# Closing Reasoning Gaps in Clinical Agents with Differential Reasoning Learning

arXiv: https://arxiv.org/abs/2602.09945 · HTML: https://mlsanity.com/paper/2602.09945/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 17 of its 43 references that are in the map.
- First posted on arXiv 10 Feb 2026.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)
- LLM agents and tool use / [Medical and scientific domain agents](https://mlsanity.com/agents/medical-and-scientific-domain-agents/)

## Builds on (most cited first, 17 of 17)

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- [Gemini 2.5: Pushing the Frontier with Advanced Reasoning, Multimodality, Long Context, and Next Generation Agentic Capabilities](https://mlsanity.com/paper/2507.06261/) (2025)
- [Fine-Tuning Language Models from Human Preferences](https://mlsanity.com/paper/1909.08593/) (2019)
- [A-MEM: Agentic Memory for LLM Agents](https://mlsanity.com/paper/2502.12110/) (2025)
- [Mem0: Building Production-Ready AI Agents with Scalable Long-Term Memory](https://mlsanity.com/paper/2504.19413/) (2025)
- [Capabilities of GPT-4 on Medical Challenge Problems](https://mlsanity.com/paper/2303.13375/) (2023)
- [LLMs-as-Judges: A Comprehensive Survey on LLM-based Evaluation Methods](https://mlsanity.com/paper/2412.05579/) (2024)
- [The Lessons of Developing Process Reward Models in Mathematical Reasoning](https://mlsanity.com/paper/2501.07301/) (2025)
- [ReasoningBank: Scaling Agent Self-Evolving with Reasoning Memory](https://mlsanity.com/paper/2509.25140/) (2025)
- [HuatuoGPT-o1, Towards Medical Complex Reasoning with LLMs](https://mlsanity.com/paper/2412.18925/) (2024)
- [MedXpertQA: Benchmarking Expert-Level Medical Reasoning and Understanding](https://mlsanity.com/paper/2501.18362/) (2025)
- [MedReason: Eliciting Factual Medical Reasoning Steps in LLMs via Knowledge Graphs](https://mlsanity.com/paper/2504.00993/) (2025)
- [GRAIL: Graph Edit Distance and Node Alignment Using LLM-Generated Code](https://mlsanity.com/paper/2505.02124/) (2025)
- [MedKGent: A Large Language Model Agent Framework for Constructing Temporally Evolving Medical Knowledge Graph](https://mlsanity.com/paper/2508.12393/) (2025)
- [Utilizing Large Language Models for Zero-Shot Medical Ontology Extension from Clinical Notes](https://mlsanity.com/paper/2511.16548/) (2025)
- [Knowledge Graph Augmented Large Language Models for Disease Prediction](https://mlsanity.com/paper/2512.01210/) (2025)
- [Automated Construction of Medical Indicator Knowledge Graphs Using Retrieval Augmented Large Language Models](https://mlsanity.com/paper/2511.13526/) (2025)

## Abstract (arXiv)

Clinical decision support requires not only correct answers but also clinically valid reasoning. We propose Differential Reasoning Learning (DRL), a framework that improves clinical agents by learning from reasoning discrepancies. From reference reasoning rationales (e.g., physician-authored clinical rationale, clinical guidelines, or outputs from more capable models) and the agent's free-form chain-of-thought (CoT), DRL extracts reasoning graphs as directed acyclic graphs (DAGs) and performs a clinically weighted graph edit distance (GED)-based discrepancy analysis. An LLM-as-a-judge aligns semantically equivalent nodes and diagnoses discrepancies between graphs. These graph-level discrepancy diagnostics are converted into natural-language instructions and stored in a Differential Reasoning Knowledge Base (DR-KB). At inference, we retrieve top-k instructions via Retrieval-Augmented Generation (RAG) to augment the agent prompt and patch likely logic gaps. Evaluation on open medical question answering (QA) benchmarks and a Return Visit Admissions (RVA) prediction task from internal clinical data demonstrates gains over baselines, improving both final-answer accuracy and reasoning fidelity. Ablation studies confirm gains from infusing reference reasoning rationales and the top-k retrieval strategy. Clinicians' review of the output provides further assurance of the approach. Together, results suggest that DRL supports more reliable clinical decision-making in complex reasoning scenarios and offers a practical mechanism for deployment under limited token budgets.