# LLMs Can Simulate Standardized Patients via Agent Coevolution

arXiv: https://arxiv.org/abs/2412.11716 · HTML: https://mlsanity.com/paper/2412.11716/

## Key facts

- Cited by 22 papers in the map (data through 14 Oct 2026).
- Placed in Medical and scientific domain agents, one of 16 directions in LLM agents and tool use.
- Builds on 23 of its 57 references that are in the map.
- First posted on arXiv 16 Dec 2024.

## Placed in

- LLM agents and tool use / [Medical and scientific domain agents](https://mlsanity.com/agents/medical-and-scientific-domain-agents/)

## Builds on (most cited first, 23 of 23)

- [BERT: Pre-training of Deep Bidirectional Transformers for Language Understanding](https://mlsanity.com/paper/1810.04805/) (2018)
- [Language Models are Few-Shot Learners](https://mlsanity.com/paper/2005.14165/) (2020)
- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [Training language models to follow instructions with human feedback](https://mlsanity.com/paper/2203.02155/) (2022)
- [Exploring the Limits of Transfer Learning with a Unified Text-to-Text Transformer](https://mlsanity.com/paper/1910.10683/) (2019)
- [Retrieval-Augmented Generation for Knowledge-Intensive NLP Tasks](https://mlsanity.com/paper/2005.11401/) (2020)
- [Self-Consistency Improves Chain of Thought Reasoning in Language Models](https://mlsanity.com/paper/2203.11171/) (2022)
- [Generative Agents: Interactive Simulacra of Human Behavior](https://mlsanity.com/paper/2304.03442/) (2023)
- [Universal and Transferable Adversarial Attacks on Aligned Language Models](https://mlsanity.com/paper/2307.15043/) (2023)
- [Sparks of Artificial General Intelligence: Early experiments with GPT-4](https://mlsanity.com/paper/2303.12712/) (2023)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [ChatDev: Communicative Agents for Software Development](https://mlsanity.com/paper/2307.07924/) (2023)
- [ExpeL: LLM Agents Are Experiential Learners](https://mlsanity.com/paper/2308.10144/) (2023)
- [Jailbreaking ChatGPT via Prompt Engineering: An Empirical Study](https://mlsanity.com/paper/2305.13860/) (2023)
- [Principle-Driven Self-Alignment of Language Models from Scratch with Minimal Human Supervision](https://mlsanity.com/paper/2305.03047/) (2023)
- [Social Simulacra: Creating Populated Prototypes for Social Computing Systems](https://mlsanity.com/paper/2208.04024/) (2022)
- [Scaling Large Language Model-based Multi-Agent Collaboration](https://mlsanity.com/paper/2406.07155/) (2024)
- [Agent-as-a-Judge: Evaluate Agents with Agents](https://mlsanity.com/paper/2410.10934/) (2024)
- [Agent Hospital: A Simulacrum of Hospital with Evolvable Medical Agents](https://mlsanity.com/paper/2405.02957/) (2024)
- [War and Peace (WarAgent): Large Language Model-based Multi-Agent Simulation of World Wars](https://mlsanity.com/paper/2311.17227/) (2023)
- [AlpaCare:Instruction-tuned Large Language Models for Medical Application](https://mlsanity.com/paper/2310.14558/) (2023)
- [MetaAgents: Large Language Model Based Agents for Decision-Making on Teaming](https://mlsanity.com/paper/2310.06500/) (2023)
- [Roleplay-doh: Enabling Domain-Experts to Create LLM-simulated Patients via Eliciting and Adhering to Principles](https://mlsanity.com/paper/2407.00870/) (2024)

## Built on by (most cited first, 22 of 22)

- [A Survey of Self-Evolving Agents: What, When, How, and Where to Evolve on the Path to Artificial Super Intelligence](https://mlsanity.com/paper/2507.21046/) (2025)
- [From LLM Reasoning to Autonomous AI Agents: A Comprehensive Review](https://mlsanity.com/paper/2504.19678/) (2025)
- [A Survey of LLM-based Agents in Medicine: How far are we from Baymax?](https://mlsanity.com/paper/2502.11211/) (2025)
- [A Survey of Agentic Reasoning for Large Language Models: Towards Recursively Self-Improving and Collective Agents](https://mlsanity.com/paper/2601.12538/) (2026)
- [Self-Evolving Multi-Agent Simulations for Realistic Clinical Interactions](https://mlsanity.com/paper/2503.22678/) (2025)
- [PatientSim: A Persona-Driven Simulator for Realistic Doctor-Patient Interactions](https://mlsanity.com/paper/2505.17818/) (2025)
- [ChatThero: An LLM-Supported Chatbot for Behavior Change and Therapeutic Support in Addiction Recovery](https://mlsanity.com/paper/2508.20996/) (2025)
- [PatientHub: A Unified Framework for Patient Simulation](https://mlsanity.com/paper/2602.11684/) (2026)
- [Strong Reasoning Isn't Enough: Evaluating Evidence Elicitation in Interactive Diagnosis](https://mlsanity.com/paper/2601.19773/) (2026)
- [Patient-Zero: Scaling Synthetic Patient Agents to Real-World Distributions without Real Patient Data](https://mlsanity.com/paper/2509.11078/) (2025)
- [Human or LLM as Standardized Patients? A Comparative Study for Medical Education](https://mlsanity.com/paper/2511.14783/) (2025)
- [The Path to Self-Evolving Clinical Systems: Scaling Medical Agents from Assistance to Autonomy](https://mlsanity.com/paper/2607.11175/) (2026)
- [Multi-Stage Patient Role-Playing Framework for Realistic Clinical Interactions](https://mlsanity.com/paper/2601.10951/) (2026)
- [From Prediction to Intervention: Personalized Meal-Level Glucose Regulation via an LLM Agent](https://mlsanity.com/paper/2608.13581/) (2026)
- [An Agentic AI Framework for Training General Practitioner Student Skills](https://mlsanity.com/paper/2512.18440/) (2025)
- [VeriSim: A Configurable Framework for Stress-Testing Medical AI Under Patient Communication Noise](https://mlsanity.com/paper/2604.10441/) (2026)
- [Beyond Prompt: Fine-grained Simulation of Cognitively Impaired Standardized Patients via Stochastic Steering](https://mlsanity.com/paper/2604.12210/) (2026)
- [MedGame: Storytelling Gamification Empowered by Large Language Models for Medical Education](https://mlsanity.com/paper/2607.21570/) (2026)
- [Clinical Communication Processing with Models Trained on LLM-Generated Synthetic Data: A Structured Survey and Novel Application Case Studies](https://mlsanity.com/paper/2608.05993/) (2026)
- [Agentic AI-driven Immersive Simulation: A Knowledge-Aware Virtual Training Platform forHigh Dose Rate (HDR) Brachytherapy](https://mlsanity.com/paper/2608.08163/) (2026)
- [When Does Defendant Statement Matter? A Study of Bias and Persuasion in LLM-Simulated Jurors](https://mlsanity.com/paper/2609.09887/) (2026)
- [Evaluating Scaffolding-Oriented Multi-Agent Large Language Model System for Clinical Interview Training](https://mlsanity.com/paper/2609.10939/) (2026)

## Abstract (arXiv)

Training medical personnel using standardized patients (SPs) remains a complex challenge, requiring extensive domain expertise and role-specific practice. Previous research on Large Language Model (LLM)-based SPs mostly focuses on improving data retrieval accuracy or adjusting prompts through human feedback. However, this focus has overlooked the critical need for patient agents to learn a standardized presentation pattern that transforms data into human-like patient responses through unsupervised simulations. To address this gap, we propose EvoPatient, a novel simulated patient framework in which a patient agent and doctor agents simulate the diagnostic process through multi-turn dialogues, simultaneously gathering experience to improve the quality of both questions and answers, ultimately enabling human doctor training. Extensive experiments on various cases demonstrate that, by providing only overall SP requirements, our framework improves over existing reasoning methods by more than 10% in requirement alignment and better human preference, while achieving an optimal balance of resource consumption after evolving over 200 cases for 10 hours, with excellent generalizability. Our system will be available at https://github.com/ZJUMAI/EvoPatient.