Longitudinal clinical agents must maintain an evolving patient state from evidence distributed across visits, time points, and specialties. However, how agent memory should be designed for this setting remains unclear. We introduce a benchmark of multi-visit, multi-specialty patient records that evaluates long-context evidence retrieval, cross-time evidence aggregation, and cross-specialty clinical reasoning. Using this benchmark, we systematically study four memory design choices: curation, organization, retrieval, and memory-augmented reasoning. We find that temporal validity is more important than simply retaining more history; specialty-factorized memory reduces context but can hide shared evidence; and multiple agents help when specialists must reason together, not merely when evidence comes from multiple memories. Guided by these findings, we propose \textit{MedCache}, a hybrid framework that constructs temporally valid patient memory, organizes evidence into overlapping specialty views, routes each query to relevant memories, and adaptively invokes one or multiple specialists. Experiments show that MedCache improves reasoning accuracy and memory efficiency over strong single-agent and multi-agent baselines, while generalizing across model backbones and external datasets.
Interactive clinical agents must gather decisive evidence and convert it into grounded actions under partial observability. A correct final diagnosis alone does not show that an agent respected evidence and care-process constraints. We introduce MediSkill-Evo, a clinical agent that evolves governed process knowledge without backbone fine-tuning. It separates experience into four typed banks for clinical skills, process rules, symbolic schemas, and measurement procedures. Provenance, support, replay, and controller-defined safety checks govern publication to a frozen test-time snapshot. A Process-Constrained Preference Harness binds evidence to its source, rejects controller-invalid candidates, and ranks actions with a safety-prioritized Clinical Process Critic. We evaluate complete agent systems across two backbone endpoints and six controlled stress dimensions under the same Doctor-turn limit. On 300 held-out Qwen encounters, MediSkill-Evo improves diagnosis accuracy from 61.33 percent to 69.00 percent and treatment-intent coverage from 33.62 percent to 66.44 percent, while reducing automatically scored critical failures from 31.00 percent to 16.33 percent relative to AgentClinic. On 180 hard-isolation conditions derived from 30 cases, target recovery reaches 93.61 percent under patient-behavior pressure, 100.00 percent for temporal evidence, and 92.22 percent for triage red flags. An exploratory 100-case MedSAM comparison evaluates request-gated tool-interface feasibility. These results provide descriptive end-to-end evidence for the complete system on fixed evaluation suites, not causal evidence for an individual bank or clinical validation of the automatic judge.
Clinical protocol-execution tasks -- checking a lab value, applying a threshold, placing a correctly structured FHIR order -- are natural candidates for RL from world feedback: once clinical SMEs encode decision logic into a verifier, that verifier grades unlimited rollouts without per-episode annotation. But applying RL requires a sound feedback channel and sufficient base capability. We audit MedAgentBench v1/v2, find a 41.7\% silent-finish ceiling that makes inaction the RL dominant strategy, and construct \textbf{MedAgentBench-v3 (MAB-v3)} (508 tasks, 8.9\% ceiling). Training Qwen3-8B exposes two structural barriers: a \emph{capability ceiling} (10/20 task types have 0\% base performance, zero gradient) and a \emph{format-knowledge barrier} (3/20 types require exact clinical codes undiscoverable by exploration). Pure RL reaches 18.2\% pass@1 vs.\ 34.1\% for rule-based SFT; the 15.9~pp gap is attributable entirely to these barriers. A decision/format-knowledge/lookup taxonomy predicts RL learnability and prescribes the fix: SFT to inject codes, RL to learn conditionals.
Computer-use agents could automate repetitive screen-based clinical work, but their reliability in medical graphical user interfaces remains largely unvalidated. Existing benchmarks focus on general web or desktop tasks and underrepresent medical software, which requires domain knowledge, exhibits markedly different UI design from mainstream applications, lacks public testing environments, and demands safety validation beyond task completion. We introduce MedCUA-Bench, an interactive benchmark for clinical computer-use agents. It covers 18 clinical scenarios across 10 medical domains, reconstructed from real product manuals and open-source medical systems to capture authentic clinical interfaces while avoiding licensing and privacy constraints. Each task ships with paired intent- and step-level goals to disentangle clinical reasoning from UI execution, and is evaluated by a deterministic checker over task completion and five clinical safety dimensions. Across 23 agents, the best closed-source model reaches 54.2% strict success, while all models remain below 9% on the real OpenEMR. Open-source agents average only 2.5%, with the best reaching 16.2%. MedCUA-Bench exposes the gap between current agents and reliable clinical software use, providing a reproducible testbed for future research.