通过对比医生推理与模型推理差异,提升医疗AI的逻辑可靠性。
Closing Reasoning Gaps in Clinical Agents with Differential Reasoning Learning
- 用图结构比对医生推理与模型推理路径
- 在医疗问答和住院复诊预测中准确率提升
- 适合需要高可信推理的临床AI部署场景
临床决策支持不仅需要正确答案,还需具备临床合理的推理过程。本文提出差异推理学习(DRL)框架,通过分析参考推理路径(如医师撰写的临床推理、临床指南或更强大模型的输出)与模型自由形式链式思维(CoT)之间的差异,提取为有向无环图(DAG),并采用临床加权图编辑距离(GED)进行差异分析。利用大模型作为评判者,对语义等价节点进行对齐,并诊断图间差异。这些图级差异诊断被转化为自然语言指令,存入差异推理知识库(DR-KB)。推理时,通过检索增强生成(RAG)获取前k个指令,注入模型提示以修补潜在逻辑漏洞。在开放医学问答基准及内部临床数据中的复诊入院(RVA)预测任务上评估显示,相比基线方法,在最终答案准确率和推理一致性上均有提升。消融实验验证了引入参考推理路径和top-k检索策略的有效性。临床医生对输出的审查进一步确认了该方法的可靠性。结果表明,DRL可在复杂推理场景中支持更可靠的临床决策,并提供一种适用于有限令牌预算的实用部署机制。
原文摘要 · Abstract (English)
Clinical decision support requires not only correct answers but also clinically valid reasoning. We propose Differential Reasoning Learning (DRL), a framework that improves clinical agents by learning from reasoning discrepancies. From reference reasoning rationales (e.g., physician-authored clinical rationale, clinical guidelines, or outputs from more capable models) and the agent's free-form chain-of-thought (CoT), DRL extracts reasoning graphs as directed acyclic graphs (DAGs) and performs a clinically weighted graph edit distance (GED)-based discrepancy analysis. An LLM-as-a-judge aligns semantically equivalent nodes and diagnoses discrepancies between graphs. These graph-level discrepancy diagnostics are converted into natural-language instructions and stored in a Differential Reasoning Knowledge Base (DR-KB). At inference, we retrieve top-$k$ instructions via Retrieval-Augmented Generation (RAG) to augment the agent prompt and patch likely logic gaps. Evaluation on open medical question answering (QA) benchmarks and a Return Visit Admissions (RVA) prediction task from internal clinical data demonstrates gains over baselines, improving both final-answer accuracy and reasoning fidelity. Ablation studies confirm gains from infusing reference reasoning rationales and the top-$k$ retrieval strategy. Clinicians' review of the output provides further assurance of the approach. Together, results suggest that DRL supports more reliable clinical decision-making in complex reasoning scenarios and offers a practical mechanism for deployment under limited token budgets.
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。