Daily Papers

Acute poly-substance intoxication requires rapid, life-saving decisions under substantial uncertainty, as clinicians must rely on incomplete ingestion details and nonspecific symptoms. Effective diagnostic reasoning in this chaotic environment requires fusing unstructured, non-medical narratives (e.g. paramedic scene descriptions and unreliable patient self-reports or known histories), with structured medical data like vital signs. While Large Language Models (LLMs) show potential for processing such heterogeneous inputs, they struggle in this setting, often underperforming simple baselines that rely solely on patient histories. To address this, we present DeToxR (Decision-support for Toxicology with Reasoning), the first adaptation of Reinforcement Learning (RL) to emergency toxicology. We design a robust data-fusion engine for multi-label prediction across 14 substance classes based on an LLM finetuned with Group Relative Policy Optimization (GRPO). We optimize the model's reasoning directly using a clinical performance reward. By formulating a multi-label agreement metric as the reward signal, the model is explicitly penalized for missing co-ingested substances and hallucinating absent poisons. Our model significantly outperforms its unadapted base LLM counterpart and supervised baselines. Furthermore, in a clinical validation study, the model indicates a clinical advantage by outperforming an expert toxicologist in identifying the correct poisons (Micro-F1: 0.644 vs. 0.473). These results demonstrate the potential of RL-aligned LLMs to synthesize unstructured pre-clinical narratives and structured medical data for decision support in high-stakes environments.

Medical visual grounding serves as a crucial foundation for fine-grained multimodal reasoning and interpretable clinical decision support. Despite recent advances in reinforcement learning (RL) for grounding tasks, existing approaches such as Group Relative Policy Optimization~(GRPO) suffer from severe reward sparsity when directly applied to medical images, primarily due to the inherent difficulty of localizing small or ambiguous regions of interest, which is further exacerbated by the rigid and suboptimal nature of fixed IoU-based reward schemes in RL. This leads to vanishing policy gradients and stagnated optimization, particularly during early training. To address this challenge, we propose MedLoc-R1, a performance-aware reward scheduling framework that progressively tightens the reward criterion in accordance with model readiness. MedLoc-R1 introduces a sliding-window performance tracker and a multi-condition update rule that automatically adjust the reward schedule from dense, easily obtainable signals to stricter, fine-grained localization requirements, while preserving the favorable properties of GRPO without introducing auxiliary networks or additional gradient paths. Experiments on three medical visual grounding benchmarks demonstrate that MedLoc-R1 consistently improves both localization accuracy and training stability over GRPO-based baselines. Our framework offers a general, lightweight, and effective solution for RL-based grounding in high-stakes medical applications. Code \& checkpoints are available at {https://github.com/MembrAI/MedLoc-R1}.

The integration of large language models (LLMs) into medical practice holds transformative potential, yet their real-world clinical utility remains limited by critical alignment challenges: (1) a disconnect between static evaluation benchmarks and dynamic clinical cognitive needs, (2) difficulties in adapting to evolving, multi-source medical standards, and (3) the inability of conventional reward models to capture nuanced, multi-dimensional medical quality criteria. To address these gaps, we propose MR-RML (Multidimensional Rubric-oriented Reward Model Learning) via GPRC (Geometric Projection Reference Constraints), a novel alignment framework that integrates medical standards into a structured "Dimensions-Scenarios-Disciplines" matrix to guide data generation and model optimization. MR-RML introduces three core innovations: (1) a "Dimensions-Scenarios-Disciplines" medical standard system that embeds domain standards into the full training pipeline; (2) an independent multi-dimensional reward model that decomposes evaluation criteria, shifting from real-time rubric-based scoring to internalized reward modeling for improved consistency and cost-efficiency; (3) geometric projection reference constraints that transform medical cognitive logic into mathematical regularization, aligning scoring gradients with clinical reasoning and enabling synthetic data-driven training. Through extensive evaluations on the authoritative medical benchmark Healthbench, our method yields substantial performance gains over the base LLM Qwen-32B (45% on the full subset and 85% on Hard subset, respectively). It achieves a SOTA among open-source LLMs with scores of 62.7 (full subset) and 44.7 (hard subset), while also outperforming the majority of closed-source models.

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/

Clinical decision-making routinely demands reasoning over heterogeneous data, yet existing multimodal language models (MLLMs) remain largely vision-centric and fail to generalize across clinical specialties. To bridge this gap, we introduce QoQ-Med-7B/32B, the first open generalist clinical foundation model that jointly reasons across medical images, time-series signals, and text reports. QoQ-Med is trained with Domain-aware Relative Policy Optimization (DRPO), a novel reinforcement-learning objective that hierarchically scales normalized rewards according to domain rarity and modality difficulty, mitigating performance imbalance caused by skewed clinical data distributions. Trained on 2.61 million instruction tuning pairs spanning 9 clinical domains, we show that DRPO training boosts diagnostic performance by 43% in macro-F1 on average across all visual domains as compared to other critic-free training methods like GRPO. Furthermore, with QoQ-Med trained on intensive segmentation data, it is able to highlight salient regions related to the diagnosis, with an IoU 10x higher than open models while reaching the performance of OpenAI o4-mini. To foster reproducibility and downstream research, we release (i) the full model weights, (ii) the modular training pipeline, and (iii) all intermediate reasoning traces at https://github.com/DDVD233/QoQ_Med.

Large vision-language models struggle with medical video understanding, where spatial precision, temporal reasoning, and clinical semantics are critical. To address this, we first introduce MedVidBench, a large-scale benchmark of 531,850 video-instruction pairs across 8 medical sources spanning video, segment, and frame-level tasks, curated through a rigorous quality assurance pipeline with expert-guided prompting and dual-model validation. While supervised fine-tuning on MedVidBench yields noticeable gains, standard Reinforcement Learning (RL) fails due to imbalanced reward scales across datasets, which destabilizes optimization and leads to training collapse. To overcome this, we introduce MedGRPO, a novel RL framework for balanced multi-dataset training with two key innovations: (1) cross-dataset reward normalization that maps each dataset's median performance to a common reward value, ensuring fair optimization regardless of difficulty, and (2) a medical LLM judge that evaluates caption quality on five clinical dimensions through comparative similarity scoring. Supervised fine-tuning Qwen2.5-VL-7B on MedVidBench substantially outperforms GPT-4.1 and Gemini-2.5-Flash across all tasks, demonstrating MedVidBench's efficacy, while our MedGRPO framework further improves upon the SFT baseline across grounding and captioning tasks. Our work establishes a foundational benchmark and robust training methodology for advancing vision-language models in medical domains. Our project website is available at https://yuhaosu.github.io/MedGRPO/.

Recently, pretrained language models based on BERT have been introduced for the French biomedical domain. Although these models have achieved state-of-the-art results on biomedical and clinical NLP tasks, they are constrained by a limited input sequence length of 512 tokens, which poses challenges when applied to clinical notes. In this paper, we present a comparative study of three adaptation strategies for long-sequence models, leveraging the Longformer architecture. We conducted evaluations of these models on 16 downstream tasks spanning both biomedical and clinical domains. Our findings reveal that further pre-training an English clinical model with French biomedical texts can outperform both converting a French biomedical BERT to the Longformer architecture and pre-training a French biomedical Longformer from scratch. The results underscore that long-sequence French biomedical models improve performance across most downstream tasks regardless of sequence length, but BERT based models remain the most efficient for named entity recognition tasks.

Multimodal large language models (MLLMs) hold significant potential in medical applications, including disease diagnosis and clinical decision-making. However, these tasks require highly accurate, context-sensitive, and professionally aligned responses, making reliable reward models and judges critical. Despite their importance, medical reward models (MRMs) and judges remain underexplored, with no dedicated benchmarks addressing clinical requirements. Existing benchmarks focus on general MLLM capabilities or evaluate models as solvers, neglecting essential evaluation dimensions like diagnostic accuracy and clinical relevance. To address this, we introduce Med-RewardBench, the first benchmark specifically designed to evaluate MRMs and judges in medical scenarios. Med-RewardBench features a multimodal dataset spanning 13 organ systems and 8 clinical departments, with 1,026 expert-annotated cases. A rigorous three-step process ensures high-quality evaluation data across six clinically critical dimensions. We evaluate 32 state-of-the-art MLLMs, including open-source, proprietary, and medical-specific models, revealing substantial challenges in aligning outputs with expert judgment. Additionally, we develop baseline models that demonstrate substantial performance improvements through fine-tuning.

Reinforcement learning (RL) with rule-based rewards has demonstrated strong potential in enhancing the reasoning and generalization capabilities of vision-language models (VLMs) and large language models (LLMs), while reducing computational overhead. However, its application in medical imaging remains underexplored. Existing reinforcement fine-tuning (RFT) approaches in this domain primarily target closed-ended visual question answering (VQA), limiting their applicability to real-world clinical reasoning. In contrast, open-ended medical VQA better reflects clinical practice but has received limited attention. While some efforts have sought to unify both formats via semantically guided RL, we observe that model-based semantic rewards often suffer from reward collapse, where responses with significant semantic differences receive similar scores. To address this, we propose ARMed (Adaptive Reinforcement for Medical Reasoning), a novel RL framework for open-ended medical VQA. ARMed first incorporates domain knowledge through supervised fine-tuning (SFT) on chain-of-thought data, then applies reinforcement learning with textual correctness and adaptive semantic rewards to enhance reasoning quality. We evaluate ARMed on six challenging medical VQA benchmarks. Results show that ARMed consistently boosts both accuracy and generalization, achieving a 32.64% improvement on in-domain tasks and an 11.65% gain on out-of-domain benchmarks. These results highlight the critical role of reward discriminability in medical RL and the promise of semantically guided rewards for enabling robust and clinically meaningful multimodal reasoning.

Large Language Models (LLMs) and multi-agent systems have shown impressive capabilities in natural language tasks but face challenges in clinical trial applications, primarily due to limited access to external knowledge. Recognizing the potential of advanced clinical trial tools that aggregate and predict based on the latest medical data, we propose an integrated solution to enhance their accessibility and utility. We introduce Clinical Agent System (ClinicalAgent), a clinical multi-agent system designed for clinical trial tasks, leveraging GPT-4, multi-agent architectures, LEAST-TO-MOST, and ReAct reasoning technology. This integration not only boosts LLM performance in clinical contexts but also introduces novel functionalities. The proposed method achieves competitive predictive performance in clinical trial outcome prediction (0.7908 PR-AUC), obtaining a 0.3326 improvement over the standard prompt Method. Publicly available code can be found at https://anonymous.4open.science/r/ClinicalAgent-6671.

Recent advances in large language models (LLMs) have shown strong reasoning capabilities through large-scale pretraining and post-training reinforcement learning, demonstrated by DeepSeek-R1. However, current post-training methods, such as Grouped Relative Policy Optimization (GRPO), mainly reward correctness, which is not aligned with the multi-dimensional objectives required in high-stakes fields such as medicine, where reasoning must also be faithful and comprehensive. We introduce Clinical-Objective Relative Policy Optimization (CRPO), a scalable, multi-objective, verifiable reinforcement learning method designed to align LLM post-training with clinical reasoning principles. CRPO integrates rule-based and verifiable reward signals that jointly optimize accuracy, faithfulness, and comprehensiveness without relying on human annotation. To demonstrate its effectiveness, we train Clinical-R1-3B, a 3B-parameter model for clinical reasoning. The experiments on three benchmarks demonstrate that our CRPO substantially improves reasoning on truthfulness and completeness over standard GRPO while maintaining comfortable accuracy enhancements. This framework provides a scalable pathway to align LLM reasoning with clinical objectives, enabling safer and more collaborative AI systems for healthcare while also highlighting the potential of multi-objective, verifiable RL methods in post-training scaling of LLMs for medical domains.

We introduce MediX-R1, an open-ended Reinforcement Learning (RL) framework for medical multimodal large language models (MLLMs) that enables clinically grounded, free-form answers beyond multiple-choice formats. MediX-R1 fine-tunes a baseline vision-language backbone with Group Based RL and a composite reward tailored for medical reasoning: an LLM-based accuracy reward that judges semantic correctness with a strict YES/NO decision, a medical embedding-based semantic reward to capture paraphrases and terminology variants, and lightweight format and modality rewards that enforce interpretable reasoning and modality recognition. This multi-signal design provides stable, informative feedback for open-ended outputs where traditional verifiable or MCQ-only rewards fall short. To measure progress, we propose a unified evaluation framework for both text-only and image+text tasks that uses a Reference-based LLM-as-judge in place of brittle string-overlap metrics, capturing semantic correctness, reasoning, and contextual alignment. Despite using only sim51K instruction examples, MediX-R1 achieves excellent results across standard medical LLM (text-only) and VLM (image + text) benchmarks, outperforming strong open-source baselines and delivering particularly large gains on open-ended clinical tasks. Our results demonstrate that open-ended RL with comprehensive reward signals and LLM-based evaluation is a practical path toward reliable medical reasoning in multimodal models. Our trained models, curated datasets and source code are available at https://medix.cvmbzuai.com

Radiology report generation (RRG) has attracted significant attention due to its potential to reduce the workload of radiologists. Current RRG approaches are still unsatisfactory against clinical standards. This paper introduces a novel RRG method, LM-RRG, that integrates large models (LMs) with clinical quality reinforcement learning to generate accurate and comprehensive chest X-ray radiology reports. Our method first designs a large language model driven feature extractor to analyze and interpret different regions of the chest X-ray image, emphasizing specific regions with medical significance. Next, based on the large model's decoder, we develop a multimodal report generator that leverages multimodal prompts from visual features and textual instruction to produce the radiology report in an auto-regressive way. Finally, to better reflect the clinical significant and insignificant errors that radiologists would normally assign in the report, we introduce a novel clinical quality reinforcement learning strategy. It utilizes the radiology report clinical quality (RadCliQ) metric as a reward function in the learning process. Extensive experiments on the MIMIC-CXR and IU-Xray datasets demonstrate the superiority of our method over the state of the art.

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.

While reinforcement learning for large language model alignment has progressed rapidly in recent years, transferring these paradigms to high-stakes medical question answering reveals a fundamental paradigm mismatch. Reinforcement Learning from Human Feedback relies on preference annotations that are prohibitively expensive and often fail to reflect the absolute correctness of medical facts. Reinforcement Learning from Verifiable Rewards lacks effective automatic verifiers and struggles to handle complex clinical contexts. Meanwhile, medical alignment requires the simultaneous optimization of correctness, safety, and compliance, yet multi-objective heterogeneous reward signals are prone to scale mismatch and optimization conflicts.To address these challenges, we propose a robust medical alignment paradigm. We first construct a holistic multi-dimensional medical alignment matrix that decomposes alignment objectives into four categories: fundamental capabilities, expert knowledge, online feedback, and format specifications. Within each category, we establish a closed loop of where observable metrics inform attributable diagnosis, which in turn drives optimizable rewards, thereby providing fine-grained, high-resolution supervision signals for subsequent iterative optimization. To resolve gradient domination and optimization instability problem caused by heterogeneous signals, we further propose a unified optimization mechanism. This mechanism employs Reference-Frozen Normalization to align reward scales and implements a Tri-Factor Adaptive Dynamic Weighting strategy to achieve collaborative optimization that is weakness-oriented, risk-prioritized, and redundancy-reducing. Experimental results demonstrate the effectiveness of our proposed paradigm in real-world medical scenario evaluations, establishing a new paradigm for complex alignment in vertical domains.

Current Large Language Models (LLMs) exhibit significant limitations, notably in structured, interpretable, and verifiable medical reasoning, alongside practical deployment challenges related to computational resources and data privacy. This report focused on the development of WiNGPT-3.0, the 32-billion parameter LLMs, engineered with the objective of enhancing its capacity for medical reasoning and exploring its potential for effective integration within healthcare IT infrastructures. The broader aim is to advance towards clinically applicable models. The approach involved a multi-stage training pipeline tailored for general, medical, and clinical reasoning. This pipeline incorporated supervised fine-tuning (SFT) and reinforcement learning (RL), leveraging curated Long Chain-of-Thought (CoT) datasets, auxiliary reward models, and an evidence-based diagnostic chain simulation. WiNGPT-3.0 demonstrated strong performance: specific model variants achieved scores of 66.6 on MedCalc and 87.1 on MedQA-USMLE. Furthermore, targeted training improved performance on a clinical reasoning task from a baseline score of 58.1 to 62.5. These findings suggest that reinforcement learning, even when applied with a limited dataset of only a few thousand examples, can enhance medical reasoning accuracy. Crucially, this demonstration of RL's efficacy with limited data and computation paves the way for more trustworthy and practically deployable LLMs within clinical workflows and health information infrastructures.

Medical language models (MLMs) have become pivotal in advancing medical natural language processing. However, prior models that rely on pre-training or supervised fine-tuning often exhibit low data efficiency and limited practicality in real-world clinical applications. While OpenAIs O1 highlights test-time scaling in mathematics, attempts to replicate this approach in medicine typically distill responses from GPT-series models to open-source models, focusing primarily on multiple-choice tasks. This strategy, though straightforward, neglects critical concerns like data privacy and realistic deployment in clinical settings. In this work, we present a deployable, small-scale medical language model, \mone, designed for long-chain reasoning in clinical tasks using a self-evolution paradigm. Starting with a seed dataset of around 8,000 instances spanning five domains and 16 datasets, we prompt a base policy model to perform Monte Carlo Tree Search (MCTS) to construct verifiable reasoning chains. Each reasoning step is assigned an evolution rollout value, allowing verified trajectories to train the policy model and the reward model. During inference, the policy model generates multiple responses, and the reward model selects the one with the highest reward score. Experiments on eleven evaluation datasets demonstrate that \mone outperforms prior open-source models by 2 points, with the addition of the reward model further boosting performance (sim13 points), surpassing GPT-4o-mini. Code and data are available at https://github.com/pixas/MedSSS.

Radiologists play a crucial role by translating medical images into medical reports. However, the field faces staffing shortages and increasing workloads. While automated approaches using vision-language models (VLMs) show promise as assistants, they require exceptionally high accuracy. Most current VLMs in radiology rely solely on supervised fine-tuning (SFT). Meanwhile, in the general domain, additional preference fine-tuning has become standard practice. The challenge in radiology lies in the prohibitive cost of obtaining radiologist feedback. We propose a scalable automated preference alignment technique for VLMs in radiology, focusing on chest X-ray (CXR) report generation. Our method leverages publicly available datasets with an LLM-as-a-Judge mechanism, eliminating the need for additional expert radiologist feedback. We evaluate and benchmark five direct alignment algorithms (DAAs). Our results show up to a 57.4% improvement in average GREEN scores, a LLM-based metric for evaluating CXR reports, and a 9.2% increase in an average across six metrics (domain specific and general), compared to the SFT baseline. We study reward overoptimization via length exploitation, with reports lengthening by up to 3.2x. To assess a potential alignment tax, we benchmark on six additional diverse tasks, finding no significant degradations. A reader study involving four board-certified radiologists indicates win rates of up to 0.62 over the SFT baseline, while significantly penalizing verbosity. Our analysis provides actionable insights for the development of VLMs in high-stakes fields like radiology.

Extending Reinforcement Learning with Verifiable Rewards (RLVR) to real-world tasks often requires balancing objective and subjective evaluation criteria. However, many such tasks lack a single, unambiguous ground truth-making it difficult to define reliable reward signals for post-training language models. While traditional preference-based methods offer a workaround, they rely on opaque reward functions that are difficult to interpret and prone to spurious correlations. We introduce Rubrics as Rewards (RaR), a framework that uses structured, checklist-style rubrics as interpretable reward signals for on-policy training with GRPO. Our best RaR method yields up to a 28% relative improvement on HealthBench-1k compared to simple Likert-based approaches, while matching or surpassing the performance of reward signals derived from expert-written references. By treating rubrics as structured reward signals, we show that RaR enables smaller-scale judge models to better align with human preferences and sustain robust performance across model scales.

Reward models have been increasingly critical for improving the reasoning capability of LLMs. Existing research has shown that a well-trained reward model can substantially improve model performances at inference time via search. However, the potential of reward models during RL training time still remains largely under-explored. It is currently unclear whether these reward models can provide additional training signals to enhance the reasoning capabilities of LLMs in RL training that uses sparse success rewards, which verify the correctness of solutions. In this work, we evaluate popular reward models for RL training, including the Outcome-supervised Reward Model (ORM) and the Process-supervised Reward Model (PRM), and train a collection of LLMs for math problems using RL by combining these learned rewards with success rewards. Surprisingly, even though these learned reward models have strong inference-time performances, they may NOT help or even hurt RL training, producing worse performances than LLMs trained with the success reward only. Our analysis reveals that an LLM can receive high rewards from some of these reward models by repeating correct but unnecessary reasoning steps, leading to a severe reward hacking issue. Therefore, we introduce two novel reward refinement techniques, including Clipping and Delta. The key idea is to ensure the accumulative reward of any reasoning trajectory is upper-bounded to keep a learned reward model effective without being exploited. We evaluate our techniques with multiple reward models over a set of 1.5B and 7B LLMs on MATH and GSM8K benchmarks and demonstrate that with a carefully designed reward function, RL training without any additional supervised tuning can improve all the evaluated LLMs, including the state-of-the-art 7B LLM Qwen2.5-Math-7B-Instruct on MATH and GSM8K benchmarks.

Large Language Models (LLMs) increasingly rely on external tools such as search engines to solve complex agentic tasks that require reasoning and external knowledge retrieval. Recently, reinforcement learning with verifiable rewards (RLVR) has demonstrated its effectiveness in advancing capabilities of LLMs by rewarding the final answers via outcome rewards. While straightforward to supervise, outcome rewards only provide sparse signals and delayed feedback, which limits their effectiveness on long trajectories. Process rewards address this by evaluating intermediate steps, providing fine-grained supervision and encouraging grounded problem solving. However, it is notoriously hard to annotate step-wise labels, especially in non-verifiable process without "golden" answers. Furthermore, step-wise judgment requires the balance between local quality with contribution to the final outcome, as optimizing towards higher process reward may not always align with better final outcomes. To address the above challenges, we introduce Principle Process Reward (PPR), an RL approach that unifies principled step-level assessment and outcome verification. We train a principle-based reward model to improve the transparency and reliability of process evaluation, and further introduce a Reward Normalization (ReNorm) strategy to calibrate outcome and process rewards. Experiment results show that PPR achieves state-of-the-art performance across a wide range of benchmarks, demonstrating its impressive robustness and generalization. Our code and model collection is available in this link.

Objective: The reading level of health educational materials significantly influences the understandability and accessibility of the information, particularly for minoritized populations. Many patient educational resources surpass the reading level and complexity of widely accepted standards. There is a critical need for high-performing text simplification models in health information to enhance dissemination and literacy. This need is particularly acute in cancer education, where effective prevention and screening education can substantially reduce morbidity and mortality. Methods: We introduce Simplified Digestive Cancer (SimpleDC), a parallel corpus of cancer education materials tailored for health text simplification research, comprising educational content from the American Cancer Society, Centers for Disease Control and Prevention, and National Cancer Institute. Utilizing SimpleDC alongside the existing Med-EASi corpus, we explore Large Language Model (LLM)-based simplification methods, including fine-tuning, reinforcement learning (RL), reinforcement learning with human feedback (RLHF), domain adaptation, and prompt-based approaches. Our experimentation encompasses Llama 2 and GPT-4. A novel RLHF reward function is introduced, featuring a lightweight model adept at distinguishing between original and simplified texts, thereby enhancing the model's effectiveness with unlabeled data. Results: Fine-tuned Llama 2 models demonstrated high performance across various metrics. Our innovative RLHF reward function surpassed existing RL text simplification reward functions in effectiveness. The results underscore that RL/RLHF can augment fine-tuning, facilitating model training on unlabeled text and improving performance.

Recent advances in reinforcement learning with verifiable, rule-based rewards have greatly enhanced the reasoning capabilities and out-of-distribution generalization of VLMs/LLMs, obviating the need for manually crafted reasoning chains. Despite these promising developments in the general domain, their translation to medical imaging remains limited. Current medical reinforcement fine-tuning (RFT) methods predominantly focus on close-ended VQA, thereby restricting the model's ability to engage in world knowledge retrieval and flexible task adaptation. More critically, these methods fall short of addressing the critical clinical demand for open-ended, reasoning-intensive decision-making. To bridge this gap, we introduce MedCCO, the first multimodal reinforcement learning framework tailored for medical VQA that unifies close-ended and open-ended data within a curriculum-driven RFT paradigm. Specifically, MedCCO is initially fine-tuned on a diverse set of close-ended medical VQA tasks to establish domain-grounded reasoning capabilities, and is then progressively adapted to open-ended tasks to foster deeper knowledge enhancement and clinical interpretability. We validate MedCCO across eight challenging medical VQA benchmarks, spanning both close-ended and open-ended settings. Experimental results show that MedCCO consistently enhances performance and generalization, achieving a 11.4\% accuracy gain across three in-domain tasks, and a 5.7\% improvement on five out-of-domain benchmarks. These findings highlight the promise of curriculum-guided RL in advancing robust, clinically-relevant reasoning in medical multimodal language models.

Large language models have achieved strong performance on medical reasoning benchmarks, yet their deployment in clinical settings demands rigorous verification to ensure factual accuracy. While reward models offer a scalable approach for reasoning trace verification, existing methods face two limitations: they produce only scalar reward values without explicit justification, and they rely on single-pass retrieval that precludes adaptive knowledge access as verification unfolds. We introduce method, an agentic framework that addresses these limitations by training medical reasoning verifiers to iteratively query external medical corpora during evaluation. Our approach combines tool-augmented verification with an iterative reinforcement learning paradigm that requires only trace-level supervision, alongside an adaptive curriculum mechanism that dynamically adjusts training data distribution. Across four medical reasoning benchmarks, method achieves substantial gains over existing methods, improving MedQA accuracy by 23.5% and MedXpertQA by 32.0% relative to the base generator in particular. Crucially, method demonstrates an 8times reduction in sampling budget requirement compared to prior reward model baselines. These findings establish that grounding verification in dynamically retrieved evidence offers a principled path toward more reliable medical reasoning systems.

Medical image segmentation is evolving from task-specific models toward generalizable frameworks. Recent research leverages Multi-modal Large Language Models (MLLMs) as autonomous agents, employing reinforcement learning with verifiable reward (RLVR) to orchestrate specialized tools like the Segment Anything Model (SAM). However, these approaches often rely on single-turn, rigid interaction strategies and lack process-level supervision during training, which hinders their ability to fully exploit the dynamic potential of interactive tools and leads to redundant actions. To bridge this gap, we propose MedSAM-Agent, a framework that reformulates interactive segmentation as a multi-step autonomous decision-making process. First, we introduce a hybrid prompting strategy for expert-curated trajectory generation, enabling the model to internalize human-like decision heuristics and adaptive refinement strategies. Furthermore, we develop a two-stage training pipeline that integrates multi-turn, end-to-end outcome verification with a clinical-fidelity process reward design to promote interaction parsimony and decision efficiency. Extensive experiments across 6 medical modalities and 21 datasets demonstrate that MedSAM-Agent achieves state-of-the-art performance, effectively unifying autonomous medical reasoning with robust, iterative optimization. Code is available https://github.com/CUHK-AIM-Group/MedSAM-Agent{here}.

Predictive artificial intelligence (AI) offers an opportunity to improve clinical practice and patient outcomes, but risks perpetuating biases if fairness is inadequately addressed. However, the definition of "fairness" remains unclear. We conducted a scoping review to identify and critically appraise fairness metrics for clinical predictive AI. We defined a "fairness metric" as a measure quantifying whether a model discriminates (societally) against individuals or groups defined by sensitive attributes. We searched five databases (2014-2024), screening 820 records, to include 41 studies, and extracted 62 fairness metrics. Metrics were classified by performance-dependency, model output level, and base performance metric, revealing a fragmented landscape with limited clinical validation and overreliance on threshold-dependent measures. Eighteen metrics were explicitly developed for healthcare, including only one clinical utility metric. Our findings highlight conceptual challenges in defining and quantifying fairness and identify gaps in uncertainty quantification, intersectionality, and real-world applicability. Future work should prioritise clinically meaningful metrics.

Chest X-Ray (CXR) report generation is a promising approach to improving the efficiency of CXR interpretation. However, a significant increase in diagnostic accuracy is required before that can be realised. Motivated by this, we propose a framework that is more inline with a radiologist's workflow by considering longitudinal data. Here, the decoder is additionally conditioned on the report from the subject's previous imaging study via a prompt. We also propose a new reward for reinforcement learning based on CXR-BERT, which computes the similarity between reports. We conduct experiments on the MIMIC-CXR dataset. The results indicate that longitudinal data improves CXR report generation. CXR-BERT is also shown to be a promising alternative to the current state-of-the-art reward based on RadGraph. This investigation indicates that longitudinal CXR report generation can offer a substantial increase in diagnostic accuracy. Our Hugging Face model is available at: https://huggingface.co/aehrc/cxrmate and code is available at: https://github.com/aehrc/cxrmate.

Recent advances in medical multi-modal models focus on specialized image analysis like dermatology, pathology, or radiology. However, they do not fully capture the complexity of real-world clinical diagnostics, which involve heterogeneous inputs and require ongoing contextual understanding during patient-physician interactions. To bridge this gap, we introduce PulseMind, a new family of multi-modal diagnostic models that integrates a systematically curated dataset, a comprehensive evaluation benchmark, and a tailored training framework. Specifically, we first construct a diagnostic dataset, MediScope, which comprises 98,000 real-world multi-turn consultations and 601,500 medical images, spanning over 10 major clinical departments and more than 200 sub-specialties. Then, to better reflect the requirements of real-world clinical diagnosis, we develop the PulseMind Benchmark, a multi-turn diagnostic consultation benchmark with a four-dimensional evaluation protocol comprising proactiveness, accuracy, usefulness, and language quality. Finally, we design a training framework tailored for multi-modal clinical diagnostics, centered around a core component named Comparison-based Reinforcement Policy Optimization (CRPO). Compared to absolute score rewards, CRPO uses relative preference signals from multi-dimensional com-parisons to provide stable and human-aligned training guidance. Extensive experiments demonstrate that PulseMind achieves competitive performance on both the diagnostic consultation benchmark and public medical benchmarks.

Clinical trials are fundamental in developing new drugs, medical devices, and treatments. However, they are often time-consuming and have low success rates. Although there have been initial attempts to create large language models (LLMs) for clinical trial design and patient-trial matching, these models remain task-specific and not adaptable to diverse clinical trial tasks. To address this challenge, we propose a clinical trial foundation model named Panacea, designed to handle multiple tasks, including trial search, trial summarization, trial design, and patient-trial matching. We also assemble a large-scale dataset, named TrialAlign, of 793,279 trial documents and 1,113,207 trial-related scientific papers, to infuse clinical knowledge into the model by pre-training. We further curate TrialInstruct, which has 200,866 of instruction data for fine-tuning. These resources enable Panacea to be widely applicable for a range of clinical trial tasks based on user requirements. We evaluated Panacea on a new benchmark, named TrialPanorama, which covers eight clinical trial tasks. Our method performed the best on seven of the eight tasks compared to six cutting-edge generic or medicine-specific LLMs. Specifically, Panacea showed great potential to collaborate with human experts in crafting the design of eligibility criteria, study arms, and outcome measures, in multi-round conversations. In addition, Panacea achieved 14.42% improvement in patient-trial matching, 41.78% to 52.02% improvement in trial search, and consistently ranked at the top for five aspects of trial summarization. Our approach demonstrates the effectiveness of Panacea in clinical trials and establishes a comprehensive resource, including training data, model, and benchmark, for developing clinical trial foundation models, paving the path for AI-based clinical trial development.

The success of Reinforcement Learning from Human Feedback (RLHF) critically depends on the quality of the reward model. While this quality is primarily evaluated through accuracy, it remains unclear whether accuracy fully captures what makes a reward model an effective teacher. We address this question from an optimization perspective. First, we prove that regardless of how accurate a reward model is, if it induces low reward variance, then the RLHF objective suffers from a flat landscape. Consequently, even a perfectly accurate reward model can lead to extremely slow optimization, underperforming less accurate models that induce higher reward variance. We additionally show that a reward model that works well for one language model can induce low reward variance, and thus a flat objective landscape, for another. These results establish a fundamental limitation of evaluating reward models solely based on accuracy or independently of the language model they guide. Experiments using models of up to 8B parameters corroborate our theory, demonstrating the interplay between reward variance, accuracy, and reward maximization rate. Overall, our findings highlight that beyond accuracy, a reward model needs to induce sufficient variance for efficient optimization.

Recruiting patients to participate in clinical trials can be challenging and time-consuming. Usually, participation in a clinical trial is initiated by a healthcare professional and proposed to the patient. Promoting clinical trials directly to patients via online recruitment might help to reach them more efficiently. In this study, we address the case where a patient is initiating their own recruitment process and wants to determine whether they are eligible for a given clinical trial, using their own language to describe their medical profile. To study whether this creates difficulties in the patient trial matching process, we design a new dataset and task, Natural Language Inference for Patient Recruitment (NLI4PR), in which patient language profiles must be matched to clinical trials. We create it by adapting the TREC 2022 Clinical Trial Track dataset, which provides patients' medical profiles, and rephrasing them manually using patient language. We also use the associated clinical trial reports where the patients are either eligible or excluded. We prompt several open-source Large Language Models on our task and achieve from 56.5 to 71.8 of F1 score using patient language, against 64.7 to 73.1 for the same task using medical language. When using patient language, we observe only a small loss in performance for the best model, suggesting that having the patient as a starting point could be adopted to help recruit patients for clinical trials. The corpus and code bases are all freely available on our Github and HuggingFace repositories.

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.

The global cost of drug discovery and development exceeds $200 billion annually. The main results of drug discovery and development are the outcomes of clinical trials, which directly influence the regulatory approval of new drug candidates and ultimately affect patient outcomes. Despite their significance, large-scale, high-quality clinical trial outcome data are not readily available to the public. Suppose a large clinical trial outcome dataset is provided; machine learning researchers can potentially develop accurate prediction models using past trials and outcome labels, which could help prioritize and optimize therapeutic programs, ultimately benefiting patients. This paper introduces Clinical Trial Outcome (CTO) dataset, the largest trial outcome dataset with around 479K clinical trials, aggregating outcomes from multiple sources of weakly supervised labels, minimizing the noise from individual sources, and eliminating the need for human annotation. These sources include large language model (LLM) decisions on trial-related documents, news headline sentiments, stock prices of trial sponsors, trial linkages across phases, and other signals such as patient dropout rates and adverse events. CTO's labels show unprecedented agreement with supervised clinical trial outcome labels from test split of the supervised TOP dataset, with a 91 F1.

Reward models are key in reinforcement learning from human feedback (RLHF) systems, aligning the model behavior with human preferences. Particularly in the math domain, there have been plenty of studies using reward models to align policies for improving reasoning capabilities. Recently, as the importance of reward models has been emphasized, RewardBench is proposed to understand their behavior. However, we figure out that the math subset of RewardBench has different representations between chosen and rejected completions, and relies on a single comparison, which may lead to unreliable results as it only see an isolated case. Therefore, it fails to accurately present the robustness of reward models, leading to a misunderstanding of its performance and potentially resulting in reward hacking. In this work, we introduce a new design for reliable evaluation of reward models, and to validate this, we construct RewardMATH, a benchmark that effectively represents the robustness of reward models in mathematical reasoning tasks. We demonstrate that the scores on RewardMATH strongly correlate with the results of optimized policy and effectively estimate reward overoptimization, whereas the existing benchmark shows almost no correlation. The results underscore the potential of our design to enhance the reliability of evaluation, and represent the robustness of reward model. We make our code and data publicly available.

Clinical trial matching is the task of identifying trials for which patients may be potentially eligible. Typically, this task is labor-intensive and requires detailed verification of patient electronic health records (EHRs) against the stringent inclusion and exclusion criteria of clinical trials. This process is manual, time-intensive, and challenging to scale up, resulting in many patients missing out on potential therapeutic options. Recent advancements in Large Language Models (LLMs) have made automating patient-trial matching possible, as shown in multiple concurrent research studies. However, the current approaches are confined to constrained, often synthetic datasets that do not adequately mirror the complexities encountered in real-world medical data. In this study, we present the first, end-to-end large-scale empirical evaluation of clinical trial matching using real-world EHRs. Our study showcases the capability of LLMs to accurately match patients with appropriate clinical trials. We perform experiments with proprietary LLMs, including GPT-4 and GPT-3.5, as well as our custom fine-tuned model called OncoLLM and show that OncoLLM, despite its significantly smaller size, not only outperforms GPT-3.5 but also matches the performance of qualified medical doctors. All experiments were carried out on real-world EHRs that include clinical notes and available clinical trials from a single cancer center in the United States.

As large language models (LLMs) advance in conversational and reasoning capabilities, their practical application in healthcare has become a critical research focus. However, there is a notable gap between the performance of medical LLMs on static benchmarks such as USMLE and their utility in real-world clinical decision-making. This discrepancy arises because traditional exams fail to capture the dynamic, interactive nature of medical consultations. To address this challenge, we introduce a novel dynamic verification framework that moves beyond static answer verifier, establishing a large-scale, high-fidelity interactive reinforcement learning system. Our framework comprises two key components: a Patient Simulator that creates realistic clinical environments using de-identified medical records, and a Clinical Rubrics Generator that dynamically produces multi-dimensional evaluation metrics. Building on this foundation, we develop Baichuan-M2, a 32B-parameter medical augmented reasoning model trained through a multi-stage reinforcement learning strategy with an improved Group Relative Policy Optimization (GRPO) algorithm. Evaluated on HealthBench, Baichuan-M2 outperforms all other open-source models and most advanced closed-source counterparts, achieving a score above 32 on the challenging HealthBench Hard benchmark-previously exceeded only by GPT-5. Our work demonstrates that robust dynamic verifier system is essential for aligning LLM capabilities with practical clinical applications, establishing a new Pareto front in the performance-parameter trade-off for medical AI deployment.

Large Language Models (LLMs) have revolutionized natural language processing, yet aligning these models with human values and preferences using RLHF remains a significant challenge. This challenge is characterized by various instabilities, such as reward hacking and catastrophic forgetting. In this technical report, we propose two innovations to stabilize RLHF training: 1) Advantage Model, which directly models advantage score i.e., extra reward compared to the expected rewards and regulates score distributions across tasks to prevent reward hacking. 2) Selective Rehearsal, which mitigates catastrophic forgetting by strategically selecting data for PPO training and knowledge rehearsing. Our experimental analysis on public and proprietary datasets reveals that the proposed methods not only increase stability in RLHF training but also achieve higher reward scores and win rates.

Reward models are used throughout the post-training of language models to capture nuanced signals from preference data and provide a training target for optimization across instruction following, reasoning, safety, and more domains. The community has begun establishing best practices for evaluating reward models, from the development of benchmarks that test capabilities in specific skill areas to others that test agreement with human preferences. At the same time, progress in evaluation has not been mirrored by the effectiveness of reward models in downstream tasks -- simpler direct alignment algorithms are reported to work better in many cases. This paper introduces RewardBench 2, a new multi-skill reward modeling benchmark designed to bring new, challenging data for accuracy-based reward model evaluation -- models score about 20 points on average lower on RewardBench 2 compared to the first RewardBench -- while being highly correlated with downstream performance. Compared to most other benchmarks, RewardBench 2 sources new human prompts instead of existing prompts from downstream evaluations, facilitating more rigorous evaluation practices. In this paper, we describe our benchmark construction process and report how existing models perform on it, while quantifying how performance on the benchmark correlates with downstream use of the models in both inference-time scaling algorithms, like best-of-N sampling, and RLHF training algorithms like proximal policy optimization.

Persona conditioning can be viewed as a behavioral prior for large language models (LLMs) and is often assumed to confer expertise and improve safety in a monotonic manner. However, its effects on high-stakes clinical decision-making remain poorly characterized. We systematically evaluate persona-based control in clinical LLMs, examining how professional roles (e.g., Emergency Department physician, nurse) and interaction styles (bold vs.\ cautious) influence behavior across models and medical tasks. We assess performance on clinical triage and patient-safety tasks using multidimensional evaluations that capture task accuracy, calibration, and safety-relevant risk behavior. We find systematic, context-dependent, and non-monotonic effects: Medical personas improve performance in critical care tasks, yielding gains of up to sim+20% in accuracy and calibration, but degrade performance in primary-care settings by comparable margins. Interaction style modulates risk propensity and sensitivity, but it's highly model-dependent. While aggregated LLM-judge rankings favor medical over non-medical personas in safety-critical cases, we found that human clinicians show moderate agreement on safety compliance (average Cohen's κ= 0.43) but indicate a low confidence in 95.9\% of their responses on reasoning quality. Our work shows that personas function as behavioral priors that introduce context-dependent trade-offs rather than guarantees of safety or expertise. The code is available at https://github.com/rsinghlab/Persona\_Paradox.

LLM-based (Large Language Model) GUI (Graphical User Interface) agents can potentially reshape our daily lives significantly. However, current LLM-based GUI agents suffer from the scarcity of high-quality training data owing to the difficulties of trajectory collection and reward annotation. Existing works have been exploring LLMs to collect trajectories for imitation learning or to offer reward signals for online RL training. However, the Outcome Reward Model (ORM) used in existing works cannot provide finegrained feedback and can over-penalize the valuable steps in finally failed trajectories. To this end, we propose Progress Reward Model (ProgRM) to provide dense informative intermediate rewards by predicting a task completion progress for each step in online training. To handle the challenge of progress reward label annotation, we further design an efficient LCS-based (Longest Common Subsequence) self-annotation algorithm to discover the key steps in trajectories and assign progress labels accordingly. ProgRM is evaluated with extensive experiments and analyses. Actors trained with ProgRM outperform leading proprietary LLMs and ORM-trained actors, illustrating the effectiveness of ProgRM. The codes for experiments will be made publicly available upon acceptance.

This study investigates GPT-4's assessment of its performance in healthcare applications. A simple prompting technique was used to prompt the LLM with questions taken from the United States Medical Licensing Examination (USMLE) questionnaire and it was tasked to evaluate its confidence score before posing the question and after asking the question. The questionnaire was categorized into two groups-questions with feedback (WF) and questions with no feedback(NF) post-question. The model was asked to provide absolute and relative confidence scores before and after each question. The experimental findings were analyzed using statistical tools to study the variability of confidence in WF and NF groups. Additionally, a sequential analysis was conducted to observe the performance variation for the WF and NF groups. Results indicate that feedback influences relative confidence but doesn't consistently increase or decrease it. Understanding the performance of LLM is paramount in exploring its utility in sensitive areas like healthcare. This study contributes to the ongoing discourse on the reliability of AI, particularly of LLMs like GPT-4, within healthcare, offering insights into how feedback mechanisms might be optimized to enhance AI-assisted medical education and decision support.

Different from its counterpart outcome reward models (ORMs), which evaluate the entire responses, a process reward model (PRM) scores a reasoning trajectory step by step, providing denser and more fine grained rewards. However, training a PRM requires labels annotated at every intermediate step, presenting significant challenges for both manual and automatic data collection. This paper aims to address this challenge. Both theoretically and empirically, we show that an implicit PRM can be obtained at no additional cost, by simply training an ORM on the cheaper response-level labels. The only assumption is to parameterize the outcome reward as the log-likelihood ratios of the policy and reference models, which can be optimized regardless of the specific choice of loss objectives. In experiments, we instantiate our implicit PRMs with various objectives and evaluate their performance on MATH. We show that our implicit PRM outperforms a strong MCTS-based baseline \'a la Math-Shepherd using less than 1/38 of the training data. Its performance can be further improved with majority voting. We further find that scaling up instructions and responses benefits our implicit PRM, and the latter brings a larger gain. Particularly, we find that our implicit PRM, when instantiated with the cross-entropy (CE) loss, is more data-efficient and can keep improving generation models even when trained with only one response per instruction, the setup that suffers from extreme data scarcity and imbalance. Further, instructions should be relevant to downstream tasks while the diversity of responses does not bring gains. Surprisingly, training on extra Math-Shepherd step labels brings no further improvements to our implicit PRM trained on only outcome data. We hope that our work will encourage a rethinking of PRM training approaches and contribute to making training PRMs more accessible.

Reinforcement learning from verifiable rewards (RLVR) has recently gained attention for its ability to elicit self-evolved reasoning capabilitie from base language models without explicit reasoning supervisions, as demonstrated by DeepSeek-R1. While prior work on RLVR has primarily focused on mathematical and coding domains, its applicability to other tasks and domains remains unexplored. In this work, we investigate whether medical reasoning can emerge from RLVR. We introduce Med-RLVR as an initial study of RLVR in the medical domain leveraging medical multiple-choice question answering (MCQA) data as verifiable labels. Our results demonstrate that RLVR is not only effective for math and coding but also extends successfully to medical question answering. Notably, Med-RLVR achieves performance comparable to traditional supervised fine-tuning (SFT) on in-distribution tasks while significantly improving out-of-distribution generalization, with an 8-point accuracy gain. Further analysis of training dynamics reveals that, with no explicit reasoning supervision, reasoning emerges from the 3B-parameter base model. These findings underscore the potential of RLVR in domains beyond math and coding, opening new avenues for its application in knowledge-intensive fields such as medicine.

Large-language models have recently demonstrated impressive zero-shot capabilities in a variety of natural language tasks such as summarization, dialogue generation, and question-answering. Despite many promising applications in clinical medicine, adoption of these models in real-world settings has been largely limited by their tendency to generate incorrect and sometimes even toxic statements. In this study, we develop Almanac, a large language model framework augmented with retrieval capabilities for medical guideline and treatment recommendations. Performance on a novel dataset of clinical scenarios (n = 130) evaluated by a panel of 5 board-certified and resident physicians demonstrates significant increases in factuality (mean of 18% at p-value < 0.05) across all specialties, with improvements in completeness and safety. Our results demonstrate the potential for large language models to be effective tools in the clinical decision-making process, while also emphasizing the importance of careful testing and deployment to mitigate their shortcomings.

Patient recruitment is challenging for clinical trials. We introduce TrialGPT, an end-to-end framework for zero-shot patient-to-trial matching with large language models. TrialGPT comprises three modules: it first performs large-scale filtering to retrieve candidate trials (TrialGPT-Retrieval); then predicts criterion-level patient eligibility (TrialGPT-Matching); and finally generates trial-level scores (TrialGPT-Ranking). We evaluate TrialGPT on three cohorts of 183 synthetic patients with over 75,000 trial annotations. TrialGPT-Retrieval can recall over 90% of relevant trials using less than 6% of the initial collection. Manual evaluations on 1,015 patient-criterion pairs show that TrialGPT-Matching achieves an accuracy of 87.3% with faithful explanations, close to the expert performance. The TrialGPT-Ranking scores are highly correlated with human judgments and outperform the best-competing models by 43.8% in ranking and excluding trials. Furthermore, our user study reveals that TrialGPT can reduce the screening time by 42.6% in patient recruitment. Overall, these results have demonstrated promising opportunities for patient-to-trial matching with TrialGPT.

In this report, we introduce a collection of methods to enhance reward modeling for LLMs, focusing specifically on data-centric techniques. We propose effective data selection and filtering strategies for curating high-quality open-source preference datasets, culminating in the Skywork-Reward data collection, which contains only 80K preference pairs -- significantly smaller than existing datasets. Using this curated dataset, we developed the Skywork-Reward model series -- Skywork-Reward-Gemma-27B and Skywork-Reward-Llama-3.1-8B -- with the former currently holding the top position on the RewardBench leaderboard. Notably, our techniques and datasets have directly enhanced the performance of many top-ranked models on RewardBench, highlighting the practical impact of our contributions in real-world preference learning applications.

Reward models (RMs) are at the crux of successful RLHF to align pretrained models to human preferences, yet there has been relatively little study that focuses on evaluation of those reward models. Evaluating reward models presents an opportunity to understand the opaque technologies used for alignment of language models and which values are embedded in them. To date, very few descriptors of capabilities, training methods, or open-source reward models exist. In this paper, we present RewardBench, a benchmark dataset and code-base for evaluation, to enhance scientific understanding of reward models. The RewardBench dataset is a collection of prompt-win-lose trios spanning chat, reasoning, and safety, to benchmark how reward models perform on challenging, structured and out-of-distribution queries. We created specific comparison datasets for RMs that have subtle, but verifiable reasons (e.g. bugs, incorrect facts) why one answer should be preferred to another. On the RewardBench leaderboard, we evaluate reward models trained with a variety of methods, such as the direct MLE training of classifiers and the implicit reward modeling of Direct Preference Optimization (DPO), and on a spectrum of datasets. We present many findings on propensity for refusals, reasoning limitations, and instruction following shortcomings of various reward models towards a better understanding of the RLHF process.

Reinforcement learning from human feedback (RLHF) has emerged as a powerful technique to make large language models (LLMs) easier to use and more effective. A core piece of the RLHF process is the training and utilization of a model of human preferences that acts as a reward function for optimization. This approach, which operates at the intersection of many stakeholders and academic disciplines, remains poorly understood. RLHF reward models are often cited as being central to achieving performance, yet very few descriptors of capabilities, evaluations, training methods, or open-source models exist. Given this lack of information, further study and transparency is needed for learned RLHF reward models. In this paper, we illustrate the complex history of optimizing preferences, and articulate lines of inquiry to understand the sociotechnical context of reward models. In particular, we highlight the ontological differences between costs, rewards, and preferences at stake in RLHF's foundations, related methodological tensions, and possible research directions to improve general understanding of how reward models function.

Neural image-to-text radiology report generation systems offer the potential to improve radiology reporting by reducing the repetitive process of report drafting and identifying possible medical errors. However, existing report generation systems, despite achieving high performances on natural language generation metrics such as CIDEr or BLEU, still suffer from incomplete and inconsistent generations. Here we introduce two new simple rewards to encourage the generation of factually complete and consistent radiology reports: one that encourages the system to generate radiology domain entities consistent with the reference, and one that uses natural language inference to encourage these entities to be described in inferentially consistent ways. We combine these with the novel use of an existing semantic equivalence metric (BERTScore). We further propose a report generation system that optimizes these rewards via reinforcement learning. On two open radiology report datasets, our system substantially improved the F1 score of a clinical information extraction performance by +22.1 (Delta +63.9%). We further show via a human evaluation and a qualitative analysis that our system leads to generations that are more factually complete and consistent compared to the baselines.

Reward models play an essential role in training vision-language models (VLMs) by assessing output quality to enable aligning with human preferences. Despite their importance, the research community lacks comprehensive open benchmarks for evaluating multimodal reward models in VLMs. To address this gap, we introduce Multimodal RewardBench, an expert-annotated benchmark covering six domains: general correctness, preference, knowledge, reasoning, safety, and visual question-answering. Our dataset comprises 5,211 annotated (prompt, chosen response, rejected response) triplets collected from various VLMs. In evaluating a range of VLM judges, we find that even the top-performing models, Gemini 1.5 Pro and Claude 3.5 Sonnet, achieve only 72% overall accuracy. Notably, most models struggle in the reasoning and safety domains. These findings suggest that Multimodal RewardBench offers a challenging testbed for advancing reward model development across multiple domains. We release the benchmark at https://github.com/facebookresearch/multimodal_rewardbench.

Aligning multimodal large language models (MLLMs) with human preferences often relies on single-signal, model-based reward methods. Such monolithic rewards often lack confidence calibration across domain-specific tasks, fail to capture diverse aspects of human preferences, and require extensive data annotation and reward model training. In this work, we propose a hybrid reward modeling framework that integrates complementary reward paradigms: (i) model-based rewards, where a learned reward model predicts scalar or vector scores from synthetic and human feedback, and (ii) rule-based rewards, where domain-specific heuristics provide explicit correctness signals with confidence. Beyond accuracy, we further incorporate multi-aspect rewards to enforce instruction adherence and introduce a generalized length-penalty reward to stabilize training and improve performance. The proposed framework provides a flexible and effective approach to aligning MLLMs through reinforcement learning policy optimization. Our experiments show consistent improvements across different multimodal benchmarks when applying hybrid and multi-aspect reward modeling. Our best performing model in the 3B family achieves an overall average improvement of ~9.5% across general and math reasoning tasks. Focusing specifically on mathematical benchmarks, the model achieves a significant average improvement of ~16%, highlighting its effectiveness in mathematical reasoning and problem solving.

Despite the critical role of reward models (RMs) in reinforcement learning from human feedback (RLHF), current state-of-the-art open RMs perform poorly on most existing evaluation benchmarks, failing to capture the spectrum of nuanced and sophisticated human preferences. Even approaches that incorporate advanced training techniques have not yielded meaningful performance improvements. We hypothesize that this brittleness stems primarily from limitations in preference datasets, which are often narrowly scoped, synthetically labeled, or lack rigorous quality control. To address these challenges, we present a large-scale preference dataset comprising 40 million preference pairs, named SynPref-40M. To enable data curation at scale, we design a human-AI synergistic two-stage pipeline that leverages the complementary strengths of human annotation quality and AI scalability. In this pipeline, humans provide verified annotations, while large language models perform automatic curation based on human guidance. Training on this preference mixture, we introduce Skywork-Reward-V2, a suite of eight reward models ranging from 0.6B to 8B parameters, trained on a carefully curated subset of 26 million preference pairs from SynPref-40M. We demonstrate that Skywork-Reward-V2 is versatile across a wide range of capabilities, including alignment with human preferences, objective correctness, safety, resistance to stylistic biases, and best-of-N scaling, achieving state-of-the-art performance across seven major reward model benchmarks. Ablation studies confirm that the effectiveness of our approach stems not only from data scale but also from high-quality curation. The Skywork-Reward-V2 series represents substantial progress in open reward models, highlighting the untapped potential of existing preference datasets and demonstrating how human-AI curation synergy can unlock significantly higher data quality.

Process Reward Models (PRMs) aim to improve multi-step reasoning in Large Language Models (LLMs) by supervising intermediate steps and identifying errors. However, building effective PRMs remains challenging due to the lack of scalable, high-quality annotations. Existing approaches rely on costly human labeling, LLM-based self-evaluation that is prone to hallucination, or Monte Carlo (MC) estimation, which infers step quality solely from rollout outcomes and often introduces noisy, misaligned supervision due to credit misattribution. These issues result in three core limitations: noisy rewards, low factual fidelity, and misalignment with step-level reasoning objectives. To address these challenges, we introduce GroundedPRM, a tree-guided and fidelity-aware framework for automatic process supervision. To reduce reward noise and enable fine-grained credit assignment, we construct structured reasoning paths via Monte Carlo Tree Search (MCTS). To eliminate hallucinated supervision, we validate each intermediate step using an external tool, providing execution-grounded correctness signals. To combine both step-level validation and global outcome assessment, we design a hybrid reward aggregation mechanism that fuses tool-based verification with MCTS-derived feedback. Finally, we format the reward signal into a rationale-enhanced, generative structure to promote interpretability and compatibility with instruction-tuned LLMs. GroundedPRM is trained on only 40K automatically labeled samples, amounting to just 10% of the data used by the best-performing PRM trained with auto-labeled supervision. Nevertheless, it achieves up to a 26% relative improvement in average performance on ProcessBench. When used for reward-guided greedy search, GroundedPRM outperforms even PRMs trained with human-labeled supervision, offering a scalable and verifiable path toward high-quality process-level reasoning.

Despite notable advancements in Multimodal Large Language Models (MLLMs), most state-of-the-art models have not undergone thorough alignment with human preferences. This gap exists because current alignment research has primarily achieved progress in specific areas (e.g., hallucination reduction), while the broader question of whether aligning models with human preferences can systematically enhance MLLM capability remains largely unexplored. To this end, we introduce MM-RLHF, a dataset containing 120k fine-grained, human-annotated preference comparison pairs. This dataset represents a substantial advancement over existing resources, offering superior size, diversity, annotation granularity, and quality. Leveraging this dataset, we propose several key innovations to improve both the quality of reward models and the efficiency of alignment algorithms. Notably, we introduce a Critique-Based Reward Model, which generates critiques of model outputs before assigning scores, offering enhanced interpretability and more informative feedback compared to traditional scalar reward mechanisms. Additionally, we propose Dynamic Reward Scaling, a method that adjusts the loss weight of each sample according to the reward signal, thereby optimizing the use of high-quality comparison pairs. Our approach is rigorously evaluated across 10 distinct dimensions and 27 benchmarks, with results demonstrating significant and consistent improvements in model performance. Specifically, fine-tuning LLaVA-ov-7B with MM-RLHF and our alignment algorithm leads to a 19.5% increase in conversational abilities and a 60% improvement in safety. We have open-sourced the preference dataset, reward model, training and evaluation code, as well as reward modeling and safety benchmarks. For more details, please visit our project page: https://mm-rlhf.github.io.

In this paper, we present a framework for training large language models (LLMs) as diagnostic agents with reinforcement learning, enabling them to manage multi-turn diagnostic processes, adaptively select examinations, and commit to final diagnoses. Unlike instruction-tuned models trained on static case summaries, our method acquires diagnostic strategies through interactive exploration and outcome-based feedback. Our contributions are fourfold: (i) We present DiagGym, a diagnostics world model trained with electronic health records that emits examination outcomes conditioned on patient history and recommended examination, serving as a virtual clinical environment for realistic diagnosis training and evaluation; (ii) We train DiagAgent via end-to-end, multi-turn reinforcement learning to learn diagnostic policies that optimize both information yield and diagnostic accuracy; (iii) We introduce DiagBench, a diagnostic benchmark comprising 750 cases with physician-validated examination recommendations and 99 cases annotated with 973 physician-written rubrics on diagnosis process; (iv) we demonstrate superior performance across diverse diagnostic settings. DiagAgent significantly outperforms 10 state-of-the-art LLMs, including DeepSeek-v3 and GPT-4o, as well as two prompt-engineered agents. In single-turn settings, DiagAgent achieves 9.34% higher diagnostic accuracy and 44.03% improvement in examination recommendation hit ratio. In end-to-end settings, it delivers 15.12% increase in diagnostic accuracy and 23.09% boost in examination recommendation F1 score. In rubric-based evaluation, it surpasses the next-best model, Claude-sonnet-4, by 7.1% in weighted rubric score. These findings indicate that learning policies in interactive clinical environments confers dynamic and clinically meaningful diagnostic management abilities unattainable through passive training alone.

Fine-tuning large language models (LLMs) on reasoning benchmarks via reinforcement learning requires a specific reward function, often binary, for each benchmark. This comes with two potential limitations: the need to design the reward, and the potentially sparse nature of binary rewards. Here, we systematically investigate rewards derived from the probability or log-probability of emitting the reference answer (or any other prompt continuation present in the data), which have the advantage of not relying on specific verifiers and being available at scale. Several recent works have advocated for the use of similar rewards (e.g., VeriFree, JEPO, RLPR, NOVER). We systematically compare variants of likelihood-based rewards with standard baselines, testing performance both on standard mathematical reasoning benchmarks, and on long-form answers where no external verifier is available. We find that using the log-probability of the reference answer as the reward for chain-of-thought (CoT) learning is the only option that performs well in all setups. This reward is also consistent with the next-token log-likelihood loss used during pretraining. In verifiable settings, log-probability rewards bring comparable or better success rates than reinforcing with standard binary rewards, and yield much better perplexity. In non-verifiable settings, they perform on par with SFT. On the other hand, methods based on probability, such as VeriFree, flatline on non-verifiable settings due to vanishing probabilities of getting the correct answer. Overall, this establishes log-probability rewards as a viable method for CoT fine-tuning, bridging the short, verifiable and long, non-verifiable answer settings.

As large language models (LLMs) increasingly interact with external tools, reward modeling for tool use has become a critical yet underexplored area. Existing reward models, trained primarily on natural language outputs, struggle to evaluate tool-based reasoning and execution. To quantify this gap, we introduce FC-RewardBench, the first benchmark designed to systematically assess reward models' performance in tool-calling scenarios. Our analysis shows that current reward models often miss key signals of effective tool use, highlighting the need for domain-specific modeling. To address this, we propose a training framework for outcome-based reward models using data synthesized from permissively licensed, open-weight LLMs. We train models ranging from 1.7B to 14B parameters and evaluate them across seven out-of-domain benchmarks. These models consistently outperform general-purpose baselines, achieving up to 25\% average improvement in downstream task performance and enabling data-efficient fine-tuning through reward-guided filtering.

Interactive medical questioning is essential in real-world clinical consultations, where physicians must actively gather information from patients. While medical Large Language Models (LLMs) have shown impressive capabilities in static medical question answering, they predominantly operate under a reactive paradigm: generating answers directly without seeking additional information, which risks incorrect diagnoses in such interactive settings. To address this limitation, we propose ProMed, a reinforcement learning (RL) framework that transitions medical LLMs toward a proactive paradigm, equipping them with the ability to ask clinically valuable questions before decision-making. At the core of ProMed is the Shapley Information Gain (SIG) reward, which quantifies the clinical utility of each question by combining the amount of newly acquired information with its contextual importance, estimated via Shapley values. We integrate SIG into a two-stage training pipeline: (1) SIG-Guided Model Initialization uses Monte Carlo Tree Search (MCTS) to construct high-reward interaction trajectories to supervise the model, and (2) SIG-Augmented Policy Optimization, which integrates SIG and enhances RL with a novel SIG-guided Reward Distribution Mechanism that assigns higher rewards to informative questions for targeted optimization. Extensive experiments on two newly curated partial-information medical benchmarks demonstrate that ProMed significantly outperforms state-of-the-art methods by an average of 6.29% and delivers a 54.45% gain over the reactive paradigm, while also generalizing robustly to out-of-domain cases.

Vision-Language Models (VLMs) are advancing computational pathology with superior visual understanding capabilities. However, current systems often reduce diagnosis to directly output conclusions without verifiable evidence-linked reasoning, which severely limits clinical trust and hinders expert error rectification. To address these barriers, we construct PathReasoner, the first large-scale dataset of whole-slide image (WSI) reasoning. Unlike previous work reliant on unverified distillation, we develop a rigorous knowledge-guided generation pipeline. By leveraging medical knowledge graphs, we explicitly align structured pathological findings and clinical reasoning with diagnoses, generating over 20K high-quality instructional samples. Based on the database, we propose PathReasoner-R1, which synergizes trajectory-masked supervised fine-tuning with reasoning-oriented reinforcement learning to instill structured chain-of-thought capabilities. To ensure medical rigor, we engineer a knowledge-aware multi-granular reward function incorporating an Entity Reward mechanism strictly aligned with knowledge graphs. This effectively guides the model to optimize for logical consistency rather than mere outcome matching, thereby enhancing robustness. Extensive experiments demonstrate that PathReasoner-R1 achieves state-of-the-art performance on both PathReasoner and public benchmarks across various image scales, equipping pathology models with transparent, clinically grounded reasoning capabilities. Dataset and code are available at https://github.com/cyclexfy/PathReasoner-R1.

Effective reward design is a central challenge in Reinforcement Learning (RL) for code generation. Mainstream pass/fail outcome rewards enforce functional correctness via executing unit tests, but the resulting sparsity limits potential performance gains. While recent work has explored external Reward Models (RM) to generate richer, continuous rewards, the learned RMs suffer from reward misalignment and prohibitive computational cost. In this paper, we introduce VeRPO (Verifiable Dense Reward Policy Optimization), a novel RL framework for code generation that synthesizes robust and dense rewards fully grounded in verifiable execution feedback. The core idea of VeRPO is constructing dense rewards from weighted partial success: by dynamically estimating the difficulty weight of each unit test based on the execution statistics during training, a dense reward is derived from the sum of weights of the passed unit tests. To solidify the consistency between partial success and end-to-end functional correctness, VeRPO further integrates the dense signal with global execution outcomes, establishing a robust and dense reward paradigm relying solely on verifiable execution feedback. Extensive experiments across diverse benchmarks and settings demonstrate that VeRPO consistently outperforms outcome-driven and RM-based baselines, achieving up to +8.83\% gain in pass@1 with negligible time cost (< 0.02\%) and zero GPU memory overhead.

Skin carcinoma is the most prevalent form of cancer globally, accounting for over $8 billion in annual healthcare expenditures. In clinical settings, physicians document patient visits using detailed SOAP (Subjective, Objective, Assessment, and Plan) notes. However, manually generating these notes is labor-intensive and contributes to clinician burnout. In this work, we propose a weakly supervised multimodal framework to generate clinically structured SOAP notes from limited inputs, including lesion images and sparse clinical text. Our approach reduces reliance on manual annotations, enabling scalable, clinically grounded documentation while alleviating clinician burden and reducing the need for large annotated data. Our method achieves performance comparable to GPT-4o, Claude, and DeepSeek Janus Pro across key clinical relevance metrics. To evaluate clinical quality, we introduce two novel metrics MedConceptEval and Clinical Coherence Score (CCS) which assess semantic alignment with expert medical concepts and input features, respectively.

While reinforcement learning with verifiable rewards (RLVR) has advanced LLM reasoning in structured domains like mathematics and programming, its application to general-domain reasoning tasks remains challenging due to the absence of verifiable reward signals. To this end, methods like Reinforcement Learning with Reference Probability Reward (RLPR) have emerged, leveraging the probability of generating the final answer as a reward signal. However, these outcome-focused approaches neglect crucial step-by-step supervision of the reasoning process itself. To address this gap, we introduce Probabilistic Process Supervision (P2S), a novel self-supervision framework that provides fine-grained process rewards without requiring a separate reward model or human-annotated reasoning steps. During reinforcement learning, P2S synthesizes and filters a high-quality reference reasoning chain (gold-CoT). The core of our method is to calculate a Path Faithfulness Reward (PFR) for each reasoning step, which is derived from the conditional probability of generating the gold-CoT's suffix, given the model's current reasoning prefix. Crucially, this PFR can be flexibly integrated with any outcome-based reward, directly tackling the reward sparsity problem by providing dense guidance. Extensive experiments on reading comprehension and medical Question Answering benchmarks show that P2S significantly outperforms strong baselines.

We present the findings of "The Alzheimer's Disease Prediction Of Longitudinal Evolution" (TADPOLE) Challenge, which compared the performance of 92 algorithms from 33 international teams at predicting the future trajectory of 219 individuals at risk of Alzheimer's disease. Challenge participants were required to make a prediction, for each month of a 5-year future time period, of three key outcomes: clinical diagnosis, Alzheimer's Disease Assessment Scale Cognitive Subdomain (ADAS-Cog13), and total volume of the ventricles. The methods used by challenge participants included multivariate linear regression, machine learning methods such as support vector machines and deep neural networks, as well as disease progression models. No single submission was best at predicting all three outcomes. For clinical diagnosis and ventricle volume prediction, the best algorithms strongly outperform simple baselines in predictive ability. However, for ADAS-Cog13 no single submitted prediction method was significantly better than random guesswork. Two ensemble methods based on taking the mean and median over all predictions, obtained top scores on almost all tasks. Better than average performance at diagnosis prediction was generally associated with the additional inclusion of features from cerebrospinal fluid (CSF) samples and diffusion tensor imaging (DTI). On the other hand, better performance at ventricle volume prediction was associated with inclusion of summary statistics, such as the slope or maxima/minima of biomarkers. TADPOLE's unique results suggest that current prediction algorithms provide sufficient accuracy to exploit biomarkers related to clinical diagnosis and ventricle volume, for cohort refinement in clinical trials for Alzheimer's disease. However, results call into question the usage of cognitive test scores for patient selection and as a primary endpoint in clinical trials.

We present Gazal-R1, a 32-billion-parameter language model that achieves state-of-the-art performance in medical reasoning while providing transparent, step-by-step explanations for clinical decision-making. Built upon Qwen3 32B, our model demonstrates that strategic training can enable mid-sized models to outperform significantly larger counterparts in specialized domains. We developed a novel two-stage training pipeline: first, supervised fine-tuning on a carefully curated dataset of 107,033 synthetic medical reasoning examples that teaches structured clinical thinking, enhanced by advanced parameter-efficient techniques including Weight-Decomposed Low-Rank Adaptation (DoRA) and Rank-Stabilized LoRA (rsLoRA); second, reinforcement learning using Group Relative Policy Optimization (GRPO) with a sophisticated multi-component reward system that refines accuracy, format adherence, and reasoning quality. Gazal-R1 achieves exceptional performance across medical benchmarks, scoring 87.1% on MedQA, 81.6% on MMLU Pro (Medical), and 79.6% on PubMedQA, surpassing models up to 12x larger. Beyond its strong empirical results, this work provides detailed insights into the challenges of training reasoning-capable models in specialized domains, including issues with reward hacking, training instability, and the fundamental tension between factual recall and detailed reasoning. Our methodology offers a reproducible framework for developing high-capability, domain-specific language models that balance performance, efficiency, and explainability.

Despite the promising performance of Large Vision Language Models (LVLMs) in visual understanding, they occasionally generate incorrect outputs. While reward models (RMs) with reinforcement learning or test-time scaling offer the potential for improving generation quality, a critical gap remains: publicly available multi-modal RMs for LVLMs are scarce, and the implementation details of proprietary models are often unclear. We bridge this gap with InternLM-XComposer2.5-Reward (IXC-2.5-Reward), a simple yet effective multi-modal reward model that aligns LVLMs with human preferences. To ensure the robustness and versatility of IXC-2.5-Reward, we set up a high-quality multi-modal preference corpus spanning text, image, and video inputs across diverse domains, such as instruction following, general understanding, text-rich documents, mathematical reasoning, and video understanding. IXC-2.5-Reward achieves excellent results on the latest multi-modal reward model benchmark and shows competitive performance on text-only reward model benchmarks. We further demonstrate three key applications of IXC-2.5-Reward: (1) Providing a supervisory signal for RL training. We integrate IXC-2.5-Reward with Proximal Policy Optimization (PPO) yields IXC-2.5-Chat, which shows consistent improvements in instruction following and multi-modal open-ended dialogue; (2) Selecting the best response from candidate responses for test-time scaling; and (3) Filtering outlier or noisy samples from existing image and video instruction tuning training data. To ensure reproducibility and facilitate further research, we have open-sourced all model weights and training recipes at https://github.com/InternLM/InternLM-XComposer

We introduce VisualPRM, an advanced multimodal Process Reward Model (PRM) with 8B parameters, which improves the reasoning abilities of existing Multimodal Large Language Models (MLLMs) across different model scales and families with Best-of-N (BoN) evaluation strategies. Specifically, our model improves the reasoning performance of three types of MLLMs and four different model scales. Even when applied to the highly capable InternVL2.5-78B, it achieves a 5.9-point improvement across seven multimodal reasoning benchmarks. Experimental results show that our model exhibits superior performance compared to Outcome Reward Models and Self-Consistency during BoN evaluation. To facilitate the training of multimodal PRMs, we construct a multimodal process supervision dataset VisualPRM400K using an automated data pipeline. For the evaluation of multimodal PRMs, we propose VisualProcessBench, a benchmark with human-annotated step-wise correctness labels, to measure the abilities of PRMs to detect erroneous steps in multimodal reasoning tasks. We hope that our work can inspire more future research and contribute to the development of MLLMs. Our model, data, and benchmark are released in https://internvl.github.io/blog/2025-03-13-VisualPRM/.

Large Language Models (LLMs) have demonstrated remarkable capabilities across various domains and are moving towards more specialized areas. Recent advanced proprietary models such as GPT-4 and Gemini have achieved significant advancements in biomedicine, which have also raised privacy and security challenges. The construction of specialized generalists hinges largely on high-quality datasets, enhanced by techniques like supervised fine-tuning and reinforcement learning from human or AI feedback, and direct preference optimization. However, these leading technologies (e.g., preference learning) are still significantly limited in the open source community due to the scarcity of specialized data. In this paper, we present the UltraMedical collections, which consist of high-quality manual and synthetic datasets in the biomedicine domain, featuring preference annotations across multiple advanced LLMs. By utilizing these datasets, we fine-tune a suite of specialized medical models based on Llama-3 series, demonstrating breathtaking capabilities across various medical benchmarks. Moreover, we develop powerful reward models skilled in biomedical and general reward benchmark, enhancing further online preference learning within the biomedical LLM community.

Discharge summaries in Electronic Health Records (EHRs) are crucial for clinical decision-making, but their length and complexity make information extraction challenging, especially when dealing with accumulated summaries across multiple patient admissions. Large Language Models (LLMs) show promise in addressing this challenge by efficiently analyzing vast and complex data. Existing benchmarks, however, fall short in properly evaluating LLMs' capabilities in this context, as they typically focus on single-note information or limited topics, failing to reflect the real-world inquiries required by clinicians. To bridge this gap, we introduce EHRNoteQA, a novel benchmark built on the MIMIC-IV EHR, comprising 962 different QA pairs each linked to distinct patients' discharge summaries. Every QA pair is initially generated using GPT-4 and then manually reviewed and refined by three clinicians to ensure clinical relevance. EHRNoteQA includes questions that require information across multiple discharge summaries and covers eight diverse topics, mirroring the complexity and diversity of real clinical inquiries. We offer EHRNoteQA in two formats: open-ended and multi-choice question answering, and propose a reliable evaluation method for each. We evaluate 27 LLMs using EHRNoteQA and examine various factors affecting the model performance (e.g., the length and number of discharge summaries). Furthermore, to validate EHRNoteQA as a reliable proxy for expert evaluations in clinical practice, we measure the correlation between the LLM performance on EHRNoteQA, and the LLM performance manually evaluated by clinicians. Results show that LLM performance on EHRNoteQA have higher correlation with clinician-evaluated performance (Spearman: 0.78, Kendall: 0.62) compared to other benchmarks, demonstrating its practical relevance in evaluating LLMs in clinical settings.

Reasoning in knowledge-intensive domains remains challenging as intermediate steps are often not locally verifiable: unlike math or code, evaluating step correctness may require synthesizing clues across large external knowledge sources. As a result, subtle errors can propagate through reasoning traces, potentially never to be detected. Prior work has proposed process reward models (PRMs), including retrieval-augmented variants, but these methods operate post hoc, scoring completed trajectories, which prevents their integration into dynamic inference procedures. Here, we introduce Process Reward Agents (PRA), a test-time method for providing domain-grounded, online, step-wise rewards to a frozen policy. In contrast to prior retrieval-augmented PRMs, PRA enables search-based decoding to rank and prune candidate trajectories at every generation step. Experiments on multiple medical reasoning benchmarks demonstrate that PRA consistently outperforms strong baselines, achieving 80.8% accuracy on MedQA with Qwen3-4B, a new state of the art at the 4B scale. Importantly, PRA generalizes to unseen frozen policy models ranging from 0.5B to 8B parameters, improving their accuracy by up to 25.7% without any policy model updates. More broadly, PRA suggests a paradigm in which frozen reasoners are decoupled from domain-specific reward modules, allowing the deployment of new backbones in complex domains without retraining.

Medical visual question answering aims to support clinical decision-making by enabling models to answer natural language questions based on medical images. While recent advances in multi-modal learning have significantly improved performance, current methods still suffer from limited answer reliability and poor interpretability, impairing the ability of clinicians and patients to understand and trust model-generated answers. To address this, this work first proposes a Thinking with Visual Grounding (ThinkVG) dataset wherein the answer generation is decomposed into intermediate reasoning steps that explicitly ground relevant visual regions of the medical image, thereby providing fine-grained explainability. Furthermore, we introduce a novel verifiable reward mechanism for reinforcement learning to guide post-training, improving the alignment between the model's reasoning process and its final answer. Remarkably, our method achieves comparable performance using only one-eighth of the training data, demonstrating the efficiency and effectiveness of the proposal. The dataset is available at https://huggingface.co/datasets/BoKelvin/GEMeX-ThinkVG.

Recent studies on post-training large language models (LLMs) for reasoning through reinforcement learning (RL) typically focus on tasks that can be accurately verified and rewarded, such as solving math problems. In contrast, our research investigates the impact of reward noise, a more practical consideration for real-world scenarios involving the post-training of LLMs using reward models. We found that LLMs demonstrate strong robustness to substantial reward noise. For example, manually flipping 40% of the reward function's outputs in math tasks still allows a Qwen-2.5-7B model to achieve rapid convergence, improving its performance on math tasks from 5% to 72%, compared to the 75% accuracy achieved by a model trained with noiseless rewards. Surprisingly, by only rewarding the appearance of key reasoning phrases (namely reasoning pattern reward, RPR), such as ``first, I need to''-without verifying the correctness of answers, the model achieved peak downstream performance (over 70% accuracy for Qwen-2.5-7B) comparable to models trained with strict correctness verification and accurate rewards. Recognizing the importance of the reasoning process over the final results, we combined RPR with noisy reward models. RPR helped calibrate the noisy reward models, mitigating potential false negatives and enhancing the LLM's performance on open-ended tasks. These findings suggest the importance of improving models' foundational abilities during the pre-training phase while providing insights for advancing post-training techniques. Our code and scripts are available at https://github.com/trestad/Noisy-Rewards-in-Learning-to-Reason.

Documentation burden is a major contributor to clinician burnout, which is rising nationally and is an urgent threat to our ability to care for patients. Artificial intelligence (AI) chatbots, such as ChatGPT, could reduce clinician burden by assisting with documentation. Although many hospitals are actively integrating such systems into electronic medical record systems, AI chatbots utility and impact on clinical decision-making have not been studied for this intended use. We are the first to examine the utility of large language models in assisting clinicians draft responses to patient questions. In our two-stage cross-sectional study, 6 oncologists responded to 100 realistic synthetic cancer patient scenarios and portal messages developed to reflect common medical situations, first manually, then with AI assistance. We find AI-assisted responses were longer, less readable, but provided acceptable drafts without edits 58% of time. AI assistance improved efficiency 77% of time, with low harm risk (82% safe). However, 7.7% unedited AI responses could severely harm. In 31% cases, physicians thought AI drafts were human-written. AI assistance led to more patient education recommendations, fewer clinical actions than manual responses. Results show promise for AI to improve clinician efficiency and patient care through assisting documentation, if used judiciously. Monitoring model outputs and human-AI interaction remains crucial for safe implementation.

In response to the pressing need for advanced clinical problem-solving tools in healthcare, we introduce BooksMed, a novel framework based on a Large Language Model (LLM). BooksMed uniquely emulates human cognitive processes to deliver evidence-based and reliable responses, utilizing the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework to effectively quantify evidence strength. For clinical decision-making to be appropriately assessed, an evaluation metric that is clinically aligned and validated is required. As a solution, we present ExpertMedQA, a multispecialty clinical benchmark comprised of open-ended, expert-level clinical questions, and validated by a diverse group of medical professionals. By demanding an in-depth understanding and critical appraisal of up-to-date clinical literature, ExpertMedQA rigorously evaluates LLM performance. BooksMed outperforms existing state-of-the-art models Med-PaLM 2, Almanac, and ChatGPT in a variety of medical scenarios. Therefore, a framework that mimics human cognitive stages could be a useful tool for providing reliable and evidence-based responses to clinical inquiries.

Large Language Models (LLMs) have shown substantial advances through reinforcement learning (RL), particularly in domains where rewards can be programmatically verified, such as mathematics and code. In these areas, models benefit from a well-defined operational base guided by explicit rule-based objectives. However, this progress reveals a significant limitation: in open-ended domains where rewards are ambiguous, subjective, or context-dependent, such as creative writing, scientific reasoning, and notably medical consultation, robust reward functions are lacking, making these areas challenging for current RL strategies. To bridge this gap, we introduce ORBIT, an open-ended rubric-based incremental training framework specifically designed for high-stakes medical dialogue. ORBIT integrates syn- thetic dialogue generation with the dynamic creation of rubrics, employing these rubrics to direct an incremental RL process. In particular, this approach does not depend on external medical knowledge or manual rules, instead utilizing rubric-guided feedback to shape learning. When implemented on the Qwen3-4B-Instruct model, our method can greatly enhance its performance on the HealthBench-Hard benchmark from 7.0 to 27.2 using only 2k samples, thus achieving state-of-the-art results for models of this scale. Our analysis confirms that rubric-driven RL fos-ters consistent performance gains across diverse consultation scenarios, going beyond simple numerical improvements. These findings underscore rubric-based feedback as a scalable strategy for advancing LLMs in intricate, open-ended tasks.

A promising approach for improving reasoning in large language models is to use process reward models (PRMs). PRMs provide feedback at each step of a multi-step reasoning trace, potentially improving credit assignment over outcome reward models (ORMs) that only provide feedback at the final step. However, collecting dense, per-step human labels is not scalable, and training PRMs from automatically-labeled data has thus far led to limited gains. To improve a base policy by running search against a PRM or using it as dense rewards for reinforcement learning (RL), we ask: "How should we design process rewards?". Our key insight is that, to be effective, the process reward for a step should measure progress: a change in the likelihood of producing a correct response in the future, before and after taking the step, corresponding to the notion of step-level advantages in RL. Crucially, this progress should be measured under a prover policy distinct from the base policy. We theoretically characterize the set of good provers and our results show that optimizing process rewards from such provers improves exploration during test-time search and online RL. In fact, our characterization shows that weak prover policies can substantially improve a stronger base policy, which we also observe empirically. We validate our claims by training process advantage verifiers (PAVs) to predict progress under such provers, and show that compared to ORMs, test-time search against PAVs is >8% more accurate, and 1.5-5times more compute-efficient. Online RL with dense rewards from PAVs enables one of the first results with 5-6times gain in sample efficiency, and >6% gain in accuracy, over ORMs.

A well-designed reward is critical for effective reinforcement learning-based policy improvement. In real-world robotic domains, obtaining such rewards typically requires either labor-intensive human labeling or brittle, handcrafted objectives. Vision-language models (VLMs) have shown promise as automatic reward models, yet their effectiveness on real robot tasks is poorly understood. In this work, we aim to close this gap by introducing (1) RoboReward, a robotics reward dataset and benchmark built on large-scale real-robot corpora from Open X-Embodiment (OXE) and RoboArena, and (2) vision-language reward models trained on this dataset (RoboReward 4B/8B). Because OXE is success-heavy and lacks failure examples, we propose a negative examples data augmentation pipeline that generates calibrated negatives and near-misses via counterfactual relabeling of successful episodes and temporal clipping to create partial-progress outcomes from the same videos. Using this framework, we produce an extensive training and evaluation dataset that spans diverse tasks and embodiments and enables systematic evaluation of whether state-of-the-art VLMs can reliably provide rewards for robotics. Our evaluation of leading open-weight and proprietary VLMs reveals that no model excels across all tasks, underscoring substantial room for improvement. We then train general-purpose 4B- and 8B-parameter models that outperform much larger VLMs in assigning rewards for short-horizon robotic tasks. Finally, we deploy the 8B-parameter reward VLM in real-robot reinforcement learning and find that it improves policy learning over Gemini Robotics-ER 1.5, a frontier physical reasoning VLM trained on robotics data, by a large margin, while substantially narrowing the gap to RL training with human-provided rewards.

Language model calibration refers to the alignment between the confidence of the model and the actual performance of its responses. While previous studies point out the overconfidence phenomenon in Large Language Models (LLMs) and show that LLMs trained with Reinforcement Learning from Human Feedback (RLHF) are overconfident with a more sharpened output probability, in this study, we reveal that RLHF tends to lead models to express verbalized overconfidence in their own responses. We investigate the underlying cause of this overconfidence and demonstrate that reward models used for Proximal Policy Optimization (PPO) exhibit inherent biases towards high-confidence scores regardless of the actual quality of responses. Building upon this insight, we propose two PPO variants: PPO-M: PPO with Calibrated Reward Modeling and PPO-C: PPO with Calibrated Reward Calculation. PPO-M integrates explicit confidence scores in reward model training, which calibrates reward models to better capture the alignment between response quality and verbalized confidence. PPO-C adjusts the reward score during PPO based on the difference between the current reward and the moving average of past rewards. Both PPO-M and PPO-C can be seamlessly integrated into the current PPO pipeline and do not require additional golden labels. We evaluate our methods on both Llama3-8B and Mistral-7B across six diverse datasets including multiple-choice and open-ended generation. Experiment results demonstrate that both of our methods can reduce calibration error and maintain performance comparable to standard PPO. We further show that they do not compromise model capabilities in open-ended conversation settings.

We propose Skywork-VL Reward, a multimodal reward model that provides reward signals for both multimodal understanding and reasoning tasks. Our technical approach comprises two key components: First, we construct a large-scale multimodal preference dataset that covers a wide range of tasks and scenarios, with responses collected from both standard vision-language models (VLMs) and advanced VLM reasoners. Second, we design a reward model architecture based on Qwen2.5-VL-7B-Instruct, integrating a reward head and applying multi-stage fine-tuning using pairwise ranking loss on pairwise preference data. Experimental evaluations show that Skywork-VL Reward achieves state-of-the-art results on multimodal VL-RewardBench and exhibits competitive performance on the text-only RewardBench benchmark. Furthermore, preference data constructed based on our Skywork-VL Reward proves highly effective for training Mixed Preference Optimization (MPO), leading to significant improvements in multimodal reasoning capabilities. Our results underscore Skywork-VL Reward as a significant advancement toward general-purpose, reliable reward models for multimodal alignment. Our model has been publicly released to promote transparency and reproducibility.

Conventional Applicant Tracking Systems (ATS) tend to be inflexible keyword-matchers, and deny gifted candidates a role due to a few minor semantic mismatches. This article describes a new two-step process to design a more refined resume evaluation model based on a small language model (<600M parameters) that is finetuned using GRPO on a custom reward function. To begin with, Supervised Fine-Tuning (SFT) was used to build a solid baseline model. Second, this SFT model was also optimized with the help of Reinforcement Learning (RL) through GRPO under the guidance of a new, multi-component reward function that can holistically assess candidates beyond simple keyword matching. We indicate that the RL application presents a critical problem of reward hacking due to the initial experiments of aggressive penalties, which produces faulty, excessively negative model behaviors. We have overcome this challenge by refining the reward function repeatedly and training hyperparameters into a stable "gentle polishing process" of the reward function. Our resulting GRPO-polished model demonstrates significant real-world efficacy, achieving a final accuracy of 91% on unseen test data. The model shows a strong ability to correctly identify qualified candidates (recall of 0.85 for the 'SELECTED' class) while also showing exceptional precision (1.0), confirming its reliability. These results indicate that a properly executed, two-step fine-tuning procedure can indeed effectively refine a small language model to be able to conduct fine-tuned and human-like candidate scoring, overcoming the drawbacks of both traditional ATS and naive RL usage.

Open-ended evaluation is essential for deploying large language models in real-world settings. In studying HealthBench, we observe that using the model itself as a grader and generating rubric-based reward signals substantially improves reasoning performance. Remarkably, the trained model also becomes a stronger grader. Motivated by this, we introduce Self-Rewarding Rubric-Based Reinforcement Learning for Open-Ended Reasoning, a lightweight framework that enables faster and more resource-efficient training while surpassing baselines. Remarkably, on Qwen3-32B, training with just the 4000-sample HealthBench Easy subset is sufficient to obtain a model that exceeds GPT-5 on HealthBench Hard. Incorporating a small amount of teacher-graded data further enhances performance for less capable models.

In order to solve a task using reinforcement learning, it is necessary to first formalise the goal of that task as a reward function. However, for many real-world tasks, it is very difficult to manually specify a reward function that never incentivises undesirable behaviour. As a result, it is increasingly popular to use reward learning algorithms, which attempt to learn a reward function from data. However, the theoretical foundations of reward learning are not yet well-developed. In particular, it is typically not known when a given reward learning algorithm with high probability will learn a reward function that is safe to optimise. This means that reward learning algorithms generally must be evaluated empirically, which is expensive, and that their failure modes are difficult to anticipate in advance. One of the roadblocks to deriving better theoretical guarantees is the lack of good methods for quantifying the difference between reward functions. In this paper we provide a solution to this problem, in the form of a class of pseudometrics on the space of all reward functions that we call STARC (STAndardised Reward Comparison) metrics. We show that STARC metrics induce both an upper and a lower bound on worst-case regret, which implies that our metrics are tight, and that any metric with the same properties must be bilipschitz equivalent to ours. Moreover, we also identify a number of issues with reward metrics proposed by earlier works. Finally, we evaluate our metrics empirically, to demonstrate their practical efficacy. STARC metrics can be used to make both theoretical and empirical analysis of reward learning algorithms both easier and more principled.

Reinforcement learning (RL) can improve the prompt following capability of text-to-image (T2I) models, yet obtaining high-quality reward signals remains challenging: CLIP Score is too coarse-grained, while VLM-based reward models (e.g., RewardDance) require costly human-annotated preference data and additional fine-tuning. We propose PromptEcho, a reward construction method that requires no annotation and no reward model training. Given a generated image and a guiding query, PromptEcho computes the token-level cross-entropy loss of a frozen VLM with the original prompt as the label, directly extracting the image-text alignment knowledge encoded during VLM pretraining. The reward is deterministic, computationally efficient, and improves automatically as stronger open-source VLMs become available. For evaluation, we develop DenseAlignBench, a benchmark of concept-rich dense captions for rigorously testing prompt following capability. Experimental results on two state-of-the-art T2I models (Z-Image and QwenImage-2512) demonstrate that PromptEcho achieves substantial improvements on DenseAlignBench (+26.8pp / +16.2pp net win rate), along with consistent gains on GenEval, DPG-Bench, and TIIFBench without any task-specific training. Ablation studies confirm that PromptEcho comprehensively outperforms inference-based scoring with the same VLM, and that reward quality scales with VLM size. We will open-source the trained models and the DenseAlignBench.

Advances in large language models (LLMs) provide new opportunities in healthcare for improved patient care, clinical decision-making, and enhancement of physician and administrator workflows. However, the potential of these models importantly depends on their ability to generalize effectively across clinical environments and populations, a challenge often underestimated in early development. To better understand reasons for these challenges and inform mitigation approaches, we evaluated ClinicLLM, an LLM trained on [HOSPITAL]'s clinical notes, analyzing its performance on 30-day all-cause readmission prediction focusing on variability across hospitals and patient characteristics. We found poorer generalization particularly in hospitals with fewer samples, among patients with government and unspecified insurance, the elderly, and those with high comorbidities. To understand reasons for lack of generalization, we investigated sample sizes for fine-tuning, note content (number of words per note), patient characteristics (comorbidity level, age, insurance type, borough), and health system aspects (hospital, all-cause 30-day readmission, and mortality rates). We used descriptive statistics and supervised classification to identify features. We found that, along with sample size, patient age, number of comorbidities, and the number of words in notes are all important factors related to generalization. Finally, we compared local fine-tuning (hospital specific), instance-based augmented fine-tuning and cluster-based fine-tuning for improving generalization. Among these, local fine-tuning proved most effective, increasing AUC by 0.25% to 11.74% (most helpful in settings with limited data). Overall, this study provides new insights for enhancing the deployment of large language models in the societally important domain of healthcare, and improving their performance for broader populations.

Reinforcement learning from human feedback (RLHF) is the mainstream paradigm used to align large language models (LLMs) with human preferences. Yet existing RLHF heavily relies on accurate and informative reward models, which are vulnerable and sensitive to noise from various sources, e.g. human labeling errors, making the pipeline fragile. In this work, we improve the effectiveness of the reward model by introducing a penalty term on the reward, named as contrastive rewards. %Contrastive rewards Our approach involves two steps: (1) an offline sampling step to obtain responses to prompts that serve as baseline calculation and (2) a contrastive reward calculated using the baseline responses and used in the Proximal Policy Optimization (PPO) step. We show that contrastive rewards enable the LLM to penalize reward uncertainty, improve robustness, encourage improvement over baselines, calibrate according to task difficulty, and reduce variance in PPO. We show empirically contrastive rewards can improve RLHF substantially, evaluated by both GPTs and humans, and our method consistently outperforms strong baselines.

Reward modeling is essential for aligning large language models (LLMs) with human preferences, especially through reinforcement learning from human feedback (RLHF). To provide accurate reward signals, a reward model (RM) should stimulate deep thinking and conduct interpretable reasoning before assigning a score or a judgment. However, existing RMs either produce opaque scalar scores or directly generate the prediction of a preferred answer, making them struggle to integrate natural language critiques, thus lacking interpretability. Inspired by recent advances of long chain-of-thought (CoT) on reasoning-intensive tasks, we hypothesize and validate that integrating reasoning capabilities into reward modeling significantly enhances RM's interpretability and performance. In this work, we introduce a new class of generative reward models -- Reasoning Reward Models (ReasRMs) -- which formulate reward modeling as a reasoning task. We propose a reasoning-oriented training pipeline and train a family of ReasRMs, RM-R1. The training consists of two key stages: (1) distillation of high-quality reasoning chains and (2) reinforcement learning with verifiable rewards. RM-R1 improves LLM rollouts by self-generating reasoning traces or chat-specific rubrics and evaluating candidate responses against them. Empirically, our models achieve state-of-the-art or near state-of-the-art performance of generative RMs across multiple comprehensive reward model benchmarks, outperforming much larger open-weight models (e.g., Llama3.1-405B) and proprietary ones (e.g., GPT-4o) by up to 13.8%. Beyond final performance, we perform thorough empirical analysis to understand the key ingredients of successful ReasRM training. To facilitate future research, we release six ReasRM models along with code and data at https://github.com/RM-R1-UIUC/RM-R1.

Dense process rewards have proven a more effective alternative to the sparse outcome-level rewards in the inference-time scaling of large language models (LLMs), particularly in tasks requiring complex multi-step reasoning. While dense rewards also offer an appealing choice for the reinforcement learning (RL) of LLMs since their fine-grained rewards have the potential to address some inherent issues of outcome rewards, such as training efficiency and credit assignment, this potential remains largely unrealized. This can be primarily attributed to the challenges of training process reward models (PRMs) online, where collecting high-quality process labels is prohibitively expensive, making them particularly vulnerable to reward hacking. To address these challenges, we propose PRIME (Process Reinforcement through IMplicit rEwards), which enables online PRM updates using only policy rollouts and outcome labels through implict process rewards. PRIME combines well with various advantage functions and forgoes the dedicated reward model training phrase that existing approaches require, substantially reducing the development overhead. We demonstrate PRIME's effectiveness on competitional math and coding. Starting from Qwen2.5-Math-7B-Base, PRIME achieves a 15.1% average improvement across several key reasoning benchmarks over the SFT model. Notably, our resulting model, Eurus-2-7B-PRIME, surpasses Qwen2.5-Math-7B-Instruct on seven reasoning benchmarks with 10% of its training data.

Reinforcement fine-tuning (RFT) often suffers from reward over-optimization, where a policy model hacks the reward signals to achieve high scores while producing low-quality outputs. Our theoretical analysis shows that the key lies in reward misspecification at the high-reward tail: the inability to reliably distinguish Excellent responses from merely Great ones. This motivate us to focus on the high-reward region. However, such tail examples are scarce under the base LLM. While off-policy exemplars (e.g. from stronger models or rewrites) are easier to obtain, naively training on them yields a misspecified reward for the policy we aim to align. To address this, we study rubric-based rewards. By design, rubrics can leverage off-policy examples while remaining insensitive to their artifacts. To elicit rubrics that capture the high-reward tail, we highlight the importance of distinguishing among great and diverse responses, and introduce a workflow to implement this idea. We empirically demonstrate that rubric-based rewards substantially mitigate reward over-optimization and deliver effective LLM post-training improvements. Our code can be accessed at https://github.com/Jun-Kai-Zhang/rubrics.git .

Reward models (RMs) are central to reinforcement learning from human feedback (RLHF), providing the critical supervision signals that align large language models (LLMs) with human preferences. Generative reward models (GRMs) provide greater interpretability than traditional scalar RMs, but they come with a critical trade-off: pairwise methods are hindered by a training-inference mismatch, while pointwise methods require expensive absolute annotations. To bridge this gap, we propose the Preference-aware Task-adaptive Reward Model (PaTaRM). Unlike prior approaches, PaTaRM enables robust pointwise training using readily available pairwise data via a novel Preference-Aware Reward (PAR) mechanism, eliminating the need for explicit rating labels. Furthermore, it incorporates a Task-Adaptive Rubric system that dynamically generates instance-specific criteria for precise evaluation. Extensive experiments demonstrate that PATRM achieves a 8.7% average improvement on RewardBench and RMBench across Qwen3-8B/14B models. Crucially, it boosts downstream RLHF performance by an average relative improvement of 13.6% across IFEval and InFoBench, validating its effectiveness for policy alignment. Our code is available at https://github.com/JaneEyre0530/PaTaRM.

Recently, remarkable progress has been made in Unified Multimodal Models (UMMs), which integrate vision-language generation and understanding capabilities within a single framework. However, a significant gap exists where a model's strong visual understanding often fails to transfer to its visual generation. A model might correctly understand an image based on user instructions, yet be unable to generate a faithful image from text prompts. This phenomenon directly raises a compelling question: Can a model achieve self-improvement by using its understanding module to reward its generation module? To bridge this gap and achieve self-improvement, we introduce SRUM, a self-rewarding post-training framework that can be directly applied to existing UMMs of various designs. SRUM creates a feedback loop where the model's own understanding module acts as an internal ``evaluator'', providing corrective signals to improve its generation module, without requiring additional human-labeled data. To ensure this feedback is comprehensive, we designed a global-local dual reward system. To tackle the inherent structural complexity of images, this system offers multi-scale guidance: a global reward ensures the correctness of the overall visual semantics and layout, while a local reward refines fine-grained, object-level fidelity. SRUM leads to powerful capabilities and shows strong generalization, boosting performance on T2I-CompBench from 82.18 to 88.37 and on T2I-ReasonBench from 43.82 to 46.75. Overall, our work establishes a powerful new paradigm for enabling a UMMs' understanding module to guide and enhance its own generation via self-rewarding.

Multimodal Reward Models (MRMs) play a crucial role in enhancing the performance of Multimodal Large Language Models (MLLMs). While recent advancements have primarily focused on improving the model structure and training data of MRMs, there has been limited exploration into the effectiveness of long-term reasoning capabilities for reward modeling and how to activate these capabilities in MRMs. In this paper, we explore how Reinforcement Learning (RL) can be used to improve reward modeling. Specifically, we reformulate the reward modeling problem as a rule-based RL task. However, we observe that directly applying existing RL algorithms, such as Reinforce++, to reward modeling often leads to training instability or even collapse due to the inherent limitations of these algorithms. To address this issue, we propose the StableReinforce algorithm, which refines the training loss, advantage estimation strategy, and reward design of existing RL methods. These refinements result in more stable training dynamics and superior performance. To facilitate MRM training, we collect 200K preference data from diverse datasets. Our reward model, R1-Reward, trained using the StableReinforce algorithm on this dataset, significantly improves performance on multimodal reward modeling benchmarks. Compared to previous SOTA models, R1-Reward achieves a 8.4% improvement on the VL Reward-Bench and a 14.3% improvement on the Multimodal Reward Bench. Moreover, with more inference compute, R1-Reward's performance is further enhanced, highlighting the potential of RL algorithms in optimizing MRMs.

Clinical evidence, derived from rigorous research and data analysis, provides healthcare professionals with reliable scientific foundations for informed decision-making. Integrating clinical evidence into real-time practice is challenging due to the enormous workload, complex professional processes, and time constraints. This highlights the need for tools that automate evidence synthesis to support more efficient and accurate decision making in clinical settings. This study introduces Quicker, an evidence-based clinical decision support system powered by large language models (LLMs), designed to automate evidence synthesis and generate clinical recommendations modeled after standard clinical guideline development processes. Quicker implements a fully automated chain that covers all phases, from questions to clinical recommendations, and further enables customized decision-making through integrated tools and interactive user interfaces. To evaluate Quicker's capabilities, we developed the Q2CRBench-3 benchmark dataset, based on clinical guideline development records for three different diseases. Experimental results highlighted Quicker's strong performance, with fine-grained question decomposition tailored to user preferences, retrieval sensitivities comparable to human experts, and literature screening performance approaching comprehensive inclusion of relevant studies. In addition, Quicker-assisted evidence assessment effectively supported human reviewers, while Quicker's recommendations were more comprehensive and logically coherent than those of clinicians. In system-level testing, collaboration between a single reviewer and Quicker reduced the time required for recommendation development to 20-40 minutes. In general, our findings affirm the potential of Quicker to help physicians make quicker and more reliable evidence-based clinical decisions.

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.

Reinforcement learning from human feedback (RLHF) offers a promising approach to aligning large language models (LLMs) with human preferences. Typically, a reward model is trained or supplied to act as a proxy for humans in evaluating generated responses during the reinforcement training phase. However, current reward models operate as sequence-to-one models, allocating a single, sparse, and delayed reward to an entire output sequence. This approach may overlook the significant contributions of individual tokens toward the desired outcome. To this end, we propose a more fine-grained, token-level guidance approach for RL training. Specifically, we introduce RED, a novel reward redistribition method that evaluates and assigns specific credit to each token using an off-the-shelf reward model. Utilizing these fine-grained rewards enhances the model's understanding of language nuances, leading to more precise performance improvements. Notably, our method does not require modifying the reward model or introducing additional training steps, thereby incurring minimal computational costs. Experimental results across diverse datasets and tasks demonstrate the superiority of our approach.

The field of computer vision applied to videos of minimally invasive surgery is ever-growing. Workflow recognition pertains to the automated recognition of various aspects of a surgery: including which surgical steps are performed; and which surgical instruments are used. This information can later be used to assist clinicians when learning the surgery; during live surgery; and when writing operation notes. The Pituitary Vision (PitVis) 2023 Challenge tasks the community to step and instrument recognition in videos of endoscopic pituitary surgery. This is a unique task when compared to other minimally invasive surgeries due to the smaller working space, which limits and distorts vision; and higher frequency of instrument and step switching, which requires more precise model predictions. Participants were provided with 25-videos, with results presented at the MICCAI-2023 conference as part of the Endoscopic Vision 2023 Challenge in Vancouver, Canada, on 08-Oct-2023. There were 18-submissions from 9-teams across 6-countries, using a variety of deep learning models. A commonality between the top performing models was incorporating spatio-temporal and multi-task methods, with greater than 50% and 10% macro-F1-score improvement over purely spacial single-task models in step and instrument recognition respectively. The PitVis-2023 Challenge therefore demonstrates state-of-the-art computer vision models in minimally invasive surgery are transferable to a new dataset, with surgery specific techniques used to enhance performance, progressing the field further. Benchmark results are provided in the paper, and the dataset is publicly available at: https://doi.org/10.5522/04/26531686.

In natural language processing applied to the clinical domain, utilizing large language models has emerged as a promising avenue for error detection and correction on clinical notes, a knowledge-intensive task for which annotated data is scarce. This paper presents MedReAct'N'MedReFlex, which leverages a suite of four LLM-based medical agents. The MedReAct agent initiates the process by observing, analyzing, and taking action, generating trajectories to guide the search to target a potential error in the clinical notes. Subsequently, the MedEval agent employs five evaluators to assess the targeted error and the proposed correction. In cases where MedReAct's actions prove insufficient, the MedReFlex agent intervenes, engaging in reflective analysis and proposing alternative strategies. Finally, the MedFinalParser agent formats the final output, preserving the original style while ensuring the integrity of the error correction process. One core component of our method is our RAG pipeline based on our ClinicalCorp corpora. Among other well-known sources containing clinical guidelines and information, we preprocess and release the open-source MedWiki dataset for clinical RAG application. Our results demonstrate the central role of our RAG approach with ClinicalCorp leveraged through the MedReAct'N'MedReFlex framework. It achieved the ninth rank on the MEDIQA-CORR 2024 final leaderboard.

Score Distillation Sampling (SDS) has emerged as an effective technique for leveraging 2D diffusion priors for tasks such as text-to-3D generation. While powerful, SDS struggles with achieving fine-grained alignment to user intent. To overcome this, we introduce RewardSDS, a novel approach that weights noise samples based on alignment scores from a reward model, producing a weighted SDS loss. This loss prioritizes gradients from noise samples that yield aligned high-reward output. Our approach is broadly applicable and can extend SDS-based methods. In particular, we demonstrate its applicability to Variational Score Distillation (VSD) by introducing RewardVSD. We evaluate RewardSDS and RewardVSD on text-to-image, 2D editing, and text-to-3D generation tasks, showing significant improvements over SDS and VSD on a diverse set of metrics measuring generation quality and alignment to desired reward models, enabling state-of-the-art performance. Project page is available at https://itaychachy. github.io/reward-sds/.

Medical coding translates clinical documentation into standardized codes for billing, research, and public health, but manual coding is time-consuming and error-prone. Existing automation efforts rely on small datasets that poorly represent real-world patient heterogeneity. We trained a language model on 5.8 million electronic health records from 1.8 million patients across nearly all specialties in Eastern Denmark (2006--2016) to predict ICD-10 codes from clinical notes, medications, and laboratory results. Evaluated on 270,000 held-out patients, the model achieved a micro F1 of 71.8% and a top-10 recall of 95.5%. Performance varied by specialty (F1: 53--91%), with higher scores in specialties with well-defined diagnostic criteria. Codes appearing predominantly as secondary diagnoses had markedly lower F1 scores. For three such codes (suicide-related behaviors, weight disorders, and hypertension), the model identified thousands of uncoded cases, of which 76-86% were confirmed valid upon manual review, suggesting systematic under-coding rather than model error. These findings suggest under-coding of secondary diagnoses in Eastern Denmark during this period, with potential implications for epidemiological research, public health surveillance, and understanding of multimorbidity. Similar time constraints and reimbursement structures in other healthcare systems suggest this may not be isolated to this dataset. The model can automate coding for approximately 50% of cases and provide accurate suggestions for most others, and may offer a practical solution to help capture missed secondary conditions.

We show that reinforcement learning with verifiable rewards (RLVR) can elicit strong mathematical reasoning in certain models even with spurious rewards that have little, no, or even negative correlation with the correct answer. For example, RLVR improves MATH-500 performance for Qwen2.5-Math-7B in absolute points by 21.4% (random reward), 13.8% (format reward), 24.1% (incorrect label), 26.0% (1-shot RL), and 27.1% (majority voting) -- nearly matching the 29.1% gained with ground truth rewards. However, the spurious rewards that work for Qwen often fail to yield gains with other model families like Llama3 or OLMo2. In particular, we find code reasoning -- thinking in code without actual code execution -- to be a distinctive Qwen2.5-Math behavior that becomes significantly more frequent after RLVR, from 65% to over 90%, even with spurious rewards. Overall, we hypothesize that, given the lack of useful reward signal, RLVR must somehow be surfacing useful reasoning representations learned during pretraining, although the exact mechanism remains a topic for future work. We suggest that future RLVR research should possibly be validated on diverse models rather than a single de facto choice, as we show that it is easy to get significant performance gains on Qwen models even with completely spurious reward signals.

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.

With the advent of LLMs, various tasks across the natural language processing domain have been transformed. However, their application in predictive tasks remains less researched. This study compares large language models, including GatorTron-Base (trained on clinical data), Llama 8B, and Mistral 7B, against models like BioBERT, DocBERT, BioClinicalBERT, Word2Vec, and Doc2Vec, setting benchmarks for predicting Shock in critically ill patients. Timely prediction of shock can enable early interventions, thus improving patient outcomes. Text data from 17,294 ICU stays of patients in the MIMIC III database were scored for length of stay > 24 hours and shock index (SI) > 0.7 to yield 355 and 87 patients with normal and abnormal SI-index, respectively. Both focal and cross-entropy losses were used during finetuning to address class imbalances. Our findings indicate that while GatorTron Base achieved the highest weighted recall of 80.5%, the overall performance metrics were comparable between SLMs and LLMs. This suggests that LLMs are not inherently superior to SLMs in predicting future clinical events despite their strong performance on text-based tasks. To achieve meaningful clinical outcomes, future efforts in training LLMs should prioritize developing models capable of predicting clinical trajectories rather than focusing on simpler tasks such as named entity recognition or phenotyping.

Clinical calculators play a vital role in healthcare by offering accurate evidence-based predictions for various purposes such as prognosis. Nevertheless, their widespread utilization is frequently hindered by usability challenges, poor dissemination, and restricted functionality. Augmenting large language models with extensive collections of clinical calculators presents an opportunity to overcome these obstacles and improve workflow efficiency, but the scalability of the manual curation process poses a significant challenge. In response, we introduce AgentMD, a novel language agent capable of curating and applying clinical calculators across various clinical contexts. Using the published literature, AgentMD has automatically curated a collection of 2,164 diverse clinical calculators with executable functions and structured documentation, collectively named RiskCalcs. Manual evaluations show that RiskCalcs tools achieve an accuracy of over 80% on three quality metrics. At inference time, AgentMD can automatically select and apply the relevant RiskCalcs tools given any patient description. On the newly established RiskQA benchmark, AgentMD significantly outperforms chain-of-thought prompting with GPT-4 (87.7% vs. 40.9% in accuracy). Additionally, we also applied AgentMD to real-world clinical notes for analyzing both population-level and risk-level patient characteristics. In summary, our study illustrates the utility of language agents augmented with clinical calculators for healthcare analytics and patient care.

Large reasoning models (LRMs) have recently shown promise in solving complex math problems when optimized with Reinforcement Learning (RL). But conventional approaches rely on outcome-only rewards that provide sparse feedback, resulting in inefficient optimization process. In this work, we investigate the function of process reward models (PRMs) to accelerate the RL training for LRMs. We propose a novel intrinsic signal-driven generative process evaluation mechanism operating at the thought level to address major bottlenecks in RL-based training. Specifically, instead of requiring PRMs to know how to solve problems, our method uses intrinsic signals in solutions to judge stepwise correctness and aggregate contiguous correct/incorrect steps into coherent 'thought' units. This structured, thought-level rewards enable more reliable credit assignment by reducing ambiguity in step segmentation and alleviating reward hacking. We further introduce a capability-adaptive reward mechanism that dynamically balances exploration and exploitation based on the LRM's current proficiency, guiding learning without stifling creative trial-and-error. These innovations are integrated into a new off-policy RL algorithm, TP-GRPO, which extends grouped proximal optimization with process-based rewards and improves training efficiency. Experiments on 1.5B and 7B parameter LRMs demonstrate that our method achieves higher problem-solving accuracy with significantly fewer training samples than outcome-only reward baselines. The results validate that well-structured process rewards can substantially accelerate LRM optimization in math reasoning tasks. Code is available at https://github.com/cs-holder/tp_grpo.

Process-supervised reward models serve as a fine-grained function that provides detailed step-wise feedback to model responses, facilitating effective selection of reasoning trajectories for complex tasks. Despite its advantages, evaluation on PRMs remains less explored, especially in the multimodal domain. To address this gap, this paper first benchmarks current vision large language models (VLLMs) as two types of reward models: output reward models (ORMs) and process reward models (PRMs) on multiple vision-language benchmarks, which reveal that neither ORM nor PRM consistently outperforms across all tasks, and superior VLLMs do not necessarily yield better rewarding performance. To further advance evaluation, we introduce ViLBench, a vision-language benchmark designed to require intensive process reward signals. Notably, OpenAI's GPT-4o with Chain-of-Thought (CoT) achieves only 27.3% accuracy, indicating the benchmark's challenge for current VLLMs. Lastly, we preliminarily showcase a promising pathway towards bridging the gap between general VLLMs and reward models -- by collecting 73.6K vision-language process reward data using an enhanced tree-search algorithm, our 3B model is able to achieve an average improvement of 3.3% over standard CoT and up to 2.5% compared to its untrained counterpart on ViLBench by selecting OpenAI o1's generations. We release the implementations at https://ucsc-vlaa.github.io/ViLBench with our code, model, and data.

Outcome-reward reinforcement learning (RL) has proven effective at improving the reasoning capabilities of large language models (LLMs). However, standard RL assigns credit only at the level of the final answer, penalizing entire reasoning traces when the outcome is incorrect and uniformly reinforcing all steps when it is correct. As a result, correct intermediate steps may be discouraged in failed traces, while spurious steps may be reinforced in successful ones. We refer to this failure mode as the problem of credit assignment. While a natural remedy is to train a process reward model, accurately optimizing such models to identify corrective reasoning steps remains challenging. We introduce Intervention Training (InT), a training paradigm in which the model performs fine-grained credit assignment on its own reasoning traces by proposing short, targeted corrections that steer trajectories toward higher reward. Using reference solutions commonly available in mathematical reasoning datasets and exploiting the fact that verifying a model-generated solution is easier than generating a correct one from scratch, the model identifies the first error in its reasoning and proposes a single-step intervention to redirect the trajectory toward the correct solution. We then apply supervised fine-tuning (SFT) to the on-policy rollout up to the point of error concatenated with the intervention, localizing error to the specific step that caused failure. We show that the resulting model serves as a far better initialization for RL training. After running InT and subsequent fine-tuning with RL, we improve accuracy by nearly 14% over a 4B-parameter base model on IMO-AnswerBench, outperforming larger open-source models such as gpt-oss-20b.

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.

Complex multi-step reasoning tasks, such as solving mathematical problems or generating code, remain a significant hurdle for even the most advanced large language models (LLMs). Verifying LLM outputs with an Outcome Reward Model (ORM) is a standard inference-time technique aimed at enhancing the reasoning performance of LLMs. However, this still proves insufficient for reasoning tasks with a lengthy or multi-hop reasoning chain, where the intermediate outcomes are neither properly rewarded nor penalized. Process supervision addresses this limitation by assigning intermediate rewards during the reasoning process. To date, the methods used to collect process supervision data have relied on either human annotation or per-step Monte Carlo estimation, both prohibitively expensive to scale, thus hindering the broad application of this technique. In response to this challenge, we propose a novel divide-and-conquer style Monte Carlo Tree Search (MCTS) algorithm named OmegaPRM for the efficient collection of high-quality process supervision data. This algorithm swiftly identifies the first error in the Chain of Thought (CoT) with binary search and balances the positive and negative examples, thereby ensuring both efficiency and quality. As a result, we are able to collect over 1.5 million process supervision annotations to train a Process Reward Model (PRM). Utilizing this fully automated process supervision alongside the weighted self-consistency algorithm, we have enhanced the instruction tuned Gemini Pro model's math reasoning performance, achieving a 69.4\% success rate on the MATH benchmark, a 36\% relative improvement from the 51\% base model performance. Additionally, the entire process operates without any human intervention, making our method both financially and computationally cost-effective compared to existing methods.

This technical report introduces a Named Clinical Entity Recognition Benchmark for evaluating language models in healthcare, addressing the crucial natural language processing (NLP) task of extracting structured information from clinical narratives to support applications like automated coding, clinical trial cohort identification, and clinical decision support. The leaderboard provides a standardized platform for assessing diverse language models, including encoder and decoder architectures, on their ability to identify and classify clinical entities across multiple medical domains. A curated collection of openly available clinical datasets is utilized, encompassing entities such as diseases, symptoms, medications, procedures, and laboratory measurements. Importantly, these entities are standardized according to the Observational Medical Outcomes Partnership (OMOP) Common Data Model, ensuring consistency and interoperability across different healthcare systems and datasets, and a comprehensive evaluation of model performance. Performance of models is primarily assessed using the F1-score, and it is complemented by various assessment modes to provide comprehensive insights into model performance. The report also includes a brief analysis of models evaluated to date, highlighting observed trends and limitations. By establishing this benchmarking framework, the leaderboard aims to promote transparency, facilitate comparative analyses, and drive innovation in clinical entity recognition tasks, addressing the need for robust evaluation methods in healthcare NLP.

In natural human-to-human conversations, participants often receive feedback signals from one another based on their follow-up reactions. These reactions can include verbal responses, facial expressions, changes in emotional state, and other non-verbal cues. Similarly, in human-machine interactions, the machine can leverage the user's follow-up utterances as feedback signals to assess whether it has appropriately addressed the user's request. Therefore, we propose using the likelihood of follow-up utterances as rewards to differentiate preferred responses from less favored ones, without relying on human or commercial LLM-based preference annotations. Our proposed reward mechanism, ``Follow-up Likelihood as Reward" (FLR), matches the performance of strong reward models trained on large-scale human or GPT-4 annotated data on 8 pairwise-preference and 4 rating-based benchmarks. Building upon the FLR mechanism, we propose to automatically mine preference data from the online generations of a base policy model. The preference data are subsequently used to boost the helpfulness of the base model through direct alignment from preference (DAP) methods, such as direct preference optimization (DPO). Lastly, we demonstrate that fine-tuning the language model that provides follow-up likelihood with natural language feedback significantly enhances FLR's performance on reward modeling benchmarks and effectiveness in aligning the base policy model's helpfulness.

Reinforcement Learning from Human Feedback (RLHF) has become a crucial technology for aligning language models with human values and intentions, enabling models to produce more helpful and harmless responses. Reward models are trained as proxies for human preferences to drive reinforcement learning optimization. While reward models are often considered central to achieving high performance, they face the following challenges in practical applications: (1) Incorrect and ambiguous preference pairs in the dataset may hinder the reward model from accurately capturing human intent. (2) Reward models trained on data from a specific distribution often struggle to generalize to examples outside that distribution and are not suitable for iterative RLHF training. In this report, we attempt to address these two issues. (1) From a data perspective, we propose a method to measure the strength of preferences within the data, based on a voting mechanism of multiple reward models. Experimental results confirm that data with varying preference strengths have different impacts on reward model performance. We introduce a series of novel methods to mitigate the influence of incorrect and ambiguous preferences in the dataset and fully leverage high-quality preference data. (2) From an algorithmic standpoint, we introduce contrastive learning to enhance the ability of reward models to distinguish between chosen and rejected responses, thereby improving model generalization. Furthermore, we employ meta-learning to enable the reward model to maintain the ability to differentiate subtle differences in out-of-distribution samples, and this approach can be utilized for iterative RLHF optimization.

Osteoarthritis (OA) is the most common musculoskeletal disease, which has no cure. Knee OA (KOA) is one of the highest causes of disability worldwide, and it costs billions of United States dollars to the global community. Prediction of KOA progression has been of high interest to the community for years, as it can advance treatment development through more efficient clinical trials and improve patient outcomes through more efficient healthcare utilization. Existing approaches for predicting KOA, however, are predominantly static, i.e. consider data from a single time point to predict progression many years into the future, and knee level, i.e. consider progression in a single joint only. Due to these and related reasons, these methods fail to deliver the level of predictive performance, which is sufficient to result in cost savings and better patient outcomes. Collecting extensive data from all patients on a regular basis could address the issue, but it is limited by the high cost at a population level. In this work, we propose to go beyond static prediction models in OA, and bring a novel Active Sensing (AS) approach, designed to dynamically follow up patients with the objective of maximizing the number of informative data acquisitions, while minimizing their total cost over a period of time. Our approach is based on Reinforcement Learning (RL), and it leverages a novel reward function designed specifically for AS of disease progression in more than one part of a human body. Our method is end-to-end, relies on multi-modal Deep Learning, and requires no human input at inference time. Throughout an exhaustive experimental evaluation, we show that using RL can provide a higher monetary benefit when compared to state-of-the-art baselines.

Reward models are crucial for aligning large language models (LLMs) with human values and intentions. Existing approaches follow either Generative (GRMs) or Discriminative (DRMs) paradigms, yet both suffer from limitations: GRMs typically demand costly point-wise supervision, while DRMs produce uncalibrated relative scores that lack probabilistic interpretation. To address these challenges, we introduce a novel reward modeling paradigm: Probabilistic Reward Model (PRM). Instead of modeling reward as a deterministic scalar, our approach treats it as a random variable, learning a full probability distribution for the quality of each response. To make this paradigm practical, we present its closed-form, discrete realization: the Ordinal Probabilistic Reward Model (OPRM), which discretizes the quality score into a finite set of ordinal ratings. Building on OPRM, we propose a data-efficient training strategy called Region Flooding Tuning (RgFT). It enables rewards to better reflect absolute text quality by incorporating quality-level annotations, which guide the model to concentrate the probability mass within corresponding rating sub-regions. Experiments on various reward model benchmarks show that our method improves accuracy by 2.9%sim7.4% compared to prior reward models, demonstrating strong performance and data efficiency. Analysis of the score distribution provides evidence that our method captures not only relative rankings but also absolute quality.

Where do learning signals come from when there is no ground truth in post-training? We propose turning exploration into supervision through Compute as Teacher (CaT), which converts the model's own exploration at inference-time into reference-free supervision by synthesizing a single reference from a group of parallel rollouts and then optimizing toward it. Concretely, the current policy produces a group of rollouts; a frozen anchor (the initial policy) reconciles omissions and contradictions to estimate a reference, turning extra inference-time compute into a teacher signal. We turn this into rewards in two regimes: (i) verifiable tasks use programmatic equivalence on final answers; (ii) non-verifiable tasks use self-proposed rubrics-binary, auditable criteria scored by an independent LLM judge, with reward given by the fraction satisfied. Unlike selection methods (best-of-N, majority, perplexity, or judge scores), synthesis may disagree with the majority and be correct even when all rollouts are wrong; performance scales with the number of rollouts. As a test-time procedure, CaT improves Gemma 3 4B, Qwen 3 4B, and Llama 3.1 8B (up to +27% on MATH-500; +12% on HealthBench). With reinforcement learning (CaT-RL), we obtain further gains (up to +33% and +30%), with the trained policy surpassing the initial teacher signal.

An effective reward model plays a pivotal role in reinforcement learning for post-training enhancement of visual generative models. However, current approaches of reward modeling suffer from implementation complexity due to their reliance on extensive human-annotated preference data or meticulously engineered quality dimensions that are often incomplete and engineering-intensive. Inspired by adversarial training in generative adversarial networks (GANs), this paper proposes GAN-RM, an efficient reward modeling framework that eliminates manual preference annotation and explicit quality dimension engineering. Our method trains the reward model through discrimination between a small set of representative, unpaired target samples(denoted as Preference Proxy Data) and model-generated ordinary outputs, requiring only a few hundred target samples. Comprehensive experiments demonstrate our GAN-RM's effectiveness across multiple key applications including test-time scaling implemented as Best-of-N sample filtering, post-training approaches like Supervised Fine-Tuning (SFT) and Direct Preference Optimization (DPO). Code and data will be released at https://github.com/Visualignment/GAN-RM.

The rapid advancement of Multimodal Large Language Models (MLLMs) has made aligning them with human preferences a critical challenge. Reward Models (RMs) are a core technology for achieving this goal, but a systematic guide for building state-of-the-art Multimodal Reward Models (MRMs) is currently lacking in both academia and industry. Through exhaustive experimental analysis, this paper aims to provide a clear ``recipe'' for constructing high-performance MRMs. We systematically investigate every crucial component in the MRM development pipeline, including reward modeling paradigms (e.g., Naive-RM, Critic-based RM, and Generative RM), reward head architecture, training strategies, data curation (covering over ten multimodal and text-only preference datasets), backbone model and model scale, and ensemble methods. Based on these experimental insights, we introduce BaseReward, a powerful and efficient baseline for multimodal reward modeling. BaseReward adopts a simple yet effective architecture, built upon a {Qwen2.5-VL} backbone, featuring an optimized two-layer reward head, and is trained on a carefully curated mixture of high-quality multimodal and text-only preference data. Our results show that BaseReward establishes a new SOTA on major benchmarks such as MM-RLHF-Reward Bench, VL-Reward Bench, and Multimodal Reward Bench, outperforming previous models. Furthermore, to validate its practical utility beyond static benchmarks, we integrate BaseReward into a real-world reinforcement learning pipeline, successfully enhancing an MLLM's performance across various perception, reasoning, and conversational tasks. This work not only delivers a top-tier MRM but, more importantly, provides the community with a clear, empirically-backed guide for developing robust reward models for the next generation of MLLMs.

Reward models are critical for aligning models to follow instructions, and are typically trained following one of two popular paradigms: Bradley-Terry style or Regression style. However, there is a lack of evidence that either approach is better than the other, when adequately matched for data. This is primarily because these approaches require data collected in different (but incompatible) formats, meaning that adequately matched data is not available in existing public datasets. To tackle this problem, we release preference annotations (designed for Bradley-Terry training) to complement existing ratings (designed for Regression style training) in the HelpSteer2 dataset. To improve data interpretability, preference annotations are accompanied with human-written justifications. Using this data, we conduct the first head-to-head comparison of Bradley-Terry and Regression models when adequately matched for data. Based on insights derived from such a comparison, we propose a novel approach to combine Bradley-Terry and Regression reward modeling. A Llama-3.1-70B-Instruct model tuned with this approach scores 94.1 on RewardBench, emerging top of more than 140 reward models as of 1 Oct 2024. We also demonstrate the effectiveness of this reward model at aligning models to follow instructions in RLHF. We open-source this dataset (CC-BY-4.0 license) at https://huggingface.co/datasets/nvidia/HelpSteer2 and openly release the trained Reward Model at https://huggingface.co/nvidia/Llama-3.1-Nemotron-70B-Reward

While large language models show promise in medical applications, achieving expert-level clinical reasoning remains challenging due to the need for both accurate answers and transparent reasoning processes. To address this challenge, we introduce Fleming-R1, a model designed for verifiable medical reasoning through three complementary innovations. First, our Reasoning-Oriented Data Strategy (RODS) combines curated medical QA datasets with knowledge-graph-guided synthesis to improve coverage of underrepresented diseases, drugs, and multi-hop reasoning chains. Second, we employ Chain-of-Thought (CoT) cold start to distill high-quality reasoning trajectories from teacher models, establishing robust inference priors. Third, we implement a two-stage Reinforcement Learning from Verifiable Rewards (RLVR) framework using Group Relative Policy Optimization, which consolidates core reasoning skills while targeting persistent failure modes through adaptive hard-sample mining. Across diverse medical benchmarks, Fleming-R1 delivers substantial parameter-efficient improvements: the 7B variant surpasses much larger baselines, while the 32B model achieves near-parity with GPT-4o and consistently outperforms strong open-source alternatives. These results demonstrate that structured data design, reasoning-oriented initialization, and verifiable reinforcement learning can advance clinical reasoning beyond simple accuracy optimization. We release Fleming-R1 publicly to promote transparent, reproducible, and auditable progress in medical AI, enabling safer deployment in high-stakes clinical environments.

Reinforcement learning from human feedback (RLHF) has been crucial in aligning large language models (LLMs) with human values. Traditionally, RLHF involves generating responses to a query and using a reward model to assign a reward to the entire response. However, this approach faces challenges due to its reliance on a single, sparse reward, which makes it challenging for the model to identify which parts of the sequence contribute most significantly to the final reward. Recent methods have attempted to address this limitation by introducing token-level rewards. However, these methods often rely on either a trained credit assignment model or AI annotators, raising concerns about the quality and reliability of the rewards. In this paper, we propose token-level reward regularization (T-REG), a novel approach that leverages both sequence-level and token-level rewards for preference optimization. Harnessing the self-refinement capabilities of LLMs, our method uses contrastive prompting to enable LLMs to self-generate token-level rewards. These self-generated rewards then act as reward regularization, guiding the model to more effectively distribute sequence-level rewards across tokens. This facilitates better token-level credit assignment and enhances alignment performance. Experiments on the instruction following benchmarks, including Alpaca Eval 2 and Arena-Hard, show that our method consistently outperforms baseline methods by up to 3.8% and 4.4%, respectively. We will release the code and models at https://github.com/wzhouad/T-REG.

Traditionally, reward models used for reinforcement learning from human feedback (RLHF) are trained to directly predict preference scores without leveraging the generation capabilities of the underlying large language model (LLM). This limits the capabilities of reward models as they must reason implicitly about the quality of a response, i.e., preference modeling must be performed in a single forward pass through the model. To enable reward models to reason explicitly about the quality of a response, we introduce Critique-out-Loud (CLoud) reward models. CLoud reward models operate by first generating a natural language critique of the assistant's response that is then used to predict a scalar reward for the quality of the response. We demonstrate the success of CLoud reward models for both Llama-3-8B and 70B base models: compared to classic reward models CLoud reward models improve pairwise preference classification accuracy on RewardBench by 4.65 and 5.84 percentage points for the 8B and 70B base models respectively. Furthermore, CLoud reward models lead to a Pareto improvement for win rate on ArenaHard when used as the scoring model for Best-of-N. Finally, we explore how to exploit the dynamic inference compute capabilities of CLoud reward models by performing self-consistency decoding for reward prediction.

This paper describes the results of SemEval 2023 task 7 -- Multi-Evidence Natural Language Inference for Clinical Trial Data (NLI4CT) -- consisting of 2 tasks, a Natural Language Inference (NLI) task, and an evidence selection task on clinical trial data. The proposed challenges require multi-hop biomedical and numerical reasoning, which are of significant importance to the development of systems capable of large-scale interpretation and retrieval of medical evidence, to provide personalized evidence-based care. Task 1, the entailment task, received 643 submissions from 40 participants, and Task 2, the evidence selection task, received 364 submissions from 23 participants. The tasks are challenging, with the majority of submitted systems failing to significantly outperform the majority class baseline on the entailment task, and we observe significantly better performance on the evidence selection task than on the entailment task. Increasing the number of model parameters leads to a direct increase in performance, far more significant than the effect of biomedical pre-training. Future works could explore the limitations of large models for generalization and numerical inference, and investigate methods to augment clinical datasets to allow for more rigorous testing and to facilitate fine-tuning. We envisage that the dataset, models, and results of this task will be useful to the biomedical NLI and evidence retrieval communities. The dataset, competition leaderboard, and website are publicly available.

Reinforcement Learning from Human Feedback (RLHF) is essential for aligning large language models (LLMs) with human values. However, RLHF is susceptible to reward hacking, where the agent exploits flaws in the reward function rather than learning the intended behavior, thus degrading alignment. While reward shaping helps stabilize RLHF and partially mitigate reward hacking, a systematic investigation into shaping techniques and their underlying principles remains lacking. To bridge this gap, we present a comprehensive study of the prevalent reward shaping methods. Our analysis suggests three key design principles: (1) RL reward is ideally bounded, (2) RL benefits from rapid initial growth followed by gradual convergence, and (3) RL reward is best formulated as a function of centered reward. Guided by these insights, we propose Preference As Reward (PAR), a novel approach that leverages the latent preferences embedded within the reward model itself as the signal for reinforcement learning. We evaluated PAR on two base models, Gemma2-2B and Llama3-8B, using two datasets, Ultrafeedback-Binarized and HH-RLHF. Experimental results demonstrate PAR's superior performance over other reward shaping methods. On the AlpacaEval 2.0 benchmark, PAR achieves a win rate at least 5 percentage points higher than competing approaches. Furthermore, PAR exhibits remarkable data efficiency, requiring only a single reference reward for optimal performance, and maintains robustness against reward hacking even after two full epochs of training. Code is available at https://github.com/PorUna-byte/PAR.