MedGuideX: Internalizing Decision Logic from Executable Guidelines into Large Language Models for Clinical Reasoning

Computer Science > Artificial Intelligence [Submitted on 26 May 2026] MedGuideX: Internalizing Decision Logic from Executable Guidelines into Large Language Models for Clinical Reasoning Yuhao Shen, Lang Cao, Simo Du, Yuqing Wang, Juexiao Zhou, Hao Peng, Yue Guo 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. Subjects: Artificial Intelligence (cs.AI) Cite as: arXiv:2605.26567 [cs.AI]   (or arXiv:2605.26567v1 [cs.AI] for this version)   https://doi.org/10.48550/arXiv.2605.26567 Focus to learn more Submission history From: Yuhao Shen [view email] [v1] Tue, 26 May 2026 05:36:05 UTC (3,807 KB) Access Paper: HTML (experimental) view license Current browse context: cs.AI < prev   |   next > new | recent | 2026-05 Change to browse by: cs References & Citations NASA ADS Google Scholar Semantic Scholar Export BibTeX Citation Bookmark Bibliographic Tools Bibliographic and Citation Tools Bibliographic Explorer Toggle Bibliographic Explorer (What is the Explorer?) Connected Papers Toggle Connected Papers (What is Connected Papers?) Litmaps Toggle Litmaps (What is Litmaps?) scite.ai Toggle scite Smart Citations (What are Smart Citations?) Code, Data, Media Demos Related Papers About arXivLabs Which authors of this paper are endorsers? | Disable MathJax (What is MathJax?)