Daily Papers

In medical education, physicians convert academic knowledge into clinical expertise through residency: years of training across thousands of encounters, with diverse sources of feedback and progressively greater autonomy. Much of clinical reasoning relies on the patient encounter, a dialogue in which a clinician elicits history, refines diagnostic hypotheses, and decides management under uncertainty. While large language models (LLMs) excel on static medical benchmarks, methods to optimize the full sequence of clinical decisions remain underdeveloped. We present ResidencyRL, a reinforcement learning (RL) method for training clinical artificial intelligence (AI) agents through simulated multi-turn clinical encounters (up to 60 dialogue turns and 8 tool calls per trajectory). ResidencyRL pairs the policy agent with LLM simulators capable of complex, adversarial behaviors, training against a structured reward aligned to diagnostic accuracy, management quality, communication, documentation, and safety. On held-out evaluations, the ResidencyRL agent improves diagnostic accuracy by 7.0% under adversarial conditions (88.0% vs. 81.0%) and reduces missed red flag rates by 31%, demonstrating rigorous mitigation of premature closure. Blinded expert clinicians validated these gains, preferring the trained agent in 87.6% of side-by-side comparisons. The procedural competencies transfer to unseen benchmarks: the agent outperforms the base model across all six clinical axes of the AMIE multi-visit benchmark, and shows consistent directional improvements on AgentClinic and CRAFT-MD. Our findings demonstrate that sequential clinical decision-making can be effectively learned through multi-turn RL in simulation, yielding robust, generalizable capabilities, paving the way towards clinical mastery. Prospective validation with real-world workflows remains necessary to establish clinical utility.

Decision-based black-box attacks often necessitate a large number of queries to craft an adversarial example. Moreover, decision-based attacks based on querying boundary points in the estimated normal vector direction often suffer from inefficiency and convergence issues. In this paper, we propose a novel query-efficient curvature-aware geometric decision-based black-box attack (CGBA) that conducts boundary search along a semicircular path on a restricted 2D plane to ensure finding a boundary point successfully irrespective of the boundary curvature. While the proposed CGBA attack can work effectively for an arbitrary decision boundary, it is particularly efficient in exploiting the low curvature to craft high-quality adversarial examples, which is widely seen and experimentally verified in commonly used classifiers under non-targeted attacks. In contrast, the decision boundaries often exhibit higher curvature under targeted attacks. Thus, we develop a new query-efficient variant, CGBA-H, that is adapted for the targeted attack. In addition, we further design an algorithm to obtain a better initial boundary point at the expense of some extra queries, which considerably enhances the performance of the targeted attack. Extensive experiments are conducted to evaluate the performance of our proposed methods against some well-known classifiers on the ImageNet and CIFAR10 datasets, demonstrating the superiority of CGBA and CGBA-H over state-of-the-art non-targeted and targeted attacks, respectively. The source code is available at https://github.com/Farhamdur/CGBA.