# Self-MedRAG: a Self-Reflective Hybrid Retrieval-Augmented Generation Framework for Reliable Medical Question Answering

arXiv: https://arxiv.org/abs/2601.04531 · HTML: https://mlsanity.com/paper/2601.04531/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Medical and biomedical RAG, one of 15 directions in Retrieval-augmented generation.
- Builds on 29 of its 39 references that are in the map.
- First posted on arXiv 8 Jan 2026.

## Placed in

- Retrieval-augmented generation / [Medical and biomedical RAG](https://mlsanity.com/rag/medical-and-biomedical-rag/)

## Builds on (most cited first, 29 of 29)

- [Measuring Massive Multitask Language Understanding](https://mlsanity.com/paper/2009.03300/) (2020)
- [Retrieval-Augmented Generation for Large Language Models: A Survey](https://mlsanity.com/paper/2312.10997/) (2023)
- [SimCSE: Simple Contrastive Learning of Sentence Embeddings](https://mlsanity.com/paper/2104.08821/) (2021)
- [BioBERT: a pre-trained biomedical language representation model for biomedical text mining](https://mlsanity.com/paper/1901.08746/) (2019)
- [Self-RAG: Learning to Retrieve, Generate, and Critique through Self-Reflection](https://mlsanity.com/paper/2310.11511/) (2023)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [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)
- [Unsupervised Dense Information Retrieval with Contrastive Learning](https://mlsanity.com/paper/2112.09118/) (2021)
- [M3-Embedding: Multi-Linguality, Multi-Functionality, Multi-Granularity Text Embeddings Through Self-Knowledge Distillation](https://mlsanity.com/paper/2402.03216/) (2024)
- [Domain-Specific Language Model Pretraining for Biomedical Natural Language Processing](https://mlsanity.com/paper/2007.15779/) (2020)
- [Benchmarking Retrieval-Augmented Generation for Medicine](https://mlsanity.com/paper/2402.13178/) (2024)
- [Agentic Retrieval-Augmented Generation: A Survey on Agentic RAG](https://mlsanity.com/paper/2501.09136/) (2025)
- [Corrective Retrieval Augmented Generation](https://mlsanity.com/paper/2401.15884/) (2024)
- [MedCPT: Contrastive Pre-trained Transformers with Large-scale PubMed Search Logs for Zero-shot Biomedical Information Retrieval](https://mlsanity.com/paper/2307.00589/) (2023)
- [Retrieval-Augmented Generation with Graphs (GraphRAG)](https://mlsanity.com/paper/2501.00309/) (2024)
- [MedRAG: Enhancing Retrieval-augmented Generation with Knowledge Graph-Elicited Reasoning for Healthcare Copilot](https://mlsanity.com/paper/2502.04413/) (2025)
- [A Comprehensive Survey of Retrieval-Augmented Generation (RAG): Evolution, Current Landscape and Future Directions](https://mlsanity.com/paper/2410.12837/) (2024)
- [Improving Retrieval-Augmented Generation in Medicine with Iterative Follow-up Questions](https://mlsanity.com/paper/2408.00727/) (2024)
- [Towards Agentic RAG with Deep Reasoning: A Survey of RAG-Reasoning Systems in LLMs](https://mlsanity.com/paper/2507.09477/) (2025)
- [Large Language Models for Medicine: A Survey](https://mlsanity.com/paper/2405.13055/) (2024)
- [LLM-MedQA: Enhancing Medical Question Answering through Case Studies in Large Language Models](https://mlsanity.com/paper/2501.05464/) (2024)
- [Knowing You Don't Know: Learning When to Continue Search in Multi-round RAG through Self-Practicing](https://mlsanity.com/paper/2505.02811/) (2025)
- [The Multi-Round Diagnostic RAG Framework for Emulating Clinical Reasoning](https://mlsanity.com/paper/2504.07724/) (2025)
- [A Survey on Retrieval And Structuring Augmented Generation with Large Language Models](https://mlsanity.com/paper/2509.10697/) (2025)
- [BMX: Entropy-weighted Similarity and Semantic-enhanced Lexical Search](https://mlsanity.com/paper/2408.06643/) (2024)
- [Talk Before You Retrieve: Agent-Led Discussions for Better RAG in Medical QA](https://mlsanity.com/paper/2504.21252/) (2025)
- [Balancing the Blend: An Experimental Analysis of Trade-offs in Hybrid Search](https://mlsanity.com/paper/2508.01405/) (2025)
- [Beyond Retrieval: Ensembling Cross-Encoders and GPT Rerankers with LLMs for Biomedical QA](https://mlsanity.com/paper/2507.05577/) (2025)

## Abstract (arXiv)

Large Language Models (LLMs) have demonstrated significant potential in medical Question Answering (QA), yet they remain prone to hallucinations and ungrounded reasoning, limiting their reliability in high-stakes clinical scenarios. While Retrieval-Augmented Generation (RAG) mitigates these issues by incorporating external knowledge, conventional single-shot retrieval often fails to resolve complex biomedical queries requiring multi-step inference. To address this, we propose Self-MedRAG, a self-reflective hybrid framework designed to mimic the iterative hypothesis-verification process of clinical reasoning. Self-MedRAG integrates a hybrid retrieval strategy, combining sparse (BM25) and dense (Contriever) retrievers via Reciprocal Rank Fusion (RRF) to maximize evidence coverage. It employs a generator to produce answers with supporting rationales, which are then assessed by a lightweight self-reflection module using Natural Language Inference (NLI) or LLM-based verification. If the rationale lacks sufficient evidentiary support, the system autonomously reformulates the query and iterates to refine the context. We evaluated Self-MedRAG on the MedQA and PubMedQA benchmarks. The results demonstrate that our hybrid retrieval approach significantly outperforms single-retriever baselines. Furthermore, the inclusion of the self-reflective loop yielded substantial gains, increasing accuracy on MedQA from 80.00% to 83.33% and on PubMedQA from 69.10% to 79.82%. These findings confirm that integrating hybrid retrieval with iterative, evidence-based self-reflection effectively reduces unsupported claims and enhances the clinical reliability of LLM-based systems.