# Learning When to Trust Medical Knowledge: Regression-Safe Routing for Clinical Reasoning

arXiv: https://arxiv.org/abs/2610.19663 · HTML: https://mlsanity.com/paper/2610.19663/

## 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 24 references that are in the map.
- First posted on arXiv 14 Oct 2026.

## Placed in

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

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

- [Retrieval-Augmented Generation for Knowledge-Intensive NLP Tasks](https://mlsanity.com/paper/2005.11401/) (2020)
- [Dense Passage Retrieval for Open-Domain Question Answering](https://mlsanity.com/paper/2004.04906/) (2020)
- [REALM: Retrieval-Augmented Language Model Pre-Training](https://mlsanity.com/paper/2002.08909/) (2020)
- [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)
- [When Not to Trust Language Models: Investigating Effectiveness of Parametric and Non-Parametric Memories](https://mlsanity.com/paper/2212.10511/) (2022)
- [Meta-learners for Estimating Heterogeneous Treatment Effects using Machine Learning](https://mlsanity.com/paper/1706.03461/) (2017)
- [Adaptive-RAG: Learning to Adapt Retrieval-Augmented Large Language Models through Question Complexity](https://mlsanity.com/paper/2403.14403/) (2024)
- [FreshLLMs: Refreshing Large Language Models with Search Engine Augmentation](https://mlsanity.com/paper/2310.03214/) (2023)
- [Knowledge Conflicts for LLMs: A Survey](https://mlsanity.com/paper/2403.08319/) (2024)
- [Chain-of-Note: Enhancing Robustness in Retrieval-Augmented Language Models](https://mlsanity.com/paper/2311.09210/) (2023)
- [Certifiably Robust RAG against Retrieval Corruption](https://mlsanity.com/paper/2405.15556/) (2024)
- [MedReason: Eliciting Factual Medical Reasoning Steps in LLMs via Knowledge Graphs](https://mlsanity.com/paper/2504.00993/) (2025)
- [InstructRAG: Instructing Retrieval-Augmented Generation via Self-Synthesized Rationales](https://mlsanity.com/paper/2406.13629/) (2024)
- [From Conflict to Consensus: Boosting Medical Reasoning via Multi-Round Agentic RAG](https://mlsanity.com/paper/2603.03292/) (2026)
- [RAGRouter-Bench: A Dataset and Benchmark for Adaptive RAG Routing](https://mlsanity.com/paper/2602.00296/) (2026)
- [Exploring Knowledge Conflicts for Faithful LLM Reasoning: Benchmark and Method](https://mlsanity.com/paper/2604.11209/) (2026)

## Abstract (arXiv)

Clinical reasoning LLMs need external medical knowledge, but retrieved evidence and reasoning chains can be outdated, poisoned, or hallucinated. Harmful knowledge can cause regression: changing a correct answer into an incorrect one. We construct a medical knowledge-poisoning benchmark covering retrieved evidence and reasoning chains, with seven attack families filtered by a three-judge "subtle-but-wrong" vote and paired clean exams that separate poisoning effects from question difficulty. No fixed knowledge-use strategy is robust across these settings: strong RAG methods trade robustness to poisoned evidence against accuracy when evidence is useful. We formulate knowledge use as per-instance routing and introduce Med-TrustRouter, a lightweight controller that keeps the solver frozen. From leakage-free runtime signals, it estimates each action's expected correctness gain and uncertainty, preserving the base answer unless another action is confidently better. Across seven medical reasoning settings, Med-TrustRouter achieves 78.9 macro and 69.2 worst-case accuracy, matching the strongest competitor on macro accuracy while substantially improving the worst-case floor. Its gains transfer across solvers and evidence judges, unlike a hand-coded router using the same signals. Similar performance across linear, tree, and neural action-value heads suggests that the benefit comes from routing rather than estimator complexity. These results support learning when to trust external knowledge for robust clinical reasoning.