# Beyond MedQA: Towards Real-world Clinical Decision Making in the Era of LLMs

arXiv: https://arxiv.org/abs/2510.20001 · HTML: https://mlsanity.com/paper/2510.20001/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 37 of its 62 references that are in the map.
- First posted on arXiv 22 Oct 2025.

## Builds on (most cited first, 30 of 37)

- [Proximal Policy Optimization Algorithms](https://mlsanity.com/paper/1707.06347/) (2017)
- [Retrieval-Augmented Generation for Knowledge-Intensive NLP Tasks](https://mlsanity.com/paper/2005.11401/) (2020)
- [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)
- [MMLU-Pro: A More Robust and Challenging Multi-Task Language Understanding Benchmark](https://mlsanity.com/paper/2406.01574/) (2024)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [A Survey on LLM-as-a-Judge](https://mlsanity.com/paper/2411.15594/) (2024)
- [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)
- [Benchmarking Retrieval-Augmented Generation for Medicine](https://mlsanity.com/paper/2402.13178/) (2024)
- [Capabilities of Gemini Models in Medicine](https://mlsanity.com/paper/2404.18416/) (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)
- [How Abilities in Large Language Models are Affected by Supervised Fine-tuning Data Composition](https://mlsanity.com/paper/2310.05492/) (2023)
- [PMC-CLIP: Contrastive Language-Image Pre-training using Biomedical Documents](https://mlsanity.com/paper/2303.07240/) (2023)
- [MediQ: Question-Asking LLMs and a Benchmark for Reliable Interactive Clinical Reasoning](https://mlsanity.com/paper/2406.00922/) (2024)
- [AI Hospital: Benchmarking Large Language Models in a Multi-agent Medical Interaction Simulator](https://mlsanity.com/paper/2402.09742/) (2024)
- [DISC-MedLLM: Bridging General Large Language Models and Real-World Medical Consultation](https://mlsanity.com/paper/2308.14346/) (2023)
- [MedCalc-Bench: Evaluating Large Language Models for Medical Calculations](https://mlsanity.com/paper/2406.12036/) (2024)
- [Reasoning-Enhanced Healthcare Predictions with Knowledge Graph Community Retrieval](https://mlsanity.com/paper/2410.04585/) (2024)
- [Evolving Language Models without Labels: Majority Drives Selection, Novelty Promotes Variation](https://mlsanity.com/paper/2509.15194/) (2025)
- [CoD, Towards an Interpretable Medical Agent using Chain of Diagnosis](https://mlsanity.com/paper/2407.13301/) (2024)
- [LongHealth: A Question Answering Benchmark with Long Clinical Documents](https://mlsanity.com/paper/2401.14490/) (2024)
- [ClinicalBench: Can LLMs Beat Traditional ML Models in Clinical Prediction?](https://mlsanity.com/paper/2411.06469/) (2024)
- [Few shot chain-of-thought driven reasoning to prompt LLMs for open ended medical question answering](https://mlsanity.com/paper/2403.04890/) (2024)
- [ClinicalLab: Aligning Agents for Multi-Departmental Clinical Diagnostics in the Real World](https://mlsanity.com/paper/2406.13890/) (2024)
- [Cats Confuse Reasoning LLM: Query Agnostic Adversarial Triggers for Reasoning Models](https://mlsanity.com/paper/2503.01781/) (2025)
- [Enhancing Diagnostic Accuracy through Multi-Agent Conversations: Using Large Language Models to Mitigate Cognitive Bias](https://mlsanity.com/paper/2401.14589/) (2024)
- [Large Language Models Perform Diagnostic Reasoning](https://mlsanity.com/paper/2307.08922/) (2023)
- [ProMed: Shapley Information Gain Guided Reinforcement Learning for Proactive Medical LLMs](https://mlsanity.com/paper/2508.13514/) (2025)

## Built on by (most cited first, 1 of 1)

- [EHRBench: An Automated and Reliable EHR-based Benchmark for Clinical Decision Making with LLMs](https://mlsanity.com/paper/2605.30637/) (2026)

## Abstract (arXiv)

Large language models (LLMs) show promise for clinical use. They are often evaluated using datasets such as MedQA. However, Many medical datasets, such as MedQA, rely on simplified Question-Answering (QA) that underrepresents real-world clinical decision-making. Based on this, we propose a unifying paradigm that characterizes clinical decision-making tasks along two dimensions: Clinical Backgrounds and Clinical Questions. As the background and questions approach the real clinical environment, the difficulty increases. We summarize the settings of existing datasets and benchmarks along two dimensions. Then we review methods to address clinical decision-making, including training-time and test-time techniques, and summarize when they help. Next, we extend evaluation beyond accuracy to include efficiency, explainability. Finally, we highlight open challenges. Our paradigm clarifies assumptions, standardizes comparisons, and guides the development of clinically meaningful LLMs.