# TARSE: Test-Time Adaptation via Retrieval of Skills and Experience for Reasoning Agents

arXiv: https://arxiv.org/abs/2603.01241 · HTML: https://mlsanity.com/paper/2603.01241/

## Key facts

- Cited by 4 papers in the map (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 42 of its 45 references that are in the map.
- First posted on arXiv 1 Mar 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, 30 of 42)

- [Chain-of-Thought Prompting Elicits Reasoning in Large Language Models](https://mlsanity.com/paper/2201.11903/) (2022)
- [Training Verifiers to Solve Math Word Problems](https://mlsanity.com/paper/2110.14168/) (2021)
- [Retrieval-Augmented Generation for Knowledge-Intensive NLP Tasks](https://mlsanity.com/paper/2005.11401/) (2020)
- [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)
- [Let's Verify Step by Step](https://mlsanity.com/paper/2305.20050/) (2023)
- [REALM: Retrieval-Augmented Language Model Pre-Training](https://mlsanity.com/paper/2002.08909/) (2020)
- [Search-R1: Training LLMs to Reason and Leverage Search Engines with Reinforcement Learning](https://mlsanity.com/paper/2503.09516/) (2025)
- [What Disease does this Patient Have? A Large-scale Open Domain Question Answering Dataset from Medical Exams](https://mlsanity.com/paper/2009.13081/) (2020)
- [Qwen2.5-Coder Technical Report](https://mlsanity.com/paper/2409.12186/) (2024)
- [OlympiadBench: A Challenging Benchmark for Promoting AGI with Olympiad-Level Bilingual Multimodal Scientific Problems](https://mlsanity.com/paper/2402.14008/) (2024)
- [MedMCQA : A Large-scale Multi-Subject Multi-Choice Dataset for Medical domain Question Answering](https://mlsanity.com/paper/2203.14371/) (2022)
- [Faith and Fate: Limits of Transformers on Compositionality](https://mlsanity.com/paper/2305.18654/) (2023)
- [MedGemma Technical Report](https://mlsanity.com/paper/2507.05201/) (2025)
- [Benchmarking Retrieval-Augmented Generation for Medicine](https://mlsanity.com/paper/2402.13178/) (2024)
- [Titans: Learning to Memorize at Test Time](https://mlsanity.com/paper/2501.00663/) (2024)
- [ChatDoctor: A Medical Chat Model Fine-Tuned on a Large Language Model Meta-AI (LLaMA) Using Medical Domain Knowledge](https://mlsanity.com/paper/2303.14070/) (2023)
- [SkillRL: Evolving Agents via Recursive Skill-Augmented Reinforcement Learning](https://mlsanity.com/paper/2602.08234/) (2026)
- [Reasoning or Reciting? Exploring the Capabilities and Limitations of Language Models Through Counterfactual Tasks](https://mlsanity.com/paper/2307.02477/) (2023)
- [Memory-R1: Enhancing Large Language Model Agents to Manage and Utilize Memories via Reinforcement Learning](https://mlsanity.com/paper/2508.19828/) (2025)
- [Lingshu: A Generalist Foundation Model for Unified Multimodal Medical Understanding and Reasoning](https://mlsanity.com/paper/2506.07044/) (2025)
- [Language is All a Graph Needs](https://mlsanity.com/paper/2308.07134/) (2023)
- [Evaluating the Logical Reasoning Ability of ChatGPT and GPT-4](https://mlsanity.com/paper/2304.03439/) (2023)
- [Almanac: Retrieval-Augmented Language Models for Clinical Medicine](https://mlsanity.com/paper/2303.01229/) (2023)
- [Inducing Programmatic Skills for Agentic Tasks](https://mlsanity.com/paper/2504.06821/) (2025)
- [Hulu-Med: A Transparent Generalist Model towards Holistic Medical Vision-Language Understanding](https://mlsanity.com/paper/2510.08668/) (2025)
- [Medical Graph RAG: Towards Safe Medical Large Language Model via Graph Retrieval-Augmented Generation](https://mlsanity.com/paper/2408.04187/) (2024)
- [Agent Learning via Early Experience](https://mlsanity.com/paper/2510.08558/) (2025)
- [AgentGen: Enhancing Planning Abilities for Large Language Model based Agent via Environment and Task Generation](https://mlsanity.com/paper/2408.00764/) (2024)
- [MedRAG: Enhancing Retrieval-augmented Generation with Knowledge Graph-Elicited Reasoning for Healthcare Copilot](https://mlsanity.com/paper/2502.04413/) (2025)

## Built on by (most cited first, 4 of 4)

- [Skills on the Fly: Test-Time Adaptive Skill Synthesis for LLM Agents](https://mlsanity.com/paper/2605.16986/) (2026)
- [SkillMaster: Toward Autonomous Skill Mastery in LLM Agents](https://mlsanity.com/paper/2605.08693/) (2026)
- [AgentStream: How Well Do Self-Evolving LLM Agents Perform Under Streaming Tasks?](https://mlsanity.com/paper/2608.00155/) (2026)
- [Workflow Closure Is Not Scientific Closure in Auto-Research Systems](https://mlsanity.com/paper/2605.26200/) (2026)

## Abstract (arXiv)

Complex clinical decision making often fails not because a model lacks facts, but because it cannot reliably select and apply the right procedural knowledge and the right prior example at the right reasoning step. We frame clinical question answering as an agent problem with two explicit, retrievable resources: skills, reusable clinical procedures such as guidelines, protocols, and pharmacologic mechanisms; and experience, verified reasoning trajectories from previously solved cases (e.g., chain-of-thought solutions and their step-level decompositions). At test time, the agent retrieves both relevant skills and experiences from curated libraries and performs lightweight test-time adaptation to align the language model's intermediate reasoning with clinically valid logic. Concretely, we build (i) a skills library from guideline-style documents organized as executable decision rules, (ii) an experience library of exemplar clinical reasoning chains indexed by step-level transitions, and (iii) a step-aware retriever that selects the most useful skill and experience items for the current case. We then adapt the model on the retrieved items to reduce instance-step misalignment and to prevent reasoning from drifting toward unsupported shortcuts. Experiments on medical question-answering benchmarks show consistent gains over strong medical RAG baselines and prompting-only reasoning methods. Our results suggest that explicitly separating and retrieving clinical skills and experience, and then aligning the model at test time, is a practical approach to more reliable medical agents.