Ruishan Liu
Publications
MedExAgent: Training LLM Agents to Ask, Examine, and Diagnose in Noisy Clinical Environments
Real-world clinical diagnosis is a complex process in which the doctor is required to obtain information from both interaction with the patient and conducting medical exams. Additionally, the doctor needs to adapt to different patient personas, as well as noisy and incomplete information that can happen at any time during the process. However, existing benchmarks for medical LLMs and methods for automatic diagnosis largely simplify this process by reducing it to single-turn question answering, noise-free conversations, or sequential exam making, etc., ignoring the interactive and uncertain nature of clinical diagnosis. In this paper, we aim to address this gap by formalizing clinical diagnosis as a Partially Observable Markov Decision Process (POMDP) with three action types: questioning the patient, ordering medical exams as tool calls, and issuing a diagnosis. We also introduce a systematic noise model comprising seven patient noise types and three exam noise types. Using our proposed environment, we train an effective diagnosis agent, \textbf{MedExAgent}, through a two-stage pipeline that first performs supervised finetuning on synthetic conversations structured after the Calgary-Cambridge model for clinical interviews, and then applies DAPO to optimize a composite reward capturing diagnostic accuracy, tool call quality, and exam cost including financial cost and patient discomfort. Through extensive experiments and ablation studies, we demonstrate that MedExAgent achieves diagnostic performance comparable to larger models while maintaining cost-efficient examination strategies.
Fairness or Fluency? An Investigation into Language Bias of Pairwise LLM-as-a-Judge
Recent advances in Large Language Models (LLMs) have incentivized the development of LLM-as-a-judge, an application of LLMs where they are used as judges to decide the quality of a certain piece of text given a certain context. However, previous studies have demonstrated that LLM-as-a-judge can be biased towards different aspects of the judged texts, which often do not align with human preference. One of the identified biases is language bias, which indicates that the decision of LLM-as-a-judge can differ based on the language of the judged texts. In this paper, we study two types of language bias in pairwise LLM-as-a-judge: (1) performance disparity between languages when the judge is prompted to compare options from the same language, and (2) bias towards options written in major languages when the judge is prompted to compare options of two different languages. We find that for same-language judging, there exist significant performance disparities across language families, with European languages consistently outperforming African languages, and this bias is more pronounced in culturally-related subjects. For inter-language judging, we observe that most models favor English answers, and that this preference is influenced more by answer language than question language. Finally, we investigate whether language bias is in fact caused by low-perplexity bias, a previously identified bias of LLM-as-a-judge, and we find that while perplexity is slightly correlated with language bias, language bias cannot be fully explained by perplexity only.