Why Chain of Thought Fails in Clinical Text Understanding

arXiv — cs.CLTuesday, December 9, 2025 at 5:00:00 AM
  • A systematic study has revealed that chain-of-thought (CoT) prompting, which is often used to enhance reasoning in large language models (LLMs), fails to improve performance in clinical text understanding. The research assessed 95 advanced LLMs across 87 real-world clinical tasks, finding that 86.3% of models experienced performance degradation in CoT settings, particularly with electronic health records that are lengthy and fragmented.
  • This finding is significant as it raises concerns about the reliability of LLMs in clinical settings, where accurate and transparent reasoning is crucial for patient safety. The degradation in performance suggests that current methodologies may not be suitable for the complexities of clinical documentation, potentially impacting the deployment of AI in healthcare.
  • The challenges faced by LLMs in clinical contexts echo broader issues in AI, such as the inconsistencies in belief updating and action alignment, as well as the limitations of hierarchical instruction schemes. These recurring themes highlight the need for improved frameworks and methodologies to enhance the effectiveness of AI in specialized fields like healthcare.
— via World Pulse Now AI Editorial System

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