Recent advances in Large Language Models (LLMs) have led to remarkable progresses in medical consultation.However, existing medical LLMs overlook the essential role of Electronic Health Records (EHR) and focus primarily on diagnosis recommendation, limiting their clinical applicability. We propose DiaLLM, the first medical LLM that integrates heterogeneous EHR data into clinically grounded dialogues, enabling clinical test recommendation, result interpretation, and diagnosis prediction to better align with real-world medical practice. To construct clinically grounded dialogues from EHR, we design a Clinical Test Reference (CTR) strategy that maps each clinical code to its corresponding description and classifies test results as “normal” or “abnormal”. Additionally, DiaLLM employs a reinforcement learning framework for evidence acquisition and automated diagnosis. To handle the large action space, we introduce a reject sampling strategy to reduce redundancy and improve exploration efficiency. Furthermore, a confirmation reward and a class-sensitive diagnosis reward are designed to guide accurate diagnosis prediction.Extensive experimental results demonstrate that DiaLLM outperforms baselines in clinical test recommendation and diagnosis prediction. Our code is available at Github.

This paper introduces a novel generalized self-imitation learning GSIL framework, which effectively and efficiently aligns large language models with offline demonstration data. We develop GSIL by deriving a surrogate objective of imitation learning with density ratio estimates, facilitating the use of self-generated data and optimizing the imitation learning objective with simple classification losses. GSIL eliminates the need for complex adversarial training in standard imitation learning, achieving lightweight and efficient fine-tuning for large language models. In addition, GSIL encompasses a family of offline losses parameterized by a general class of convex functions for density ratio estimation and enables a unified view for alignment with demonstration data. Extensive experiments show that GSIL consistently and significantly outperforms baselines in many challenging benchmarks, such as coding (HuamnEval), mathematical reasoning (GSM8K) and instruction-following benchmark (MT-Bench). Code is public available at https://github.com/tengxiao1/GSIL.