Daily Papers

The meaningful use of electronic health records (EHR) continues to progress in the digital era with clinical decision support systems augmented by artificial intelligence. A priority in improving provider experience is to overcome information overload and reduce the cognitive burden so fewer medical errors and cognitive biases are introduced during patient care. One major type of medical error is diagnostic error due to systematic or predictable errors in judgment that rely on heuristics. The potential for clinical natural language processing (cNLP) to model diagnostic reasoning in humans with forward reasoning from data to diagnosis and potentially reduce the cognitive burden and medical error has not been investigated. Existing tasks to advance the science in cNLP have largely focused on information extraction and named entity recognition through classification tasks. We introduce a novel suite of tasks coined as Diagnostic Reasoning Benchmarks, DR.BENCH, as a new benchmark for developing and evaluating cNLP models with clinical diagnostic reasoning ability. The suite includes six tasks from ten publicly available datasets addressing clinical text understanding, medical knowledge reasoning, and diagnosis generation. DR.BENCH is the first clinical suite of tasks designed to be a natural language generation framework to evaluate pre-trained language models. Experiments with state-of-the-art pre-trained generative language models using large general domain models and models that were continually trained on a medical corpus demonstrate opportunities for improvement when evaluated in DR. BENCH. We share DR. BENCH as a publicly available GitLab repository with a systematic approach to load and evaluate models for the cNLP community.

Doctors and patients alike increasingly use Large Language Models (LLMs) to diagnose clinical cases. However, unlike domains such as math or coding, where correctness can be objectively defined by the final answer, medical diagnosis requires both the outcome and the reasoning process to be accurate. Currently, widely used medical benchmarks like MedQA and MMLU assess only accuracy in the final answer, overlooking the quality and faithfulness of the clinical reasoning process. To address this limitation, we introduce MedCaseReasoning, the first open-access dataset for evaluating LLMs on their ability to align with clinician-authored diagnostic reasoning. The dataset includes 14,489 diagnostic question-and-answer cases, each paired with detailed reasoning statements derived from open-access medical case reports. We evaluate state-of-the-art reasoning LLMs on MedCaseReasoning and find significant shortcomings in their diagnoses and reasoning: for instance, the top-performing open-source model, DeepSeek-R1, achieves only 48% 10-shot diagnostic accuracy and mentions only 64% of the clinician reasoning statements (recall). However, we demonstrate that fine-tuning LLMs on the reasoning traces derived from MedCaseReasoning significantly improves diagnostic accuracy and clinical reasoning recall by an average relative gain of 29% and 41%, respectively. The open-source dataset, code, and models are available at https://github.com/kevinwu23/Stanford-MedCaseReasoning.

The emergence of groundbreaking large language models capable of performing complex reasoning tasks holds significant promise for addressing various scientific challenges, including those arising in complex clinical scenarios. To enable their safe and effective deployment in real-world healthcare settings, it is urgently necessary to benchmark the diagnostic capabilities of current models systematically. Given the limitations of existing medical benchmarks in evaluating advanced diagnostic reasoning, we present DiagnosisArena, a comprehensive and challenging benchmark designed to rigorously assess professional-level diagnostic competence. DiagnosisArena consists of 1,113 pairs of segmented patient cases and corresponding diagnoses, spanning 28 medical specialties, deriving from clinical case reports published in 10 top-tier medical journals. The benchmark is developed through a meticulous construction pipeline, involving multiple rounds of screening and review by both AI systems and human experts, with thorough checks conducted to prevent data leakage. Our study reveals that even the most advanced reasoning models, o3-mini, o1, and DeepSeek-R1, achieve only 45.82%, 31.09%, and 17.79% accuracy, respectively. This finding highlights a significant generalization bottleneck in current large language models when faced with clinical diagnostic reasoning challenges. Through DiagnosisArena, we aim to drive further advancements in AIs diagnostic reasoning capabilities, enabling more effective solutions for real-world clinical diagnostic challenges. We provide the benchmark and evaluation tools for further research and development https://github.com/SPIRAL-MED/DiagnosisArena.

Recent advances in semi-supervised semantic segmentation have been heavily reliant on pseudo labeling to compensate for limited labeled data, disregarding the valuable relational knowledge among semantic concepts. To bridge this gap, we devise LogicDiag, a brand new neural-logic semi-supervised learning framework. Our key insight is that conflicts within pseudo labels, identified through symbolic knowledge, can serve as strong yet commonly ignored learning signals. LogicDiag resolves such conflicts via reasoning with logic-induced diagnoses, enabling the recovery of (potentially) erroneous pseudo labels, ultimately alleviating the notorious error accumulation problem. We showcase the practical application of LogicDiag in the data-hungry segmentation scenario, where we formalize the structured abstraction of semantic concepts as a set of logic rules. Extensive experiments on three standard semi-supervised semantic segmentation benchmarks demonstrate the effectiveness and generality of LogicDiag. Moreover, LogicDiag highlights the promising opportunities arising from the systematic integration of symbolic reasoning into the prevalent statistical, neural learning approaches.

Large language models (LLMs) hold significant potential for mental health support, capable of generating empathetic responses and simulating therapeutic conversations. However, existing LLM-based approaches often lack the clinical grounding necessary for real-world psychological counseling, particularly in explicit diagnostic reasoning aligned with standards like the DSM/ICD and incorporating diverse therapeutic modalities beyond basic empathy or single strategies. To address these critical limitations, we propose PsyLLM, the first large language model designed to systematically integrate both diagnostic and therapeutic reasoning for mental health counseling. To develop the PsyLLM, we propose a novel automated data synthesis pipeline. This pipeline processes real-world mental health posts, generates multi-turn dialogue structures, and leverages LLMs guided by international diagnostic standards (e.g., DSM/ICD) and multiple therapeutic frameworks (e.g., CBT, ACT, psychodynamic) to simulate detailed clinical reasoning processes. Rigorous multi-dimensional filtering ensures the generation of high-quality, clinically aligned dialogue data. In addition, we introduce a new benchmark and evaluation protocol, assessing counseling quality across four key dimensions: comprehensiveness, professionalism, authenticity, and safety. Our experiments demonstrate that PsyLLM significantly outperforms state-of-the-art baseline models on this benchmark.

Recent progress in Large Vision-Language Models (LVLMs) has enabled promising applications in medical tasks, such as report generation and visual question answering. However, existing benchmarks focus mainly on the final diagnostic answer, offering limited insight into whether models engage in clinically meaningful reasoning. To address this, we present CheXStruct and CXReasonBench, a structured pipeline and benchmark built on the publicly available MIMIC-CXR-JPG dataset. CheXStruct automatically derives a sequence of intermediate reasoning steps directly from chest X-rays, such as segmenting anatomical regions, deriving anatomical landmarks and diagnostic measurements, computing diagnostic indices, and applying clinical thresholds. CXReasonBench leverages this pipeline to evaluate whether models can perform clinically valid reasoning steps and to what extent they can learn from structured guidance, enabling fine-grained and transparent assessment of diagnostic reasoning. The benchmark comprises 18,988 QA pairs across 12 diagnostic tasks and 1,200 cases, each paired with up to 4 visual inputs, and supports multi-path, multi-stage evaluation including visual grounding via anatomical region selection and diagnostic measurements. Even the strongest of 10 evaluated LVLMs struggle with structured reasoning and generalization, often failing to link abstract knowledge with anatomically grounded visual interpretation. The code is available at https://github.com/ttumyche/CXReasonBench

Electrocardiography plays a central role in cardiovascular diagnostics, yet existing automated approaches often struggle to generalize across clinical tasks and offer limited support for open-ended reasoning. We present DiagECG, a novel framework that integrates time-series and language modeling by enabling large language models to process 12-lead ECG signals for clinical text generation tasks. Our approach discretizes continuous ECG embeddings into symbolic tokens using a lead-independent encoder and quantization module. These tokens are then used to extend the vocabulary of LLM, allowing the model to handle both ECG and natural language inputs in a unified manner. To bridge the modality gap, we pretrain the model on an autoregressive ECG forecasting task, enabling the LLM to model temporal dynamics using its native language modeling capabilities. Finally, we perform instruction tuning on both ECG question answering and diagnostic report generation. Without modifying the core model, DiagECG achieves strong performance across tasks while maintaining generalization to out-of-distribution settings. Extensive experiments demonstrate the effectiveness of each component and highlight the potential of integrating symbolic ECG representations into LLMs for medical reasoning.

The differential diagnosis of neurodegenerative dementias is a challenging clinical task, mainly because of the overlap in symptom presentation and the similarity of patterns observed in structural neuroimaging. To improve diagnostic efficiency and accuracy, deep learning-based methods such as Convolutional Neural Networks and Vision Transformers have been proposed for the automatic classification of brain MRIs. However, despite their strong predictive performance, these models find limited clinical utility due to their opaque decision making. In this work, we propose a framework that integrates two core components to enhance diagnostic transparency. First, we introduce a modular pipeline for converting 3D T1-weighted brain MRIs into textual radiology reports. Second, we explore the potential of modern Large Language Models (LLMs) to assist clinicians in the differential diagnosis between Frontotemporal dementia subtypes, Alzheimer's disease, and normal aging based on the generated reports. To bridge the gap between predictive accuracy and explainability, we employ reinforcement learning to incentivize diagnostic reasoning in LLMs. Without requiring supervised reasoning traces or distillation from larger models, our approach enables the emergence of structured diagnostic rationales grounded in neuroimaging findings. Unlike post-hoc explainability methods that retrospectively justify model decisions, our framework generates diagnostic rationales as part of the inference process-producing causally grounded explanations that inform and guide the model's decision-making process. In doing so, our framework matches the diagnostic performance of existing deep learning methods while offering rationales that support its diagnostic conclusions.

Accurate diagnosis with medical large language models is hindered by knowledge gaps and hallucinations. Retrieval and tool-augmented methods help, but their impact is limited by weak use of external knowledge and poor feedback-reasoning traceability. To address these challenges, We introduce Deep-DxSearch, an agentic RAG system trained end-to-end with reinforcement learning (RL) that enables steer tracebale retrieval-augmented reasoning for medical diagnosis. In Deep-DxSearch, we first construct a large-scale medical retrieval corpus comprising patient records and reliable medical knowledge sources to support retrieval-aware reasoning across diagnostic scenarios. More crutially, we frame the LLM as the core agent and the retrieval corpus as its environment, using tailored rewards on format, retrieval, reasoning structure, and diagnostic accuracy, thereby evolving the agentic RAG policy from large-scale data through RL. Experiments demonstrate that our end-to-end agentic RL training framework consistently outperforms prompt-engineering and training-free RAG approaches across multiple data centers. After training, Deep-DxSearch achieves substantial gains in diagnostic accuracy, surpassing strong diagnostic baselines such as GPT-4o, DeepSeek-R1, and other medical-specific frameworks for both common and rare disease diagnosis under in-distribution and out-of-distribution settings. Moreover, ablation studies on reward design and retrieval corpus components confirm their critical roles, underscoring the uniqueness and effectiveness of our approach compared with traditional implementations. Finally, case studies and interpretability analyses highlight improvements in Deep-DxSearch's diagnostic policy, providing deeper insight into its performance gains and supporting clinicians in delivering more reliable and precise preliminary diagnoses. See https://github.com/MAGIC-AI4Med/Deep-DxSearch.

Rare diseases collectively affect over 300 million individuals worldwide, yet timely and accurate diagnosis remains a pervasive challenge. This is largely due to their clinical heterogeneity, low individual prevalence, and the limited familiarity most clinicians have with rare conditions. Here, we introduce DeepRare, the first rare disease diagnosis agentic system powered by a large language model (LLM), capable of processing heterogeneous clinical inputs. The system generates ranked diagnostic hypotheses for rare diseases, each accompanied by a transparent chain of reasoning that links intermediate analytic steps to verifiable medical evidence. DeepRare comprises three key components: a central host with a long-term memory module; specialized agent servers responsible for domain-specific analytical tasks integrating over 40 specialized tools and web-scale, up-to-date medical knowledge sources, ensuring access to the most current clinical information. This modular and scalable design enables complex diagnostic reasoning while maintaining traceability and adaptability. We evaluate DeepRare on eight datasets. The system demonstrates exceptional diagnostic performance among 2,919 diseases, achieving 100% accuracy for 1013 diseases. In HPO-based evaluations, DeepRare significantly outperforms other 15 methods, like traditional bioinformatics diagnostic tools, LLMs, and other agentic systems, achieving an average Recall@1 score of 57.18% and surpassing the second-best method (Reasoning LLM) by a substantial margin of 23.79 percentage points. For multi-modal input scenarios, DeepRare achieves 70.60% at Recall@1 compared to Exomiser's 53.20% in 109 cases. Manual verification of reasoning chains by clinical experts achieves 95.40% agreements. Furthermore, the DeepRare system has been implemented as a user-friendly web application http://raredx.cn/doctor.

Multimodal large language models (MLLMs) demonstrate significant potential in the field of medical diagnosis. However, they face critical challenges in specialized domains such as ophthalmology, particularly the fragmentation of annotation granularity and inconsistencies in clinical reasoning logic, which hinder precise cross-modal understanding. This paper introduces FundusExpert, an ophthalmology-specific MLLM with integrated positioning-diagnosis reasoning capabilities, along with FundusGen, a dataset constructed through the intelligent Fundus-Engine system. Fundus-Engine automates localization and leverages MLLM-based semantic expansion to integrate global disease classification, local object detection, and fine-grained feature analysis within a single fundus image. Additionally, by constructing a clinically aligned cognitive chain, it guides the model to generate interpretable reasoning paths. FundusExpert, fine-tuned with instruction data from FundusGen, achieves the best performance in ophthalmic question-answering tasks, surpassing the average accuracy of the 40B MedRegA by 26.6%. It also excels in zero-shot report generation tasks, achieving a clinical consistency of 77.0%, significantly outperforming GPT-4o's 47.6%. Furthermore, we reveal a scaling law between data quality and model capability (L propto N^{0.068}), demonstrating that the cognitive alignment annotations in FundusGen enhance data utilization efficiency. By integrating region-level localization with diagnostic reasoning chains, our work develops a scalable, clinically-aligned MLLM and explores a pathway toward bridging the visual-language gap in specific MLLMs. Our project can be found at https://github.com/MeteorElf/FundusExpert.

Explanations for AI models in high-stakes domains like medicine often lack verifiability, which can hinder trust. To address this, we propose an interactive agent that produces explanations through an auditable sequence of actions. The agent learns a policy to strategically seek external visual evidence to support its diagnostic reasoning. This policy is optimized using reinforcement learning, resulting in a model that is both efficient and generalizable. Our experiments show that this action-based reasoning process significantly improves calibrated accuracy, reducing the Brier score by 18\% compared to a non-interactive baseline. To validate the faithfulness of the agent's explanations, we introduce a causal intervention method. By masking the visual evidence the agent chooses to use, we observe a measurable degradation in its performance (DeltaBrier=+0.029), confirming that the evidence is integral to its decision-making process. Our work provides a practical framework for building AI systems with verifiable and faithful reasoning capabilities.

Current Vision-Language Models (VLMs) struggle to ground anatomical regions in 3D medical images and reason about them in a step-by-step manner, a key requirement of real-world diagnostic assessment. This ability is essential for aligning model outputs with the diagnostic workflows clinicians use in practice, enabling trustworthy clinician-AI collaboration. Existing 3D datasets provide localization labels, but none support this "grounded reasoning" ability. To address this gap, we introduce 3DReasonKnee, the first 3D grounded reasoning dataset for medical images, which provides 494k high-quality quintuples derived from 7,970 3D knee MRI volumes. Each quintuple includes: (1) the 3D MRI volume, (2) a diagnostic question targeting a specific anatomical region (3) a 3D bounding box localizing the relevant anatomical structures, (4) clinician-generated diagnostic reasoning steps that explicitly detail the 3D reasoning process, and (5) structured severity assessments for the relevant anatomical region. The creation and validation of 3DReasonKnee, involving over 450 hours of expert clinician time for manually segmenting MRIs and generating reasoning chains, ensures its superior quality and clinical relevance. We establish ReasonKnee-Bench to evaluate localization and diagnostic accuracy, providing insight into VLM ability to perform grounding and severity assessment across anatomical regions and diagnostic inquiries. We benchmark five state-of-the-art VLMs, providing baseline performance for ReasonKnee-Bench. By providing this unique resource of expert-annotated 3D reasoning pathways, 3DReasonKnee serves as a repository of orthopedic surgeons' diagnostic expertise and offers a vital testbed for advancing multimodal medical AI systems towards 3D, clinically aligned, localized decision-making capabilities. The dataset can be found in: https://huggingface.co/datasets/rajpurkarlab/3DReasonKnee

Recent advances in reasoning with large language models (LLMs)has shown remarkable reasoning capabilities in domains such as mathematics and coding, yet their application to clinical diagnosis remains underexplored. Here, we introduce ClinicalGPT-R1, a reasoning enhanced generalist large language model for disease diagnosis. Trained on a dataset of 20,000 real-world clinical records, ClinicalGPT-R1 leverages diverse training strategies to enhance diagnostic reasoning. To benchmark performance, we curated MedBench-Hard, a challenging dataset spanning seven major medical specialties and representative diseases. Experimental results demonstrate that ClinicalGPT-R1 outperforms GPT-4o in Chinese diagnostic tasks and achieves comparable performance to GPT-4 in English settings. This comparative study effectively validates the superior performance of ClinicalGPT-R1 in disease diagnosis tasks. Resources are available at https://github.com/medfound/medfound.

In many real-world applications, deployed models encounter inputs that differ from the data seen during training. Out-of-distribution detection identifies whether an input stems from an unseen distribution, while open-world recognition flags such inputs to ensure the system remains robust as ever-emerging, previously unknown categories appear and must be addressed without retraining. Foundation and vision-language models are pre-trained on large and diverse datasets with the expectation of broad generalization across domains, including medical imaging. However, benchmarking these models on test sets with only a few common outlier types silently collapses the evaluation back to a closed-set problem, masking failures on rare or truly novel conditions encountered in clinical use. We therefore present NOVA, a challenging, real-life evaluation-only benchmark of sim900 brain MRI scans that span 281 rare pathologies and heterogeneous acquisition protocols. Each case includes rich clinical narratives and double-blinded expert bounding-box annotations. Together, these enable joint assessment of anomaly localisation, visual captioning, and diagnostic reasoning. Because NOVA is never used for training, it serves as an extreme stress-test of out-of-distribution generalisation: models must bridge a distribution gap both in sample appearance and in semantic space. Baseline results with leading vision-language models (GPT-4o, Gemini 2.0 Flash, and Qwen2.5-VL-72B) reveal substantial performance drops across all tasks, establishing NOVA as a rigorous testbed for advancing models that can detect, localize, and reason about truly unknown anomalies.

Accurate and interpretable multi-disease diagnosis remains a critical challenge in medical research, particularly when leveraging heterogeneous multimodal medical data. Current approaches often rely on single-modal data, limiting their ability to comprehensively understand complex diseases. To address this, we propose MedTVT-R1, a novel Multimodal Large Language Model (MLLM) framework designed to integrate clinical multimodal data for reasoning and diagnosing multiple diseases. We construct MedTVT-QA, a curated instruction dataset that provides question-answer pairs for physiological-level interpretations and disease-level diagnoses with a Chain of Evidence approach. MedTVT-R1 incorporates a modality perception layer to capture inter-modal dependencies and adaptively weight modality contributions. Additionally, we employ Group Relative Policy Optimization (GRPO)-based Reinforcement Fine-Tuning with a Jaccard Reward function to enhance diagnostic reasoning. Experimental results demonstrate MedTVT-R1's superiority in multimodal feature utilization and multi-disease diagnosis, offering significant potential for clinical applications such as diagnostic report generation and comorbidity reasoning. The dataset and code are available at https://github.com/keke-nice/MedTVT-R1.

Medical Visual Question Answering (Med-VQA) holds significant potential for clinical decision support, yet existing efforts primarily focus on 2D imaging with limited task diversity. This paper presents 3D-RAD, a large-scale dataset designed to advance 3D Med-VQA using radiology CT scans. The 3D-RAD dataset encompasses six diverse VQA tasks: anomaly detection, image observation, medical computation, existence detection, static temporal diagnosis, and longitudinal temporal diagnosis. It supports both open- and closed-ended questions while introducing complex reasoning challenges, including computational tasks and multi-stage temporal analysis, to enable comprehensive benchmarking. Extensive evaluations demonstrate that existing vision-language models (VLMs), especially medical VLMs exhibit limited generalization, particularly in multi-temporal tasks, underscoring the challenges of real-world 3D diagnostic reasoning. To drive future advancements, we release a high-quality training set 3D-RAD-T of 136,195 expert-aligned samples, showing that fine-tuning on this dataset could significantly enhance model performance. Our dataset and code, aiming to catalyze multimodal medical AI research and establish a robust foundation for 3D medical visual understanding, are publicly available at https://github.com/Tang-xiaoxiao/3D-RAD.

An accurate differential diagnosis (DDx) is a cornerstone of medical care, often reached through an iterative process of interpretation that combines clinical history, physical examination, investigations and procedures. Interactive interfaces powered by Large Language Models (LLMs) present new opportunities to both assist and automate aspects of this process. In this study, we introduce an LLM optimized for diagnostic reasoning, and evaluate its ability to generate a DDx alone or as an aid to clinicians. 20 clinicians evaluated 302 challenging, real-world medical cases sourced from the New England Journal of Medicine (NEJM) case reports. Each case report was read by two clinicians, who were randomized to one of two assistive conditions: either assistance from search engines and standard medical resources, or LLM assistance in addition to these tools. All clinicians provided a baseline, unassisted DDx prior to using the respective assistive tools. Our LLM for DDx exhibited standalone performance that exceeded that of unassisted clinicians (top-10 accuracy 59.1% vs 33.6%, [p = 0.04]). Comparing the two assisted study arms, the DDx quality score was higher for clinicians assisted by our LLM (top-10 accuracy 51.7%) compared to clinicians without its assistance (36.1%) (McNemar's Test: 45.7, p < 0.01) and clinicians with search (44.4%) (4.75, p = 0.03). Further, clinicians assisted by our LLM arrived at more comprehensive differential lists than those without its assistance. Our study suggests that our LLM for DDx has potential to improve clinicians' diagnostic reasoning and accuracy in challenging cases, meriting further real-world evaluation for its ability to empower physicians and widen patients' access to specialist-level expertise.

Multimodal Large Language Models (MLLMs) have exhibited immense potential across numerous medical specialties; yet, dentistry remains underexplored, in part due to limited domain-specific data, scarce dental expert annotations, insufficient modality-specific modeling, and challenges in reliability. In this paper, we present OralGPT-Omni, the first dental-specialized MLLM designed for comprehensive and trustworthy analysis across diverse dental imaging modalities and clinical tasks. To explicitly capture dentists' diagnostic reasoning, we construct TRACE-CoT, a clinically grounded chain-of-thought dataset that mirrors dental radiologists' decision-making processes. This reasoning supervision, combined with our proposed four-stage training paradigm, substantially strengthens the model's capacity for dental image understanding and analysis. In parallel, we introduce MMOral-Uni, the first unified multimodal benchmark for dental image analysis. It comprises 2,809 open-ended question-answer pairs spanning five modalities and five tasks, offering a comprehensive evaluation suite to date for MLLMs in digital dentistry. OralGPT-Omni achieves an overall score of 51.84 on the MMOral-Uni benchmark and 45.31 on the MMOral-OPG benchmark, dramatically outperforming the scores of GPT-5. Our work promotes intelligent dentistry and paves the way for future advances in dental image analysis. All code, benchmark, and models will be made publicly available.

Bridging clinical diagnostic reasoning with AI remains a central challenge in medical imaging. We introduce MedCLM, an automated pipeline that converts detection datasets into large-scale medical visual question answering (VQA) data with Chain-of-Thought (CoT) reasoning by linking lesion boxes to organ segmentation and structured rationales. These contextual signals enable medical vision-language models to generate question-answer pairs with step-by-step reasoning. To utilize this data effectively, we propose an Integrated CoT-Curriculum Strategy composed of an Easy stage with explicit lesion boxes for visual grounding, a Medium stage that encourages implicit localization, and a Hard stage for weakly supervised reasoning. Experimental results demonstrate that MedCLM attains state-of-the-art performance on several medical VQA benchmarks, providing a scalable framework for developing clinically aligned medical vision-language models.

The gigapixel scale of whole slide images (WSIs) poses a challenge for histopathology multi-modal chatbots, requiring a global WSI analysis for diagnosis, compounding evidence from different WSI patches. Current visual instruction datasets, generated through large language models, focus on creating question/answer pairs for individual image patches, which may lack diagnostic capacity on their own in histopathology, further complicated by the absence of spatial grounding in histopathology image captions. To bridge this gap, we introduce Quilt-Instruct, a large-scale dataset of 107,131 histopathology-specific instruction question/answer pairs, that is collected by leveraging educational histopathology videos from YouTube, which provides spatial localization of captions by automatically extracting narrators' cursor movements. In addition, we provide contextual reasoning by extracting diagnosis and supporting facts from the entire video content to guide the extrapolative reasoning of GPT-4. Using Quilt-Instruct, we train Quilt-LLaVA, which can reason beyond the given single image patch, enabling diagnostic reasoning and the capability of spatial awareness. To evaluate Quilt-LLaVA, we propose a comprehensive evaluation dataset created from 985 images and 1283 human-generated question-answers. We also thoroughly evaluate Quilt-LLaVA using public histopathology datasets, where Quilt-LLaVA significantly outperforms SOTA by over 10% on relative GPT-4 score and 4% and 9% on open and closed set VQA. Our code, data, and model are publicly available at quilt-llava.github.io.

Automated structured radiology report generation (SRRG) from chest X-ray images offers significant potential to reduce workload of radiologists by generating reports in structured formats that ensure clarity, consistency, and adherence to clinical reporting standards. While radiologists effectively utilize available clinical contexts in their diagnostic reasoning, existing SRRG systems overlook these essential elements. This fundamental gap leads to critical problems including temporal hallucinations when referencing non-existent clinical contexts. To address these limitations, we propose contextualized SRRG (C-SRRG) that comprehensively incorporates rich clinical context for SRRG. We curate C-SRRG dataset by integrating comprehensive clinical context encompassing 1) multi-view X-ray images, 2) clinical indication, 3) imaging techniques, and 4) prior studies with corresponding comparisons based on patient histories. Through extensive benchmarking with state-of-the-art multimodal large language models, we demonstrate that incorporating clinical context with the proposed C-SRRG significantly improves report generation quality. We publicly release dataset, code, and checkpoints to facilitate future research for clinically-aligned automated RRG at https://github.com/vuno/contextualized-srrg.

Radiology reports convey detailed clinical observations and capture diagnostic reasoning that evolves over time. However, existing evaluation methods are limited to single-report settings and rely on coarse metrics that fail to capture fine-grained clinical semantics and temporal dependencies. We introduce LUNGUAGE,a benchmark dataset for structured radiology report generation that supports both single-report evaluation and longitudinal patient-level assessment across multiple studies. It contains 1,473 annotated chest X-ray reports, each reviewed by experts, and 80 of them contain longitudinal annotations to capture disease progression and inter-study intervals, also reviewed by experts. Using this benchmark, we develop a two-stage framework that transforms generated reports into fine-grained, schema-aligned structured representations, enabling longitudinal interpretation. We also propose LUNGUAGESCORE, an interpretable metric that compares structured outputs at the entity, relation, and attribute level while modeling temporal consistency across patient timelines. These contributions establish the first benchmark dataset, structuring framework, and evaluation metric for sequential radiology reporting, with empirical results demonstrating that LUNGUAGESCORE effectively supports structured report evaluation. The code is available at: https://github.com/SuperSupermoon/Lunguage

Multimodal language models (MLMs) show promise for clinical decision support and diagnostic reasoning, raising the prospect of end-to-end automated medical image interpretation. However, clinicians are highly selective in adopting AI tools; a model that makes errors on seemingly simple perception tasks such as determining image orientation or identifying whether a CT scan is contrast-enhance are unlikely to be adopted for clinical tasks. We introduce Medblink, a benchmark designed to probe these models for such perceptual abilities. Medblink spans eight clinically meaningful tasks across multiple imaging modalities and anatomical regions, totaling 1,429 multiple-choice questions over 1,605 images. We evaluate 19 state-of-the-art MLMs, including general purpose (GPT4o, Claude 3.5 Sonnet) and domain specific (Med Flamingo, LLaVA Med, RadFM) models. While human annotators achieve 96.4% accuracy, the best-performing model reaches only 65%. These results show that current MLMs frequently fail at routine perceptual checks, suggesting the need to strengthen their visual grounding to support clinical adoption. Data is available on our project page.

LLMs for clinical decision support often fail under small but clinically meaningful input shifts such as masking a symptom or negating a finding, despite high performance on static benchmarks. These reasoning failures frequently go undetected by standard NLP metrics, which are insensitive to latent representation shifts that drive diagnosis instability. We propose a geometry-aware evaluation framework, LAPD (Latent Agentic Perturbation Diagnostics), which systematically probes the latent robustness of clinical LLMs under structured adversarial edits. Within this framework, we introduce Latent Diagnosis Flip Rate (LDFR), a model-agnostic diagnostic signal that captures representational instability when embeddings cross decision boundaries in PCA-reduced latent space. Clinical notes are generated using a structured prompting pipeline grounded in diagnostic reasoning, then perturbed along four axes: masking, negation, synonym replacement, and numeric variation to simulate common ambiguities and omissions. We compute LDFR across both foundation and clinical LLMs, finding that latent fragility emerges even under minimal surface-level changes. Finally, we validate our findings on 90 real clinical notes from the DiReCT benchmark (MIMIC-IV), confirming the generalizability of LDFR beyond synthetic settings. Our results reveal a persistent gap between surface robustness and semantic stability, underscoring the importance of geometry-aware auditing in safety-critical clinical AI.

Background: General-purpose large language models that utilize both text and images have not been evaluated on a diverse array of challenging medical cases. Methods: Using 934 cases from the NEJM Image Challenge published between 2005 and 2023, we evaluated the accuracy of the recently released Generative Pre-trained Transformer 4 with Vision model (GPT-4V) compared to human respondents overall and stratified by question difficulty, image type, and skin tone. We further conducted a physician evaluation of GPT-4V on 69 NEJM clinicopathological conferences (CPCs). Analyses were conducted for models utilizing text alone, images alone, and both text and images. Results: GPT-4V achieved an overall accuracy of 61% (95% CI, 58 to 64%) compared to 49% (95% CI, 49 to 50%) for humans. GPT-4V outperformed humans at all levels of difficulty and disagreement, skin tones, and image types; the exception was radiographic images, where performance was equivalent between GPT-4V and human respondents. Longer, more informative captions were associated with improved performance for GPT-4V but similar performance for human respondents. GPT-4V included the correct diagnosis in its differential for 80% (95% CI, 68 to 88%) of CPCs when using text alone, compared to 58% (95% CI, 45 to 70%) of CPCs when using both images and text. Conclusions: GPT-4V outperformed human respondents on challenging medical cases and was able to synthesize information from both images and text, but performance deteriorated when images were added to highly informative text. Overall, our results suggest that multimodal AI models may be useful in medical diagnostic reasoning but that their accuracy may depend heavily on context.

We investigate fine-tuning Vision-Language Models (VLMs) for multi-task medical image understanding, focusing on detection, localization, and counting of findings in medical images. Our objective is to evaluate whether instruction-tuned VLMs can simultaneously improve these tasks, with the goal of enhancing diagnostic accuracy and efficiency. Using MedMultiPoints, a multimodal dataset with annotations from endoscopy (polyps and instruments) and microscopy (sperm cells), we reformulate each task into instruction-based prompts suitable for vision-language reasoning. We fine-tune Qwen2.5-VL-7B-Instruct using Low-Rank Adaptation (LoRA) across multiple task combinations. Results show that multi-task training improves robustness and accuracy. For example, it reduces the Count Mean Absolute Error (MAE) and increases Matching Accuracy in the Counting + Pointing task. However, trade-offs emerge, such as more zero-case point predictions, indicating reduced reliability in edge cases despite overall performance gains. Our study highlights the potential of adapting general-purpose VLMs to specialized medical tasks via prompt-driven fine-tuning. This approach mirrors clinical workflows, where radiologists simultaneously localize, count, and describe findings - demonstrating how VLMs can learn composite diagnostic reasoning patterns. The model produces interpretable, structured outputs, offering a promising step toward explainable and versatile medical AI. Code, model weights, and scripts will be released for reproducibility at https://github.com/simula/PointDetectCount.

Recent research on large language models (LLMs) has primarily focused on their adaptation and application in specialized domains. The application of LLMs in the medical field is mainly concentrated on tasks such as the automation of medical report generation, summarization, diagnostic reasoning, and question-and-answer interactions between doctors and patients. The challenge of becoming a good teacher is more formidable than that of becoming a good student, and this study pioneers the application of LLMs in the field of medical education. In this work, we investigate the extent to which LLMs can generate medical qualification exam questions and corresponding answers based on few-shot prompts. Utilizing a real-world Chinese dataset of elderly chronic diseases, we tasked the LLMs with generating open-ended questions and answers based on a subset of sampled admission reports across eight widely used LLMs, including ERNIE 4, ChatGLM 4, Doubao, Hunyuan, Spark 4, Qwen, Llama 3, and Mistral. Furthermore, we engaged medical experts to manually evaluate these open-ended questions and answers across multiple dimensions. The study found that LLMs, after using few-shot prompts, can effectively mimic real-world medical qualification exam questions, whereas there is room for improvement in the correctness, evidence-based statements, and professionalism of the generated answers. Moreover, LLMs also demonstrate a decent level of ability to correct and rectify reference answers. Given the immense potential of artificial intelligence in the medical field, the task of generating questions and answers for medical qualification exams aimed at medical students, interns and residents can be a significant focus of future research.

Explainable AI (XAI) in medical histopathology is essential for enhancing the interpretability and clinical trustworthiness of deep learning models in cancer diagnosis. However, the black-box nature of these models often limits their clinical adoption. We introduce GRAPHITE (Graph-based Interpretable Tissue Examination), a post-hoc explainable framework designed for breast cancer tissue microarray (TMA) analysis. GRAPHITE employs a multiscale approach, extracting patches at various magnification levels, constructing an hierarchical graph, and utilising graph attention networks (GAT) with scalewise attention (SAN) to capture scale-dependent features. We trained the model on 140 tumour TMA cores and four benign whole slide images from which 140 benign samples were created, and tested it on 53 pathologist-annotated TMA samples. GRAPHITE outperformed traditional XAI methods, achieving a mean average precision (mAP) of 0.56, an area under the receiver operating characteristic curve (AUROC) of 0.94, and a threshold robustness (ThR) of 0.70, indicating that the model maintains high performance across a wide range of thresholds. In clinical utility, GRAPHITE achieved the highest area under the decision curve (AUDC) of 4.17e+5, indicating reliable decision support across thresholds. These results highlight GRAPHITE's potential as a clinically valuable tool in computational pathology, providing interpretable visualisations that align with the pathologists' diagnostic reasoning and support precision medicine.

Multimodal large language models (MLLMs) have made significant strides, yet they face challenges in the medical domain due to limited specialized knowledge. While recent medical MLLMs demonstrate strong performance in lab settings, they often struggle in real-world applications, highlighting a substantial gap between research and practice. In this paper, we seek to address this gap at various stages of the end-to-end learning pipeline, including data collection, model fine-tuning, and evaluation. At the data collection stage, we introduce SemiHVision, a dataset that combines human annotations with automated augmentation techniques to improve both medical knowledge representation and diagnostic reasoning. For model fine-tuning, we trained PMC-Cambrian-8B-AN over 2400 H100 GPU hours, resulting in performance that surpasses public medical models like HuatuoGPT-Vision-34B (79.0% vs. 66.7%) and private general models like Claude3-Opus (55.7%) on traditional benchmarks such as SLAKE and VQA-RAD. In the evaluation phase, we observed that traditional benchmarks cannot accurately reflect realistic clinical task capabilities. To overcome this limitation and provide more targeted guidance for model evaluation, we introduce the JAMA Clinical Challenge, a novel benchmark specifically designed to evaluate diagnostic reasoning. On this benchmark, PMC-Cambrian-AN achieves state-of-the-art performance with a GPT-4 score of 1.29, significantly outperforming HuatuoGPT-Vision-34B (1.13) and Claude3-Opus (1.17), demonstrating its superior diagnostic reasoning abilities.

This paper presents MathBode, a dynamic diagnostic for mathematical reasoning in large language models (LLMs). Instead of one-shot accuracy, MathBode treats each parametric problem as a system: we drive a single parameter sinusoidally and fit first-harmonic responses of model outputs and exact solutions. This yields interpretable, frequency-resolved metrics -- gain (amplitude tracking) and phase (lag) -- that form Bode-style fingerprints. Across five closed-form families (linear solve, ratio/saturation, compound interest, 2x2 linear systems, similar triangles), the diagnostic surfaces systematic low-pass behavior and growing phase lag that accuracy alone obscures. We compare several models against a symbolic baseline that calibrates the instrument (G approx 1, phi approx 0). Results separate frontier from mid-tier models on dynamics, providing a compact, reproducible protocol that complements standard benchmarks with actionable measurements of reasoning fidelity and consistency. We open-source the dataset and code to enable further research and adoption.

Recent advances in reasoning-enhanced large language models (LLMs) and multimodal LLMs (MLLMs) have significantly improved performance in complex tasks, yet medical AI models often overlook the structured reasoning processes inherent in clinical practice. In this work, we present ChestX-Reasoner, a radiology diagnosis MLLM designed to leverage process supervision mined directly from clinical reports, reflecting the step-by-step reasoning followed by radiologists. We construct a large dataset by extracting and refining reasoning chains from routine radiology reports. Our two-stage training framework combines supervised fine-tuning and reinforcement learning guided by process rewards to better align model reasoning with clinical standards. We introduce RadRBench-CXR, a comprehensive benchmark featuring 59K visual question answering samples with 301K clinically validated reasoning steps, and propose RadRScore, a metric evaluating reasoning factuality, completeness, and effectiveness. ChestX-Reasoner outperforms existing medical and general-domain MLLMs in both diagnostic accuracy and reasoning ability, achieving 16%, 5.9%, and 18% improvements in reasoning ability compared to the best medical MLLM, the best general MLLM, and its base model, respectively, as well as 3.3%, 24%, and 27% improvements in outcome accuracy. All resources are open-sourced to facilitate further research in medical reasoning MLLMs.

We present a comprehensive evaluation of the ability of large language models (LLMs) to process culturally grounded language, specifically to understand and pragmatically use figurative expressions that encode local knowledge and cultural nuance. Using figurative language as a proxy for cultural nuance and local knowledge, we design evaluation tasks for contextual understanding, pragmatic use, and connotation interpretation in Arabic and English. We evaluate 22 open- and closed-source LLMs on Egyptian Arabic idioms, multidialectal Arabic proverbs, and English proverbs. Our results show a consistent hierarchy: the average accuracy for Arabic proverbs is 4.29% lower than for English proverbs, and performance for Egyptian idioms is 10.28% lower than for Arabic proverbs. For the pragmatic use task, accuracy drops by 14.07% relative to understanding, though providing contextual idiomatic sentences improves accuracy by 10.66%. Models also struggle with connotative meaning, reaching at most 85.58% agreement with human annotators on idioms with 100% inter-annotator agreement. These findings demonstrate that figurative language serves as an effective diagnostic for cultural reasoning: while LLMs can often interpret figurative meaning, they face challenges in using it appropriately. To support future research, we release Kinayat, the first dataset of Egyptian Arabic idioms designed for both figurative understanding and pragmatic use evaluation.

Recent advances in vision language models (VLMs) have enabled broad progress in the general medical field. However, pathology still remains a more challenging subdomain, with current pathology specific VLMs exhibiting limitations in both diagnostic accuracy and reasoning plausibility. Such shortcomings are largely attributable to the nature of current pathology datasets, which are primarily composed of image description pairs that lack the depth and structured diagnostic paradigms employed by real world pathologists. In this study, we leverage pathology textbooks and real world pathology experts to construct high-quality, reasoning-oriented datasets. Building on this, we introduce Patho-R1, a multimodal RL-based pathology Reasoner, trained through a three-stage pipeline: (1) continued pretraining on 3.5 million image-text pairs for knowledge infusion; (2) supervised fine-tuning on 500k high-quality Chain-of-Thought samples for reasoning incentivizing; (3) reinforcement learning using Group Relative Policy Optimization and Decoupled Clip and Dynamic sAmpling Policy Optimization strategies for multimodal reasoning quality refinement. To further assess the alignment quality of our dataset, we propose PathoCLIP, trained on the same figure-caption corpus used for continued pretraining. Comprehensive experimental results demonstrate that both PathoCLIP and Patho-R1 achieve robust performance across a wide range of pathology-related tasks, including zero-shot classification, cross-modal retrieval, Visual Question Answering, and Multiple Choice Question. Our project is available at the Patho-R1 repository: https://github.com/Wenchuan-Zhang/Patho-R1.

Vision-Language Models (VLM) can support clinicians by analyzing medical images and engaging in natural language interactions to assist in diagnostic and treatment tasks. However, VLMs often exhibit "hallucinogenic" behavior, generating textual outputs not grounded in contextual multimodal information. This challenge is particularly pronounced in the medical domain, where we do not only require VLM outputs to be accurate in single interactions but also to be consistent with clinical reasoning and diagnostic pathways throughout multi-turn conversations. For this purpose, we propose a new alignment algorithm that uses symbolic representations of clinical reasoning to ground VLMs in medical knowledge. These representations are utilized to (i) generate GPT-4-guided visual instruction tuning data at scale, simulating clinician-VLM conversations with demonstrations of clinical reasoning, and (ii) create an automatic reward function that evaluates the clinical validity of VLM generations throughout clinician-VLM interactions. Our algorithm eliminates the need for human involvement in training data generation or reward model construction, reducing costs compared to standard reinforcement learning with human feedback (RLHF). We apply our alignment algorithm to develop Dr-LLaVA, a conversational VLM finetuned for analyzing bone marrow pathology slides, demonstrating strong performance in multi-turn medical conversations.

When building artificial intelligence systems that can reason and answer questions about visual data, we need diagnostic tests to analyze our progress and discover shortcomings. Existing benchmarks for visual question answering can help, but have strong biases that models can exploit to correctly answer questions without reasoning. They also conflate multiple sources of error, making it hard to pinpoint model weaknesses. We present a diagnostic dataset that tests a range of visual reasoning abilities. It contains minimal biases and has detailed annotations describing the kind of reasoning each question requires. We use this dataset to analyze a variety of modern visual reasoning systems, providing novel insights into their abilities and limitations.

Although large multimodal models (LMMs) have demonstrated remarkable capabilities in visual scene interpretation and reasoning, their capacity for complex and precise 3-dimensional spatial reasoning remains uncertain. Existing benchmarks focus predominantly on 2D spatial understanding and lack a framework to comprehensively evaluate 6D spatial reasoning across varying complexities. To address this limitation, we present PulseCheck457, a scalable and unbiased synthetic dataset designed with 4 key capability for spatial reasoning: multi-object recognition, 2D location, 3D location, and 3D orientation. We develop a cascading evaluation structure, constructing 7 question types across 5 difficulty levels that range from basic single object recognition to our new proposed complex 6D spatial reasoning tasks. We evaluated various large multimodal models (LMMs) on PulseCheck457, observing a general decline in performance as task complexity increases, particularly in 3D reasoning and 6D spatial tasks. To quantify these challenges, we introduce the Relative Performance Dropping Rate (RPDR), highlighting key weaknesses in 3D reasoning capabilities. Leveraging the unbiased attribute design of our dataset, we also uncover prediction biases across different attributes, with similar patterns observed in real-world image settings.

The recent success of natural language understanding (NLU) systems has been troubled by results highlighting the failure of these models to generalize in a systematic and robust way. In this work, we introduce a diagnostic benchmark suite, named CLUTRR, to clarify some key issues related to the robustness and systematicity of NLU systems. Motivated by classic work on inductive logic programming, CLUTRR requires that an NLU system infer kinship relations between characters in short stories. Successful performance on this task requires both extracting relationships between entities, as well as inferring the logical rules governing these relationships. CLUTRR allows us to precisely measure a model's ability for systematic generalization by evaluating on held-out combinations of logical rules, and it allows us to evaluate a model's robustness by adding curated noise facts. Our empirical results highlight a substantial performance gap between state-of-the-art NLU models (e.g., BERT and MAC) and a graph neural network model that works directly with symbolic inputs---with the graph-based model exhibiting both stronger generalization and greater robustness.

Visual Dialog is a multimodal task of answering a sequence of questions grounded in an image, using the conversation history as context. It entails challenges in vision, language, reasoning, and grounding. However, studying these subtasks in isolation on large, real datasets is infeasible as it requires prohibitively-expensive complete annotation of the 'state' of all images and dialogs. We develop CLEVR-Dialog, a large diagnostic dataset for studying multi-round reasoning in visual dialog. Specifically, we construct a dialog grammar that is grounded in the scene graphs of the images from the CLEVR dataset. This combination results in a dataset where all aspects of the visual dialog are fully annotated. In total, CLEVR-Dialog contains 5 instances of 10-round dialogs for about 85k CLEVR images, totaling to 4.25M question-answer pairs. We use CLEVR-Dialog to benchmark performance of standard visual dialog models; in particular, on visual coreference resolution (as a function of the coreference distance). This is the first analysis of its kind for visual dialog models that was not possible without this dataset. We hope the findings from CLEVR-Dialog will help inform the development of future models for visual dialog. Our dataset and code are publicly available.

Synthetic datasets have successfully been used to probe visual question-answering datasets for their reasoning abilities. CLEVR (johnson2017clevr), for example, tests a range of visual reasoning abilities. The questions in CLEVR focus on comparisons of shapes, colors, and sizes, numerical reasoning, and existence claims. This paper introduces a minimally biased, diagnostic visual question-answering dataset, QLEVR, that goes beyond existential and numerical quantification and focus on more complex quantifiers and their combinations, e.g., asking whether there are more than two red balls that are smaller than at least three blue balls in an image. We describe how the dataset was created and present a first evaluation of state-of-the-art visual question-answering models, showing that QLEVR presents a formidable challenge to our current models. Code and Dataset are available at https://github.com/zechenli03/QLEVR

We present Voice Evaluation of Reasoning Ability (VERA), a benchmark for evaluating reasoning ability in voice-interactive systems under real-time conversational constraints. VERA comprises 2,931 voice-native episodes derived from established text benchmarks and organized into five tracks (Math, Web, Science, Long-Context, Factual). Each item is adapted for speech interaction while preserving reasoning difficulty. VERA enables direct text-voice comparison within model families and supports analysis of how architectural choices affect reliability. We assess 12 contemporary voice systems alongside strong text baselines and observe large, consistent modality gaps: on competition mathematics a leading text model attains 74.8% accuracy while its voice counterpart reaches 6.1%; macro-averaged across tracks the best text models achieve 54.0% versus 11.3% for voice. Latency-accuracy analyses reveal a low-latency plateau, where fast voice systems cluster around ~10% accuracy, while approaching text performance requires sacrificing real-time interaction. Diagnostic experiments indicate that common mitigations are insufficient. Increasing "thinking time" yields negligible gains; a decoupled cascade that separates reasoning from narration improves accuracy but still falls well short of text and introduces characteristic grounding/consistency errors. Failure analyses further show distinct error signatures across native streaming, end-to-end, and cascade designs. VERA provides a reproducible testbed and targeted diagnostics for architectures that decouple thinking from speaking, offering a principled way to measure progress toward real-time voice assistants that are both fluent and reliably reasoned.

Integrating large language models (LLMs) like DeepSeek R1 into healthcare requires rigorous evaluation of their reasoning alignment with clinical expertise. This study assesses DeepSeek R1's medical reasoning against expert patterns using 100 MedQA clinical cases. The model achieved 93% diagnostic accuracy, demonstrating systematic clinical judgment through differential diagnosis, guideline-based treatment selection, and integration of patient-specific factors. However, error analysis of seven incorrect cases revealed persistent limitations: anchoring bias, challenges reconciling conflicting data, insufficient exploration of alternatives, overthinking, knowledge gaps, and premature prioritization of definitive treatment over intermediate care. Crucially, reasoning length correlated with accuracy - shorter responses (<5,000 characters) were more reliable, suggesting extended explanations may signal uncertainty or rationalization of errors. While DeepSeek R1 exhibits foundational clinical reasoning capabilities, recurring flaws highlight critical areas for refinement, including bias mitigation, knowledge updates, and structured reasoning frameworks. These findings underscore LLMs' potential to augment medical decision-making through artificial reasoning but emphasize the need for domain-specific validation, interpretability safeguards, and confidence metrics (e.g., response length thresholds) to ensure reliability in real-world applications.

Large language models have demonstrated remarkable proficiency in long and complex reasoning tasks. However, they frequently exhibit a problematic reliance on familiar reasoning patterns, a phenomenon we term reasoning rigidity. Despite explicit instructions from users, these models often override clearly stated conditions and default to habitual reasoning trajectories, leading to incorrect conclusions. This behavior presents significant challenges, particularly in domains such as mathematics and logic puzzle, where precise adherence to specified constraints is critical. To systematically investigate reasoning rigidity, a behavior largely unexplored in prior work, we introduce a expert-curated diagnostic set, . Our dataset includes specially modified variants of existing mathematical benchmarks, namely AIME and MATH500, as well as well-known puzzles deliberately redesigned to require deviation from familiar reasoning strategies. Using this dataset, we identify recurring contamination patterns that occur when models default to ingrained reasoning. Specifically, we categorize this contamination into three distinctive modes: (i) Interpretation Overload, (ii) Input Distrust, and (iii) Partial Instruction Attention, each causing models to ignore or distort provided instructions. We publicly release our diagnostic set to facilitate future research on mitigating reasoning rigidity in language models.

Large Language Models have demonstrated strong performance on many established reasoning benchmarks. However, these benchmarks primarily evaluate structured skills like quantitative problem-solving, leaving a gap in assessing flexible, multifaceted reasoning abilities that are central to human intelligence. These abilities require integrating logical deduction with spatial awareness and constraint satisfaction, which current evaluations do not measure well. To address this, we introduce RiddleBench, a benchmark of 1,737 challenging puzzles in English designed to probe these core reasoning capabilities. Evaluation of state-of-the-art models on RiddleBench shows fundamental weaknesses. Even top proprietary models like Gemini 2.5 Pro, o3, and Claude 4 Sonnet achieve accuracy just above 60% (60.30%, 63.37%, and 63.16%). Analysis further reveals deep failures, including hallucination cascades (accepting flawed reasoning from other models) and poor self-correction due to a strong self-confirmation bias. Their reasoning is also fragile, with performance degrading significantly when constraints are reordered or irrelevant information is introduced. RiddleBench functions as a diagnostic tool for these issues and as a resource for guiding the development of more robust and reliable language models.

Limited access to mental healthcare, extended wait times, and increasing capabilities of Large Language Models (LLMs) has led individuals to turn to LLMs for fulfilling their mental health needs. However, examining the multi-turn mental health conversation capabilities of LLMs remains under-explored. Existing evaluation frameworks typically focus on diagnostic accuracy and win-rates and often overlook alignment with patient-specific goals, values, and personalities required for meaningful conversations. To address this, we introduce MedAgent, a novel framework for synthetically generating realistic, multi-turn mental health sensemaking conversations and use it to create the Mental Health Sensemaking Dialogue (MHSD) dataset, comprising over 2,200 patient-LLM conversations. Additionally, we present MultiSenseEval, a holistic framework to evaluate the multi-turn conversation abilities of LLMs in healthcare settings using human-centric criteria. Our findings reveal that frontier reasoning models yield below-par performance for patient-centric communication and struggle at advanced diagnostic capabilities with average score of 31%. Additionally, we observed variation in model performance based on patient's persona and performance drop with increasing turns in the conversation. Our work provides a comprehensive synthetic data generation framework, a dataset and evaluation framework for assessing LLMs in multi-turn mental health conversations.

Medical reasoning in large language models (LLMs) aims to emulate clinicians' diagnostic thinking, but current benchmarks such as MedQA-USMLE, MedMCQA, and PubMedQA often mix reasoning with factual recall. We address this by separating 11 biomedical QA benchmarks into reasoning- and knowledge-focused subsets using a PubMedBERT classifier that reaches 81 percent accuracy, comparable to human performance. Our analysis shows that only 32.8 percent of questions require complex reasoning. We evaluate biomedical models (HuatuoGPT-o1, MedReason, m1) and general-domain models (DeepSeek-R1, o4-mini, Qwen3), finding consistent gaps between knowledge and reasoning performance. For example, m1 scores 60.5 on knowledge but only 47.1 on reasoning. In adversarial tests where models are misled with incorrect initial reasoning, biomedical models degrade sharply, while larger or RL-trained general models show more robustness. To address this, we train BioMed-R1 using fine-tuning and reinforcement learning on reasoning-heavy examples. It achieves the strongest performance among similarly sized models. Further gains may come from incorporating clinical case reports and training with adversarial and backtracking scenarios.

Multimodal large language models (MLLMs) are increasingly deployed in open-ended, real-world environments where inputs are messy, underspecified, and not always trustworthy. Unlike curated benchmarks, these settings frequently involve instructions that refer to missing objects or contradictory facts, rely on ambiguous references, or request infeasible actions. In such cases, success hinges not on task execution alone, but on a model's ability to detect when something is silently wrong. This paper presents a systematic analysis of how current MLLMs handle such implicit reasoning scenarios: cases where the flaw is not explicitly stated but must be inferred from context. Using a curated diagnostic suite spanning four categories of real-world failure modes, we evaluate six MLLMs, including o3 and GPT-4o, and find that models frequently fail to surface hidden issues, even when they possess the necessary perceptual and reasoning skills. Explicit prompting reveals that the underlying capabilities exist but are often suppressed in favor of user compliance. We further show that simple inference-time interventions, such as cautious persona prompting and, in particular, requiring a clarifying question, can dramatically recover performance. Our findings highlight a persistent gap between reasoning competence and behavioral compliance in current MLLMs and suggest practical strategies for making these models more trustworthy in underconstrained environments.

This paper introduces GeoChain, a large-scale benchmark for evaluating step-by-step geographic reasoning in multimodal large language models (MLLMs). Leveraging 1.46 million Mapillary street-level images, GeoChain pairs each image with a 21-step chain-of-thought (CoT) question sequence (over 30 million Q&A pairs). These sequences guide models from coarse attributes to fine-grained localization across four reasoning categories - visual, spatial, cultural, and precise geolocation - annotated by difficulty. Images are also enriched with semantic segmentation (150 classes) and a visual locatability score. Our benchmarking of contemporary MLLMs (GPT-4.1 variants, Claude 3.7, Gemini 2.5 variants) on a diverse 2,088-image subset reveals consistent challenges: models frequently exhibit weaknesses in visual grounding, display erratic reasoning, and struggle to achieve accurate localization, especially as the reasoning complexity escalates. GeoChain offers a robust diagnostic methodology, critical for fostering significant advancements in complex geographic reasoning within MLLMs.

Despite the successes of recent developments in visual AI, different shortcomings still exist; from missing exact logical reasoning, to abstract generalization abilities, to understanding complex and noisy scenes. Unfortunately, existing benchmarks, were not designed to capture more than a few of these aspects. Whereas deep learning datasets focus on visually complex data but simple visual reasoning tasks, inductive logic datasets involve complex logical learning tasks, however, lack the visual component. To address this, we propose the visual logical learning dataset, V-LoL, that seamlessly combines visual and logical challenges. Notably, we introduce the first instantiation of V-LoL, V-LoL-Trains, -- a visual rendition of a classic benchmark in symbolic AI, the Michalski train problem. By incorporating intricate visual scenes and flexible logical reasoning tasks within a versatile framework, V-LoL-Trains provides a platform for investigating a wide range of visual logical learning challenges. We evaluate a variety of AI systems including traditional symbolic AI, neural AI, as well as neuro-symbolic AI. Our evaluations demonstrate that even state-of-the-art AI faces difficulties in dealing with visual logical learning challenges, highlighting unique advantages and limitations specific to each methodology. Overall, V-LoL opens up new avenues for understanding and enhancing current abilities in visual logical learning for AI systems.

We propose a novel multimodal video benchmark - the Perception Test - to evaluate the perception and reasoning skills of pre-trained multimodal models (e.g. Flamingo, BEiT-3, or GPT-4). Compared to existing benchmarks that focus on computational tasks (e.g. classification, detection or tracking), the Perception Test focuses on skills (Memory, Abstraction, Physics, Semantics) and types of reasoning (descriptive, explanatory, predictive, counterfactual) across video, audio, and text modalities, to provide a comprehensive and efficient evaluation tool. The benchmark probes pre-trained models for their transfer capabilities, in a zero-shot / few-shot or limited finetuning regime. For these purposes, the Perception Test introduces 11.6k real-world videos, 23s average length, designed to show perceptually interesting situations, filmed by around 100 participants worldwide. The videos are densely annotated with six types of labels (multiple-choice and grounded video question-answers, object and point tracks, temporal action and sound segments), enabling both language and non-language evaluations. The fine-tuning and validation splits of the benchmark are publicly available (CC-BY license), in addition to a challenge server with a held-out test split. Human baseline results compared to state-of-the-art video QA models show a significant gap in performance (91.4% vs 43.6%), suggesting that there is significant room for improvement in multimodal video understanding. Dataset, baselines code, and challenge server are available at https://github.com/deepmind/perception_test

Large language models have shown promise in clinical decision making, but current approaches struggle to localize and correct errors at specific steps of the reasoning process. This limitation is critical in medicine, where identifying and addressing reasoning errors is essential for accurate diagnosis and effective patient care. We introduce Med-PRM, a process reward modeling framework that leverages retrieval-augmented generation to verify each reasoning step against established medical knowledge bases. By verifying intermediate reasoning steps with evidence retrieved from clinical guidelines and literature, our model can precisely assess the reasoning quality in a fine-grained manner. Evaluations on five medical QA benchmarks and two open-ended diagnostic tasks demonstrate that Med-PRM achieves state-of-the-art performance, with improving the performance of base models by up to 13.50% using Med-PRM. Moreover, we demonstrate the generality of Med-PRM by integrating it in a plug-and-play fashion with strong policy models such as Meerkat, achieving over 80\% accuracy on MedQA for the first time using small-scale models of 8 billion parameters. Our code and data are available at: https://med-prm.github.io/

Video Large Language Models (Video LLMs) have shown promising capabilities in video comprehension, yet they struggle with tracking temporal changes and reasoning about temporal relationships. While previous research attributed this limitation to the ineffective temporal encoding of visual inputs, our diagnostic study reveals that video representations contain sufficient information for even small probing classifiers to achieve perfect accuracy. Surprisingly, we find that the key bottleneck in Video LLMs' temporal reasoning capability stems from the underlying LLM's inherent difficulty with temporal concepts, as evidenced by poor performance on textual temporal question-answering tasks. Building on this discovery, we introduce the Textual Temporal reasoning Transfer (T3). T3 synthesizes diverse temporal reasoning tasks in pure text format from existing image-text datasets, addressing the scarcity of video samples with complex temporal scenarios. Remarkably, without using any video data, T3 enhances LongVA-7B's temporal understanding, yielding a 5.3 absolute accuracy improvement on the challenging TempCompass benchmark, which enables our model to outperform ShareGPT4Video-8B trained on 28,000 video samples. Additionally, the enhanced LongVA-7B model achieves competitive performance on comprehensive video benchmarks. For example, it achieves a 49.7 accuracy on the Temporal Reasoning task of Video-MME, surpassing powerful large-scale models such as InternVL-Chat-V1.5-20B and VILA1.5-40B. Further analysis reveals a strong correlation between textual and video temporal task performance, validating the efficacy of transferring temporal reasoning abilities from text to video domains.

We introduce FloorplanQA, a diagnostic benchmark for evaluating spatial reasoning in large-language models (LLMs). FloorplanQA is grounded in structured representations of indoor scenes, such as (e.g., kitchens, living rooms, bedrooms, bathrooms, and others), encoded symbolically in JSON or XML layouts. The benchmark covers core spatial tasks, including distance measurement, visibility, path finding, and object placement within constrained spaces. Our results across a variety of frontier open-source and commercial LLMs reveal that while models may succeed in shallow queries, they often fail to respect physical constraints, preserve spatial coherence, though they remain mostly robust to small spatial perturbations. FloorplanQA uncovers a blind spot in today's LLMs: inconsistent reasoning about indoor layouts. We hope this benchmark inspires new work on language models that can accurately infer and manipulate spatial and geometric properties in practical settings.

Multimodal Large Language Models (MLLMs) hold promise for accelerating scientific discovery by interpreting complex experimental procedures. However, their true capabilities are poorly understood, as existing benchmarks neglect the fine-grained and long-horizon nature of authentic laboratory work, especially in wet-lab settings. To bridge this gap, we introduce ExpVid, the first benchmark designed to systematically evaluate MLLMs on scientific experiment videos. Curated from peer-reviewed video publications, ExpVid features a new three-level task hierarchy that mirrors the scientific process: (1) Fine-grained Perception of tools, materials, and actions; (2) Procedural Understanding of step order and completeness; and (3) Scientific Reasoning that connects the full experiment to its published conclusions. Our vision-centric annotation pipeline, combining automated generation with multi-disciplinary expert validation, ensures that tasks require visual grounding. We evaluate 19 leading MLLMs on ExpVid and find that while they excel at coarse-grained recognition, they struggle with disambiguating fine details, tracking state changes over time, and linking experimental procedures to scientific outcomes. Our results reveal a notable performance gap between proprietary and open-source models, particularly in high-order reasoning. ExpVid not only provides a diagnostic tool but also charts a roadmap for developing MLLMs capable of becoming trustworthy partners in scientific experimentation.

The scarcity of high-quality, logically sound data is a critical bottleneck for advancing the mathematical reasoning of Large Language Models (LLMs). Our work confronts this challenge by turning decades of automated theorem proving research into a scalable data engine. Rather than relying on error-prone LLMs or complex proof-assistant syntax like Lean and Isabelle, our framework leverages E-prover's saturation capabilities on the vast TPTP axiom library to derive a massive, guaranteed-valid corpus of theorems. Our pipeline is principled and simple: saturate axioms, filter for "interesting" theorems, and generate tasks. With no LLMs in the loop, we eliminate factual errors by construction. This purely symbolic data is then transformed into three difficulty-controlled challenges: entailment verification, premise selection, and proof reconstruction. Our zero-shot experiments on frontier models reveal a clear weakness: performance collapses on tasks requiring deep, structural reasoning. Our framework provides both the diagnostic tool to measure this gap and a scalable source of symbolic training data to address it. We make the code and data publicly available. https://github.com/sileod/reasoning_core https://hf.co/datasets/reasoning-core/rc1

The rapid advancement of text-to-image (T2I) models has increased the need for reliable human preference modeling, a demand further amplified by recent progress in reinforcement learning for preference alignment. However, existing approaches typically quantify the quality of a generated image using a single scalar, limiting their ability to provide comprehensive and interpretable feedback on image quality. To address this, we introduce ImageDoctor, a unified multi-aspect T2I model evaluation framework that assesses image quality across four complementary dimensions: plausibility, semantic alignment, aesthetics, and overall quality. ImageDoctor also provides pixel-level flaw indicators in the form of heatmaps, which highlight misaligned or implausible regions, and can be used as a dense reward for T2I model preference alignment. Inspired by the diagnostic process, we improve the detail sensitivity and reasoning capability of ImageDoctor by introducing a "look-think-predict" paradigm, where the model first localizes potential flaws, then generates reasoning, and finally concludes the evaluation with quantitative scores. Built on top of a vision-language model and trained through a combination of supervised fine-tuning and reinforcement learning, ImageDoctor demonstrates strong alignment with human preference across multiple datasets, establishing its effectiveness as an evaluation metric. Furthermore, when used as a reward model for preference tuning, ImageDoctor significantly improves generation quality -- achieving an improvement of 10% over scalar-based reward models.

Recent advancements in reasoning-enhanced large language models (LLMs), such as DeepSeek-R1 and OpenAI-o3, have demonstrated significant progress. However, their application in professional medical contexts remains underexplored, particularly in evaluating the quality of their reasoning processes alongside final outputs. Here, we introduce MedR-Bench, a benchmarking dataset of 1,453 structured patient cases, annotated with reasoning references derived from clinical case reports. Spanning 13 body systems and 10 specialties, it includes both common and rare diseases. To comprehensively evaluate LLM performance, we propose a framework encompassing three critical examination recommendation, diagnostic decision-making, and treatment planning, simulating the entire patient care journey. To assess reasoning quality, we present the Reasoning Evaluator, a novel automated system that objectively scores free-text reasoning responses based on efficiency, actuality, and completeness using dynamic cross-referencing and evidence checks. Using this benchmark, we evaluate five state-of-the-art reasoning LLMs, including DeepSeek-R1, OpenAI-o3-mini, and Gemini-2.0-Flash Thinking, etc. Our results show that current LLMs achieve over 85% accuracy in relatively simple diagnostic tasks when provided with sufficient examination results. However, performance declines in more complex tasks, such as examination recommendation and treatment planning. While reasoning outputs are generally reliable, with factuality scores exceeding 90%, critical reasoning steps are frequently missed. These findings underscore both the progress and limitations of clinical LLMs. Notably, open-source models like DeepSeek-R1 are narrowing the gap with proprietary systems, highlighting their potential to drive accessible and equitable advancements in healthcare.

The emergence of vision-language models (VLMs) has opened new possibilities for clinical reasoning and has shown promising performance in dermatological diagnosis. However, their trustworthiness and clinical utility are often limited by three major factors: (1) Data heterogeneity, where diverse datasets lack consistent diagnostic labels and clinical concept annotations; (2) Absence of grounded diagnostic rationales, leading to a scarcity of reliable reasoning supervision; and (3) Limited scalability and generalization, as models trained on small, densely annotated datasets struggle to transfer nuanced reasoning to large, sparsely-annotated ones. To address these limitations, we propose SkinR1, a novel dermatological VLM that combines deep, textbook-based reasoning with the broad generalization capabilities of reinforcement learning (RL). SkinR1 systematically resolves the key challenges through a unified, end-to-end framework. First, we design a textbook-based reasoning generator that synthesizes high-fidelity, hierarchy-aware, and differential-diagnosis (DDx)-informed trajectories, providing reliable expert-level supervision. Second, we leverage the constructed trajectories for supervised fine-tuning (SFT) empowering the model with grounded reasoning ability. Third, we develop a novel RL paradigm that, by incorporating the hierarchical structure of diseases, effectively transfers these grounded reasoning patterns to large-scale, sparse data. Extensive experiments on multiple dermatology datasets demonstrate that SkinR1 achieves superior diagnostic accuracy. The ablation study demonstrates the importance of the reasoning foundation instilled by SFT.

Deep learning based automated pathological diagnosis has markedly improved diagnostic efficiency and reduced variability between observers, yet its clinical adoption remains limited by opaque model decisions and a lack of traceable rationale. To address this, recent multimodal visual reasoning architectures provide a unified framework that generates segmentation masks at the pixel level alongside semantically aligned textual explanations. By localizing lesion regions and producing expert style diagnostic narratives, these models deliver the transparent and interpretable insights necessary for dependable AI assisted pathology. Building on these advancements, we propose PathMR, a cell-level Multimodal visual Reasoning framework for Pathological image analysis. Given a pathological image and a textual query, PathMR generates expert-level diagnostic explanations while simultaneously predicting cell distribution patterns. To benchmark its performance, we evaluated our approach on the publicly available PathGen dataset as well as on our newly developed GADVR dataset. Extensive experiments on these two datasets demonstrate that PathMR consistently outperforms state-of-the-art visual reasoning methods in text generation quality, segmentation accuracy, and cross-modal alignment. These results highlight the potential of PathMR for improving interpretability in AI-driven pathological diagnosis. The code will be publicly available in https://github.com/zhangye-zoe/PathMR.

We introduce InterChart, a diagnostic benchmark that evaluates how well vision-language models (VLMs) reason across multiple related charts, a task central to real-world applications such as scientific reporting, financial analysis, and public policy dashboards. Unlike prior benchmarks focusing on isolated, visually uniform charts, InterChart challenges models with diverse question types ranging from entity inference and trend correlation to numerical estimation and abstract multi-step reasoning grounded in 2-3 thematically or structurally related charts. We organize the benchmark into three tiers of increasing difficulty: (1) factual reasoning over individual charts, (2) integrative analysis across synthetically aligned chart sets, and (3) semantic inference over visually complex, real-world chart pairs. Our evaluation of state-of-the-art open and closed-source VLMs reveals consistent and steep accuracy declines as chart complexity increases. We find that models perform better when we decompose multi-entity charts into simpler visual units, underscoring their struggles with cross-chart integration. By exposing these systematic limitations, InterChart provides a rigorous framework for advancing multimodal reasoning in complex, multi-visual environments.

Large Reasoning Models (LRMs) extend large language models with explicit, multi-step reasoning traces to enhance transparency and performance on complex tasks. However, these reasoning traces can be redundant or logically inconsistent, making them a new source of hallucination that is difficult to detect. Existing hallucination detection methods focus primarily on answer-level uncertainty and often fail to detect hallucinations or logical inconsistencies arising from the model's reasoning trace. This oversight is particularly problematic for LRMs, where the explicit thinking trace is not only an important support to the model's decision-making process but also a key source of potential hallucination. To this end, we propose RACE (Reasoning and Answer Consistency Evaluation), a novel framework specifically tailored for hallucination detection in LRMs. RACE operates by extracting essential reasoning steps and computing four diagnostic signals: inter-sample consistency of reasoning traces, entropy-based answer uncertainty, semantic alignment between reasoning and answers, and internal coherence of reasoning. This joint analysis enables fine-grained hallucination detection even when the final answer appears correct. Experiments across datasets and different LLMs demonstrate that RACE outperforms existing hallucination detection baselines, offering a robust and generalizable solution for evaluating LRMs. Our code is available at: https://github.com/bebr2/RACE.

Daily progress notes are common types in the electronic health record (EHR) where healthcare providers document the patient's daily progress and treatment plans. The EHR is designed to document all the care provided to patients, but it also enables note bloat with extraneous information that distracts from the diagnoses and treatment plans. Applications of natural language processing (NLP) in the EHR is a growing field with the majority of methods in information extraction. Few tasks use NLP methods for downstream diagnostic decision support. We introduced the 2022 National NLP Clinical Challenge (N2C2) Track 3: Progress Note Understanding - Assessment and Plan Reasoning as one step towards a new suite of tasks. The Assessment and Plan Reasoning task focuses on the most critical components of progress notes, Assessment and Plan subsections where health problems and diagnoses are contained. The goal of the task was to develop and evaluate NLP systems that automatically predict causal relations between the overall status of the patient contained in the Assessment section and its relation to each component of the Plan section which contains the diagnoses and treatment plans. The goal of the task was to identify and prioritize diagnoses as the first steps in diagnostic decision support to find the most relevant information in long documents like daily progress notes. We present the results of 2022 n2c2 Track 3 and provide a description of the data, evaluation, participation and system performance.

The Uniform Information Density (UID) hypothesis suggests that effective communication maintains a stable flow of information. In this work, we revisit this principle in the context of large language model (LLM) reasoning traces, asking whether step-level uniformity reflects reasoning quality. To this end, we propose an entropy-based stepwise information density metric and introduce two complementary measures of uniformity, local and global uniformity scores. Across the experiments on six different reasoning benchmarks, we find that step-level uniformity not only provides a strong theoretical lens but also yields practical performance benefits; for example, selecting reasoning traces with more uniform information density at the step-level improves accuracy by 10-32\% relative gains over baselines at AIME2025. Our analysis further reveals that correct reasoning traces tend to avoid sharp information density spikes, while incorrect traces exhibit irregular information bursts. These results demonstrate that UID-inspired information density measures outperform alternative internal signals as predictors of reasoning quality. Results highlight the uniformity of the information density as a robust diagnostic and selection criterion for building more reliable and accurate reasoning systems.

Incentivizing the reasoning ability of Multimodal Large Language Models (MLLMs) is essential for medical applications to transparently analyze medical scans and provide reliable diagnosis. However, existing medical MLLMs rely solely on internal knowledge during reasoning, leading to hallucinated reasoning and factual inaccuracies when encountering cases beyond their training scope. Although recent Agentic Retrieval-Augmented Generation (RAG) methods elicit the medical model's proactive retrieval ability during reasoning, they are confined to unimodal LLMs, neglecting the crucial visual information during reasoning and retrieval. Consequently, we propose the first Multimodal Medical Reasoning-with-Retrieval framework, Med-RwR, which actively retrieves external knowledge by querying observed symptoms or domain-specific medical concepts during reasoning. Specifically, we design a two-stage reinforcement learning strategy with tailored rewards that stimulate the model to leverage both visual diagnostic findings and textual clinical information for effective retrieval. Building on this foundation, we further propose a Confidence-Driven Image Re-retrieval (CDIR) method for test-time scaling when low prediction confidence is detected. Evaluation on various public medical benchmarks demonstrates Med-RwR's significant improvements over baseline models, proving the effectiveness of enhancing reasoning capabilities with external knowledge integration. Furthermore, Med-RwR demonstrates remarkable generalizability to unfamiliar domains, evidenced by 8.8% performance gain on our proposed EchoCardiography Benchmark (ECBench), despite the scarcity of echocardiography data in the training corpus. Our data, model, and codes will be made publicly available at https://github.com/xmed-lab/Med-RwR.

Dynamic graph learning methods have recently emerged as powerful tools for modelling relational data evolving through time. However, despite extensive benchmarking efforts, it remains unclear whether current Temporal Graph Neural Networks (TGNNs) effectively capture core temporal patterns such as periodicity, cause-and-effect, and long-range dependencies. In this work, we introduce the Temporal Graph Reasoning Benchmark (T-GRAB), a comprehensive set of synthetic tasks designed to systematically probe the capabilities of TGNNs to reason across time. T-GRAB provides controlled, interpretable tasks that isolate key temporal skills: counting/memorizing periodic repetitions, inferring delayed causal effects, and capturing long-range dependencies over both spatial and temporal dimensions. We evaluate 11 temporal graph learning methods on these tasks, revealing fundamental shortcomings in their ability to generalize temporal patterns. Our findings offer actionable insights into the limitations of current models, highlight challenges hidden by traditional real-world benchmarks, and motivate the development of architectures with stronger temporal reasoning abilities. The code for T-GRAB can be found at: https://github.com/alirezadizaji/T-GRAB.

Multimodal large language models (MLLMs) have shown great potential in general domains but perform poorly in some specific domains due to a lack of domain-specific data, such as image-text data or vedio-text data. In some specific domains, there is abundant graphic and textual data scattered around, but lacks standardized arrangement. In the field of medical ultrasound, there are ultrasonic diagnostic books, ultrasonic clinical guidelines, ultrasonic diagnostic reports, and so on. However, these ultrasonic materials are often saved in the forms of PDF, images, etc., and cannot be directly used for the training of MLLMs. This paper proposes a novel image-text reasoning supervised fine-tuning data generation pipeline to create specific domain quadruplets (image, question, thinking trace, and answer) from domain-specific materials. A medical ultrasound domain dataset ReMUD is established, containing over 45,000 reasoning and non-reasoning supervised fine-tuning Question Answering (QA) and Visual Question Answering (VQA) data. The ReMUD-7B model, fine-tuned on Qwen2.5-VL-7B-Instruct, outperforms general-domain MLLMs in medical ultrasound field. To facilitate research, the ReMUD dataset, data generation codebase, and ReMUD-7B parameters will be released at https://github.com/ShiDaizi/ReMUD, addressing the data shortage issue in specific domain MLLMs.

Large language models (LLMs) offer a promising pre-screening tool, improving early disease detection and providing enhanced healthcare access for underprivileged communities. The early diagnosis of various diseases continues to be a significant challenge in healthcare, primarily due to the nonspecific nature of early symptoms, the shortage of expert medical practitioners, and the need for prolonged clinical evaluations, all of which can delay treatment and adversely affect patient outcomes. With impressive accuracy in prediction across a range of diseases, LLMs have the potential to revolutionize clinical pre-screening and decision-making for various medical conditions. In this work, we study the diagnostic capability of LLMs for Rheumatoid Arthritis (RA) with real world patients data. Patient data was collected alongside diagnoses from medical experts, and the performance of LLMs was evaluated in comparison to expert diagnoses for RA disease prediction. We notice an interesting pattern in disease diagnosis and find an unexpected misalignment between prediction and explanation. We conduct a series of multi-round analyses using different LLM agents. The best-performing model accurately predicts rheumatoid arthritis (RA) diseases approximately 95\% of the time. However, when medical experts evaluated the reasoning generated by the model, they found that nearly 68\% of the reasoning was incorrect. This study highlights a clear misalignment between LLMs high prediction accuracy and its flawed reasoning, raising important questions about relying on LLM explanations in clinical settings. LLMs provide incorrect reasoning to arrive at the correct answer for RA disease diagnosis.

Large language models (LLMs) often fail to ask effective questions under uncertainty, making them unreliable in domains where proactive information-gathering is essential for decisionmaking. We present ALFA, a framework that improves LLM question-asking by (i) decomposing the notion of a "good" question into a set of theory-grounded attributes (e.g., clarity, relevance), (ii) controllably synthesizing attribute-specific question variations, and (iii) aligning models via preference-based optimization to explicitly learn to ask better questions along these fine-grained attributes. Focusing on clinical reasoning as a case study, we introduce the MediQ-AskDocs dataset, composed of 17k real-world clinical interactions augmented with 80k attribute-specific preference pairs of follow-up questions, as well as a novel expert-annotated interactive healthcare QA task to evaluate question-asking abilities. Models aligned with ALFA reduce diagnostic errors by 56.6% on MediQ-AskDocs compared to SOTA instruction-tuned LLMs, with a question-level win-rate of 64.4% and strong generalizability. Our findings suggest that explicitly guiding question-asking with structured, fine-grained attributes offers a scalable path to improve LLMs, especially in expert application domains.

Vision-Language Models (VLMs) have demonstrated remarkable progress in multimodal understanding, yet their capabilities for scientific reasoning remains inadequately assessed. Current multimodal benchmarks predominantly evaluate generic image comprehension or text-driven reasoning, lacking authentic scientific contexts that require domain-specific knowledge integration with visual evidence analysis. To fill this gap, we present CSVQA, a diagnostic multimodal benchmark specifically designed for evaluating scientific reasoning through domain-grounded visual question answering.Our benchmark features 1,378 carefully constructed question-answer pairs spanning diverse STEM disciplines, each demanding domain knowledge, integration of visual evidence, and higher-order reasoning. Compared to prior multimodal benchmarks, CSVQA places greater emphasis on real-world scientific content and complex reasoning.We additionally propose a rigorous evaluation protocol to systematically assess whether model predictions are substantiated by valid intermediate reasoning steps based on curated explanations. Our comprehensive evaluation of 15 VLMs on this benchmark reveals notable performance disparities, as even the top-ranked proprietary model attains only 49.6\% accuracy.This empirical evidence underscores the pressing need for advancing scientific reasoning capabilities in VLMs. Our CSVQA is released at https://huggingface.co/datasets/Skywork/CSVQA.

Root Cause Analysis (RCA) in mobile networks remains a challenging task due to the need for interpretability, domain expertise, and causal reasoning. In this work, we propose a lightweight framework that leverages Large Language Models (LLMs) for RCA. To do so, we introduce TeleLogs, a curated dataset of annotated troubleshooting problems designed to benchmark RCA capabilities. Our evaluation reveals that existing open-source reasoning LLMs struggle with these problems, underscoring the need for domain-specific adaptation. To address this issue, we propose a two-stage training methodology that combines supervised fine-tuning with reinforcement learning to improve the accuracy and reasoning quality of LLMs. The proposed approach fine-tunes a series of RCA models to integrate domain knowledge and generate structured, multi-step diagnostic explanations, improving both interpretability and effectiveness. Extensive experiments across multiple LLM sizes show significant performance gains over state-of-the-art reasoning and non-reasoning models, including strong generalization to randomized test variants. These results demonstrate the promise of domain-adapted, reasoning-enhanced LLMs for practical and explainable RCA in network operation and management.

Retrieval-augmented generation (RAG) is a well-suited technique for retrieving privacy-sensitive Electronic Health Records (EHR). It can serve as a key module of the healthcare copilot, helping reduce misdiagnosis for healthcare practitioners and patients. However, the diagnostic accuracy and specificity of existing heuristic-based RAG models used in the medical domain are inadequate, particularly for diseases with similar manifestations. This paper proposes MedRAG, a RAG model enhanced by knowledge graph (KG)-elicited reasoning for the medical domain that retrieves diagnosis and treatment recommendations based on manifestations. MedRAG systematically constructs a comprehensive four-tier hierarchical diagnostic KG encompassing critical diagnostic differences of various diseases. These differences are dynamically integrated with similar EHRs retrieved from an EHR database, and reasoned within a large language model. This process enables more accurate and specific decision support, while also proactively providing follow-up questions to enhance personalized medical decision-making. MedRAG is evaluated on both a public dataset DDXPlus and a private chronic pain diagnostic dataset (CPDD) collected from Tan Tock Seng Hospital, and its performance is compared against various existing RAG methods. Experimental results show that, leveraging the information integration and relational abilities of the KG, our MedRAG provides more specific diagnostic insights and outperforms state-of-the-art models in reducing misdiagnosis rates. Our code will be available at https://github.com/SNOWTEAM2023/MedRAG

Recent advances in reasoning-centric models promise improved robustness through mechanisms such as chain-of-thought prompting and test-time scaling. However, their ability to withstand misleading user input remains underexplored. In this paper, we conduct a systematic evaluation of three state-of-the-art reasoning models, i.e., OpenAI's o4-mini, Claude-3.7-Sonnet and Gemini-2.5-Flash, across three multimodal benchmarks: MMMU, MathVista, and CharXiv. Our evaluation reveals significant accuracy drops (25-29% on average) following gaslighting negation prompts, indicating that even top-tier reasoning models struggle to preserve correct answers under manipulative user feedback. Built upon the insights of the evaluation and to further probe this vulnerability, we introduce GaslightingBench-R, a new diagnostic benchmark specifically designed to evaluate reasoning models' susceptibility to defend their belief under gaslighting negation prompt. Constructed by filtering and curating 1,025 challenging samples from the existing benchmarks, GaslightingBench-R induces even more dramatic failures, with accuracy drops exceeding 53% on average. Our findings reveal fundamental limitations in the robustness of reasoning models, highlighting the gap between step-by-step reasoning and belief persistence.

Current medical retrieval benchmarks primarily emphasize lexical or shallow semantic similarity, overlooking the reasoning-intensive demands that are central to clinical decision-making. In practice, physicians often retrieve authoritative medical evidence to support diagnostic hypotheses. Such evidence typically aligns with an inferred diagnosis rather than the surface form of a patient's symptoms, leading to low lexical or semantic overlap between queries and relevant documents. To address this gap, we introduce R2MED, the first benchmark explicitly designed for reasoning-driven medical retrieval. It comprises 876 queries spanning three tasks: Q&A reference retrieval, clinical evidence retrieval, and clinical case retrieval. These tasks are drawn from five representative medical scenarios and twelve body systems, capturing the complexity and diversity of real-world medical information needs. We evaluate 15 widely-used retrieval systems on R2MED and find that even the best model achieves only 31.4 nDCG@10, demonstrating the benchmark's difficulty. Classical re-ranking and generation-augmented retrieval methods offer only modest improvements. Although large reasoning models improve performance via intermediate inference generation, the best results still peak at 41.4 nDCG@10. These findings underscore a substantial gap between current retrieval techniques and the reasoning demands of real clinical tasks. We release R2MED as a challenging benchmark to foster the development of next-generation medical retrieval systems with enhanced reasoning capabilities. Data and code are available at https://github.com/R2MED/R2MED

Recently, DALL-E, a multimodal transformer language model, and its variants (including diffusion models) have shown high-quality text-to-image generation capabilities. However, despite the interesting image generation results, there has not been a detailed analysis on how to evaluate such models. In this work, we investigate the visual reasoning capabilities and social biases of different text-to-image models, covering both multimodal transformer language models and diffusion models. First, we measure three visual reasoning skills: object recognition, object counting, and spatial relation understanding. For this, we propose PaintSkills, a compositional diagnostic dataset and evaluation toolkit that measures these skills. In our experiments, there exists a large gap between the performance of recent text-to-image models and the upper bound accuracy in object counting and spatial relation understanding skills. Second, we assess gender and skin tone biases by measuring the variance of the gender/skin tone distribution based on automated and human evaluation. We demonstrate that recent text-to-image models learn specific gender/skin tone biases from web image-text pairs. We hope that our work will help guide future progress in improving text-to-image generation models on visual reasoning skills and learning socially unbiased representations. Code and data: https://github.com/j-min/DallEval

Models like OpenAI-o3 pioneer visual grounded reasoning by dynamically referencing visual regions, just like human "thinking with images". However, no benchmark exists to evaluate these capabilities holistically. To bridge this gap, we propose TreeBench (Traceable Evidence Evaluation Benchmark), a diagnostic benchmark built on three principles: (1) focused visual perception of subtle targets in complex scenes, (2) traceable evidence via bounding box evaluation, and (3) second-order reasoning to test object interactions and spatial hierarchies beyond simple object localization. Prioritizing images with dense objects, we initially sample 1K high-quality images from SA-1B, and incorporate eight LMM experts to manually annotate questions, candidate options, and answers for each image. After three stages of quality control, TreeBench consists of 405 challenging visual question-answering pairs, even the most advanced models struggle with this benchmark, where none of them reach 60% accuracy, e.g., OpenAI-o3 scores only 54.87. Furthermore, we introduce TreeVGR (Traceable Evidence Enhanced Visual Grounded Reasoning), a training paradigm to supervise localization and reasoning jointly with reinforcement learning, enabling accurate localizations and explainable reasoning pathways. Initialized from Qwen2.5-VL-7B, it improves V* Bench (+16.8), MME-RealWorld (+12.6), and TreeBench (+13.4), proving traceability is key to advancing vision-grounded reasoning. The code is available at https://github.com/Haochen-Wang409/TreeVGR.

At the heart of medicine lies the physician-patient dialogue, where skillful history-taking paves the way for accurate diagnosis, effective management, and enduring trust. Artificial Intelligence (AI) systems capable of diagnostic dialogue could increase accessibility, consistency, and quality of care. However, approximating clinicians' expertise is an outstanding grand challenge. Here, we introduce AMIE (Articulate Medical Intelligence Explorer), a Large Language Model (LLM) based AI system optimized for diagnostic dialogue. AMIE uses a novel self-play based simulated environment with automated feedback mechanisms for scaling learning across diverse disease conditions, specialties, and contexts. We designed a framework for evaluating clinically-meaningful axes of performance including history-taking, diagnostic accuracy, management reasoning, communication skills, and empathy. We compared AMIE's performance to that of primary care physicians (PCPs) in a randomized, double-blind crossover study of text-based consultations with validated patient actors in the style of an Objective Structured Clinical Examination (OSCE). The study included 149 case scenarios from clinical providers in Canada, the UK, and India, 20 PCPs for comparison with AMIE, and evaluations by specialist physicians and patient actors. AMIE demonstrated greater diagnostic accuracy and superior performance on 28 of 32 axes according to specialist physicians and 24 of 26 axes according to patient actors. Our research has several limitations and should be interpreted with appropriate caution. Clinicians were limited to unfamiliar synchronous text-chat which permits large-scale LLM-patient interactions but is not representative of usual clinical practice. While further research is required before AMIE could be translated to real-world settings, the results represent a milestone towards conversational diagnostic AI.

Large language models (LLMs) now perform strongly on many public math suites, yet frontier separation within mathematics increasingly suffers from ceiling effects. We present two complementary benchmarks: SKYLENAGE-ReasoningMATH, a 100-item, structure-aware diagnostic set with per-item metadata on length, numeric density, and symbolic complexity; and SKYLENAGE-MATH, a 150-item contest-style suite spanning four stages from high school to doctoral under a seven-subject taxonomy. We evaluate fifteen contemporary LLM variants under a single setup and analyze subject x model and grade x model performance. On the contest suite, the strongest model reaches 44% while the runner-up reaches 37%; accuracy declines from high school to doctoral, and top systems exhibit a doctoral-to-high-school retention near 79%. On the reasoning set, the best model attains 81% overall, and hardest-slice results reveal clear robustness gaps between leaders and the mid-tier. In summary, we release SKYLENAGE-ReasoningMATH and report aggregate results for SKYLENAGE-MATH; together, SKYLENAGE provides a hard, reasoning-centered and broadly covering math benchmark with calibrated difficulty and rich metadata, serving as a reference benchmark for future evaluations of mathematical reasoning.

Recognizing and reasoning about occluded (partially or fully hidden) objects is vital to understanding visual scenes, as occlusions frequently occur in real-world environments and act as obstacles for spatial comprehension. To test models' ability to reason about multiple occluded objects, we introduce a novel task, Counting Amodally for Patterns Through Unseen REgions (CAPTURe), which requires a model to count objects arranged in a pattern by inferring how the pattern continues behind an occluder (an object which blocks parts of the scene). CAPTURe requires both recognizing visual patterns and reasoning, making it a useful testbed for evaluating vision-language models (VLMs) on whether they understand occluded patterns and possess spatial understanding skills. By requiring models to reason about occluded objects, CAPTURe also tests VLMs' ability to form world models that would allow them to fill in missing information. CAPTURe consists of two parts: (1) CAPTURe-real, with manually filtered images of real objects in patterns and (2) CAPTURe-synthetic, a controlled diagnostic with generated patterned images. We evaluate four strong VLMs (GPT-4o, Intern-VL2, Molmo, and Qwen2-VL) on CAPTURe, finding that models struggle to count on both occluded and unoccluded patterns. Crucially, we find that models perform worse with occlusion, suggesting that VLMs are also deficient in inferring unseen spatial relationships: even the strongest VLMs like GPT-4o fail to count with occlusion. In contrast, we find that humans achieve very little error on CAPTURe. We also find that providing auxiliary information of occluded object locations increases performance, underscoring that the model error comes both from an inability to handle occlusion as well as difficulty counting in images.

Radiologic diagnostic errors-under-reading errors, inattentional blindness, and communication failures-remain prevalent in clinical practice. These issues often stem from missed localized abnormalities, limited global context, and variability in report language. These challenges are amplified in 3D imaging, where clinicians must examine hundreds of slices per scan. Addressing them requires systems with precise localized detection, global volume-level reasoning, and semantically consistent natural language reporting. However, existing 3D vision-language models are unable to meet all three needs jointly, lacking local-global understanding for spatial reasoning and struggling with the variability and noise of uncurated radiology reports. We present MedVista3D, a multi-scale semantic-enriched vision-language pretraining framework for 3D CT analysis. To enable joint disease detection and holistic interpretation, MedVista3D performs local and global image-text alignment for fine-grained representation learning within full-volume context. To address report variability, we apply language model rewrites and introduce a Radiology Semantic Matching Bank for semantics-aware alignment. MedVista3D achieves state-of-the-art performance on zero-shot disease classification, report retrieval, and medical visual question answering, while transferring well to organ segmentation and prognosis prediction. Code and datasets will be released.

Recent progress in multimodal large language models (MLLMs) has demonstrated promising performance on medical benchmarks and in preliminary trials as clinical assistants. Yet, our pilot audit of diagnostic cases uncovers a critical failure mode: instability in early evidence interpretation precedes hallucination, creating branching reasoning trajectories that cascade into globally inconsistent conclusions. This highlights the need for clinical reasoning agents that constrain stochasticity and hallucination while producing auditable decision flows. We introduce MedMMV, a controllable multimodal multi-agent framework for reliable and verifiable clinical reasoning. MedMMV stabilizes reasoning through diversified short rollouts, grounds intermediate steps in a structured evidence graph under the supervision of a Hallucination Detector, and aggregates candidate paths with a Combined Uncertainty scorer. On six medical benchmarks, MedMMV improves accuracy by up to 12.7% and, more critically, demonstrates superior reliability. Blind physician evaluations confirm that MedMMV substantially increases reasoning truthfulness without sacrificing informational content. By controlling instability through a verifiable, multi-agent process, our framework provides a robust path toward deploying trustworthy AI systems in high-stakes domains like clinical decision support.

Medical Large Vision-Language Models (Med-LVLMs) have shown strong potential in multimodal diagnostic tasks. However, existing single-agent models struggle to generalize across diverse medical specialties, limiting their performance. Recent efforts introduce multi-agent collaboration frameworks inspired by clinical workflows, where general practitioners (GPs) and specialists interact in a fixed sequence. Despite improvements, these static pipelines lack flexibility and adaptability in reasoning. To address this, we propose MMedAgent-RL, a reinforcement learning (RL)-based multi-agent framework that enables dynamic, optimized collaboration among medical agents. Specifically, we train two GP agents based on Qwen2.5-VL via RL: the triage doctor learns to assign patients to appropriate specialties, while the attending physician integrates the judgments from multi-specialists and its own knowledge to make final decisions. To address the inconsistency in specialist outputs, we introduce a curriculum learning (CL)-guided RL strategy that progressively teaches the attending physician to balance between imitating specialists and correcting their mistakes. Experiments on five medical VQA benchmarks demonstrate that MMedAgent-RL not only outperforms both open-source and proprietary Med-LVLMs, but also exhibits human-like reasoning patterns. Notably, it achieves an average performance gain of 20.7% over supervised fine-tuning baselines.

Spatial reasoning is a core component of human cognition, enabling individuals to perceive, comprehend, and interact with the physical world. It relies on a nuanced understanding of spatial structures and inter-object relationships, serving as the foundation for complex reasoning and decision-making. To investigate whether current vision-language models (VLMs) exhibit similar capability, we introduce Jigsaw-Puzzles, a novel benchmark consisting of 1,100 carefully curated real-world images with high spatial complexity. Based on this dataset, we design five tasks to rigorously evaluate VLMs' spatial perception, structural understanding, and reasoning capabilities, while deliberately minimizing reliance on domain-specific knowledge to better isolate and assess the general spatial reasoning capability. We conduct a comprehensive evaluation across 24 state-of-the-art VLMs. The results show that even the strongest model, Gemini-2.5-Pro, achieves only 77.14% overall accuracy and performs particularly poorly on the Order Generation task, with only 30.00% accuracy, far below the performance exceeding 90% achieved by human participants. This persistent gap underscores the need for continued progress, positioning Jigsaw-Puzzles as a challenging and diagnostic benchmark for advancing spatial reasoning research in VLMs.

We present SpinBench, a cognitively grounded diagnostic benchmark for evaluating spatial reasoning in vision language models (VLMs). SpinBench is designed around the core challenge of spatial reasoning: perspective taking, the ability to reason about how scenes and object relations change under viewpoint transformation. Since perspective taking requires multiple cognitive capabilities, such as recognizing objects across views, relative positions grounding, and mentally simulating transformations, SpinBench introduces a set of fine-grained diagnostic categories. Our categories target translation, rotation, object relative pose, and viewpoint change, and are progressively structured so that single-object simpler tasks scaffold toward the most demanding multi-object perspective-taking setting. We evaluate 37 state-of-the-art VLMs, both proprietary and open source. Results reveal systematic weaknesses: strong egocentric bias, poor rotational understanding, and inconsistencies under symmetrical and syntactic reformulations. Scaling analysis shows both smooth improvements and emergent capabilities. While human subjects achieve high accuracy (91.2\%), task difficulty as measured by human response time shows strong correlation with VLM accuracy, indicating that SpinBench captures spatial reasoning challenges shared across humans and VLMs. We believe SpinBench provides critical insights into spatial reasoning in VLMs and highlights key gaps in their ability to reason about physical space. Our website can be found at https://spinbench25.github.io/.

We introduce CompareBench, a benchmark for evaluating visual comparison reasoning in vision-language models (VLMs), a fundamental yet understudied skill. CompareBench consists of 1000 QA pairs across four tasks: quantity (600), temporal (100), geometric (200), and spatial (100). It is derived from two auxiliary datasets that we constructed: TallyBench (2000 counting images with QA) and HistCaps (515 historical images with bilingual captions). We evaluate both closed-source APIs (OpenAI, Gemini, Claude) and open-source models (Qwen2.5-VL and Qwen3-VL series). Results show clear scaling trends but also reveal critical limitations: even the strongest models consistently fail at temporal ordering and spatial relations, and they often make mistakes in basic counting and geometric comparisons that are trivial for humans. These findings demonstrate that visual comparison remains a systematic blind spot for current VLMs. By providing controlled, diverse, and diagnostic evaluation, CompareBench establishes a foundation for advancing more reliable multimodal reasoning.

Vision-Language Models (VLMs) show promise in medical image analysis, yet their capacity for structured reasoning in complex domains like dermatology is often limited by data scarcity and the high computational cost of advanced training techniques. To address these challenges, we introduce DermIQ-VLM, a VLM developed through a multi-stage, resource-efficient methodology designed to emulate a dermatologist's diagnostic process. Our primary contribution is a modified version of Grouped Relative Policy Optimization (GRPO), called GRPO++, which stabilizes the powerful but data-intensive GRPO framework. Our proposed training pipeline first employs GRPO++ for reasoning-oriented disease recognition, followed by supervised fine-tuning for conversational ability. To mitigate factual errors introduced during this step, we then align the model using Direct Preference Optimization (DPO), leveraging a Knowledge Graph-based system as a scalable proxy for expert preference. A preliminary evaluation on a curated dermatological dataset demonstrates that our proposed methodology yields notable performance gains over standard fine-tuning approaches. These findings validate the potential of our pipeline as a feasible pathway for developing specialized, reliable VLMs in resource-constrained environments.

Chest X-ray imaging is crucial for diagnosing pulmonary and cardiac diseases, yet its interpretation demands extensive clinical experience and suffers from inter-observer variability. While deep learning models offer high diagnostic accuracy, their black-box nature hinders clinical adoption in high-stakes medical settings. To address this, we propose X-Ray-CoT (Chest X-Ray Chain-of-Thought), a novel framework leveraging Vision-Language Large Models (LVLMs) for intelligent chest X-ray diagnosis and interpretable report generation. X-Ray-CoT simulates human radiologists' "chain-of-thought" by first extracting multi-modal features and visual concepts, then employing an LLM-based component with a structured Chain-of-Thought prompting strategy to reason and produce detailed natural language diagnostic reports. Evaluated on the CORDA dataset, X-Ray-CoT achieves competitive quantitative performance, with a Balanced Accuracy of 80.52% and F1 score of 78.65% for disease diagnosis, slightly surpassing existing black-box models. Crucially, it uniquely generates high-quality, explainable reports, as validated by preliminary human evaluations. Our ablation studies confirm the integral role of each proposed component, highlighting the necessity of multi-modal fusion and CoT reasoning for robust and transparent medical AI. This work represents a significant step towards trustworthy and clinically actionable AI systems in medical imaging.

We conduct a systematic audit of three widely used reasoning benchmarks, SocialIQa, FauxPas-EAI, and ToMi, and uncover pervasive flaws in both benchmark items and evaluation methodology. Using five LLMs (GPT-{3, 3.5, 4, o1}, and LLaMA 3.1) as diagnostic tools, we identify structural, semantic, and pragmatic issues in benchmark design (e.g., duplicated items, ambiguous wording, and implausible answers), as well as scoring procedures that prioritize output form over reasoning process. Through systematic human annotation and re-evaluation on cleaned benchmark subsets, we find that model scores often improve not due to due to erratic surface wording variations and not to improved reasoning. Infact, further analyses show that model performance is highly sensitive to minor input variations such as context availability and phrasing, revealing that high scores may reflect alignment with format-specific cues rather than consistent inference based on the input. These findings challenge the validity of current benchmark-based claims about reasoning in LLMs, and highlight the need for evaluation protocols that assess reasoning as a process of drawing inference from available information, rather than as static output selection. We release audited data and evaluation tools to support more interpretable and diagnostic assessments of model reasoning.

Developing reliable AI systems to assist human clinicians in multi-modal medical diagnosis has long been a key objective for researchers. Recently, Multi-modal Large Language Models (MLLMs) have gained significant attention and achieved success across various domains. With strong reasoning capabilities and the ability to perform diverse tasks based on user instructions, they hold great potential for enhancing medical diagnosis. However, directly applying MLLMs to the medical domain still presents challenges. They lack detailed perception of visual inputs, limiting their ability to perform quantitative image analysis, which is crucial for medical diagnostics. Additionally, MLLMs often exhibit hallucinations and inconsistencies in reasoning, whereas clinical diagnoses must adhere strictly to established criteria. To address these challenges, we propose MedAgent-Pro, an evidence-based reasoning agentic system designed to achieve reliable, explainable, and precise medical diagnoses. This is accomplished through a hierarchical workflow: at the task level, knowledge-based reasoning generate reliable diagnostic plans for specific diseases following retrieved clinical criteria. While at the case level, multiple tool agents process multi-modal inputs, analyze different indicators according to the plan, and provide a final diagnosis based on both quantitative and qualitative evidence. Comprehensive experiments on both 2D and 3D medical diagnosis tasks demonstrate the superiority and effectiveness of MedAgent-Pro, while case studies further highlight its reliability and interpretability. The code is available at https://github.com/jinlab-imvr/MedAgent-Pro.

Multimodal large language models (MLLMs) have demonstrated promising prospects in healthcare, particularly for addressing complex medical tasks, supporting multidisciplinary treatment (MDT), and enabling personalized precision medicine. However, their practical deployment faces critical challenges in resource efficiency, diagnostic accuracy, clinical considerations, and ethical privacy. To address these limitations, we propose Infi-Med, a comprehensive framework for medical MLLMs that introduces three key innovations: (1) a resource-efficient approach through curating and constructing high-quality supervised fine-tuning (SFT) datasets with minimal sample requirements, with a forward-looking design that extends to both pretraining and posttraining phases; (2) enhanced multimodal reasoning capabilities for cross-modal integration and clinical task understanding; and (3) a systematic evaluation system that assesses model performance across medical modalities and task types. Our experiments demonstrate that Infi-Med achieves state-of-the-art (SOTA) performance in general medical reasoning while maintaining rapid adaptability to clinical scenarios. The framework establishes a solid foundation for deploying MLLMs in real-world healthcare settings by balancing model effectiveness with operational constraints.

Existing medical VQA benchmarks mostly focus on single-image analysis, yet clinicians almost always compare a series of images before reaching a diagnosis. To better approximate this workflow, we introduce MedFrameQA -- the first benchmark that explicitly evaluates multi-image reasoning in medical VQA. To build MedFrameQA both at scale and in high-quality, we develop 1) an automated pipeline that extracts temporally coherent frames from medical videos and constructs VQA items whose content evolves logically across images, and 2) a multiple-stage filtering strategy, including model-based and manual review, to preserve data clarity, difficulty, and medical relevance. The resulting dataset comprises 2,851 VQA pairs (gathered from 9,237 high-quality frames in 3,420 videos), covering nine human body systems and 43 organs; every question is accompanied by two to five images. We comprehensively benchmark ten advanced Multimodal LLMs -- both proprietary and open source, with and without explicit reasoning modules -- on MedFrameQA. The evaluation challengingly reveals that all models perform poorly, with most accuracies below 50%, and accuracy fluctuates as the number of images per question increases. Error analysis further shows that models frequently ignore salient findings, mis-aggregate evidence across images, and propagate early mistakes through their reasoning chains; results also vary substantially across body systems, organs, and modalities. We hope this work can catalyze research on clinically grounded, multi-image reasoning and accelerate progress toward more capable diagnostic AI systems.

Medical vision-language models (VLMs) excel at image-text understanding but typically rely on a single-pass reasoning that neglects localized visual cues. In clinical practice, however, human experts iteratively scan, focus, and refine the regions of interest before reaching a final diagnosis. To narrow this machine-human perception gap, we introduce ViTAR, a novel VLM framework that emulates the iterative reasoning process of human experts through a cognitive chain of "think-act-rethink-answer". ViTAR treats medical images as interactive objects, enabling models to engage multi-step visual reasoning. To support this approach, we curate a high-quality instruction dataset comprising 1K interactive examples that encode expert-like diagnostic behaviors. In addition, a 16K visual question answering training data has been curated towards fine-grained visual diagnosis. We introduce a two-stage training strategy that begins with supervised fine-tuning to guide cognitive trajectories, followed by the reinforcement learning to optimize decision-making. Extensive evaluations demonstrate that ViTAR outperforms strong state-of-the-art models. Visual attention analysis reveals that from the "think" to "rethink" rounds, ViTAR increasingly anchors visual grounding to clinically critical regions and maintains high attention allocation to visual tokens during reasoning, providing mechanistic insight into its improved performance. These findings demonstrate that embedding expert-style iterative thinking chains into VLMs enhances both performance and trustworthiness of medical AI.

Users typically engage with LLMs interactively, yet most existing benchmarks evaluate them in a static, single-turn format, posing reliability concerns in interactive scenarios. We identify a key obstacle towards reliability: LLMs are trained to answer any question, even with incomplete context or insufficient knowledge. In this paper, we propose to change the static paradigm to an interactive one, develop systems that proactively ask questions to gather more information and respond reliably, and introduce an benchmark - MediQ - to evaluate question-asking ability in LLMs. MediQ simulates clinical interactions consisting of a Patient System and an adaptive Expert System; with potentially incomplete initial information, the Expert refrains from making diagnostic decisions when unconfident, and instead elicits missing details via follow-up questions. We provide a pipeline to convert single-turn medical benchmarks into an interactive format. Our results show that directly prompting state-of-the-art LLMs to ask questions degrades performance, indicating that adapting LLMs to proactive information-seeking settings is nontrivial. We experiment with abstention strategies to better estimate model confidence and decide when to ask questions, improving diagnostic accuracy by 22.3%; however, performance still lags compared to an (unrealistic in practice) upper bound with complete information upfront. Further analyses show improved interactive performance with filtering irrelevant contexts and reformatting conversations. Overall, we introduce a novel problem towards LLM reliability, an interactive MediQ benchmark and a novel question-asking system, and highlight directions to extend LLMs' information-seeking abilities in critical domains.

Tool-augmented large language models (LLMs) are rapidly being integrated into real-world applications. Due to the lack of benchmarks, the community still needs to fully understand the hallucination issues within these models. To address this challenge, we introduce a comprehensive diagnostic benchmark, ToolBH. Specifically, we assess the LLM's hallucinations through two perspectives: depth and breadth. In terms of depth, we propose a multi-level diagnostic process, including (1) solvability detection, (2) solution planning, and (3) missing-tool analysis. For breadth, we consider three scenarios based on the characteristics of the toolset: missing necessary tools, potential tools, and limited functionality tools. Furthermore, we developed seven tasks and collected 700 evaluation samples through multiple rounds of manual annotation. The results show the significant challenges presented by the ToolBH benchmark. The current advanced models Gemini-1.5-Pro and GPT-4o only achieve a total score of 45.3 and 37.0, respectively, on a scale of 100. In this benchmark, larger model parameters do not guarantee better performance; the training data and response strategies also play a crucial role in tool-enhanced LLM scenarios. Our diagnostic analysis indicates that the primary reason for model errors lies in assessing task solvability. Additionally, open-weight models suffer from performance drops with verbose replies, whereas proprietary models excel with longer reasoning.

Test-time compute has empowered multimodal large language models to generate extended reasoning chains, yielding strong performance on tasks such as multimodal math reasoning. However, this improved reasoning ability often comes with increased hallucination: as generations become longer, models tend to drift away from image-grounded content and rely more heavily on language priors. Attention analysis shows that longer reasoning chains lead to reduced focus on visual inputs, which contributes to hallucination. To systematically study this phenomenon, we introduce RH-AUC, a metric that quantifies how a model's perception accuracy changes with reasoning length, allowing us to evaluate whether the model preserves visual grounding during reasoning. We also release RH-Bench, a diagnostic benchmark that spans a variety of multimodal tasks, designed to assess the trade-off between reasoning ability and hallucination. Our analysis reveals that (i) larger models typically achieve a better balance between reasoning and perception, and (ii) this balance is influenced more by the types and domains of training data than by its overall volume. These findings underscore the importance of evaluation frameworks that jointly consider both reasoning quality and perceptual fidelity.

Recent advances in general medical AI have made significant strides, but existing models often lack the reasoning capabilities needed for complex medical decision-making. This paper presents GMAI-VL-R1, a multimodal medical reasoning model enhanced by reinforcement learning (RL) to improve its reasoning abilities. Through iterative training, GMAI-VL-R1 optimizes decision-making, significantly boosting diagnostic accuracy and clinical support. We also develop a reasoning data synthesis method, generating step-by-step reasoning data via rejection sampling, which further enhances the model's generalization. Experimental results show that after RL training, GMAI-VL-R1 excels in tasks such as medical image diagnosis and visual question answering. While the model demonstrates basic memorization with supervised fine-tuning, RL is crucial for true generalization. Our work establishes new evaluation benchmarks and paves the way for future advancements in medical reasoning models. Code, data, and model will be released at https://github.com/uni-medical/GMAI-VL-R1{this link}.

Spatial intelligence is a critical frontier for Multimodal Large Language Models (MLLMs), empowering them to comprehend the physical world. Drawing inspiration from human perception mechanisms, existing studies attempt to construct a coherent spatial understanding via grid-based cognitive maps from multi-frame visual inputs. However, current grid-based map methods rely on discretized raster representations, which limit the model's ability in fine-grained spatial reasoning. To overcome this limitation, we propose Video2Layout, a framework for reconstructing metric-grounded spatial layouts from video. The framework employs continuous object boundary coordinates to quantify inter-object physical distances and object size. This empowers the model with quantitative spatial computation capabilities, effectively alleviating the inherent ambiguity when describing spatial relationships in natural language. Specifically, our method comprises two core stages. First, in supervised fine-tuning stage, we construct a high-quality dataset from the AI2THOR simulator, which enables the model to learn the mapping from visual inputs to precise boundary coordinates. Subsequently, a reinforcement fine-tuning stage further enhances the model's real-world generalization capabilities. To systematically evaluate the correlation between cognitive map accuracy and image quantity, as well as how the quantity of image inputs affects spatial reasoning accuracy, we introduce QVS-Bench, a diagnostic benchmark designed to analyze the relevant mechanisms. Evaluated on QVS-Bench and mainstream spatial reasoning benchmarks, our model, V2LO-7B achieves an average improvement of 4.92% over the model trained on grid maps, validating the superiority of our method. Our code is available at https://github.com/ybrrraway/Video2Layout.

Olympiad-level benchmarks in mathematics and physics are crucial testbeds for advanced AI reasoning, but chemistry, with its unique multimodal symbolic language, has remained an open challenge. We introduce ChemO, a new benchmark built from the International Chemistry Olympiad (IChO) 2025. ChemO features two key innovations for automated assessment: Assessment-Equivalent Reformulation (AER), which converts problems requiring visual outputs (e.g., drawing molecules) into computationally tractable formats, and Structured Visual Enhancement (SVE), a diagnostic mechanism to disentangle a model's visual perception capabilities from its core chemical reasoning. To tackle this benchmark, we propose ChemLabs, a hierarchical multi-agent framework that mimics human expert collaboration through specialized agents for problem decomposition, perception, reasoning, and auditing. Experiments on state-of-the-art multimodal models demonstrate that combining SVE with our multi-agent system yields dramatic performance gains. Our top configuration achieves a score of 93.6 out of 100, surpassing an estimated human gold medal threshold and establishing a new state-of-the-art in automated chemical problem-solving. ChemO Dataset: https://huggingface.co/datasets/IDEA-AI4SCI/ChemO

Large reasoning models (e.g., R1, o3) have demonstrated remarkable mathematical problem-solving abilities. However, the high reported accuracy of these advanced models on popular datasets, reliance on purely numerical evaluation and potential benchmark leakage, often masks their true reasoning shortcomings. To address this, we propose leveraging the inherent rigor and methodological complexity of mathematical proofs as a diagnostic tool to expose these hidden failures. Specifically, we introduce the RFMDataset (Reveal Failure Modes), a collection of 200 diverse mathematical proof problems, and thoroughly evaluate advanced models' performance on it. Our in-depth analysis of their failures uncovers 10 fine-grained error types, which shows fundamental limitations in current large reasoning models: 1) large reasoning models grapple profoundly with mathematical proofs, with some generating entirely correct proofs for less than 20% of problems and failing even on basic ones; 2) models exhibit a diverse spectrum of reasoning failures, prominently demonstrating the lack of guarantees for the correctness and rigor of single-step reasoning; and 3) models show hallucination and incompleteness during the reasoning process. Our findings reveal that models' self-reflection is insufficient to resolve the current logical dilemmas, necessitating formalized and fine-grained logical training.

While Chain-of-Thought (CoT) prompting enables sophisticated symbolic reasoning in LLMs, it remains confined to discrete text and cannot simulate the continuous, physics-governed dynamics of the real world. Recent video generation models have emerged as potential world simulators through Chain-of-Frames (CoF) reasoning -- materializing thought as frame-by-frame visual sequences, with each frame representing a physically-grounded reasoning step. Despite compelling demonstrations, a challenge persists: existing benchmarks, focusing on fidelity or alignment, do not assess CoF reasoning and thus cannot measure core cognitive abilities in multi-step planning, algorithmic logic, or abstract pattern extrapolation. This evaluation void prevents systematic understanding of model capabilities and principled guidance for improvement. We introduce Gen-ViRe (Generative Visual Reasoning Benchmark), a framework grounded in cognitive science and real-world AI applications, which decomposes CoF reasoning into six cognitive dimensions -- from perceptual logic to abstract planning -- and 24 subtasks. Through multi-source data curation, minimal prompting protocols, and hybrid VLM-assisted evaluation with detailed criteria, Gen-ViRe delivers the first quantitative assessment of video models as reasoners. Our experiments on SOTA systems reveal substantial discrepancies between impressive visual quality and actual reasoning depth, establishing baselines and diagnostic tools to advance genuine world simulators.

Building upon our previous investigations of O1 replication (Part 1: Journey Learning [Qin et al., 2024] and Part 2: Distillation [Huang et al., 2024]), this work explores the potential of inference-time scaling in large language models (LLMs) for medical reasoning tasks, ranging from diagnostic decision-making to treatment planning. Through extensive experiments on medical benchmarks of varying complexity (MedQA, Medbullets, and JAMA Clinical Challenges), our investigation reveals several key insights: (1) Increasing inference time does lead to improved performance. With a modest training set of 500 samples, our model yields substantial performance improvements of 6%-11%. (2) Task complexity directly correlates with the required length of reasoning chains, confirming the necessity of extended thought processes for challenging problems. (3) The differential diagnoses generated by our model adhere to the principles of the hypothetico-deductive method, producing a list of potential conditions that may explain a patient's symptoms and systematically narrowing these possibilities by evaluating the evidence. These findings demonstrate the promising synergy between inference-time scaling and journey learning in advancing LLMs' real-world clinical reasoning capabilities.

Medical imaging provides critical evidence for clinical diagnosis, treatment planning, and surgical decisions, yet most existing imaging models are narrowly focused and require multiple specialized networks, limiting their generalization. Although large-scale language and multimodal models exhibit strong reasoning and multi-task capabilities, real-world clinical applications demand precise visual grounding, multimodal integration, and chain-of-thought reasoning. We introduce Citrus-V, a multimodal medical foundation model that combines image analysis with textual reasoning. The model integrates detection, segmentation, and multimodal chain-of-thought reasoning, enabling pixel-level lesion localization, structured report generation, and physician-like diagnostic inference in a single framework. We propose a novel multimodal training approach and release a curated open-source data suite covering reasoning, detection, segmentation, and document understanding tasks. Evaluations demonstrate that Citrus-V outperforms existing open-source medical models and expert-level imaging systems across multiple benchmarks, delivering a unified pipeline from visual grounding to clinical reasoning and supporting precise lesion quantification, automated reporting, and reliable second opinions.

Large language models (LLMs) are increasingly being used for complex research tasks such as literature review, idea generation, and scientific paper analysis, yet their ability to truly understand and process the intricate relationships within complex research papers, such as the logical links between claims and supporting evidence remains largely unexplored. In this study, we present CLAIM-BENCH, a comprehensive benchmark for evaluating LLMs' capabilities in scientific claim-evidence extraction and validation, a task that reflects deeper comprehension of scientific argumentation. We systematically compare three approaches which are inspired by divide and conquer approaches, across six diverse LLMs, highlighting model-specific strengths and weaknesses in scientific comprehension. Through evaluation involving over 300 claim-evidence pairs across multiple research domains, we reveal significant limitations in LLMs' ability to process complex scientific content. Our results demonstrate that closed-source models like GPT-4 and Claude consistently outperform open-source counterparts in precision and recall across claim-evidence identification tasks. Furthermore, strategically designed three-pass and one-by-one prompting approaches significantly improve LLMs' abilities to accurately link dispersed evidence with claims, although this comes at increased computational cost. CLAIM-BENCH sets a new standard for evaluating scientific comprehension in LLMs, offering both a diagnostic tool and a path forward for building systems capable of deeper, more reliable reasoning across full-length papers.

Puzzlehunts are a genre of complex, multi-step puzzles lacking well-defined problem definitions. In contrast to conventional reasoning benchmarks consisting of tasks with clear instructions, puzzlehunts require models to discover the underlying problem structure from multimodal evidence and iterative reasoning, mirroring real-world domains such as scientific discovery, exploratory data analysis, or investigative problem-solving. Despite recent progress in foundation models, their performance on such open-ended settings remains largely untested. In this paper, we introduce PuzzleWorld, a large-scale benchmark of 667 puzzlehunt-style problems designed to assess step-by-step, open-ended, and creative multimodal reasoning. Each puzzle is annotated with the final solution, detailed reasoning traces, and cognitive skill labels, enabling holistic benchmarking and fine-grained diagnostic analysis. Most state-of-the-art models achieve only 1-2% final answer accuracy, with the best model solving only 14% of puzzles and reaching 40% stepwise accuracy. To demonstrate the value of our reasoning annotations, we show that fine-tuning a small model on reasoning traces improves stepwise reasoning from 4% to 11%, while training on final answers alone degrades performance to near zero. Our error analysis reveals that current models exhibit myopic reasoning, are bottlenecked by the limitations of language-based inference, and lack sketching capabilities crucial for visual and spatial reasoning. We release PuzzleWorld at https://github.com/MIT-MI/PuzzleWorld to support future work on building more general, open-ended, and creative reasoning systems.

Compared to single-turn dialogue, multi-turn dialogue involving multiple images better aligns with the needs of real-world human-AI interactions. Additionally, as training data, it provides richer contextual reasoning information, thereby guiding the model to achieve better performance. However, existing vision-language models (VLMs) primarily rely on single-turn dialogue training and evaluation benchmarks. In this paper, following the characteristics of human dialogue, such as focused topics and concise, clear content, we present MMCR (Multimodal Multi-turn Contextual Reasoning), a novel dataset comprising: (1) MMCR-310k -- the largest multi-image multi-turn instruction tuning dataset with 310K contextual dialogues, each covering 1-4 images and 4 or 8 dialogue turns; and (2) MMCR-Bench -- a diagnostic benchmark featuring dialogues, spanning 8 domains (Humanities, Natural, Science, Education, etc.) and 40 sub-topics. Extensive evaluations demonstrate that models fine-tuned with MMCR-310k achieve 5.2\% higher contextual accuracy on MMCR-Bench, while showing consistent improvements on existing benchmarks (+1.1\% on AI2D, +1.2\% on MMMU and MMVet). MMCR and prompt engineering will be released publicly.

Ultrasound is crucial in modern medicine but faces challenges like operator dependence, image noise, and real-time scanning, hindering AI integration. While large multimodal models excel in other medical imaging areas, they struggle with ultrasound's complexities. To address this, we introduce Dolphin v1.0 (V1) and its reasoning-augmented version, Dolphin R1-the first large-scale multimodal ultrasound foundation models unifying diverse clinical tasks in a single vision-language framework.To tackle ultrasound variability and noise, we curated a 2-million-scale multimodal dataset, combining textbook knowledge, public data, synthetic samples, and general corpora. This ensures robust perception, generalization, and clinical adaptability.The Dolphin series employs a three-stage training strategy: domain-specialized pretraining, instruction-driven alignment, and reinforcement-based refinement. Dolphin v1.0 delivers reliable performance in classification, detection, regression, and report generation. Dolphin R1 enhances diagnostic inference, reasoning transparency, and interpretability through reinforcement learning with ultrasound-specific rewards.Evaluated on U2-Bench across eight ultrasound tasks, Dolphin R1 achieves a U2-score of 0.5835-over twice the second-best model (0.2968) setting a new state of the art. Dolphin v1.0 also performs competitively, validating the unified framework. Comparisons show reasoning-enhanced training significantly improves diagnostic accuracy, consistency, and interpretability, highlighting its importance for high-stakes medical AI.

End-to-end speech large language models ((LLMs)) extend the capabilities of text-based models to directly process and generate audio tokens. However, this often leads to a decline in reasoning and generation performance compared to text input, a phenomenon referred to as intelligence degradation. To systematically evaluate this gap, we propose S2SBench, a benchmark designed to quantify performance degradation in Speech LLMs. It includes diagnostic datasets targeting sentence continuation and commonsense reasoning under audio input. We further introduce a pairwise evaluation protocol based on perplexity differences between plausible and implausible samples to measure degradation relative to text input. We apply S2SBench to analyze the training process of Baichuan-Audio, which further demonstrates the benchmark's effectiveness. All datasets and evaluation code are available at https://github.com/undobug/S2SBench.

Equation discovery from data is a core challenge in machine learning for science, requiring the recovery of concise symbolic expressions that govern complex physical and geometric phenomena. Recent approaches with large language models (LLMs) show promise in symbolic regression, but their success often hinges on memorized formulas or overly simplified functional forms. Existing benchmarks exacerbate this limitation: they focus on scalar functions, ignore domain grounding, and rely on brittle string-matching based metrics that fail to capture scientific equivalence. We introduce SurfaceBench, first comprehensive benchmark for symbolic surface discovery. SurfaceBench comprises 183 tasks across 15 categories of symbolic complexity, spanning explicit, implicit, and parametric equation representation forms. Each task includes ground-truth equations, variable semantics, and synthetically sampled three dimensional data. Unlike prior SR datasets, our tasks reflect surface-level structure, resist LLM memorization through novel symbolic compositions, and are grounded in scientific domains such as fluid dynamics, robotics, electromagnetics, and geometry. To evaluate equation discovery quality, we pair symbolic checks with geometry-aware metrics such as Chamfer and Hausdorff distances, capturing both algebraic fidelity and spatial reconstruction accuracy. Our experiments reveal that state-of-the-art frameworks, while occasionally successful on specific families, struggle to generalize across representation types and surface complexities. SurfaceBench thus establishes a challenging and diagnostic testbed that bridges symbolic reasoning with geometric reconstruction, enabling principled benchmarking of progress in compositional generalization, data-driven scientific induction, and geometry-aware reasoning with LLMs. We release the code here: https://github.com/Sanchit-404/surfacebench

Complex question answering over knowledge base (Complex KBQA) is challenging because it requires various compositional reasoning capabilities, such as multi-hop inference, attribute comparison, set operation. Existing benchmarks have some shortcomings that limit the development of Complex KBQA: 1) they only provide QA pairs without explicit reasoning processes; 2) questions are poor in diversity or scale. To this end, we introduce KQA Pro, a dataset for Complex KBQA including ~120K diverse natural language questions. We introduce a compositional and interpretable programming language KoPL to represent the reasoning process of complex questions. For each question, we provide the corresponding KoPL program and SPARQL query, so that KQA Pro serves for both KBQA and semantic parsing tasks. Experimental results show that SOTA KBQA methods cannot achieve promising results on KQA Pro as on current datasets, which suggests that KQA Pro is challenging and Complex KBQA requires further research efforts. We also treat KQA Pro as a diagnostic dataset for testing multiple reasoning skills, conduct a thorough evaluation of existing models and discuss further directions for Complex KBQA. Our codes and datasets can be obtained from https://github.com/shijx12/KQAPro_Baselines.

The field of medical diagnosis has undergone a significant transformation with the advent of large language models (LLMs), yet the challenges of interpretability within these models remain largely unaddressed. This study introduces Chain-of-Diagnosis (CoD) to enhance the interpretability of LLM-based medical diagnostics. CoD transforms the diagnostic process into a diagnostic chain that mirrors a physician's thought process, providing a transparent reasoning pathway. Additionally, CoD outputs the disease confidence distribution to ensure transparency in decision-making. This interpretability makes model diagnostics controllable and aids in identifying critical symptoms for inquiry through the entropy reduction of confidences. With CoD, we developed DiagnosisGPT, capable of diagnosing 9604 diseases. Experimental results demonstrate that DiagnosisGPT outperforms other LLMs on diagnostic benchmarks. Moreover, DiagnosisGPT provides interpretability while ensuring controllability in diagnostic rigor.

We introduce PRISM-Bench, a benchmark of puzzle-based visual challenges designed to evaluate not only whether models can solve problems, but how their reasoning unfolds. Unlike prior evaluations that measure only final-answer accuracy, PRISM-Bench introduces a diagnostic task: given a visual puzzle and a step-by-step chain-of-thought (CoT) containing exactly one error, models must identify the first incorrect step. This setting enables fine-grained assessment of logical consistency, error detection, and visual reasoning. The puzzles in PRISM-Bench require multi-step symbolic, geometric, and analogical reasoning, resisting shortcuts based on superficial pattern matching. Evaluations across state-of-the-art MLLMs reveal a persistent gap between fluent generation and faithful reasoning: models that produce plausible CoTs often fail to locate simple logical faults. By disentangling answer generation from reasoning verification, PRISM-Bench offers a sharper lens on multimodal reasoning competence and underscores the need for diagnostic evaluation protocols in the development of trustworthy MLLMs.

Although Vision Language Models (VLMs) have shown strong generalization in medical imaging, pathology presents unique challenges due to ultra-high resolution, complex tissue structures, and nuanced clinical semantics. These factors make pathology VLMs prone to hallucinations, i.e., generating outputs inconsistent with visual evidence, which undermines clinical trust. Existing RAG approaches in this domain largely depend on text-based knowledge bases, limiting their ability to leverage diagnostic visual cues. To address this, we propose Patho-AgenticRAG, a multimodal RAG framework with a database built on page-level embeddings from authoritative pathology textbooks. Unlike traditional text-only retrieval systems, it supports joint text-image search, enabling direct retrieval of textbook pages that contain both the queried text and relevant visual cues, thus avoiding the loss of critical image-based information. Patho-AgenticRAG also supports reasoning, task decomposition, and multi-turn search interactions, improving accuracy in complex diagnostic scenarios. Experiments show that Patho-AgenticRAG significantly outperforms existing multimodal models in complex pathology tasks like multiple-choice diagnosis and visual question answering. Our project is available at the Patho-AgenticRAG repository: https://github.com/Wenchuan-Zhang/Patho-AgenticRAG.

Continuous perception, the ability to integrate visual observations over time in a continuous stream fashion, is essential for robust real-world understanding, yet remains largely untested in current multimodal models. We introduce CP-Bench, a minimal and fully controlled benchmark designed to isolate this capability using an extremely simple task: counting identical cubes in a synthetic scene while the camera moves and only reveals subsets of objects at any moment. Despite the simplicity of the setting, we find that state-of-the-art open-source and commercial models, including Qwen-3-VL, InternVL3, GPT-5, and Gemini-3-Pro, fail dramatically. A static-camera control variant confirms that the failure arises not from object recognition but from an inability to accumulate evidence across time. Further experiments show that neither higher sampling FPS, perception- or spatial-enhanced models, nor finetuning with additional videos leads to meaningful cross-temporal generalization. Our results reveal a fundamental limitation in modern multimodal architectures and training paradigms. CP-Bench provides a simple yet powerful diagnostic tool and establishes a clean testbed for developing models capable of genuine time-consistent visual reasoning.

Achieving human-like perception and reasoning in Multimodal Large Language Models (MLLMs) remains a central challenge in artificial intelligence. While recent research has primarily focused on enhancing reasoning capabilities in MLLMs, a fundamental question persists: Can Multimodal Large Language Models truly perceive the world as humans do? This paper shifts focus from reasoning to perception. Rather than constructing benchmarks specifically for reasoning, we introduce the Turing Eye Test (TET), a challenging perception-oriented benchmark comprising four diagnostic tasks that evaluate MLLMs' performance on synthetic images that humans process intuitively. Our findings reveal that state-of-the-art MLLMs exhibit catastrophic failures on our perceptual tasks trivial for humans. Both in-context learning and training on language backbone-effective for previous benchmarks-fail to improve performance on our tasks, while fine-tuning the vision tower enables rapid adaptation, suggesting that our benchmark poses challenges for vision tower generalization rather than for the knowledge and reasoning capabilities of the language backbone-a key gap between current MLLMs and human perception. We release a representative subset of TET tasks in this version, and will introduce more diverse tasks and methods to enhance visual generalization in future work.

Large language models (LLMs) have demonstrated excellent capabilities in the field of biomedical question answering, but their application in real-world clinical consultations still faces core challenges. Existing systems rely on a one-way information transmission mode where patients must fully describe their symptoms in a single round, leading to nonspecific diagnostic recommendations when complaints are vague. Traditional multi-turn dialogue methods based on supervised learning are constrained by static data-driven paradigms, lacking generalizability and struggling to intelligently extract key clinical information. To address these limitations, we propose DoctorAgent-RL, a reinforcement learning (RL)-based multi-agent collaborative framework that models medical consultations as a dynamic decision-making process under uncertainty. The doctor agent continuously optimizes its questioning strategy within the RL framework through multi-turn interactions with the patient agent, dynamically adjusting its information-gathering path based on comprehensive rewards from the Consultation Evaluator. This RL fine-tuning mechanism enables LLMs to autonomously develop interaction strategies aligned with clinical reasoning logic, rather than superficially imitating patterns in existing dialogue data. Notably, we constructed MTMedDialog, the first English multi-turn medical consultation dataset capable of simulating patient interactions. Experiments demonstrate that DoctorAgent-RL outperforms existing models in both multi-turn reasoning capability and final diagnostic performance, demonstrating practical value in assisting clinical consultations. https://github.com/JarvisUSTC/DoctorAgent-RL

RAG (Retrieval-Augmented Generation) systems and web agents are increasingly evaluated on multi-hop deep search tasks, yet current practice suffers from two major limitations. First, most benchmarks leak the reasoning path in the question text, allowing models to follow surface cues rather than discover reasoning chains autonomously. Second, evaluation is typically reduced to a single pass rate, which collapses diverse behaviours into one score and obscures whether failures stem from inadequate search, poor knowledge use, or inappropriate refusal. To address these issues, we present WebDetective, a benchmark of hint-free multi-hop questions paired with a controlled Wikipedia sandbox that ensures full traceability of model actions, and a holistic evaluation framework that separates search sufficiency, knowledge utilisation, and refusal behaviour. Our evaluation of 25 state-of-the-art models reveals systematic weaknesses across all architectures: models struggle with knowledge utilisation despite having sufficient evidence and demonstrate near-absent appropriate refusal when evidence is lacking. These patterns expose a fundamental gap: today's systems excel at executing given reasoning paths but fail when required to discover them. We develop an agentic workflow, EvidenceLoop, that explicitly targets the challenges our benchmark identifies, incorporating verification loops and systematic evidence tracking that improve both search and synthesis capabilities. This baseline demonstrates that WebDetective's diagnostic framework can guide concrete architectural improvements, establishing our benchmark as a critical tool for developing genuinely autonomous reasoning systems rather than pattern-following agents.

Omni-modal large language models (OLLMs) aim to unify audio, vision, and text understanding within a single framework. While existing benchmarks primarily evaluate general cross-modal question-answering ability, it remains unclear whether OLLMs achieve modality-invariant reasoning or exhibit modality-specific biases. We introduce XModBench, a large-scale tri-modal benchmark explicitly designed to measure cross-modal consistency. XModBench comprises 60,828 multiple-choice questions spanning five task families and systematically covers all six modality compositions in question-answer pairs, enabling fine-grained diagnosis of an OLLM's modality-invariant reasoning, modality disparity, and directional imbalance. Experiments show that even the strongest model, Gemini 2.5 Pro, (i) struggles with spatial and temporal reasoning, achieving less than 60% accuracy, (ii) reveals persistent modality disparities, with performance dropping substantially when the same semantic content is conveyed through audio rather than text, and (iii) shows systematic directional imbalance, exhibiting lower consistency when vision serves as context compared to text. These findings indicate that current OLLMs remain far from truly modality-invariant reasoning and position XModBench as a fundamental diagnostic tool for evaluating and improving cross-modal competence. All data and evaluation tools will be available at https://xingruiwang.github.io/projects/XModBench/.

We investigate the ability of Vision Language Models (VLMs) to perform visual perspective taking using a novel set of visual tasks inspired by established human tests. Our approach leverages carefully controlled scenes, in which a single humanoid minifigure is paired with a single object. By systematically varying spatial configurations - such as object position relative to the humanoid minifigure and the humanoid minifigure's orientation - and using both bird's-eye and surface-level views, we created 144 unique visual tasks. Each visual task is paired with a series of 7 diagnostic questions designed to assess three levels of visual cognition: scene understanding, spatial reasoning, and visual perspective taking. Our evaluation of several state-of-the-art models, including GPT-4-Turbo, GPT-4o, Llama-3.2-11B-Vision-Instruct, and variants of Claude Sonnet, reveals that while they excel in scene understanding, the performance declines significantly on spatial reasoning and further deteriorates on perspective-taking. Our analysis suggests a gap between surface-level object recognition and the deeper spatial and perspective reasoning required for complex visual tasks, pointing to the need for integrating explicit geometric representations and tailored training protocols in future VLM development.

We introduce RJUA-QA, a novel medical dataset for question answering (QA) and reasoning with clinical evidence, contributing to bridge the gap between general large language models (LLMs) and medical-specific LLM applications. RJUA-QA is derived from realistic clinical scenarios and aims to facilitate LLMs in generating reliable diagnostic and advice. The dataset contains 2,132 curated Question-Context-Answer pairs, corresponding about 25,000 diagnostic records and clinical cases. The dataset covers 67 common urological disease categories, where the disease coverage exceeds 97.6\% of the population seeking medical services in urology. Each data instance in RJUA-QA comprises: (1) a question mirroring real patient to inquiry about clinical symptoms and medical conditions, (2) a context including comprehensive expert knowledge, serving as a reference for medical examination and diagnosis, (3) a doctor response offering the diagnostic conclusion and suggested examination guidance, (4) a diagnosed clinical disease as the recommended diagnostic outcome, and (5) clinical advice providing recommendations for medical examination. RJUA-QA is the first medical QA dataset for clinical reasoning over the patient inquiries, where expert-level knowledge and experience are required for yielding diagnostic conclusions and medical examination advice. A comprehensive evaluation is conducted to evaluate the performance of both medical-specific and general LLMs on the RJUA-QA dataset.

Large language models (LLMs), particularly those with reasoning capabilities, have rapidly advanced in recent years, demonstrating significant potential across a wide range of applications. However, their deployment in healthcare, especially in disease reasoning tasks, is hindered by the challenge of acquiring expert-level cognitive data. In this paper, we introduce Citrus, a medical language model that bridges the gap between clinical expertise and AI reasoning by emulating the cognitive processes of medical experts. The model is trained on a large corpus of simulated expert disease reasoning data, synthesized using a novel approach that accurately captures the decision-making pathways of clinicians. This approach enables Citrus to better simulate the complex reasoning processes involved in diagnosing and treating medical conditions.To further address the lack of publicly available datasets for medical reasoning tasks, we release the last-stage training data, including a custom-built medical diagnostic dialogue dataset. This open-source contribution aims to support further research and development in the field. Evaluations using authoritative benchmarks such as MedQA, covering tasks in medical reasoning and language understanding, show that Citrus achieves superior performance compared to other models of similar size. These results highlight Citrus potential to significantly enhance medical decision support systems, providing a more accurate and efficient tool for clinical decision-making.

This paper is concerned with learning to solve tasks that require a chain of interdependent steps of relational inference, like answering complex questions about the relationships between objects, or solving puzzles where the smaller elements of a solution mutually constrain each other. We introduce the recurrent relational network, a general purpose module that operates on a graph representation of objects. As a generalization of Santoro et al. [2017]'s relational network, it can augment any neural network model with the capacity to do many-step relational reasoning. We achieve state of the art results on the bAbI textual question-answering dataset with the recurrent relational network, consistently solving 20/20 tasks. As bAbI is not particularly challenging from a relational reasoning point of view, we introduce Pretty-CLEVR, a new diagnostic dataset for relational reasoning. In the Pretty-CLEVR set-up, we can vary the question to control for the number of relational reasoning steps that are required to obtain the answer. Using Pretty-CLEVR, we probe the limitations of multi-layer perceptrons, relational and recurrent relational networks. Finally, we show how recurrent relational networks can learn to solve Sudoku puzzles from supervised training data, a challenging task requiring upwards of 64 steps of relational reasoning. We achieve state-of-the-art results amongst comparable methods by solving 96.6% of the hardest Sudoku puzzles.