# Bridging Stepwise Lab-Informed Pretraining and Knowledge-Guided Learning for Diagnostic Reasoning

arXiv: https://arxiv.org/abs/2410.19955 · HTML: https://mlsanity.com/paper/2410.19955/

## Key facts

- Cited by 3 papers in the map (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 22 of its 62 references that are in the map.
- First posted on arXiv 25 Oct 2024.

## Placed in

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

## Builds on (most cited first, 22 of 22)

- [The Llama 3 Herd of Models](https://mlsanity.com/paper/2407.21783/) (2024)
- [RotatE: Knowledge Graph Embedding by Relational Rotation in Complex Space](https://mlsanity.com/paper/1902.10197/) (2019)
- [Poincar'e Embeddings for Learning Hierarchical Representations](https://mlsanity.com/paper/1705.08039/) (2017)
- [Med-BERT: pre-trained contextualized embeddings on large-scale structured electronic health records for disease prediction](https://mlsanity.com/paper/2005.12833/) (2020)
- [RETAIN: An Interpretable Predictive Model for Healthcare using Reverse Time Attention Mechanism](https://mlsanity.com/paper/1608.05745/) (2016)
- [Doctor AI: Predicting Clinical Events via Recurrent Neural Networks](https://mlsanity.com/paper/1511.05942/) (2015)
- [GRAM: Graph-based Attention Model for Healthcare Representation Learning](https://mlsanity.com/paper/1611.07012/) (2016)
- [Deep EHR: A Survey of Recent Advances in Deep Learning Techniques for Electronic Health Record (EHR) Analysis](https://mlsanity.com/paper/1706.03446/) (2017)
- [Learning Hierarchy-Aware Knowledge Graph Embeddings for Link Prediction](https://mlsanity.com/paper/1911.09419/) (2019)
- [Pre-training of Graph Augmented Transformers for Medication Recommendation](https://mlsanity.com/paper/1906.00346/) (2019)
- [Dipole: Diagnosis Prediction in Healthcare via Attention-based Bidirectional Recurrent Neural Networks](https://mlsanity.com/paper/1706.05764/) (2017)
- [Learning the Graphical Structure of Electronic Health Records with Graph Convolutional Transformer](https://mlsanity.com/paper/1906.04716/) (2019)
- [MiME: Multilevel Medical Embedding of Electronic Health Records for Predictive Healthcare](https://mlsanity.com/paper/1810.09593/) (2018)
- [Deepr: A Convolutional Net for Medical Records](https://mlsanity.com/paper/1607.07519/) (2016)
- [GraphCare: Enhancing Healthcare Predictions with Personalized Knowledge Graphs](https://mlsanity.com/paper/2305.12788/) (2023)
- [ConCare: Personalized Clinical Feature Embedding via Capturing the Healthcare Context](https://mlsanity.com/paper/1911.12216/) (2019)
- [AdaCare: Explainable Clinical Health Status Representation Learning via Scale-Adaptive Feature Extraction and Recalibration](https://mlsanity.com/paper/1911.12205/) (2019)
- [Reasoning-Enhanced Healthcare Predictions with Knowledge Graph Community Retrieval](https://mlsanity.com/paper/2410.04585/) (2024)
- [Collaborative Graph Learning with Auxiliary Text for Temporal Event Prediction in Healthcare](https://mlsanity.com/paper/2105.07542/) (2021)
- [RAM-EHR: Retrieval Augmentation Meets Clinical Predictions on Electronic Health Records](https://mlsanity.com/paper/2403.00815/) (2024)
- [Self-Supervised Graph Learning with Hyperbolic Embedding for Temporal Health Event Prediction](https://mlsanity.com/paper/2106.04751/) (2021)
- [Graph-Text Multi-Modal Pre-training for Medical Representation Learning](https://mlsanity.com/paper/2203.09994/) (2022)

## Built on by (most cited first, 3 of 3)

- [MedSynapse-V: Bridging Visual Perception and Clinical Intuition via Latent Memory Evolution](https://mlsanity.com/paper/2604.26283/) (2026)
- [Implicit Hypergraph Neural Networks: A Stable Framework for Higher-Order Relational Learning with Provable Guarantees](https://mlsanity.com/paper/2508.09427/) (2025)
- [Lightweight Baselines for Medical Abstract Classification: DistilBERT with Cross-Entropy as a Strong Default](https://mlsanity.com/paper/2510.10025/) (2025)

## Abstract (arXiv)

Despite the growing use of Electronic Health Records (EHR) for AI-assisted diagnosis prediction, most data-driven models struggle to incorporate clinically meaningful medical knowledge. They often rely on limited ontologies, lacking structured reasoning capabilities and comprehensive coverage. This raises an important research question: Will medical knowledge improve predictive models to support stepwise clinical reasoning as performed by human doctors? To address this problem, we propose DuaLK, a dual-expertise framework that combines two complementary sources of information. For external knowledge, we construct a Diagnosis Knowledge Graph (KG) that encodes both hierarchical and semantic relations enriched by large language models (LLM). To align with patient data, we further introduce a lab-informed proxy task that guides the model to follow a clinically consistent, stepwise reasoning process based on lab test signals. Experimental results on two public EHR datasets demonstrate that DuaLK consistently outperforms existing baselines across four clinical prediction tasks. These findings highlight the potential of combining structured medical knowledge with individual-level clinical signals to achieve more accurate and interpretable diagnostic predictions. The source code is publicly available on https://github.com/humphreyhuu/DuaLK.