EAPO: Entropy-Driven Adaptive Positive-Negative Sample Weighting for Policy Optimization in Open-Ended QA

Large Reasoning Models are typically trained via reinforcement learning from verifiable rewards (RLVR). However, existing approaches adopt fixed weights for positive and negative samples, and the conclusions hardly generalize to open-ended question answering (QA). In this paper, we systematically investigate the roles of positive and negative samples in reinforcement learning for open-ended QA. We propose a reward-mean-based strategy for distinguishing positive from negative samples, and observe that negative samples predominantly govern response diversity and the performance upper bound, whereas positive samples primarily determine response quality and convergence stability. Building on these observations, we propose EAPO, an Entropy-driven Adaptive Policy Optimization method that adaptively computes the weighting coefficients of positive samples based on the ratio of the current policy entropy to the initial entropy. During the entropy-decreasing phase, the weight assigned to positive samples is reduced to preserve exploration, whereas during the entropy-increasing phase it is amplified to reinforce stability, thereby mitigating entropy collapse. Experiments on two publicly available open-ended medical QA datasets demonstrate that EAPO consistently and substantially outperforms fixed-weight baselines in both response diversity and stability.

C-MIG: Multi-view Information Gain-based Retrieval-Augmented Generation for Clinical Diagnosis Reasoning

Retrieval-augmented generation combined with reinforcement learning has shown promise for grounding large language models in trustworthy medical evidence. However, existing methods rely on exact-match binary rewards, which in clinical diagnosis cause two issues: (i) semantically relevant but non-verbatim steps receive zero signal, discarding valuable learning signals; and (ii) uni-dimensional rewards cannot effectively supervise heterogeneous reasoning capabilities. To address these issues, we propose C-MIG, a Multi-view Information Gain-based retrieval-augmented generation framework for Clinical diagnosis. C-MIG estimates information gain under a frozen reference model from two complementary views, retrieved-document and document-refinement, to jointly guide what to retrieve and how to refine, alleviating the issues of valuable reward signal loss and credit assignment. We further design a multi-subquery retrieval augmentation strategy that improves knowledge recall coverage in clinical diagnostic scenarios. Comprehensive experiments on four medical benchmarks demonstrate that C-MIG achieves the best performance among all RAG-RL methods on both in-domain and out-of-domain sets, and outperforms state-of-the-art general-purpose LLMs for clinical diagnosis.

Dr. Assistant: Enhancing Clinical Diagnostic Inquiry via Structured Diagnostic Reasoning Data and Reinforcement Learning

Clinical Decision Support Systems (CDSSs) provide reasoning and inquiry guidance for physicians, yet they face notable challenges, including high maintenance costs and low generalization capability. Recently, Large Language Models (LLMs) have been widely adopted in healthcare due to their extensive knowledge reserves, retrieval, and communication capabilities. While LLMs show promise and excel at medical benchmarks, their diagnostic reasoning and inquiry skills are constrained. To mitigate this issue, we propose (1) Clinical Diagnostic Reasoning Data (CDRD) structure to capture abstract clinical reasoning logic, and a pipeline for its construction, and (2) the Dr. Assistant, a clinical diagnostic model equipped with clinical reasoning and inquiry skills. Its training involves a two-stage process: SFT, followed by RL with a tailored reward function. We also introduce a benchmark to evaluate both diagnostic reasoning and inquiry. Our experiments demonstrate that the Dr. Assistant outperforms open-source models and achieves competitive performance to closed-source models, providing an effective solution for clinical diagnostic inquiry guidance.