测试临床模型能否随患者情况变化调整治疗决策。
Do Clinical Models Change Treatment Decisions?
- 构建基于生物医学关系的可审计决策基准ClinPivot。
- 顶尖模型在情境变化时仍常做出错误治疗选择。
- 结构化监督能提升模型对决策变化的敏感性。
临床基础模型通常通过事实性或考试式医疗问答评估，但治疗决策必须随患者情况变化而调整。我们提出ClinPivot，一个基于生物医学关系并引入患者情境切换的可审计治疗决策基准。该基准考察模型在新临床约束改变行动空间时，是否能正确调整治疗选择。实验发现，强医疗问答表现并不能可靠预测决策性能：前沿模型及任务适配的Qwen变体常未能正确改变决策，且模型排名在不同评估条件下发生显著变化。结构化决策监督在相同知识预算下，同时提升模型对情境变化的敏感性与医疗问答能力；轻量级重放机制则有效降低通用助手能力的损失。
原文摘要 · Abstract (English)
Clinical foundation models are evaluated with factual or exam-style medical QA, but treatment decisions must change when patient context changes. We introduce ClinPivot, an auditable treatment-decision benchmark built from biomedical relations and pivoted patient contexts. ClinPivot asks whether models change treatment choices when new clinical constraints shift the action space. We find that strong medical QA performance does not reliably predict decision-making performance: frontier models and task-adapted Qwen variants often fail to change decisions correctly, and model rankings shift across evaluation regimes. Decision-structured supervision improves pivot-sensitive decision-making and medical QA under matched knowledge budgets, while lightweight replay reduces losses in general assistant ability.
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