The paper proposes a reinforcement learning (RL) fine‑tuning framework for electronic health record (EHR) foundation models, treating them as generative policies over patient trajectories. By framing clinical prediction tasks such as hospital readmission as event‑conditioned, time‑windowed reasoning problems and designing time‑aware, rollout‑sensitive rewards, the authors show that RL fine‑tuning consistently outperforms pre‑trained backbones and strong baselines. The approach enables smaller models to surpass larger pre‑trained models in data‑limited settings, induces positive transfer across tasks, and produces trajectories with stronger structural and semantic alignment to ground truth, improving downstream utility.
By Yuxin Xiao, Sheng Zhang, Chandan Singh, Tristan Naumann, Hoifung Poon, Jianfeng Gao, Xiaodong Liu
The paper introduces DeToxR, a reinforcement‑learning‑enhanced large language model designed to support decision making in acute toxicology cases. It fuses unstructured narratives from paramedics and patients with structured vital‑sign data to predict co‑ingested substances across 14 classes. In preliminary validation, DeToxR outperforms baseline models, achieving higher micro‑F1 and recall scores for poison identification.
By Nico Oberl\"ander, David Bani-Harouni, Tobias Zellner, Nassir Navab, Florian Eyer, Matthias Keicher
arXiv:2609.24480v1 Announce Type: cross
Abstract: Deploying Large Language Models (LLMs) in healthcare requires robust performance across two complementary dimensions - diagnostic reasoning: the conv...
By Kalash Shah, Kunal Singh, Snehan J, Shreyas Singh
arXiv:2608. 07418v1 Announce Type: new Abstract: In medical education, physicians convert academic knowledge into clinical expertise through residency: years of training across thousands of encounters, with diverse sources of feedback and progressively greater autonomy.
By Valentin Li\'{e}vin, Samuel Schmidgall, Tim Strother, Alex Bijamov, Akshay Goel, Anil Palepu, Chunjong Park, Vahid Balazadeh, Min Woo Sun, Marius Guerard, Justin Chen, Dave Steiner, Vikram Dhillon, Ibrahim Azar, Akhil Mehta, Nicholas Spetsieris, Shilpan Shah, Maen Abdelrahim, Amit Dahiya, Yun Liu, Katherine Chou, Yossi Matias, Avinatan Hassidim, Dale R. Webster, Quoc V. Le, Raia Hadsell, Joelle Barral, Carey Radebaugh, Aleksandra Faust, Shekoofeh Azizi, Mike Schaekermann, Po-Hsuan Cameron Chen, Tao Tu, David Racz, Lin Yang
arXiv:2606. 19183v1 Announce Type: cross Abstract: Large language models (LLMs) can make clinical decision support more accessible by interpreting free-text documentation, but their direct use as diagnostic engines is limited by sensitivity to prompts, information order, and plausible but incorrect outputs.
By Soheyl Bateni, Maryam Abdolali
arXiv:2606. 05174v1 Announce Type: cross Abstract: Large Language Models (LLMs) have shown strong promise in healthcare applications.
By Arash Ahmadi, Parisa Masnadi, Sarah Sharif, Charles Nicholson, David Ebert, Mike Banad
arXiv:2607. 02983v1 Announce Type: new Abstract: Recent reasoning-centric Large Language Models (LLMs) have made significant strides, yet they predominantly operate on a passive-inference pattern that assumes complete information.
By Shengyi Hua, Kangzhe Hu, Conghui He, Xiaofan Zhang, Shaoting Zhang
The paper introduces BRIDGE, a bilevel optimization framework that jointly trains a large language model (LLM) and a retriever for agentic reinforcement learning (ARL). It demonstrates that adapting the retriever before the policy yields better rewards, and that BRIDGE outperforms existing methods on seven open‑domain QA benchmarks and medical QA tasks, achieving significant gains in accuracy and reasoning quality.
By Quan Xiao, Mingda Liu, Gaowen Liu, Katsuki Fujisawa, Tianyi Chen
The paper introduces CARing, a framework that improves next‑visit diagnosis prediction by representing diagnoses with compositional Semantic IDs (SIDs) and optimizing multi‑label coverage through reinforcement learning. CARing encodes ontology‑enriched disease semantics into compact SIDs, aligns them with natural language and EHR contexts, and employs a coverage reward to encourage diverse diagnosis predictions. On MIMIC‑III and MIMIC‑IV datasets, CARing outperforms all EHR‑trained baselines in weighted F1 and achieves the highest top‑k recall, including R@30 scores above 46% in reasoning mode.
By Kaisong Zhang, Haotian Fang, Junmeng Zhou, Hang Lv, Yulan Pan, Yanchao Tan
arXiv:2607. 11954v1 Announce Type: cross Abstract: Clinical code prediction maps unstructured discharge summaries to ICD-10-CM leaf codes in a large, sparse, and deeply hierarchical label space.
By Amritpal Singh, Sebastian Torres, Khawar Shakeel, Syed Ahmad Chan Bukhari
arXiv:2607. 15447v1 Announce Type: new Abstract: Recent research in clinical machine learning, focusing on outcome predictions in intensive care unit (ICU), has shifted from bespoke supervised models to foundation models, utilising modern representation learning methods.
By Jingteng Li, Alexander Capstick, Louise Rigny, Iona Biggart, Neil J Sebire, Payam Barnaghi
The paper introduces an evidence ladder for evaluating reinforcement learning (RL) in healthcare, outlining stages from problem formulation to lifecycle monitoring. It argues that success in historical data does not guarantee real‑world improvement and highlights assumptions and failure modes at each rung. The authors propose reporting practices to support cumulative evaluation and emphasize that RL should be tested as an intervention within a dynamic sociotechnical system.
By Yunfan Zhao