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This research introduces Policy Iteration with Human Feedback (PIHF), a framework that leverages pretrained language models as fixed execution substrates while offloading persistent policy revision to versioned natural-language tools and expert oversight. By integrating clinical experts into the evaluation loop, the method significantly boosts diagnostic recall for ultra-rare diseases across various model scales without requiring further pretraining weights updates. The study validates that combining in-context learning with generalized policy iteration structures can effectively enhance specialized reasoning tasks through iterative human-in-the-loop refinement.
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Policy Iteration with Human Feedback: Bringing Post-Training RL to In-context Learning

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arXiv:2608.16831v1 Announce Type: cross Abstract: Generative pretraining established reusable task representations; later work on language-based task conditioning and in-context learning showed that a fixed model could adapt its behavior from instructions and demonstrations. Policy Iteration with Human Feedback (PIHF) builds on this development and the recurrent evaluate-and-improve structure of generalized policy iteration. PIHF uses a pretrained language model as its execution substrate and moves persistent revision to a versioned natural-language policy and tool set. A language-model critic and clinical expert review complete-panel reasoning and tool-use trajectories to localize recurrent failures and form candidate revisions; the expert may reinterpret the evidence and retains authority over admission and rollback, while Recall@1 and Recall@5 validate outcomes after candidate execution. Across cumulative ablations and ultra-rare-disease benchmarks, a PIHF-derived policy improved Recall@1 in one proprietary executor and three open-weight executors spanning 3 to 49 billion active parameters. Gains were 32.7 percentage points for GPT-5.4 and 31.1 points for Qwen3.6-35B, a difference of 1.7 points. These results support the feasibility of using pretrained language models as fixed-weight execution substrates for expert-guided policy development in rare-disease diagnosis.

Abstract:Generative pretraining established reusable task representations; later work on language-based task conditioning and in-context learning showed that a fixed model could adapt its behavior from instructions and demonstrations. Policy Iteration with Human Feedback (PIHF) builds on this development and the recurrent evaluate-and-improve structure of generalized policy iteration. PIHF uses a pretrained language model as its execution substrate and moves persistent revision to a versioned natural-language policy and tool set. A language-model critic and clinical expert review complete-panel reasoning and tool-use trajectories to localize recurrent failures and form candidate revisions; the expert may reinterpret the evidence and retains authority over admission and rollback, while Recall@1 and Recall@5 validate outcomes after candidate execution. Across cumulative ablations and ultra-rare-disease benchmarks, a PIHF-derived policy improved Recall@1 in one proprietary executor and three open-weight executors spanning 3 to 49 billion active parameters. Gains were 32.7 percentage points for GPT-5.4 and 31.1 points for Qwen3.6-35B, a difference of 1.7 points. These results support the feasibility of using pretrained language models as fixed-weight execution substrates for expert-guided policy development in rare-disease diagnosis.

Artificial Intelligence (cs.AI); Computation and Language (cs.CL)

arXiv:2608.16831 [cs.AI]

(or arXiv:2608.16831v1 [cs.AI] for this version)

https://doi.org/10.48550/arXiv.2608.16831 Focus to learn more arXiv-issued DOI via DataCite (pending registration)

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