A dual-view approach that connects clinical practice with computational methods is presented, establishing a five-level competency scheme following Miller’s Pyramid and linking deductive, inductive, and abductive reasoning patterns to common medical goals and tasks.
Abstract
Large language models (LLMs) have emerged as important tools in healthcare, showing growing potential for clinical reasoning and patient care. This survey examines recent progress in medical LLMs, focusing on reasoning applications and requirements. We present a dual-view approach that connects clinical practice with computational methods. On the clinical side, we establish a five-level competency scheme following Miller’s Pyramid, progressing from knowledge recall to dynamic case management. On the computational side, we link deductive, inductive, and abductive reasoning patterns to common medical goals and tasks. We also introduce a benchmark dataset spanning five levels of medical reasoning capability and report results on 18 state-of-the-art models, revealing that medical specialist models excel in diagnosis-centric tasks while general models lead in decision support and dialogue. We conclude by discussing current progress and open challenges, including data limitations, hallucination, and grounding issues, and outline directions toward safer, more reliable, and more workflow-ready systems.
This review provides a structured overview of recent progress in Med-LLMs by examining their major application areas, key challenges, and emerging future directions.
Yuyang Sha, Li Yu, Zejia Lin et al.· Military Medical Research· 0 citations
This entry-level tutorial aims to equip healthcare professionals with the tools necessary to effectively integrate LLMs into clinical practice, ensuring that these powerful technologies are applied in a safe, reliable, and impactful manner.
Qiao Jin, Nicholas Wan, Robert Leaman et al.· Nature Protocols· 1 citation
Uncommon and off-guideline cases are difficult for clinical decision support, because physicians must make a series of management decisions under diagnostic uncertainty and rarely see the full case at once. Most large language model (LLM) benchmarks for medicine score only the final diagnosis, yet much of clinical care turns on the next appropriate action: the next test to order, the imaging study to obtain, the specialist to involve, or the differential to pursue. We introduce MedUPSQA, a dataset of 21,874 mid-stream clinical decision points built from 5,535 real case reports, and MedUPS, an alignment framework that supervises models on these intermediate decisions as they unfold along a patient's trajectory. We segment free-text case presentations into chronologically ordered, accumulating clinical chunks and align models to predict the next step with reinforcement learning (GRPO), using an external LLM-as-a-Judge reward. This objective mirrors how clinicians actually meet patients, reasoning forward from accumulating evidence toward the next decision, rather than committing to a final label. Across three backbones, mid-stream alignment raises next-step accuracy from 55.2 to 66.7 for Qwen3.6-27B, from 47.2 to 57.8 for Qwen3.5-9B, and from 37.8 to 44.4 for HuatuoGPT-3-8B, with 95% CI. In several model scales we test the objective improves accuracy more than scale, with smaller models surpassing larger, frontier models we evaluate. We further train supervised fine-tuning (SFT) baselines on the mid-stream task, SFT improves all backbones above base, indicating the target framwork carries signal independently of the optimizer. We release the dataset, code, and aligned checkpoints.
Ofir Ben Shoham, O. Perets, Nir Grinberg et al.· 0 citations
A scoping review of 24 PubMed-indexed studies published between 2023 and 2026 was conducted to assess current applications, benefits, limitations, and future directions of LLMs in healthcare.
Antoni Klamka, Paulina Kawalec, Kamil Bronikowski et al.· Quality in Sport· 0 citations
IMCBench is introduced, an image-grounded, multi-turn medical conversation benchmark that pairs real, publicly available clinical images with synthetic patient profiles to simulate realistic patient-clinician interactions and demonstrates that accurate clinical description does not guarantee safe patient guidance, motivating the need for multi-dimensional evaluation frameworks in medical AI.
Maria Xenochristou, Ashutosh Joshi, Korosh Vatanparvar et al.· arXiv.org· 0 citations
Medical Question Answering (MQA) has emerged as a critical artificial intelligence (AI) capability for supporting clinicians, researchers, and the general public with timely and evidence-based responses to medical queries. Recent advances in natural language processing (NLP), computer vision, and large language models (LLMs) have expanded MQA from text-only systems to multimodal frameworks. This survey aims to provide a comprehensive and structured review of MQA systems, covering both text and image-based approaches. We present a systematic review of MQA literature, including applications, datasets, and modeling paradigms. We introduce a unified taxonomy categorizing MQA systems into scientific, clinical, consumer, and examination-oriented tasks. We also analyze representative datasets for text-based and vision-based question answering, focusing on data sources, annotation strategies, task formulations, and evaluation protocols. Furthermore, we review methodological developments ranging from classical and transformer-based models to multimodal vision-language systems and LLM-driven approaches. The analysis highlights a rapid evolution of MQA systems toward multimodal and LLM-based frameworks, particularly in medical visual question answering. Existing datasets and models demonstrate strong progress but also reveal limitations in generalization, reasoning, and real-world clinical applicability. Key challenges remain, including reliability, hallucination, explainability, fairness, and clinical safety. This survey identifies open research directions such as improved data quality, knowledge-grounded reasoning, trustworthy evaluation, and real-world deployment. The study provides a comprehensive reference and roadmap for developing reliable and clinically applicable MQA systems.
Eya Mhedhbi, Xiang Zhu, Muhammad Ayaz et al.· Computer Methods and Program...· 0 citations