MedOrchestra: A Hybrid Cloud-Local LLM Approach for Clinical Data Interpretation

Deploying large language models (LLMs) in clinical settings faces critical trade-offs: cloud LLMs, with their extensive parameters and superior performance, pose risks to sensitive clinical data privacy, while local LLMs preserve privacy but often fail at complex clinical interpretation tasks. We propose MedOrchestra, a hybrid framework where a cloud LLM decomposes complex clinical tasks into manageable subtasks and prompt generation, while a local LLM executes these subtasks in a privacy-preserving manner. Without accessing clinical data, the cloud LLM generates and validates subtask prompts using clinical guidelines and synthetic test cases. The local LLM executes subtasks locally and synthesizes outputs generated by the cloud LLM. We evaluate MedOrchestra on pancreatic cancer staging using 100 radiology reports under NCCN guidelines. On free-text reports, MedOrchestra achieves 70.21% accuracy, outperforming local model baselines (without guideline: 48.94%, with guideline: 56.59%) and board-certified clinicians (gastroenterologists: 59.57%, surgeons: 65.96%, radiologists: 55.32%). On structured reports, MedOrchestra reaches 85.42% accuracy, showing clear superiority across all settings.

Dr. Strategy: Model-Based Generalist Agents with Strategic Dreaming

Model-based reinforcement learning (MBRL) has been a primary approach to ameliorating the sample efficiency issue as well as to make a generalist agent. However, there has not been much effort toward enhancing the strategy of dreaming itself. Therefore, it is a question whether and how an agent can "dream better" in a more structured and strategic way. In this paper, inspired by the observation from cognitive science suggesting that humans use a spatial divide-and-conquer strategy in planning, we propose a new MBRL agent, called Dr. Strategy, which is equipped with a novel Dreaming Strategy. The proposed agent realizes a version of divide-and-conquer-like strategy in dreaming. This is achieved by learning a set of latent landmarks and then utilizing these to learn a landmark-conditioned highway policy. With the highway policy, the agent can first learn in the dream to move to a landmark, and from there it tackles the exploration and achievement task in a more focused way. In experiments, we show that the proposed model outperforms prior pixel-based MBRL methods in various visually complex and partially observable navigation tasks. The source code will be available at https://github.com/ahn-ml/drstrategy