Dialogue is Better Than Monologue: Instructing Meidcal LLMs via Strategic Conversations

摘要

In real clinical practice, clinicians must sift through noisy and often conflicting information, progressively gathering and sequencing evidence before reaching conclusions. However, existing tuning methods for medical AI models are typically monologue-based — that is, models are fine-tuned on static question answering (QA) tasks or medical articles, which fail to reflect the interactive and iterative nature of clinical reasoning. To bridge this gap, we introduce MuddyMaze, a benchmark designed to expose the limitations of current monologue-based tuning, and construct a large dialogue dataset of 22.2k doctor–patient interactions that capture stepwise diagnostic reasoning validated by medical experts. Building on those, we propose dialogue-tuning, a new fine-tuning paradigm that captures the internal reasoning dynamics unfolding across interactions.To assess the effectiveness of our approach, we evaluated dialogue-tuned models on MuddyMaze, where they outperform monologue-tuned baselines (e.g., MedQA) by +16.1% in one-round and +4.1% in multi-round evidence ranking, while maintaining or even improving accuracy on standard medical QA benchmarks (e.g., PubMedQA). These results indicate that dialogue-tuning not only enhances reasoning robustness and evidence integration but also preserves the factual precision of traditional QA performance.