The Next Paradigm in Medical AI: A Survey of Agentic AI in Biomedicine.

Abstract

Biomedical AI is increasingly shaped by policy-bound, multi-step clinical workflows and non-stationary, multimodal data and tools. In this setting, the field is moving beyond static predictors toward agentic systems, enabled by foundation models that maintain task-relevant state and operate through a closed perceive$\rightarrow$plan$\rightarrow$act$\rightarrow$observe loop under explicit oversight. However, the field lacks a coherent account that defines biomedical agency, relates foundational model capabilities to agent behaviors, and traces the pathway from pretraining to domain-adapted, deployable systems. This survey offers such an account by synthesizing operational boundaries of agency and framing six core components (memory, planning, reflection, tool use, dialogue, and collaboration) as foundational agent-enabling capabilities that drive the transition from isolated pipelines to fully realized agents. This survey situates these perspectives along the model-building pathway, from pretraining through post-training adaptation to the orchestration mechanisms that operationalize agents. We highlight safety and governance considerations for high-stakes settings, emphasizing the fidelity of process and reasoning, uncertainty and abstention, privacy and provenance, and human oversight. Taken together, this survey provides a structured synthesis of how recent work connects foundation models to governable biomedical agentic systems and distills the recurring challenges and directions identified in the literature for reliable, accountable deployment.