# MedCoG: Maximizing LLM Inference Density in Medical Reasoning via Meta-Cognitive Regulation

arXiv: https://arxiv.org/abs/2602.07905 · HTML: https://mlsanity.com/paper/2602.07905/

## 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 41 of its 56 references that are in the map.
- First posted on arXiv 8 Feb 2026.

## Placed in

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

## Builds on (most cited first, 30 of 41)

- [Chain-of-Thought Prompting Elicits Reasoning in Large Language Models](https://mlsanity.com/paper/2201.11903/) (2022)
- [ReAct: Synergizing Reasoning and Acting in Language Models](https://mlsanity.com/paper/2210.03629/) (2022)
- [Measuring Massive Multitask Language Understanding](https://mlsanity.com/paper/2009.03300/) (2020)
- [Self-Consistency Improves Chain of Thought Reasoning in Language Models](https://mlsanity.com/paper/2203.11171/) (2022)
- [GPT-4o System Card](https://mlsanity.com/paper/2410.21276/) (2024)
- [Reflexion: Language Agents with Verbal Reinforcement Learning](https://mlsanity.com/paper/2303.11366/) (2023)
- [Self-Refine: Iterative Refinement with Self-Feedback](https://mlsanity.com/paper/2303.17651/) (2023)
- [Scaling LLM Test-Time Compute Optimally can be More Effective than Scaling Model Parameters](https://mlsanity.com/paper/2408.03314/) (2024)
- [MMLU-Pro: A More Robust and Challenging Multi-Task Language Understanding Benchmark](https://mlsanity.com/paper/2406.01574/) (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)
- [Capabilities of GPT-4 on Medical Challenge Problems](https://mlsanity.com/paper/2303.13375/) (2023)
- [A Survey on the Memory Mechanism of Large Language Model based Agents](https://mlsanity.com/paper/2404.13501/) (2024)
- [MedMCQA : A Large-scale Multi-Subject Multi-Choice Dataset for Medical domain Question Answering](https://mlsanity.com/paper/2203.14371/) (2022)
- [AFlow: Automating Agentic Workflow Generation](https://mlsanity.com/paper/2410.10762/) (2024)
- [Can Generalist Foundation Models Outcompete Special-Purpose Tuning? Case Study in Medicine](https://mlsanity.com/paper/2311.16452/) (2023)
- [MedAgents: Large Language Models as Collaborators for Zero-shot Medical Reasoning](https://mlsanity.com/paper/2311.10537/) (2023)
- [ReConcile: Round-Table Conference Improves Reasoning via Consensus among Diverse LLMs](https://mlsanity.com/paper/2309.13007/) (2023)
- [Memory in the Age of AI Agents](https://mlsanity.com/paper/2512.13564/) (2025)
- [HuatuoGPT-o1, Towards Medical Complex Reasoning with LLMs](https://mlsanity.com/paper/2412.18925/) (2024)
- [Unleashing the Emergent Cognitive Synergy in Large Language Models: A Task-Solving Agent through Multi-Persona Self-Collaboration](https://mlsanity.com/paper/2307.05300/) (2023)
- [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)
- [Agent Hospital: A Simulacrum of Hospital with Evolvable Medical Agents](https://mlsanity.com/paper/2405.02957/) (2024)
- [MDAgents: An Adaptive Collaboration of LLMs for Medical Decision-Making](https://mlsanity.com/paper/2404.15155/) (2024)
- [MediQ: Question-Asking LLMs and a Benchmark for Reliable Interactive Clinical Reasoning](https://mlsanity.com/paper/2406.00922/) (2024)
- [MedReason: Eliciting Factual Medical Reasoning Steps in LLMs via Knowledge Graphs](https://mlsanity.com/paper/2504.00993/) (2025)
- [dParallel: Learnable Parallel Decoding for dLLMs](https://mlsanity.com/paper/2509.26488/) (2025)
- [Densing Law of LLMs](https://mlsanity.com/paper/2412.04315/) (2024)
- [MedicalAgentsBench for Complex Medical Reasoning: Comparing Internalized Reasoning Models versus Externalized Agent-based Frameworks](https://mlsanity.com/paper/2503.07459/) (2025)

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

- [MIRROR: A Hierarchical Benchmark for Metacognitive Calibration in Large Language Models](https://mlsanity.com/paper/2604.19809/) (2026)
- [MedEvo: Medical Reasoning Evolution through Knowledge Navigation](https://mlsanity.com/paper/2610.17690/) (2026)

## Abstract (arXiv)

Large Language Models (LLMs) have shown strong potential in complex medical reasoning yet face diminishing gains under inference scaling laws. While existing studies augment LLMs with various knowledge types, it remains unclear how effectively the additional costs translate into accuracy. In this paper, we explore how meta-cognition of LLMs, i.e., their self-assessment of their own cognitive states, can regulate the reasoning process. Specifically, we propose MedCoG, a Medical Meta-Cognition Agent with Knowledge Graph, where the meta-cognitive assessments of task complexity, familiarity, and knowledge density dynamically regulate utilization of procedural, episodic, and factual knowledge. The LLM-centric on-demand reasoning aims to mitigate the diminishing returns under scaling law by (1) reducing costs via avoiding indiscriminate scaling, (2) improving accuracy via filtering out distractive knowledge. To validate this, we empirically characterize the scaling curve and introduce inference density to quantify inference efficiency. Experiments demonstrate the effectiveness and efficiency of MedCoG on five hard sets of medical benchmarks, yielding 6.2x inference density. Furthermore, the Oracle study highlights the significant potential of meta-cognitive regulation.