With the remarkable performance of large language models (LLMs) in medicine, particularly their ability to support clinical decision-making in medical dialogues, a key limitation remains: the static reasoning patterns derived from human expert experience are often inadequate for the dynamic and diverse nature of real-world multi-turn conversations. While recent large reasoning models (such as R1) enable deeper and more complex thought processes to address such challenges, they also introduce significant redundancy. Meanwhile, recent studies on reusing atomic thoughts demonstrate a practical pathway toward dynamic and precise reasoning in general domains. In this paper, we investigate the role of atomic thought-based experience in medical dialogue tasks. First, we collect human expert clinical experience. Then, we propose a novel distillation framework that extracts atomic thoughts from teacher models and reuses them to guide reasoning and generate responses. Based on this framework, we construct training data from ReMeDi and fine-tune student models, which demonstrate enhanced performance in both static and interactive medical dialogue scenarios. Furthermore, we examine the impact of experience across various models, datasets, and scenarios. Crucially, transferring this experience empowers weaker models to generate high-quality reasoning data, matching the annotation capabilities of stronger LLMs while significantly reducing costs. The code is available in this repository https://github.com/VioletAmethystLunar/Atomic-Thoughts-Medical-Dialogue.

Training large language models for domain adaptation poses a significant challenge in balancing the acquisition of domain knowledge with the retention of general abilities, often leading to catastrophic forgetting. While curriculum learning offers a promising direction, conventional methods typically rely on a single dimension of knowledge or task, which is insufficient to navigate the trade-off between knowledge breadth and task depth. In this paper, we propose a two-dimensional curriculum learning framework that coordinates model training along two orthogonal axes: the knowledge dimension and the task dimension. We first reconstruct the dataset by clustering instances according to their semantic similarity to general-domain data, and subsequently annotate them with a task hierarchy. Then, we design an integrated curriculum that develops from general to domain-specific knowledge clusters, and within each cluster, from lower- to higher-order cognitive tasks. Compared with the second-best method, our method improves accuracy on medical evaluations by 2.49% and on financial evaluations by 1.2%. Ablation and cross-domain experiments further demonstrate our method as a scalable and effective framework for structured domain adaptation in large language model fine-tuning. We have released the code in an anonymous repository at https://github.com/Melo-1017/Balancing-Knowledge-Breadth-and-Task-Depth.

Enhancing the task-specific capabilities of Large Language Models (LLMs) primarily requires substantial instruction-tuning datasets. However, the sheer volume of such data imposes a considerable annotation cost, and a lack of optimization methods for tailoring LLMs to specific tasks persists. To address the above issues, we propose a Planning framework for constructing Extractive-based LLMs called PlanE, which includes data decomposition, instruction tuning, and prompt inference. Additionally, we introduce a Data-Tuning-Inference (DTI) planner, aimed at selecting the optimal base-LLM and its DTI combinations for specific datasets to improve construction efficiency. The experimental results demonstrate the effectiveness of our PlanE from two views: (1) across different datasets using the same base-LLM, and (2) on the same dataset using different base-LLMs. Furthermore, we validate the generalizability of the proposed DTI planner under different optimization objectives. The codes are publicly available at https://github.com/gugugu-469/PlanE.

Medical visual question answering (MedVQA) requires models to provide accurate answers given a medical image and a corresponding question. Recently, instruction tuning of general large vision–language models (LVLMs) has become a dominant paradigm for this task, enabling open-ended predictions and effective integration of multimodal information. However, existing methods synthesize instruction data from image–caption pairs that primarily focus on visual attributes, rather than knowledge-level QA generation. This situation limits the model’s ability to learn relevant medical knowledge during training, thereby restricting its performance on MedVQA. Hence, this paper proposes MedKInstruct, which incorporates a multimodal medical knowledge graph (MMKG) to assist LVLMs in synthesizing knowledge-intensive instruction data. Additionally, we design an MMKG path–based reward function to train a stronger MedVQA model through reinforcement learning. Experimental results on the public datasets Slake and VQA-RAD show that MedKInstruct outperforms previous methods by 4.16% and 4.50%. The source code is available at the following link: https://github.com/Sonder-hang/MedKinstruct

Medical insurance plays a pivotal role in the healthcare system, where effective supervision relies on the precise execution of complex medical insurance rules. Existing solutions for medical insurance violation detection mainly rely on costly manual labor, limiting efficiency. Although current Large Language Models (LLMs) have demonstrated significant potential in general Natural Language Processing (NLP) tasks, they still struggle to understand these rules, and a corresponding evaluation benchmark is lacking. Hence, we propose T2ER, a benchmark to evaluate the capability of LLMs in converting texts into executable rules in medical insurance. T2ER consists of 2,115 rules and 5,636 synthetic Electronic Medical Record (EMR) test cases for execution verification. Furthermore, we design a dual evaluation framework spanning rule and execution levels to comprehensively assess transformation quality. We conduct extensive experiments on advanced LLMs. The results reveal a significant human-AI performance gap, indicating that this conversion remains a formidable challenge. The dataset is available at https://github.com/YHJ1223/T2ER.

Large language models (LLMs) have demonstrated notable advancements in psychological counseling. However, existing models generally do not explicitly model seekers’ emotion shifts across counseling sessions, a core focus in classical psychological schools. Moreover, how to align counselor models’ responses with these emotion shifts while proactively mitigating safety risks remains underexplored. To bridge these gaps, we propose PsychēChat, which explicitly integrates emotion shift tracking and safety risk analysis for psychological counseling. Specifically, we employ interactive role-playing to synthesize counselor-seeker dialogues, incorporating two modules: Emotion Management Module, to capture seekers’ current emotions and emotion shifts; and Risk Control Module, to anticipate seekers’ subsequent reactions and identify potential risks. Furthermore, we introduce two modeling paradigms. The Agent Mode structures emotion management, risk control, and counselor responses into a collaborative multi-agent pipeline. The LLM Mode integrates these stages into a unified chain-of-thought for end-to-end inference, balancing efficiency and performance. Experiments with simulated interaction, dialogue-level evaluation, ablation studies, and expert assessment indicate that PsychēChat improves emotion-shift awareness and risk-aware response generation in psychological counseling support. Our data and code are available at https://github.com/XNeil12138/PsycheChat.

Artificial intelligence doctor assistants (AIDAs) help streamline clinical decision-making and reduce physician workload. While existing systems primarily utilize Large Language Models (LLMs) or retrieval-augmented generation (RAG), these methods typically retrieve static facts—whether as text passages or structured graphs—lacking the explicit logical pathways essential for multi-step reasoning. In this paper, we propose the AIDA-SEAT framework to provide reliable clinical decision-making support. First, we design the state-evaluation-action tree (SEAT), which covers diagnosis, treatment, and examination. To develop this tree, we refine and transform SEAT collected from medical documents and doctors. Then, we propose an adaptive method to select optimal trees tailored to the current patients’ state. Finally, we leverage LLMs to perform state assessment, evaluation, and action execution based on the tree, thereby generating reliable responses. To evaluate the effectiveness of our method, we conducted extensive experiments on a self-built dataset. Our method achieves 1.01% higher than current state-of-the-art (SOTA) baselines across five departments, including common RAG-based methods. Furthermore, analysis of 200 consultation records during deployment on an online hospital revealed that system-assisted responses are 24.16 seconds faster on average than manual ones, improving efficiency by 26.85%.

Medical quality control indicators are essential to assess the qualifications of healthcare institutions for medical services. With the impressive performance of large language models (LLMs) like GPT-4 in the medical field, leveraging these technologies for the Medical Quality Control Indicator Calculation (MQCIC) presents a promising approach. In this work, (1) we introduce a real-world task MQCIC and propose an open-source Chinese electronic medical records (EMRs)-based dataset (CMQCIC-Bench) comprising 785 instances and 76 indicators. (2) We propose a semi-automatic method to enhance the rule representation. Then we propose the Clinical Facts-based Inferential Rule (CF-IR) method that disentangles the clinical fact verification and inferential rule reasoning actions. (3) We conduct comprehensive experiments on 20 representative LLMs, covering general and medical models. Our findings reveal that CF-IR outperforms Chain-of-Thought methods in MQCIC tasks. (4) We conduct an error analysis and investigate the capabilities of clinical fact verification and inferential rule reasoning, providing insights to improve performance in the MQCIC further. The dataset and code is available in this repository https://github.com/YuY-2001/C-MQCIC.

Spatial relation reasoning is a crucial task for multimodal large language models (MLLMs) to understand the objective world. However, current benchmarks have issues like relying on bounding boxes, ignoring perspective substitutions, or allowing questions to be answered using only the model’s prior knowledge without image understanding. To address these issues, we introduce SpatialMQA, a human-annotated spatial relation reasoning benchmark based on COCO2017, which enables MLLMs to focus more on understanding images in the objective world. To ensure data quality, we design a well-tailored annotation procedure, resulting in SpatialMQA consisting of 5,392 samples. Based on this benchmark, a series of closed- and open-source MLLMs are implemented and the results indicate that the current state-of-the-art MLLM achieves only 48.14% accuracy, far below the human-level accuracy of 98.40%. Extensive experimental analyses are also conducted, suggesting the future research directions. The benchmark and codes are available at https://huggingface.co/datasets/liuziyan/SpatialMQA.

Despite the remarkable performance of Large Language Models (LLMs) in automated discharge summary generation, they still suffer from generating inaccurate content or fabricating information without valid sources. To address these issues, we propose LCDS, a tool for empowering LLMs with Logic-Controlled Discharge Summary generation. LCDS constructs a source mapping table by calculating the textual similarity between electronic medical records (EMRs) and discharge summaries, providing a structured reference for generation. Based on a comprehensive set of logical rules, LCDS identifies the structured writing logic of discharge summaries and integrates it with EMRs to generate silver discharge summaries. Furthermore, LCDS traces the provenance of generated content, allowing experts to review, provide feedback, and rectify errors to produce golden discharge summaries, which are subsequently recorded for the incremental fine-tuning of LLMs.Our project and demo video are in the GitHub repository https://github.com/ycycyc02/LCDS.

Information extraction plays a critical role in natural language processing. When applying large language models (LLMs) to this domain, we discover an unexpected phenomenon: LLMs’ spurious associations. In tasks such as relation extraction, LLMs can accurately identify entity pairs, even if the given relation (label) is semantically unrelated to the pre-defined original one. To find these labels, we design two strategies in this study, including forward label extension and backward label validation. We also leverage the extended labels to improve model performance. Our comprehensive experiments show that spurious associations occur consistently in both Chinese and English datasets across various LLM sizes. Moreover, the use of extended labels significantly enhances LLM performance in information extraction tasks. Remarkably, there is a performance increase of 9.55%, 11.42%, and 21.27% in F1 scores on the SciERC, ACE05, and DuEE datasets, respectively.