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.

Radiology reports are critical for clinical decision-making but often lack a standardized format, limiting both human interpretability and machine learning (ML) applications. While large language models (LLMs) have shown strong capabilities in reformatting clinical text, their high computational requirements, lack of transparency, and data privacy concerns hinder practical deployment. To address these challenges, we explore lightweight encoder-decoder models (<300M parameters)—specifically T5 and BERT2BERT—for structuring radiology reports from the MIMIC-CXR and CheXpert Plus datasets. We benchmark these models against eight open-source LLMs (1B–70B parameters), adapted using prefix prompting, in-context learning (ICL), and low-rank adaptation (LoRA) finetuning. Our best-performing lightweight model outperforms all LLMs adapted using prompt-based techniques on a human-annotated test set. While some LoRA-finetuned LLMs achieve modest gains over the lightweight model on the Findings section (BLEU 6.4%, ROUGE-L 4.8%, BERTScore 3.6%, F1-RadGraph 1.1%, GREEN 3.6%, and F1-SRR-BERT 4.3%), these improvements come at the cost of substantially greater computational resources. For example, LLaMA-3-70B incurred more than 400 times the inference time, cost, and carbon emissions compared to the lightweight model. These results underscore the potential of lightweight, task-specific models as sustainable and privacy-preserving solutions for structuring clinical text in resource-constrained healthcare settings.

Automated radiology report generation from chest X-ray (CXR) images has the potential to improve clinical efficiency and reduce radiologists’ workload. However, most datasets, including the publicly available MIMIC-CXR and CheXpert Plus, consist entirely of free-form reports, which are inherently variable and unstructured. This variability poses challenges for both generation and evaluation: existing models struggle to produce consistent, clinically meaningful reports, and standard evaluation metrics fail to capture the nuances of radiological interpretation. To address this, we introduce Structured Radiology Report Generation (SRRG), a new task that reformulates free-text radiology reports into a standardized format, ensuring clarity, consistency, and structured clinical reporting. We create a novel dataset by restructuring reports using large language models (LLMs) following strict structured reporting desiderata. Additionally, we introduce SRR-BERT, a fine-grained disease classification model trained on 55 labels, enabling more precise and clinically informed evaluation of structured reports. To assess report quality, we propose F1-SRR-BERT, a metric that leverages SRR-BERT’s hierarchical disease taxonomy to bridge the gap between free-text variability and structured clinical reporting. We validate our dataset through a reader study conducted by five board-certified radiologists and extensive benchmarking experiments.