用病历生成对话,让大模型更会问诊。
Note2Chat: Improving LLMs for Multi-Turn Clinical History Taking Using Medical Notes
- 将真实病历转为问答数据,训练模型模拟问诊过程。
- 比GPT-4o提升16.9点F1和21.0点诊断准确率。
- 适合临床辅助、医疗AI开发人员使用。
有效采集临床病史是临床推理的基础,但尚未得到充分研究。尽管大语言模型在静态基准上表现良好,但在需要迭代提问与假设修正的动态多轮诊断场景中仍表现不足。为此,我们提出Note2Chat,一种基于病历的框架,通过学习广泛可得的医学记录来训练模型进行结构化问诊与诊断。我们采用决策树引导的生成与优化流程,将真实病历转化为高质量医患对话数据。进而设计三阶段微调策略:监督学习、模拟数据增强与偏好学习。此外,提出一种新型单轮推理范式,将问诊重构为一系列单轮推理任务,提升可解释性,支持局部监督、动态适应与更高样本效率。实验表明,该方法显著提升临床推理能力,在F1指标上较GPT-4o提升16.9点,诊断准确率提升21.0点。代码与数据集见https://github.com/zhentingsheng/Note2Chat。
原文摘要 · Abstract (English)
Effective clinical history taking is a foundational yet underexplored component of clinical reasoning. While large language models (LLMs) have shown promise on static benchmarks, they often fall short in dynamic, multi-turn diagnostic settings that require iterative questioning and hypothesis refinement. To address this gap, we propose \method{}, a note-driven framework that trains LLMs to conduct structured history taking and diagnosis by learning from widely available medical notes. Instead of relying on scarce and sensitive dialogue data, we convert real-world medical notes into high-quality doctor-patient dialogues using a decision tree-guided generation and refinement pipeline. We then propose a three-stage fine-tuning strategy combining supervised learning, simulated data augmentation, and preference learning. Furthermore, we propose a novel single-turn reasoning paradigm that reframes history taking as a sequence of single-turn reasoning problems. This design enhances interpretability and enables local supervision, dynamic adaptation, and greater sample efficiency. Experimental results show that our method substantially improves clinical reasoning, achieving gains of +16.9 F1 and +21.0 Top-1 diagnostic accuracy over GPT-4o. Our code and dataset can be found at https://github.com/zhentingsheng/Note2Chat.
Thank you to arXiv for use of its open access interoperability. PaperDance 不是 arXiv 官方产品;中文卡片由大模型生成,请以原文为准。