# Self-Evolving Multi-Agent Simulations for Realistic Clinical Interactions

arXiv: https://arxiv.org/abs/2503.22678 · HTML: https://mlsanity.com/paper/2503.22678/

## Key facts

- Cited by 40 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 39 of its 57 references that are in the map.
- First posted on arXiv 28 Mar 2025.

## Placed in

- LLM agents and tool use / [Medical and scientific domain agents](https://mlsanity.com/agents/medical-and-scientific-domain-agents/)
- Synthetic data and self-improvement for LLMs / [Medical synthetic data and agents](https://mlsanity.com/synth/medical-synthetic-data-and-agents/)

## Builds on (most cited first, 30 of 39)

- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [The Llama 3 Herd of Models](https://mlsanity.com/paper/2407.21783/) (2024)
- [Llama 2: Open Foundation and Fine-Tuned Chat Models](https://mlsanity.com/paper/2307.09288/) (2023)
- [Chain-of-Thought Prompting Elicits Reasoning in Large Language Models](https://mlsanity.com/paper/2201.11903/) (2022)
- [Visual Instruction Tuning](https://mlsanity.com/paper/2304.08485/) (2023)
- [Efficient Memory Management for Large Language Model Serving with PagedAttention](https://mlsanity.com/paper/2309.06180/) (2023)
- [Qwen2-VL: Enhancing Vision-Language Model's Perception of the World at Any Resolution](https://mlsanity.com/paper/2409.12191/) (2024)
- [Generative Agents: Interactive Simulacra of Human Behavior](https://mlsanity.com/paper/2304.03442/) (2023)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [Mixtral of Experts](https://mlsanity.com/paper/2401.04088/) (2024)
- [What Disease does this Patient Have? A Large-scale Open Domain Question Answering Dataset from Medical Exams](https://mlsanity.com/paper/2009.13081/) (2020)
- [Domain-Specific Language Model Pretraining for Biomedical Natural Language Processing](https://mlsanity.com/paper/2007.15779/) (2020)
- [Large Language Model based Multi-Agents: A Survey of Progress and Challenges](https://mlsanity.com/paper/2402.01680/) (2024)
- [BioGPT: Generative Pre-trained Transformer for Biomedical Text Generation and Mining](https://mlsanity.com/paper/2210.10341/) (2022)
- [Benchmarking Retrieval-Augmented Generation for Medicine](https://mlsanity.com/paper/2402.13178/) (2024)
- [Can Generalist Foundation Models Outcompete Special-Purpose Tuning? Case Study in Medicine](https://mlsanity.com/paper/2311.16452/) (2023)
- [MedAgents: Large Language Models as Collaborators for Zero-shot Medical Reasoning](https://mlsanity.com/paper/2311.10537/) (2023)
- [MEDITRON-70B: Scaling Medical Pretraining for Large Language Models](https://mlsanity.com/paper/2311.16079/) (2023)
- [Unleashing the Emergent Cognitive Synergy in Large Language Models: A Task-Solving Agent through Multi-Persona Self-Collaboration](https://mlsanity.com/paper/2307.05300/) (2023)
- [AgentClinic: a multimodal agent benchmark to evaluate AI in simulated clinical environments](https://mlsanity.com/paper/2405.07960/) (2024)
- [Agent Hospital: A Simulacrum of Hospital with Evolvable Medical Agents](https://mlsanity.com/paper/2405.02957/) (2024)
- [LinkBERT: Pretraining Language Models with Document Links](https://mlsanity.com/paper/2203.15827/) (2022)
- [Can large language models reason about medical questions?](https://mlsanity.com/paper/2207.08143/) (2022)
- [Deep Bidirectional Language-Knowledge Graph Pretraining](https://mlsanity.com/paper/2210.09338/) (2022)
- [LLM Post-Training: A Deep Dive into Reasoning Large Language Models](https://mlsanity.com/paper/2502.21321/) (2025)
- [DoctorGLM: Fine-tuning your Chinese Doctor is not a Herculean Task](https://mlsanity.com/paper/2304.01097/) (2023)
- [Should we be going MAD? A Look at Multi-Agent Debate Strategies for LLMs](https://mlsanity.com/paper/2311.17371/) (2023)
- [AI Hospital: Benchmarking Large Language Models in a Multi-agent Medical Interaction Simulator](https://mlsanity.com/paper/2402.09742/) (2024)
- [DISC-MedLLM: Bridging General Large Language Models and Real-World Medical Consultation](https://mlsanity.com/paper/2308.14346/) (2023)
- [BioMedLM: A 2.7B Parameter Language Model Trained On Biomedical Text](https://mlsanity.com/paper/2403.18421/) (2024)

## Built on by (most cited first, 30 of 40)

- [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)
- [A Survey of Agentic Reasoning for Large Language Models: Towards Recursively Self-Improving and Collective Agents](https://mlsanity.com/paper/2601.12538/) (2026)
- [PatientSim: A Persona-Driven Simulator for Realistic Doctor-Patient Interactions](https://mlsanity.com/paper/2505.17818/) (2025)
- [LLM-based Agentic Reasoning Frameworks: A Survey from Methods to Scenarios](https://mlsanity.com/paper/2508.17692/) (2025)
- [MedDialogRubrics: A Comprehensive Benchmark and Evaluation Framework for Multi-turn Medical Consultations in Large Language Models](https://mlsanity.com/paper/2601.03023/) (2026)
- [Evolving Medical Imaging Agents via Experience-driven Self-skill Discovery](https://mlsanity.com/paper/2603.05860/) (2026)
- [Evolving Interactive Diagnostic Agents in a Virtual Clinical Environment](https://mlsanity.com/paper/2510.24654/) (2025)
- [Trustworthy AI Psychotherapy: Multi-Agent LLM Workflow for Counseling and Explainable Mental Disorder Diagnosis](https://mlsanity.com/paper/2508.11398/) (2025)
- [EvoClinician: A Self-Evolving Agent for Multi-Turn Medical Diagnosis via Test-Time Evolutionary Learning](https://mlsanity.com/paper/2601.22964/) (2026)
- [HealthAgentBench: A Unified Benchmark Suite of Realistic Agentic Healthcare Environments for Challenging Frontier AI Agents](https://mlsanity.com/paper/2606.31179/) (2026)
- [Meissa: Multi-modal Medical Agentic Intelligence](https://mlsanity.com/paper/2603.09018/) (2026)
- [AgentMental: An Interactive Multi-Agent Framework for Explainable and Adaptive Mental Health Assessment](https://mlsanity.com/paper/2508.11567/) (2025)
- [CP-Env: Evaluating Large Language Models on Clinical Pathways in a Controllable Hospital Environment](https://mlsanity.com/paper/2512.10206/) (2025)
- [Agentic Large Language Models for Training-Free Neuro-Radiological Image Analysis](https://mlsanity.com/paper/2604.16729/) (2026)
- [MeDxAgent: Multi-Agent Consultation for Interactive Medical Diagnosis](https://mlsanity.com/paper/2606.03416/) (2026)
- [AutoMedic: An Automated Evaluation Framework for Clinical Conversational Agents with Medical Dataset Grounding](https://mlsanity.com/paper/2512.10195/) (2025)
- [Strong Reasoning Isn't Enough: Evaluating Evidence Elicitation in Interactive Diagnosis](https://mlsanity.com/paper/2601.19773/) (2026)
- [Information-seeking failures of large language models in agentic clinical reasoning](https://mlsanity.com/paper/2607.10275/) (2026)
- [Human or LLM as Standardized Patients? A Comparative Study for Medical Education](https://mlsanity.com/paper/2511.14783/) (2025)
- [What Makes a Sale? Simulating End-to-End Seller--Buyer Retail Dynamics with LLM Agents](https://mlsanity.com/paper/2604.04468/) (2026)
- [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)
- [Agentic AI in Healthcare & Medicine: A Seven-Dimensional Taxonomy for Empirical Evaluation of LLM-based Agents](https://mlsanity.com/paper/2602.04813/) (2026)
- [QuarkMedBench: A Real-World Scenario Driven Benchmark for Evaluating Large Language Models](https://mlsanity.com/paper/2603.13691/) (2026)
- [OpenHospital: A Thing-in-itself Arena for Evolving and Benchmarking LLM-based Collective Intelligence](https://mlsanity.com/paper/2603.14771/) (2026)
- [MentalHospital: A Virtual Environment for Evaluating Psychiatric Clinical Encounters](https://mlsanity.com/paper/2607.08257/) (2026)
- [EMR: Self-Evolving Medical Multi-Agent System via Experience Mining and Reuse](https://mlsanity.com/paper/2609.15161/) (2026)
- [GraphMed-LT: Patient-Specific Graph Memory with Latent Clinical Thought Refinement for Multi-Turn Medical Conversations](https://mlsanity.com/paper/2510.03536/) (2025)
- [H-AdminSim: A Multi-Agent Simulator for Realistic Hospital Administrative Workflows with FHIR Integration](https://mlsanity.com/paper/2602.05407/) (2026)
- [CoMMa: Contribution-Aware Medical Multi-Agents for Decentralized Oncology Decision Support](https://mlsanity.com/paper/2602.09159/) (2026)

## Abstract (arXiv)

In this work, we introduce MedAgentSim, an open-source simulated clinical environment with doctor, patient, and measurement agents designed to evaluate and enhance LLM performance in dynamic diagnostic settings. Unlike prior approaches, our framework requires doctor agents to actively engage with patients through multi-turn conversations, requesting relevant medical examinations (e.g., temperature, blood pressure, ECG) and imaging results (e.g., MRI, X-ray) from a measurement agent to mimic the real-world diagnostic process. Additionally, we incorporate self improvement mechanisms that allow models to iteratively refine their diagnostic strategies. We enhance LLM performance in our simulated setting by integrating multi-agent discussions, chain-of-thought reasoning, and experience-based knowledge retrieval, facilitating progressive learning as doctor agents interact with more patients. We also introduce an evaluation benchmark for assessing the LLM's ability to engage in dynamic, context-aware diagnostic interactions. While MedAgentSim is fully automated, it also supports a user-controlled mode, enabling human interaction with either the doctor or patient agent. Comprehensive evaluations in various simulated diagnostic scenarios demonstrate the effectiveness of our approach. Our code, simulation tool, and benchmark are available at hrefhttps://medagentsim.netlify.app/.