Clinical Reasoning

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Clinical reasoning asks how systems can turn symptoms, records, test results, and images into diagnoses and care decisions while handling uncertainty and missing information. Current methods include retrieval from guidelines and knowledge graphs, Bayesian or symbolic reasoning, structured prompting and reinforcement learning, and agents that ask follow-up questions or coordinate specialist perspectives. Work increasingly evaluates multi-turn consultations, longitudinal EHR tasks, and multimodal cases, measuring evidence use, calibration, safety, and decision quality alongside diagnostic accuracy. A central tension is that strong exam or static-case performance does not reliably translate to consistent, evidence-grounded decisions in interactive clinical settings, making prospective validation and trustworthy process evaluation important open challenges.

Latest papers

184 papers19 papers in the last four weeks, up 6% on the four weeks before. 0.1% of all new papers.

Agentic LLM reasoning in pediatric diabetes outcome prediction from multimodal medical records
Oct 29, 2026Daniel Palacios, Guantong Qi, Anna Kadi +8Clinical Outcome Prediction Agentic Reasoning
Quantitative and Computational Biosciences, Baylor College of Medicine, Houston, Texas, USA · Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA · Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, Texas, USA +8
Latent Decision Flow Rewards for Clinical Guideline Reasoning
Oct 28, 2026Gaurav Bhatt, Marinka ZitnikRL for Language Model Reasoning Clinical Reasoning
Harvard University
TCM-DiagCommit: A TCM-SD-Derived Benchmark for Evidence-Conditioned Syndrome Selection and Commitment
Oct 27, 2026Erwei Hou, Yue HuClinical Language Model Evaluation Clinical Decision-Making
Beijing University of Posts and Telecommunications, Beijing, China
Ontology-guided multi-agent reasoning for explainable differential diagnosis
Oct 26, 2026Roxana Ramona Szomiu, George Ursu, Adrian GrozaDifferential Diagnosis Clinical Reasoning
Patient-specific rubric-based evaluation of large language models across longitudinal cancer care
Oct 26, 2026Wei-Wei Zhang, Pengkai Wang, Yan Li +13Clinical Language Model Evaluation Medical LLMs
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China. · Department of Computing, The Hong Kong Polytechnic University, Hong Kong, China. · Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China. +2
Beyond Federated Learning: Decentralized Agentic Systems for Self-Evolving Clinical Intelligence
Oct 26, 2026Haoyuan Li, Mathias Funk, Aaqib SaeedMulti-Agent Systems Clinical Reasoning
Eindhoven University of Technology, Eindhoven, The Netherlands.
CasePlay: Self-Play Reinforcement Learning from Case Reports for Medical Reasoning
Oct 18, 2026Hao Wang, Zihan Wang, Kai Wu +6Self-Play RL RL for Language Model Reasoning
City University of Hong Kong · Northeastern University · Tongji University +2
EGIP: An Evidence-Grounded Interaction Protocol for Clinical Agents
Oct 17, 2026Zecheng Ren, Ruichen Cong, Yi Min Chen +8Evidence-Grounded Reasoning Clinical Decision-Making
Waseda University, Tokorozawa, Japan · Shanghai Jiao Tong University, Shanghai, China
AI Consilium: a Benchmark of LLM Clinical Multidisciplinary Second Opinions
Oct 15, 2026Alexey A. Bokov, Ivan I. Panin, Nikolay B. Nechaev +10Clinical Language Model Evaluation Clinical Decision Support
AIRI, Moscow, Russian Federation · Northern State Medical University, Arkhangelsk, Russian Federation · Arkhangelsk Clinical Oncological Dispensary, Arkhangelsk, Russian Federation +5
From Hindsight to Foresight: Dissecting Clinical Evidence Acquisition in Large Language Models
Oct 13, 2026Ziyang LingMedical LLMs Clinical Language Model Evaluation
School of Biomedical Engineering, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
Output Discipline Sets the Floor: A Falsification-Guided, Model-Agnostic Agent Protocol for Auditable Hypothesis-Driven Decision Making
Oct 13, 2026Jing Liu, Yongxing Qi, Ping Yao +1LLM Decision-Making Structured Output Generation
Hangzhou Innovation Institute, Beihang University, Hangzhou, China · Unit, Beijing, China
ClinEdge: An Expert-Graded Benchmark of Real Patient Edge Cases Where Frontier Multimodal Models Fail
Oct 11, 2026Anurag Sharma, Aditya Sharma, Sapna BaalwanMultimodal Model Evaluation Medical Image Benchmarks
Orthopaedic Surgeon · FutrBridge · Independent Researcher
Coverage-Aware Reasoning with Medical Tokens for Diagnosis Prediction
Oct 7, 2026Kaisong Zhang, Haotian Fang, Junmeng Zhou +3Medical LLMs Clinical Prediction
Fuzhou University · Shanghai Jiao Tong University · Beihang University
PsyCIDRA: A Dual-Agent Framework for Psychiatric Interviewing and Diagnostic Reasoning
Oct 5, 2026Milad Mohammadi, Fatemeh Akrami Shamsabadi, Zahra Mohseni +4LLM Agents Clinical Reasoning
School of Electrical and Computer Engineering, University of Tehran · Faculty of Psychology and Educational Sciences, University of Tehran · School of Medicine, Yazd (Shahid Sadoghi) University of Medical Sciences
TrustMed-RL: Long-Horizon Reinforcement Learning for Evidence-Grounded Clinical Diagnosis
Oct 3, 2026Wenxin Zhan, Yizheng Jiao, Haifeng Song +4Medical Diagnosis Clinical Decision-Making
Department of Information Systems and Statistics, Baruch College · Department of Computer Science, University of North Carolina at Chapel Hill · Tsinghua University +2
TCMClinicalReason-Bench: Can Language Models Reason from Pathogenesis to Prescription over Real-World Clinical Cases?
Oct 3, 2026Jirui Dai, Chenkai Zhang, Yan Jia +4Traditional Chinese Medicine Clinical Language Model Evaluation
the Department of Computer Science, Johns Hopkins University, Baltimore, USA · the School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China · the School of Information Engineering, Huzhou University, Huzhou, China +3
A rubric landscape for evaluating clinical reasoning in large language models: what exists, what is missing, and what needs to be combined
Oct 1, 2026Zhangshu Joshua Jiang, Zina Ibrahim, James T. TeoFaithfulness of Language Model Explanations Temporal Reasoning in Language Models
DRIVE-Health CDT Department of Biostatistics and Health Informatics Institute of Psychiatry, Psychology and Neuroscience King’s College London London, UK · Cleveland Clinic London London, UK
ASCRIBE: Atomic and Significance-Based Reasoning for Thai Clinical SOAP Note Generation
Oct 1, 2026Tarm Kalavantavanich, Teerawut Ponarchar, Pattaramanee Arsomngern +5Medical Report Generation Clinical Reasoning
Looloo Health, Thailand · Kasetsart University, Thailand · Mahidol University, Thailand
Can LLMs Reason Over Long Horizons? An Empirical Evaluation of Context Strategies for Longitudinal Clinical Reasoning
Sep 30, 2026Taye Akinrele, Noorbakhsh Amiri Golilarz, Subash Neupane +2Long-Context Language Model Evaluation Clinical Reasoning
Department of Computer Science, The University of Alabama
EHR-RobustGym: Benchmarking and Training Agents for Robust Clinical Reasoning
Sep 30, 2026Yitong Qiao, Yancheng Jin, Lei Liu +4Evidence-Grounded Reasoning AI Agent Benchmarks
Zhejiang University · Ant Healthcare, Ant Group
From Image Interpretation to Clinical Reasoning: Upstream Physician-Context-Aware Multimodal Learning with Causal Reinforcement Learning
Sep 30, 2026Jialu Pi, Yanan Ma, Weijie Chen +8Clinical Outcome Prediction Multimodal Reasoning
Dept. of Radiology, Mayo Clinic, Phoenix, AZ, USA · School of Computing and Augmented Intelligence, Arizona State University, Tempe, USA · Dept. of Radiology, Mayo Clinic, Phoenix, USA +2
KlinikeBench: Evaluating Language Models Beyond Diagnostic Accuracy
Sep 29, 2026Xueting Fang, Zehui Li, Yang Yang +5Clinical Decision-Making Multi-Turn Dialogue Evaluation
Zhejiang University · Imperial College London · Nanchang University +2
A Proposed Rubric for Evaluating Expressed Clinical Reasoning in Large Language Model Responses
Sep 29, 2026Zhangshu Joshua Jiang, Zina Ibrahim, James T. TeoClinical Reasoning Rubric-Based Evaluation
DRIVE-Health CDT Department of Biostatistics and Health Informatics Institute of Psychiatry, Psychology and Neuroscience King’s College London, London, UK · Neurological Institute, Cleveland Clinic London, London, UK · King’s College London, London, UK +1
CLIMB: A Clinical Multimorbidity Benchmark for Diagnosing Co-occurring Conditions through Multiturn Conversations
Sep 28, 2026Yusuf Kesmen, Aniruddha Mukherjee, Yena Chang +7Medical Diagnosis Multi-Turn Dialogue Evaluation
EPFL · Aarhus University
Training-Free Clinical Reasoning through Medical Ontologies and Cognitive Mapping: A Symbolic-Probabilistic Knowledge Graph Framework
Sep 28, 2026Surajit DasSymbolic Reasoning Clinical Reasoning
Jev in Medicine: A Benchmark Evaluation
Sep 27, 2026Alfredo Madrid-García, Beatriz Merino-BarbanchoMedical QA Clinical Reasoning
Independent researcher, Madrid, Spain
An auditable conditional-strategy framework for open-ended decision-making in complex lung cancer
Sep 24, 2026Daoyun Wang, Zhicheng Huang, Huaiyuan Sun +39Clinical Decision Support Clinical Decision-Making
PCQC: Privileged Counterfactual Question Credit for Multi-Turn Medical Dialogue
Sep 23, 2026Chenxuan Li, Jiayi Wan, Xinrong Chen +3Clinical Reasoning Medical LLMs
Peking University, Beijing, China · Department of Medical Bioinformatics, School of Basic Medical Sciences, Peking University, Beijing, China
Syndrome, Synergy, and Safety: Structured Reasoning and Knowledge-Driven Alignment for TCM Prescription Generation
Sep 22, 2026Zheng Chen, ZhiCheng Du, Haoxuan Li +1LLM Safety Alignment CoT Reasoning
Tsinghua University · Guangdong Provincial Laboratory of Traditional Chinese Medicine Hengqin
Fathom-Vaidya: Advancing Medical Reasoning with Rubric-Based Rewards
Sep 21, 2026Kalash Shah, Kunal Singh, Snehan J +1RL for Language Model Reasoning Rubric-Based RL
Fractal AI Research

Oct 29, 2026J/K move · Enter open · S save

Agentic LLM reasoning in pediatric diabetes outcome prediction from multimodal medical records

Daniel Palacios, Guantong Qi, Anna Kadi, Natali Borrego+7

Quantitative and Computational Biosciences, Baylor College of Medicine, Houston, Texas, USA · Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA · Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, Texas, USA+8

Clinical Outcome Prediction Agentic Reasoning Clinical Reasoning Longitudinal EHR Modeling

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Large language model (LLM) agents are proposed for clinical prediction but are untested in pediatrics, where cohorts are small and outcomes are uncommon. Using records from 2,489 youth with type 2 diabetes (T2D) and 4,018 with type 1 diabetes (T1D), spanning structured data, note-derived social determinants and, in T1D, continuous glucose monitoring data, we predicted seven T2D outcomes, four also in T1D, at 24 months from 18 months of follow-up. CEDAR (Clinical Evidence-Driven Agent for Risk-prediction), an evidence-citing, self-auditing LLM pipeline, outperformed trained machine learning in both cohorts (pooled area under the receiver operating characteristic curve 0.815 versus 0.656 to 0.700 in T2D and 0.756 versus 0.603 to 0.631 in T1D), most on the sparsely screened outcomes. Only 4 of 70,246 values it cited did not match the chart. Reading only the evidence and reasoning cited by CEDAR, two pediatric endocrinologists reached the same prediction as CEDAR in about nine of ten cases, agreeing with each other on 90.5%.