# Critique of Impure Reason: Unveiling the reasoning behaviour of medical Large Language Models

arXiv: https://arxiv.org/abs/2412.15748 · HTML: https://mlsanity.com/paper/2412.15748/

## Key facts

- Cited by 2 papers in the map (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 54 of its 100 references that are in the map.
- First posted on arXiv 20 Dec 2024.

## Placed in

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

## Builds on (most cited first, 30 of 54)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [Training language models to follow instructions with human feedback](https://mlsanity.com/paper/2203.02155/) (2022)
- [Proximal Policy Optimization Algorithms](https://mlsanity.com/paper/1707.06347/) (2017)
- [LLaMA: Open and Efficient Foundation Language Models](https://mlsanity.com/paper/2302.13971/) (2023)
- [Chain-of-Thought Prompting Elicits Reasoning in Large Language Models](https://mlsanity.com/paper/2201.11903/) (2022)
- [DeepSeekMath: Pushing the Limits of Mathematical Reasoning in Open Language Models](https://mlsanity.com/paper/2402.03300/) (2024)
- [Direct Preference Optimization: Your Language Model is Secretly a Reward Model](https://mlsanity.com/paper/2305.18290/) (2023)
- [Measuring Massive Multitask Language Understanding](https://mlsanity.com/paper/2009.03300/) (2020)
- [Grad-CAM: Visual Explanations from Deep Networks via Gradient-based Localization](https://mlsanity.com/paper/1610.02391/) (2016)
- [A Unified Approach to Interpreting Model Predictions](https://mlsanity.com/paper/1705.07874/) (2017)
- [Self-Consistency Improves Chain of Thought Reasoning in Language Models](https://mlsanity.com/paper/2203.11171/) (2022)
- [XGBoost: A Scalable Tree Boosting System](https://mlsanity.com/paper/1603.02754/) (2016)
- [Deep reinforcement learning from human preferences](https://mlsanity.com/paper/1706.03741/) (2017)
- [Let's Verify Step by Step](https://mlsanity.com/paper/2305.20050/) (2023)
- [Axiomatic Attribution for Deep Networks](https://mlsanity.com/paper/1703.01365/) (2017)
- [Tree of Thoughts: Deliberate Problem Solving with Large Language Models](https://mlsanity.com/paper/2305.10601/) (2023)
- [Qwen2 Technical Report](https://mlsanity.com/paper/2407.10671/) (2024)
- [Scaling LLM Test-Time Compute Optimally can be More Effective than Scaling Model Parameters](https://mlsanity.com/paper/2408.03314/) (2024)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [A Survey on Hallucination in Large Language Models: Principles, Taxonomy, Challenges, and Open Questions](https://mlsanity.com/paper/2311.05232/) (2023)
- [What Disease does this Patient Have? A Large-scale Open Domain Question Answering Dataset from Medical Exams](https://mlsanity.com/paper/2009.13081/) (2020)
- [PubMedQA: A Dataset for Biomedical Research Question Answering](https://mlsanity.com/paper/1909.06146/) (2019)
- [Self-Supervised Learning from Images with a Joint-Embedding Predictive Architecture](https://mlsanity.com/paper/2301.08243/) (2023)
- [Solving math word problems with process- and outcome-based feedback](https://mlsanity.com/paper/2211.14275/) (2022)
- [Training Large Language Models to Reason in a Continuous Latent Space](https://mlsanity.com/paper/2412.06769/) (2024)
- [MedMCQA : A Large-scale Multi-Subject Multi-Choice Dataset for Medical domain Question Answering](https://mlsanity.com/paper/2203.14371/) (2022)
- [From Generation to Judgment: Opportunities and Challenges of LLM-as-a-judge](https://mlsanity.com/paper/2411.16594/) (2024)
- [Causal Reasoning and Large Language Models: Opening a New Frontier for Causality](https://mlsanity.com/paper/2305.00050/) (2023)
- [Chain-of-Thought Reasoning Without Prompting](https://mlsanity.com/paper/2402.10200/) (2024)

## Built on by (most cited first, 2 of 2)

- [A Sober Look at Progress in Language Model Reasoning: Pitfalls and Paths to Reproducibility](https://mlsanity.com/paper/2504.07086/) (2025)
- [Reforming the Mechanism: Editing Reasoning Patterns in LLMs with Circuit Reshaping](https://mlsanity.com/paper/2603.06923/) (2026)

## Abstract (arXiv)

Background: Despite the current ubiquity of Large Language Models (LLMs) across the medical domain, there is a surprising lack of studies which address their reasoning behaviour. We emphasise the importance of understanding reasoning behaviour as opposed to high-level prediction accuracies, since it is equivalent to explainable AI (XAI) in this context. In particular, achieving XAI in medical LLMs used in the clinical domain will have a significant impact across the healthcare sector. Results: Therefore, in this work, we adapt the existing concept of reasoning behaviour and articulate its interpretation within the specific context of medical LLMs. We survey and categorise current state-of-the-art approaches for modeling and evaluating reasoning reasoning in medical LLMs. Additionally, we propose theoretical frameworks which can empower medical professionals or machine learning engineers to gain insight into the low-level reasoning operations of these previously obscure models. We also outline key open challenges facing the development of Large Reasoning Models. Conclusion: The subsequent increased transparency and trust in medical machine learning models by clinicians as well as patients will accelerate the integration, application as well as further development of medical AI for the healthcare system as a whole.