# Medical Reasoning in the Era of LLMs: A Systematic Review of Enhancement Techniques and Applications

arXiv: https://arxiv.org/abs/2508.00669 · HTML: https://mlsanity.com/paper/2508.00669/

## Key facts

- Cited by 10 papers in the map (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 58 of its 157 references that are in the map.
- First posted on arXiv 1 Aug 2025.

## Placed in

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

## Builds on (most cited first, 30 of 58)

- [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)
- [DeepSeek-R1: Incentivizing Reasoning Capability in LLMs via Reinforcement Learning](https://mlsanity.com/paper/2501.12948/) (2025)
- [Self-Consistency Improves Chain of Thought Reasoning in Language Models](https://mlsanity.com/paper/2203.11171/) (2022)
- [Tree of Thoughts: Deliberate Problem Solving with Large Language Models](https://mlsanity.com/paper/2305.10601/) (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)
- [OpenAI o1 System Card](https://mlsanity.com/paper/2412.16720/) (2024)
- [Emu3: Next-Token Prediction is All You Need](https://mlsanity.com/paper/2409.18869/) (2024)
- [HealthBench: Evaluating Large Language Models Towards Improved Human Health](https://mlsanity.com/paper/2505.08775/) (2025)
- [HuatuoGPT-o1, Towards Medical Complex Reasoning with LLMs](https://mlsanity.com/paper/2412.18925/) (2024)
- [AgentClinic: a multimodal agent benchmark to evaluate AI in simulated clinical environments](https://mlsanity.com/paper/2405.07960/) (2024)
- [MedXpertQA: Benchmarking Expert-Level Medical Reasoning and Understanding](https://mlsanity.com/paper/2501.18362/) (2025)
- [Chain-of-Note: Enhancing Robustness in Retrieval-Augmented Language Models](https://mlsanity.com/paper/2311.09210/) (2023)
- [MedVLM-R1: Incentivizing Medical Reasoning Capability of Vision-Language Models (VLMs) via Reinforcement Learning](https://mlsanity.com/paper/2502.19634/) (2025)
- [A Survey of Large Language Models in Medicine: Progress, Application, and Challenge](https://mlsanity.com/paper/2311.05112/) (2023)
- [MedReason: Eliciting Factual Medical Reasoning Steps in LLMs via Knowledge Graphs](https://mlsanity.com/paper/2504.00993/) (2025)
- [DISC-MedLLM: Bridging General Large Language Models and Real-World Medical Consultation](https://mlsanity.com/paper/2308.14346/) (2023)
- [MedRAX: Medical Reasoning Agent for Chest X-ray](https://mlsanity.com/paper/2502.02673/) (2025)
- [Sequential Diagnosis with Language Models](https://mlsanity.com/paper/2506.22405/) (2025)
- [m1: Unleash the Potential of Test-Time Scaling for Medical Reasoning with Large Language Models](https://mlsanity.com/paper/2504.00869/) (2025)
- [DrugAgent: Automating AI-aided Drug Discovery Programming through LLM Multi-Agent Collaboration](https://mlsanity.com/paper/2411.15692/) (2024)
- [GMAI-VL-R1: Harnessing Reinforcement Learning for Multimodal Medical Reasoning](https://mlsanity.com/paper/2504.01886/) (2025)
- [Med-RLVR: Emerging Medical Reasoning from a 3B base model via reinforcement Learning](https://mlsanity.com/paper/2502.19655/) (2025)
- [MedicalAgentsBench for Complex Medical Reasoning: Comparing Internalized Reasoning Models versus Externalized Agent-based Frameworks](https://mlsanity.com/paper/2503.07459/) (2025)
- [Beyond Distillation: Pushing the Limits of Medical LLM Reasoning with Minimalist Rule-Based RL](https://mlsanity.com/paper/2505.17952/) (2025)
- [O1 Replication Journey -- Part 3: Inference-time Scaling for Medical Reasoning](https://mlsanity.com/paper/2501.06458/) (2025)
- [Medical World Model: Generative Simulation of Tumor Evolution for Treatment Planning](https://mlsanity.com/paper/2506.02327/) (2025)
- [ClinicalAgent: Clinical Trial Multi-Agent System with Large Language Model-based Reasoning](https://mlsanity.com/paper/2404.14777/) (2024)
- [ChestX-Reasoner: Advancing Radiology Foundation Models with Reasoning through Step-by-Step Verification](https://mlsanity.com/paper/2504.20930/) (2025)
- [ClinicalLab: Aligning Agents for Multi-Departmental Clinical Diagnostics in the Real World](https://mlsanity.com/paper/2406.13890/) (2024)

## Built on by (most cited first, 10 of 10)

- [MedSAM-Agent: Empowering Interactive Medical Image Segmentation with Multi-turn Agentic Reinforcement Learning](https://mlsanity.com/paper/2602.03320/) (2026)
- [Training and Evaluation of Guideline-Based Medical Reasoning in LLMs](https://mlsanity.com/paper/2512.03838/) (2025)
- [Trustworthy and Fair SkinGPT-R1 for Democratizing Dermatological Reasoning across Diverse Ethnicities](https://mlsanity.com/paper/2511.15242/) (2025)
- [When Does RL Help Medical VLMs? Disentangling Vision, SFT, and RL Gains](https://mlsanity.com/paper/2603.01301/) (2026)
- [Information-seeking failures of large language models in agentic clinical reasoning](https://mlsanity.com/paper/2607.10275/) (2026)
- [MedPruner: Training-Free Hierarchical Token Pruning for Efficient 3D Medical Image Understanding in Vision-Language Models](https://mlsanity.com/paper/2603.11625/) (2026)
- [To Reason or Not to: Selective Chain-of-Thought in Medical Question Answering](https://mlsanity.com/paper/2602.20130/) (2026)
- [Deciphering Scientific Reasoning Steps from Outcome Data for Molecule Optimization](https://mlsanity.com/paper/2603.20262/) (2026)
- [HealthNLP_Retrievers at ArchEHR-QA 2026: Cascaded LLM Pipeline for Grounded Clinical Question Answering](https://mlsanity.com/paper/2604.26880/) (2026)
- [Reasoning4Sciences: Bridging Reasoning Language Models to All Scientific Branches](https://mlsanity.com/paper/2606.01145/) (2026)

## Abstract (arXiv)

The proliferation of Large Language Models (LLMs) in medicine has enabled impressive capabilities, yet a critical gap remains in their ability to perform systematic, transparent, and verifiable reasoning, a cornerstone of clinical practice. This has catalyzed a shift from single-step answer generation to the development of LLMs explicitly designed for medical reasoning. This paper provides the first systematic review of this emerging field. We propose a taxonomy of reasoning enhancement techniques, categorized into training-time strategies (e.g., supervised fine-tuning, reinforcement learning) and test-time mechanisms (e.g., prompt engineering, multi-agent systems). We analyze how these techniques are applied across different data modalities (text, image, code) and in key clinical applications such as diagnosis, education, and treatment planning. Furthermore, we survey the evolution of evaluation benchmarks from simple accuracy metrics to sophisticated assessments of reasoning quality and visual interpretability. Based on an analysis of 60 seminal studies from 2022-2025, we conclude by identifying critical challenges, including the faithfulness-plausibility gap and the need for native multimodal reasoning, and outlining future directions toward building efficient, robust, and sociotechnically responsible medical AI.