arXiv:2505.19630cs.CL2025-05被引 21

用强化学习让医生代理主动问诊,提升真实场景下的诊断准确率。

Real-World Doctor Agent with Proactive Consultation through Multi-Agent Reinforcement Learning

  • 构建多智能体强化学习框架,让医生代理通过策略性提问逐步获取关键信息。
  • 在真实患者测试中达到70%的精准诊断匹配率,超越前沿模型。
  • 适合需要高交互性、动态决策的医疗咨询系统研发与临床辅助工具落地。

大型语言模型在真实临床咨询中表现不佳。单轮咨询要求患者一次性描述所有症状,常导致表述不清和误诊。传统对话模型受限于静态监督学习,仅能模仿现有对话模式,缺乏在动态交互中主动构建理解的能力,无法实现真正的临床推理。为解决这些问题,我们提出 DoctorAgent-RL,一个基于强化学习的多智能体协作框架,并在 Qwen2.5-7B-Instruct 上训练医生代理。该框架将医疗咨询建模为不确定性下的动态决策过程,将医生代理的核心能力从“知道答案”转向“掌握最优问诊方法”,通过策略性提问引导多轮对话中关键患者信息的逐步浮现。为支持高保真的真实诊断过程模拟,我们构建了 MTMedDialog,一个面向动态交互训练的新型英文多轮医疗咨询数据集。通过盲评人类评估和真实患者试验验证其现实有效性,DoctorAgent-RL 在诊断准确率上优于前沿模型,达到70%的精确诊断匹配率,证实其作为协同工具的潜力。通过承担初步筛查任务,可帮助临床医生聚焦复杂病例,缓解医师短缺与误诊风险,减轻医疗资源压力。

原文摘要 · Abstract (English)

Large language models (LLMs) struggle in real-world clinical consultations. Single-turn consultation systems require patients to describe all symptoms at once, which often leads to unclear complaints and vague diagnoses. Traditional dialogue models, constrained by static supervised learning, are limited to superficially imitating existing dialogue patterns and lack the ability to actively construct understanding in dynamic interactions, thus failing to achieve genuine clinical reasoning.To address these challenges, we propose DoctorAgent-RL, a reinforcement learning (RL)-based multi-agent collaborative framework, and train a doctor agent on Qwen2.5-7B-Instruct using this framework. Within this framework, a medical consultation is modeled as a dynamic decision-making process under uncertainty. The core intelligence of the doctor agent is shifted from knowing the answer to learning and mastering a questioning methodology aimed at achieving an optimal diagnosis. Through strategic questioning, it guides the progressive emergence of key patient information in multi-turn dialogues. To support this high-fidelity simulation of the real diagnostic process, we constructed MTMedDialog, a novel English multi-turn medical consultation dataset designed for dynamic, interactive training.To validate its real-world effectiveness, rigorous evaluations including blinded human assessments and trials with real patients were conducted. DoctorAgent-RL outperformed frontier models and achieved a 70% exact diagnostic match rate, confirming its potential as a collaborative tool. By handling initial screenings, it can free clinicians to focus on complex cases, thereby addressing critical issues like physician shortages and misdiagnosis risks while alleviating the strain on healthcare resources.

医疗AI多智能体强化学习问诊系统

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