Evidence-Grounded Subspecialty Reasoning: Evaluating a Curated Clinical Intelligence Layer on the 2025 Endocrinology Board-Style Examination

TL;DR

This study evaluates an evidence-grounded clinical reasoning system, Mirror, which outperforms large language models and human experts on a challenging endocrinology exam by integrating curated evidence and structured reasoning.

Contribution

The paper introduces Mirror, a novel evidence-grounded reasoning system that leverages curated clinical evidence to enhance subspecialty medical question answering.

Findings

Mirror achieved 87.5% accuracy on the exam.

Mirror outperformed GPT-5.2, GPT-5, and Gemini-3-Pro.

74.2% of Mirror's outputs cited guideline-tier sources.

Abstract

Background: Large language models have demonstrated strong performance on general medical examinations, but subspecialty clinical reasoning remains challenging due to rapidly evolving guidelines and nuanced evidence hierarchies. Methods: We evaluated January Mirror, an evidence-grounded clinical reasoning system, against frontier LLMs (GPT-5, GPT-5.2, Gemini-3-Pro) on a 120-question endocrinology board-style examination. Mirror integrates a curated endocrinology and cardiometabolic evidence corpus with a structured reasoning architecture to generate evidence-linked outputs. Mirror operated under a closed-evidence constraint without external retrieval. Comparator LLMs had real-time web access to guidelines and primary literature. Results: Mirror achieved 87.5% accuracy (105/120; 95% CI: 80.4-92.3%), exceeding a human reference of 62.3% and frontier LLMs including GPT-5.2 (74.6%), GPT-5 (74.0%), and Gemini-3-Pro (69.8%). On the 30 most difficult questions (human accuracy less than 50%), Mirror achieved 76.7% accuracy. Top-2 accuracy was 92.5% for Mirror versus 85.25% for GPT-5.2. Conclusions: Mirror provided evidence traceability: 74.2% of outputs cited at least one guideline-tier source, with 100% citation accuracy on manual verification. Curated evidence with explicit provenance can outperform unconstrained web retrieval for subspecialty clinical reasoning and supports auditability for clinical deployment.