Title:LLM-Guided Evolution for Medical Decision Pipelines

Abstract:Adapting large language models (LLMs) to clinical workflows often requires costly fine-tuning or manual prompt and pipeline engineering. We study LLM-guided MAP-Elites evolution as an inference-time alternative for discovering medical decision strategies and provide an implementation repository at this https URL. We formulate urgency triage, interactive consultation, and medical image classification as evolutionary searches over executable artifacts optimized by task-specific fitness functions.
Across all three settings, evolution improves over manually designed baselines under practical constraints. In triage, evolved programs increase Semigran accuracy from $77.3\%$ to $87.1\%$ and emergency recall from $0.60$ to $0.97$, while improving safety-weighted held-out MIMIC-ESI performance. In interactive consultation, evolved policies improve the accuracy--cost frontier across Llama-3, Qwen-3.5, and Gemma-4 and transfer to held-out iCRAFTMD. In PneumoniaMNIST, prompt-only evolution improves frozen MedGemma VLMs while preserving strict JSON outputs. Qualitative analysis shows that the gains come from interpretable program-level mechanisms, calibrated triage boundaries, targeted evidence acquisition, selective commitment, and finding-oriented visual decision rules, rather than superficial prompt rewording alone.

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