# Guiding Clinical Reasoning with Large Language Models via Knowledge Seeds

arXiv: https://arxiv.org/abs/2403.06609 · HTML: https://mlsanity.com/paper/2403.06609/

## Key facts

- Cited by 19 papers in the map (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 24 of its 44 references that are in the map.
- First posted on arXiv 11 Mar 2024.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)

## Builds on (most cited first, 24 of 24)

- [LLaMA: Open and Efficient Foundation Language Models](https://mlsanity.com/paper/2302.13971/) (2023)
- [RoBERTa: A Robustly Optimized BERT Pretraining Approach](https://mlsanity.com/paper/1907.11692/) (2019)
- [Chain-of-Thought Prompting Elicits Reasoning in Large Language Models](https://mlsanity.com/paper/2201.11903/) (2022)
- [ReAct: Synergizing Reasoning and Acting in Language Models](https://mlsanity.com/paper/2210.03629/) (2022)
- [BART: Denoising Sequence-to-Sequence Pre-training for Natural Language Generation, Translation, and Comprehension](https://mlsanity.com/paper/1910.13461/) (2019)
- [Self-Consistency Improves Chain of Thought Reasoning in Language Models](https://mlsanity.com/paper/2203.11171/) (2022)
- [Large Language Models are Zero-Shot Reasoners](https://mlsanity.com/paper/2205.11916/) (2022)
- [Tree of Thoughts: Deliberate Problem Solving with Large Language Models](https://mlsanity.com/paper/2305.10601/) (2023)
- [A Survey of Large Language Models](https://mlsanity.com/paper/2303.18223/) (2023)
- [GLM: General Language Model Pretraining with Autoregressive Blank Infilling](https://mlsanity.com/paper/2103.10360/) (2021)
- [Graph of Thoughts: Solving Elaborate Problems with Large Language Models](https://mlsanity.com/paper/2308.09687/) (2023)
- [Baichuan 2: Open Large-scale Language Models](https://mlsanity.com/paper/2309.10305/) (2023)
- [Capabilities of GPT-4 on Medical Challenge Problems](https://mlsanity.com/paper/2303.13375/) (2023)
- [Towards Generalist Biomedical AI](https://mlsanity.com/paper/2307.14334/) (2023)
- [MedAlpaca -- An Open-Source Collection of Medical Conversational AI Models and Training Data](https://mlsanity.com/paper/2304.08247/) (2023)
- [Large Language Models are Few-Shot Clinical Information Extractors](https://mlsanity.com/paper/2205.12689/) (2022)
- [Can large language models reason about medical questions?](https://mlsanity.com/paper/2207.08143/) (2022)
- [HuaTuo: Tuning LLaMA Model with Chinese Medical Knowledge](https://mlsanity.com/paper/2304.06975/) (2023)
- [ChatCAD: Interactive Computer-Aided Diagnosis on Medical Image using Large Language Models](https://mlsanity.com/paper/2302.07257/) (2023)
- [ChatGPT Makes Medicine Easy to Swallow: An Exploratory Case Study on Simplified Radiology Reports](https://mlsanity.com/paper/2212.14882/) (2022)
- [Benchmarking Large Language Models on CMExam -- A Comprehensive Chinese Medical Exam Dataset](https://mlsanity.com/paper/2306.03030/) (2023)
- [Translating Radiology Reports into Plain Language using ChatGPT and GPT-4 with Prompt Learning: Promising Results, Limitations, and Potential](https://mlsanity.com/paper/2303.09038/) (2023)
- [Leveraging Medical Knowledge Graphs Into Large Language Models for Diagnosis Prediction: Design and Application Study](https://mlsanity.com/paper/2308.14321/) (2023)
- [Healthcare NER Models Using Language Model Pretraining](https://mlsanity.com/paper/1910.11241/) (2019)

## Built on by (most cited first, 19 of 19)

- [A Survey on Medical Large Language Models: Technology, Application, Trustworthiness, and Future Directions](https://mlsanity.com/paper/2406.03712/) (2024)
- [medIKAL: Integrating Knowledge Graphs as Assistants of LLMs for Enhanced Clinical Diagnosis on EMRs](https://mlsanity.com/paper/2406.14326/) (2024)
- [Probabilistic Medical Predictions of Large Language Models](https://mlsanity.com/paper/2408.11316/) (2024)
- [BRIDGE: Benchmarking Large Language Models for Understanding Real-world Clinical Practice Text](https://mlsanity.com/paper/2504.19467/) (2025)
- [KERAP: A Knowledge-Enhanced Reasoning Approach for Accurate Zero-shot Diagnosis Prediction Using Multi-agent LLMs](https://mlsanity.com/paper/2507.02773/) (2025)
- [MedGUIDE: Benchmarking Clinical Decision-Making in Large Language Models](https://mlsanity.com/paper/2505.11613/) (2025)
- [Why Chain of Thought Fails in Clinical Text Understanding](https://mlsanity.com/paper/2509.21933/) (2025)
- [MedEthicsQA: A Comprehensive Question Answering Benchmark for Medical Ethics Evaluation of LLMs](https://mlsanity.com/paper/2506.22808/) (2025)
- [MedKGent: A Large Language Model Agent Framework for Constructing Temporally Evolving Medical Knowledge Graph](https://mlsanity.com/paper/2508.12393/) (2025)
- [Prompting Large Language Models for Supporting the Differential Diagnosis of Anemia](https://mlsanity.com/paper/2409.15377/) (2024)
- [Deep Learning for Ophthalmology: The State-of-the-Art and Future Trends](https://mlsanity.com/paper/2501.04073/) (2025)
- [Scalable Medication Extraction and Discontinuation Identification from Electronic Health Records Using Large Language Models](https://mlsanity.com/paper/2506.11137/) (2025)
- [MedCoAct: Confidence-Aware Multi-Agent Collaboration for Complete Clinical Decision](https://mlsanity.com/paper/2510.10461/) (2025)
- [coTherapist: A Behavior-Aligned Small Language Model to Support Mental Healthcare Experts](https://mlsanity.com/paper/2601.10246/) (2026)
- [ICA-RAG: Information Completeness Guided Adaptive Retrieval-Augmented Generation for Disease Diagnosis](https://mlsanity.com/paper/2502.14614/) (2025)
- [MedOrchestra: A Hybrid Cloud-Local LLM Approach for Clinical Data Interpretation](https://mlsanity.com/paper/2505.23806/) (2025)
- [Enhancing Trustworthy Clinical Diagnosis Decision-Making in Large Language Models via Etiology-Aware Attention Supervision](https://mlsanity.com/paper/2508.00285/) (2025)
- [CAREAgent: Clinical Agent with Structured Reasoning and Tool-Integrated for Order Generation](https://mlsanity.com/paper/2606.01094/) (2026)
- [ASCRIBE: Atomic and Significance-Based Reasoning for Thai Clinical SOAP Note Generation](https://mlsanity.com/paper/2610.01234/) (2026)

## Abstract (arXiv)

Clinical reasoning refers to the cognitive process that physicians employ in evaluating and managing patients. This process typically involves suggesting necessary examinations, diagnosing patients' diseases, and deciding on appropriate therapies, etc. Accurate clinical reasoning requires extensive medical knowledge and rich clinical experience, setting a high bar for physicians. This is particularly challenging in developing countries due to the overwhelming number of patients and limited physician resources, contributing significantly to global health inequity and necessitating automated clinical reasoning approaches. Recently, the emergence of large language models (LLMs) such as ChatGPT and GPT-4 have demonstrated their potential in clinical reasoning. However, these LLMs are prone to hallucination problems, and the reasoning process of LLMs may not align with the clinical decision path of physicians. In this study, we introduce a novel framework, In-Context Padding (ICP), designed to enhance LLMs with medical knowledge. Specifically, we infer critical clinical reasoning elements (referred to as knowledge seeds) and use these as anchors to guide the generation process of LLMs. Experiments on two clinical question datasets demonstrate that ICP significantly improves the clinical reasoning ability of LLMs.