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Taking the PULSE of Medical Reasoning: Step-Level Retrieval Timing for Knowledge-Grounded Inference

2026-10-14 14:47:03
Danyang Zhao, Sendong Zhao, Yanrui Du, Haochun Wang, Ming Ma, Wenhao Li, Jingbo Wang, Jiatong Liu, Bing Qin

Abstract

Reliable medical reasoning requires LLMs to dynamically access external biomedical evidence to improve factual trustworthiness and reasoning accuracy. However, indiscriminate retrieval can introduce noise and latency, raising a critical retrieval-timing problem: at each reasoning step, the system must decide whether the model's internal knowledge is reliable or external evidence is needed. We propose PUlSE, a lightweight probing method that uses the model's internal representations as intrinsic signals for step-level retrieval control. Our posterior trajectory analysis reveals that erroneous steps exhibit substantially higher inter-layer volatility than correct ones, suggesting unstable internal knowledge. Based on this finding, PUlSE trains a compact probe on inter-layer geometric features to detect factual errors upon step completion, and uses it as an adaptive trigger for retrieval and step regeneration. Across four medical benchmarks, PUlSE-timed retrieval matches exhaustive per-step retrieval in accuracy while reducing retrieval calls by 72%, and can transfer to an unseen legal domain, indicating potential domain-agnostic generality. Overall, our study provides an initial step toward shifting retrieval-trigger design from surface-level confidence estimates to internal activation dynamics for adaptive access.

Abstract (translated)

URL

https://arxiv.org/abs/2610.20292

PDF

https://arxiv.org/pdf/2610.20292.pdf


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