# Dialogue is Better Than Monologue: Instructing Medical LLMs via Strategical Conversations

arXiv: https://arxiv.org/abs/2501.17860 · HTML: https://mlsanity.com/paper/2501.17860/

## Key facts

- Cited by 4 papers in the map (data through 14 Oct 2026).
- Builds on 18 of its 28 references that are in the map.
- First posted on arXiv 29 Jan 2025.

## Builds on (most cited first, 18 of 18)

- [BioBERT: a pre-trained biomedical language representation model for biomedical text mining](https://mlsanity.com/paper/1901.08746/) (2019)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [What Disease does this Patient Have? A Large-scale Open Domain Question Answering Dataset from Medical Exams](https://mlsanity.com/paper/2009.13081/) (2020)
- [PubMedQA: A Dataset for Biomedical Research Question Answering](https://mlsanity.com/paper/1909.06146/) (2019)
- [Domain-Specific Language Model Pretraining for Biomedical Natural Language Processing](https://mlsanity.com/paper/2007.15779/) (2020)
- [BioGPT: Generative Pre-trained Transformer for Biomedical Text Generation and Mining](https://mlsanity.com/paper/2210.10341/) (2022)
- [ChatDoctor: A Medical Chat Model Fine-Tuned on a Large Language Model Meta-AI (LLaMA) Using Medical Domain Knowledge](https://mlsanity.com/paper/2303.14070/) (2023)
- [MedAlpaca -- An Open-Source Collection of Medical Conversational AI Models and Training Data](https://mlsanity.com/paper/2304.08247/) (2023)
- [Learning to Exploit Temporal Structure for Biomedical Vision-Language Processing](https://mlsanity.com/paper/2301.04558/) (2023)
- [MedDialog: Two Large-scale Medical Dialogue Datasets](https://mlsanity.com/paper/2004.03329/) (2020)
- [MediQ: Question-Asking LLMs and a Benchmark for Reliable Interactive Clinical Reasoning](https://mlsanity.com/paper/2406.00922/) (2024)
- [Benchmarking Large Language Models on Answering and Explaining Challenging Medical Questions](https://mlsanity.com/paper/2402.18060/) (2024)
- [AlpaCare:Instruction-tuned Large Language Models for Medical Application](https://mlsanity.com/paper/2310.14558/) (2023)
- [PMC-LLaMA: Towards Building Open-source Language Models for Medicine](https://mlsanity.com/paper/2304.14454/) (2023)
- [Parameter-Efficient Fine-Tuning of LLaMA for the Clinical Domain](https://mlsanity.com/paper/2307.03042/) (2023)
- [Large Language Models are Clinical Reasoners: Reasoning-Aware Diagnosis Framework with Prompt-Generated Rationales](https://mlsanity.com/paper/2312.07399/) (2023)
- [ReMeDi: Resources for Multi-domain, Multi-service, Medical Dialogues](https://mlsanity.com/paper/2109.00430/) (2021)
- [ConvCounsel: A Conversational Dataset for Student Counseling](https://mlsanity.com/paper/2411.00604/) (2024)

## Built on by (most cited first, 4 of 4)

- [Advancing Conversational Diagnostic AI with Multimodal Reasoning](https://mlsanity.com/paper/2505.04653/) (2025)
- [ProMed: Shapley Information Gain Guided Reinforcement Learning for Proactive Medical LLMs](https://mlsanity.com/paper/2508.13514/) (2025)
- [VOLMO: Versatile and Open Large Models for Ophthalmology](https://mlsanity.com/paper/2603.23953/) (2026)
- [Reinforcement Learning for Evidence-Seeking Diagnostic Reasoning with Large Language Models](https://mlsanity.com/paper/2607.02983/) (2026)

## Abstract (arXiv)

Current medical AI systems often fail to replicate real-world clinical reasoning, as they are predominantly trained and evaluated on static text and question-answer tasks. These tuning methods and benchmarks overlook critical aspects like evidence-based reasoning and handling distracting information. To bridge this gap, we introduce a novel benchmark that simulates real-world diagnostic scenarios, integrating noise and difficulty levels aligned with USMLE standards. Moreover, we explore dialogue-based fine-tuning, which transforms static datasets into conversational formats to better capture iterative reasoning processes. Experiments show that dialogue-tuned models outperform traditional methods, with improvements of 9.64% in multi-round reasoning scenarios and 6.18% in accuracy in a noisy environment. Our findings highlight dialogue tuning as a promising approach for advancing clinically aligned and robust medical AI systems.