# A Structured Debate-Mixture-of-Agents Framework for Complex Clinical Diagnostic Decision Support

arXiv: https://arxiv.org/abs/2609.05069 · HTML: https://mlsanity.com/paper/2609.05069/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Medical and scientific domain agents, one of 16 directions in LLM agents and tool use.
- Builds on 21 of its 47 references that are in the map.
- First posted on arXiv 4 Sep 2026.

## 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, 21 of 21)

- [Training language models to follow instructions with human feedback](https://mlsanity.com/paper/2203.02155/) (2022)
- [Let's Verify Step by Step](https://mlsanity.com/paper/2305.20050/) (2023)
- [Outrageously Large Neural Networks: The Sparsely-Gated Mixture-of-Experts Layer](https://mlsanity.com/paper/1701.06538/) (2017)
- [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)
- [Mixture-of-Agents Enhances Large Language Model Capabilities](https://mlsanity.com/paper/2406.04692/) (2024)
- [AI safety via debate](https://mlsanity.com/paper/1805.00899/) (2018)
- [Language Models Are Greedy Reasoners: A Systematic Formal Analysis of Chain-of-Thought](https://mlsanity.com/paper/2210.01240/) (2022)
- [MedAgents: Large Language Models as Collaborators for Zero-shot Medical Reasoning](https://mlsanity.com/paper/2311.10537/) (2023)
- [RLHF Workflow: From Reward Modeling to Online RLHF](https://mlsanity.com/paper/2405.07863/) (2024)
- [Adapted Large Language Models Can Outperform Medical Experts in Clinical Text Summarization](https://mlsanity.com/paper/2309.07430/) (2023)
- [AgentClinic: a multimodal agent benchmark to evaluate AI in simulated clinical environments](https://mlsanity.com/paper/2405.07960/) (2024)
- [Towards Accurate Differential Diagnosis with Large Language Models](https://mlsanity.com/paper/2312.00164/) (2023)
- [Multi-Agent Design: Optimizing Agents with Better Prompts and Topologies](https://mlsanity.com/paper/2502.02533/) (2025)
- [MedReason: Eliciting Factual Medical Reasoning Steps in LLMs via Knowledge Graphs](https://mlsanity.com/paper/2504.00993/) (2025)
- [Diagnostic Reasoning Prompts Reveal the Potential for Large Language Model Interpretability in Medicine](https://mlsanity.com/paper/2308.06834/) (2023)
- [Beyond Accuracy: Evaluating the Reasoning Behavior of Large Language Models -- A Survey](https://mlsanity.com/paper/2404.01869/) (2024)
- [Large Language Models for Disease Diagnosis: A Scoping Review](https://mlsanity.com/paper/2409.00097/) (2024)
- [Understanding Agent Scaling in LLM-Based Multi-Agent Systems via Diversity](https://mlsanity.com/paper/2602.03794/) (2026)
- [Med-RewardBench: Benchmarking Reward Models and Judges for Medical Multimodal Large Language Models](https://mlsanity.com/paper/2508.21430/) (2025)
- [Guided Collaboration in Heterogeneous LLM-Based Multi-Agent Systems via Entropy-Based Understanding Assessment and Experience Retrieval](https://mlsanity.com/paper/2602.13639/) (2026)

## Abstract (arXiv)

Large language models (LLMs) show potential for medical tasks, but their single-turn question-answer format does not reflect how clinical diagnosis is performed in practice. As a result, they remain limited in complex diagnostic settings. We developed Debate-Mixture-of-Agents (DMoA), a novel multi-agent framework that structures role-based interaction to support iterative diagnostic reasoning. Base models and DMoA were evaluated on 297 rare disease cases and 1,719 challenging cases. Across both datasets, DMoA improved most likely diagnosis accuracy by 10.21 percentage points and safety rate by 11.36 percentage points over GPT-4o baseline. Ablation experiments showed that the gains were not simply due to the use of more models or longer outputs, but also reflected the contribution of the structured workflow. Further analyses examined how framework design, base model choice, and token budget affected performance. DMoA performed better with a 4*2 structure, stronger base models, and a larger token budget. These findings demonstrate the potential of DMoA for clinical tasks and suggest further investigation of multi-agent frameworks.