Daily Papers

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.

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.

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.

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.

Recent large language models (LLMs) have demonstrated significant advancements, particularly in their ability to serve as agents thereby surpassing their traditional role as chatbots. These agents can leverage their planning and tool utilization capabilities to address tasks specified at a high level. However, a standardized dataset to benchmark the agent capabilities of LLMs in medical applications is currently lacking, making the evaluation of LLMs on complex tasks in interactive healthcare environments challenging. To address this gap, we introduce MedAgentBench, a broad evaluation suite designed to assess the agent capabilities of large language models within medical records contexts. MedAgentBench encompasses 300 patient-specific clinically-derived tasks from 10 categories written by human physicians, realistic profiles of 100 patients with over 700,000 data elements, a FHIR-compliant interactive environment, and an accompanying codebase. The environment uses the standard APIs and communication infrastructure used in modern EMR systems, so it can be easily migrated into live EMR systems. MedAgentBench presents an unsaturated agent-oriented benchmark that current state-of-the-art LLMs exhibit some ability to succeed at. The best model (Claude 3.5 Sonnet v2) achieves a success rate of 69.67%. However, there is still substantial space for improvement which gives the community a next direction to optimize. Furthermore, there is significant variation in performance across task categories. MedAgentBench establishes this and is publicly available at https://github.com/stanfordmlgroup/MedAgentBench , offering a valuable framework for model developers to track progress and drive continuous improvements in the agent capabilities of large language models within the medical domain.

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 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.

Reward models (RMs) have driven the state-of-the-art performance of LLMs today by enabling the integration of human feedback into the language modeling process. However, RMs are primarily trained and evaluated in English, and their capabilities in multilingual settings remain largely understudied. In this work, we conduct a systematic evaluation of several reward models in multilingual settings. We first construct the first-of-its-kind multilingual RM evaluation benchmark, M-RewardBench, consisting of 2.87k preference instances for 23 typologically diverse languages, that tests the chat, safety, reasoning, and translation capabilities of RMs. We then rigorously evaluate a wide range of reward models on M-RewardBench, offering fresh insights into their performance across diverse languages. We identify a significant gap in RMs' performances between English and non-English languages and show that RM preferences can change substantially from one language to another. We also present several findings on how different multilingual aspects impact RM performance. Specifically, we show that the performance of RMs is improved with improved translation quality. Similarly, we demonstrate that the models exhibit better performance for high-resource languages. We release M-RewardBench dataset and the codebase in this study to facilitate a better understanding of RM evaluation in multilingual settings.

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/

Large Language Models (LLMs) have shown impressive performance on existing medical question-answering benchmarks. This high performance makes it increasingly difficult to meaningfully evaluate and differentiate advanced methods. We present MedAgentsBench, a benchmark that focuses on challenging medical questions requiring multi-step clinical reasoning, diagnosis formulation, and treatment planning-scenarios where current models still struggle despite their strong performance on standard tests. Drawing from seven established medical datasets, our benchmark addresses three key limitations in existing evaluations: (1) the prevalence of straightforward questions where even base models achieve high performance, (2) inconsistent sampling and evaluation protocols across studies, and (3) lack of systematic analysis of the interplay between performance, cost, and inference time. Through experiments with various base models and reasoning methods, we demonstrate that the latest thinking models, DeepSeek R1 and OpenAI o3, exhibit exceptional performance in complex medical reasoning tasks. Additionally, advanced search-based agent methods offer promising performance-to-cost ratios compared to traditional approaches. Our analysis reveals substantial performance gaps between model families on complex questions and identifies optimal model selections for different computational constraints. Our benchmark and evaluation framework are publicly available at https://github.com/gersteinlab/medagents-benchmark.

Medicine is inherently multimodal, with rich data modalities spanning text, imaging, genomics, and more. Generalist biomedical artificial intelligence (AI) systems that flexibly encode, integrate, and interpret this data at scale can potentially enable impactful applications ranging from scientific discovery to care delivery. To enable the development of these models, we first curate MultiMedBench, a new multimodal biomedical benchmark. MultiMedBench encompasses 14 diverse tasks such as medical question answering, mammography and dermatology image interpretation, radiology report generation and summarization, and genomic variant calling. We then introduce Med-PaLM Multimodal (Med-PaLM M), our proof of concept for a generalist biomedical AI system. Med-PaLM M is a large multimodal generative model that flexibly encodes and interprets biomedical data including clinical language, imaging, and genomics with the same set of model weights. Med-PaLM M reaches performance competitive with or exceeding the state of the art on all MultiMedBench tasks, often surpassing specialist models by a wide margin. We also report examples of zero-shot generalization to novel medical concepts and tasks, positive transfer learning across tasks, and emergent zero-shot medical reasoning. To further probe the capabilities and limitations of Med-PaLM M, we conduct a radiologist evaluation of model-generated (and human) chest X-ray reports and observe encouraging performance across model scales. In a side-by-side ranking on 246 retrospective chest X-rays, clinicians express a pairwise preference for Med-PaLM M reports over those produced by radiologists in up to 40.50% of cases, suggesting potential clinical utility. While considerable work is needed to validate these models in real-world use cases, our results represent a milestone towards the development of generalist biomedical AI systems.

In this study, we present MedS-Bench, a comprehensive benchmark designed to evaluate the performance of large language models (LLMs) in clinical contexts. Unlike existing benchmarks that focus on multiple-choice question answering, MedS-Bench spans 11 high-level clinical tasks, including clinical report summarization, treatment recommendations, diagnosis, named entity recognition, and medical concept explanation, among others. We evaluated six leading LLMs, e.g., MEDITRON, Mistral, InternLM 2, Llama 3, GPT-4, and Claude-3.5 using few-shot prompting, and found that even the most sophisticated models struggle with these complex tasks. To address these limitations, we developed MedS-Ins, a large-scale instruction tuning dataset for medicine. MedS-Ins comprises 58 medically oriented language corpora, totaling 13.5 million samples across 122 tasks. To demonstrate the dataset's utility, we conducted a proof-of-concept experiment by performing instruction tuning on a lightweight, open-source medical language model. The resulting model, MMedIns-Llama 3, significantly outperformed existing models across nearly all clinical tasks. To promote further advancements in the application of LLMs to clinical challenges, we have made the MedS-Ins dataset fully accessible and invite the research community to contribute to its expansion.Additionally, we have launched a dynamic leaderboard for MedS-Bench, which we plan to regularly update the test set to track progress and enhance the adaptation of general LLMs to the medical domain. Leaderboard: https://henrychur.github.io/MedS-Bench/. Github: https://github.com/MAGIC-AI4Med/MedS-Ins.

Reward models have become a staple in modern NLP, serving as not only a scalable text evaluator, but also an indispensable component in many alignment recipes and inference-time algorithms. However, while recent reward models increase performance on standard benchmarks, this may partly be due to overfitting effects, which would confound an understanding of their true capability. In this work, we scrutinize the robustness of reward models and the extent of such overfitting. We build **reWordBench**, which systematically transforms reward model inputs in meaning- or ranking-preserving ways. We show that state-of-the-art reward models suffer from substantial performance degradation even with minor input transformations, sometimes dropping to significantly below-random accuracy, suggesting brittleness. To improve reward model robustness, we propose to explicitly train them to assign similar scores to paraphrases, and find that this approach also improves robustness to other distinct kinds of transformations. For example, our robust reward model reduces such degradation by roughly half for the Chat Hard subset in RewardBench. Furthermore, when used in alignment, our robust reward models demonstrate better utility and lead to higher-quality outputs, winning in up to 59% of instances against a standardly trained RM.

Large language models (LLMs) have demonstrated remarkable performance in reasoning tasks, where reinforcement learning (RL) serves as a key algorithm for enhancing their reasoning capabilities. Currently, there are two mainstream reward paradigms: model-based rewards and rule-based rewards. However, both approaches suffer from limitations: rule-based rewards lack robustness, while model-based rewards are vulnerable to reward hacking. To address these issues, we propose Cooper(Co-optimizing Policy Model and Reward Model), a RL framework that jointly optimizes both the policy model and the reward model. Cooper leverages the high precision of rule-based rewards when identifying correct responses, and dynamically constructs and selects positive-negative sample pairs for continued training the reward model. This design enhances robustness and mitigates the risk of reward hacking. To further support Cooper, we introduce a hybrid annotation strategy that efficiently and accurately generates training data for the reward model. We also propose a reference-based reward modeling paradigm, where the reward model takes a reference answer as input. Based on this design, we train a reward model named VerifyRM, which achieves higher accuracy on VerifyBench compared to other models of the same size. We conduct reinforcement learning using both VerifyRM and Cooper. Our experiments show that Cooper not only alleviates reward hacking but also improves end-to-end RL performance, for instance, achieving a 0.54% gain in average accuracy on Qwen2.5-1.5B-Instruct. Our findings demonstrate that dynamically updating reward model is an effective way to combat reward hacking, providing a reference for better integrating reward models into RL.

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.

Vision-language generative reward models (VL-GenRMs) play a crucial role in aligning and evaluating multimodal AI systems, yet their own evaluation remains under-explored. Current assessment methods primarily rely on AI-annotated preference labels from traditional VL tasks, which can introduce biases and often fail to effectively challenge state-of-the-art models. To address these limitations, we introduce VL-RewardBench, a comprehensive benchmark spanning general multimodal queries, visual hallucination detection, and complex reasoning tasks. Through our AI-assisted annotation pipeline combining sample selection with human verification, we curate 1,250 high-quality examples specifically designed to probe model limitations. Comprehensive evaluation across 16 leading large vision-language models, demonstrates VL-RewardBench's effectiveness as a challenging testbed, where even GPT-4o achieves only 65.4% accuracy, and state-of-the-art open-source models such as Qwen2-VL-72B, struggle to surpass random-guessing. Importantly, performance on VL-RewardBench strongly correlates (Pearson's r > 0.9) with MMMU-Pro accuracy using Best-of-N sampling with VL-GenRMs. Analysis experiments uncover three critical insights for improving VL-GenRMs: (i) models predominantly fail at basic visual perception tasks rather than reasoning tasks; (ii) inference-time scaling benefits vary dramatically by model capacity; and (iii) training VL-GenRMs to learn to judge substantially boosts judgment capability (+14.7% accuracy for a 7B VL-GenRM). We believe VL-RewardBench along with the experimental insights will become a valuable resource for advancing VL-GenRMs.

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.

Reasoning is an essential capacity for large language models (LLMs) to address complex tasks, where the identification of process errors is vital for improving this ability. Recently, process-level reward models (PRMs) were proposed to provide step-wise rewards that facilitate reinforcement learning and data production during training and guide LLMs toward correct steps during inference, thereby improving reasoning accuracy. However, existing benchmarks of PRMs are text-based and focus on error detection, neglecting other scenarios like reasoning search. To address this gap, we introduce MPBench, a comprehensive, multi-task, multimodal benchmark designed to systematically assess the effectiveness of PRMs in diverse scenarios. MPBench employs three evaluation paradigms, each targeting a specific role of PRMs in the reasoning process: (1) Step Correctness, which assesses the correctness of each intermediate reasoning step; (2) Answer Aggregation, which aggregates multiple solutions and selects the best one; and (3) Reasoning Process Search, which guides the search for optimal reasoning steps during inference. Through these paradigms, MPBench makes comprehensive evaluations and provides insights into the development of multimodal PRMs.

Large reasoning models such as OpenAI o1 and DeepSeek-R1 have achieved remarkable performance in the domain of reasoning. A key component of their training is the incorporation of verifiable rewards within reinforcement learning (RL). However, existing reward benchmarks do not evaluate reference-based reward systems, leaving researchers with limited understanding of the accuracy of verifiers used in RL. In this paper, we introduce two benchmarks, VerifyBench and VerifyBench-Hard, designed to assess the performance of reference-based reward systems. These benchmarks are constructed through meticulous data collection and curation, followed by careful human annotation to ensure high quality. Current models still show considerable room for improvement on both VerifyBench and VerifyBench-Hard, especially smaller-scale models. Furthermore, we conduct a thorough and comprehensive analysis of evaluation results, offering insights for understanding and developing reference-based reward systems. Our proposed benchmarks serve as effective tools for guiding the development of verifier accuracy and the reasoning capabilities of models trained via RL in reasoning tasks.

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.

We introduce WildBench, an automated evaluation framework designed to benchmark large language models (LLMs) using challenging, real-world user queries. WildBench consists of 1,024 tasks carefully selected from over one million human-chatbot conversation logs. For automated evaluation with WildBench, we have developed two metrics, WB-Reward and WB-Score, which are computable using advanced LLMs such as GPT-4-turbo. WildBench evaluation uses task-specific checklists to evaluate model outputs systematically and provides structured explanations that justify the scores and comparisons, resulting in more reliable and interpretable automatic judgments. WB-Reward employs fine-grained pairwise comparisons between model responses, generating five potential outcomes: much better, slightly better, slightly worse, much worse, or a tie. Unlike previous evaluations that employed a single baseline model, we selected three baseline models at varying performance levels to ensure a comprehensive pairwise evaluation. Additionally, we propose a simple method to mitigate length bias, by converting outcomes of ``slightly better/worse'' to ``tie'' if the winner response exceeds the loser one by more than K characters. WB-Score evaluates the quality of model outputs individually, making it a fast and cost-efficient evaluation metric. WildBench results demonstrate a strong correlation with the human-voted Elo ratings from Chatbot Arena on hard tasks. Specifically, WB-Reward achieves a Pearson correlation of 0.98 with top-ranking models. Additionally, WB-Score reaches 0.95, surpassing both ArenaHard's 0.91 and AlpacaEval2.0's 0.89 for length-controlled win rates, as well as the 0.87 for regular win rates.

In this paper, we introduce AceMath, a suite of frontier math models that excel in solving complex math problems, along with highly effective reward models capable of evaluating generated solutions and reliably identifying the correct ones. To develop the instruction-tuned math models, we propose a supervised fine-tuning (SFT) process that first achieves competitive performance across general domains, followed by targeted fine-tuning for the math domain using a carefully curated set of prompts and synthetically generated responses. The resulting model, AceMath-72B-Instruct greatly outperforms Qwen2.5-Math-72B-Instruct, GPT-4o and Claude-3.5 Sonnet. To develop math-specialized reward model, we first construct AceMath-RewardBench, a comprehensive and robust benchmark for evaluating math reward models across diverse problems and difficulty levels. After that, we present a systematic approach to build our math reward models. The resulting model, AceMath-72B-RM, consistently outperforms state-of-the-art reward models. Furthermore, when combining AceMath-72B-Instruct with AceMath-72B-RM, we achieve the highest average rm@8 score across the math reasoning benchmarks. We will release model weights, training data, and evaluation benchmarks at: https://research.nvidia.com/labs/adlr/acemath

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.

Reward Models, essential for guiding Large Language Model optimization, are typically trained on fixed preference datasets, resulting in rigid alignment to single, implicit preference distributions. This prevents adaptation to diverse real-world needs-from conciseness in one task to detailed explanations in another. The standard practice of collecting task-specific preference data and retraining reward models is resource-intensive, often producing biased rewards, and limits practical application. We introduce generalizable, principle-following reward models. We propose that RMs should understand and adhere to dynamically provided natural language specifications of reward principles, similar to instruction-following in LLMs. To measure this capability, we develop RABench, a comprehensive benchmark for RMs focusing on generalization across diverse principles. Evaluations on RABench reveal poor generalization of current RMs. As a solution, we present RewardAnything, a novel RM designed and trained to explicitly follow natural language principles. We achieve SotA performance with RewardAnything in traditional RM benchmark simply by specifying a well-defined principle, and results on RABench show we excel in adapting to novel principles without retraining. Furthermore, RewardAnything integrates seamlessly with existing RLHF methods and we show by a case study on how to automatically and efficiently align LLMs with only natural language principles.

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.

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.

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 Vision-Language Models (LVLMs) are increasingly being explored for applications in telemedicine, yet their ability to engage with diverse patient behaviors remains underexplored. We introduce 3MDBench (Medical Multimodal Multi-agent Dialogue Benchmark), an open-source evaluation framework designed to assess LLM-driven medical consultations. Unlike existing benchmarks, 3MDBench simulates real-world patient variability by incorporating four temperament-driven Patient Agents and an Assessor Agent that evaluates diagnostic accuracy and dialogue quality. The benchmark integrates textual and image-based patient data across 34 common diagnoses, mirroring real-world telemedicine interactions. Under different diagnostic strategies, we evaluate state-of-the-art LVLMs. Our findings demonstrate that incorporating dialogue improves the F1 score from 50.4 to 54.2 compared to non-dialogue settings, underscoring the value of context-driven, information-seeking questioning. Additionally, we demonstrate that multimodal inputs enhance diagnostic efficiency. Image-supported models outperform text-only counterparts by raising the diagnostic F1 score from 52.8 to 54.2 in a similar dialogue setting. Finally, we suggest an approach that improves the diagnostic F1-score to 70.3 by training the CNN model on the diagnosis prediction task and incorporating its top-3 predictions into the LVLM context. 3MDBench provides a reproducible and extendable evaluation framework for AI-driven medical assistants. It offers insights into how patient temperament, dialogue strategies, and multimodal reasoning influence diagnosis quality. By addressing real-world complexities in telemedicine, our benchmark paves the way for more empathetic, reliable, and context-aware AI-driven healthcare solutions. The source code of our benchmark is publicly available: https://github.com/univanxx/3mdbench

Reward Models (RMs) are critical for improving generation models via Reinforcement Learning (RL), yet the RM scaling paradigm in visual generation remains largely unexplored. It primarily due to fundamental limitations in existing approaches: CLIP-based RMs suffer from architectural and input modality constraints, while prevalent Bradley-Terry losses are fundamentally misaligned with the next-token prediction mechanism of Vision-Language Models (VLMs), hindering effective scaling. More critically, the RLHF optimization process is plagued by Reward Hacking issue, where models exploit flaws in the reward signal without improving true quality. To address these challenges, we introduce RewardDance, a scalable reward modeling framework that overcomes these barriers through a novel generative reward paradigm. By reformulating the reward score as the model's probability of predicting a "yes" token, indicating that the generated image outperforms a reference image according to specific criteria, RewardDance intrinsically aligns reward objectives with VLM architectures. This alignment unlocks scaling across two dimensions: (1) Model Scaling: Systematic scaling of RMs up to 26 billion parameters; (2) Context Scaling: Integration of task-specific instructions, reference examples, and chain-of-thought (CoT) reasoning. Extensive experiments demonstrate that RewardDance significantly surpasses state-of-the-art methods in text-to-image, text-to-video, and image-to-video generation. Crucially, we resolve the persistent challenge of "reward hacking": Our large-scale RMs exhibit and maintain high reward variance during RL fine-tuning, proving their resistance to hacking and ability to produce diverse, high-quality outputs. It greatly relieves the mode collapse problem that plagues smaller models.

Large language models (LLMs) fine-tuned with alignment techniques, such as reinforcement learning from human feedback, have been instrumental in developing some of the most capable AI systems to date. Despite their success, existing methods typically rely on simple binary labels, such as those indicating preferred outputs in pairwise preferences, which fail to capture the subtle differences in relative quality between pairs. To address this limitation, we introduce an approach called Margin Matching Preference Optimization (MMPO), which incorporates relative quality margins into optimization, leading to improved LLM policies and reward models. Specifically, given quality margins in pairwise preferences, we design soft target probabilities based on the Bradley-Terry model, which are then used to train models with the standard cross-entropy objective. Experiments with both human and AI feedback data demonstrate that MMPO consistently outperforms baseline methods, often by a substantial margin, on popular benchmarks including MT-bench and RewardBench. Notably, the 7B model trained with MMPO achieves state-of-the-art performance on RewardBench as of June 2024, outperforming other models of the same scale. Our analysis also shows that MMPO is more robust to overfitting, leading to better-calibrated models.

Large Language Models (LLMs) have demonstrated significant promise for various applications in healthcare. However, their efficacy in the Arabic medical domain remains unexplored due to the lack of high-quality domain-specific datasets and benchmarks. This study introduces MedArabiQ, a novel benchmark dataset consisting of seven Arabic medical tasks, covering multiple specialties and including multiple choice questions, fill-in-the-blank, and patient-doctor question answering. We first constructed the dataset using past medical exams and publicly available datasets. We then introduced different modifications to evaluate various LLM capabilities, including bias mitigation. We conducted an extensive evaluation with five state-of-the-art open-source and proprietary LLMs, including GPT-4o, Claude 3.5-Sonnet, and Gemini 1.5. Our findings highlight the need for the creation of new high-quality benchmarks that span different languages to ensure fair deployment and scalability of LLMs in healthcare. By establishing this benchmark and releasing the dataset, we provide a foundation for future research aimed at evaluating and enhancing the multilingual capabilities of LLMs for the equitable use of generative AI in healthcare.

Large language models (LLMs) are increasingly envisioned as decision-support tools in clinical practice, yet safe clinical reasoning demands integrating heterogeneous knowledge bases -- trials, primary studies, regulatory documents, and cost data -- under strict accuracy constraints. Existing evaluations often rely on synthetic prompts, reduce the task to single-hop factoid queries, or conflate reasoning with open-ended generation, leaving their real-world utility unclear. To close this gap, we present MedBrowseComp, the first benchmark that systematically tests an agent's ability to reliably retrieve and synthesize multi-hop medical facts from live, domain-specific knowledge bases. MedBrowseComp contains more than 1,000 human-curated questions that mirror clinical scenarios where practitioners must reconcile fragmented or conflicting information to reach an up-to-date conclusion. Applying MedBrowseComp to frontier agentic systems reveals performance shortfalls as low as ten percent, exposing a critical gap between current LLM capabilities and the rigor demanded in clinical settings. MedBrowseComp therefore offers a clear testbed for reliable medical information seeking and sets concrete goals for future model and toolchain upgrades. You can visit our project page at: https://moreirap12.github.io/mbc-browse-app/

Recent developments in Large Language Model (LLM)-based agents have shown impressive capabilities spanning multiple domains, exemplified by deep research systems that demonstrate superior performance on complex information-seeking and synthesis tasks. While general-purpose deep research agents have shown impressive capabilities, they struggle significantly with medical domain challenges, as evidenced by leading proprietary systems achieving limited accuracy on complex medical benchmarks. The key limitations are: (1) the model lacks sufficient dense medical knowledge for clinical reasoning, and (2) the framework is constrained by the absence of specialized retrieval tools tailored for medical contexts.We present a medical deep research agent that addresses these challenges through two core innovations. First, we develop a novel data synthesis framework using medical knowledge graphs, extracting the longest chains from subgraphs around rare medical entities to generate complex multi-hop question-answer pairs. Second, we integrate a custom-built private medical retrieval engine alongside general-purpose tools, enabling accurate medical information synthesis. Our approach generates 2100+ diverse trajectories across 12 medical specialties, each averaging 4.2 tool interactions.Through a two-stage training paradigm combining supervised fine-tuning and online reinforcement learning with composite rewards, our MedResearcher-R1-32B model demonstrates exceptional performance, establishing new state-of-the-art results on medical benchmarks while maintaining competitive performance on general deep research tasks. Our work demonstrates that strategic domain-specific innovations in architecture, tool design, and training data construction can enable smaller open-source models to outperform much larger proprietary systems in specialized domains.

Multimodal document retrieval systems enable information access across text, images, and layouts, benefiting various domains like document-based question answering, report analysis, and interactive content summarization. Rerankers improve retrieval precision by reordering retrieved candidates. However, current multimodal reranking methods remain underexplored, with significant room for improvement in both training strategies and overall effectiveness. Moreover, the lack of explicit reasoning makes it difficult to analyze and optimize these methods further. In this paper, We propose MM-R5, a MultiModal Reasoning-Enhanced ReRanker via Reinforcement Learning for Document Retrieval, aiming to provide a more effective and reliable solution for multimodal reranking tasks. MM-R5 is trained in two stages: supervised fine-tuning (SFT) and reinforcement learning (RL). In the SFT stage, we focus on improving instruction-following and guiding the model to generate complete and high-quality reasoning chains. To support this, we introduce a novel data construction strategy that produces rich, high-quality reasoning data. In the RL stage, we design a task-specific reward framework, including a reranking reward tailored for multimodal candidates and a composite template-based reward to further refine reasoning quality. We conduct extensive experiments on MMDocIR, a challenging public benchmark spanning multiple domains. MM-R5 achieves state-of-the-art performance on most metrics and delivers comparable results to much larger models on the remaining ones. Moreover, compared to the best retrieval-only method, MM-R5 improves recall@1 by over 4%. These results validate the effectiveness of our reasoning-enhanced training pipeline.

In this paper, we propose DuaShepherd, a novel reward modeling framework that integrates two complementary reward signals, correctness and potential, to enhance the mathematical reasoning capabilities of Large Language Models (LLMs). While correctness-based signals emphasize identification of stepwise errors, potential-based signals focus on the likelihood of reaching the correct final answer. We developed an automated pipeline for constructing large-scale reward modeling dataset with both signals. A unified, multi-head architecture was explored to train the two reward models in a multi-task setup, demonstrating benefits from learning both correctness and potential in parallel. By combining these two signals into a compound probability, our model achieves consistent performance improvements across multiple benchmarks. Empirical evaluations on MATH500 and ProcessBench confirm that this combined reward significantly outperforms models trained on either reward type alone, achieving state-of-the-art performance under comparable resource constraints.

As opposed to evaluating computation and logic-based reasoning, current benchmarks for evaluating large language models (LLMs) in medicine are primarily focused on question-answering involving domain knowledge and descriptive reasoning. While such qualitative capabilities are vital to medical diagnosis, in real-world scenarios, doctors frequently use clinical calculators that follow quantitative equations and rule-based reasoning paradigms for evidence-based decision support. To this end, we propose MedCalc-Bench, a first-of-its-kind dataset focused on evaluating the medical calculation capability of LLMs. MedCalc-Bench contains an evaluation set of over 1000 manually reviewed instances from 55 different medical calculation tasks. Each instance in MedCalc-Bench consists of a patient note, a question requesting to compute a specific medical value, a ground truth answer, and a step-by-step explanation showing how the answer is obtained. While our evaluation results show the potential of LLMs in this area, none of them are effective enough for clinical settings. Common issues include extracting the incorrect entities, not using the correct equation or rules for a calculation task, or incorrectly performing the arithmetic for the computation. We hope our study highlights the quantitative knowledge and reasoning gaps in LLMs within medical settings, encouraging future improvements of LLMs for various clinical calculation tasks.

Large Language Models (LLMs) hold great promise to revolutionize current clinical systems for their superior capacities on medical text processing tasks and medical licensing exams. Meanwhile, traditional ML models such as SVM and XGBoost have still been mainly adopted in clinical prediction tasks. An emerging question is Can LLMs beat traditional ML models in clinical prediction? Thus, we build a new benchmark ClinicalBench to comprehensively study the clinical predictive modeling capacities of both general-purpose and medical LLMs, and compare them with traditional ML models. ClinicalBench embraces three common clinical prediction tasks, two databases, 14 general-purpose LLMs, 8 medical LLMs, and 11 traditional ML models. Through extensive empirical investigation, we discover that both general-purpose and medical LLMs, even with different model scales, diverse prompting or fine-tuning strategies, still cannot beat traditional ML models in clinical prediction yet, shedding light on their potential deficiency in clinical reasoning and decision-making. We call for caution when practitioners adopt LLMs in clinical applications. ClinicalBench can be utilized to bridge the gap between LLMs' development for healthcare and real-world clinical practice.

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.

Vision-language models (VLMs) have advanced reasoning in natural scenes, but their role in medical imaging remains underexplored. Medical reasoning tasks demand robust image analysis and well-justified answers, posing challenges due to the complexity of medical images. Transparency and trustworthiness are essential for clinical adoption and regulatory compliance. We introduce Med-R1, a framework exploring reinforcement learning (RL) to enhance VLMs' generalizability and trustworthiness in medical reasoning. Leveraging the DeepSeek strategy, we employ Group Relative Policy Optimization (GRPO) to guide reasoning paths via reward signals. Unlike supervised fine-tuning (SFT), which often overfits and lacks generalization, RL fosters robust and diverse reasoning. Med-R1 is evaluated across eight medical imaging modalities: CT, MRI, Ultrasound, Dermoscopy, Fundus Photography, Optical Coherence Tomography (OCT), Microscopy, and X-ray Imaging. Compared to its base model, Qwen2-VL-2B, Med-R1 achieves a 29.94% accuracy improvement and outperforms Qwen2-VL-72B, which has 36 times more parameters. Testing across five question types-modality recognition, anatomy identification, disease diagnosis, lesion grading, and biological attribute analysis Med-R1 demonstrates superior generalization, exceeding Qwen2-VL-2B by 32.06% and surpassing Qwen2-VL-72B in question-type generalization. These findings show that RL improves medical reasoning and enables parameter-efficient models to outperform significantly larger ones. With interpretable reasoning outputs, Med-R1 represents a promising step toward generalizable, trustworthy, and clinically viable medical VLMs.

Reward models are critical in techniques like Reinforcement Learning from Human Feedback (RLHF) and Inference Scaling Laws, where they guide language model alignment and select optimal responses. Despite their importance, existing reward model benchmarks often evaluate models by asking them to distinguish between responses generated by models of varying power. However, this approach fails to assess reward models on subtle but critical content changes and variations in style, resulting in a low correlation with policy model performance. To this end, we introduce RM-Bench, a novel benchmark designed to evaluate reward models based on their sensitivity to subtle content differences and resistance to style biases. Extensive experiments demonstrate that RM-Bench strongly correlates with policy model performance, making it a reliable reference for selecting reward models to align language models effectively. We evaluate nearly 40 reward models on RM-Bench. Our results reveal that even state-of-the-art models achieve an average performance of only 46.6%, which falls short of random-level accuracy (50%) when faced with style bias interference. These findings highlight the significant room for improvement in current reward models. Related code and data are available at https://github.com/THU-KEG/RM-Bench.

Developing artificial intelligence (AI) for vertical domains requires a solid data foundation for both training and evaluation. In this work, we introduce TrialPanorama, a large-scale, structured database comprising 1,657,476 clinical trial records aggregated from 15 global sources. The database captures key aspects of trial design and execution, including trial setups, interventions, conditions, biomarkers, and outcomes, and links them to standard biomedical ontologies such as DrugBank and MedDRA. This structured and ontology-grounded design enables TrialPanorama to serve as a unified, extensible resource for a wide range of clinical trial tasks, including trial planning, design, and summarization. To demonstrate its utility, we derive a suite of benchmark tasks directly from the TrialPanorama database. The benchmark spans eight tasks across two categories: three for systematic review (study search, study screening, and evidence summarization) and five for trial design (arm design, eligibility criteria, endpoint selection, sample size estimation, and trial completion assessment). The experiments using five state-of-the-art large language models (LLMs) show that while general-purpose LLMs exhibit some zero-shot capability, their performance is still inadequate for high-stakes clinical trial workflows. We release TrialPanorama database and the benchmark to facilitate further research on AI for clinical trials.

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.

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

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.

Reward models (RMs) are fundamental to aligning Large Language Models (LLMs) via human feedback, yet they often suffer from reward hacking. They tend to latch on to superficial or spurious attributes, such as response length or formatting, mistaking these cues learned from correlations in training data for the true causal drivers of quality (e.g., factuality, relevance). This occurs because standard training objectives struggle to disentangle these factors, leading to brittle RMs and misaligned policies. We introduce Crome (Causally Robust Reward Modeling), a novel framework grounded in an explicit causal model designed to mitigate reward hacking. Crome employs the following synthetic targeted augmentations during training: (1) Causal Augmentations, which are pairs that differ along specific causal attributes, to enforce sensitivity along each causal attribute individually, and (2) Neutral Augmentations, which are tie-label pairs varying primarily in spurious attributes, to enforce invariance along spurious attributes. Notably, our augmentations are produced without any knowledge of spurious factors, via answer interventions only along causal rubrics, that are identified by querying an oracle LLM. Empirically, Crome significantly outperforms standard baselines on RewardBench, improving average accuracy by up to 5.4% and achieving gains of up to 13.2% and 7.2% in specific categories. The robustness of Crome is further testified by the consistent gains obtained in a Best-of-N inference setting across increasing N, across various benchmarks, including the popular RewardBench (covering chat, chat-hard, safety, and reasoning tasks), the safety-focused WildGuardTest, and the reasoning-specific GSM8k.

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

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 growing demand for data-driven decision-making has created an urgent need for data agents that can integrate structured and unstructured data for analysis. While data agents show promise for enabling users to perform complex analytics tasks, this field still suffers from three critical limitations: first, comprehensive data agent benchmarks remain absent due to the difficulty of designing test cases that evaluate agents' abilities across multi-source analytical tasks; second, constructing reliable test cases that combine structured and unstructured data remains costly and prohibitively complex; third, existing benchmarks exhibit limited adaptability and generalizability, resulting in narrow evaluation scope. To address these challenges, we present FDABench, the first data agent benchmark specifically designed for evaluating agents in multi-source data analytical scenarios. Our contributions include: (i) we construct a standardized benchmark with 2,007 diverse tasks across different data sources, domains, difficulty levels, and task types to comprehensively evaluate data agent performance; (ii) we design an agent-expert collaboration framework ensuring reliable and efficient benchmark construction over heterogeneous data; (iii) we equip FDABench with robust generalization capabilities across diverse target systems and frameworks. We use FDABench to evaluate various data agent systems, revealing that each system exhibits distinct advantages and limitations regarding response quality, accuracy, latency, and token cost.

With the growing use of language models (LMs) in clinical environments, there is an immediate need to evaluate the accuracy and safety of LM-generated medical text. Currently, such evaluation relies solely on manual physician review. However, detecting errors in LM-generated text is challenging because 1) manual review is costly and 2) expert-composed reference outputs are often unavailable in real-world settings. While the "LM-as-judge" paradigm (a LM evaluating another LM) offers scalable evaluation, even frontier LMs can miss subtle but clinically significant errors. To address these challenges, we propose MedVAL, a self-supervised framework that leverages synthetic data to train evaluator LMs to assess whether LM-generated medical outputs are factually consistent with inputs, without requiring physician labels or reference outputs. To evaluate LM performance, we introduce MedVAL-Bench, a dataset containing 840 outputs annotated by physicians, following a physician-defined taxonomy of risk levels and error categories. Across 6 diverse medical tasks and 10 state-of-the-art LMs spanning open-source, proprietary, and medically adapted models, MedVAL fine-tuning significantly improves (p < 0.001) alignment with physicians on both seen and unseen tasks, increasing average F1 scores from 66% to 83%, with per-sample safety classification scores up to 86%. MedVAL improves the performance of even the best-performing proprietary LM (GPT-4o) by 8%. To support a scalable, risk-aware pathway towards clinical integration, we open-source the 1) codebase ( https://github.com/StanfordMIMI/MedVAL ), 2) MedVAL-Bench ( https://huggingface.co/datasets/stanfordmimi/MedVAL-Bench ), and 3) MedVAL-4B ( https://huggingface.co/stanfordmimi/MedVAL-4B ), the best-performing open-source LM. Our research provides the first evidence of LMs approaching expert-level validation ability for medical text.

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.

Large Language Models (LLMs) have shown significant potential in designing reward functions for Reinforcement Learning (RL) tasks. However, obtaining high-quality reward code often involves human intervention, numerous LLM queries, or repetitive RL training. To address these issues, we propose CARD, a LLM-driven Reward Design framework that iteratively generates and improves reward function code. Specifically, CARD includes a Coder that generates and verifies the code, while a Evaluator provides dynamic feedback to guide the Coder in improving the code, eliminating the need for human feedback. In addition to process feedback and trajectory feedback, we introduce Trajectory Preference Evaluation (TPE), which evaluates the current reward function based on trajectory preferences. If the code fails the TPE, the Evaluator provides preference feedback, avoiding RL training at every iteration and making the reward function better aligned with the task objective. Empirical results on Meta-World and ManiSkill2 demonstrate that our method achieves an effective balance between task performance and token efficiency, outperforming or matching the baselines across all tasks. On 10 out of 12 tasks, CARD shows better or comparable performance to policies trained with expert-designed rewards, and our method even surpasses the oracle on 3 tasks.

Reward models (RMs) play a pivotal role in aligning large language models (LLMs) with human preferences. However, traditional RM training, which relies on response pairs tied to specific prompts, struggles to disentangle prompt-driven preferences from prompt-independent artifacts, such as response length and format. In this work, we expose a fundamental limitation of current RM training methods, where RMs fail to effectively distinguish between contextual signals and irrelevant artifacts when determining preferences. To address this, we introduce a causal framework that learns preferences independent of these artifacts and propose a novel data augmentation technique designed to eliminate them. Extensive experiments show that our approach successfully filters out undesirable artifacts, yielding a more robust reward model (RRM). Our RRM improves the performance of a pairwise reward model trained on Gemma-2-9b-it, on RewardBench, increasing accuracy from 80.61% to 84.15%. Additionally, we train two DPO policies using both the RM and RRM, demonstrating that the RRM significantly enhances DPO-aligned policies, improving MT-Bench scores from 7.27 to 8.31 and length-controlled win-rates in AlpacaEval-2 from 33.46% to 52.49%.

With the rapid development of large language models (LLMs), assessing their performance on health-related inquiries has become increasingly essential. It is critical that these models provide accurate and trustworthy health information, as their application in real-world contexts--where misinformation can have serious consequences for individuals seeking medical advice and support--depends on their reliability. In this work, we present CHBench, the first comprehensive Chinese Health-related Benchmark designed to evaluate LLMs' capabilities in understanding physical and mental health across diverse scenarios. CHBench includes 6,493 entries related to mental health and 2,999 entries focused on physical health, covering a broad spectrum of topics. This dataset serves as a foundation for evaluating Chinese LLMs' capacity to comprehend and generate accurate health-related information. Our extensive evaluations of four popular Chinese LLMs demonstrate that there remains considerable room for improvement in their understanding of health-related information. The code is available at https://github.com/TracyGuo2001/CHBench.

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.

Medical Vision-Language Pretraining (MedVLP) shows promise in learning generalizable and transferable visual representations from paired and unpaired medical images and reports. MedVLP can provide useful features to downstream tasks and facilitate adapting task-specific models to new setups using fewer examples. However, existing MedVLP methods often differ in terms of datasets, preprocessing, and finetuning implementations. This pose great challenges in evaluating how well a MedVLP method generalizes to various clinically-relevant tasks due to the lack of unified, standardized, and comprehensive benchmark. To fill this gap, we propose BenchX, a unified benchmark framework that enables head-to-head comparison and systematical analysis between MedVLP methods using public chest X-ray datasets. Specifically, BenchX is composed of three components: 1) Comprehensive datasets covering nine datasets and four medical tasks; 2) Benchmark suites to standardize data preprocessing, train-test splits, and parameter selection; 3) Unified finetuning protocols that accommodate heterogeneous MedVLP methods for consistent task adaptation in classification, segmentation, and report generation, respectively. Utilizing BenchX, we establish baselines for nine state-of-the-art MedVLP methods and found that the performance of some early MedVLP methods can be enhanced to surpass more recent ones, prompting a revisiting of the developments and conclusions from prior works in MedVLP. Our code are available at https://github.com/yangzhou12/BenchX.

What fundamental properties of reward functions enable efficient sparse-reward reinforcement learning? We address this question through the lens of low-rank structure in reward matrices, showing that such structure induces a sharp transition from exponential to polynomial sample complexity, the first result of this kind for sparse-reward RL. We introduce Policy-Aware Matrix Completion (PAMC), which connects matrix completion theory with reinforcement learning via a new analysis of policy-dependent sampling. Our framework provides: (i) impossibility results for general sparse reward observation, (ii) reward-free representation learning from dynamics, (iii) distribution-free confidence sets via conformal prediction, and (iv) robust completion guarantees that degrade gracefully when low-rank structure is only approximate. Empirically, we conduct a pre-registered evaluation across 100 systematically sampled domains, finding exploitable structure in over half. PAMC improves sample efficiency by factors between 1.6 and 2.1 compared to strong exploration, structured, and representation-learning baselines, while adding only about 20 percent computational overhead.These results establish structural reward learning as a promising new paradigm, with immediate implications for robotics, healthcare, and other safety-critical, sample-expensive applications.

Web navigation is a unique domain that can automate many repetitive real-life tasks and is challenging as it requires long-horizon sequential decision making beyond typical multimodal large language model (MLLM) tasks. Yet, specialized reward models for web navigation that can be utilized during both training and test-time have been absent until now. Despite the importance of speed and cost-effectiveness, prior works have utilized MLLMs as reward models, which poses significant constraints for real-world deployment. To address this, in this work, we propose the first process reward model (PRM) called Web-Shepherd which could assess web navigation trajectories in a step-level. To achieve this, we first construct the WebPRM Collection, a large-scale dataset with 40K step-level preference pairs and annotated checklists spanning diverse domains and difficulty levels. Next, we also introduce the WebRewardBench, the first meta-evaluation benchmark for evaluating PRMs. In our experiments, we observe that our Web-Shepherd achieves about 30 points better accuracy compared to using GPT-4o on WebRewardBench. Furthermore, when testing on WebArena-lite by using GPT-4o-mini as the policy and Web-Shepherd as the verifier, we achieve 10.9 points better performance, in 10 less cost compared to using GPT-4o-mini as the verifier. Our model, dataset, and code are publicly available at LINK.

Reward models (RMs) play a crucial role in Reinforcement Learning from Human Feedback by serving as proxies for human preferences in aligning large language models. In this paper, we identify a model preference bias in RMs, where they systematically assign disproportionately high scores to responses from certain policy models. This bias distorts ranking evaluations and leads to unfair judgments. To address this issue, we propose a calibration method named CHatbot Arena calibrated Reward Modeling (CHARM) that leverages Elo scores from the Chatbot Arena leaderboard to mitigate RM overvaluation. We also introduce a Mismatch Degree metric to measure this preference bias. Our approach is computationally efficient, requiring only a small preference dataset for continued training of the RM. We conduct extensive experiments on reward model benchmarks and human preference alignment. Results demonstrate that our calibrated RMs (1) achieve improved evaluation accuracy on RM-Bench and the Chat-Hard domain of RewardBench, and (2) exhibit a stronger correlation with human preferences by producing scores more closely aligned with Elo rankings. By mitigating model preference bias, our method provides a generalizable and efficient solution for building fairer and more reliable reward models.

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.

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

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.

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.

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

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

We introduce MedAgentGYM, the first publicly available training environment designed to enhance coding-based medical reasoning capabilities in large language model (LLM) agents. MedAgentGYM comprises 72,413 task instances across 129 categories derived from authentic real-world biomedical scenarios. Tasks are encapsulated within executable coding environments, each featuring detailed task descriptions, interactive feedback mechanisms, verifiable ground-truth annotations, and scalable training trajectory generation. Extensive benchmarking of over 30 LLMs reveals a notable performance disparity between commercial API-based models and open-source counterparts. Leveraging MedAgentGYM, Med-Copilot-7B achieves substantial performance gains through supervised fine-tuning (+36.44%) and continued reinforcement learning (+42.47%), emerging as an affordable and privacy-preserving alternative competitive with gpt-4o. By offering both a comprehensive benchmark and accessible, expandable training resources within unified execution environments, MedAgentGYM delivers an integrated platform to develop LLM-based coding assistants for advanced biomedical research and practice.

Reward function design and exploration time are arguably the biggest obstacles to the deployment of reinforcement learning (RL) agents in the real world. In many real-world tasks, designing a reward function takes considerable hand engineering and often requires additional sensors to be installed just to measure whether the task has been executed successfully. Furthermore, many interesting tasks consist of multiple implicit intermediate steps that must be executed in sequence. Even when the final outcome can be measured, it does not necessarily provide feedback on these intermediate steps. To address these issues, we propose leveraging the abstraction power of intermediate visual representations learned by deep models to quickly infer perceptual reward functions from small numbers of demonstrations. We present a method that is able to identify key intermediate steps of a task from only a handful of demonstration sequences, and automatically identify the most discriminative features for identifying these steps. This method makes use of the features in a pre-trained deep model, but does not require any explicit specification of sub-goals. The resulting reward functions can then be used by an RL agent to learn to perform the task in real-world settings. To evaluate the learned reward, we present qualitative results on two real-world tasks and a quantitative evaluation against a human-designed reward function. We also show that our method can be used to learn a real-world door opening skill using a real robot, even when the demonstration used for reward learning is provided by a human using their own hand. To our knowledge, these are the first results showing that complex robotic manipulation skills can be learned directly and without supervised labels from a video of a human performing the task. Supplementary material and data are available at https://sermanet.github.io/rewards

As large language models (LLMs) advance, it becomes more challenging to reliably evaluate their output due to the high costs of human evaluation. To make progress towards better LLM autoraters, we introduce FLAMe, a family of Foundational Large Autorater Models. FLAMe is trained on our large and diverse collection of 100+ quality assessment tasks comprising 5M+ human judgments, curated and standardized using publicly released human evaluations from previous research. FLAMe significantly improves generalization to a wide variety of held-out tasks, outperforming LLMs trained on proprietary data like GPT-4 and Claude-3 on many tasks. We show that FLAMe can also serve as a powerful starting point for further downstream fine-tuning, using reward modeling evaluation as a case study (FLAMe-RM). Notably, on RewardBench, our FLAMe-RM-24B model (with an accuracy of 87.8%) is the top-performing generative model trained exclusively on permissively licensed data, outperforming both GPT-4-0125 (85.9%) and GPT-4o (84.7%). Additionally, we explore a more computationally efficient approach using a novel tail-patch fine-tuning strategy to optimize our FLAMe multitask mixture for reward modeling evaluation (FLAMe-Opt-RM), offering competitive RewardBench performance while requiring approximately 25x less training datapoints. Overall, our FLAMe variants outperform all popular proprietary LLM-as-a-Judge models we consider across 8 out of 12 autorater evaluation benchmarks, encompassing 53 quality assessment tasks, including RewardBench and LLM-AggreFact. Finally, our analysis reveals that FLAMe is significantly less biased than these LLM-as-a-Judge models on the CoBBLEr autorater bias benchmark, while effectively identifying high-quality responses for code generation.

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.

Text-to-image generative models have recently attracted considerable interest, enabling the synthesis of high-quality images from textual prompts. However, these models often lack the capability to generate specific subjects from given reference images or to synthesize novel renditions under varying conditions. Methods like DreamBooth and Subject-driven Text-to-Image (SuTI) have made significant progress in this area. Yet, both approaches primarily focus on enhancing similarity to reference images and require expensive setups, often overlooking the need for efficient training and avoiding overfitting to the reference images. In this work, we present the lambda-Harmonic reward function, which provides a reliable reward signal and enables early stopping for faster training and effective regularization. By combining the Bradley-Terry preference model, the lambda-Harmonic reward function also provides preference labels for subject-driven generation tasks. We propose Reward Preference Optimization (RPO), which offers a simpler setup (requiring only 3% of the negative samples used by DreamBooth) and fewer gradient steps for fine-tuning. Unlike most existing methods, our approach does not require training a text encoder or optimizing text embeddings and achieves text-image alignment by fine-tuning only the U-Net component. Empirically, lambda-Harmonic proves to be a reliable approach for model selection in subject-driven generation tasks. Based on preference labels and early stopping validation from the lambda-Harmonic reward function, our algorithm achieves a state-of-the-art CLIP-I score of 0.833 and a CLIP-T score of 0.314 on DreamBench.

Restless multi-armed bandits (RMAB) have demonstrated success in optimizing resource allocation for large beneficiary populations in public health settings. Unfortunately, RMAB models lack flexibility to adapt to evolving public health policy priorities. Concurrently, Large Language Models (LLMs) have emerged as adept automated planners across domains of robotic control and navigation. In this paper, we propose a Decision Language Model (DLM) for RMABs, enabling dynamic fine-tuning of RMAB policies in public health settings using human-language commands. We propose using LLMs as automated planners to (1) interpret human policy preference prompts, (2) propose reward functions as code for a multi-agent RMAB environment, and (3) iterate on the generated reward functions using feedback from grounded RMAB simulations. We illustrate the application of DLM in collaboration with ARMMAN, an India-based non-profit promoting preventative care for pregnant mothers, that currently relies on RMAB policies to optimally allocate health worker calls to low-resource populations. We conduct a technology demonstration in simulation using the Gemini Pro model, showing DLM can dynamically shape policy outcomes using only human prompts as input.

Reward modeling (a.k.a., preference modeling) is instrumental for aligning large language models with human preferences, particularly within the context of reinforcement learning from human feedback (RLHF). While conventional reward models (RMs) have exhibited remarkable scalability, they oft struggle with fundamental functionality such as arithmetic computation, code execution, and factual lookup. In this paper, we propose a tool-augmented preference modeling approach, named Themis, to address these limitations by empowering RMs with access to external environments, including calculators and search engines. This approach not only fosters synergy between tool utilization and reward grading but also enhances interpretive capacity and scoring reliability. Our study delves into the integration of external tools into RMs, enabling them to interact with diverse external sources and construct task-specific tool engagement and reasoning traces in an autoregressive manner. We validate our approach across a wide range of domains, incorporating seven distinct external tools. Our experimental results demonstrate a noteworthy overall improvement of 17.7% across eight tasks in preference ranking. Furthermore, our approach outperforms Gopher 280B by 7.3% on TruthfulQA task in zero-shot evaluation. In human evaluations, RLHF trained with Themis attains an average win rate of 32% when compared to baselines across four distinct tasks. Additionally, we provide a comprehensive collection of tool-related RM datasets, incorporating data from seven distinct tool APIs, totaling 15,000 instances. We have made the code, data, and model checkpoints publicly available to facilitate and inspire further research advancements\url{https://github.com/ernie-research/Tool-Augmented-Reward-Model}.

In recent years, the emergence of large reasoning models (LRMs), such as OpenAI-o1 and DeepSeek-R1, has shown impressive capabilities in complex problems, e.g., mathematics and coding. Some pioneering studies attempt to bring the success of LRMs in neural machine translation (MT). They try to build LRMs with deep reasoning MT ability via reinforcement learning (RL). Despite some progress that has been made, these attempts generally focus on several high-resource languages, e.g., English and Chinese, leaving the performance on other languages unclear. Besides, the reward modeling methods in previous work do not fully unleash the potential of reinforcement learning in MT. In this work, we first design a new reward modeling method that compares the translation results of the policy MT model with a strong LRM (i.e., DeepSeek-R1-671B), and quantifies the comparisons to provide rewards. Experimental results demonstrate the superiority of the reward modeling method. Using Qwen2.5-7B-Instruct as the backbone, the trained model achieves the new state-of-the-art performance in literary translation, and outperforms strong LRMs including OpenAI-o1 and DeepSeeK-R1. Furthermore, we extend our method to the multilingual settings with 11 languages. With a carefully designed lightweight reward modeling in RL, we can simply transfer the strong MT ability from a single direction into multiple (i.e., 90) translation directions and achieve impressive multilingual MT performance.

We present ImageReward -- the first general-purpose text-to-image human preference reward model -- to address various prevalent issues in generative models and align them with human values and preferences. Its training is based on our systematic annotation pipeline that covers both the rating and ranking components, collecting a dataset of 137k expert comparisons to date. In human evaluation, ImageReward outperforms existing scoring methods (e.g., CLIP by 38.6\%), making it a promising automatic metric for evaluating and improving text-to-image synthesis. The reward model is publicly available via the image-reward package at https://github.com/THUDM/ImageReward.

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.

Reward engineering has long been a challenge in Reinforcement Learning (RL) research, as it often requires extensive human effort and iterative processes of trial-and-error to design effective reward functions. In this paper, we propose RL-VLM-F, a method that automatically generates reward functions for agents to learn new tasks, using only a text description of the task goal and the agent's visual observations, by leveraging feedbacks from vision language foundation models (VLMs). The key to our approach is to query these models to give preferences over pairs of the agent's image observations based on the text description of the task goal, and then learn a reward function from the preference labels, rather than directly prompting these models to output a raw reward score, which can be noisy and inconsistent. We demonstrate that RL-VLM-F successfully produces effective rewards and policies across various domains - including classic control, as well as manipulation of rigid, articulated, and deformable objects - without the need for human supervision, outperforming prior methods that use large pretrained models for reward generation under the same assumptions.

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.

Reward sparsity in long-horizon reinforcement learning (RL) tasks remains a significant challenge, while existing outcome-based reward shaping struggles to define meaningful immediate rewards without introducing bias or requiring explicit task decomposition. Alternatively, verification-based reward shaping uses stepwise critics, but misalignment between immediate rewards and long-term objectives can lead to reward hacking and suboptimal policies. In this work, we address this problem in the context of software engineering (SWE) tasks, where multi-turn reasoning and rule-based verification are critical. We introduce the SWE-oriented RL Framework, a unified system supporting multi-turn interaction, docker-based execution, and customizable reward functions. Additionally, we propose Gated Reward Accumulation (G-RA), a novel method that accumulates immediate rewards only when high-level (long-term) rewards meet a predefined threshold, ensuring stable RL optimization. Experiments on SWE-bench Verified and kBench demonstrate that G-RA leads to an increase in completion rates (47.6\% \rightarrow 93.8\% and 22.0\% \rightarrow 86.0\%) and modification rates (19.6\% \rightarrow 23.8\% and 12.0\% \rightarrow 42.0\%), while avoiding policy degradation caused by reward misalignment. Our findings highlight the importance of balanced reward accumulation in long-horizon RL and provide a practical solution.

Recent advancements highlight the importance of GRPO-based reinforcement learning methods and benchmarking in enhancing text-to-image (T2I) generation. However, current methods using pointwise reward models (RM) for scoring generated images are susceptible to reward hacking. We reveal that this happens when minimal score differences between images are amplified after normalization, creating illusory advantages that drive the model to over-optimize for trivial gains, ultimately destabilizing the image generation process. To address this, we propose Pref-GRPO, a pairwise preference reward-based GRPO method that shifts the optimization objective from score maximization to preference fitting, ensuring more stable training. In Pref-GRPO, images are pairwise compared within each group using preference RM, and the win rate is used as the reward signal. Extensive experiments demonstrate that PREF-GRPO differentiates subtle image quality differences, providing more stable advantages and mitigating reward hacking. Additionally, existing T2I benchmarks are limited by coarse evaluation criteria, hindering comprehensive model assessment. To solve this, we introduce UniGenBench, a unified T2I benchmark comprising 600 prompts across 5 main themes and 20 subthemes. It evaluates semantic consistency through 10 primary and 27 sub-criteria, leveraging MLLM for benchmark construction and evaluation. Our benchmarks uncover the strengths and weaknesses of both open and closed-source T2I models and validate the effectiveness of Pref-GRPO.

Text-to-SQL is a challenging task involving multiple reasoning-intensive subtasks, including natural language understanding, database schema comprehension, and precise SQL query formulation. Existing approaches often rely on handcrafted reasoning paths with inductive biases that can limit their overall effectiveness. Motivated by the recent success of reasoning-enhanced models such as DeepSeek R1 and OpenAI o1, which effectively leverage reward-driven self-exploration to enhance reasoning capabilities and generalization, we propose a novel set of partial rewards tailored specifically for the Text-to-SQL task. Our reward set includes schema-linking, AI feedback, n-gram similarity, and syntax check, explicitly designed to address the reward sparsity issue prevalent in reinforcement learning (RL). Leveraging group relative policy optimization (GRPO), our approach explicitly encourages large language models (LLMs) to develop intrinsic reasoning skills necessary for accurate SQL query generation. With models of different sizes, we demonstrate that RL-only training with our proposed rewards consistently achieves higher accuracy and superior generalization compared to supervised fine-tuning (SFT). Remarkably, our RL-trained 14B-parameter model significantly outperforms larger proprietary models, e.g. o3-mini by 4% and Gemini-1.5-Pro-002 by 3% on the BIRD benchmark. These highlight the efficacy of our proposed RL-training framework with partial rewards for enhancing both accuracy and reasoning capabilities in Text-to-SQL tasks.

Large vision-language models have recently achieved remarkable progress, exhibiting great perception and reasoning abilities concerning visual information. However, how to effectively evaluate these large vision-language models remains a major obstacle, hindering future model development. Traditional benchmarks like VQAv2 or COCO Caption provide quantitative performance measurements but suffer from a lack of fine-grained ability assessment and non-robust evaluation metrics. Recent subjective benchmarks, such as OwlEval, offer comprehensive evaluations of a model's abilities by incorporating human labor, but they are not scalable and display significant bias. In response to these challenges, we propose MMBench, a novel multi-modality benchmark. MMBench methodically develops a comprehensive evaluation pipeline, primarily comprised of two elements. The first element is a meticulously curated dataset that surpasses existing similar benchmarks in terms of the number and variety of evaluation questions and abilities. The second element introduces a novel CircularEval strategy and incorporates the use of ChatGPT. This implementation is designed to convert free-form predictions into pre-defined choices, thereby facilitating a more robust evaluation of the model's predictions. MMBench is a systematically-designed objective benchmark for robustly evaluating the various abilities of vision-language models. We hope MMBench will assist the research community in better evaluating their models and encourage future advancements in this domain. Project page: https://opencompass.org.cn/mmbench.

Generalist foundation models such as GPT-4 have displayed surprising capabilities in a wide variety of domains and tasks. Yet, there is a prevalent assumption that they cannot match specialist capabilities of fine-tuned models. For example, most explorations to date on medical competency benchmarks have leveraged domain-specific training, as exemplified by efforts on BioGPT and Med-PaLM. We build on a prior study of GPT-4's capabilities on medical challenge benchmarks in the absence of special training. Rather than using simple prompting to highlight the model's out-of-the-box capabilities, we perform a systematic exploration of prompt engineering. We find that prompting innovation can unlock deeper specialist capabilities and show that GPT-4 easily tops prior leading results for medical benchmarks. The prompting methods we explore are general purpose, and make no specific use of domain expertise, removing the need for expert-curated content. Our experimental design carefully controls for overfitting during the prompt engineering process. We introduce Medprompt, based on a composition of several prompting strategies. With Medprompt, GPT-4 achieves state-of-the-art results on all nine of the benchmark datasets in the MultiMedQA suite. The method outperforms leading specialist models such as Med-PaLM 2 by a significant margin with an order of magnitude fewer calls to the model. Steering GPT-4 with Medprompt achieves a 27% reduction in error rate on the MedQA dataset over the best methods to date achieved with specialist models and surpasses a score of 90% for the first time. Beyond medical problems, we show the power of Medprompt to generalize to other domains and provide evidence for the broad applicability of the approach via studies of the strategy on exams in electrical engineering, machine learning, philosophy, accounting, law, nursing, and clinical psychology.

Reward-model training is the cost bottleneck in modern Reinforcement Learning Human Feedback (RLHF) pipelines, often requiring tens of billions of parameters and an offline preference-tuning phase. In the proposed method, a frozen, instruction-tuned 7B LLM is augmented with only a one line JSON rubric and a rank-16 LoRA adapter (affecting just 0.8% of the model's parameters), enabling it to serve as a complete substitute for the previously used heavyweight evaluation models. The plug-and-play judge achieves 96.2% accuracy on RewardBench, outperforming specialized reward networks ranging from 27B to 70B parameters. Additionally, it allows a 7B actor to outperform the top 70B DPO baseline, which scores 61.8%, by achieving 92% exact match accuracy on GSM-8K utilizing online PPO. Thorough ablations indicate that (i) six in context demonstrations deliver the majority of the zero-to-few-shot improvements (+2pp), and (ii) the LoRA effectively addresses the remaining disparity, particularly in the safety and adversarial Chat-Hard segments. The proposed model introduces HH-Rationales, a subset of 10,000 pairs from Anthropic HH-RLHF, to examine interpretability, accompanied by human generated justifications. GPT-4 scoring indicates that our LoRA judge attains approximately = 9/10 in similarity to human explanations, while zero-shot judges score around =5/10. These results indicate that the combination of prompt engineering and tiny LoRA produces a cost effective, transparent, and easily adjustable reward function, removing the offline phase while achieving new state-of-the-art outcomes for both static evaluation and online RLHF.

Traditional drug design faces significant challenges due to inherent chemical and biological complexities, often resulting in high failure rates in clinical trials. Deep learning advancements, particularly generative models, offer potential solutions to these challenges. One promising algorithm is DrugGPT, a transformer-based model, that generates small molecules for input protein sequences. Although promising, it generates both chemically valid and invalid structures and does not incorporate the features of approved drugs, resulting in time-consuming and inefficient drug discovery. To address these issues, we introduce DrugGen, an enhanced model based on the DrugGPT structure. DrugGen is fine-tuned on approved drug-target interactions and optimized with proximal policy optimization. By giving reward feedback from protein-ligand binding affinity prediction using pre-trained transformers (PLAPT) and a customized invalid structure assessor, DrugGen significantly improves performance. Evaluation across multiple targets demonstrated that DrugGen achieves 100% valid structure generation compared to 95.5% with DrugGPT and produced molecules with higher predicted binding affinities (7.22 [6.30-8.07]) compared to DrugGPT (5.81 [4.97-6.63]) while maintaining diversity and novelty. Docking simulations further validate its ability to generate molecules targeting binding sites effectively. For example, in the case of fatty acid-binding protein 5 (FABP5), DrugGen generated molecules with superior docking scores (FABP5/11, -9.537 and FABP5/5, -8.399) compared to the reference molecule (Palmitic acid, -6.177). Beyond lead compound generation, DrugGen also shows potential for drug repositioning and creating novel pharmacophores for existing targets. By producing high-quality small molecules, DrugGen provides a high-performance medium for advancing pharmaceutical research and drug discovery.

The reward model has become increasingly important in alignment, assessment, and data construction for large language models (LLMs). Most existing researchers focus on enhancing reward models through data improvements, following the conventional training framework for reward models that directly optimizes the predicted rewards. In this paper, we propose a hybrid alignment framework HaF-RM for reward model training by introducing an additional constraint on token-level policy probabilities in addition to the reward score. It can simultaneously supervise the internal preference model at the token level and optimize the mapping layer of the reward model at the sequence level. Theoretical justifications and experiment results on five datasets show the validity and effectiveness of our proposed hybrid framework for training a high-quality reward model. By decoupling the reward modeling procedure and incorporating hybrid supervision, our HaF-RM framework offers a principled and effective approach to enhancing the performance and alignment of reward models, a critical component in the responsible development of powerful language models. We release our code at https://haf-rm.github.io.

Current Large Language Models (LLMs) often undergo supervised fine-tuning (SFT) to acquire tool use capabilities. However, SFT struggles to generalize to unfamiliar or complex tool use scenarios. Recent advancements in reinforcement learning (RL), particularly with R1-like models, have demonstrated promising reasoning and generalization abilities. Yet, reward design for tool use presents unique challenges: multiple tools may be invoked with diverse parameters, and coarse-grained reward signals, such as answer matching, fail to offer the finegrained feedback required for effective learning. In this work, we present the first comprehensive study on reward design for tool selection and application tasks within the RL paradigm. We systematically explore a wide range of reward strategies, analyzing their types, scales, granularity, and temporal dynamics. Building on these insights, we propose a principled reward design tailored for tool use tasks and apply it to train LLMs using Group Relative Policy Optimization (GRPO). Empirical evaluations across diverse benchmarks demonstrate that our approach yields robust, scalable, and stable training, achieving a 17% improvement over base models and a 15% gain over SFT models. These results highlight the critical role of thoughtful reward design in enhancing the tool use capabilities and generalization performance of LLMs. All the codes are released to facilitate future research.

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

Several studies showed that Large Language Models (LLMs) can answer medical questions correctly, even outperforming the average human score in some medical exams. However, to our knowledge, no study has been conducted to assess the ability of language models to validate existing or generated medical text for correctness and consistency. In this paper, we introduce MEDEC (https://github.com/abachaa/MEDEC), the first publicly available benchmark for medical error detection and correction in clinical notes, covering five types of errors (Diagnosis, Management, Treatment, Pharmacotherapy, and Causal Organism). MEDEC consists of 3,848 clinical texts, including 488 clinical notes from three US hospital systems that were not previously seen by any LLM. The dataset has been used for the MEDIQA-CORR shared task to evaluate seventeen participating systems [Ben Abacha et al., 2024]. In this paper, we describe the data creation methods and we evaluate recent LLMs (e.g., o1-preview, GPT-4, Claude 3.5 Sonnet, and Gemini 2.0 Flash) for the tasks of detecting and correcting medical errors requiring both medical knowledge and reasoning capabilities. We also conducted a comparative study where two medical doctors performed the same task on the MEDEC test set. The results showed that MEDEC is a sufficiently challenging benchmark to assess the ability of models to validate existing or generated notes and to correct medical errors. We also found that although recent LLMs have a good performance in error detection and correction, they are still outperformed by medical doctors in these tasks. We discuss the potential factors behind this gap, the insights from our experiments, the limitations of current evaluation metrics, and share potential pointers for future research.

Reward models (RMs) are essential for aligning Large Language Models (LLMs) with human preferences. However, they often struggle with capturing complex human preferences and generalizing to unseen data. To address these challenges, we introduce Energy-Based Reward Model (EBRM), a lightweight post-hoc refinement framework that enhances RM robustness and generalization. EBRM models the reward distribution explicitly, capturing uncertainty in human preferences and mitigating the impact of noisy or misaligned annotations. It achieves this through conflict-aware data filtering, label-noise-aware contrastive training, and hybrid initialization. Notably, EBRM enhances RMs without retraining, making it computationally efficient and adaptable across different models and tasks. Empirical evaluations on RM benchmarks demonstrate significant improvements in both robustness and generalization, achieving up to a 5.97% improvement in safety-critical alignment tasks compared to standard RMs. Furthermore, reinforcement learning experiments confirm that our refined rewards enhance alignment quality, effectively delaying reward hacking. These results demonstrate our approach as a scalable and effective enhancement for existing RMs and alignment pipelines. The code is available at EBRM.

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.

Chest X-rays (CXRs) play an integral role in driving critical decisions in disease management and patient care. While recent innovations have led to specialized models for various CXR interpretation tasks, these solutions often operate in isolation, limiting their practical utility in clinical practice. We present MedRAX, the first versatile AI agent that seamlessly integrates state-of-the-art CXR analysis tools and multimodal large language models into a unified framework. MedRAX dynamically leverages these models to address complex medical queries without requiring additional training. To rigorously evaluate its capabilities, we introduce ChestAgentBench, a comprehensive benchmark containing 2,500 complex medical queries across 7 diverse categories. Our experiments demonstrate that MedRAX achieves state-of-the-art performance compared to both open-source and proprietary models, representing a significant step toward the practical deployment of automated CXR interpretation systems. Data and code have been publicly available at https://github.com/bowang-lab/MedRAX

Evaluating creative writing generated by large language models (LLMs) remains challenging because open-ended narratives lack ground truths. Without performant automated evaluation methods, off-the-shelf (OTS) language models are employed as zero-shot judges, yet their reliability is unclear in this context. In pursuit of robust evaluation for creative writing, we introduce LitBench, the first standardized benchmark and paired dataset for creative writing verification, comprising a held-out test set of 2,480 debiased, human-labeled story comparisons drawn from Reddit and a 43,827-pair training corpus of human preference labels. Using LitBench, we (i) benchmark zero-shot LLM judges, (ii) train Bradley Terry and generative reward models, and (iii) conduct an online human study to validate reward model rankings on newly LLM-generated stories. Our benchmark identifies Claude-3.7-Sonnet as the strongest off-the-shelf judge, reaching 73% agreement with human preferences; among trained reward models, Bradley-Terry and Generative reward models both attain an accuracy of 78%, outperforming all off-the-shelf judges. An online human study further confirms that our trained reward models consistently align with human preferences in novel LLM-generated stories. We release LitBench and reward models at https://huggingface.co/collections/SAA-Lab/litbench-68267b5da3aafe58f9e43461, providing a vetted resource for reliable, automated evaluation and optimization of creative writing systems.

Precision therapeutics require multimodal adaptive models that generate personalized treatment recommendations. We introduce TxAgent, an AI agent that leverages multi-step reasoning and real-time biomedical knowledge retrieval across a toolbox of 211 tools to analyze drug interactions, contraindications, and patient-specific treatment strategies. TxAgent evaluates how drugs interact at molecular, pharmacokinetic, and clinical levels, identifies contraindications based on patient comorbidities and concurrent medications, and tailors treatment strategies to individual patient characteristics. It retrieves and synthesizes evidence from multiple biomedical sources, assesses interactions between drugs and patient conditions, and refines treatment recommendations through iterative reasoning. It selects tools based on task objectives and executes structured function calls to solve therapeutic tasks that require clinical reasoning and cross-source validation. The ToolUniverse consolidates 211 tools from trusted sources, including all US FDA-approved drugs since 1939 and validated clinical insights from Open Targets. TxAgent outperforms leading LLMs, tool-use models, and reasoning agents across five new benchmarks: DrugPC, BrandPC, GenericPC, TreatmentPC, and DescriptionPC, covering 3,168 drug reasoning tasks and 456 personalized treatment scenarios. It achieves 92.1% accuracy in open-ended drug reasoning tasks, surpassing GPT-4o and outperforming DeepSeek-R1 (671B) in structured multi-step reasoning. TxAgent generalizes across drug name variants and descriptions. By integrating multi-step inference, real-time knowledge grounding, and tool-assisted decision-making, TxAgent ensures that treatment recommendations align with established clinical guidelines and real-world evidence, reducing the risk of adverse events and improving therapeutic decision-making.

Despite recent advances in AI, the development of systems capable of executing complex, multi-step reasoning tasks involving multiple tools remains a significant challenge. Current benchmarks fall short in capturing the real-world complexity of tool-use reasoning, where verifying the correctness of not only the final answer but also the intermediate steps is important for evaluation, development, and identifying failures during inference time. To bridge this gap, we introduce ToolComp, a comprehensive benchmark designed to evaluate multi-step tool-use reasoning. ToolComp is developed through a collaboration between models and human annotators, featuring human-edited/verified prompts, final answers, and process supervision labels, allowing for the evaluation of both final outcomes and intermediate reasoning. Evaluation across six different model families demonstrates the challenging nature of our dataset, with the majority of models achieving less than 50% accuracy. Additionally, we generate synthetic training data to compare the performance of outcome-supervised reward models (ORMs) with process-supervised reward models (PRMs) to assess their ability to improve complex tool-use reasoning as evaluated by ToolComp. Our results show that PRMs generalize significantly better than ORMs, achieving a 19% and 11% improvement in rank@1 accuracy for ranking base and fine-tuned model trajectories, respectively. These findings highlight the critical role of process supervision in both the evaluation and training of AI models, paving the way for more robust and capable systems in complex, multi-step tool-use tasks.

High-quality preference datasets are essential for training reward models that can effectively guide large language models (LLMs) in generating high-quality responses aligned with human preferences. As LLMs become stronger and better aligned, permissively licensed preference datasets, such as Open Assistant, HH-RLHF, and HelpSteer need to be updated to remain effective for reward modeling. Methods that distil preference data from proprietary LLMs such as GPT-4 have restrictions on commercial usage imposed by model providers. To improve upon both generated responses and attribute labeling quality, we release HelpSteer2, a permissively licensed preference dataset (CC-BY-4.0). Using a powerful internal base model trained on HelpSteer2, we are able to achieve the SOTA score (92.0%) on Reward-Bench's primary dataset, outperforming currently listed open and proprietary models, as of June 12th, 2024. Notably, HelpSteer2 consists of only ten thousand response pairs, an order of magnitude fewer than existing preference datasets (e.g., HH-RLHF), which makes it highly efficient for training reward models. Our extensive experiments demonstrate that reward models trained with HelpSteer2 are effective in aligning LLMs. In particular, we propose SteerLM 2.0, a model alignment approach that can effectively make use of the rich multi-attribute score predicted by our reward models. HelpSteer2 is available at https://huggingface.co/datasets/nvidia/HelpSteer2 and code is available at https://github.com/NVIDIA/NeMo-Aligner

We offer a novel perspective on reward modeling by formulating it as a policy discriminator, which quantifies the difference between two policies to generate a reward signal, guiding the training policy towards a target policy with desired behaviors. Based on this conceptual insight, we propose a scalable pre-training method named Policy Discriminative Learning (POLAR), which trains a reward model (RM) to discern identical policies and discriminate different ones. Unlike traditional reward modeling methods relying on absolute preferences, POLAR captures the relative difference between one policy and an arbitrary target policy, which is a scalable, high-level optimization objective suitable for modeling generic ranking relationships. Leveraging the POLAR pre-training paradigm, we present a series of RMs with parameter scales from 1.8B to 7B. Empirical results show that POLAR substantially outperforms traditional non-pre-trained methods, significantly enhancing RM performance. For instance, POLAR-7B could improve preference accuracy from 54.8% to 81.0% on STEM tasks and from 57.9% to 85.5% on creative writing tasks compared to SOTA baselines. POLAR also shows robust generalization capabilities in RLHF using Reinforcement Fine-tuning (RFT), providing reliable reward signals and markedly enhancing policy performance--improving LLaMa3.1-8B from an average of 47.36% to 56.33% and Qwen2.5-32B from 64.49% to 70.47% on 20 benchmarks. Moreover, scaling experiments reveal a clear power-law relationship between computation and performance, supported by linear correlation coefficients approaching 0.99. The impressive performance, strong generalization, and scaling properties suggest that POLAR is a promising direction for developing general and strong reward models.

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

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

Best-of-N (BoN) sampling, a common strategy for test-time scaling of Large Language Models (LLMs), relies on reward models to select the best candidate solution from multiple generations. However, traditional reward models often assign arbitrary and inconsistent scores, limiting their effectiveness. To address this, we propose a Pairwise Reward Model (Pairwise RM) combined with a knockout tournament for BoN sampling. Instead of assigning absolute scores, given one math problem, Pairwise RM evaluates two candidate solutions' correctness simultaneously. This approach eliminates the need for arbitrary scoring and enables cross-validation of solutions through parallel comparison. In the knockout tournament, Pairwise RM conducts pairwise comparisons between candidate solutions and eliminates the incorrect ones iteratively. We construct \ourdataset, a large-scale dataset of 443K pairwise comparisons derived from NumiaMath and annotated using gemini-1.5-flash, and train the Pairwise RM via supervised fine-tuning. Experiments on MATH-500 and the Olympiad Bench demonstrate significant improvements over traditional discriminative reward models. And a 40\% to 60\% relative improvement is achieved on the top 50\% challenging problems.

Reinforcement Learning from Human Feedback (RLHF) is crucial for aligning large language models with human preferences. While recent research has focused on algorithmic improvements, the importance of prompt-data construction has been overlooked. This paper addresses this gap by exploring data-driven bottlenecks in RLHF performance scaling, particularly reward hacking and decreasing response diversity. We introduce a hybrid reward system combining reasoning task verifiers (RTV) and a generative reward model (GenRM) to mitigate reward hacking. We also propose a novel prompt-selection method, Pre-PPO, to maintain response diversity and enhance learning effectiveness. Additionally, we find that prioritizing mathematical and coding tasks early in RLHF training significantly improves performance. Experiments across two model sizes validate our methods' effectiveness and scalability. Results show that RTV is most resistant to reward hacking, followed by GenRM with ground truth, and then GenRM with SFT Best-of-N responses. Our strategies enable rapid capture of subtle task-specific distinctions, leading to substantial improvements in overall RLHF performance. This work highlights the importance of careful data construction and provides practical methods to overcome performance barriers in RLHF.

Recent artificial intelligence (AI) systems have reached milestones in "grand challenges" ranging from Go to protein-folding. The capability to retrieve medical knowledge, reason over it, and answer medical questions comparably to physicians has long been viewed as one such grand challenge. Large language models (LLMs) have catalyzed significant progress in medical question answering; Med-PaLM was the first model to exceed a "passing" score in US Medical Licensing Examination (USMLE) style questions with a score of 67.2% on the MedQA dataset. However, this and other prior work suggested significant room for improvement, especially when models' answers were compared to clinicians' answers. Here we present Med-PaLM 2, which bridges these gaps by leveraging a combination of base LLM improvements (PaLM 2), medical domain finetuning, and prompting strategies including a novel ensemble refinement approach. Med-PaLM 2 scored up to 86.5% on the MedQA dataset, improving upon Med-PaLM by over 19% and setting a new state-of-the-art. We also observed performance approaching or exceeding state-of-the-art across MedMCQA, PubMedQA, and MMLU clinical topics datasets. We performed detailed human evaluations on long-form questions along multiple axes relevant to clinical applications. In pairwise comparative ranking of 1066 consumer medical questions, physicians preferred Med-PaLM 2 answers to those produced by physicians on eight of nine axes pertaining to clinical utility (p < 0.001). We also observed significant improvements compared to Med-PaLM on every evaluation axis (p < 0.001) on newly introduced datasets of 240 long-form "adversarial" questions to probe LLM limitations. While further studies are necessary to validate the efficacy of these models in real-world settings, these results highlight rapid progress towards physician-level performance in medical question answering.

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.

This paper introduces BiMediX2, a bilingual (Arabic-English) Bio-Medical EXpert Large Multimodal Model (LMM) with a unified architecture that integrates text and visual modalities, enabling advanced image understanding and medical applications. BiMediX2 leverages the Llama3.1 architecture and integrates text and visual capabilities to facilitate seamless interactions in both English and Arabic, supporting text-based inputs and multi-turn conversations involving medical images. The model is trained on an extensive bilingual healthcare dataset consisting of 1.6M samples of diverse medical interactions for both text and image modalities, mixed in Arabic and English. We also propose the first bilingual GPT-4o based medical LMM benchmark named BiMed-MBench. BiMediX2 is benchmarked on both text-based and image-based tasks, achieving state-of-the-art performance across several medical benchmarks. It outperforms recent state-of-the-art models in medical LLM evaluation benchmarks. Our model also sets a new benchmark in multimodal medical evaluations with over 9% improvement in English and over 20% in Arabic evaluations. Additionally, it surpasses GPT-4 by around 9% in UPHILL factual accuracy evaluations and excels in various medical Visual Question Answering, Report Generation, and Report Summarization tasks. The project page including source code and the trained model, is available at https://github.com/mbzuai-oryx/BiMediX2.

Recent advances in large language models (LLMs) have demonstrated notable performance in medical licensing exams. However, comprehensive evaluation of LLMs across various healthcare roles, particularly in high-stakes clinical scenarios, remains a challenge. Existing benchmarks are typically text-based, English-centric, and focus primarily on medicines, which limits their ability to assess broader healthcare knowledge and multimodal reasoning. To address these gaps, we introduce KokushiMD-10, the first multimodal benchmark constructed from ten Japanese national healthcare licensing exams. This benchmark spans multiple fields, including Medicine, Dentistry, Nursing, Pharmacy, and allied health professions. It contains over 11588 real exam questions, incorporating clinical images and expert-annotated rationales to evaluate both textual and visual reasoning. We benchmark over 30 state-of-the-art LLMs, including GPT-4o, Claude 3.5, and Gemini, across both text and image-based settings. Despite promising results, no model consistently meets passing thresholds across domains, highlighting the ongoing challenges in medical AI. KokushiMD-10 provides a comprehensive and linguistically grounded resource for evaluating and advancing reasoning-centric medical AI across multilingual and multimodal clinical tasks.

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.

We introduce MedXpertQA, a highly challenging and comprehensive benchmark to evaluate expert-level medical knowledge and advanced reasoning. MedXpertQA includes 4,460 questions spanning 17 specialties and 11 body systems. It includes two subsets, Text for text evaluation and MM for multimodal evaluation. Notably, MM introduces expert-level exam questions with diverse images and rich clinical information, including patient records and examination results, setting it apart from traditional medical multimodal benchmarks with simple QA pairs generated from image captions. MedXpertQA applies rigorous filtering and augmentation to address the insufficient difficulty of existing benchmarks like MedQA, and incorporates specialty board questions to improve clinical relevance and comprehensiveness. We perform data synthesis to mitigate data leakage risk and conduct multiple rounds of expert reviews to ensure accuracy and reliability. We evaluate 16 leading models on MedXpertQA. Moreover, medicine is deeply connected to real-world decision-making, providing a rich and representative setting for assessing reasoning abilities beyond mathematics and code. To this end, we develop a reasoning-oriented subset to facilitate the assessment of o1-like models.

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.

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.

We introduce Agent Process Reward Models (AgentPRM), a simple and scalable framework for training LLM agents to continually improve through interactions. AgentPRM follows a lightweight actor-critic paradigm, using Monte Carlo rollouts to compute reward targets and optimize policies. It requires minimal modifications to existing RLHF pipelines, making it easy to integrate at scale. Beyond AgentPRM, we propose InversePRM, which learns process rewards directly from demonstrations without explicit outcome supervision. We also explore key challenges and opportunities, including exploration, process reward shaping, and model-predictive reasoning. We evaluate on ALFWorld benchmark, show that small 3B models trained with AgentPRM and InversePRM outperform strong GPT-4o baselines, and analyze test-time scaling, reward hacking, and more. Our code is available at: https://github.com/sanjibanc/agent_prm.

A central aspect of machine learning research is experimentation, the process of designing and running experiments, analyzing the results, and iterating towards some positive outcome (e.g., improving accuracy). Could agents driven by powerful language models perform machine learning experimentation effectively? To answer this question, we introduce MLAgentBench, a suite of 13 tasks ranging from improving model performance on CIFAR-10 to recent research problems like BabyLM. For each task, an agent can perform actions like reading/writing files, executing code, and inspecting outputs. We then construct an agent that can perform ML experimentation based on ReAct framework. We benchmark agents based on Claude v1.0, Claude v2.1, Claude v3 Opus, GPT-4, GPT-4-turbo, Gemini-Pro, and Mixtral and find that a Claude v3 Opus agent is the best in terms of success rate. It can build compelling ML models over many tasks in MLAgentBench with 37.5% average success rate. Our agents also display highly interpretable plans and actions. However, the success rates vary considerably; they span from 100% on well-established older datasets to as low as 0% on recent Kaggle challenges created potentially after the underlying LM was trained. Finally, we identify several key challenges for LM-based agents such as long-term planning and reducing hallucination. Our code is released at https://github.com/snap-stanford/MLAgentBench.

Reward models (RMs) guide the alignment of large language models (LLMs), steering them toward behaviors preferred by humans. Evaluating RMs is the key to better aligning LLMs. However, the current evaluation of RMs may not directly correspond to their alignment performance due to the limited distribution of evaluation data and evaluation methods that are not closely related to alignment objectives. To address these limitations, we propose RMB, a comprehensive RM benchmark that covers over 49 real-world scenarios and includes both pairwise and Best-of-N (BoN) evaluations to better reflect the effectiveness of RMs in guiding alignment optimization. We demonstrate a positive correlation between our benchmark and the downstream alignment task performance. Based on our benchmark, we conduct extensive analysis on the state-of-the-art RMs, revealing their generalization defects that were not discovered by previous benchmarks, and highlighting the potential of generative RMs. Furthermore, we delve into open questions in reward models, specifically examining the effectiveness of majority voting for the evaluation of reward models and analyzing the impact factors of generative RMs, including the influence of evaluation criteria and instructing methods. Our evaluation code and datasets are available at https://github.com/Zhou-Zoey/RMB-Reward-Model-Benchmark.

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.

The accelerating development of general medical artificial intelligence (GMAI), powered by multimodal large language models (MLLMs), offers transformative potential for addressing persistent healthcare challenges, including workforce deficits and escalating costs. The parallel development of systematic evaluation benchmarks emerges as a critical imperative to enable performance assessment and provide technological guidance. Meanwhile, as an invaluable knowledge source, the potential of medical textbooks for benchmark development remains underexploited. Here, we present MedBookVQA, a systematic and comprehensive multimodal benchmark derived from open-access medical textbooks. To curate this benchmark, we propose a standardized pipeline for automated extraction of medical figures while contextually aligning them with corresponding medical narratives. Based on this curated data, we generate 5,000 clinically relevant questions spanning modality recognition, disease classification, anatomical identification, symptom diagnosis, and surgical procedures. A multi-tier annotation system categorizes queries through hierarchical taxonomies encompassing medical imaging modalities (42 categories), body anatomies (125 structures), and clinical specialties (31 departments), enabling nuanced analysis across medical subdomains. We evaluate a wide array of MLLMs, including proprietary, open-sourced, medical, and reasoning models, revealing significant performance disparities across task types and model categories. Our findings highlight critical capability gaps in current GMAI systems while establishing textbook-derived multimodal benchmarks as essential evaluation tools. MedBookVQA establishes textbook-derived benchmarking as a critical paradigm for advancing clinical AI, exposing limitations in GMAI systems while providing anatomically structured performance metrics across specialties.

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.

We investigate reinforcement learning (RL) for privileged planning in autonomous driving. State-of-the-art approaches for this task are rule-based, but these methods do not scale to the long tail. RL, on the other hand, is scalable and does not suffer from compounding errors like imitation learning. Contemporary RL approaches for driving use complex shaped rewards that sum multiple individual rewards, \eg~progress, position, or orientation rewards. We show that PPO fails to optimize a popular version of these rewards when the mini-batch size is increased, which limits the scalability of these approaches. Instead, we propose a new reward design based primarily on optimizing a single intuitive reward term: route completion. Infractions are penalized by terminating the episode or multiplicatively reducing route completion. We find that PPO scales well with higher mini-batch sizes when trained with our simple reward, even improving performance. Training with large mini-batch sizes enables efficient scaling via distributed data parallelism. We scale PPO to 300M samples in CARLA and 500M samples in nuPlan with a single 8-GPU node. The resulting model achieves 64 DS on the CARLA longest6 v2 benchmark, outperforming other RL methods with more complex rewards by a large margin. Requiring only minimal adaptations from its use in CARLA, the same method is the best learning-based approach on nuPlan. It scores 91.3 in non-reactive and 90.6 in reactive traffic on the Val14 benchmark while being an order of magnitude faster than prior work.

Online Mental Health Communities (OMHCs) provide crucial peer and expert support, yet many posts remain unanswered due to missing support attributes that signal the need for help. We present a novel framework that identifies these gaps and prompts users to enrich their posts, thereby improving engagement. To support this, we introduce REDDME, a new dataset of 4,760 posts from mental health subreddits annotated for the span and intensity of three key support attributes: event what happened?, effect what did the user experience?, and requirement what support they need?. Next, we devise a hierarchical taxonomy, CueTaxo, of support attributes for controlled question generation. Further, we propose MH-COPILOT, a reinforcement learning-based system that integrates (a) contextual attribute-span identification, (b) support attribute intensity classification, (c) controlled question generation via a hierarchical taxonomy, and (d) a verifier for reward modeling. Our model dynamically assesses posts for the presence/absence of support attributes, and generates targeted prompts to elicit missing information. Empirical results across four notable language models demonstrate significant improvements in attribute elicitation and user engagement. A human evaluation further validates the model's effectiveness in real-world OMHC settings.

Reward models (RM) capture the values and preferences of humans and play a central role in Reinforcement Learning with Human Feedback (RLHF) to align pretrained large language models (LLMs). Traditionally, training these models relies on extensive human-annotated preference data, which poses significant challenges in terms of scalability and cost. To overcome these limitations, we propose Semi-Supervised Reward Modeling (SSRM), an approach that enhances RM training using unlabeled data. Given an unlabeled dataset, SSRM involves three key iterative steps: pseudo-labeling unlabeled examples, selecting high-confidence examples through a confidence threshold, and supervised finetuning on the refined dataset. Across extensive experiments on various model configurations, we demonstrate that SSRM significantly improves reward models without incurring additional labeling costs. Notably, SSRM can achieve performance comparable to models trained entirely on labeled data of equivalent volumes. Overall, SSRM substantially reduces the dependency on large volumes of human-annotated data, thereby decreasing the overall cost and time involved in training effective reward models.

We introduce xbench, a dynamic, profession-aligned evaluation suite designed to bridge the gap between AI agent capabilities and real-world productivity. While existing benchmarks often focus on isolated technical skills, they may not accurately reflect the economic value agents deliver in professional settings. To address this, xbench targets commercially significant domains with evaluation tasks defined by industry professionals. Our framework creates metrics that strongly correlate with productivity value, enables prediction of Technology-Market Fit (TMF), and facilitates tracking of product capabilities over time. As our initial implementations, we present two benchmarks: Recruitment and Marketing. For Recruitment, we collect 50 tasks from real-world headhunting business scenarios to evaluate agents' abilities in company mapping, information retrieval, and talent sourcing. For Marketing, we assess agents' ability to match influencers with advertiser needs, evaluating their performance across 50 advertiser requirements using a curated pool of 836 candidate influencers. We present initial evaluation results for leading contemporary agents, establishing a baseline for these professional domains. Our continuously updated evalsets and evaluations are available at https://xbench.org.

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/.

The rapid evolution of Large Language Models (LLMs) offers promising potential to alleviate the global scarcity of mental health professionals. However, LLMs' alignment with essential mental health counseling competencies remains understudied. We introduce CounselingBench, a novel NCMHCE-based benchmark evaluating LLMs across five key mental health counseling competencies. Testing 22 general-purpose and medical-finetuned LLMs, we find frontier models exceed minimum thresholds but fall short of expert-level performance, with significant variations: they excel in Intake, Assessment & Diagnosis yet struggle with Core Counseling Attributes and Professional Practice & Ethics. Medical LLMs surprisingly underperform generalist models accuracy-wise, while at the same time producing slightly higher-quality justifications but making more context-related errors. Our findings highlight the complexities of developing AI systems for mental health counseling, particularly for competencies requiring empathy and contextual understanding. We found that frontier LLMs perform at a level exceeding the minimal required level of aptitude for all key mental health counseling competencies, but fall short of expert-level performance, and that current medical LLMs do not significantly improve upon generalist models in mental health counseling competencies. This underscores the critical need for specialized, mental health counseling-specific fine-tuned LLMs that rigorously aligns with core competencies combined with appropriate human supervision before any responsible real-world deployment can be considered.

Reward models (RMs) are crucial for the training and inference-time scaling up of large language models (LLMs). However, existing reward models primarily focus on human preferences, neglecting verifiable correctness signals which have shown strong potential in training LLMs. In this paper, we propose agentic reward modeling, a reward system that combines reward models with verifiable correctness signals from different aspects to provide reliable rewards. We empirically implement a reward agent, named RewardAgent, that combines human preference rewards with two verifiable signals: factuality and instruction following, to provide more reliable rewards. We conduct comprehensive experiments on existing reward model benchmarks and inference time best-of-n searches on real-world downstream tasks. RewardAgent significantly outperforms vanilla reward models, demonstrating its effectiveness. We further construct training preference pairs using RewardAgent and train an LLM with the DPO objective, achieving superior performance on various NLP benchmarks compared to conventional reward models. Our codes are publicly released to facilitate further research (https://github.com/THU-KEG/Agentic-Reward-Modeling).

With the advent of Vision-Language Models (VLMs), medical artificial intelligence (AI) has experienced significant technological progress and paradigm shifts. This survey provides an extensive review of recent advancements in Medical Vision-Language Models (Med-VLMs), which integrate visual and textual data to enhance healthcare outcomes. We discuss the foundational technology behind Med-VLMs, illustrating how general models are adapted for complex medical tasks, and examine their applications in healthcare. The transformative impact of Med-VLMs on clinical practice, education, and patient care is highlighted, alongside challenges such as data scarcity, narrow task generalization, interpretability issues, and ethical concerns like fairness, accountability, and privacy. These limitations are exacerbated by uneven dataset distribution, computational demands, and regulatory hurdles. Rigorous evaluation methods and robust regulatory frameworks are essential for safe integration into healthcare workflows. Future directions include leveraging large-scale, diverse datasets, improving cross-modal generalization, and enhancing interpretability. Innovations like federated learning, lightweight architectures, and Electronic Health Record (EHR) integration are explored as pathways to democratize access and improve clinical relevance. This review aims to provide a comprehensive understanding of Med-VLMs' strengths and limitations, fostering their ethical and balanced adoption in healthcare.

In this paper, we introduce BiMediX, the first bilingual medical mixture of experts LLM designed for seamless interaction in both English and Arabic. Our model facilitates a wide range of medical interactions in English and Arabic, including multi-turn chats to inquire about additional details such as patient symptoms and medical history, multiple-choice question answering, and open-ended question answering. We propose a semi-automated English-to-Arabic translation pipeline with human refinement to ensure high-quality translations. We also introduce a comprehensive evaluation benchmark for Arabic medical LLMs. Furthermore, we introduce BiMed1.3M, an extensive Arabic-English bilingual instruction set covering 1.3 Million diverse medical interactions, resulting in over 632 million healthcare specialized tokens for instruction tuning. Our BiMed1.3M dataset includes 250k synthesized multi-turn doctor-patient chats and maintains a 1:2 Arabic-to-English ratio. Our model outperforms state-of-the-art Med42 and Meditron by average absolute gains of 2.5% and 4.1%, respectively, computed across multiple medical evaluation benchmarks in English, while operating at 8-times faster inference. Moreover, our BiMediX outperforms the generic Arabic-English bilingual LLM, Jais-30B, by average absolute gains of 10% on our Arabic medical benchmark and 15% on bilingual evaluations across multiple datasets. Our project page with source code and trained model is available at https://github.com/mbzuai-oryx/BiMediX .

Predicting multiple heterogeneous biological and medical targets is a challenge for traditional deep learning models. In contrast to single-task learning, in which a separate model is trained for each target, multi-task learning (MTL) optimizes a single model to predict multiple related targets simultaneously. To address this challenge, we propose the Multi-gate Mixture-of-Experts with Exclusivity (MMoEEx). Our work aims to tackle the heterogeneous MTL setting, in which the same model optimizes multiple tasks with different characteristics. Such a scenario can overwhelm current MTL approaches due to the challenges in balancing shared and task-specific representations and the need to optimize tasks with competing optimization paths. Our method makes two key contributions: first, we introduce an approach to induce more diversity among experts, thus creating representations more suitable for highly imbalanced and heterogenous MTL learning; second, we adopt a two-step optimization [6, 11] approach to balancing the tasks at the gradient level. We validate our method on three MTL benchmark datasets, including Medical Information Mart for Intensive Care (MIMIC-III) and PubChem BioAssay (PCBA).

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.

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/.

Retrieval-augmented generation (RAG) enhances Large Language Models (LLMs) with relevant and up-to-date knowledge, improving their ability to answer knowledge-intensive questions. It has been shown to enhance both generation quality and trustworthiness. While numerous works have focused on improving retrieval, generation, and evaluation, the role of reward models in reinforcement learning for optimizing RAG and establishing automated benchmarking pipelines remains underexplored. In this paper, we introduce RAG-Reward, a dataset designed to enable hallucination-free, comprehensive, reliable, and efficient RAG. We define four key metrics for assessing generation quality and develop an automated annotation pipeline that leverages multiple LLMs to generate outputs across diverse RAG scenarios. GPT-4o is used to evaluate and construct preference data. Using RAG-Reward, we train reward models and apply reinforcement learning with human feedback (RLHF) to improve LLMs' effectiveness in RAG. Experimental results show that our reward model achieves state-of-the-art performance on a held-out test set, demonstrating both the effectiveness of our approach and the quality of our dataset. Furthermore, the improved generation quality of the trained policy model highlights the feasibility of using RLHF to enhance RAG pipelines.

LLMs have become increasingly capable at accomplishing a range of specialized-tasks and can be utilized to expand equitable access to medical knowledge. Most medical LLMs have involved extensive fine-tuning, leveraging specialized medical data and significant, thus costly, amounts of computational power. Many of the top performing LLMs are proprietary and their access is limited to very few research groups. However, open-source (OS) models represent a key area of growth for medical LLMs due to significant improvements in performance and an inherent ability to provide the transparency and compliance required in healthcare. We present OpenMedLM, a prompting platform which delivers state-of-the-art (SOTA) performance for OS LLMs on medical benchmarks. We evaluated a range of OS foundation LLMs (7B-70B) on four medical benchmarks (MedQA, MedMCQA, PubMedQA, MMLU medical-subset). We employed a series of prompting strategies, including zero-shot, few-shot, chain-of-thought (random selection and kNN selection), and ensemble/self-consistency voting. We found that OpenMedLM delivers OS SOTA results on three common medical LLM benchmarks, surpassing the previous best performing OS models that leveraged computationally costly extensive fine-tuning. The model delivers a 72.6% accuracy on the MedQA benchmark, outperforming the previous SOTA by 2.4%, and achieves 81.7% accuracy on the MMLU medical-subset, establishing itself as the first OS LLM to surpass 80% accuracy on this benchmark. Our results highlight medical-specific emergent properties in OS LLMs which have not yet been documented to date elsewhere, and showcase the benefits of further leveraging prompt engineering to improve the performance of accessible LLMs for medical applications.

Recent works on large language models (LLMs) have successfully demonstrated the emergence of reasoning capabilities via reinforcement learning (RL). Although recent efforts leverage group relative policy optimization (GRPO) for MLLMs post-training, they constantly explore one specific aspect, such as grounding tasks, math problems, or chart analysis. There are no works that can leverage multi-source MLLM tasks for stable reinforcement learning. In this work, we present a unified perspective to solve this problem. We present Mixed-R1, a unified yet straightforward framework that contains a mixed reward function design (Mixed-Reward) and a mixed post-training dataset (Mixed-45K). We first design a data engine to select high-quality examples to build the Mixed-45K post-training dataset. Then, we present a Mixed-Reward design, which contains various reward functions for various MLLM tasks. In particular, it has four different reward functions: matching reward for binary answer or multiple-choice problems, chart reward for chart-aware datasets, IoU reward for grounding problems, and open-ended reward for long-form text responses such as caption datasets. To handle the various long-form text content, we propose a new open-ended reward named Bidirectional Max-Average Similarity (BMAS) by leveraging tokenizer embedding matching between the generated response and the ground truth. Extensive experiments show the effectiveness of our proposed method on various MLLMs, including Qwen2.5-VL and Intern-VL on various sizes. Our dataset and model are available at https://github.com/xushilin1/mixed-r1.

Medical tasks such as diagnosis and treatment planning require precise and complex reasoning, particularly in life-critical domains. Unlike mathematical reasoning, medical reasoning demands meticulous, verifiable thought processes to ensure reliability and accuracy. However, there is a notable lack of datasets that provide transparent, step-by-step reasoning to validate and enhance the medical reasoning ability of AI models. To bridge this gap, we introduce MedReason, a large-scale high-quality medical reasoning dataset designed to enable faithful and explainable medical problem-solving in large language models (LLMs). We utilize a structured medical knowledge graph (KG) to convert clinical QA pairs into logical chains of reasoning, or ``thinking paths'', which trace connections from question elements to answers via relevant KG entities. Each path is validated for consistency with clinical logic and evidence-based medicine. Our pipeline generates detailed reasoning for various medical questions from 7 medical datasets, resulting in a dataset of 32,682 question-answer pairs, each with detailed, step-by-step explanations. Experiments demonstrate that fine-tuning with our dataset consistently boosts medical problem-solving capabilities, achieving significant gains of up to 7.7% for DeepSeek-Ditill-8B. Our top-performing model, MedReason-8B, outperforms the Huatuo-o1-8B, a state-of-the-art medical reasoning model, by up to 4.2% on the clinical benchmark MedBullets. We also engage medical professionals from diverse specialties to assess our dataset's quality, ensuring MedReason offers accurate and coherent medical reasoning. Our data, models, and code will be publicly available.

Artificial intelligence (AI) has significant potential in healthcare applications, but its training and deployment faces challenges due to healthcare's diverse data, complex tasks, and the need to preserve privacy. Foundation models that perform well on medical tasks and require less task-specific tuning data are critical to accelerate the development of healthcare AI applications. We introduce MedGemma, a collection of medical vision-language foundation models based on Gemma 3 4B and 27B. MedGemma demonstrates advanced medical understanding and reasoning on images and text, significantly exceeding the performance of similar-sized generative models and approaching the performance of task-specific models, while maintaining the general capabilities of the Gemma 3 base models. For out-of-distribution tasks, MedGemma achieves 2.6-10% improvement on medical multimodal question answering, 15.5-18.1% improvement on chest X-ray finding classification, and 10.8% improvement on agentic evaluations compared to the base models. Fine-tuning MedGemma further improves performance in subdomains, reducing errors in electronic health record information retrieval by 50% and reaching comparable performance to existing specialized state-of-the-art methods for pneumothorax classification and histopathology patch classification. We additionally introduce MedSigLIP, a medically-tuned vision encoder derived from SigLIP. MedSigLIP powers the visual understanding capabilities of MedGemma and as an encoder achieves comparable or better performance than specialized medical image encoders. Taken together, the MedGemma collection provides a strong foundation of medical image and text capabilities, with potential to significantly accelerate medical research and development of downstream applications. The MedGemma collection, including tutorials and model weights, can be found at https://goo.gle/medgemma.

Reasoning is a critical frontier for advancing medical image analysis, where transparency and trustworthiness play a central role in both clinician trust and regulatory approval. Although Medical Visual Language Models (VLMs) show promise for radiological tasks, most existing VLMs merely produce final answers without revealing the underlying reasoning. To address this gap, we introduce MedVLM-R1, a medical VLM that explicitly generates natural language reasoning to enhance transparency and trustworthiness. Instead of relying on supervised fine-tuning (SFT), which often suffers from overfitting to training distributions and fails to foster genuine reasoning, MedVLM-R1 employs a reinforcement learning framework that incentivizes the model to discover human-interpretable reasoning paths without using any reasoning references. Despite limited training data (600 visual question answering samples) and model parameters (2B), MedVLM-R1 boosts accuracy from 55.11% to 78.22% across MRI, CT, and X-ray benchmarks, outperforming larger models trained on over a million samples. It also demonstrates robust domain generalization under out-of-distribution tasks. By unifying medical image analysis with explicit reasoning, MedVLM-R1 marks a pivotal step toward trustworthy and interpretable AI in clinical practice.

Large Language Models (LLMs) have the potential to automate reward engineering by leveraging their broad domain knowledge across various tasks. However, they often need many iterations of trial-and-error to generate effective reward functions. This process is costly because evaluating every sampled reward function requires completing the full policy optimization process for each function. In this paper, we introduce an LLM-driven reward generation framework that is able to produce state-of-the-art policies on the challenging Bi-DexHands benchmark with 20x fewer reward function samples than the prior state-of-the-art work. Our key insight is that we reduce the problem of generating task-specific rewards to the problem of coarsely estimating task progress. Our two-step solution leverages the task domain knowledge and the code synthesis abilities of LLMs to author progress functions that estimate task progress from a given state. Then, we use this notion of progress to discretize states, and generate count-based intrinsic rewards using the low-dimensional state space. We show that the combination of LLM-generated progress functions and count-based intrinsic rewards is essential for our performance gains, while alternatives such as generic hash-based counts or using progress directly as a reward function fall short.

Many reinforcement learning environments (e.g., Minecraft) provide only sparse rewards that indicate task completion or failure with binary values. The challenge in exploration efficiency in such environments makes it difficult for reinforcement-learning-based agents to learn complex tasks. To address this, this paper introduces an advanced learning system, named Auto MC-Reward, that leverages Large Language Models (LLMs) to automatically design dense reward functions, thereby enhancing the learning efficiency. Auto MC-Reward consists of three important components: Reward Designer, Reward Critic, and Trajectory Analyzer. Given the environment information and task descriptions, the Reward Designer first design the reward function by coding an executable Python function with predefined observation inputs. Then, our Reward Critic will be responsible for verifying the code, checking whether the code is self-consistent and free of syntax and semantic errors. Further, the Trajectory Analyzer summarizes possible failure causes and provides refinement suggestions according to collected trajectories. In the next round, Reward Designer will further refine and iterate the dense reward function based on feedback. Experiments demonstrate a significant improvement in the success rate and learning efficiency of our agents in complex tasks in Minecraft, such as obtaining diamond with the efficient ability to avoid lava, and efficiently explore trees and animals that are sparse in the plains biome.

A successful tactic that is followed by the scientific community for advancing AI is to treat games as problems, which has been proven to lead to various breakthroughs. We adapt this strategy in order to study Rocket League, a widely popular but rather under-explored 3D multiplayer video game with a distinct physics engine and complex dynamics that pose a significant challenge in developing efficient and high-performance game-playing agents. In this paper, we present Lucy-SKG, a Reinforcement Learning-based model that learned how to play Rocket League in a sample-efficient manner, outperforming by a notable margin the two highest-ranking bots in this game, namely Necto (2022 bot champion) and its successor Nexto, thus becoming a state-of-the-art agent. Our contributions include: a) the development of a reward analysis and visualization library, b) novel parameterizable reward shape functions that capture the utility of complex reward types via our proposed Kinesthetic Reward Combination (KRC) technique, and c) design of auxiliary neural architectures for training on reward prediction and state representation tasks in an on-policy fashion for enhanced efficiency in learning speed and performance. By performing thorough ablation studies for each component of Lucy-SKG, we showed their independent effectiveness in overall performance. In doing so, we demonstrate the prospects and challenges of using sample-efficient Reinforcement Learning techniques for controlling complex dynamical systems under competitive team-based multiplayer conditions.

Process-level Reward Models (PRMs) are crucial for complex reasoning and decision-making tasks, where each intermediate step plays an important role in the reasoning process. Since language models are prone to various types of errors during the reasoning process, PRMs are required to possess nuanced capabilities for detecting various implicit error types in real-world scenarios. However, current benchmarks primarily focus on step correctness, failing to evaluate PRMs' performance systematically. To address this gap, we introduce PRMBench, a process-level benchmark specifically designed to assess the fine-grained error detection capabilities of PRMs. PRMBench comprises 6,216 carefully designed problems and 83,456 step-level labels, evaluating models across multiple dimensions, including simplicity, soundness, and sensitivity. In our experiments on 15 models, spanning both open-source PRMs and closed-source large language models prompted as critic models, we uncover significant weaknesses in current PRMs. These findings underscore the challenges inherent in process-level evaluation and highlight key directions for future research. We hope PRMBench can be a robust bench for advancing research on PRM evaluation and development.

Reward machines (RMs) are a recent formalism for representing the reward function of a reinforcement learning task through a finite-state machine whose edges encode subgoals of the task using high-level events. The structure of RMs enables the decomposition of a task into simpler and independently solvable subtasks that help tackle long-horizon and/or sparse reward tasks. We propose a formalism for further abstracting the subtask structure by endowing an RM with the ability to call other RMs, thus composing a hierarchy of RMs (HRM). We exploit HRMs by treating each call to an RM as an independently solvable subtask using the options framework, and describe a curriculum-based method to learn HRMs from traces observed by the agent. Our experiments reveal that exploiting a handcrafted HRM leads to faster convergence than with a flat HRM, and that learning an HRM is feasible in cases where its equivalent flat representation is not.

Despite the significant progress made by existing retrieval augmented language models (RALMs) in providing trustworthy responses and grounding in reliable sources, they often overlook effective alignment with human preferences. In the alignment process, reward models (RMs) act as a crucial proxy for human values to guide optimization. However, it remains unclear how to evaluate and select a reliable RM for preference alignment in RALMs. To this end, we propose RAG-RewardBench, the first benchmark for evaluating RMs in RAG settings. First, we design four crucial and challenging RAG-specific scenarios to assess RMs, including multi-hop reasoning, fine-grained citation, appropriate abstain, and conflict robustness. Then, we incorporate 18 RAG subsets, six retrievers, and 24 RALMs to increase the diversity of data sources. Finally, we adopt an LLM-as-a-judge approach to improve preference annotation efficiency and effectiveness, exhibiting a strong correlation with human annotations. Based on the RAG-RewardBench, we conduct a comprehensive evaluation of 45 RMs and uncover their limitations in RAG scenarios. Additionally, we also reveal that existing trained RALMs show almost no improvement in preference alignment, highlighting the need for a shift towards preference-aligned training.We release our benchmark and code publicly at https://huggingface.co/datasets/jinzhuoran/RAG-RewardBench/ for future work.

With the proliferation of Large Language Models (LLMs) in diverse domains, there is a particular need for unified evaluation standards in clinical medical scenarios, where models need to be examined very thoroughly. We present CliMedBench, a comprehensive benchmark with 14 expert-guided core clinical scenarios specifically designed to assess the medical ability of LLMs across 7 pivot dimensions. It comprises 33,735 questions derived from real-world medical reports of top-tier tertiary hospitals and authentic examination exercises. The reliability of this benchmark has been confirmed in several ways. Subsequent experiments with existing LLMs have led to the following findings: (i) Chinese medical LLMs underperform on this benchmark, especially where medical reasoning and factual consistency are vital, underscoring the need for advances in clinical knowledge and diagnostic accuracy. (ii) Several general-domain LLMs demonstrate substantial potential in medical clinics, while the limited input capacity of many medical LLMs hinders their practical use. These findings reveal both the strengths and limitations of LLMs in clinical scenarios and offer critical insights for medical research.

Medical image analysis is essential to clinical diagnosis and treatment, which is increasingly supported by multi-modal large language models (MLLMs). However, previous research has primarily focused on 2D medical images, leaving 3D images under-explored, despite their richer spatial information. This paper aims to advance 3D medical image analysis with MLLMs. To this end, we present a large-scale 3D multi-modal medical dataset, M3D-Data, comprising 120K image-text pairs and 662K instruction-response pairs specifically tailored for various 3D medical tasks, such as image-text retrieval, report generation, visual question answering, positioning, and segmentation. Additionally, we propose M3D-LaMed, a versatile multi-modal large language model for 3D medical image analysis. Furthermore, we introduce a new 3D multi-modal medical benchmark, M3D-Bench, which facilitates automatic evaluation across eight tasks. Through comprehensive evaluation, our method proves to be a robust model for 3D medical image analysis, outperforming existing solutions. All code, data, and models are publicly available at: https://github.com/BAAI-DCAI/M3D.

Reward design is a fundamental, yet challenging aspect of practical reinforcement learning (RL). For simple tasks, researchers typically handcraft the reward function, e.g., using a linear combination of several reward factors. However, such reward engineering is subject to approximation bias, incurs large tuning cost, and often cannot provide the granularity required for complex tasks. To avoid these difficulties, researchers have turned to reinforcement learning from human feedback (RLHF), which learns a reward function from human preferences between pairs of trajectory sequences. By leveraging preference-based reward modeling, RLHF learns complex rewards that are well aligned with human preferences, allowing RL to tackle increasingly difficult problems. Unfortunately, the applicability of RLHF is limited due to the high cost and difficulty of obtaining human preference data. In light of this cost, we investigate learning reward functions for complex tasks with less human effort; simply by ranking the importance of the reward factors. More specifically, we propose a new RL framework -- HERON, which compares trajectories using a hierarchical decision tree induced by the given ranking. These comparisons are used to train a preference-based reward model, which is then used for policy learning. We find that our framework can not only train high performing agents on a variety of difficult tasks, but also provide additional benefits such as improved sample efficiency and robustness. Our code is available at https://github.com/abukharin3/HERON.

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.

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.

Dynamic treatment regimes (DTRs) are personalized, adaptive, multi-stage treatment plans that adapt treatment decisions both to an individual's initial features and to intermediate outcomes and features at each subsequent stage, which are affected by decisions in prior stages. Examples include personalized first- and second-line treatments of chronic conditions like diabetes, cancer, and depression, which adapt to patient response to first-line treatment, disease progression, and individual characteristics. While existing literature mostly focuses on estimating the optimal DTR from offline data such as from sequentially randomized trials, we study the problem of developing the optimal DTR in an online manner, where the interaction with each individual affect both our cumulative reward and our data collection for future learning. We term this the DTR bandit problem. We propose a novel algorithm that, by carefully balancing exploration and exploitation, is guaranteed to achieve rate-optimal regret when the transition and reward models are linear. We demonstrate our algorithm and its benefits both in synthetic experiments and in a case study of adaptive treatment of major depressive disorder using real-world data.

The integration of Artificial Intelligence (AI), especially Large Language Models (LLMs), into the clinical diagnosis process offers significant potential to improve the efficiency and accessibility of medical care. While LLMs have shown some promise in the medical domain, their application in clinical diagnosis remains underexplored, especially in real-world clinical practice, where highly sophisticated, patient-specific decisions need to be made. Current evaluations of LLMs in this field are often narrow in scope, focusing on specific diseases or specialties and employing simplified diagnostic tasks. To bridge this gap, we introduce CliBench, a novel benchmark developed from the MIMIC IV dataset, offering a comprehensive and realistic assessment of LLMs' capabilities in clinical diagnosis. This benchmark not only covers diagnoses from a diverse range of medical cases across various specialties but also incorporates tasks of clinical significance: treatment procedure identification, lab test ordering and medication prescriptions. Supported by structured output ontologies, CliBench enables a precise and multi-granular evaluation, offering an in-depth understanding of LLM's capability on diverse clinical tasks of desired granularity. We conduct a zero-shot evaluation of leading LLMs to assess their proficiency in clinical decision-making. Our preliminary results shed light on the potential and limitations of current LLMs in clinical settings, providing valuable insights for future advancements in LLM-powered healthcare.

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.

While recent advancements in commercial large language models (LM) have shown promising results in medical tasks, their closed-source nature poses significant privacy and security concerns, hindering their widespread use in the medical field. Despite efforts to create open-source models, their limited parameters often result in insufficient multi-step reasoning capabilities required for solving complex medical problems. To address this, we introduce Meerkat-7B, a novel medical AI system with 7 billion parameters. Meerkat-7B was trained using our new synthetic dataset consisting of high-quality chain-of-thought reasoning paths sourced from 18 medical textbooks, along with diverse instruction-following datasets. Our system achieved remarkable accuracy across seven medical benchmarks, surpassing GPT-3.5 by 13.1%, as well as outperforming the previous best 7B models such as MediTron-7B and BioMistral-7B by 13.4% and 9.8%, respectively. Notably, it surpassed the passing threshold of the United States Medical Licensing Examination (USMLE) for the first time for a 7B-parameter model. Additionally, our system offered more detailed free-form responses to clinical queries compared to existing 7B and 13B models, approaching the performance level of GPT-3.5. This significantly narrows the performance gap with large LMs, showcasing its effectiveness in addressing complex medical challenges.

Finetuning language models with reinforcement learning (RL), e.g. from human feedback (HF), is a prominent method for alignment. But optimizing against a reward model can improve on reward while degrading performance in other areas, a phenomenon known as reward hacking, alignment tax, or language drift. First, we argue that commonly-used test metrics are insufficient and instead measure how different algorithms tradeoff between reward and drift. The standard method modified the reward with a Kullback-Lieber (KL) penalty between the online and initial model. We propose Elastic Reset, a new algorithm that achieves higher reward with less drift without explicitly modifying the training objective. We periodically reset the online model to an exponentially moving average (EMA) of itself, then reset the EMA model to the initial model. Through the use of an EMA, our model recovers quickly after resets and achieves higher reward with less drift in the same number of steps. We demonstrate that fine-tuning language models with Elastic Reset leads to state-of-the-art performance on a small scale pivot-translation benchmark, outperforms all baselines in a medium-scale RLHF-like IMDB mock sentiment task and leads to a more performant and more aligned technical QA chatbot with LLaMA-7B. Code available at github.com/mnoukhov/elastic-reset.

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 (RL) requires either manually specifying a reward function, which is often infeasible, or learning a reward model from a large amount of human feedback, which is often very expensive. We study a more sample-efficient alternative: using pretrained vision-language models (VLMs) as zero-shot reward models (RMs) to specify tasks via natural language. We propose a natural and general approach to using VLMs as reward models, which we call VLM-RMs. We use VLM-RMs based on CLIP to train a MuJoCo humanoid to learn complex tasks without a manually specified reward function, such as kneeling, doing the splits, and sitting in a lotus position. For each of these tasks, we only provide a single sentence text prompt describing the desired task with minimal prompt engineering. We provide videos of the trained agents at: https://sites.google.com/view/vlm-rm. We can improve performance by providing a second ``baseline'' prompt and projecting out parts of the CLIP embedding space irrelevant to distinguish between goal and baseline. Further, we find a strong scaling effect for VLM-RMs: larger VLMs trained with more compute and data are better reward models. The failure modes of VLM-RMs we encountered are all related to known capability limitations of current VLMs, such as limited spatial reasoning ability or visually unrealistic environments that are far off-distribution for the VLM. We find that VLM-RMs are remarkably robust as long as the VLM is large enough. This suggests that future VLMs will become more and more useful reward models for a wide range of RL applications.

Large language models (LLMs) have demonstrated impressive capabilities in natural language understanding and generation, but the quality bar for medical and clinical applications is high. Today, attempts to assess models' clinical knowledge typically rely on automated evaluations on limited benchmarks. There is no standard to evaluate model predictions and reasoning across a breadth of tasks. To address this, we present MultiMedQA, a benchmark combining six existing open question answering datasets spanning professional medical exams, research, and consumer queries; and HealthSearchQA, a new free-response dataset of medical questions searched online. We propose a framework for human evaluation of model answers along multiple axes including factuality, precision, possible harm, and bias. In addition, we evaluate PaLM (a 540-billion parameter LLM) and its instruction-tuned variant, Flan-PaLM, on MultiMedQA. Using a combination of prompting strategies, Flan-PaLM achieves state-of-the-art accuracy on every MultiMedQA multiple-choice dataset (MedQA, MedMCQA, PubMedQA, MMLU clinical topics), including 67.6% accuracy on MedQA (US Medical License Exam questions), surpassing prior state-of-the-art by over 17%. However, human evaluation reveals key gaps in Flan-PaLM responses. To resolve this we introduce instruction prompt tuning, a parameter-efficient approach for aligning LLMs to new domains using a few exemplars. The resulting model, Med-PaLM, performs encouragingly, but remains inferior to clinicians. We show that comprehension, recall of knowledge, and medical reasoning improve with model scale and instruction prompt tuning, suggesting the potential utility of LLMs in medicine. Our human evaluations reveal important limitations of today's models, reinforcing the importance of both evaluation frameworks and method development in creating safe, helpful LLM models for clinical applications.

Despite the vast repository of global medical knowledge predominantly being in English, local languages are crucial for delivering tailored healthcare services, particularly in areas with limited medical resources. To extend the reach of medical AI advancements to a broader population, we aim to develop medical LLMs across the six most widely spoken languages, encompassing a global population of 6.1 billion. This effort culminates in the creation of the ApolloCorpora multilingual medical dataset and the XMedBench benchmark. In the multilingual medical benchmark, the released Apollo models, at various relatively-small sizes (i.e., 0.5B, 1.8B, 2B, 6B, and 7B), achieve the best performance among models of equivalent size. Especially, Apollo-7B is the state-of-the-art multilingual medical LLMs up to 70B. Additionally, these lite models could be used to improve the multi-lingual medical capabilities of larger models without fine-tuning in a proxy-tuning fashion. We will open-source training corpora, code, model weights and evaluation benchmark.

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.

Model-based evaluation is at the heart of successful model development -- as a reward model for training, and as a replacement for human evaluation. To train such evaluators, the standard approach is to collect a large amount of human preference judgments over model responses, which is costly and the data becomes stale as models improve. In this work, we present an approach that aims to im-prove evaluators without human annotations, using synthetic training data only. Starting from unlabeled instructions, our iterative self-improvement scheme generates contrasting model outputs and trains an LLM-as-a-Judge to produce reasoning traces and final judgments, repeating this training at each new iteration using the improved predictions. Without any labeled preference data, our Self-Taught Evaluator can improve a strong LLM (Llama3-70B-Instruct) from 75.4 to 88.3 (88.7 with majority vote) on RewardBench. This outperforms commonly used LLM judges such as GPT-4 and matches the performance of the top-performing reward models trained with labeled examples.

Building systems that are good for society in the face of complex societal effects requires a dynamic approach. Recent approaches to machine learning (ML) documentation have demonstrated the promise of discursive frameworks for deliberation about these complexities. However, these developments have been grounded in a static ML paradigm, leaving the role of feedback and post-deployment performance unexamined. Meanwhile, recent work in reinforcement learning has shown that the effects of feedback and optimization objectives on system behavior can be wide-ranging and unpredictable. In this paper we sketch a framework for documenting deployed and iteratively updated learning systems, which we call Reward Reports. Taking inspiration from various contributions to the technical literature on reinforcement learning, we outline Reward Reports as living documents that track updates to design choices and assumptions behind what a particular automated system is optimizing for. They are intended to track dynamic phenomena arising from system deployment, rather than merely static properties of models or data. After presenting the elements of a Reward Report, we discuss a concrete example: Meta's BlenderBot 3 chatbot. Several others for game-playing (DeepMind's MuZero), content recommendation (MovieLens), and traffic control (Project Flow) are included in the appendix.

Large language models (LLMs) have been widely deployed across numerous fields. Reinforcement Learning from Human Feedback (RLHF) leverages reward models (RMs) as proxies for human preferences to align LLM behaviors with human values, making the accuracy, reliability, and interpretability of RMs critical for effective alignment. However, traditional RMs lack interpretability, offer limited insight into the reasoning behind reward assignments, and are inflexible toward user preference shifts. While recent multidimensional RMs aim for improved interpretability, they often fail to provide feature-level attribution and require costly annotations. To overcome these limitations, we introduce the Sparse Autoencoder-enhanced Reward Model (SARM), a novel architecture that integrates a pretrained Sparse Autoencoder (SAE) into a reward model. SARM maps the hidden activations of LLM-based RM into an interpretable, sparse, and monosemantic feature space, from which a scalar head aggregates feature activations to produce transparent and conceptually meaningful reward scores. Empirical evaluations demonstrate that SARM facilitates direct feature-level attribution of reward assignments, allows dynamic adjustment to preference shifts, and achieves superior alignment performance compared to conventional reward models. Our code is available at https://github.com/schrieffer-z/sarm.

Providing effective treatment and making informed clinical decisions are essential goals of modern medicine and clinical care. We are interested in simulating disease dynamics for clinical decision-making, leveraging recent advances in large generative models. To this end, we introduce the Medical World Model (MeWM), the first world model in medicine that visually predicts future disease states based on clinical decisions. MeWM comprises (i) vision-language models to serve as policy models, and (ii) tumor generative models as dynamics models. The policy model generates action plans, such as clinical treatments, while the dynamics model simulates tumor progression or regression under given treatment conditions. Building on this, we propose the inverse dynamics model that applies survival analysis to the simulated post-treatment tumor, enabling the evaluation of treatment efficacy and the selection of the optimal clinical action plan. As a result, the proposed MeWM simulates disease dynamics by synthesizing post-treatment tumors, with state-of-the-art specificity in Turing tests evaluated by radiologists. Simultaneously, its inverse dynamics model outperforms medical-specialized GPTs in optimizing individualized treatment protocols across all metrics. Notably, MeWM improves clinical decision-making for interventional physicians, boosting F1-score in selecting the optimal TACE protocol by 13%, paving the way for future integration of medical world models as the second readers.

Millions of individuals' well-being are challenged by the harms of substance use. Harm reduction as a public health strategy is designed to improve their health outcomes and reduce safety risks. Some large language models (LLMs) have demonstrated a decent level of medical knowledge, promising to address the information needs of people who use drugs (PWUD). However, their performance in relevant tasks remains largely unexplored. We introduce HRIPBench, a benchmark designed to evaluate LLM's accuracy and safety risks in harm reduction information provision. The benchmark dataset HRIP-Basic has 2,160 question-answer-evidence pairs. The scope covers three tasks: checking safety boundaries, providing quantitative values, and inferring polysubstance use risks. We build the Instruction and RAG schemes to evaluate model behaviours based on their inherent knowledge and the integration of domain knowledge. Our results indicate that state-of-the-art LLMs still struggle to provide accurate harm reduction information, and sometimes, carry out severe safety risks to PWUD. The use of LLMs in harm reduction contexts should be cautiously constrained to avoid inducing negative health outcomes. WARNING: This paper contains illicit content that potentially induces harms.

Reward-based alignment methods for large language models (LLMs) face two key limitations: vulnerability to reward hacking, where models exploit flaws in the reward signal; and reliance on brittle, labor-intensive prompt engineering when LLMs are used as reward models. We introduce Meta Policy Optimization (MPO), a framework that addresses these challenges by integrating a meta-reward model that dynamically refines the reward model's prompt throughout training. In MPO, the meta-reward model monitors the evolving training context and continuously adjusts the reward model's prompt to maintain high alignment, providing an adaptive reward signal that resists exploitation by the policy. This meta-learning approach promotes a more stable policy optimization, and greatly reduces the need for manual reward prompt design. It yields performance on par with or better than models guided by extensively hand-crafted reward prompts. Furthermore, we show that MPO maintains its effectiveness across diverse tasks, such as question answering and mathematical reasoning, without requiring specialized reward designs. Beyond standard RLAIF, MPO's meta-learning formulation is readily extensible to higher-level alignment frameworks. Overall, this method addresses theoretical and practical challenges in reward-based RL alignment for LLMs, paving the way for more robust and adaptable alignment strategies. The code and models will be publicly shared.

With the advent of Large Language Models (LLMs), medical artificial intelligence (AI) has experienced substantial technological progress and paradigm shifts, highlighting the potential of LLMs to streamline healthcare delivery and improve patient outcomes. Considering this rapid technical progress, in this survey, we trace the recent advances of Medical Large Language Models (Med-LLMs), including the background, key findings, and mainstream techniques, especially for the evolution from general-purpose models to medical-specialized applications. Firstly, we delve into the foundational technology of Med-LLMs, indicating how general models can be progressively adapted and refined for the complicated medical tasks. Secondly, the wide-ranging applications of Med-LLMs are investigated across various healthcare domains, as well as an up-to-date review of existing Med-LLMs. The transformative impact of these models on daily medical practice is evident through their ability to assist clinicians, educators, and patients. Recognizing the importance of responsible innovation, we discuss the challenges associated with ensuring fairness, accountability, privacy, and robustness. Ethical considerations, rigorous evaluation methodologies, and the establishment of regulatory frameworks are crucial for building trustworthiness in the real-world system. We emphasize the need for ongoing scrutiny and development to maintain high standards of safety and reliability. Finally, we anticipate possible future trajectories for Med-LLMs, identifying key avenues for prudent expansion. By consolidating these insights, our review aims to provide professionals and researchers with a thorough understanding of the strengths and limitations of Med-LLMs, fostering a balanced and ethical approach to their integration into the healthcare ecosystem.

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.

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.

Text-to-SQL, the task of translating natural language questions into SQL queries, has significantly advanced with the introduction of Large Language Models (LLMs), broadening database accessibility for a wide range of users. Despite substantial progress in generating valid SQL, current LLMs still struggle with complex queries that require precise alignment between user intent and the database schema. To mitigate this, test-time strategies such as Best-of-N (BoN) and Majority Voting (Maj) are often employed, based on the assumption that LLMs can generate correct answers but may require multiple attempts. However, these methods rely on surface-level heuristics, selecting either the syntactically correct query through execution-based BoN (ex-BoN) or the most frequently generated query with Maj. Recently, Outcome Reward Models (ORMs), which assign utility scores to generated outputs based on semantic correctness, have emerged as a promising approach for better aligning model predictions with user intent. Nevertheless, their application to Text-to-SQL remains largely underexplored. In this work, we evaluate ORMs as an effective heuristic for BoN, compare them with ex-BoN and Maj, and introduce a framework for training ORMs for the Text-to-SQL task. We evaluate our ORMs on the BIRD and SPIDER benchmarks, finetuning various open-source LLMs, including the Qwen2, Granite3, and Llama3 model families. Our results show that ORMs outperform ex-BoN and Maj, achieving execution accuracy gains of +4.33% (BIRD) and +2.10% (Spider) over ex-BoN, and +2.91% (BIRD) and +0.93% (Spider) over Maj. We further demonstrate that finetuning models already aligned with SQL generation, such as OmniSQL, yields superior ORM performance. Additionally, we observe that ORMs achieve competitive results on simple queries and benefit more from an increased number of candidates compared to ex-BoN and Maj.

Text-to-Image (T2I) models have made significant advancements in recent years, but they still struggle to accurately capture intricate details specified in complex compositional prompts. While fine-tuning T2I models with reward objectives has shown promise, it suffers from "reward hacking" and may not generalize well to unseen prompt distributions. In this work, we propose Reward-based Noise Optimization (ReNO), a novel approach that enhances T2I models at inference by optimizing the initial noise based on the signal from one or multiple human preference reward models. Remarkably, solving this optimization problem with gradient ascent for 50 iterations yields impressive results on four different one-step models across two competitive benchmarks, T2I-CompBench and GenEval. Within a computational budget of 20-50 seconds, ReNO-enhanced one-step models consistently surpass the performance of all current open-source Text-to-Image models. Extensive user studies demonstrate that our model is preferred nearly twice as often compared to the popular SDXL model and is on par with the proprietary Stable Diffusion 3 with 8B parameters. Moreover, given the same computational resources, a ReNO-optimized one-step model outperforms widely-used open-source models such as SDXL and PixArt-alpha, highlighting the efficiency and effectiveness of ReNO in enhancing T2I model performance at inference time. Code is available at https://github.com/ExplainableML/ReNO.

Benchmarks are essential for quantitatively tracking progress in AI. As AI agents become increasingly capable, researchers and practitioners have introduced agentic benchmarks to evaluate agents on complex, real-world tasks. These benchmarks typically measure agent capabilities by evaluating task outcomes via specific reward designs. However, we show that many agentic benchmarks have issues task setup or reward design. For example, SWE-bench Verified uses insufficient test cases, while TAU-bench counts empty responses as successful. Such issues can lead to under- or overestimation agents' performance by up to 100% in relative terms. To make agentic evaluation rigorous, we introduce the Agentic Benchmark Checklist (ABC), a set of guidelines that we synthesized from our benchmark-building experience, a survey of best practices, and previously reported issues. When applied to CVE-Bench, a benchmark with a particularly complex evaluation design, ABC reduces the performance overestimation by 33%.

In the last decade, Deep Reinforcement Learning has evolved into a powerful tool for complex sequential decision-making problems. It combines deep learning's proficiency in processing rich input signals with reinforcement learning's adaptability across diverse control tasks. At its core, an RL agent seeks to maximize its cumulative reward, enabling AI algorithms to uncover novel solutions previously unknown to experts. However, this focus on reward maximization also introduces a significant difficulty: improper reward specification can result in unexpected, misaligned agent behavior and inefficient learning. The complexity of accurately specifying the reward function is further amplified by the sequential nature of the task, the sparsity of learning signals, and the multifaceted aspects of the desired behavior. In this thesis, we survey the literature on effective reward specification strategies, identify core challenges relating to each of these approaches, and propose original contributions addressing the issue of sample efficiency and alignment in deep reinforcement learning. Reward specification represents one of the most challenging aspects of applying reinforcement learning in real-world domains. Our work underscores the absence of a universal solution to this complex and nuanced challenge; solving it requires selecting the most appropriate tools for the specific requirements of each unique application.