# EvoClinician: A Self-Evolving Agent for Multi-Turn Medical Diagnosis via Test-Time Evolutionary Learning

arXiv: https://arxiv.org/abs/2601.22964 · HTML: https://mlsanity.com/paper/2601.22964/

## Key facts

- Cited by 8 papers in the map (data through 14 Oct 2026).
- Builds on 49 of its 58 references that are in the map.
- First posted on arXiv 30 Jan 2026.

## Builds on (most cited first, 30 of 49)

- [Retrieval-Augmented Generation for Knowledge-Intensive NLP Tasks](https://mlsanity.com/paper/2005.11401/) (2020)
- [GPT-4o System Card](https://mlsanity.com/paper/2410.21276/) (2024)
- [Reflexion: Language Agents with Verbal Reinforcement Learning](https://mlsanity.com/paper/2303.11366/) (2023)
- [Let's Verify Step by Step](https://mlsanity.com/paper/2305.20050/) (2023)
- [Self-Refine: Iterative Refinement with Self-Feedback](https://mlsanity.com/paper/2303.17651/) (2023)
- [A Survey on Large Language Model based Autonomous Agents](https://mlsanity.com/paper/2308.11432/) (2023)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [OpenAI GPT-5 System Card](https://mlsanity.com/paper/2601.03267/) (2025)
- [Math-Shepherd: Verify and Reinforce LLMs Step-by-step without Human Annotations](https://mlsanity.com/paper/2312.08935/) (2023)
- [ExpeL: LLM Agents Are Experiential Learners](https://mlsanity.com/paper/2308.10144/) (2023)
- [Large Language Models as Optimizers](https://mlsanity.com/paper/2309.03409/) (2023)
- [Mem0: Building Production-Ready AI Agents with Scalable Long-Term Memory](https://mlsanity.com/paper/2504.19413/) (2025)
- [Automatic Prompt Optimization with "Gradient Descent" and Beam Search](https://mlsanity.com/paper/2305.03495/) (2023)
- [Capabilities of GPT-4 on Medical Challenge Problems](https://mlsanity.com/paper/2303.13375/) (2023)
- [Promptbreeder: Self-Referential Self-Improvement Via Prompt Evolution](https://mlsanity.com/paper/2309.16797/) (2023)
- [GEPA: Reflective Prompt Evolution Can Outperform Reinforcement Learning](https://mlsanity.com/paper/2507.19457/) (2025)
- [MedGemma Technical Report](https://mlsanity.com/paper/2507.05201/) (2025)
- [RAGEN: Understanding Self-Evolution in LLM Agents via Multi-Turn Reinforcement Learning](https://mlsanity.com/paper/2504.20073/) (2025)
- [Agent Workflow Memory](https://mlsanity.com/paper/2409.07429/) (2024)
- [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)
- [EvoPrompt: Connecting LLMs with Evolutionary Algorithms Yields Powerful Prompt Optimizers](https://mlsanity.com/paper/2309.08532/) (2023)
- [OmniMedVQA: A New Large-Scale Comprehensive Evaluation Benchmark for Medical LVLM](https://mlsanity.com/paper/2402.09181/) (2024)
- [MediQ: Question-Asking LLMs and a Benchmark for Reliable Interactive Clinical Reasoning](https://mlsanity.com/paper/2406.00922/) (2024)
- [Evo-Memory: Benchmarking LLM Agent Test-time Learning with Self-Evolving Memory](https://mlsanity.com/paper/2511.20857/) (2025)
- [CMB: A Comprehensive Medical Benchmark in Chinese](https://mlsanity.com/paper/2308.08833/) (2023)
- [GuardReasoner: Towards Reasoning-based LLM Safeguards](https://mlsanity.com/paper/2501.18492/) (2025)
- [GMAI-MMBench: A Comprehensive Multimodal Evaluation Benchmark Towards General Medical AI](https://mlsanity.com/paper/2408.03361/) (2024)
- [UniGraph: Learning a Unified Cross-Domain Foundation Model for Text-Attributed Graphs](https://mlsanity.com/paper/2402.13630/) (2024)
- [Safety in Large Reasoning Models: A Survey](https://mlsanity.com/paper/2504.17704/) (2025)

## Built on by (most cited first, 8 of 8)

- [Zombie Agents: Persistent Control of Self-Evolving LLM Agents via Self-Reinforcing Injections](https://mlsanity.com/paper/2602.15654/) (2026)
- [The Last AI Built by Humans: Toward Genuine Recursive Self-Improvement](https://mlsanity.com/paper/2609.11873/) (2026)
- [Agentic Environment Engineering for Large Language Models: A Survey of Environment Modeling, Synthesis, Evaluation, and Application](https://mlsanity.com/paper/2606.12191/) (2026)
- [Self-Improvement of Large Language Models: A Technical Overview and Future Outlook](https://mlsanity.com/paper/2603.25681/) (2026)
- [Continual Learning in Transition](https://mlsanity.com/paper/2608.06216/) (2026)
- [CDPR: Counterfactual Advantage-based Credit Assignment for Cost-Aware Sequential Medical Diagnosis](https://mlsanity.com/paper/2608.28599/) (2026)
- [Asclepius: An Adaptive Harness for Long-Horizon Clinical Agents](https://mlsanity.com/paper/2609.13543/) (2026)
- [PrivMeSA: Privacy-Aware Self-Evolving Multi-Agent System for Medicine via Local-Remote LLM Collaboration](https://mlsanity.com/paper/2609.38458/) (2026)

## Abstract (arXiv)

Prevailing medical AI operates on an unrealistic ''one-shot'' model, diagnosing from a complete patient file. However, real-world diagnosis is an iterative inquiry where Clinicians sequentially ask questions and order tests to strategically gather information while managing cost and time. To address this, we first propose Med-Inquire, a new benchmark designed to evaluate an agent's ability to perform multi-turn diagnosis. Built upon a dataset of real-world clinical cases, Med-Inquire simulates the diagnostic process by hiding a complete patient file behind specialized Patient and Examination agents. They force the agent to proactively ask questions and order tests to gather information piece by piece. To tackle the challenges posed by Med-Inquire, we then introduce EvoClinician, a self-evolving agent that learns efficient diagnostic strategies at test time. Its core is a ''Diagnose-Grade-Evolve'' loop: an Actor agent attempts a diagnosis; a Process Grader agent performs credit assignment by evaluating each action for both clinical yield and resource efficiency; finally, an Evolver agent uses this feedback to update the Actor's strategy by evolving its prompt and memory. Our experiments show EvoClinician outperforms continual learning baselines and other self-evolving agents like memory agents. The code is available at https://github.com/yf-he/EvoClinician