Trajectory Inspection: A Method for Iterative Clinician-Driven Design of Reinforcement Learning Studies.

View Abstract

Reinforcement learning (RL) has the potential to significantly improve clinical decision making. However, treatment policies learned via RL from observational data are sensitive to subtle choices in study design. We highlight a simple approach, trajectory inspection, to bring clinicians into an iterative design process for model-based RL studies. We identify where the model recommends unexpectedly aggressive treatments or expects surprisingly positive outcomes from its recommendations. Then, we examine clinical trajectories simulated with the learned model and policy alongside the actual hospital course. Applying this approach to recent work on RL for sepsis management, we uncover a model bias towards discharge, a preference for high vasopressor doses that may be linked to small sample sizes, and clinically implausible expectations of discharge without weaning off vasopressors. We hope that iterations of detecting and addressing the issues unearthed by our method will result in RL policies that inspire more confidence in deployment.

Investigators
Abbreviation
AMIA Annu Symp Proc
Publication Date
2021-05-17
Volume
2021
Page Numbers
305-314
Pubmed ID
34457145
Medium
Electronic-eCollection
Full Title
Trajectory Inspection: A Method for Iterative Clinician-Driven Design of Reinforcement Learning Studies.
Authors
Ji CX, Oberst M, Kanjilal S, Sontag D