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PCQC: Privileged Counterfactual Question Credit for Multi-Turn Medical Dialogue

arXiv · AI, language, vision and robotics · article · Sep 23, 2026 · UTC

Large language models (LLMs) have made substantial progress on medical question-answering, yet effective medical dialogue also requires learning to ask questions that uncover relevant patient information. To train such dialogue policies, a common pipeline combines supervised fine-tuning with reinforcement learning (RL) based on final diagnostic correctness. However, this outcome-based supervision does not directly distinguish the contributions of individual questions and provides no question-level feedback for unexecuted alternatives. To address this gap, we introduce PCQC (Privileged Counterf

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