Aligning Clinical Needs and AI Capabilities: A Survey on LLMs for Medical Reasoning
Abstract Large language models (LLMs) have emerged as important tools in healthcare, showing growing potential for clinical reasoning and patient care. This survey examines recent progress in medical LLMs, focusing on reasoning applications and requirements. We present a dual-view approach that connects clinical practice with computational methods. On the clinical side, we establish a five-level competency scheme following Miller’s Pyramid, progressing from knowledge recall to dynamic case management. On the computational side, we link deductive, inductive, and abductive reasoning patterns to common medical goals and tasks. We also introduce a benchmark dataset spanning five levels of medical reasoning capability and report results on 18 state-of-the-art models, revealing that medical specialist models excel in diagnosis-centric tasks while general models lead in decision support and dialogue. We conclude by discussing current progress and open challenges, including data limitations, hallucination, and grounding issues, and outline directions toward safer, more reliable, and more workflow-ready systems.
Authors
- Xiaoyong Wei (ORCID: https://orcid.org/0000-0001-9677-4227)
- Kecheng Gong
- J. C. Li (ORCID: https://orcid.org/0009-0000-9260-1214)
- Xiao-Yong Wei (ORCID: https://orcid.org/0000-0002-5706-5177)
- Qi Peng (ORCID: https://orcid.org/0000-0002-9223-5856)
- Sirui Huang
- Changmeng Zheng (ORCID: https://orcid.org/0000-0002-2945-8248)
- Shijie Ye (ORCID: https://orcid.org/0000-0001-6655-2295)
- Qing Li (ORCID: https://orcid.org/0000-0003-0251-9159)
- Qing Li (ORCID: https://orcid.org/0000-0003-3370-471X)
- Xiaobo Yang (ORCID: https://orcid.org/0000-0003-4585-4176)
- Ran Ding (ORCID: https://orcid.org/0000-0002-7453-8968)
- Yiyang Jiang
- Yiyang Jiang (ORCID: https://orcid.org/0009-0007-1169-4465)
- Kaisong Gong
- Jin Huang
- Ronger Ding (ORCID: https://orcid.org/0009-0005-6422-1130)
- Yi Cai
Institutions
- Hong Kong Polytechnic University (HK)
- University of Toronto (CA)
- Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
- Sichuan University (CN)
- Peking Union Medical College Hospital (CN)
- West China Hospital of Sichuan University (CN)
- University of Hong Kong (HK)
- South China University of Technology (CN)
Publication Details
- Journal
- Machine Intelligence Research
- Published
- 2026-07-31
- DOI
- https://doi.org/10.1007/s11633-026-1659-4
- Citations
- 1
- Primary Topic
- Artificial Intelligence in Healthcare and Education
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- Commonwealth Scientific and Industrial Research Organisation
- National Natural Science Foundation of China
- Natural Science Foundation of Guangdong Province
- Hunan University
- Hong Kong Polytechnic University
- Zhejiang University
- Sichuan University
- South China University of Technology
- Wuhan University
- University of Science and Technology of China
- Fundamental Research Funds for the Central Universities
- Science and Technology Planning Project of Guangdong Province
- West China Hospital, Sichuan University