From Retrieval to Generation: Unifying External and Parametric Knowledge for Medical Question Answering

Medical question answering (QA) requires extensive access to domain-specific knowledge. A promising direction is to enhance large language models (LLMs) with external knowledge retrieved from medical corpora or parametric knowledge stored in model parameters. Existing approaches typically fall into two categories: Retrieval-Augmented Generation (RAG), which grounds model reasoning on externally retrieved evidence, and Generation-Augmented Generation (GAG), which depends solely on the models internal knowledge to generate contextual documents. However, RAG often suffers from noisy or incomplete retrieval, while GAG is vulnerable to hallucinated or inaccurate information due to unconstrained generation. Both issues can mislead reasoning and undermine answer reliability. To address these challenges, we propose MedRGAG, a unified retrieval-generation augmented framework that seamlessly integrates external and parametric knowledge for medical QA. MedRGAG comprises two key modules: Knowledge-Guided Context Completion (KGCC), which directs the generator to produce background documents that complement the missing knowledge revealed by retrieval; and Knowledge-Aware Document Selection (KADS), which adaptively selects an optimal combination of retrieved and generated documents to form concise yet comprehensive evidence for answer generation. Extensive experiments on five medical QA benchmarks demonstrate that MedRGAG achieves a 12.5% improvement over MedRAG and a 4.5% gain over MedGENIE, highlighting the effectiveness of unifying retrieval and generation for knowledge-intensive reasoning. Our code and data are publicly available at https://anonymous.4open.science/r/MedRGAG