# Reinforcement Learning for Evidence-Seeking Diagnostic Reasoning with Large Language Models

arXiv: https://arxiv.org/abs/2607.02983 · HTML: https://mlsanity.com/paper/2607.02983/

## 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 32 of its 50 references that are in the map.
- First posted on arXiv 3 Jul 2026.

## Placed in

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

## Builds on (most cited first, 30 of 32)

- [Chain-of-Thought Prompting Elicits Reasoning in Large Language Models](https://mlsanity.com/paper/2201.11903/) (2022)
- [Qwen3 Technical Report](https://mlsanity.com/paper/2505.09388/) (2025)
- [DeepSeek-R1: Incentivizing Reasoning Capability in LLMs via Reinforcement Learning](https://mlsanity.com/paper/2501.12948/) (2025)
- [Qwen2.5 Technical Report](https://mlsanity.com/paper/2412.15115/) (2024)
- [LlamaFactory: Unified Efficient Fine-Tuning of 100+ Language Models](https://mlsanity.com/paper/2403.13372/) (2024)
- [OpenAI o1 System Card](https://mlsanity.com/paper/2412.16720/) (2024)
- [Can Generalist Foundation Models Outcompete Special-Purpose Tuning? Case Study in Medicine](https://mlsanity.com/paper/2311.16452/) (2023)
- [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)
- [Deliberative Alignment: Reasoning Enables Safer Language Models](https://mlsanity.com/paper/2412.16339/) (2024)
- [HuatuoGPT-o1, Towards Medical Complex Reasoning with LLMs](https://mlsanity.com/paper/2412.18925/) (2024)
- [Reinforcement Learning with Verifiable Rewards: GRPO's Effective Loss, Dynamics, and Success Amplification](https://mlsanity.com/paper/2503.06639/) (2025)
- [DISC-MedLLM: Bridging General Large Language Models and Real-World Medical Consultation](https://mlsanity.com/paper/2308.14346/) (2023)
- [Towards Conversational Diagnostic AI](https://mlsanity.com/paper/2401.05654/) (2024)
- [OpenRLHF: An Easy-to-use, Scalable and High-performance RLHF Framework](https://mlsanity.com/paper/2405.11143/) (2024)
- [Clinical Camel: An Open Expert-Level Medical Language Model with Dialogue-Based Knowledge Encoding](https://mlsanity.com/paper/2305.12031/) (2023)
- [BianQue: Balancing the Questioning and Suggestion Ability of Health LLMs with Multi-turn Health Conversations Polished by ChatGPT](https://mlsanity.com/paper/2310.15896/) (2023)
- [MedAgentBench: A Realistic Virtual EHR Environment to Benchmark Medical LLM Agents](https://mlsanity.com/paper/2501.14654/) (2025)
- [Baichuan-M2: Scaling Medical Capability with Large Verifier System](https://mlsanity.com/paper/2509.02208/) (2025)
- [Med-RLVR: Emerging Medical Reasoning from a 3B base model via reinforcement Learning](https://mlsanity.com/paper/2502.19655/) (2025)
- [Self-Evolving Multi-Agent Simulations for Realistic Clinical Interactions](https://mlsanity.com/paper/2503.22678/) (2025)
- [O1 Replication Journey -- Part 3: Inference-time Scaling for Medical Reasoning](https://mlsanity.com/paper/2501.06458/) (2025)
- [Large Language Models are Clinical Reasoners: Reasoning-Aware Diagnosis Framework with Prompt-Generated Rationales](https://mlsanity.com/paper/2312.07399/) (2023)
- [From Medprompt to o1: Exploration of Run-Time Strategies for Medical Challenge Problems and Beyond](https://mlsanity.com/paper/2411.03590/) (2024)
- [MedS3: Towards Medical Slow Thinking with Self-Evolved Soft Dual-sided Process Supervision](https://mlsanity.com/paper/2501.12051/) (2025)
- [Ask Patients with Patience: Enabling LLMs for Human-Centric Medical Dialogue with Grounded Reasoning](https://mlsanity.com/paper/2502.07143/) (2025)
- [Fleming-R1: Toward Expert-Level Medical Reasoning via Reinforcement Learning](https://mlsanity.com/paper/2509.15279/) (2025)
- [Evolving Interactive Diagnostic Agents in a Virtual Clinical Environment](https://mlsanity.com/paper/2510.24654/) (2025)
- [Toward Effective Reinforcement Learning Fine-Tuning for Medical VQA in Vision-Language Models](https://mlsanity.com/paper/2505.13973/) (2025)
- [Open-Medical-R1: How to Choose Data for RLVR Training at Medicine Domain](https://mlsanity.com/paper/2504.13950/) (2025)
- [Reward Hacking Mitigation using Verifiable Composite Rewards](https://mlsanity.com/paper/2509.15557/) (2025)

## Abstract (arXiv)

Recent reasoning-centric Large Language Models (LLMs) have made significant strides, yet they predominantly operate on a passive-inference pattern that assumes complete information. In contrast, real-world clinical intelligence is inherently an iterative investigative process requiring strategic evidence acquisition. To bridge this gap, we formalize medical diagnosis as an Iterative Evidence-Seeking Task. We leverage Reinforcement Learning with Verifiable Rewards (RLVR) to elicit intrinsic reasoning within a closed-loop environment, guided by a novel suite of rewards that enforce diagnostic precision and examination consistency. To facilitate this, we introduce the Retrieval-Augmented Generation-based Examination Simulator (RAGES), a high-fidelity clinical oracle that provides realistic, knowledge-grounded follow-up evidence. Empirical results across diverse datasets demonstrate that our framework enables LLMs to transition from passive responders to autonomous assistants. Notably, our model demonstrates comparable performance to larger and reasoning-enhanced baselines, while RAGES proves superior to vanilla LLMs in generating biologically plausible clinical feedback.