Self-Evolving Multi-Agent Simulations for Realistic Clinical Interactions

Presents MedAgentSim is a fully automated, open-source hospital simulation where LLM-powered agents simulate doctor-patient interactions in dynamic diagnostic settings. Unlike previous static QA benchmarks, MedAgentSim mimics real-world clinical workflows with multi-turn dialogue, test requests, and self-improvement. More about this paper: ● Active doctor agents – MedAgentSim requires LLM doctor agents to engage in multi-turn consultations, request labs and imaging (e.g., ECG, X-ray), and iteratively refine diagnoses, making it far more realistic than pre-filled medical QA datasets. ● Self-improvement via memory + reflection – The system maintains buffers of successful and failed diagnoses. It uses retrieved past cases (via kNN), chain-of-thought reasoning, and ensembling to improve performance over time. Misdiagnoses trigger a reflection phase before inclusion in memory. ● Fully autonomous or human-in-the-loop – Users can optionally take control of the doctor or patient agents. Simulation assets are built using a 2D game engine (Phaser), and the agents can navigate, converse, and interact with virtual medical tools. ● Big performance boost across benchmarks – On NEJM, MedQA, and MIMIC-IV, MedAgentSim (with LLaMA 3.3) outperforms baseline setups by +6–37%, especially in vision-language tasks using LLaVA for interpreting medical images. ● Bias analysis & fairness focus – The team studied diagnostic accuracy under cognitive and implicit bias conditions. Models like GPT-4o and LLaMA proved more robust than Mixtral/Mistral, highlighting the importance of bias-aware evaluation.