analiza aiqbench
This paper proposes GUIDER, a training method that jointly learns a decision-flow controller and a reasoning policy for clinical guideline tasks. It addresses two problems in process supervision: a guideline-consistent path does not guarantee the right answer, and many valid paths can reach the same decision. The reported gains on MedGUIDE and out-of-domain benchmarks are measured against clinical RL baselines, so readers should weigh them as benchmark results rather than evidence of clinical readiness.
Latent Decision Flow Rewards for Clinical Guideline Reasoning
arXiv:2610.38709v1 Announce Type: cross Abstract: Clinical practice guidelines encode evidence-based recommendations as conditional decision flows, which makes them a natural source of process supervision for training reasoning models. Two properties of clinical reasoning make this supervision difficult to use. A decision flow consistent with a guideline does not by itself determine the correct answer for a given patient, which we call the path--answer gap, and several valid decision flows can support the same clinical decision, which we call path multiplicity. Current training approaches address parts of this problem. Answer rewards supervise the final decision, and process rewards computed against a reference flow supervise one valid decision flow per case. Supervised fine-tuning on annotated flows teaches guideline-consistent reasoning but constrains the model to one trajectory per case and can reduce answer accuracy. We introduce GUIDER, a method that jointly optimizes a decision flow controller and a reasoning policy. The controller learns to generate plausible decision flows from guideline-derived supervision, and the policy learns to generate a decision flow and a final answer for each patient case. GUIDER computes the process reward for the policy over several controller-generated flows, which accounts for path multiplicity, and gates this reward on answer correctness, which addresses the path--answer gap. Joint training allows the process supervision to evolve with the policy. On MedGUIDE, GUIDER with Qwen3-14B achieves 82.5 weighted accuracy and 73.5 guideline adherence, 3.3 and 3.1 points above the strongest clinical reinforcement learning baseline. With Qwen3-14B and Gemma4-12B backbones, GUIDER also improves over CRPO, MRPO, and FaithMed on the out-of-domain benchmarks AMEGA-LLM, RealMedQA, and CancerGUIDE.
Abstract:Clinical practice guidelines encode evidence-based recommendations as conditional decision flows, which makes them a natural source of process supervision for training reasoning models. Two properties of clinical reasoning make this supervision difficult to use. A decision flow consistent with a guideline does not by itself determine the correct answer for a given patient, which we call the path--answer gap, and several valid decision flows can support the same clinical decision, which we call path multiplicity. Current training approaches address parts of this problem. Answer rewards supervise the final decision, and process rewards computed against a reference flow supervise one valid decision flow per case. Supervised fine-tuning on annotated flows teaches guideline-consistent reasoning but constrains the model to one trajectory per case and can reduce answer accuracy. We introduce GUIDER, a method that jointly optimizes a decision flow controller and a reasoning policy. The controller learns to generate plausible decision flows from guideline-derived supervision, and the policy learns to generate a decision flow and a final answer for each patient case. GUIDER computes the process reward for the policy over several controller-generated flows, which accounts for path multiplicity, and gates this reward on answer correctness, which addresses the path--answer gap. Joint training allows the process supervision to evolve with the policy. On MedGUIDE, GUIDER with Qwen3-14B achieves 82.5 weighted accuracy and 73.5 guideline adherence, 3.3 and 3.1 points above the strongest clinical reinforcement learning baseline. With Qwen3-14B and Gemma4-12B backbones, GUIDER also improves over CRPO, MRPO, and FaithMed on the out-of-domain benchmarks AMEGA-LLM, RealMedQA, and CancerGUIDE.
Machine Learning (cs.LG); Artificial Intelligence (cs.AI)
arXiv:2610.38709 [cs.LG]
(or arXiv:2610.38709v1 [cs.LG] for this version)
https://doi.org/10.48550/arXiv.2610.38709 Focus to learn more arXiv-issued DOI via DataCite (pending registration)
arXivLabs is a framework that allows collaborators to develop and share new arXiv features directly on our website.
Both individuals and organizations that work with arXivLabs have embraced and accepted our values of openness, community, excellence, and user data privacy. arXiv is committed to these values and only works with partners that adhere to them.
Have an idea for a project that will add value for arXiv's community? Learn more about arXivLabs.
Text integral sub licența deschisă a publicației · 352 cuvinte
Subiecte conexe
GuideSkill: Evolving Executable LLM Agent Skills for Guideline-Grounded Clinical Reasoning
arXiv · 31 iul. 2026
More Reasoning Is Not Always Better: Executing Clinical Guidelines with LLMs and Rules
arXiv · 14 oct. 2026
Neutralizing Popularity Bias in LLM-based Recommendation via Counterfactual Reasoning Guidelines
arXiv · 9 sept. 2026
Guidelines for the Annotation and Visualization of Legal Argumentation Structures in Chinese Judicial Decisions
arXiv · 17 iun. 2026