medR: Reward Engineering for Clinical Offline Reinforcement Learning via Tri-Drive Potential Functions

Reinforcement Learning (RL) offers a powerful framework for optimizing dynamic treatment regimes (DTRs). However, clinical RL is fundamentally bottlenecked by reward engineering: the challenge of defining signals that safely and effectively guide policy learning in complex, sparse offline environments. Existing approaches often rely on manual heuristics that fail to generalize across diverse pathologies. To address this, we propose an automated pipeline leveraging Large Language Models (LLMs) for offline reward design and verification. We formulate the reward function using potential functions consisted of three core components: survival, confidence, and competence. We further introduce quantitative metrics to rigorously evaluate and select the optimal reward structure prior to deployment. By integrating LLM-driven domain knowledge, our framework automates the design of reward functions for specific diseases while significantly enhancing the performance of the resulting policies.

S3-CoT: Self-Sampled Succinct Reasoning Enables Efficient Chain-of-Thought LLMs

Large language models (LLMs) equipped with chain-of-thought (CoT) achieve strong performance and offer a window into LLM behavior. However, recent evidence suggests that improvements in CoT capabilities often come with redundant reasoning processes, motivating a key question: Can LLMs acquire a fast-thinking mode analogous to human System 1 reasoning? To explore this, our study presents a self-sampling framework based on activation steering for efficient CoT learning. Our method can induce style-aligned and variable-length reasoning traces from target LLMs themselves without any teacher guidance, thereby alleviating a central bottleneck of SFT-based methods-the scarcity of high-quality supervision data. Using filtered data by gold answers, we perform SFT for efficient CoT learning with (i) a human-like dual-cognitive system, and (ii) a progressive compression curriculum. Furthermore, we explore a self-evolution regime in which SFT is driven solely by prediction-consistent data of variable-length variants, eliminating the need for gold answers. Extensive experiments on math benchmarks, together with cross-domain generalization tests in medicine, show that our method yields stable improvements for both general and R1-style LLMs. Our data and model checkpoints can be found at https://github.com/DYR1/S3-CoT.

MedDreamer: Model-Based Reinforcement Learning with Latent Imagination on Complex EHRs for Clinical Decision Support

Timely and personalized treatment decisions are essential across a wide range of healthcare settings where patient responses vary significantly and evolve over time. Clinical data used to support these decisions are often irregularly sampled, sparse, and noisy. Existing decision support systems commonly rely on discretization and imputation, which can distort critical temporal dynamics and degrade decision quality. Moreover, they often overlook the clinical significance of irregular recording frequencies, filtering out patterns in how and when data is collected. Reinforcement Learning (RL) is a natural fit for clinical decision-making, enabling sequential, long-term optimization in dynamic, uncertain environments. However, most existing treatment recommendation systems are model-free and trained solely on offline data, making them sample-inefficient, sensitive to data quality, and poorly generalizable across tasks or cohorts. To address these limitations, we propose MedDreamer, a two-phase model-based RL framework for personalized treatment recommendation. MedDreamer uses a world model with an Adaptive Feature Integration (AFI) module to effectively model irregular, sparse clinical data. Through latent imagination, it simulates plausible patient trajectories to enhance learning, refining its policy using a mix of real and imagined experiences. This enables learning policies that go beyond suboptimal historical decisions while remaining grounded in clinical data. To our knowledge, this is the first application of latent imagination to irregular healthcare data. Evaluations on sepsis and mechanical ventilation (MV) treatment using two large-scale EHR datasets show that MedDreamer outperforms both model-free and model-based baselines in clinical outcomes and off-policy metrics.

Advancing Multi-Organ Disease Care: A Hierarchical Multi-Agent Reinforcement Learning Framework

Multi-organ diseases present significant challenges due to their simultaneous impact on multiple organ systems, necessitating complex and adaptive treatment strategies. Despite recent advancements in AI-powered healthcare decision support systems, existing solutions are limited to individual organ systems. They often ignore the intricate dependencies between organ system and thereby fails to provide holistic treatment recommendations that are useful in practice. We propose a novel hierarchical multi-agent reinforcement learning (HMARL) framework to address these challenges. This framework uses dedicated agents for each organ system, and model dynamic through explicit inter-agent communication channels, enabling coordinated treatment strategies across organs. Furthermore, we introduce a dual-layer state representation technique to contextualize patient conditions at various hierarchical levels, enhancing the treatment accuracy and relevance. Through extensive qualitative and quantitative evaluations in managing sepsis (a complex multi-organ disease), our approach demonstrates its ability to learn effective treatment policies that significantly improve patient survival rates. This framework marks a substantial advancement in clinical decision support systems, pioneering a comprehensive approach for multi-organ treatment recommendations.