MediSkill-Evo: Process-Constrained Self-Evolution for Evidence-Grounded Clinical Interaction

• URL: http://arxiv.org/abs/2608.23397v2
• Date: Tue, 25 Aug 2026 10:41:01 GMT
• Title: MediSkill-Evo: Process-Constrained Self-Evolution for Evidence-Grounded Clinical Interaction
• Abstract summary: We introduce MediSkill-Evo, which self-evolves governed process knowledge without fine-tuning the backbone.<n>On Qwen FullChain, MediSkill-Evo improves diagnosis accuracy by 7.81% and treatment-intent coverage by 70.67% over the best-performing prior agent.<n>On multimodal NEJM diagnosis, MediSkill-Evo with optional MedSAM localization improves diagnosis accuracy by 2.56% and core score by 18.96% over the best-performing memory agent.
• Score: 8.036967404810378
• License: http://creativecommons.org/licenses/by/4.0/
• Abstract: Interactive clinical agents operate under partial observability, so reliable care depends on reaching the correct diagnosis through evidence-grounded, safe interactions. Yet existing agents struggle to convert experience into reusable process knowledge with explicit provenance and authority. To address this gap, we introduce MediSkill-Evo, which self-evolves governed process knowledge without fine-tuning the backbone. It realizes this self-evolution by updating clinical, process, symbolic, and visual knowledge in four typed banks under type-specific validation and scope rules. The Process-Constrained Preference Harness then turns validated knowledge into action by grounding candidates in evidence and prioritizing safer decisions. We evaluate on 300 MIMIC-IV-derived FullChain encounters, 180 hard-isolation conditions covering six process obligations, and 100 multimodal NEJM image-diagnosis cases. On Qwen FullChain, MediSkill-Evo improves diagnosis accuracy by 7.81% and treatment-intent coverage by 70.67% over the best-performing prior agent, while reducing critical failures by 43.04%. Under stress, it improves the stress-process composite by 7.77% and required-action completion by 12.41% over the best-performing agent for each metric, with stronger patient-fact, temporal-evidence, and triage-red-flag recovery and no controller-scored errors in unavailable-evidence, treatment, and triage safety checks. On multimodal NEJM diagnosis, MediSkill-Evo with optional MedSAM localization improves diagnosis accuracy by 2.56% and core score by 18.96% over the best-performing memory agent. Code is available at https://anonymous.4open.science/r/mediskill-evo_anonymous-68E7.

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