Reward design for clinical multi-turn agents: outcome-only training shortens the work-up, dense question credit keeps high-risk cases
Clinical multi-turn agents must decide what to ask, when to stop, and what to do from incomplete information. Across three controlled simulated settings, medication refill triage, acute diagnostic work-up and dosing titration, the study compares reward designs: outcome-only GRPO often raises average value by asking fewer questions while producing premature commitment and weaker high-risk performance, whereas extra credit for questions that reduce uncertainty about the hidden state raises held-out value and moderate-case support across three training seeds in diagnostics without the high-risk seed collapse seen under outcome-only training.