An LLM agent trained by reinforcement learning in psychiatric intake simulation beat its prompted base model in 76.7 percent of matched scenarios
AspireAI community · arXiv (cs.AI)
Psychiatric intake is a conversational diagnostic instrument, and it is hard to train a model for without real patients. This study trains one in simulation and then tests it with clinicians. In a randomised double-blind crossover study of 60 matched scenario pairs and 120 encounters, 32 board-certified psychiatrists role-played standardised patients while a separate panel of 15 independent board-certified psychiatrists scored de-identified transcripts. The agent trained with multi-turn reinforcement learning in simulation outperformed its identically prompted base model in 76.7 percent of matched pairs, with patient-centred communication at 82.0 versus 65.2 percent and differential-diagnosis appropriateness at 68.3 versus 33.3 percent. Across 127 psychiatrist-validated scenarios the clinical rubric score nearly doubled, 0.706 versus 0.379. A Delphi-consensus safety taxonomy produced 256 adversarial presentations, and simulation training more than halved under-triage of acute safety risks, 12.9 versus 30.5 percent. The authors are explicit that residual gaps remain and that clinician oversight is required.
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