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ACL Findings2024

Benchmarking Retrieval-Augmented Generation for Medicine

Guangzhi Xiong, Qiao Jin, Zhiyong Lu, Aidong Zhang

Abstract

While large language models (LLMs) have achieved state-of-the-art performance on a wide range of medical question answering (QA) tasks, they still face challenges with hallucinations and outdated knowledge. Retrievalaugmented generation (RAG) is a promising solution and has been widely adopted. However, a RAG system can involve multiple flexible components, and there is a lack of best practices regarding the optimal RAG setting for various medical purposes. To systematically evaluate such systems, we propose the Medical Information Retrieval-Augmented Generation Evaluation (MIRAGE), a first-of-its-kind benchmark including 7,663 questions from five medical QA datasets. Using MIRAGE, we conducted large-scale experiments with over 1.8 trillion prompt tokens on 41 combinations of different corpora, retrievers, and backbone LLMs through the MEDRAG toolkit introduced in this work. Overall, MEDRAG improves the accuracy of six different LLMs by up to 18% over chain-of-thought prompting, elevating the performance of GPT-3.5 and Mixtral to GPT-4level. Our results show that the combination of various medical corpora and retrievers achieves the best performance. In addition, we discovered a log-linear scaling property and the "lostin-the-middle" effects in medical RAG. We believe our comprehensive evaluations can serve as practical guidelines for implementing RAG systems for medicine.

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Cited by top-tier papers68

  1. RankRAG: Unifying Context Ranking with Retrieval-Augmented Generation in LLMsYue Yu, Wei Ping, Zihan Liu, Boxin Wang et al.NeurIPS 2024 · 321 citations
  2. MDAgents: An Adaptive Collaboration of LLMs for Medical Decision-MakingYubin Kim, Chanwoo Park, Hyewon Jeong, Yik Siu Chan et al.NeurIPS 2024 · 291 citations
  3. Process vs. Outcome Reward: Which is Better for Agentic RAG Reinforcement LearningWenlin Zhang, Xiangyang Li, Kuicai Dong, Yichao Wang et al.NeurIPS 2025 · 85 citations
  4. Medical Graph RAG: Evidence-based Medical Large Language Model via Graph Retrieval-Augmented GenerationJunde Wu, Jiayuan Zhu, Yunli Qi, Jingkun Chen et al.ACL 2025 · 64 citations
  5. A Systematic Survey and Critical Review on Evaluating Large Language Models: Challenges, Limitations, and RecommendationsMd. Tahmid Rahman Laskar, Sawsan Alqahtani, M. Saiful Bari, Mizanur Rahman et al.EMNLP 2024 · 47 citations

Builds on14

  1. Chain-of-Thought Prompting Elicits Reasoning in Large Language ModelsJason Wei, Xuezhi Wang, Dale Schuurmans, Maarten Bosma et al.NeurIPS 2022 · 22,562 citations
  2. Retrieval-Augmented Generation for Knowledge-Intensive NLP TasksPatrick Lewis, Ethan Perez, Aleksandra Piktus, Fabio Petroni et al.NeurIPS 2020 · 19,162 citations
  3. Measuring Massive Multitask Language UnderstandingDan Hendrycks, Collin Burns, Steven Basart, Andy Zou et al.ICLR 2021 · 7,905 citations
  4. Improving Language Models by Retrieving from Trillions of TokensSebastian Borgeaud, Arthur Mensch, Jordan Hoffmann, Trevor Cai et al.ICML 2022 · 1,629 citations
  5. Approximate Nearest Neighbor Negative Contrastive Learning for Dense Text RetrievalLee Xiong, Chenyan Xiong, Ye Li, Kwok-Fung Tang et al.ICLR 2021 · 1,547 citations

Related papers

  1. MIRAGE: Scaling Test-Time Inference with Parallel Graph-Retrieval-Augmented Reasoning ChainsKaiwen Wei, Rui Shan, Dongsheng Zou, Jianzhong Yang et al.AAAI 2026 · 5 citations
  2. MIRA: A Novel Framework for Fusing Modalities in Medical RAGJinhong Wang, Tajamul Ashraf, Zongyan Han, Jorma Laaksonen et al.ACM MM 2025 · 5 citations
  3. From Retrieval to Generation: Unifying External and Parametric Knowledge for Medical Question AnsweringLei Li, Xiao Zhou, Yingying Zhang, Xian WuWWW 2026
  4. RGAR: Recurrence Generation-augmented Retrieval for Factual-aware Medical Question AnsweringSichu Liang, Linhai Zhang, Hongyu Zhu, Wenwen Wang et al.EMNLP Findings 2025 · 9 citations
  5. From Conflict to Consensus: Boosting Medical Reasoning via Multi-Round Agentic RAGWenhao Wu, Zhentao Tang, Yafu Li, Shixiong Kai et al.ICML 2026
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