Hsin-Ling Hsu

Hsin-Ling Hsu, Zizheng Wang, Donghua Zhang et al.

Most existing LLM diagnoses are evaluated on static, single-turn settings where complete patient information is provided upfront, an oversimplification of real clinical practice. We study active diagnosis: the real-life clinical process of starting from initial observation, ordering tests, interpreting results, and updating a differential diagnosis across multiple turns. Through systematic analysis, we identify three recurring failure modes in current LLMs: ungrounded test ordering, unreliable diagnostic update, and degraded multi-turn coherence. Together, these failures reveal a core deficit: existing medical training data teaches models to reason from complete information but not to act under evolving, partial evidence. To address this gap, we introduce MedAction, a tree-structured distillation pipeline that synthesizes diverse and high-quality multi-turn diagnostic trajectories via LLM-environment interaction. We propose two knowledge-graph-grounded metrics to filter trajectory quality: Disease Trajectory Consistency (DTC), which tracks whether the model's hypothesis converges toward the correct diagnosis, and Reasoning-Action Consistency (RAC), which verifies that belief updates are driven by gathered evidence. Using this pipeline, we construct MedAction-32K, a dataset of 32,681 trajectories from 2,896 PMC cases. Fine-tuning an 8B model on MedAction-32K achieves state-of-the-art performance among open-source models on both MedR-Bench and our curated MedAction-300-Hard benchmark, pushing the edge for open-source medical LLMs.

Hsin-Ling Hsu, Cong-Tinh Dao, Luning Wang et al.

Despite recent success in applying large language models (LLMs) to electronic health records (EHR), most systems focus primarily on assessment rather than treatment planning. We identify three critical limitations in current approaches: they generate treatment plans in a single pass rather than following the sequential reasoning process used by clinicians; they rarely incorporate patient-specific historical context; and they fail to effectively distinguish between subjective and objective clinical information. Motivated by the SOAP methodology (Subjective, Objective, Assessment, Plan), we introduce \ours{}, a novel framework that structures LLM reasoning to align with real-life clinician workflows. Our approach employs a two-stage architecture that first generates a clinical assessment based on patient symptoms and objective data, then formulates a structured treatment plan informed by this assessment and enriched with patient-specific information through retrieval-augmented generation. Comprehensive evaluation demonstrates that our method significantly outperforms baseline approaches in both assessment accuracy and treatment plan quality.

Hsin-Ling Hsu, Min-Yu Chen, Nai-Chia Chen et al.

Transformer-based NLP models remain vulnerable to adversarial perturbations, yet existing repair methods face a fundamental trade-off: gradient-based approaches offer flexibility but lack verifiability and often overfit; methods that do provide repair guarantees are restricted to the final layer or small networks, significantly limiting the parameter search space available for repair. We present WARP (Weight-Adjusted Repair with Provability), a constraint-based repair framework that extends repair beyond the last layer of Transformer models. WARP formulates repair as a convex quadratic program derived from a first-order linearization of the logit gap, enabling tractable optimization over a high-dimensional parameter space. Under the condition that the first-order approximation holds, this formulation induces three per-sample guarantees: (i) a positive margin constraint ensuring correct classification on repaired inputs, (ii) preservation constraints over a designated remain set, and (iii) a certified robustness radius derived from Lipschitz continuity. To ensure feasibility across varying model architectures, we introduce a sensitivity-based preprocessing step that conditions the optimization landscape accordingly. We further show that the iterative optimization procedure converges to solutions satisfying all repair constraints under mild assumptions. Empirical evaluation on encoder-only Transformers with varying layer architectures validates that these guarantees hold in practice while improving robustness to adversarial inputs. Our results demonstrate that guaranteed, generalizable Transformer repair is achievable through principled constraint-based optimization.

Chia-Hsuan Hsu, Jun-En Ding, Hsin-Ling Hsu et al.

Medical question answering requires advanced reasoning that integrates domain knowledge with logical inference. However, existing large language models (LLMs) often generate reasoning chains that lack factual accuracy and clinical reliability. We propose Ranked Preference Reinforcement Optimization (RPRO), a novel framework that combines reinforcement learning with preference-driven reasoning refinement to enhance clinical chain-of-thought (CoT) performance. RPRO distinguishes itself from prior approaches by employing task-adaptive reasoning templates and a probabilistic evaluation mechanism that aligns model outputs with established clinical workflows, while automatically identifying and correcting low-quality reasoning chains. Unlike traditional pairwise preference methods, RPRO introduces a groupwise ranking optimization based on the Bradley--Terry model and incorporates KL-divergence regularization for stable training. Experiments on PubMedQA, MedQA-USMLE, and a real-world clinical dataset from Far Eastern Memorial Hospital (FEMH) demonstrate consistent improvements over strong baselines. Remarkably, our 2B-parameter model outperforms much larger 7B--20B models, including medical-specialized variants. These findings demonstrate that combining preference optimization with quality-driven refinement provides a scalable and clinically grounded approach to building more reliable medical LLMs.