Daily Papers

Clinical dialogue represents a complex duality requiring both the empathetic fluency of natural conversation and the rigorous precision of evidence-based medicine. While Large Language Models possess unprecedented linguistic capabilities, their architectural reliance on reactive and stateless processing often favors probabilistic plausibility over factual veracity. This structural limitation has catalyzed a paradigm shift in medical AI from generative text prediction to agentic autonomy, where the model functions as a central reasoning engine capable of deliberate planning and persistent memory. Moving beyond existing reviews that primarily catalog downstream applications, this survey provides a first-principles analysis of the cognitive architecture underpinning this shift. We introduce a novel taxonomy structured along the orthogonal axes of knowledge source and agency objective to delineate the provenance of clinical knowledge against the system's operational scope. This framework facilitates a systematic analysis of the intrinsic trade-offs between creativity and reliability by categorizing methods into four archetypes: Latent Space Clinicians, Emergent Planners, Grounded Synthesizers, and Verifiable Workflow Automators. For each paradigm, we deconstruct the technical realization across the entire cognitive pipeline, encompassing strategic planning, memory management, action execution, collaboration, and evolution to reveal how distinct architectural choices balance the tension between autonomy and safety.

Adaptive optimizers such as Adam (Kingma & Ba, 2015) have been central to the success of large language models. However, they often require to maintain optimizer states throughout training, which can result in memory requirements several times greater than the model footprint. This overhead imposes constraints on scalability and computational efficiency. Stochastic Gradient Descent (SGD), in contrast, is a stateless optimizer, as it does not track state variables during training. Consequently, it achieves optimal memory efficiency. However, its capability in LLM training is limited (Zhao et al., 2024b). In this work, we show that pre-processing SGD in a stateless manner can achieve the same performance as the Adam optimizer for LLM training, while drastically reducing the memory cost. Specifically, we propose to pre-process the instantaneous stochastic gradients using normalization and whitening. We show that normalization stabilizes gradient distributions, and whitening counteracts the local curvature of the loss landscape. This results in SWAN (SGD with Whitening And Normalization), a stochastic optimizer that eliminates the need to store any optimizer states. Empirically, SWAN has the same memory footprint as SGD, achieving approx 50% reduction on total end-to-end memory compared to Adam. In language modeling tasks, SWAN demonstrates comparable or even better performance than Adam: when pre-training the LLaMA model with 350M and 1.3B parameters, SWAN achieves a 2x speedup by reaching the same evaluation perplexity using half as many tokens.

The Transformer architecture has become the de facto standard for Large Language Models (LLMs), demonstrating remarkable capabilities in language understanding and generation. However, its application in conversational AI is fundamentally constrained by its stateless nature and the quadratic computational complexity (O(L^2)) with respect to sequence length L. Current models emulate memory by reprocessing an ever-expanding conversation history with each turn, leading to prohibitive costs and latency in long dialogues. This paper introduces the Reactive Transformer (RxT), a novel architecture designed to overcome these limitations by shifting from a data-driven to an event-driven paradigm. RxT processes each conversational turn as a discrete event in real-time, maintaining context in an integrated, fixed-size Short-Term Memory (STM) system. The architecture features a distinct operational cycle where a generator-decoder produces a response based on the current query and the previous memory state, after which a memory-encoder and a dedicated Memory Attention network asynchronously update the STM with a representation of the complete interaction. This design fundamentally alters the scaling dynamics, reducing the total user-facing cost of a conversation from quadratic (O(N^2 cdot T)) to linear (O(N cdot T)) with respect to the number of interactions N. By decoupling response generation from memory updates, RxT achieves low latency, enabling truly real-time, stateful, and economically viable long-form conversations. We validated our architecture with a series of proof-of-concept experiments on synthetic data, demonstrating superior performance and constant-time inference latency compared to a baseline stateless model of comparable size.