TARSE: Test-Time Adaptation via Retrieval of Skills and Experience for Reasoning Agents

TL;DR

This paper introduces TARSE, a method that improves clinical question answering by retrieving relevant skills and experiences and performing test-time adaptation to enhance reasoning accuracy.

Contribution

It presents a novel framework that explicitly retrieves and aligns clinical skills and experiences at test time for better reasoning in medical agents.

Findings

Consistent performance improvements over baseline methods.

Effective retrieval of relevant skills and experiences.

Enhanced reasoning accuracy in medical question answering.

Abstract

Complex clinical decision making often fails not because a model lacks facts, but because it cannot reliably select and apply the right procedural knowledge and the right prior example at the right reasoning step. We frame clinical question answering as an agent problem with two explicit, retrievable resources: skills, reusable clinical procedures such as guidelines, protocols, and pharmacologic mechanisms; and experience, verified reasoning trajectories from previously solved cases (e.g., chain-of-thought solutions and their step-level decompositions). At test time, the agent retrieves both relevant skills and experiences from curated libraries and performs lightweight test-time adaptation to align the language model's intermediate reasoning with clinically valid logic. Concretely, we build (i) a skills library from guideline-style documents organized as executable decision rules, (ii) an experience library of exemplar clinical reasoning chains indexed by step-level transitions, and (iii) a step-aware retriever that selects the most useful skill and experience items for the current case. We then adapt the model on the retrieved items to reduce instance-step misalignment and to prevent reasoning from drifting toward unsupported shortcuts. Experiments on medical question-answering benchmarks show consistent gains over strong medical RAG baselines and prompting-only reasoning methods. Our results suggest that explicitly separating and retrieving clinical skills and experience, and then aligning the model at test time, is a practical approach to more reliable medical agents.