TRACE: Deployable Tree-Relational Structure Enhancement for Oncology LLMs

Large language models (LLMs) perform well across many real-world tasks but remain prone to hallucination, limiting their reliability in domains such as biomedicine and healthcare, where answers must be grounded in established knowledge. Retrieval-augmented generation (RAG) mitigates this problem by incorporating external information, but often overlooks logical relationships and relies heavily on the LLM's own reasoning, which can compromise answer faithfulness. We propose OA-RAG, an agent that integrates formal reasoning with LLM reasoning, drawing on both the logical structure and informal annotations of domain ontologies. For each answer, OA-RAG reports the ontology observations used as evidence and a model-assessed grounding level (entailed, supported, related, or unrelated) that characterises the strength of that evidence. Across benchmarks derived from three large-scale ontologies and six real-world medical question-answering tasks, OA-RAG achieves the best overall performance among the evaluated ontology-fine-tuned and popular RAG methods, with particularly strong results on reasoning-intensive tasks. The reported grounding levels also offer a useful indication of answer reliability, with stronger grounding generally associated with higher accuracy. Finally, our results demonstrate the value of ontologies as knowledge sources: OA-RAG is competitive with, and sometimes outperforms, domain-specific RAG systems that draw on sources such as textbooks.

In medical multiple-choice question answering (MCQA), Retrieval-Augmented Generation (RAG) can supplement the domain knowledge of language models (LMs). However, since vanilla RAG indiscriminately utilizes retrieved documents, it can degrade LM performance. To address this, we propose MedJudgeRAG. Our framework represents retrieved documents as a dynamic knowledge graph (KG) composed of entities and relations. For each option, the model judges an evidence verdict from the retrieved documents and the KG. Based on the verdict combination, the model determines a knowledge utilization strategy to reason toward the final answer. These capabilities are trained via supervised fine-tuning using structured reasoning traces generated by a teacher LM. The training employs a weighted cross-entropy loss that differentially weights the KG and reasoning segments. Experiments on two medical MCQA benchmarks demonstrate that MedJudgeRAG consistently outperforms both vanilla RAG and parametric baselines. Furthermore, ablation analysis reveals that the dynamic KG is more effective as graph-conditioned supervision at training time than as an explicit output at inference time. Our code is available at https://github.com/hyu-amllab/medjudgerag, and the generated reasoning traces are released at https://huggingface.co/datasets/youarethewon/medjudgerag.

Across medical specialties, clinical practice is anchored in evidence-based guidelines that codify best studied diagnostic and treatment pathways. These pathways routinely fall short for the long tail of real-world care not covered by guidelines. Most medical large language models (LLMs), however, are trained to encode common, guideline-focused medical knowledge in their parameters. Current evaluations test models primarily on recalling and reasoning with this memorized content, often in multiple-choice settings. Given the fundamental importance of evidence-based reasoning in medicine, it is neither feasible nor reliable to depend on memorization in practice. To address this gap, we introduce OGCaReBench, a free-form retrieval-focused benchmark aimed at evaluating LLMs at answering clinical questions that require going beyond typical guidelines. Extracted from published medical case reports and validated by medical experts, OGCaReBench contains long-form clinical questions requiring free-text answers, providing a systematic framework for assessing open-ended medical reasoning in rare, case-based scenarios. Our experiments reveal that even the best-performing baseline (GPT-5.2) correctly answers only 56% of our benchmark with specialized models only reaching 42%. Augmenting models with retrieved medical articles improves this performance to up to 82% (using GPT-5.2) highlighting the importance of evidence-grounding for real-world medical reasoning tasks. This work thus establishes a foundation for benchmarking and advancing both general-purpose and medical LLMs to produce reliable answers in challenging clinical contexts.