Evidence-Grounded Subspecialty Reasoning: Evaluating a Curated Clinical Intelligence Layer on the 2025 Endocrinology Board-Style Examination

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Auteurs principaux: Hosseinian, Amir, Shahneh, MohammadReza Zare, Mansoor, Umer, Szeto, Gilbert, Karlin, Kirill, Aghaeepour, Nima
Format: Preprint
Publié: 2026
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author Hosseinian, Amir
Shahneh, MohammadReza Zare
Mansoor, Umer
Szeto, Gilbert
Karlin, Kirill
Aghaeepour, Nima
author_facet Hosseinian, Amir
Shahneh, MohammadReza Zare
Mansoor, Umer
Szeto, Gilbert
Karlin, Kirill
Aghaeepour, Nima
contents Background: Large language models have demonstrated strong performance on general medical examinations, but subspecialty clinical reasoning remains challenging due to rapidly evolving guidelines and nuanced evidence hierarchies. Methods: We evaluated January Mirror, an evidence-grounded clinical reasoning system, against frontier LLMs (GPT-5, GPT-5.2, Gemini-3-Pro) on a 120-question endocrinology board-style examination. Mirror integrates a curated endocrinology and cardiometabolic evidence corpus with a structured reasoning architecture to generate evidence-linked outputs. Mirror operated under a closed-evidence constraint without external retrieval. Comparator LLMs had real-time web access to guidelines and primary literature. Results: Mirror achieved 87.5% accuracy (105/120; 95% CI: 80.4-92.3%), exceeding a human reference of 62.3% and frontier LLMs including GPT-5.2 (74.6%), GPT-5 (74.0%), and Gemini-3-Pro (69.8%). On the 30 most difficult questions (human accuracy less than 50%), Mirror achieved 76.7% accuracy. Top-2 accuracy was 92.5% for Mirror versus 85.25% for GPT-5.2. Conclusions: Mirror provided evidence traceability: 74.2% of outputs cited at least one guideline-tier source, with 100% citation accuracy on manual verification. Curated evidence with explicit provenance can outperform unconstrained web retrieval for subspecialty clinical reasoning and supports auditability for clinical deployment.
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id arxiv_https___arxiv_org_abs_2602_16050
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publishDate 2026
record_format arxiv
spellingShingle Evidence-Grounded Subspecialty Reasoning: Evaluating a Curated Clinical Intelligence Layer on the 2025 Endocrinology Board-Style Examination
Hosseinian, Amir
Shahneh, MohammadReza Zare
Mansoor, Umer
Szeto, Gilbert
Karlin, Kirill
Aghaeepour, Nima
Artificial Intelligence
Computation and Language
Background: Large language models have demonstrated strong performance on general medical examinations, but subspecialty clinical reasoning remains challenging due to rapidly evolving guidelines and nuanced evidence hierarchies. Methods: We evaluated January Mirror, an evidence-grounded clinical reasoning system, against frontier LLMs (GPT-5, GPT-5.2, Gemini-3-Pro) on a 120-question endocrinology board-style examination. Mirror integrates a curated endocrinology and cardiometabolic evidence corpus with a structured reasoning architecture to generate evidence-linked outputs. Mirror operated under a closed-evidence constraint without external retrieval. Comparator LLMs had real-time web access to guidelines and primary literature. Results: Mirror achieved 87.5% accuracy (105/120; 95% CI: 80.4-92.3%), exceeding a human reference of 62.3% and frontier LLMs including GPT-5.2 (74.6%), GPT-5 (74.0%), and Gemini-3-Pro (69.8%). On the 30 most difficult questions (human accuracy less than 50%), Mirror achieved 76.7% accuracy. Top-2 accuracy was 92.5% for Mirror versus 85.25% for GPT-5.2. Conclusions: Mirror provided evidence traceability: 74.2% of outputs cited at least one guideline-tier source, with 100% citation accuracy on manual verification. Curated evidence with explicit provenance can outperform unconstrained web retrieval for subspecialty clinical reasoning and supports auditability for clinical deployment.
title Evidence-Grounded Subspecialty Reasoning: Evaluating a Curated Clinical Intelligence Layer on the 2025 Endocrinology Board-Style Examination
topic Artificial Intelligence
Computation and Language
url https://arxiv.org/abs/2602.16050