The most plausible near-term role of medical LLMs is to assist rather than replace physicians, yet current evaluations often test isolated capabilities: clinical knowledge, EHR system interaction, or patient communication. Physician assistance instead requires coordinating these capabilities within the same interaction, where physicians issue underspecified requests, patients describe symptoms ambiguously, and EHR systems demand precise tool use. We introduce PhysAssistBench, a benchmark for interactive doctor-patient-EHR assistance. Built from real MIMIC-IV cases, PhysAssistBench uses a scalable pipeline to construct agentic patients: interactive, record-grounded agents that turn static EHR records into multi-turn clinical scenarios while preserving clinical factuality. PhysAssistBench provides a curated evaluation set of 1,296 manually reviewed and physician-validated turns. Experiments with leading LLMs show that current models remain unreliable in this setting, struggling to infer physician intent, clarify vague patient descriptions, formulate grounded EHR queries, and integrate evidence across sources. These results expose a key bottleneck for clinical LLMs: reliable assistance requires coordination across knowledge, communication, and systems, not isolated gains in any of them.

LLM agents acting in structured environments fail in operational rather than conversational ways, and reliability depends on procedural knowledge of the environment. Prior self-improvement methods accumulate natural-language guidance without checking that each new item preserves previously correct behavior, so a note that fixes one trajectory can silently regress another. We introduce GRASP (Gated Regression-Aware Skill Proposer), which treats agent improvement as a sequence of edits to a bounded skill library, admitting each candidate only if it produces a net improvement on a balanced held-out probe under a hard regression budget. We evaluate GRASP across five base models (gpt-oss-120b, DeepSeek V4 Flash, Gemini 3.1 Flash Lite, GPT-4.1, GPT-5.4) on two FHIR-based clinical benchmarks. On MedAgentBench, GRASP lifts gpt-oss-120b from 40.6% to 88.8%, exceeds the strongest of five self-improvement baselines by 21.0 points, and improves every other base model by 17.2 to 40.3 points. Ablations attribute the gain to comparative proposal generation, the acceptance gate, and the hard regression budget rather than to skill writing itself, which without validation is no better than using no skills. The mechanism generalizes beyond the clinical domain, improving agents on three of four non-clinical environments and remaining flat only where the action space is open-ended. Frozen libraries transfer across models, where skills from a stronger model improve weaker executors beyond what they learn for themselves while the reverse does not, an asymmetry that no ungated baseline reproduces.

We introduce Evo, a duality latent trajectory model that bridges autoregressive (AR) and diffusion-based language generation within a continuous evolutionary generative framework. Rather than treating AR decoding and diffusion generation as separate paradigms, Evo reconceptualizes text generation as a latent flow: each token is associated with a vector-valued embedding that evolves over a progression variable, indicating its semantic maturity. Low values correspond to confident AR-like refinement, while high values invoke diffusion-style planning, allowing the model to adaptively balance AR and diffusion based on uncertainty. Theoretically, we show that both AR and diffusion models emerge as discretizations of a shared probability flow, and we derive Evo’s training objective from a unified variational ELBO. The model is implemented as a time-conditioned Transformer governed by a shared vector field, trained end-to-end to jointly infer latent codes and their progression times. During decoding, Evo performs efficient, semantics-aware refinement, achieving high-quality outputs without sacrificing speed. Empirically, Evo 8B achieves state-of-the-art or highly competitive results on 15 diverse benchmarks, including reasoning (GSM8K, ARC-C), code generation (HumanEval, MBPP), and general language understanding, while maintaining fast inference speed. Our results demonstrate that Evo delivers a new paradigm for LLM design with strong generation quality, robust symbolic reasoning, and decoding efficiency.

The severe shortage of medical doctors limits access to timely and reliable healthcare, leaving millions underserved. Large language models (LLMs) offer a potential solution but struggle in real-world clinical interactions. Many LLMs are not grounded in authoritative medical guidelines and fail to transparently manage diagnostic uncertainty. Their language is often rigid and mechanical, lacking the human-like qualities essential for patient trust. To address these challenges, we propose Ask Patients with Patience (APP), a multi-turn LLM-based medical assistant designed for grounded reasoning, transparent diagnoses, and human-centric interaction. APP enhances communication by eliciting user symptoms through empathetic dialogue, significantly improving accessibility and user engagement. It also incorporates Bayesian active learning to support transparent and adaptive diagnoses. The framework is built on verified medical guidelines, ensuring clinically grounded and evidence-based reasoning. To evaluate its performance, we develop a new benchmark that simulates realistic medical conversations using patient agents driven by profiles extracted from real-world consultation cases. We compare APP against SOTA one-shot and multi-turn LLM baselines. The results show that APP improves diagnostic accuracy, reduces uncertainty, and enhances user experience. By integrating medical expertise with transparent, human-like interaction, APP bridges the gap between AI-driven medical assistance and real-world clinical practice.