estimate the value of a new reinforcement learning (RL) policy prior to deployment. Recent advances have shown that leveraging auxiliary datasets, such as those synthesized by generative models, can improve the accuracy of OPE methods. Unfortunately, such auxiliary datasets may also be biased, and existing methods for using data augmentation within OPE lack principled uncertainty quantification. In high stakes domains like healthcare, reliable uncertainty estimates are important for ensuring safe and informed deployment of RL policies. In this work, we propose two methods to construct valid confidence intervals for OPE with data augmentation. The first provides a confidence interval over $V^π(s)$, the policy value conditioned on an initial state $s$. To do so we introduce a new conformal prediction method suitable for Markov Decision Processes (MDPs) with continuous state spaces, extending prior work to higher-dimensional settings. Second, we consider the more common task of estimating the average policy performance over all initial states, $V^π$; we introduce a method that draws on ideas from doubly robust estimation and prediction powered inference. Across simulators spanning inventory management, robotics, healthcare, and a real healthcare dataset from MIMIC-IV, we find that our methods can effectively leverage auxiliary data and consistently produce confidence intervals that cover the ground truth policy values, unlike previously proposed methods. Our work enables a future in which OPE can provide rigorous uncertainty estimates for high-stakes domains.

Developing algorithms for real-life problems that perform well in practice depends on the availability of realistic data for testing. Obtaining real-life data for optimization problems in health care, however, is often difficult, and such data typically cannot be published, which limits reproducibility by other researchers. This is especially true for patient-related problems because of data privacy policies such as the patient-to-room assignment problem. Therefore, artificially generated instances are commonly used. To improve the generation of realistic instances, we develop a configurable instance generator for the patient-to-room assignment problem and other patient-related problems, featuring an easy-to-use graphical user interface. The design of the generator is based on an extensive empirical analysis of real hospital data, which identifies relevant ward-specific patterns such as patients' age and length-of-stay distributions. Moreover, as randomly generated instances are often infeasible, we address this issue in two ways. We implement a dynamic programming approach in the generator to optionally enforce feasibility and extend existing results from the literature to derive new combinatorial insights into patient-to-room feasibility.

Domain generalization has become a critical challenge in predictive healthcare, where different patient groups exhibit shifting data distributions that degrade model performance. Still, regular domain generalization approaches often struggle in clinical settings due to (1) the absence of domain labels and (2) the lack of clinical insight integration. To address these challenges in healthcare, we aim to explore how medical ontologies can be used to discover dynamic yet hierarchy-grounded patient domains, a partitioning strategy that remains under-explored in prior work. Hence, we introduce UdonCare, a hierarchy-pruning method that iteratively divides patients into latent domains and retrieves domain-invariant (label) information from patient data. On public datasets (MIMIC-III, MIMIC-IV, and eICU), UdonCare shows superiority over eight generalization baselines across four representative clinical prediction tasks with substantial domain gaps, highlighting the potential of medical knowledge for enhancing model generalization.

Background and purpose: Intensity-modulated proton therapy (IMPT) enables conformal dose delivery for head and neck (H&N) cancers. However, its sensitivity to inter-fractional anatomical changes motivates online adaptations, where rapid and accurate Monte Carlo (MC) dose calculation remains a major bottleneck. Low-statistics MC simulations reduce computation time but introduce noise. This study aimed to develop a diffusion-transformer framework to recover high-statistics dose distributions from noisy MC simulations. Materials and methods: A diffusion-transformer-based dose denoising framework was developed. Eighty H&N patients were used for training and additional 10 H&N patients and 30 patients with lung, breast, and prostate cancers (10 per site) were used for evaluation. Noisy and high-statistics dose maps were generated using MCsquare. The model was trained using noisy dose maps and CT images as inputs and high-statistics dose maps as ground truth, with mean squared error, residual, regional mean absolute error (MAE), and dose-volume histogram (DVH) losses. Performance was evaluated using MAE, 3D gamma passing rates, and DVH indices. Results: Mean whole-body MAE ranged from 0.08 +/- 0.06 to 0.20 +/- 0.11 Gy (Relative Biological Effectiveness, RBE) (RBE = 1.1) across test cohorts. Mean whole-body 3 %/2 mm gamma passing rates ranged from 95.8 +/- 0.8 % to 97.6 +/- 0.9 %. DVH indices from high-statistics and predicted dose distributions showed close agreement for clinical target volumes and organs of interest. Conclusions: The diffusion-transformer-based framework denoised low-statistics MC dose distributions. Despite being trained on H&N data, the model generalized to lung, breast, and prostate cohorts without retraining.

Background: Federated learning (FL) enables collaborative training of clinical AI models without centralizing patient data, but adoption is limited by privacy concerns, heterogeneous institutional compliance, and resource disparities; standard differential privacy (DP) applies uniform noise to all clients, penalizing well-compliant or under-resourced institutions. Objective: We introduce a compliance-aware FL framework that adapts DP to institutional compliance, letting lower-compliance sites participate without uniformly penalizing others. Methods: A compliance scoring tool aligned with HIPAA, GDPR, NIST, ISO, and HL7/FHIR maps each client score to a per-step Gaussian noise scale for server-side DP-SGD on a small aggregator dataset. The formal $(ε,δ)$ bound applies to the aggregator dataset under a semi-honest aggregator; client-level DP needs secure aggregation (future work). We evaluate five FL strategies on PneumoniaMNIST and BreastMNIST (16 clients, 50 rounds, five seeds); the cumulative aggregator-dataset $ε$ is about 1434 (Breast) and 513 (Pneumonia) at $δ=10^{-5}$. Results: Including 12 lower-compliance clients (Experiment 1) versus a compliant-only baseline (Experiment 4) changed BreastMNIST accuracy by +4.5 (FedAvg), +6.8 (FedMedian), +5.2 (FedProx), +1.6 (FedYogi), and -4.1 (FedAdam) percentage points (pooled +2.8 pp; not significant at n=5; up to +17 pp per configuration); compliance-weighted allocation matched uniform server-side DP at equal mean noise (+0.1 pp), carrying no utility penalty, and first-round noise cost 1.3 pp (Breast) and 2.5 pp (Pneumonia, FedAvg). Conclusions: Compliance-weighted server-side DP lets lower-compliance institutions join FL without degrading performance, giving auditable per-site noise control at no utility cost; formal guarantees apply to the aggregator dataset, with client-level DP requiring secure aggregation.

Manually refining radiological segmentation masks is highly resource-intensive. To determine when this expert commitment is truly justified for the training of segmentation models, we investigate the relationship between label quality and model performance. Expanding beyond models trained directly for inference, we conduct the first study isolating the impact of label quality in pre-training datasets. While high-quality labels remain essential for models proceeding directly to deployment, we find no evidence that strict label quality is crucial for pre-training efficacy. These results question the necessity of exhaustive human-in-the-loop refinement for massive corpora intended for pretraining and suggest that expert effort is more effectively invested in well-curated downstream target datasets.

Scheduling echocardiographic examinations in a hospital setting presents significant challenges due to non-deterministic factors such as patient no-shows, variable arrival times, and heterogeneous exam durations, as well as asymmetric resource constraints between fetal and non-fetal patient streams. Fetal cases involve specialized ultrasound examinations performed during pregnancy, whereas non-fetal cases correspond to general diagnostic echocardiography services. Using one week (184 patients) of operational data from the Echo Laboratory at Stanford University's Lucile Packard Children's Hospital, we estimate patient no-show probabilities and derive empirical distributions of arrival times and exam durations, and use them to build a discrete-event stochastic simulation model using SimPy, exposed through an open-source Gymnasium interface (https://github.com/desResLab/echo_rl). As a baseline for policy optimization, we systematically compare two scheduling paradigms: on-the-fly allocation, in which patients are served according to their arrival time without prior reservations, and reservation-based allocation, in which varying proportions of resources are preassigned. We consider a hospital with seven ultrasound rooms (one equipped for both fetal and non-fetal exams, six for non-fetal exams only) and six sonographers (four qualified for both exam types, two for non-fetal exams only). In this setting, on-the-fly allocation markedly reduces the average patient waiting time compared with every reservation-based configuration tested. Building on this foundation, we train a Dueling Double Deep Q-Network (DQN) with prioritized experience replay to approximate an optimal dynamic on-the-fly allocation policy. The learned RL policy is comparable to, but does not outperform, the best on-the-fly rule-based policy.

Introduction: Horizon scanning in healthcare assesses early signals of innovation, crucial for timely adoption. Current horizon scanning faces challenges in efficient information retrieval and analysis, especially in grey literature, presenting a need for innovative tools. Methodology: This article introduces SCANAR and AIDOC, open-source Python-based tools designed to improve horizon scanning. SCANAR automates the retrieval and processing of news articles, using de-duplication and unsupervised relevancy ranking. AIDOC aids filtration by leveraging large language models and text embeddings for calculation of semantic similarity, to reorder data based on relevancy. Results: Twelve internal datasets from horizon scans and four external benchmarking datasets were used. SCANAR improved retrieval efficiency by automating processes previously dependent on manual labour. AIDOC displayed work-saving potential, achieving around 65% theoretic reduction in manual review efforts at 95% recall or 20% reduction when adding CMH, an existing open-source algorithm to make data-driven decisions on stopping screening early. Comparative analysis with benchmarking data showed AIDOC's performance was similar to existing systematic review automation tools, though performance varied depending on dataset characteristics. Conclusion: The validation indicates that SCANAR and AIDOC show potential to enhance horizon scanning efficiency by streamlining data retrieval and prioritisation. These tools may alleviate methodological limitations and allow broader, swifter horizon scans. Further studies are suggested to optimize these models and to design new workflows and validation processes that integrate large language models.

Learning-based medical image registration has matched the accuracy of conventional methods while offering superior computational efficiency. However, existing approaches suffer from poor generalization across diverse clinical scenarios, requiring the laborious development of multiple isolated networks for specific registration tasks, e.g., inter-/intra-subject registration or anatomical region-specific alignment, leading to cumbersome development pipelines. To overcome this limitation, we propose UniReg, the first conditional unified model for multi-scenario medical image registration, which combines the precision advantages of task-specific learning methods with the generalization of traditional optimization methods. Our key innovation is a unified registration framework that adaptively estimates deformation fields conditioned on: (1) anatomical structure priors, (2) registration type constraints (inter/intra-subject), and (3) instance-specific features, enabling effective alignment across heterogeneous CT and MR registration scenarios within a single model. Through comprehensive experiments on multiple CT/MR registration datasets, UniReg achieves superior average registration accuracy compared with current state-of-the-art learning-based methods while exhibiting strong cross-scenario generalization. Moreover, by replacing multiple isolated task-specific models with a compact unified model, UniReg substantially reduces the overall training burden in terms of total training cost and model redundancy.

To overcome the black-box nature of predictive AI and the hallucination risks of generative models, retrieval-based models offer an interpretable, evidence-based paradigm for pathology clinical workflow. However, real-world clinical queries are inherently interleaved (e.g., pathology images and text). Current dual-encoders suffer from an Architectural Mismatch, lacking the mechanism to fuse such composed queries. To address this, we formalize the task of Pathology Composed Retrieval (PCR). While Multimodal Large Language Models (MLLMs) offer deep-fusion capabilities, directly applying them exposes a Task Mismatch and a Domain Mismatch. To resolve these challenges, we propose HOMIE, a model-agnostic adaptation framework that transforms any generative MLLM into a specialized pathology retrieval expert. Evaluated on our newly introduced PCR Benchmark, a lightweight 2B-parameter HOMIE variant substantially outperforms existing paradigms, surpassing specialized 7B pathology MLLMs and dual-encoders by large margins on composed retrieval, while maintaining strong performance on traditional simple retrieval. The project page is available at https://qfchou.github.io/HOMIE_page/.

The rapid development of large language models (LLMs) has transformed many industries, including healthcare. In practice, hospitals and patients increasingly seek LLM-based systems capable of interpreting personal health records and providing healthcare guidance. However, existing approaches mainly rely on general medical knowledge and often fail to account for individual variability, limiting their ability to provide personalized guidance. To address this, we propose personalized prompt learning (PPL), a framework that learns individualized prompts to guide LLMs in generating personalized healthcare recommendations. PPL constructs initial personalized prompts by leveraging both self-informed patient information and peer-informed signals derived from clinically similar cases. These prompts are then refined using reinforcement learning (RL) to better align the generated responses with physician recommendations written for each patient. PPL operates with hard prompts, enabling seamless integration with proprietary LLMs without modifying the underlying models. We evaluate PPL on real-world obstetrics and gynecology data. The results show that our approach produces more personalized healthcare guidance and wins 97 out of 100 comparisons in expert evaluation, demonstrating its potential for broader healthcare applications. Our code is publicly available at https://github.com/CGCL-codes/PPL.

Radiology, with its heterogeneous modalities, anatomies, and evolving protocols, is a natural yet high-stakes testbed for agentic AI. As LLMs grow more capable and tool ecosystems such as MCP and Agent Skills more complex, their capability boundaries in radiology remain unclear. We introduce RadA-BenchPlat, a two-layer benchmark spanning idealized reasoning and real-world execution: a synthetic layer with 2.2k clinician-verified records, 24.2k QA pairs, and 10 tool categories under diverse availability settings; and a real-environment layer pairing 165 2D/3D cases with executable tools for grounding, diagnosis, and report generation. We find that high completion rates under idealized settings do not carry over to real environments, where the best agents trail their upper bound by approximately 15% and drop to 0.327 on long-chain tasks. Prompting strategies (few-shot exemplars, multi-agent coordination) and AutoTB (on-the-fly synthesis of missing tools) mitigate execution drift and breakdowns in difficult scenarios, lifting execution success to 94.5%, yet remain not fully reliable. Overall, our findings suggest that radiology agents are no longer limited to conceptual demonstrations, but are beginning to show potential for real-world applications. Project repository: https://github.com/MAGIC-AI4Med/RadABench

Medical multimodal large language models (MLLMs) can perform well on existing medical visual question answering (MedVQA) benchmarks, but their training data often does not match clinical diagnosis. Most supervision is organized around isolated images or short QA pairs, leaving two structures weakly specified: how evidence leads to a decision, and how views, series, modalities, and patient context from the same case are linked. We introduce MultiViewDx, a partly physician-validated multimodal instruction dataset for evidence-linked multi-view medical imaging diagnosis. MultiViewDx uses the clinical case as the supervision unit. It links imaging studies with patient context, normalizes heterogeneous reports into an evidence-linked workflow (evidence -> findings -> differential discussion -> diagnosis), and uses a unified image-text retriever to constrain instruction synthesis to source-supported evidence. It covers X-ray, CT, MRI, ultrasound, histopathology, and other clinical visual sources. We fine-tune MultiViewDx-8B-AN and evaluate it on both existing MedVQA benchmarks and real-world case-based diagnostic reasoning. Across four MedVQA benchmarks, it achieves the best average accuracy among compared systems (79.0%), outperforming HuatuoGPT-Vision-34B (66.7%) and Claude3-Opus (55.7%). Beyond MedVQA, on JAMA Clinical Challenge cases, it receives the strongest overall rating under a physician-designed rubric for key clinical points, diagnostic inference, and evidence grounding. Controlled ablations and clinician evaluation show that both case-level multi-view organization and evidence-linked reasoning targets contribute to the gain.

Cancer treatments are known to introduce cardiotoxicity, negatively impacting outcomes and survivorship. Identifying cancer patients at risk of heart failure (HF) is critical to improving cancer treatment outcomes and safety. This study examined machine learning (ML) models to identify cancer patients at risk of HF using electronic health records (EHRs), including traditional ML, Time-Aware long short-term memory (T-LSTM), and large language models (LLMs) using novel narrative features derived from the structured medical codes. We identified a cancer cohort of 12,806 patients from the University of Florida Health, diagnosed with lung, breast, and colorectal cancers, among which 1,602 individuals developed HF after cancer. The LLM, GatorTron-3.9B, achieved the best F1 scores, outperforming the traditional support vector machines by 39%, the T-LSTM deep learning model by 7%, and a widely used transformer model, BERT, by 5.6%. The analysis shows that the proposed narrative features remarkably increased feature density and improved performance.

In this paper, we propose a modified version of the MedQA-USMLE dataset, named MEDQA-OPEN, which contains open-ended medical questions without options to mimic clinical scenarios, along with clinician-approved reasoned answers. Additionally, we implement a prompt driven by Chain of Thought (CoT) reasoning, CLINICR, to mirror the prospective process of incremental reasoning, reaching a correct response to medical questions. We empirically demonstrate how CLINICR outperforms the state-of-the-art 5-shot CoT-based prompt (Liévin et al., 2022). We also present an approach that mirrors real-life clinical practice by first exploring multiple differential diagnoses through MCQ-CLINICR and subsequently narrowing down to a final diagnosis using MCQ-ELIMINATIVE. Finally, emphasizing the importance of response verification in medical settings, we utilize a reward model mechanism, replacing the elimination process performed by MCQ-ELIMINATIVE.