mlsanityData to 7 Oct 2026

Step-CoT: Stepwise Visual Chain-of-Thought for Medical Visual Question Answering

arXiv 2603.13878 ↗First posted 14 Mar 2026cs.CV cs.AI cs.CLcited by 2

On the map: LLM reasoning → Clinical and biomedical applications

Abstract (arXiv)

Chain-of-thought (CoT) reasoning has advanced medical visual question answering (VQA), yet most existing CoT rationales are free-form and fail to capture the structured reasoning process clinicians actually follow. This work asks: Can traceable, multi-step reasoning supervision improve reasoning accuracy and the interpretability of Medical VQA? To this end, we introduce Step-CoT, a large-scale medical reasoning dataset with expert-curated, structured multi-step CoT aligned to clinical diagnostic workflows, implicitly grounding the model's reasoning in radiographic evidence. Step-CoT comprises more than 10K real clinical cases and 70K VQA pairs organized around diagnostic workflows, providing supervised intermediate steps that guide models to follow valid reasoning trajectories. To effectively learn from Step-CoT, we further introduce a teacher-student framework with a dynamic graph-structured focusing mechanism that prioritizes diagnostically informative steps while filtering out less relevant contexts. Our experiments show that using Step-CoT can improve reasoning accuracy and interpretability. Benchmark: github.com/hahaha111111/Step-CoT. Dataset Card: huggingface.co/datasets/fl-15o/Step-CoT

Key facts. Cited by 2 papers in the map (data through 7 Oct 2026). Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning. Builds on 33 of its 51 references that are in the map. First posted on arXiv 14 Mar 2026.

Builds on

33 of 51 references.

Closest ancestors · 3

Same direction, newest first

  1. 2025ReasonMed: A 370K Multi-Agent Generated Dataset for Advancing Medical Reasoning11 Jun
  2. 2025Building a Human-Verified Clinical Reasoning Dataset via a Human LLM Hybrid Pipeline for Trustworthy Medical AI11 May
  3. 2024MedCoT: Medical Chain of Thought via Hierarchical Expert18 Dec

Other references · 30

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18 more
  1. 2025SFT Memorizes, RL Generalizes: A Comparative Study of Foundation Model Post-trainingcited by 655
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  15. 2025Reasoning with OmniThought: A Large CoT Dataset with Verbosity and Cognitive Difficulty Annotationscited by 14
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Built on by

Cited by year (2026 to 7 Oct)

Citing papers per year: 2026: 2.

2 papers.

  1. 2026LiteMedCoT-VL: Parameter-Efficient Adaptation for Medical Visual Question Answeringcited by 0
  2. 2026R3: Training Robots to Reason in Natural Language via Reinforcement Learningcited by 0

Similar, not cited

Close in wording, no citation either way

  1. 2026M3CoTBench: Benchmark Chain-of-Thought of MLLMs in Medical Image Understanding
  2. 2025S-Chain: Structured Visual Chain-of-Thought For Medicine
  3. 2025CoTBox-TTT: Grounding Medical VQA with Visual Chain-of-Thought Boxes During Test-time Training
  4. 2025MedCLM: Learning to Localize and Reason via a CoT-Curriculum in Medical Vision-Language Models
  5. 2024MC-CoT: A Modular Collaborative CoT Framework for Zero-shot Medical-VQA with LLM and MLLM Integration
  6. 2026To Reason or Not to: Selective Chain-of-Thought in Medical Question Answering
  7. 2025Reasoning Visual Language Model for Chest X-Ray Analysis
  8. 2026Beyond Visual Cues: CoT-Enhanced Reasoning for Semi-supervised Medical Image Segmentation