Small Language Models Learn Enhanced Reasoning Skills from Medical Textbooks
On the map: LLM reasoning → Clinical and biomedical applications
Abstract (arXiv)
While recent advancements in commercial large language models (LM) have shown promising results in medical tasks, their closed-source nature poses significant privacy and security concerns, hindering their widespread use in the medical field. Despite efforts to create open-source models, their limited parameters often result in insufficient multi-step reasoning capabilities required for solving complex medical problems. To address this, we introduce Meerkat, a new family of medical AI systems ranging from 7 to 70 billion parameters. The models were trained using our new synthetic dataset consisting of high-quality chain-of-thought reasoning paths sourced from 18 medical textbooks, along with diverse instruction-following datasets. Our systems achieved remarkable accuracy across six medical benchmarks, surpassing the previous best models such as MediTron and BioMistral, and GPT-3.5 by a large margin. Notably, Meerkat-7B surpassed the passing threshold of the United States Medical Licensing Examination (USMLE) for the first time for a 7B-parameter model, while Meerkat-70B outperformed GPT-4 by an average of 1.3%. Additionally, Meerkat-70B correctly diagnosed 21 out of 38 complex clinical cases, outperforming humans' 13.8 and closely matching GPT-4's 21.8. Our systems offered more detailed free-form responses to clinical queries compared to existing small models, approaching the performance level of large commercial models. This significantly narrows the performance gap with large LMs, showcasing its effectiveness in addressing complex medical challenges.
Key facts. Cited by 30 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 53 references that are in the map. First posted on arXiv 30 Mar 2024.
Builds on
24 of 53 references.
References · 24
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12 more
- 2024BioMistral: A Collection of Open-Source Pretrained Large Language Models for Medical Domainscited by 301
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- 2024Me LLaMA: Foundation Large Language Models for Medical Applicationscited by 10
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Citing papers per year: 2024: 9; 2025: 14; 2026: 7.
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- 2024UltraMedical: Building Specialized Generalists in Biomedicinecited by 67
- 2024AGILE: A Novel Reinforcement Learning Framework of LLM Agentscited by 45
- 2024Rationale-Guided Retrieval Augmented Generation for Medical Question Answeringcited by 41
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- 2025SLM-SQL: An Exploration of Small Language Models for Text-to-SQLcited by 10
- 2024Large Model Strategic Thinking, Small Model Efficiency: Transferring Theory of Mind in Large Language Modelscited by 7
- 2024MedConceptsQA: Open Source Medical Concepts QA Benchmarkcited by 6
- 2025CUPCase: Clinically Uncommon Patient Cases and Diagnoses Datasetcited by 6
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- 2026Unveiling and Bridging the Functional Perception Gap in MLLMs: Atomic Visual Alignment and Hierarchical Evaluation via PET-Benchcited by 3
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- 2024Lightweight Large Language Model for Medication Enquiry: Med-Palcited by 1
- 2025TeamMedAgents: Pareto-Efficient Multi-Agent Medical Reasoning Through Teamwork Theorycited by 1
- 2026The Reliability Gap in Benchmark Auditing: Distribution Shift and Scale as Failure Modes of Contamination Detectioncited by 1
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- 2025SOLVE-Med: Specialized Orchestration for Leading Vertical Experts across Medical Specialtiescited by 0
- 2026Supervised Fine-tuning with Synthetic Rationale Data Hurts Real-World Disease Predictioncited by 0
- 2026MedJudgeRAG: Option-Wise Evidence Judgment with Dynamic Knowledge Graphs for Medical MCQAcited by 0
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- 2026Patients-like-me: A Variational LM--GNN Framework for Explainable Clinical Predictioncited by 0
- 2026Patients-like-me: A Variational LM--GNN Framework for Explainable Clinical Prediction4 Aug 2026
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- 2026MedJudgeRAG: Option-Wise Evidence Judgment with Dynamic Knowledge Graphs for Medical MCQA24 Jul 2026
- 2026Supervised Fine-tuning with Synthetic Rationale Data Hurts Real-World Disease Prediction9 Jun 2026
- 2026The Reliability Gap in Benchmark Auditing: Distribution Shift and Scale as Failure Modes of Contamination Detection2 Jun 2026
- 2026Routing with Generated Data: Annotation-Free LLM Skill Estimation and Expert Selection14 Jan 2026
- 2026Unveiling and Bridging the Functional Perception Gap in MLLMs: Atomic Visual Alignment and Hierarchical Evaluation via PET-Bench6 Jan 2026
- 2025SOLVE-Med: Specialized Orchestration for Leading Vertical Experts across Medical Specialties5 Nov 2025
- 2025Semi-Supervised Preference Optimization with Limited Feedback28 Oct 2025
- 2025A Locally Executable AI System for Improving Preoperative Patient Communication: A Multi-Domain Clinical Evaluation2 Oct 2025
- 2025RAR2: Retrieval-Augmented Medical Reasoning via Thought-Driven Retrieval24 Sep 2025
- 2025MACD: Multi-Agent Clinical Diagnosis with Self-Learned Knowledge for LLM24 Sep 2025
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- 2025TeamMedAgents: Pareto-Efficient Multi-Agent Medical Reasoning Through Teamwork Theory11 Aug 2025
- 2025SLM-SQL: An Exploration of Small Language Models for Text-to-SQL30 Jul 2025
- 2025Bottom-up Domain-specific Superintelligence: A Reliable Knowledge Graph is What We Need18 Jul 2025
- 2025Leveraging Online Data to Enhance Medical Knowledge in a Small Persian Language Model21 May 2025
- 2025Multimodal Large Language Models for Medicine: A Comprehensive Survey29 Apr 2025
- 2025How Well Can General Vision-Language Models Learn Medicine By Watching Public Educational Videos?19 Apr 2025
- 2025CUPCase: Clinically Uncommon Patient Cases and Diagnoses Dataset8 Mar 2025
- 2025Agentic Medical Knowledge Graphs Enhance Medical Question Answering: Bridging the Gap Between LLMs and Evolving Medical Knowledge18 Feb 2025
- 2025Small Language Models (SLMs) Can Still Pack a Punch: A survey (updated 2026)3 Jan 2025
- 2024Rationale-Guided Retrieval Augmented Generation for Medical Question Answering1 Nov 2024
- 2024Large Model Strategic Thinking, Small Model Efficiency: Transferring Theory of Mind in Large Language Models5 Aug 2024
- 2024LAPIS: Language Model-Augmented Police Investigation System19 Jul 2024
- 2024Lightweight Large Language Model for Medication Enquiry: Med-Pal2 Jul 2024
- 2024A Survey on Large Language Models from General Purpose to Medical Applications: Datasets, Methodologies, and Evaluations14 Jun 2024
- 2024UltraMedical: Building Specialized Generalists in Biomedicine6 Jun 2024
- 2024Pattern Recognition or Medical Knowledge? The Problem with Multiple-Choice Questions in Medicine4 Jun 2024
- 2024AGILE: A Novel Reinforcement Learning Framework of LLM Agents23 May 2024
- 2024MedConceptsQA: Open Source Medical Concepts QA Benchmark12 May 2024
- 2025Bottom-up Domain-specific Superintelligence: A Reliable Knowledge Graph is What We Needcited by 13
- 2024Large Model Strategic Thinking, Small Model Efficiency: Transferring Theory of Mind in Large Language Modelscited by 7
- 2025RAR2: Retrieval-Augmented Medical Reasoning via Thought-Driven Retrievalcited by 2
- 2025TeamMedAgents: Pareto-Efficient Multi-Agent Medical Reasoning Through Teamwork Theorycited by 1
- 2025RAR2: Retrieval-Augmented Medical Reasoning via Thought-Driven Retrieval24 Sep 2025
- 2025TeamMedAgents: Pareto-Efficient Multi-Agent Medical Reasoning Through Teamwork Theory11 Aug 2025
- 2025Bottom-up Domain-specific Superintelligence: A Reliable Knowledge Graph is What We Need18 Jul 2025
- 2024Large Model Strategic Thinking, Small Model Efficiency: Transferring Theory of Mind in Large Language Models5 Aug 2024
- 2024AGILE: A Novel Reinforcement Learning Framework of LLM Agentscited by 45
- 2025Agentic Medical Knowledge Graphs Enhance Medical Question Answering: Bridging the Gap Between LLMs and Evolving Medical Knowledgecited by 12
- 2025MACD: Multi-Agent Clinical Diagnosis with Self-Learned Knowledge for LLMcited by 6
- 2025MACD: Multi-Agent Clinical Diagnosis with Self-Learned Knowledge for LLM24 Sep 2025
- 2025Agentic Medical Knowledge Graphs Enhance Medical Question Answering: Bridging the Gap Between LLMs and Evolving Medical Knowledge18 Feb 2025
- 2024AGILE: A Novel Reinforcement Learning Framework of LLM Agents23 May 2024
- 2025Multimodal Large Language Models for Medicine: A Comprehensive Surveycited by 16
- 2025How Well Can General Vision-Language Models Learn Medicine By Watching Public Educational Videos?cited by 6
- 2026Unveiling and Bridging the Functional Perception Gap in MLLMs: Atomic Visual Alignment and Hierarchical Evaluation via PET-Benchcited by 3
- 2026Unveiling and Bridging the Functional Perception Gap in MLLMs: Atomic Visual Alignment and Hierarchical Evaluation via PET-Bench6 Jan 2026
- 2025Multimodal Large Language Models for Medicine: A Comprehensive Survey29 Apr 2025
- 2025How Well Can General Vision-Language Models Learn Medicine By Watching Public Educational Videos?19 Apr 2025
- 2024UltraMedical: Building Specialized Generalists in Biomedicinecited by 67
- 2024A Survey on Large Language Models from General Purpose to Medical Applications: Datasets, Methodologies, and Evaluationscited by 16
- 2024Pattern Recognition or Medical Knowledge? The Problem with Multiple-Choice Questions in Medicinecited by 13
- 2025SLM-SQL: An Exploration of Small Language Models for Text-to-SQLcited by 10
- 2024MedConceptsQA: Open Source Medical Concepts QA Benchmarkcited by 6
- 2025CUPCase: Clinically Uncommon Patient Cases and Diagnoses Datasetcited by 6
- 2025Leveraging Online Data to Enhance Medical Knowledge in a Small Persian Language Modelcited by 4
- 2026Routing with Generated Data: Annotation-Free LLM Skill Estimation and Expert Selectioncited by 4
- 2024LAPIS: Language Model-Augmented Police Investigation Systemcited by 2
- 2025Small Language Models (SLMs) Can Still Pack a Punch: A survey (updated 2026)cited by 2
- 2024Lightweight Large Language Model for Medication Enquiry: Med-Palcited by 1
- 2026The Reliability Gap in Benchmark Auditing: Distribution Shift and Scale as Failure Modes of Contamination Detectioncited by 1
12 most cited of 17 All 17 (JSON)
- 2026Patients-like-me: A Variational LM--GNN Framework for Explainable Clinical Prediction4 Aug 2026
- 2026Gaokerena: A Small Persian Medical Language Model Family2 Aug 2026
- 2026Supervised Fine-tuning with Synthetic Rationale Data Hurts Real-World Disease Prediction9 Jun 2026
- 2026The Reliability Gap in Benchmark Auditing: Distribution Shift and Scale as Failure Modes of Contamination Detection2 Jun 2026
- 2026Routing with Generated Data: Annotation-Free LLM Skill Estimation and Expert Selection14 Jan 2026
- 2025SOLVE-Med: Specialized Orchestration for Leading Vertical Experts across Medical Specialties5 Nov 2025
- 2025A Locally Executable AI System for Improving Preoperative Patient Communication: A Multi-Domain Clinical Evaluation2 Oct 2025
- 2025SLM-SQL: An Exploration of Small Language Models for Text-to-SQL30 Jul 2025
- 2025Leveraging Online Data to Enhance Medical Knowledge in a Small Persian Language Model21 May 2025
- 2025CUPCase: Clinically Uncommon Patient Cases and Diagnoses Dataset8 Mar 2025
- 2025Small Language Models (SLMs) Can Still Pack a Punch: A survey (updated 2026)3 Jan 2025
- 2024LAPIS: Language Model-Augmented Police Investigation System19 Jul 2024
12 newest of 17 All 17 (JSON)
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