Yuhao Shen
Publications
GuideSkill: Evolving Executable LLM Agent Skills for Guideline-Grounded Clinical Reasoning
Clinical practice guidelines (CPGs) encode diagnostic criteria, but LLM systems typically retrieve guideline text or absorb it through training rather than execute its rules. We introduce GuideSkill, an external reasoning layer that compiles disease-specific criteria into executable functions returning ordinal diagnostic-support scores. GuideSkill-Zero is initialized from guidelines, while GuideSkill-Evo uses case--diagnosis pairs to refine covered skills and add missing diagnoses. At inference, an LLM proposes a differential diagnosis, grounds the features required by each matched skill, and fuses its ranking with the executed skill scores. Across four benchmarks and four backbones, GuideSkill-Zero improves macro-average accuracy over guideline RAG by 13.45% on average. GuideSkill-Evo achieves the highest macro-average for every backbone, improves over direct inference by 18.49% relatively, and increases gold-label skill coverage from 56.5% to 99.5%. On Qwen3.5-9B, it also exceeds the strongest parameter-update baseline by 11.16% without updating the backbone. Expert evaluation further indicates that GuideSkill produces clinically sound and broadly acceptable skills, suggesting that its initialized and evolved rules are reliable and practically meaningful. These results support executable skills as a model-agnostic mechanism for combining guideline-derived procedures with case-derived diagnostic patterns.
MedGuideX: Internalizing Decision Logic from Executable Guidelines into Large Language Models for Clinical Reasoning
Clinical practice guidelines (CPGs) encode evidence-based decision logic that clinicians apply by evaluating patient variables, conditional criteria, and recommendation rules. However, existing methods often use CPGs as free-text training data or retrieval sources, underutilizing their procedural decision structure. To better exploit this structure, we introduce a guideline-derived training pipeline that transforms CPG recommendations into executable clinical decision logic and uses it to generate factual and counterfactual question-answering data. Theses data teach models both guideline-supported decisions and how decisions change under different patient conditions. Post-training a medical LLM on the generated data yields MedGuideX. Across four clinical reasoning benchmarks, MedGuideX achieves a 10.28% relative improvement in average accuracy. Physician evaluation further shows that MedGuideX better recovers clinician authored reasoning steps and produces physician-preferred rationales in faithfulness, validity, completeness, and clarity. Overall, our results show that executable decision logic from CPGs can be transformed into scalable supervision for building reliable medical LLMs.
SkinGPT-X: A Self-Evolving Collaborative Multi-Agent System for Transparent and Trustworthy Dermatological Diagnosis
While recent advancements in Large Language Models have significantly advanced dermatological diagnosis, monolithic LLMs frequently struggle with fine-grained, large-scale multi-class diagnostic tasks and rare skin disease diagnosis owing to training data sparsity, while also lacking the interpretability and traceability essential for clinical reasoning. Although multi-agent systems can offer more transparent and explainable diagnostics, existing frameworks are primarily concentrated on Visual Question Answering and conversational tasks, and their heavy reliance on static knowledge bases restricts adaptability in complex real-world clinical settings. Here, we present SkinGPT-X, a multimodal collaborative multi-agent system for dermatological diagnosis integrated with a self-evolving dermatological memory mechanism. By simulating the diagnostic workflow of dermatologists and enabling continuous memory evolution, SkinGPT-X delivers transparent and trustworthy diagnostics for the management of complex and rare dermatological cases. To validate the robustness of SkinGPT-X, we design a three-tier comparative experiment. First, we benchmark SkinGPT-X against four state-of-the-art LLMs across four public datasets, demonstrating its state-of-the-art performance with a +9.6% accuracy improvement on DDI31 and +13% weighted F1 gain on Dermnet over the state-of-the-art model. Second, we construct a large-scale multi-class dataset covering 498 distinct dermatological categories to evaluate its fine-grained classification capabilities. Finally, we curate the rare skin disease dataset, the first benchmark to address the scarcity of clinical rare skin diseases which contains 564 clinical samples with eight rare dermatological diseases. On this dataset, SkinGPT-X achieves a +9.8% accuracy improvement, a +7.1% weighted F1 improvement, a +10% Cohen's Kappa improvement.