Critique of Impure Reason: Unveiling the reasoning behaviour of medical Large Language Models

Background: Despite the current ubiquity of Large Language Models (LLMs) across the medical domain, there is a surprising lack of studies which address their reasoning behaviour. We emphasise the importance of understanding reasoning behaviour as opposed to high-level prediction accuracies, since it is equivalent to explainable AI (XAI) in this context. In particular, achieving XAI in medical LLMs used in the clinical domain will have a significant impact across the healthcare sector. Results: Therefore, we define the concept of reasoning behaviour in the specific context of medical LLMs. We then categorise and discuss the current state of the art of methods which evaluate reasoning behaviour in medical LLMs. Finally, we propose theoretical frameworks which can empower medical professionals or machine learning engineers to gain insight into the low-level reasoning operations of these previously obscure models. Conclusion: The subsequent increased transparency and trust in medical machine learning models by clinicians as well as patients will accelerate the integration, application as well as further development of medical AI for the healthcare system as a whole