MedGuideX: Internalizing Decision Logic from Executable Guidelines into Large Language Models for Clinical Reasoning
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arXiv
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| Autori principali: | , , , , , , |
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| Natura: | Preprint |
| Pubblicazione: |
2026
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| _version_ | 1866918523590148096 |
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| author | Shen, Yuhao Cao, Lang Du, Simo Wang, Yuqing Zhou, Juexiao Peng, Hao Guo, Yue |
| author_facet | Shen, Yuhao Cao, Lang Du, Simo Wang, Yuqing Zhou, Juexiao Peng, Hao Guo, Yue |
| contents | Clinical practice guidelines (CPGs) encode evidence-based decision logic that clinicians apply by evaluating patient variables, conditional criteria, and recommendation rules. However, existing methods often use CPGs as free-text training data or retrieval sources, underutilizing their procedural decision structure. To better exploit this structure, we introduce a guideline-derived training pipeline that transforms CPG recommendations into executable clinical decision logic and uses it to generate factual and counterfactual question-answering data. Theses data teach models both guideline-supported decisions and how decisions change under different patient conditions. Post-training a medical LLM on the generated data yields MedGuideX. Across four clinical reasoning benchmarks, MedGuideX achieves a 10.28% relative improvement in average accuracy. Physician evaluation further shows that MedGuideX better recovers clinician authored reasoning steps and produces physician-preferred rationales in faithfulness, validity, completeness, and clarity. Overall, our results show that executable decision logic from CPGs can be transformed into scalable supervision for building reliable medical LLMs. |
| format | Preprint |
| id |
arxiv_https___arxiv_org_abs_2605_26567 |
| institution | arXiv |
| publishDate | 2026 |
| record_format | arxiv |
| spellingShingle | MedGuideX: Internalizing Decision Logic from Executable Guidelines into Large Language Models for Clinical Reasoning Shen, Yuhao Cao, Lang Du, Simo Wang, Yuqing Zhou, Juexiao Peng, Hao Guo, Yue Artificial Intelligence Clinical practice guidelines (CPGs) encode evidence-based decision logic that clinicians apply by evaluating patient variables, conditional criteria, and recommendation rules. However, existing methods often use CPGs as free-text training data or retrieval sources, underutilizing their procedural decision structure. To better exploit this structure, we introduce a guideline-derived training pipeline that transforms CPG recommendations into executable clinical decision logic and uses it to generate factual and counterfactual question-answering data. Theses data teach models both guideline-supported decisions and how decisions change under different patient conditions. Post-training a medical LLM on the generated data yields MedGuideX. Across four clinical reasoning benchmarks, MedGuideX achieves a 10.28% relative improvement in average accuracy. Physician evaluation further shows that MedGuideX better recovers clinician authored reasoning steps and produces physician-preferred rationales in faithfulness, validity, completeness, and clarity. Overall, our results show that executable decision logic from CPGs can be transformed into scalable supervision for building reliable medical LLMs. |
| title | MedGuideX: Internalizing Decision Logic from Executable Guidelines into Large Language Models for Clinical Reasoning |
| topic | Artificial Intelligence |
| url | https://arxiv.org/abs/2605.26567 |