Daily Papers

Psychiatric consultation requires agents to elicit discriminative evidence, map uncertain narratives to diagnostic criteria, and decide when evidence suffices. Existing dialogue and retrieval-augmented systems condition policies on raw histories or appended passages, leaving observed evidence, missing checks, differentials, and support reliability entangled. We introduce MIND, a criteria-grounded evidence-state decision interface. At each turn, MIND constructs a typed state containing observed evidence, unresolved criterion checks, active differentials, criterion-linked supports, and reliability metadata. A training-split Psychiatric Reasoning Bank supplies gated supports, turning retrieval into state construction rather than prompt injection. The same state conditions action selection, process rewards, information-gain scoring, and trajectory rectification. Under EMR-grounded simulator protocols, MIND improves accuracy by 8.8 and 7.3 points over strong inference-only, RAG, and RL baselines, with gains transferring to public MDD-5k dialogues. Matched interventions attribute these gains to the shared state rather than prompt length, retrieval text, or formatting. MIND targets screening-level decision support, not autonomous diagnosis. Code is available at https://github.com/Lingxi-mental-health/MIND.Å

While recent multimodal large language models (MLLMs) have advanced automated ECG interpretation, they still face two key limitations: (1) insufficient multimodal synergy between time series signals and visual ECG representations, and (2) limited explainability in linking diagnoses to granular waveform evidence. We introduce GEM, the first MLLM unifying ECG time series, 12-lead ECG images and text for grounded and clinician-aligned ECG interpretation. GEM enables feature-grounded analysis, evidence-driven reasoning, and a clinician-like diagnostic process through three core innovations: a dual-encoder framework extracting complementary time series and image features, cross-modal alignment for effective multimodal understanding, and knowledge-guided instruction generation for generating high-granularity grounding data (ECG-Grounding) linking diagnoses to measurable parameters (e.g., QRS/PR Intervals). Additionally, we propose the Grounded ECG Understanding task, a clinically motivated benchmark designed to comprehensively assess the MLLM's capability in grounded ECG understanding. Experimental results on both existing and our proposed benchmarks show GEM significantly improves predictive performance (CSN 7.4% uparrow), explainability (22.7% uparrow), and grounding (24.8% uparrow), making it more suitable for real-world clinical applications. GitHub repository: https://github.com/lanxiang1017/GEM.git

Frontier language models are rarely used in clinical workflows because the realistic, longitudinal benchmarks needed to develop them are scarce. Real electronic health record (EHR) data cannot be openly shared due to privacy, ethics or data use issues and it does not contain verifiable ground truth since the chart records only reflect what clinicians documented. We introduce Synthetic Hospital, an open, fully synthetic, fact-grounded longitudinal EHR benchmark that resolves the open sharing and verifiable ground truth barriers. Built entirely from public medical-education material with no protected health information, it comprises 1,268 longitudinal patients and 5,602 encounters, where every diagnosis, finding, and temporal relation is grounded in standard ontologies (ICD-10-CM, SNOMED CT, LOINC) and with a complete provenance chain back to its source medical education material. Synthetic Hospital is served through a simulated hospital record system that mirrors real EHR infrastructure (standard interoperability APIs, role-based access and function-calling interface). In a blinded review, physicians distinguished its records from real patient charts at near-chance rates (53\%). Across 10 frontier and open models, none approaches ceiling: the best model reconstructs a patient's longitudinal problem list with a severity-weighted F1 of 0.73, level with the mean of seven physicians on a matched subset but well below the best of them (0.89), and misses roughly half of clinically relevant findings when summarizing a chart. Overall, these results highlight that Synthetic Hospital is a difficult and realistic test of clinical AI performance.

Improving large language models (LLMs) for electronic health record (EHR) reasoning is essential for enabling accurate and generalizable clinical predictions. While LLMs excel at medical text understanding, they underperform on EHR-based prediction tasks due to challenges in modeling temporally structured, high-dimensional data. Existing approaches often rely on hybrid paradigms, where LLMs serve merely as frozen prior retrievers while downstream deep learning (DL) models handle prediction, failing to improve the LLM's intrinsic reasoning capacity and inheriting the generalization limitations of DL models. To this end, we propose EAG-RL, a novel two-stage training framework designed to intrinsically enhance LLMs' EHR reasoning ability through expert attention guidance, where expert EHR models refer to task-specific DL models trained on EHR data. Concretely, EAG-RL first constructs high-quality, stepwise reasoning trajectories using expert-guided Monte Carlo Tree Search to effectively initialize the LLM's policy. Then, EAG-RL further optimizes the policy via reinforcement learning by aligning the LLM's attention with clinically salient features identified by expert EHR models. Extensive experiments on two real-world EHR datasets show that EAG-RL improves the intrinsic EHR reasoning ability of LLMs by an average of 14.62%, while also enhancing robustness to feature perturbations and generalization to unseen clinical domains. These results demonstrate the practical potential of EAG-RL for real-world deployment in clinical prediction tasks. Our code have been available at https://github.com/devilran6/EAG-RL.

Radiology reporting is a complex task that requires detailed image understanding, integration of multiple inputs, including comparison with prior imaging, and precise language generation. This makes it ideal for the development and use of generative multimodal models. Here, we extend report generation to include the localisation of individual findings on the image - a task we call grounded report generation. Prior work indicates that grounding is important for clarifying image understanding and interpreting AI-generated text. Therefore, grounded reporting stands to improve the utility and transparency of automated report drafting. To enable evaluation of grounded reporting, we propose a novel evaluation framework - RadFact - leveraging the reasoning capabilities of large language models (LLMs). RadFact assesses the factuality of individual generated sentences, as well as correctness of generated spatial localisations when present. We introduce MAIRA-2, a large multimodal model combining a radiology-specific image encoder with a LLM, and trained for the new task of grounded report generation on chest X-rays. MAIRA-2 uses more comprehensive inputs than explored previously: the current frontal image, the current lateral image, the prior frontal image and prior report, as well as the Indication, Technique and Comparison sections of the current report. We demonstrate that these additions significantly improve report quality and reduce hallucinations, establishing a new state of the art on findings generation (without grounding) on MIMIC-CXR while demonstrating the feasibility of grounded reporting as a novel and richer task.

The successes of foundation models such as ChatGPT and AlphaFold have spurred significant interest in building similar models for electronic medical records (EMRs) to improve patient care and hospital operations. However, recent hype has obscured critical gaps in our understanding of these models' capabilities. We review over 80 foundation models trained on non-imaging EMR data (i.e. clinical text and/or structured data) and create a taxonomy delineating their architectures, training data, and potential use cases. We find that most models are trained on small, narrowly-scoped clinical datasets (e.g. MIMIC-III) or broad, public biomedical corpora (e.g. PubMed) and are evaluated on tasks that do not provide meaningful insights on their usefulness to health systems. In light of these findings, we propose an improved evaluation framework for measuring the benefits of clinical foundation models that is more closely grounded to metrics that matter in healthcare.

Clinicians spend large amounts of time on clinical documentation, and inefficiencies impact quality of care and increase clinician burnout. Despite the promise of electronic medical records (EMR), the transition from paper-based records has been negatively associated with clinician wellness, in part due to poor user experience, increased burden of documentation, and alert fatigue. In this study, we present Almanac Copilot, an autonomous agent capable of assisting clinicians with EMR-specific tasks such as information retrieval and order placement. On EHR-QA, a synthetic evaluation dataset of 300 common EHR queries based on real patient data, Almanac Copilot obtains a successful task completion rate of 74% (n = 221 tasks) with a mean score of 2.45 over 3 (95% CI:2.34-2.56). By automating routine tasks and streamlining the documentation process, our findings highlight the significant potential of autonomous agents to mitigate the cognitive load imposed on clinicians by current EMR systems.

We study whether grounded reasoning supervision from abundant 2D medical images can improve 3D medical VQA when both input types are aligned through a common reasoning interface. We introduce UniReason-Med, a single-checkpoint framework that processes either a 2D image or a slice-serialized 3D volume at inference time, generating interleaved textual reasoning and localized visual evidence through shared box syntax, region-token injection, and a common grounded reasoning policy. To train this interface, we construct UniMed-CoT, a 220K instruction-tuning dataset with interleaved textual reasoning and grounded visual evidence, including 170K 2D and 50K 3D samples. Through supervised fine-tuning followed by outcome-level reinforcement learning, UniReason-Med learns to generate grounded reasoning traces without IoU/Dice-based localization rewards during RL. Data-mixture and component ablations show that joint 2D+3D grounded supervision substantially improves 3D reasoning over 3D-only training, while grounding and region-token injection consistently benefit both 2D and 3D tasks. These results suggest that a shared grounded reasoning interface can transfer reasoning structure from 2D images to slice-serialized volumetric medical understanding. The code and data are publicly available at https://github.com/IQuestLab/unireason-med.

Despite the rapid progress of Multimodal Large Language Models (MLLMs), their ability to perform reliable visual grounding in high-stakes clinical software environments remains underexplored. Existing GUI benchmarks largely focus on isolated, single-step grounding queries, overlooking the sequential, workflow-driven reasoning required in real-world medical interfaces, where tasks evolve across independent steps and dynamic interface states. We introduce MedSPOT, a workflow-aware sequential grounding benchmark for clinical GUI environments. Unlike prior benchmarks that treat grounding as a standalone prediction task, MedSPOT models procedural interaction as a sequence of structured spatial decisions. The benchmark comprises 216 task-driven videos with 597 annotated keyframes, in which each task consists of 2 to 3 interdependent grounding steps within realistic medical workflows. This design captures interface hierarchies, contextual dependencies, and fine-grained spatial precision under evolving conditions. To evaluate procedural robustness, we propose a strict sequential evaluation protocol that terminates task assessment upon the first incorrect grounding prediction, explicitly measuring error propagation in multi-step workflows. We further introduce a comprehensive failure taxonomy, including edge bias, small-target errors, no prediction, near miss, far miss, and toolbar confusion, to enable systematic diagnosis of model behavior in clinical GUI settings. By shifting evaluation from isolated grounding to workflow-aware sequential reasoning, MedSPOT establishes a realistic and safety-critical benchmark for assessing multimodal models in medical software environments. Code and data are available at: https://github.com/Tajamul21/MedSPOT.

Transformers have significantly advanced the modeling of Electronic Health Records (EHR), yet their deployment in real-world healthcare is limited by several key challenges. Firstly, the quadratic computational cost and insufficient context length of these models pose significant obstacles for hospitals in processing the extensive medical histories typical in EHR data. Additionally, existing models employ separate finetuning for each clinical task, complicating maintenance in healthcare environments. Moreover, these models focus exclusively on either clinical prediction or EHR forecasting, lacking the flexibility to perform well across both. To overcome these limitations, we introduce EHRMamba, a robust foundation model built on the Mamba architecture. EHRMamba can process sequences up to four times longer than previous models due to its linear computational cost. We also introduce a novel approach to Multitask Prompted Finetuning (MTF) for EHR data, which enables EHRMamba to simultaneously learn multiple clinical tasks in a single finetuning phase, significantly enhancing deployment and cross-task generalization. Furthermore, our model leverages the HL7 FHIR data standard to simplify integration into existing hospital systems. Alongside EHRMamba, we open-source Odyssey, a toolkit designed to support the development and deployment of EHR foundation models, with an emphasis on data standardization and interpretability. Our evaluations on the MIMIC-IV dataset demonstrate that EHRMamba advances state-of-the-art performance across 6 major clinical tasks and excels in EHR forecasting, marking a significant leap forward in the field.

Electronic Health Records (EHRs) contain rich yet complex information, and their automated analysis is critical for clinical decision-making. Despite recent advances of large language models (LLMs) in clinical workflows, their ability to analyze EHRs remains limited due to narrow task coverage and lack of EHR-oriented reasoning capabilities. This paper aims to bridge the gap, specifically, we present EHR-Ins, a large-scale, comprehensive EHR reasoning instruction dataset, comprising 300k high-quality reasoning cases and 4M non-reasoning cases across 42 distinct EHR tasks. Its core innovation is a thinking-graph-driven framework that enables to generate high-quality reasoning data at scale. Based on it, we develop EHR-R1, a series of reasoning-enhanced LLMs with up to 72B parameters tailored for EHR analysis. Through a multi-stage training paradigm, including domain adaptation, reasoning enhancement, and reinforcement learning, EHR-R1 systematically acquires domain knowledge and diverse reasoning capabilities, enabling accurate and robust EHR analysis. Lastly, we introduce EHR-Bench, a new benchmark curated from MIMIC-IV, spanning 42 tasks, to comprehensively assess reasoning and prediction across EHR scenarios. In experiments, we show that the resulting EHR-R1 consistently outperforms state-of-the-art commercial and open-source LLMs (including DeepSeek-V3 and GPT-4o), surpassing GPT-4o by over 30 points on MIMIC-Bench and achieving a 10\% higher zero-shot AUROC on EHRSHOT. Collectively, EHR-Ins, EHR-R1, and EHR-Bench have significantly advanced the development for more reliable and clinically relevant EHR analysis.

Current medical language models, adapted from large language models (LLMs), typically predict ICD code-based diagnosis from electronic health records (EHRs) because these labels are readily available. However, ICD codes do not capture the nuanced, context-rich reasoning clinicians use for diagnosis. Clinicians synthesize diverse patient data and reference clinical practice guidelines (CPGs) to make evidence-based decisions. This misalignment limits the clinical utility of existing models. We introduce GARMLE-G, a Generation-Augmented Retrieval framework that grounds medical language model outputs in authoritative CPGs. Unlike conventional Retrieval-Augmented Generation based approaches, GARMLE-G enables hallucination-free outputs by directly retrieving authoritative guideline content without relying on model-generated text. It (1) integrates LLM predictions with EHR data to create semantically rich queries, (2) retrieves relevant CPG knowledge snippets via embedding similarity, and (3) fuses guideline content with model output to generate clinically aligned recommendations. A prototype system for hypertension diagnosis was developed and evaluated on multiple metrics, demonstrating superior retrieval precision, semantic relevance, and clinical guideline adherence compared to RAG-based baselines, while maintaining a lightweight architecture suitable for localized healthcare deployment. This work provides a scalable, low-cost, and hallucination-free method for grounding medical language models in evidence-based clinical practice, with strong potential for broader clinical deployment.

We study how to train visually grounded vision-language models (VLMs) for radiology without manual spatial annotations. We introduce RefRad2D, a large-scale bilingual (German/English) dataset of 1.2M CT and MR image-text pairs derived from clinical practice, with task-specific VQA and spatial grounding subsets generated automatically via LLM-based curation and automated segmentation. Trained on this data, our model RadGrounder jointly performs report generation, visual question answering, and spatial grounding via bounding-box detection or segmentation. On external VQA benchmarks (Slake, VQA-RAD), RadGrounder achieves competitive results with specialized medical VLMs. Adding our clinical data to the training mixture improves open-ended VQA over fine-tuning on the downstream datasets alone, showing the transferability of our dataset. Crucially, adding grounding supervision does not degrade language quality, enabling spatially verifiable outputs at no cost to VQA performance.

In this work, we address the problem of grounding abnormalities in medical images, where the goal is to localize clinical findings based on textual descriptions. While generalist Vision-Language Models (VLMs) excel in natural grounding tasks, they often struggle in the medical domain due to rare, compositional, and domain-specific terms that are poorly aligned with visual patterns. Specialized medical VLMs address this challenge via large-scale domain pretraining, but at the cost of substantial annotation and computational resources. To overcome these limitations, we propose Knowledge to Sight (K2Sight), a framework that introduces structured semantic supervision by decomposing clinical concepts into interpretable visual attributes, such as shape, density, and anatomical location. These attributes are distilled from domain ontologies and encoded into concise instruction-style prompts, which guide region-text alignment during training. Unlike conventional report-level supervision, our approach explicitly bridges domain knowledge and spatial structure, enabling data-efficient training of compact models. We train compact models with 0.23B and 2B parameters using only 1.5\% of the data required by state-of-the-art medical VLMs. Despite their small size and limited training data, these models achieve performance on par with or better than 7B+ medical VLMs, with up to 9.82\% improvement in mAP_{50}. Code and models: https://lijunrio.github.io/K2Sight/{SOTAPink{https://lijunrio.github.io/K2Sight/}}.

Chest X-ray plays a central role in thoracic diagnosis, and its interpretation inherently requires multi-step, evidence-grounded reasoning. However, large vision-language models (LVLMs) often generate plausible responses that are not faithfully grounded in diagnostic evidence and provide limited visual evidence for verification, while also requiring costly retraining to support new diagnostic tasks, limiting their reliability and adaptability in clinical settings. To address these limitations, we present CXReasonAgent, a diagnostic agent that integrates a large language model (LLM) with clinically grounded diagnostic tools to perform evidence-grounded diagnostic reasoning using image-derived diagnostic and visual evidence. To evaluate these capabilities, we introduce CXReasonDial, a multi-turn dialogue benchmark with 1,946 dialogues across 12 diagnostic tasks, and show that CXReasonAgent produces faithfully grounded responses, enabling more reliable and verifiable diagnostic reasoning than LVLMs. These findings highlight the importance of integrating clinically grounded diagnostic tools, particularly in safety-critical clinical settings.

Visual grounding is essential for precise perception and reasoning in multimodal large language models (MLLMs), especially in medical imaging domains. While existing medical visual grounding benchmarks primarily focus on single-image scenarios, real-world clinical applications often involve sequential images, where accurate lesion localization across different modalities and temporal tracking of disease progression (e.g., pre- vs. post-treatment comparison) require fine-grained cross-image semantic alignment and context-aware reasoning. To remedy the underrepresentation of image sequences in existing medical visual grounding benchmarks, we propose MedSG-Bench, the first benchmark tailored for Medical Image Sequences Grounding. It comprises eight VQA-style tasks, formulated into two paradigms of the grounding tasks, including 1) Image Difference Grounding, which focuses on detecting change regions across images, and 2) Image Consistency Grounding, which emphasizes detection of consistent or shared semantics across sequential images. MedSG-Bench covers 76 public datasets, 10 medical imaging modalities, and a wide spectrum of anatomical structures and diseases, totaling 9,630 question-answer pairs. We benchmark both general-purpose MLLMs (e.g., Qwen2.5-VL) and medical-domain specialized MLLMs (e.g., HuatuoGPT-vision), observing that even the advanced models exhibit substantial limitations in medical sequential grounding tasks. To advance this field, we construct MedSG-188K, a large-scale instruction-tuning dataset tailored for sequential visual grounding, and further develop MedSeq-Grounder, an MLLM designed to facilitate future research on fine-grained understanding across medical sequential images. The benchmark, dataset, and model are available at https://huggingface.co/MedSG-Bench

Electronic medical records (EMR) contain sensitive personal information. For example, they may include details about infectious diseases, such as human immunodeficiency virus (HIV), or they may contain information about a mental illness. They may also contain other sensitive information such as medical details related to fertility treatments. Because EMRs are subject to confidentiality requirements, accessing and analyzing EMR databases is a privilege given to only a small number of individuals. Individuals who work at institutions that do not have access to EMR systems have no opportunity to gain hands-on experience with this valuable resource. Simulated medical databases are currently available; however, they are difficult to configure and are limited in their resemblance to real clinical databases. Generating highly accessible repositories of virtual patient EMRs while relying only minimally on real patient data is expected to serve as a valuable resource to a broader audience of medical personnel, including those who reside in underdeveloped countries.

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.

Electronic Health Records (EHRs) are pivotal in clinical practices, yet their retrieval remains a challenge mainly due to semantic gap issues. Recent advancements in dense retrieval offer promising solutions but existing models, both general-domain and biomedical-domain, fall short due to insufficient medical knowledge or mismatched training corpora. This paper introduces DR.EHR, a series of dense retrieval models specifically tailored for EHR retrieval. We propose a two-stage training pipeline utilizing MIMIC-IV discharge summaries to address the need for extensive medical knowledge and large-scale training data. The first stage involves medical entity extraction and knowledge injection from a biomedical knowledge graph, while the second stage employs large language models to generate diverse training data. We train two variants of DR.EHR, with 110M and 7B parameters, respectively. Evaluated on the CliniQ benchmark, our models significantly outperforms all existing dense retrievers, achieving state-of-the-art results. Detailed analyses confirm our models' superiority across various match and query types, particularly in challenging semantic matches like implication and abbreviation. Ablation studies validate the effectiveness of each pipeline component, and supplementary experiments on EHR QA datasets demonstrate the models' generalizability on natural language questions, including complex ones with multiple entities. This work significantly advances EHR retrieval, offering a robust solution for clinical applications.

LLM agents are predominantly benchmarked on short, single-task trajectories, yet real deployments run for hours under contention, surfacing a different class of failures. We use the Clinical Environment Simulator (CES), in which an agent manages an entire emergency-department shift under continuous time and resource pressure, as a testbed: long-horizon execution failures manifest measurably in a single rollout under structured, multi-dimensional grading. On CES, current agents reach the correct diagnosis in most cases yet fail to deliver complete and timely critical actions, revealing an execution gap. We attribute this gap to three long-horizon failure modes, each operationalized as a per-trace counter: instruction-adherence drift, treatment incompleteness, and a severity-equity gap in timeliness. We then introduce Asclepius, an adaptive agent scaffolding with a self-evolving harness that rewrites the operating manual between shifts from trace-level feedback, an externalized clinical skills library for high-stakes regimen knowledge, and three isolated subagents that partition per-turn decisions across the patient queue. On held-out batches never observed during harness evolution, Asclepius improves critical-action correctness by 22% (p = 0.024) over a strong baseline agent framework while preserving diagnostic accuracy, with consistent gains across five LLM judges from three model families; on the full ten-batch set, improvements reach 25% on critical actions and 13% on timeliness. The three failure modes form a coupled bottleneck: decisive reductions appear only when all three components act together.

Grounded Situation Recognition (GSR) is the task that not only classifies a salient action (verb), but also predicts entities (nouns) associated with semantic roles and their locations in the given image. Inspired by the remarkable success of Transformers in vision tasks, we propose a GSR model based on a Transformer encoder-decoder architecture. The attention mechanism of our model enables accurate verb classification by capturing high-level semantic feature of an image effectively, and allows the model to flexibly deal with the complicated and image-dependent relations between entities for improved noun classification and localization. Our model is the first Transformer architecture for GSR, and achieves the state of the art in every evaluation metric on the SWiG benchmark. Our code is available at https://github.com/jhcho99/gsrtr .

Reliable agentic tool use requires training data that pair diverse multi-step workflows with executable evidence that the requested outcomes were achieved. Scaling either trajectory coverage or verification alone is insufficient as new environments introduce distinct states, rules, and dependencies that must also be reflected in the success criteria. To address this challenge, we introduce Davinci-Tool, a 30B tool-use model, and Davinci-ToolData, an execution-grounded dataset designed to scale environment coverage and outcome verification together. Davinci-ToolData preserves restorable states, execution traces, outcomes, and verifiers as a unified substrate for supervision. Two complementary pipelines populate this substrate: Execution-Grounded Task Synthesis (EGTS) derives verified demonstrations from independently authored systems, and Executable Environment Synthesis (EES) synthesizes auditable environments, state-grounded tasks, and executable verifiers across single and coordinated domains. These pipelines yield 30,395 verified trajectories spanning 2,260 invoked tool names. We first train on these demonstrations with supervised fine-tuning, then reuse EES states and verifiers to compare alternative actions and construct outcome-grounded preferences for Direct Preference Optimization. Davinci-Tool improves Qwen3-Coder-30B-A3B-Instruct from 52.4 to 88.2 on τ^2-bench, from 30.4 to 62.8 on BFCL v4 multi-turn, and from 16.9 to 56.2 on MCP-Atlas, outperforming Qwen3-Coder-480B-A35B-Instruct on all three benchmarks with only 1/16 of its total parameters. Code is available at https://github.com/MassLab-SII/Davinci-Tool.

Electronic health record (EHR) foundation models trained on longitudinal patient trajectories have demonstrated strong performance across diverse clinical prediction tasks. However, their clinical reasoning capabilities remain constrained by next-token prediction on limited and incomplete EHR data. To address this, we propose a reinforcement learning (RL) fine-tuning framework that treats EHR foundation models as generative policies over patient trajectories. We formulate common clinical prediction problems (e.g., hospital readmission) as event-conditioned, time-windowed reasoning tasks. We then design time-aware, rollout-sensitive rewards to account for finite rollout lengths and temporally inconclusive outcomes. We find that RL fine-tuning consistently improves over pre-trained backbones and strong baselines. Notably, it enables smaller models to surpass larger pre-trained models in data-limited regimes and induces positive transfer across tasks. Further analysis shows that RL fine-tuned models generate trajectories with stronger structural and semantic alignment to ground truth and greater downstream utility.

Research in emergency triage is restricted to structured electronic health records (EHR) due to regulatory constraints on nurse-patient interactions. We introduce TriageSim, a simulation framework for generating persona-conditioned triage conversations from structured records. TriageSim enables multi-turn nurse-patient interactions with explicit control over disfluency and decision behaviour, producing a corpus of ~800 synthetic transcripts and corresponding audio. We use a combination of automated analysis for linguistic, behavioural and acoustic fidelity alongside manual evaluation for medical fidelity using a random subset of 50 conversations. The utility of the generated corpus is examined via conversational triage classification. We observe modest agreement for acuity levels across three modalities: generated synthetic text, ASR transcripts, and direct audio inputs. The code, persona schemata and triage policy prompts for TriageSim will be available upon acceptance.

Medical image grounding aims to align natural language phrases with specific regions in medical images, serving as a foundational task for intelligent diagnosis, visual question answering (VQA), and automated report generation (MRG). However, existing research is constrained by limited modality coverage, coarse-grained annotations, and the absence of a unified, generalizable grounding framework. To address these challenges, we construct a large-scale medical grounding dataset Med-GLIP-5M comprising over 5.3 million region-level annotations across seven imaging modalities, covering diverse anatomical structures and pathological findings. The dataset supports both segmentation and grounding tasks with hierarchical region labels, ranging from organ-level boundaries to fine-grained lesions. Based on this foundation, we propose Med-GLIP, a modality-aware grounding framework trained on Med-GLIP-5M. Rather than relying on explicitly designed expert modules, Med-GLIP implicitly acquires hierarchical semantic understanding from diverse training data -- enabling it to recognize multi-granularity structures, such as distinguishing lungs from pneumonia lesions. Extensive experiments demonstrate that Med-GLIP consistently outperforms state-of-the-art baselines across multiple grounding benchmarks. Furthermore, integrating its spatial outputs into downstream tasks, including medical VQA and report generation, leads to substantial performance gains. Our dataset will be released soon.

Medical phrase grounding is crucial for identifying relevant regions in medical images based on phrase queries, facilitating accurate image analysis and diagnosis. However, current methods rely on manual extraction of key phrases from medical reports, reducing efficiency and increasing the workload for clinicians. Additionally, the lack of model confidence estimation limits clinical trust and usability. In this paper, we introduce a novel task called Medical Report Grounding (MRG), which aims to directly identify diagnostic phrases and their corresponding grounding boxes from medical reports in an end-to-end manner. To address this challenge, we propose uMedGround, a robust and reliable framework that leverages a multimodal large language model to predict diagnostic phrases by embedding a unique token, <BOX>, into the vocabulary to enhance detection capabilities. A vision encoder-decoder processes the embedded token and input image to generate grounding boxes. Critically, uMedGround incorporates an uncertainty-aware prediction model, significantly improving the robustness and reliability of grounding predictions. Experimental results demonstrate that uMedGround outperforms state-of-the-art medical phrase grounding methods and fine-tuned large visual-language models, validating its effectiveness and reliability. This study represents a pioneering exploration of the MRG task, marking the first-ever endeavor in this domain. Additionally, we demonstrate the applicability of uMedGround in medical visual question answering and class-based localization tasks, where it highlights visual evidence aligned with key diagnostic phrases, supporting clinicians in interpreting various types of textual inputs, including free-text reports, visual question answering queries, and class labels.

Accurately grounding regions of interest (ROIs) is critical for diagnosis and treatment planning in medical imaging. While multimodal large language models (MLLMs) combine visual perception with natural language, current medical-grounding pipelines still rely on supervised fine-tuning with explicit spatial hints, making them ill-equipped to handle the implicit queries common in clinical practice. This work makes three core contributions. We first define Unified Medical Reasoning Grounding (UMRG), a novel vision-language task that demands clinical reasoning and pixel-level grounding. Second, we release U-MRG-14K, a dataset of 14K samples featuring pixel-level masks alongside implicit clinical queries and reasoning traces, spanning 10 modalities, 15 super-categories, and 108 specific categories. Finally, we introduce MedReasoner, a modular framework that distinctly separates reasoning from segmentation: an MLLM reasoner is optimized with reinforcement learning, while a frozen segmentation expert converts spatial prompts into masks, with alignment achieved through format and accuracy rewards. MedReasoner achieves state-of-the-art performance on U-MRG-14K and demonstrates strong generalization to unseen clinical queries, underscoring the significant promise of reinforcement learning for interpretable medical grounding.

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

We introduce PhysicianBench, a benchmark for evaluating LLM agents on physician tasks grounded in real clinical setting within electronic health record (EHR) environments. Existing medical agent benchmarks primarily focus on static knowledge recall, single-step atomic actions, or action intent without verifiable execution against the environment. As a result, they fail to capture the long-horizon, composite workflows that characterize real clinical systems. PhysicianBench comprises 100 long-horizon tasks adapted from real consultation cases between primary care and subspecialty physicians, with each task independently reviewed by a separate panel of physicians. Tasks are instantiated in an EHR environment with real patient records and accessed through the same standard APIs used by commercial EHR vendors. Tasks span 21 specialties (e.g., cardiology, endocrinology, oncology, psychiatry) and diverse workflow types (e.g., diagnosis interpretation, medication prescribing, treatment planning), requiring an average of 27 tool calls per task. Solving each task requires retrieving data across encounters, reasoning over heterogeneous clinical information, executing consequential clinical actions, and producing clinical documentation. Each task is decomposed into structured checkpoints (670 in total across the benchmark) capturing distinct stages of completion graded by task-specific scripts with execution-grounded verification. Across 13 proprietary and open-source LLM agents, the best-performing model achieves only 46% success rate (pass@1), while open-source models reach at most 19%, revealing a substantial gap between current agent capabilities and the demands of real-world clinical workflows. PhysicianBench provides a realistic and execution-grounded benchmark for measuring progress toward autonomous clinical agents.

Open medical language models have converged on a single scale: every widely used system runs at 7B parameters or more, leaving the sub-billion regime uncharacterized. We present MedLLM, an open 0.1B-parameter medical language model trained through a fully open three-phase pipeline: general pretraining with curriculum sequence-length scheduling, domain fine-tuning on MedFineWeb, a reference-guided medical corpus we release that is selected from general web data by embedding similarity to medical question-answering (QA) data, and preference-aligned fine-tuning combining SFT with direct preference optimization (DPO). Across medical benchmarks, MedLLM shows a pattern visible only at sub-billion scale: medical competence does not degrade uniformly under compression but splits by task type. On context-grounded QA it comes within 2.9pp of a medically adapted 7B model and surpasses the instruction-tuned and general-purpose 7B baselines; on knowledge-recall QA it stays near the task floor on clinical-vignette MedQA yet significantly exceeds every 7B and sub-7B baseline on MedMCQA, indicating that where recall fails the constraint is model capacity rather than adaptation. This dissociation is masked at 7B, where both capabilities are present, and surfaces only when capacity is scarce.

Large language models (LLMs) trained with next-word-prediction have achieved success as clinical foundation models. Representations from these language backbones yield strong linear probe performance across biomedical tasks, suggesting that patient semantics emerge from next-token prediction at scale. However, this paradigm treats patients as a document to be summarized rather than a dynamical system to be simulated; a patient's trajectory emerges from their state evolving under interventions and time, requiring models that simulate dynamics rather than predict tokens. To address this, we introduce SMB-Structure, a world model for structured EHR that grounds a joint-embedding prediction architecture (JEPA) with next-token prediction (SFT). SFT grounds our model to reconstruct future patient states in token space, while JEPA predicts those futures in latent space from the initial patient representation alone, forcing trajectory dynamics to be encoded before the next state is observed. We validate across two large-scale cohorts: Memorial Sloan Kettering (23,319 oncology patients; 323,000+ patient-years) and INSPECT (19,402 pulmonary embolism patients). Using a linear probe evaluated at multiple points along the disease trajectory, we demonstrate that our training paradigm learns embeddings that capture disease dynamics not recoverable by autoregressive baselines, enabling SMB-Structure to achieve competitive performance on complex tasks characterized by high patient heterogeneity. Model weights are available at https://huggingface.co/standardmodelbio/SMB-v1-1.7B-Structure.

Vision-grounded medical report generation aims to produce clinically accurate descriptions of medical images, anchored in explicit visual evidence to improve interpretability and facilitate integration into clinical workflows. However, existing methods often rely on separately trained detection modules that require extensive expert annotations, introducing high labeling costs and limiting generalizability due to pathology distribution bias across datasets. To address these challenges, we propose Self-Supervised Anatomical Consistency Learning (SS-ACL) -- a novel and annotation-free framework that aligns generated reports with corresponding anatomical regions using simple textual prompts. SS-ACL constructs a hierarchical anatomical graph inspired by the invariant top-down inclusion structure of human anatomy, organizing entities by spatial location. It recursively reconstructs fine-grained anatomical regions to enforce intra-sample spatial alignment, inherently guiding attention maps toward visually relevant areas prompted by text. To further enhance inter-sample semantic alignment for abnormality recognition, SS-ACL introduces a region-level contrastive learning based on anatomical consistency. These aligned embeddings serve as priors for report generation, enabling attention maps to provide interpretable visual evidence. Extensive experiments demonstrate that SS-ACL, without relying on expert annotations, (i) generates accurate and visually grounded reports -- outperforming state-of-the-art methods by 10\% in lexical accuracy and 25\% in clinical efficacy, and (ii) achieves competitive performance on various downstream visual tasks, surpassing current leading visual foundation models by 8\% in zero-shot visual grounding.

Clinical question answering over electronic health records (EHRs) can help clinicians and patients access relevant medical information more efficiently. However, many recent approaches rely on large cloud-based models, which are difficult to deploy in clinical environments due to privacy constraints and computational requirements. In this work, we investigate how far grounded EHR question answering can be pushed when restricted to a single notebook. We participate in all four subtasks of the ArchEHR-QA 2026 shared task and evaluate several approaches designed to run on commodity hardware. All experiments are conducted locally without external APIs or cloud infrastructure. Our results show that such systems can achieve competitive performance on the shared task leaderboards. In particular, our submissions perform above average in two subtasks, and we observe that smaller models can approach the performance of much larger systems when properly configured. These findings suggest that privacy-preserving EHR QA systems running fully locally are feasible with current models and commodity hardware. The source code is available at https://github.com/ibrahimey/ArchEHR-QA-2026.

Medical triage is the task of allocating medical resources and prioritizing patients based on medical need. This paper introduces the first large-scale public dataset for studying medical triage in the context of asynchronous outpatient portal messages. Our novel task formulation views patient message triage as a pairwise inference problem, where we train LLMs to choose `"which message is more medically urgent" in a head-to-head tournament-style re-sort of a physician's inbox. Our novel benchmark PMR-Bench contains 1569 unique messages and 2,000+ high-quality test pairs for pairwise medical urgency assessment alongside a scalable training data generation pipeline. PMR-Bench includes samples that contain both unstructured patient-written messages alongside real electronic health record (EHR) data, emulating a real-world medical triage scenario. We develop a novel automated data annotation strategy to provide LLMs with in-domain guidance on this task. The resulting data is used to train two model classes, UrgentReward and UrgentSFT, leveraging Bradley-Terry and next token prediction objective, respectively to perform pairwise urgency classification. We find that UrgentSFT achieves top performance on PMR-Bench, with UrgentReward showing distinct advantages in low-resource settings. For example, UrgentSFT-8B and UrgentReward-8B provide a 15- and 16-point boost, respectively, on inbox sorting metrics over off-the-shelf 8B models. Paper resources can be found at https://tinyurl.com/Patient-Message-Triage

The electrocardiogram (ECG) is a cost-effective, highly accessible and widely employed diagnostic tool. With the advent of Foundation Models (FMs), the field of AI-assisted ECG interpretation has begun to evolve, as they enable model reuse across different tasks by relying on embeddings. However, to responsibly employ FMs, it is crucial to rigorously assess to which extent the embeddings they produce are generalizable, particularly in error-sensitive domains such as healthcare. Although prior works have already addressed the problem of benchmarking ECG-expert FMs, they focus predominantly on the evaluation of downstream performance. To fill this gap, this study aims to find an in-depth, comprehensive benchmarking framework for FMs, with a specific focus on ECG-expert ones. To this aim, we introduce a benchmark methodology that complements performance-based evaluation with representation-level analysis, leveraging SHAP and UMAP techniques. Furthermore, we rely on the methodology for carrying out an extensive evaluation of several ECG-expert FMs pretrained via state-of-the-art techniques over different cross-continental datasets and data availability settings; this includes ones featuring data scarcity, a fairly common situation in real-world medical scenarios. Experimental results show that our benchmarking protocol provides a rich insight of ECG-expert FMs' embedded patterns, enabling a deeper understanding of their representational structure and generalizability.

Multimodal large language models (MLLMs) hold immense potential to revolutionize clinical practice, yet deploying them in the medical domain is fundamentally a vision-centric challenge: models must absorb knowledge from heterogeneous 2D and 3D medical images, and evaluation protocols must align with radiologists' clinical practice and provide an accurate, fine-grained and factualness-driven assessment. In this paper, we introduce ClinFusion, a vision-centric MLLM designed for holistic medical understanding that systematically addresses these limitations. We propose a compositional and cascaded vision encoder architecture featuring a Cascade Spatial-Aware Locality Fusion operator that unifies diverse 2D and native 3D medical image understanding within a fused encoder. We further introduce a vision-grounded evaluation framework, including MedIF-Bench for instruction-following assessment and a region-of-interest-grounded method for clinically aligned and factualness-driven report generation evaluation. We show that ClinFusion sets a new state-of-the-art across a comprehensive suite of 2D and 3D multimodal medical benchmarks---spanning visual question answering, report generation, and instruction following---as well as textual medical tasks, outperforming leading open-source medical MLLMs (e.g., Hulu-Med, Lingshu) on 20 out of 24 benchmarks and demonstrating multimodal capabilities better than powerful proprietary models such as GPT-5.2 and Gemini-3-Flash on 13 out of 16 benchmarks, and can be further augmented with agentic tool use for retrieval-augmented and tool-assisted clinical workflows. A blinded evaluation by board-certified radiologists confirms that ClinFusion produces the highest-ranked reports, and validates our RoI-grounded metric as achieving the strongest correlation with expert judgment among all automatic evaluation metrics examined.

Grounded generation aims to equip language models (LMs) with the ability to produce more credible and accountable responses by accurately citing verifiable sources. However, existing methods, by either feeding LMs with raw or preprocessed materials, remain prone to errors. To address this, we introduce CaLM, a novel verification framework. CaLM leverages the insight that a robust grounded response should be consistent with information derived solely from its cited sources. Our framework empowers smaller LMs, which rely less on parametric memory and excel at processing relevant information given a query, to validate the output of larger LMs. Larger LM responses that closely align with the smaller LMs' output, which relies exclusively on cited documents, are verified. Responses showing discrepancies are iteratively refined through a feedback loop. Experiments on three open-domain question-answering datasets demonstrate significant performance gains of 1.5% to 7% absolute average without any required model fine-tuning.

Large language models (LLMs) integrated into agent-driven workflows hold immense promise for healthcare, yet a significant gap exists between their potential and practical implementation within clinical settings. To address this, we present a practitioner-oriented field manual for deploying generative agents that use electronic health record (EHR) data. This guide is informed by our experience deploying the "irAE-Agent", an automated system to detect immune-related adverse events from clinical notes at Mass General Brigham, and by structured interviews with 21 clinicians, engineers, and informatics leaders involved in the project. Our analysis reveals a critical misalignment in clinical AI development: less than 20% of our effort was dedicated to prompt engineering and model development, while over 80% was consumed by the sociotechnical work of implementation. We distill this effort into five "heavy lifts": data integration, model validation, ensuring economic value, managing system drift, and governance. By providing actionable solutions for each of these challenges, this field manual shifts the focus from algorithmic development to the essential infrastructure and implementation work required to bridge the "valley of death" and successfully translate generative AI from pilot projects into routine clinical care.

Large language models (LLMs) have achieved strong performance on medical exam-style tasks, motivating growing interest in their deployment in real-world clinical settings. However, clinical decision-making is inherently safety-critical, context-dependent, and conducted under evolving evidence. In such situations, reliable LLM performance depends not on factual recall alone, but on robust medical reasoning. In this work, we present a comprehensive review of medical reasoning with LLMs. Grounded in cognitive theories of clinical reasoning, we conceptualize medical reasoning as an iterative process of abduction, deduction, and induction, and organize existing methods into seven major technical routes spanning training-based and training-free approaches. We further conduct a unified cross-benchmark evaluation of representative medical reasoning models under a consistent experimental setting, enabling a more systematic and comparable assessment of the empirical impact of existing methods. To better assess clinically grounded reasoning, we introduce MR-Bench, a benchmark derived from real-world hospital data. Evaluations on MR-Bench expose a pronounced gap between exam-level performance and accuracy on authentic clinical decision tasks. Overall, this survey provides a unified view of existing medical reasoning methods, benchmarks, and evaluation practices, and highlights key gaps between current model performance and the requirements of real-world clinical reasoning.

Spatial reasoning and visual grounding are core capabilities for vision-language models (VLMs), yet most medical VLMs produce predictions without transparent reasoning or spatial evidence. Existing benchmarks also evaluate VLMs on isolated 2D images, overlooking the volumetric nature of clinical imaging, where findings can span multiple frames or appear on only a few slices. We introduce Spatially Grounded MRI Visual Question Answering (SGMRI-VQA), a 41,307-pair benchmark for multi-frame, spatially grounded reasoning on volumetric MRI. Built from expert radiologist annotations in the fastMRI+ dataset across brain and knee studies, each QA pair includes a clinician-aligned chain-of-thought trace with frame-indexed bounding box coordinates. Tasks are organized hierarchically across detection, localization, counting/classification, and captioning, requiring models to jointly reason about what is present, where it is, and across which frames it extends. We benchmark 10 VLMs and show that supervised fine-tuning of Qwen3-VL-8B with bounding box supervision consistently improves grounding performance over strong zero-shot baselines, indicating that targeted spatial supervision is an effective path toward grounded clinical reasoning.

The rapid evolution of artificial intelligence, especially in large language models (LLMs), has significantly impacted various domains, including healthcare. In chest X-ray (CXR) analysis, previous studies have employed LLMs, but with limitations: either underutilizing the multi-tasking capabilities of LLMs or lacking clinical accuracy. This paper presents M4CXR, a multi-modal LLM designed to enhance CXR interpretation. The model is trained on a visual instruction-following dataset that integrates various task-specific datasets in a conversational format. As a result, the model supports multiple tasks such as medical report generation (MRG), visual grounding, and visual question answering (VQA). M4CXR achieves state-of-the-art clinical accuracy in MRG by employing a chain-of-thought prompting strategy, in which it identifies findings in CXR images and subsequently generates corresponding reports. The model is adaptable to various MRG scenarios depending on the available inputs, such as single-image, multi-image, and multi-study contexts. In addition to MRG, M4CXR performs visual grounding at a level comparable to specialized models and also demonstrates outstanding performance in VQA. Both quantitative and qualitative assessments reveal M4CXR's versatility in MRG, visual grounding, and VQA, while consistently maintaining clinical accuracy.

Fine-grained visual representations are essential for medical image analysis, particularly when diagnostically relevant evidence is subtle and spatially localized. Modern transformer-based medical vision encoders must therefore learn patch-level representations that are both clinically meaningful and spatially consistent. Without these properties, large vision-language models (LVLMs) operate on an ambiguous visual foundation, limiting their ability to generate clinically reliable and spatially grounded responses. However, existing training strategies for medical vision encoders rarely achieve both objectives. Image-text alignment provides clinically meaningful supervision primarily at the image level, leaving the spatial localization of diagnostic evidence weakly constrained. In contrast, self-supervised learning promotes spatial consistency but lacks the semantic supervision needed to distinguish visually similar yet clinically distinct regions. To address this gap, we present LoFi, a medical vision foundation model built on location-aware fine-grained representation learning. LoFi trains a vision encoder with a lightweight large language model under grounding and grounded captioning objectives. Because these objectives require predicting location from clinical text and vice versa, spatial consistency emerges without any explicit patch-level regularization. To enable training at scale, we construct MedG, a large-scale medical grounding dataset of 4.48M image-text-box triplets curated from 84 datasets spanning 7 modalities. Across phrase grounding, visual question answering, and region-based organ classification under perturbations, LoFi consistently outperforms general-purpose and medical vision foundation models as well as state-of-the-art LVLMs. Code is available at https://github.com/myeongkyunkang/lofi-medg.

Multimodal Large Language Models (MLLMs) inherit the superior text understanding capabilities of LLMs and extend these capabilities to multimodal scenarios. These models achieve excellent results in the general domain of multimodal tasks. However, in the medical domain, the substantial training costs and the requirement for extensive medical data pose challenges to the development of medical MLLMs. Furthermore, due to the free-text form of answers, tasks such as visual grounding that need to produce output in a prescribed form become difficult for MLLMs. So far, there have been no medical MLLMs works in medical visual grounding area. For the medical vision grounding task, which involves identifying locations in medical images based on short text descriptions, we propose Parameter-efficient Fine-tuning medical multimodal large language models for Medcial Visual Grounding (PFMVG). To validate the performance of the model, we evaluate it on a public benchmark dataset for medical visual grounding, where it achieves competitive results, and significantly outperforming GPT-4v. Our code will be open sourced after peer review.

Foundation models (FMs) trained on electronic health records (EHRs) have shown strong performance on a range of clinical prediction tasks. However, adapting these models to local health systems remains challenging due to limited data availability and resource constraints. In this study, we investigated what these models learn and evaluated the transferability of an FM trained on MIMIC-IV to an institutional EHR dataset at the University of Chicago Medical Center. We assessed their ability to identify outlier patients and examined representation-space patient trajectories in relation to future clinical outcomes. We also evaluated the performance of supervised fine-tuned classifiers on both source and target datasets. Our findings offer insights into the adaptability of FMs across different healthcare systems, highlight considerations for their effective implementation, and provide an empirical analysis of the underlying factors that contribute to their predictive performance.

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

Multimodal Large Language Models (MLLMs) are increasingly deployed in human-facing roles where personality perception is critical, yet existing benchmarks evaluate this capability solely on numerical Big Five score prediction, leaving open whether models truly perceive personality through behavioral understanding or merely prejudge through superficial pattern matching. We address this gap with three contributions. (i) A new task: we formalize Grounded Personality Reasoning (GPR), which requires MLLMs to anchor each Big Five rating in observable evidence through a chain of rating, reasoning, and grounding. (ii) A new dataset: we release MM-OCEAN (1,104 videos, 5,320 MCQs), produced by a multi-agent pipeline with human verification, with timestamped behavioral observations, evidence-grounded trait analyses, and seven categories of cue-grounding MCQs. (iii) Benchmark and analysis: we design a three-tier evaluation (rating, reasoning, grounding) plus four sample-level failure-mode metrics: Prejudice Rate (PR), Confabulation Rate (CR), Integration-failure Rate (IR), and Holistic-grounding Rate (HR), and benchmark 27 MLLMs (13 closed, 14 open). The analysis uncovers a striking Prejudice Gap: across the field, 51% of correct ratings are not grounded in retrieved cues, and the Holistic-Grounding Rate spans only 0-33.5%. These findings expose a disconnect between getting the right score and reasoning for the right reason, charting a roadmap for grounded social cognition in MLLMs.

Predicting disease trajectories from electronic health records (EHRs) is a complex task due to major challenges such as data non-stationarity, high granularity of medical codes, and integration of multimodal data. EHRs contain both structured data, such as diagnostic codes, and unstructured data, such as clinical notes, which hold essential information often overlooked. Current models, primarily based on structured data, struggle to capture the complete medical context of patients, resulting in a loss of valuable information. To address this issue, we propose an approach that integrates unstructured clinical notes into transformer-based deep learning models for sequential disease prediction. This integration enriches the representation of patients' medical histories, thereby improving the accuracy of diagnosis predictions. Experiments on MIMIC-IV datasets demonstrate that the proposed approach outperforms traditional models relying solely on structured data.

Large visual language models (VLMs) have shown strong multi-modal medical reasoning ability, but most operate as end-to-end black boxes, diverging from clinicians' evidence-based, staged workflows and hindering clinical accountability. Complementarily, expert visual grounding models can accurately localize regions of interest (ROIs), providing explicit, reliable evidence that improves both reasoning accuracy and trust. In this paper, we introduce CARE, advancing Clinical Accountability in multi-modal medical Reasoning with an Evidence-grounded agentic framework. Unlike existing approaches that couple grounding and reasoning within a single generalist model, CARE decomposes the task into coordinated sub-modules to reduce shortcut learning and hallucination: a compact VLM proposes relevant medical entities; an expert entity-referring segmentation model produces pixel-level ROI evidence; and a grounded VLM reasons over the full image augmented by ROI hints. The VLMs are optimized with reinforcement learning with verifiable rewards to align answers with supporting evidence. Furthermore, a VLM coordinator plans tool invocation and reviews evidence-answer consistency, providing agentic control and final verification. Evaluated on standard medical VQA benchmarks, our CARE-Flow (coordinator-free) improves average accuracy by 10.9% over the same size (10B) state-of-the-art (SOTA). With dynamic planning and answer review, our CARE-Coord yields a further gain, outperforming the heavily pre-trained SOTA by 5.2%. Our experiments demonstrate that an agentic framework that emulates clinical workflows, incorporating decoupled specialized models and explicit evidence, yields more accurate and accountable medical AI. Project page: https://xypb.github.io/CARE-Project-Page/

Hospitals struggle to predict critical outcomes. Traditional early warning systems, like NEWS and MEWS, rely on static variables and fixed thresholds, limiting their adaptability, accuracy, and personalization. We previously developed the Enhanced Transformer for Health Outcome Simulation (ETHOS), an AI model that tokenizes patient health timelines (PHTs) from EHRs and uses transformer-based architectures to predict future PHTs. ETHOS is a versatile framework for developing a wide range of applications. In this work, we develop the Adaptive Risk Estimation System (ARES) that leverages ETHOS to compute dynamic, personalized risk probabilities for clinician-defined critical events. ARES also features a personalized explainability module that highlights key clinical factors influencing risk estimates. We evaluated ARES using the MIMIC-IV v2.2 dataset together with its Emergency Department (ED) extension and benchmarked performance against both classical early warning systems and contemporary machine learning models. The entire dataset was tokenized resulting in 285,622 PHTs, comprising over 360 million tokens. ETHOS outperformed benchmark models in predicting hospital admissions, ICU admissions, and prolonged stays, achieving superior AUC scores. Its risk estimates were robust across demographic subgroups, with calibration curves confirming model reliability. The explainability module provided valuable insights into patient-specific risk factors. ARES, powered by ETHOS, advances predictive healthcare AI by delivering dynamic, real-time, personalized risk estimation with patient-specific explainability. Although our results are promising, the clinical impact remains uncertain. Demonstrating ARES's true utility in real-world settings will be the focus of our future work. We release the source code to facilitate future research.

Multimodal large language models (MLLMs) have rapidly advanced, yet their adoption in medicine remains limited by gaps in domain coverage, modality alignment, and grounded reasoning. In this work, we introduce MedMO, a medical foundation model built upon a generalized MLLM architecture and trained exclusively on large-scale, domain-specific data. MedMO follows a multi-stage training recipe: (i) cross-modal pretraining to align heterogeneous visual encoders with a medical language backbone; (ii) instruction tuning on multi-task supervision that spans captioning, VQA, report generation, retrieval, and grounded disease localization with bounding boxes; and (iii) reinforcement learning with verifiable rewards that combine factuality checks with a box-level GIoU reward to strengthen spatial grounding and step-by-step reasoning in complex clinical scenarios. MedMO consistently outperforms strong open-source medical MLLMs across multiple modalities and tasks. On VQA benchmarks, MedMO achieves an average accuracy improvement of +13.7% over the baseline and performs within 1.9% of the SOTA Fleming-VL. For text-based QA, it attains +6.9% over the baseline and +14.5% over Fleming-VL. In medical report generation, MedMO delivers significant gains in both semantic and clinical accuracy. Moreover, it exhibits strong grounding capability, achieving an IoU improvement of +40.4 over the baseline and +37.0% over Fleming-VL, underscoring its robust spatial reasoning and localization performance. Evaluations across radiology, ophthalmology, and pathology-microscopy confirm MedMO's broad cross-modality generalization. We release two versions of MedMO: 4B and 8B. Project is available at https://genmilab.github.io/MedMO-Page

Medical vision-language models can automate the generation of radiology reports but struggle with accurate visual grounding and factual consistency. Existing models often misalign textual findings with visual evidence, leading to unreliable or weakly grounded predictions. We present CURE, an error-aware curriculum learning framework that improves grounding and report quality without any additional data. CURE fine-tunes a multimodal instructional model on phrase grounding, grounded report generation, and anatomy-grounded report generation using public datasets. The method dynamically adjusts sampling based on model performance, emphasizing harder samples to improve spatial and textual alignment. CURE improves grounding accuracy by +0.37 IoU, boosts report quality by +0.188 CXRFEScore, and reduces hallucinations by 18.6%. CURE is a data-efficient framework that enhances both grounding accuracy and report reliability. Code is available at https://github.com/PabloMessina/CURE and model weights at https://huggingface.co/pamessina/medgemma-4b-it-cure

Knowledge grounded dialogue system is designed to generate responses that convey information from given knowledge documents. However, it's a challenge for the current Seq2Seq model to acquire knowledge from complex documents and integrate it to perform correct responses without the aid of an explicit semantic structure. To address these issues, we present a novel graph structure, Ground Graph (G^2), which models the semantic structure of both dialogue contexts and knowledge documents to facilitate knowledge selection and integration for the task. Besides, a Ground Graph Aware Transformer (G^2AT) is proposed to enhance knowledge grounded response generation. Empirical results show that our proposed model outperforms previous state-of-the-art methods with more than 10\% and 20\% gains on response generation and factual consistency. Furthermore, our structure-aware approach shows excellent generalization ability in resource-limited situations.

Large Language Models have demonstrated profound utility in the medical domain. However, their application to autonomous Electronic Health Records~(EHRs) navigation remains constrained by a reliance on curated inputs and simplified retrieval tasks. To bridge the gap between idealized experimental settings and realistic clinical environments, we present AgentEHR. This benchmark challenges agents to execute complex decision-making tasks, such as diagnosis and treatment planning, requiring long-range interactive reasoning directly within raw and high-noise databases. In tackling these tasks, we identify that existing summarization methods inevitably suffer from critical information loss and fractured reasoning continuity. To address this, we propose RetroSum, a novel framework that unifies a retrospective summarization mechanism with an evolving experience strategy. By dynamically re-evaluating interaction history, the retrospective mechanism prevents long-context information loss and ensures unbroken logical coherence. Additionally, the evolving strategy bridges the domain gap by retrieving accumulated experience from a memory bank. Extensive empirical evaluations demonstrate that RetroSum achieves performance gains of up to 29.16% over competitive baselines, while significantly decreasing total interaction errors by up to 92.3%.

Our approach, which we call Embeddings for Language/Image-aligned X-Rays, or ELIXR, leverages a language-aligned image encoder combined or grafted onto a fixed LLM, PaLM 2, to perform a broad range of tasks. We train this lightweight adapter architecture using images paired with corresponding free-text radiology reports from the MIMIC-CXR dataset. ELIXR achieved state-of-the-art performance on zero-shot chest X-ray (CXR) classification (mean AUC of 0.850 across 13 findings), data-efficient CXR classification (mean AUCs of 0.893 and 0.898 across five findings (atelectasis, cardiomegaly, consolidation, pleural effusion, and pulmonary edema) for 1% (~2,200 images) and 10% (~22,000 images) training data), and semantic search (0.76 normalized discounted cumulative gain (NDCG) across nineteen queries, including perfect retrieval on twelve of them). Compared to existing data-efficient methods including supervised contrastive learning (SupCon), ELIXR required two orders of magnitude less data to reach similar performance. ELIXR also showed promise on CXR vision-language tasks, demonstrating overall accuracies of 58.7% and 62.5% on visual question answering and report quality assurance tasks, respectively. These results suggest that ELIXR is a robust and versatile approach to CXR AI.

Large vision language models (VLMs) report strong accuracy on medical question-answering, yet it remains unclear whether they reason from visual evidence or exploit textual shortcuts. We introduce a counterfactual evaluation framework that decouples visual and textual contributions by substituting input images with controlled surrogates blank, pixel-shuffled, image-absent, and CLIP-retrieved hard negatives and derive a suite of grounding metrics including the Visual Reliance Score (VRS) and Visual Hallucination Rate (VHR). We further introduce CORAL (COntrastive Retrieval-Augmented Learning), a 7B-parameter LoRA fine-tune of Qwen2.5-VL-7B trained with a Contrastive Grounding Objective (CGO) that penalises answer invariance under hard-negative image swaps. On a paired controlled evaluation across four closed-form medical VQA benchmarks (PathVQA, PMC-VQA, SLAKE, VQA-RAD; n=400 total), CORAL improves macro accuracy by +6.7 pp (P(Delta>0)=0.988) and reduces VHR by 8.0 pp (P<0.001) over the matched Qwen2.5-VL-7B base; neither MedVLThinker RL variant achieves a significant gain on either metric. Cross-domain diagnostics further reveal that image substitution costs only <=6.5 pp on medical benchmarks versus 48-61 pp on general-domain tasks, situating the grounding gap that CGO targets. We discuss evaluation limitations openly including train/eval benchmark overlap and underpowered secondary metrics and release our framework, training code, and model weights to support reproducible grounding audits of medical VLMs.

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

Generative models trained using self-supervision of tokenized electronic health record (EHR) timelines show promise for clinical outcome prediction. This is typically done using Monte Carlo simulation for future patient trajectories. However, existing approaches suffer from three key limitations: sparse estimate distributions that poorly differentiate patient risk levels, extreme computational costs, and high sampling variance. We propose two new estimators: the Sum of Conditional Outcome Probability Estimator (SCOPE) and Risk Estimation from Anticipated Conditional Hazards (REACH), that leverage next-token probability distributions discarded by standard Monte Carlo. We prove both estimators are unbiased and that REACH guarantees variance reduction over Monte Carlo sampling for any model and outcome. Empirically, on hospital mortality prediction in MIMIC-IV using the ETHOS-ARES framework, SCOPE and REACH match 100-sample Monte Carlo performance using only 10-11 samples (95% CI: [9,11]), representing a ~10x reduction in inference cost without degrading calibration. For ICU admission prediction, efficiency gains are more modest (~1.2x), which we attribute to the outcome's lower "spontaneity," a property we characterize theoretically and empirically. These methods substantially improve the feasibility of deploying generative EHR models in resource-constrained clinical settings.

Medical Vision-Language Models (Med-VLMs) have achieved expert-level proficiency in interpreting diagnostic imaging. However, current models are predominantly trained on professional literature, limiting their ability to communicate findings in the lay register required for patient-centered care. While text-centric research has actively developed resources for simplifying medical jargon, there is a critical absence of large-scale multimodal benchmarks designed to facilitate lay-accessible medical image understanding. To bridge this resource gap, we introduce MedLayBench-V, the first large-scale multimodal benchmark dedicated to expert-lay semantic alignment. Unlike naive simplification approaches that risk hallucination, our dataset is constructed via a Structured Concept-Grounded Refinement (SCGR) pipeline. This method enforces strict semantic equivalence by integrating Unified Medical Language System (UMLS) Concept Unique Identifiers (CUIs) with micro-level entity constraints. MedLayBench-V provides a verified foundation for training and evaluating next-generation Med-VLMs capable of bridging the communication divide between clinical experts and patients.

Medical Vision-Language Models (VLMs) hold immense promise for complex clinical tasks, but their reasoning capabilities are often constrained by text-only paradigms that fail to ground inferences in visual evidence. This limitation not only curtails performance on tasks requiring fine-grained visual analysis but also introduces risks of visual hallucination in safety-critical applications. Thus, we introduce MedVR, a novel reinforcement learning framework that enables annotation-free visual reasoning for medical VLMs. Its core innovation lies in two synergistic mechanisms: Entropy-guided Visual Regrounding (EVR) uses model uncertainty to direct exploration, while Consensus-based Credit Assignment (CCA) distills pseudo-supervision from rollout agreement. Without any human annotations for intermediate steps, MedVR achieves state-of-the-art performance on diverse public medical VQA benchmarks, significantly outperforming existing models. By learning to reason directly with visual evidence, MedVR promotes the robustness and transparency essential for accelerating the clinical deployment of medical AI.

Radiologists routinely compare current and prior chest X-rays to track disease progression, producing follow-up reports that describe multiple findings, each localised to an anatomical region and annotated with a temporal change status. Existing automated methods either generate reports from a single image without modelling temporal context, or incorporate temporal information but do not ground their outputs spatially. The few approaches that combine temporal reasoning with spatial grounding are restricted to single-finding descriptions, leaving multi-finding reports with mixed change directions unaddressed. We present GRCD, a framework for grounded report generation from chest X-ray pairs in the multi-finding setting. We first construct a rigorously cleaned dataset of temporal chest X-ray pairs by identifying and correcting two systematic labelling errors in the source annotations. We then introduce a Region-Guided Change Token module that encodes per-region temporal change across anatomical structures and injects this signal into a language model through a dual-pathway strategy combining prepended spatial tokens with gated cross-attention. On a multi-finding test set, GRCD outperforms existing baselines on text generation and clinical accuracy metrics, with gains in change detection. Ablation studies confirm that the dual-pathway design outperforms either integration strategy in isolation on text and clinical metrics, and that region-level change encoding is necessary for multi-finding generation. Code is available at https://github.com/UTSA-VIRLab/GRCD

Public power-system datasets often lack electromagnetic transient (EMT) waveforms, inverter control dynamics, and diverse disturbance coverage, which limits their usefulness for training surrogate models and studying cyber-physical behavior in inverter-based microgrids. This paper presents a high-fidelity digital twin dataset generated from a MATLAB/Simulink EMT model of a low-voltage AC microgrid with ten inverter-based distributed generators. The dataset records synchronized three-phase PCC voltages and currents, per-DG active power, reactive power, and frequency, together with embedded scenario labels, producing 38 aligned channels sampled at Δt = 2~μs over T = 1~s (N = 500{,}001 samples) per scenario. Eleven operating and disturbance scenarios are included: normal operation, load step, voltage sag (temporary three-phase fault), load ramp, frequency ramp, DG trip, tie-line trip, reactive power step, single-line-to-ground faults, measurement noise injection, and communication delay. To ensure numerical stability without altering sequence length, invalid samples (NaN, Inf, and extreme outliers) are repaired using linear interpolation. Each scenario is further validated using system-level evidence from mean frequency, PCC voltage magnitude, total active power, voltage unbalance, and zero-sequence current to confirm physical observability and correct timing. The resulting dataset provides a consistent, labeled EMT benchmark for surrogate modeling, disturbance classification, robustness testing under noise and delay, and cyber-physical resilience analysis in inverter-dominated microgrids. The dataset and processing scripts will be released upon acceptance

Large language models (LLMs) are increasingly proposed as clinical agents, yet static, single-turn benchmarks cannot capture how a model dynamically delivers care across an encounter: gathering information, planning treatment, and adapting longitudinal management across successive patient states. Medical education has long addressed an analogous challenge through standardized patients (SPs): trained actors who consistently portray clinical cases, enabling realistic practice and objective, scripted assessment. Here we introduce MedSP1000, an SP-derived interactive benchmark for clinical-agent evaluation, including 1,638 SP cases with 24,602 trajectory-level peer-reviewed rubrics. MedSP1000 converts peer-reviewed SP teaching cases into executable scenarios with defined SP case scripts, clinical environment contexts, and human-validated structured rubric. In each simulation evaluation run, a clinical agent interacts in closed loop with a patient agent and an environment controller, and its behaviour is scored throughout the encounter against expert criteria specified in the original materials. Applying MedSP1000 to a range of general-purpose and medically specialized LLMs, we find that performance on static benchmarks does not reliably translate to such educational scenarios. The best-performing model, GPT-5.5, completes only 60.4% of expert-defined rubric items, whereas the strongest medically specialized model reaches 40.0%; increasing test-time compute produces no measurable gain. These results suggest that current LLMs, including agentic systems tuned for medicine, are not yet reliable enough to be safely integrated into actual clinical practice. More broadly, MedSP1000 shows how process-level, SP-style evaluation can reveal clinically relevant failure modes that single-turn benchmarks miss.

Databases of electronic health records (EHRs) are increasingly used to inform clinical decisions. Machine learning methods can find patterns in EHRs that are predictive of future adverse outcomes. However, statistical models may be built upon patterns of health-seeking behavior that vary across patient subpopulations, leading to poor predictive performance when training on one patient population and predicting on another. This note proposes two tests to better measure and understand model generalization. We use these tests to compare models derived from two data sources: (i) historical medical records, and (ii) electrocardiogram (EKG) waveforms. In a predictive task, we show that EKG-based models can be more stable than EHR-based models across different patient populations.

Electrocardiography (ECG) serves as an indispensable diagnostic tool in clinical practice, yet existing multimodal large language models (MLLMs) remain unreliable for ECG interpretation, often producing plausible but clinically incorrect analyses. To address this, we propose ECG-R1, the first reasoning MLLM designed for reliable ECG interpretation via three innovations. First, we construct the interpretation corpus using Protocol-Guided Instruction Data Generation, grounding interpretation in measurable ECG features and monograph-defined quantitative thresholds and diagnostic logic. Second, we present a modality-decoupled architecture with Interleaved Modality Dropout to improve robustness and cross-modal consistency when either the ECG signal or ECG image is missing. Third, we present Reinforcement Learning with ECG Diagnostic Evidence Rewards to strengthen evidence-grounded ECG interpretation. Additionally, we systematically evaluate the ECG interpretation capabilities of proprietary, open-source, and medical MLLMs, and provide the first quantitative evidence that severe hallucinations are widespread, suggesting that the public should not directly trust these outputs without independent verification. Code and data are publicly available at https://github.com/PKUDigitalHealth/ECG-R1{here}, and an online platform can be accessed at http://ai.heartvoice.com.cn/ECG-R1/{here}.

Medical phrase grounding (MPG) aims to locate the most relevant region in a medical image, given a phrase query describing certain medical findings, which is an important task for medical image analysis and radiological diagnosis. However, existing visual grounding methods rely on general visual features for identifying objects in natural images and are not capable of capturing the subtle and specialized features of medical findings, leading to sub-optimal performance in MPG. In this paper, we propose MedRPG, an end-to-end approach for MPG. MedRPG is built on a lightweight vision-language transformer encoder and directly predicts the box coordinates of mentioned medical findings, which can be trained with limited medical data, making it a valuable tool in medical image analysis. To enable MedRPG to locate nuanced medical findings with better region-phrase correspondences, we further propose Tri-attention Context contrastive alignment (TaCo). TaCo seeks context alignment to pull both the features and attention outputs of relevant region-phrase pairs close together while pushing those of irrelevant regions far away. This ensures that the final box prediction depends more on its finding-specific regions and phrases. Experimental results on three MPG datasets demonstrate that our MedRPG outperforms state-of-the-art visual grounding approaches by a large margin. Additionally, the proposed TaCo strategy is effective in enhancing finding localization ability and reducing spurious region-phrase correlations.

Large language models (LLMs) show promise for clinical reasoning and decision support, but evaluation in realistic, electronic health record-congruent settings remains limited. Existing benchmarks often rely on static datasets or unstructured inputs that do not reflect the structured, interoperable data formats used in clinical systems. We introduce a pipeline for generating clinically realistic HL7 FHIR R4 bundles from unstructured text, enabling controllable evaluation of clinical decision support systems. The pipeline combines staged LLM generation with terminology-grounded validation and repair to reduce hallucinated codes and enforce structural and semantic consistency. Applying this approach to MedCaseReasoning, we construct MedCase-Structured, a synthetic dataset aligned with clinician-authored diagnostic cases, achieving valid FHIR generation for 82.5% of cases. Evaluation on MedCase-Structured reveals consistently lower diagnostic accuracy for LLMs on structured FHIR inputs than with plain text, highlighting the importance of deployment-aligned benchmarking.

Foundation Models (FMs) trained on Electronic Health Records (EHRs) have achieved state-of-the-art results on numerous clinical prediction tasks. However, most existing EHR FMs have context windows of <1k tokens. This prevents them from modeling full patient EHRs which can exceed 10k's of events. Recent advancements in subquadratic long-context architectures (e.g., Mamba) offer a promising solution. However, their application to EHR data has not been well-studied. We address this gap by presenting the first systematic evaluation of the effect of context length on modeling EHR data. We find that longer context models improve predictive performance -- our Mamba-based model surpasses the prior state-of-the-art on 9/14 tasks on the EHRSHOT prediction benchmark. For clinical applications, however, model performance alone is insufficient -- robustness to the unique properties of EHR is crucial. Thus, we also evaluate models across three previously underexplored properties of EHR data: (1) the prevalence of "copy-forwarded" diagnoses which creates artificial repetition of tokens within EHR sequences; (2) the irregular time intervals between EHR events which can lead to a wide range of timespans within a context window; and (3) the natural increase in disease complexity over time which makes later tokens in the EHR harder to predict than earlier ones. Stratifying our EHRSHOT results, we find that higher levels of each property correlate negatively with model performance, but that longer context models are more robust to more extreme levels of these properties. Our work highlights the potential for using long-context architectures to model EHR data, and offers a case study for identifying new challenges in modeling sequential data motivated by domains outside of natural language. We release our models and code at: https://github.com/som-shahlab/long_context_clues

Emergency Medical Services (EMS) are critical to patient survival in emergencies, but first responders often face intense cognitive demands in high-stakes situations. AI cognitive assistants, acting as virtual partners, have the potential to ease this burden by supporting real-time data collection and decision making. In pursuit of this vision, we introduce EgoEMS, the first end-to-end, high-fidelity, multimodal, multiperson dataset capturing over 20 hours of realistic, procedural EMS activities from an egocentric view in 233 simulated emergency scenarios performed by 62 participants, including 46 EMS professionals. Developed in collaboration with EMS experts and aligned with national standards, EgoEMS is captured using an open-source, low-cost, and replicable data collection system and is annotated with keysteps, timestamped audio transcripts with speaker diarization, action quality metrics, and bounding boxes with segmentation masks. Emphasizing realism, the dataset includes responder-patient interactions reflecting real-world emergency dynamics. We also present a suite of benchmarks for real-time multimodal keystep recognition and action quality estimation, essential for developing AI support tools for EMS. We hope EgoEMS inspires the research community to push the boundaries of intelligent EMS systems and ultimately contribute to improved patient outcomes.

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

Developing generalist foundation model has recently attracted tremendous attention among researchers in the field of AI for Medicine (AI4Medicine). A pivotal insight in developing these models is their reliance on dataset scaling, which emphasizes the requirements on developing open-source medical image datasets that incorporate diverse supervision signals across various imaging modalities. In this paper, we introduce RadGenome-Chest CT, a comprehensive, large-scale, region-guided 3D chest CT interpretation dataset based on CT-RATE. Specifically, we leverage the latest powerful universal segmentation and large language models, to extend the original datasets (over 25,692 non-contrast 3D chest CT volume and reports from 20,000 patients) from the following aspects: (i) organ-level segmentation masks covering 197 categories, which provide intermediate reasoning visual clues for interpretation; (ii) 665 K multi-granularity grounded reports, where each sentence of the report is linked to the corresponding anatomical region of CT volume in the form of a segmentation mask; (iii) 1.3 M grounded VQA pairs, where questions and answers are all linked with reference segmentation masks, enabling models to associate visual evidence with textual explanations. All grounded reports and VQA pairs in the validation set have gone through manual verification to ensure dataset quality. We believe that RadGenome-Chest CT can significantly advance the development of multimodal medical foundation models, by training to generate texts based on given segmentation regions, which is unattainable with previous relevant datasets. We will release all segmentation masks, grounded reports, and VQA pairs to facilitate further research and development in this field.

Road traffic injuries remain a major challenge in low- and middle-income countries, where proactive road safety auditing is limited by incomplete crash records, shortages of qualified auditors, and the high cost of large-scale field inspections. To address this problem, we propose Expert-Grounded Distillation (EGD), a novel artificial intelligence framework that transfers institutional road safety expertise into a compact vision-language model for scalable visual road safety auditing. The key innovation is a quantified expert-grounding stage in which the teacher vision-language model is calibrated against authoritative field audits. Large-scale annotation is permitted only after the teacher reaches substantial agreement with expert risk assessments (Cohen's kappa = 0.74). The calibrated teacher then generates structured supervision that is distilled into an 8-billion-parameter student vision-language model using Low-Rank Adaptation and a single leakage-free prompt. We also introduce Bangladesh Road Safety Audit (BD-ARSA), the first open, expert-grounded Bangladeshi visual road safety audit dataset containing 21,947 image-audit records with near-national coverage, and Expert-Grounded Road Safety Auditor (EG-ARSA), the first vision-language model developed specifically for this task. Experimental results show that grounded fine-tuning substantially improves ordinal risk assessment over the zero-shot baseline, while blind expert evaluation demonstrates that the compact student outperforms both its 31 billion-parameter teacher and Gemini-2.5-Flash. These findings demonstrate that EGD provides an effective and scalable engineering solution for proactive road safety auditing in resource-constrained environments.

Multimodal Large Language Models have demonstrated powerful cross-modal understanding and reasoning capabilities in general domains. However, in the electromagnetic (EM) domain, they still face challenges such as data scarcity and insufficient integration of domain knowledge. This paper proposes PReD, the first foundation model for the EM domain that covers the intelligent closed-loop of "perception, recognition, decision-making." We constructed a high-quality multitask EM dataset, PReD-1.3M, and an evaluation benchmark, PReD-Bench. The dataset encompasses multi-perspective representations such as raw time-domain waveform, frequency-domain spectrograms, and constellation diagrams, covering typical features of communication and radar signals. It supports a range of core tasks, including signal detection, modulation recognition, parameter estimation, protocol recognition, radio frequency fingerprint recognition, and anti-jamming decision-making. PReD adopts a multi-stage training strategy that unifies multiple tasks for EM signals. It achieves closed-loop optimization from end-to-end signal understanding to language-driven reasoning and decision-making, significantly enhancing EM domain expertise while maintaining general multimodal capabilities. Experimental results show that PReD achieves state-of-the-art performance on PReD-Bench constructed from both open-source and self-collected signal datasets. These results collectively validate the feasibility and potential of vision-aligned foundation models in advancing the understanding and reasoning of EM signals.

In this work, we present a model for document-grounded response generation in dialog that is decomposed into two components according to Bayes theorem. One component is a traditional ungrounded response generation model and the other component models the reconstruction of the grounding document based on the dialog context and generated response. We propose different approximate decoding schemes and evaluate our approach on multiple open-domain and task-oriented document-grounded dialog datasets. Our experiments show that the model is more factual in terms of automatic factuality metrics than the baseline model. Furthermore, we outline how introducing scaling factors between the components allows for controlling the tradeoff between factuality and fluency in the model output. Finally, we compare our approach to a recently proposed method to control factuality in grounded dialog, CTRL (arXiv:2107.06963), and show that both approaches can be combined to achieve additional improvements.

While multimodal large language models (MLLMs) excel in medical applications, most of them favor static images or short-term signals. In the critical field of dynamic electrocardiograms (ECG), models struggle with complex temporal reasoning and diagnostic report generation due to a lack of high-quality datasets and benchmarks. To address this, we introduce (i) Holtercare-23K, a large-scale multimodal dynamic ECG dataset comprising 22,980 QA pairs derived from 788 clinical Holter records and featuring a novel signal-video-text tri-modal alignment. Based on this dataset, we present (ii) Holtercare-Bench, a multimodal benchmark that evaluates models on temporal localization, clinical diagnosis, and global summarization. Zero-shot evaluations of leading MLLMs reveal a significant performance gap in processing ultra-long pathological sequences. However, fine-tuning representative models yields substantial improvements. This work illuminates the limitations of current MLLMs in electrophysiology and provides a foundational benchmark for long-term medical MLLMs. Our project is available at https://github.com/ZJU4HealthCare/Holtercare-Bench.

Electronic health record (EHR) systems are used extensively throughout the healthcare domain. However, data interchangeability between EHR systems is limited due to the use of different coding standards across systems. Existing methods of mapping coding standards based on manual human experts mapping, dictionary mapping, symbolic NLP and classification are unscalable and cannot accommodate large scale EHR datasets. In this work, we present Text2Node, a cross-domain mapping system capable of mapping medical phrases to concepts in a large taxonomy (such as SNOMED CT). The system is designed to generalize from a limited set of training samples and map phrases to elements of the taxonomy that are not covered by training data. As a result, our system is scalable, robust to wording variants between coding systems and can output highly relevant concepts when no exact concept exists in the target taxonomy. Text2Node operates in three main stages: first, the lexicon is mapped to word embeddings; second, the taxonomy is vectorized using node embeddings; and finally, the mapping function is trained to connect the two embedding spaces. We compared multiple algorithms and architectures for each stage of the training, including GloVe and FastText word embeddings, CNN and Bi-LSTM mapping functions, and node2vec for node embeddings. We confirmed the robustness and generalisation properties of Text2Node by mapping ICD-9-CM Diagnosis phrases to SNOMED CT and by zero-shot training at comparable accuracy. This system is a novel methodological contribution to the task of normalizing and linking phrases to a taxonomy, advancing data interchangeability in healthcare. When applied, the system can use electronic health records to generate an embedding that incorporates taxonomical medical knowledge to improve clinical predictive models.

Recent radiology multi-modal language models have made substantial progress in chest X-ray report generation, visual question answering, and temporal reasoning. While longitudinal chest X-ray interpretation compares sequential examinations to describe change, visual grounding aims to connect clinical language with localized image evidence. Although longitudinal modeling and visual grounding have each advanced radiology language models, how localized visual evidence can support longitudinal interpretation remains under-explored. We introduce CheXGround, a region-grounded longitudinal chest X-ray language model that represents paired studies through corresponding anatomical regions. CheXGround extracts anatomical regions from current and prior radiographs, encodes them as temporally enhanced Region-of-Interest (ROI) tokens, and combines them with global temporal image context during generation. To connect these region tokens with clinical text, we propose Temporal Region--Phrase Alignment, a pretraining objective that aligns temporal anatomical representations with localized report phrases. We evaluate CheXGround on single-study and longitudinal Visual Question Answering (VQA), longitudinal findings generation, temporal grounded VQA, and anatomical grounding. Across these tasks, CheXGround improves clinical language quality, temporal reasoning, and localization accuracy over recent baselines. Our results suggest that organizing longitudinal evidence at the anatomical level is a strong representation for grounded radiology language modeling. Project page: https://adonaydem.github.io/chexground-website

Recent advances in large-scale pre-training such as GPT-3 allow seemingly high quality text to be generated from a given prompt. However, such generation systems often suffer from problems of hallucinated facts, and are not inherently designed to incorporate useful external information. Grounded generation models appear to offer remedies, but their training typically relies on rarely-available parallel data where information-relevant documents are provided for context. We propose a framework that alleviates this data constraint by jointly training a grounded generator and document retriever on the language model signal. The model learns to reward retrieval of the documents with the highest utility in generation, and attentively combines them using a Mixture-of-Experts (MoE) ensemble to generate follow-on text. We demonstrate that both generator and retriever can take advantage of this joint training and work synergistically to produce more informative and relevant text in both prose and dialogue generation.

The lack of standardized evaluation benchmarks in the medical domain for text inputs can be a barrier to widely adopting and leveraging the potential of natural language models for health-related downstream tasks. This paper revisited an openly available MIMIC-IV benchmark for electronic health records (EHRs) to address this issue. First, we integrate the MIMIC-IV data within the Hugging Face datasets library to allow an easy share and use of this collection. Second, we investigate the application of templates to convert EHR tabular data to text. Experiments using fine-tuned and zero-shot LLMs on the mortality of patients task show that fine-tuned text-based models are competitive against robust tabular classifiers. In contrast, zero-shot LLMs struggle to leverage EHR representations. This study underlines the potential of text-based approaches in the medical field and highlights areas for further improvement.

Electronic Health Records (EHRs) are integral for storing comprehensive patient medical records, combining structured data (e.g., medications) with detailed clinical notes (e.g., physician notes). These elements are essential for straightforward data retrieval and provide deep, contextual insights into patient care. However, they often suffer from discrepancies due to unintuitive EHR system designs and human errors, posing serious risks to patient safety. To address this, we developed EHRCon, a new dataset and task specifically designed to ensure data consistency between structured tables and unstructured notes in EHRs. EHRCon was crafted in collaboration with healthcare professionals using the MIMIC-III EHR dataset, and includes manual annotations of 3,943 entities across 105 clinical notes checked against database entries for consistency. EHRCon has two versions, one using the original MIMIC-III schema, and another using the OMOP CDM schema, in order to increase its applicability and generalizability. Furthermore, leveraging the capabilities of large language models, we introduce CheckEHR, a novel framework for verifying the consistency between clinical notes and database tables. CheckEHR utilizes an eight-stage process and shows promising results in both few-shot and zero-shot settings. The code is available at https://github.com/dustn1259/EHRCon.

Electronic health records (EHR) contain narrative notes that provide extensive details on the medical condition and management of patients. Natural language processing (NLP) of clinical notes can use observed frequencies of clinical terms as predictive features for downstream applications such as clinical decision making and patient trajectory prediction. However, due to the vast number of highly similar and related clinical concepts, a more effective modeling strategy is to represent clinical terms as semantic embeddings via representation learning and use the low dimensional embeddings as feature vectors for predictive modeling. To achieve efficient representation, fine-tuning pretrained language models with biomedical knowledge graphs may generate better embeddings for biomedical terms than those from standard language models alone. These embeddings can effectively discriminate synonymous pairs of from those that are unrelated. However, they often fail to capture different degrees of similarity or relatedness for concepts that are hierarchical in nature. To overcome this limitation, we propose HiPrBERT, a novel biomedical term representation model trained on additionally complied data that contains hierarchical structures for various biomedical terms. We modify an existing contrastive loss function to extract information from these hierarchies. Our numerical experiments demonstrate that HiPrBERT effectively learns the pair-wise distance from hierarchical information, resulting in a substantially more informative embeddings for further biomedical applications

Clinical decision-making increasingly relies on timely and context-aware access to patient information within Electronic Health Records (EHRs), yet most existing natural language question-answering (QA) systems are evaluated solely on benchmark datasets, limiting their practical relevance. To overcome this limitation, we introduce EHRNavigator, a multi-agent framework that harnesses AI agents to perform patient-level question answering across heterogeneous and multimodal EHR data. We assessed its performance using both public benchmark and institutional datasets under realistic hospital conditions characterized by diverse schemas, temporal reasoning demands, and multimodal evidence integration. Through quantitative evaluation and clinician-validated chart review, EHRNavigator demonstrated strong generalization, achieving 86% accuracy on real-world cases while maintaining clinically acceptable response times. Overall, these findings confirm that EHRNavigator effectively bridges the gap between benchmark evaluation and clinical deployment, offering a robust, adaptive, and efficient solution for real-world EHR question answering.

Online medical consultation (OMC) restricts doctors to gathering patient information solely through inquiries, making the already complex sequential decision-making process of diagnosis even more challenging. Recently, the rapid advancement of large language models has demonstrated a significant potential to transform OMC. However, most studies have primarily focused on improving diagnostic accuracy under conditions of relatively sufficient information, while paying limited attention to the "inquiry" phase of the consultation process. This lack of focus has left the relationship between "inquiry" and "diagnosis" insufficiently explored. In this paper, we first extract real patient interaction strategies from authentic doctor-patient conversations and use these strategies to guide the training of a patient simulator that closely mirrors real-world behavior. By inputting medical records into our patient simulator to simulate patient responses, we conduct extensive experiments to explore the relationship between "inquiry" and "diagnosis" in the consultation process. Experimental results demonstrate that inquiry and diagnosis adhere to the Liebig's law: poor inquiry quality limits the effectiveness of diagnosis, regardless of diagnostic capability, and vice versa. Furthermore, the experiments reveal significant differences in the inquiry performance of various models. To investigate this phenomenon, we categorize the inquiry process into four types: (1) chief complaint inquiry; (2) specification of known symptoms; (3) inquiry about accompanying symptoms; and (4) gathering family or medical history. We analyze the distribution of inquiries across the four types for different models to explore the reasons behind their significant performance differences. We plan to open-source the weights and related code of our patient simulator at https://github.com/LIO-H-ZEN/PatientSimulator.

Medical care follows complex clinical pathways that extend beyond isolated physician-patient encounters, emphasizing decision-making and transitions between different stages. Current benchmarks focusing on static exams or isolated dialogues inadequately evaluate large language models (LLMs) in dynamic clinical scenarios. We introduce CP-Env, a controllable agentic hospital environment designed to evaluate LLMs across end-to-end clinical pathways. CP-Env simulates a hospital ecosystem with patient and physician agents, constructing scenarios ranging from triage and specialist consultation to diagnostic testing and multidisciplinary team meetings for agent interaction. Following real hospital adaptive flow of healthcare, it enables branching, long-horizon task execution. We propose a three-tiered evaluation framework encompassing Clinical Efficacy, Process Competency, and Professional Ethics. Results reveal that most models struggle with pathway complexity, exhibiting hallucinations and losing critical diagnostic details. Interestingly, excessive reasoning steps can sometimes prove counterproductive, while top models tend to exhibit reduced tool dependency through internalized knowledge. CP-Env advances medical AI agents development through comprehensive end-to-end clinical evaluation. We provide the benchmark and evaluation tools for further research and development at https://github.com/SPIRAL-MED/CP_ENV.

Large Language Models (LLMs) have shown strong promise for mining Electronic Health Records (EHRs) by reasoning over longitudinal clinical information to capture context-rich patient trajectories. However, leveraging LLMs for structured EHRs (e.g., standardized diagnosis and medication codes) presents two key challenges. First, translating time-stamped EHR sequences into plain text can obscure both temporal structure and code identities, weakening the ability to capture code co-occurrence and longitudinal regularities. Second, unlike cohort-trained predictive models that learn a shared, task-aligned representation space across patients, LLMs are often applied in a case-isolated inference setting where each patient is processed independently without leveraging population-level patterns. To address these challenges, we introduce RePrompT, a time-aware LLM framework that integrates structured EHR encoders through prompt tuning, without modifying underlying architectures. Specifically, RePrompT recurrently incorporates latent states from prior visits to preserve longitudinal information, and injects population-level information through trainable prompt tokens derived from a cohort-trained, task-aligned EHR encoder. Experiments on MIMIC-III and MIMIC-IV demonstrate that RePrompT consistently outperforms both EHR-based and LLM-based baselines across multiple clinical prediction tasks.

Discharge summaries require extracting critical information from lengthy electronic health records (EHRs), a process that is labor-intensive when performed manually. Large language models (LLMs) can improve generation efficiency; however, they are prone to producing faithfulness hallucinations, statements that contradict source records, posing direct risks to patient safety. To address this, we present CuraView, a multi-agent framework for sentence-level detection and evidence-grounded explanation of faithfulness hallucinations in discharge summaries. CuraView constructs a GraphRAG-based knowledge graph from patient-level EHRs and implements a closed-loop generation-detection pipeline with sentence-level evidence retrieval and classification spanning four evidence grades from strong support to direct contradiction (E1-E4), yielding structured and interpretable evidence chains. We evaluate CuraView on a subset of 250 patients from the Discharge-Me benchmark, with 50 patients held out for testing. Our fine-tuned Qwen3-14B detection model achieves an F1 of 0.831 on the safety-critical E4 metric (90.9% recall, 76.5% precision) and an F1 of 0.823 on E3+E4, representing a 50.0% relative improvement over the base model and outperforming RAGTruth-style and QAGS-style baselines. These results demonstrate that evidence-chain-based graph retrieval verification substantially improves the factual reliability of clinical documentation, while simultaneously producing reusable annotated datasets for downstream model training and distillation.

Most multimodal large language models (MLLMs) learn language-to-object grounding through causal language modeling where grounded objects are captured by bounding boxes as sequences of location tokens. This paradigm lacks pixel-level representations that are important for fine-grained visual understanding and diagnosis. In this work, we introduce GROUNDHOG, an MLLM developed by grounding Large Language Models to holistic segmentation. GROUNDHOG incorporates a masked feature extractor and converts extracted features into visual entity tokens for the MLLM backbone, which then connects groundable phrases to unified grounding masks by retrieving and merging the entity masks. To train GROUNDHOG, we carefully curated M3G2, a grounded visual instruction tuning dataset with Multi-Modal Multi-Grained Grounding, by harvesting a collection of segmentation-grounded datasets with rich annotations. Our experimental results show that GROUNDHOG achieves superior performance on various language grounding tasks without task-specific fine-tuning, and significantly reduces object hallucination. GROUNDHOG also demonstrates better grounding towards complex forms of visual input and provides easy-to-understand diagnosis in failure cases.

We present Clin-JEPA, a multi-phase co-training framework for joint-embedding predictive (JEPA) pretraining on EHR patient trajectories. JEPA architectures have enabled latent-space planning in robotics and high-quality representation learning in vision, but extending the paradigm to EHR data -- to obtain a single backbone that simultaneously forecasts patient trajectories and serves diverse downstream risk-prediction tasks without per-task fine-tuning -- remains an open challenge. Existing JEPA frameworks either discard the predictor after pretraining (I-JEPA, V-JEPA) or train it on a frozen pretrained encoder (V-JEPA 2-AC), leaving the encoder unaware of the rollout signal that the retained predictor must use at inference; co-training the encoder and predictor under a shared JEPA prediction objective would supply this grounding, but naïve co-training is unstable, with representation collapse and online/target drift causing autoregressive rollout to diverge. Clin-JEPA's five-phase pretraining curriculum -- predictor warmup, joint refinement, EMA target alignment, hard sync, and predictor finalization -- addresses each failure mode by phase, stably co-training a Qwen3-8B-based encoder and a 92M-parameter latent trajectory predictor. On MIMIC-IV ICU data, three independent evaluations support the framework: (1) latent ell_1 rollout drift uniquely converges (-15.7%) over 48-hour horizons while baselines and ablations diverge (+3% to +4951%); (2) the encoder learns a clinically discriminative latent geometry (deteriorating-patient cohorts displace 4.83times further than stable patients in latent space, vs leq2.62times for baseline encoders); (3) a single backbone outperforms strong tabular and sequence baselines on multi-task downstream evaluation. Clin-JEPA achieves mean AUROC 0.851 on ICareFM EEP and 0.883 on 8 binary risk tasks (+0.038 and +0.041 vs baseline average).

Electrocardiogram (ECG) serves as the primary non-invasive diagnostic tool for cardiac conditions monitoring, are crucial in assisting clinicians. Recent studies have concentrated on classifying cardiac conditions using ECG data but have overlooked ECG report generation, which is not only time-consuming but also requires clinical expertise. To automate ECG report generation and ensure its versatility, we propose the Multimodal ECG Instruction Tuning (MEIT) framework, the first attempt to tackle ECG report generation with LLMs and multimodal instructions. To facilitate future research, we establish a benchmark to evaluate MEIT with various LLMs backbones across two large-scale ECG datasets. Our approach uniquely aligns the representations of the ECG signal and the report, and we conduct extensive experiments to benchmark MEIT with nine open source LLMs, using more than 800,000 ECG reports. MEIT's results underscore the superior performance of instruction-tuned LLMs, showcasing their proficiency in quality report generation, zero-shot capabilities, and resilience to signal perturbation. These findings emphasize the efficacy of our MEIT framework and its potential for real-world clinical application.

Large language models (LLMs) have shown strong performance on isolated psychiatric tasks, including dialogue, diagnosis, and treatment planning, yet existing benchmarks rarely simulate complete psychiatric clinical encounters. We introduce MentalHospital, a virtual evaluation environment for LLM-based psychiatric clinical encounters. MentalHospital instantiates the Subjective Interviewing, Objective Examination, Diagnostic Assessment, and Treatment Planning (S.O.A.P.) workflow, using skill-augmented standardized patients constructed from 1,193 de-identified psychiatric electronic health record (EHR) cases spanning all major ICD-11 categories and 76 disorders. Each encounter is assessed through a dual-track protocol that combines objective comparison against EHR-derived references with subjective assessment of clinical process quality. To scale specialist judgment, we develop MentalEval, five domain-specific evaluators covering communication empathy, interviewing professionalism, clinical-note quality, diagnostic rigor, and treatment appropriateness, trained with rubric-grounded SFT and expert-guided DPO. Survey responses from 22 clinicians support MentalHospital's clinical fidelity (3.88/5), while MentalEval achieves strong expert alignment with an average QWK of 0.944. Benchmarking shows that even the strongest LLM trails clinicians by 37.28 percentage points in objective psychiatric competence, with mental status assessment as a key bottleneck.

Multimodal large language models (MLLMs) have recently achieved remarkable progress in radiology by integrating visual perception with natural language understanding. However, they often generate clinically unsupported descriptions, known as medical hallucinations, which pose serious risks in medical applications that demand accuracy and image-grounded outputs. Through empirical analysis, we find that prompt-induced hallucinations remain prevalent in radiology MLLMs, largely due to over-sensitivity to clinical sections. To address this, we introduce Clinical Contrastive Cecoding (CCD), a training-free and retrieval-free inference framework that integrates structured clinical signals from task-specific radiology expert models. CCD introduces a dual-stage contrastive mechanism to refine token-level logits during generation, thereby enhancing clinical fidelity without modifying the base MLLM. Experiments on three datasets and multiple models demonstrate that CCD consistently improves overall performance on radiology report generation (RRG). On the MIMIC-CXR dataset, it yields up to a 17% improvement in RadGraph-F1 when applied to state-of-the-art RRG models. Our approach provides a lightweight and generalisable solution for mitigating medical hallucinations, effectively bridging expert models and MLLMs in radiology.

The reasoning gap between large and compact vision-language models (VLMs) limits the deployment of medical AI on portable clinical devices. Compact VLMs of 2--4B parameters can run on resource-constrained hardware but lack the multi-step reasoning capacity needed for interpretable clinical decision support. Existing knowledge distillation methods transfer answers without the reasoning process behind them. Medical visual question answering (VQA) serves as a testbed for this problem, as it requires models to integrate visual evidence with clinical knowledge through structured reasoning chains. We introduce LiteMedCoT-VL, a pipeline that transfers chain-of-thought reasoning from a 235B teacher model to 2B student models through LoRA-based fine-tuning on explanation-enriched training data. All inference is conducted without image captions by default, simulating the clinical scenario in which a physician interprets a medical image directly without an accompanying radiology report. On the PMC-VQA benchmark, LiteMedCoT-VL achieves 64.9% accuracy, exceeding the zero-shot Qwen3-VL-4B baseline of 53.9% by 11.0 percentage points and outperforming all published baselines. This result indicates that a 2B model with reasoning distillation can match or exceed models with twice the parameters. Visual grounding analysis shows that the model relies on image content rather than exploiting textual priors. Our code is publicly available at https://anonymous.4open.science/r/LiteMedCoT-VL.

In clinical practice, electrocardiography (ECG) remains the gold standard for cardiac monitoring, providing crucial insights for diagnosing a wide range of cardiovascular diseases (CVDs). However, its reliance on specialized equipment and trained personnel limits feasibility for continuous routine monitoring. Photoplethysmography (PPG) offers accessible, continuous monitoring but lacks definitive electrophysiological information, preventing conclusive diagnosis. Generative models present a promising approach to translate PPG into clinically valuable ECG signals, yet current methods face substantial challenges, including the misalignment of physiological semantics in generative models and the complexity of modeling in high-dimensional signals. To this end, we propose PPGFlowECG, a two-stage framework that aligns PPG and ECG in a shared latent space via the CardioAlign Encoder and employs latent rectified flow to generate ECGs with high fidelity and interpretability. To the best of our knowledge, this is the first study to experiment on MCMED, a newly released clinical-grade dataset comprising over 10 million paired PPG-ECG samples from more than 118,000 emergency department visits with expert-labeled cardiovascular disease annotations. Results demonstrate the effectiveness of our method for PPG-to-ECG translation and cardiovascular disease detection. Moreover, cardiologist-led evaluations confirm that the synthesized ECGs achieve high fidelity and improve diagnostic reliability, underscoring our method's potential for real-world cardiovascular screening.

Deep-learning survival models for electronic health record (EHR) data are hard to compare across papers because the upstream preprocessing step, which includes cohort definition, time discretisation, missingness handling, and censoring rules, is typically undocumented and inconsistent. A reported difference in concordance between two mortality models can therefore reflect any of these choices rather than a modelling contribution. We present SurvBench, an open-source preprocessing pipeline that converts raw PhysioNet exports into model-ready tensors for survival analysis. SurvBench covers four critical-care databases (MIMIC-IV, eICU, MC-MED, HiRID) and four input modalities: time-series vitals and laboratory values, static demographics, International Classification of Diseases (ICD) codes, and radiology report embeddings. Every preprocessing decision is controlled through YAML configuration. Imputation, scaling, and feature filtering are fit on the training fold only. Missingness is recorded as a binary mask alongside each feature tensor. The pipeline handles single-risk endpoints (in-hospital and in-ICU mortality) and competing-risks endpoints (a three-way emergency-department admission pathway, with home discharge treated as administrative censoring). We also provide support for harmonised cross-dataset external validation between eICU and MIMIC-IV. SurvBench is publicly available at https://github.com/munibmesinovic/SurvBench, providing a robust platform that future deep-learning EHR survival work, especially nascent multi-modal approaches, can be measured against under matched preprocessing.

Visual grounding refers to the ability of a model to identify a region within some visual input that matches a textual description. Consequently, a model equipped with visual grounding capabilities can target a wide range of applications in various domains, including referring expression comprehension, answering questions pertinent to fine-grained details in images or videos, caption visual context by explicitly referring to entities, as well as low and high-level control in simulated and real environments. In this survey paper, we review representative works across the key areas of research on modern general-purpose vision language models (VLMs). We first outline the importance of grounding in VLMs, then delineate the core components of the contemporary paradigm for developing grounded models, and examine their practical applications, including benchmarks and evaluation metrics for grounded multimodal generation. We also discuss the multifaceted interrelations among visual grounding, multimodal chain-of-thought, and reasoning in VLMs. Finally, we analyse the challenges inherent to visual grounding and suggest promising directions for future research.

Medical Vision-Language Models (Med-VLMs) achieve strong expert-level performance, yet their ability to generate patient-accessible descriptions remains underexplored. With the 21st Century Cures Act now mandating immediate patient access to diagnostic imaging results, evaluating whether Med-VLMs can bridge this Expert-Lay Gap is both urgent and clinically consequential for patient education and shared decision-making. To this end, we introduce MedLayXPlain, the first large-scale multimodal benchmark and evaluation framework for Medical Lay Language Generation (MLLG). MedLayXPlain-122K provides 122,789 region-grounded samples across 8 imaging modalities from 12 publicly available source datasets, each comprising a medical image with paired expert and lay captions anchored in a three-level Unified Medical Language System (UMLS) ontology hierarchy spanning 7 semantic groups, 43 semantic types, and 2,411 medical concepts. Lay captions are constructed via Hierarchical Ontology-Verified Refinement (HOVER), a three-step pipeline combining patient-centric vocabulary mapping, LLM-based constrained rewriting, and cross-model visual verification to enforce semantic equivalence while preventing hallucination. We further introduce MedLayEval, a lightweight 3B evaluator distilled from a 27B verifier that scores expert-lay alignment across five clinically grounded attributes, addressing the poor correlation between standard NLG metrics and clinical judgment. Benchmarking 33 VLMs on MedLayXPlain-122K reveals a systematic Expert-Lay Gap: medical VLMs achieve strong expert captioning but suffer significant lay-register degradation, while general-purpose VLMs produce more accessible language yet lack clinical precision, confirming that neither current paradigm adequately serves patient-facing communication.

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

Grounded situation recognition is the task of predicting the main activity, entities playing certain roles within the activity, and bounding-box groundings of the entities in the given image. To effectively deal with this challenging task, we introduce a novel approach where the two processes for activity classification and entity estimation are interactive and complementary. To implement this idea, we propose Collaborative Glance-Gaze TransFormer (CoFormer) that consists of two modules: Glance transformer for activity classification and Gaze transformer for entity estimation. Glance transformer predicts the main activity with the help of Gaze transformer that analyzes entities and their relations, while Gaze transformer estimates the grounded entities by focusing only on the entities relevant to the activity predicted by Glance transformer. Our CoFormer achieves the state of the art in all evaluation metrics on the SWiG dataset. Training code and model weights are available at https://github.com/jhcho99/CoFormer.

In text-to-video (T2V) generation, significant attention has been directed toward its development, yet unifying discrete and continuous grounding conditions in T2V generation remains under-explored. This paper proposes a Grounded text-to-Video generation framework, termed GVDIFF. First, we inject the grounding condition into the self-attention through an uncertainty-based representation to explicitly guide the focus of the network. Second, we introduce a spatial-temporal grounding layer that connects the grounding condition with target objects and enables the model with the grounded generation capacity in the spatial-temporal domain. Third, our dynamic gate network adaptively skips the redundant grounding process to selectively extract grounding information and semantics while improving efficiency. We extensively evaluate the grounded generation capacity of GVDIFF and demonstrate its versatility in applications, including long-range video generation, sequential prompts, and object-specific editing.

Electronic Health Records (EHRs) contain rich, longitudinal patient information across structured (e.g., labs, vitals, and imaging) and unstructured (e.g., clinical notes) modalities. While deep learning models such as RNNs and Transformers have advanced single- and multimodal EHR analysis, existing methods often optimize for specific downstream tasks and overlook the creation of generalizable patient representations that can be reused across multiple tasks. To address this gap, we propose CAAT-EHR, a novel Cross-Attentional Autoregressive Transformer architecture that produces task-agnostic, longitudinal embeddings of multimodal EHR data. In CAAT-EHR, self-attention layers capture temporal dependencies within each modality, while cross-attention layers fuse information across modalities to model complex interrelationships. During pre-training, an autoregressive decoder predicts future time steps from the fused embeddings, enforcing temporal consistency and enriching the encoder output. Once trained, the encoder alone generates versatile multimodal EHR embeddings that can be applied directly to a variety of predictive tasks. CAAT-EHR demonstrates significant improvements on benchmark EHR datasets for mortality prediction, ICU length-of-stay estimation, and Alzheimer's disease diagnosis prediction. Models using EHR embeddings generated by CAAT-EHR outperform models trained on raw EHR data in eleven out of twelve comparisons for F1 score and AUC across all three downstream tasks. Ablation studies confirm the critical roles of cross-modality fusion and autoregressive refinement. Overall, CAAT-EHR provides a unified framework for learning generalizable, temporally consistent multimodal EHR representations that support more reliable clinical decision support systems.

Electronic Health Records (EHR) are high-dimensional data with implicit connections among thousands of medical concepts. These connections, for instance, the co-occurrence of diseases and lab-disease correlations can be informative when only a subset of these variables is documented by the clinician. A feasible approach to improving the representation learning of EHR data is to associate relevant medical concepts and utilize these connections. Existing medical ontologies can be the reference for EHR structures, but they place numerous constraints on the data source. Recent progress on graph neural networks (GNN) enables end-to-end learning of topological structures for non-grid or non-sequential data. However, there are problems to be addressed on how to learn the medical graph adaptively and how to understand the effect of the medical graph on representation learning. In this paper, we propose a variationally regularized encoder-decoder graph network that achieves more robustness in graph structure learning by regularizing node representations. Our model outperforms the existing graph and non-graph based methods in various EHR predictive tasks based on both public data and real-world clinical data. Besides the improvements in empirical experiment performances, we provide an interpretation of the effect of variational regularization compared to standard graph neural network, using singular value analysis.

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

Clinical notes are assigned ICD codes - sets of codes for diagnoses and procedures. In the recent years, predictive machine learning models have been built for automatic ICD coding. However, there is a lack of widely accepted benchmarks for automated ICD coding models based on large-scale public EHR data. This paper proposes a public benchmark suite for ICD-10 coding using a large EHR dataset derived from MIMIC-IV, the most recent public EHR dataset. We implement and compare several popular methods for ICD coding prediction tasks to standardize data preprocessing and establish a comprehensive ICD coding benchmark dataset. This approach fosters reproducibility and model comparison, accelerating progress toward employing automated ICD coding in future studies. Furthermore, we create a new ICD-9 benchmark using MIMIC-IV data, providing more data points and a higher number of ICD codes than MIMIC-III. Our open-source code offers easy access to data processing steps, benchmark creation, and experiment replication for those with MIMIC-IV access, providing insights, guidance, and protocols to efficiently develop ICD coding models.

Disasters are inevitable and increasingly costly, and effective response depends on querying structured tabular data: precise, information-dense records of hazard, exposure, vulnerability, and lifeline infrastructure that underpin disaster management. Current text-to-SQL methods enable natural-language access to such tables but transfer poorly to the disaster domain, where queries span heterogeneous geospatial schemas and require reasoning over causal relations. We introduce DisasterLex, a knowledge-graph-mediated framework that inserts an Expert Knowledge Graph (EKG) of curated concepts and typed causal edges between the user query and the database, bridged to schema by concept-to-table links. The orchestration runs four stages (identifying query entities, routing to the operational domain, planning over causal edges, and grounding the SQL), restricting the schema passed to the model at each step. We instantiate it on a disaster-analytics database (36 geospatial tables, 150 columns) with an EKG of 107 concepts, 117 causal edges, and 52 concept-to-schema links, evaluated on a 75-query test set. On all seven base models spanning proprietary and open-weight families, DisasterLex beats four state-of-the-art baselines (LightRAG, HippoRAG 2, ReFoRCE, CHESS) by 1.4x to 2.75x, with absolute scores of 1.65 to 3.56 (of 5.0). Error analysis shows baseline failures cluster in routing and multi-table SQL composition, the operations our orchestration explicitly addresses. Code, data, and the EKG artifact are available at https://github.com/YimingXiao98/DisasterLex and on Zenodo at https://doi.org/10.5281/zenodo.20388029.

Reliable end-to-end clinical report generation has been a longstanding goal of medical ML research. The end goal for this process is to alleviate radiologists' workloads and provide second opinions to clinicians or patients. Thus, a necessary prerequisite for report generation models is a strong general performance and some type of innate grounding capability, to convince clinicians or patients of the veracity of the generated reports. In this paper, we present ASaRG (Automatic Segmentation-assisted Report Generation), an extension of the popular LLaVA architecture that aims to tackle both of these problems. ASaRG proposes to fuse intermediate features and fine-grained segmentation maps created by specialist radiological models into LLaVA's multi-modal projection layer via simple concatenation. With a small number of added parameters, our approach achieves a +0.89\% performance gain (p=0.012) in CE F1 score compared to the LLaVA baseline when using only intermediate features, and +2.77\% performance gain (p<0.001) when adding a combination of intermediate features and fine-grained segmentation maps. Compared with COMG and ORID, two other report generation methods that utilize segmentations, the performance gain amounts to 6.98\% and 6.28\% in F1 score, respectively. ASaRG is not mutually exclusive with other changes made to the LLaVA architecture, potentially allowing our method to be combined with other advances in the field. Finally, the use of an arbitrary number of segmentations as part of the input demonstrably allows tracing elements of the report to the corresponding segmentation maps and verifying the groundedness of assessments. Our code will be made publicly available at a later date.

While Multimodal Large Language Models (MLLMs) show promising performance in automated electrocardiogram interpretation, it remains unclear whether they genuinely perform actual step-by-step reasoning or just rely on superficial visual cues. To investigate this, we introduce ECG-Reasoning-Benchmark, a novel multi-turn evaluation framework comprising over 6,400 samples to systematically assess step-by-step reasoning across 17 core ECG diagnoses. Our comprehensive evaluation of state-of-the-art models reveals a critical failure in executing multi-step logical deduction. Although models possess the medical knowledge to retrieve clinical criteria for a diagnosis, they exhibit near-zero success rates (6% Completion) in maintaining a complete reasoning chain, primarily failing to ground the corresponding ECG findings to the actual visual evidence in the ECG signal. These results demonstrate that current MLLMs bypass actual visual interpretation, exposing a critical flaw in existing training paradigms and underscoring the necessity for robust, reasoning-centric medical AI. The code and data are available at https://github.com/Jwoo5/ecg-reasoning-benchmark.

The electrocardiogram (ECG) is an essential non-invasive diagnostic tool for assessing cardiac conditions. Existing automatic interpretation methods suffer from limited generalizability, focusing on a narrow range of cardiac conditions, and typically depend on raw physiological signals, which may not be readily available in resource-limited settings where only printed or digital ECG images are accessible. Recent advancements in multimodal large language models (MLLMs) present promising opportunities for addressing these challenges. However, the application of MLLMs to ECG image interpretation remains challenging due to the lack of instruction tuning datasets and well-established ECG image benchmarks for quantitative evaluation. To address these challenges, we introduce ECGInstruct, a comprehensive ECG image instruction tuning dataset of over one million samples, covering a wide range of ECG-related tasks from diverse data sources. Using ECGInstruct, we develop PULSE, an MLLM tailored for ECG image comprehension. In addition, we curate ECGBench, a new evaluation benchmark covering four key ECG image interpretation tasks across nine different datasets. Our experiments show that PULSE sets a new state-of-the-art, outperforming general MLLMs with an average accuracy improvement of 15% to 30%. This work highlights the potential of PULSE to enhance ECG interpretation in clinical practice.

Electronic health records (EHRs) are multimodal by nature, consisting of structured tabular features like lab tests and unstructured clinical notes. In real-life clinical practice, doctors use complementary multimodal EHR data sources to get a clearer picture of patients' health and support clinical decision-making. However, most EHR predictive models do not reflect these procedures, as they either focus on a single modality or overlook the inter-modality interactions/redundancy. In this work, we propose MEDFuse, a Multimodal EHR Data Fusion framework that incorporates masked lab-test modeling and large language models (LLMs) to effectively integrate structured and unstructured medical data. MEDFuse leverages multimodal embeddings extracted from two sources: LLMs fine-tuned on free clinical text and masked tabular transformers trained on structured lab test results. We design a disentangled transformer module, optimized by a mutual information loss to 1) decouple modality-specific and modality-shared information and 2) extract useful joint representation from the noise and redundancy present in clinical notes. Through comprehensive validation on the public MIMIC-III dataset and the in-house FEMH dataset, MEDFuse demonstrates great potential in advancing clinical predictions, achieving over 90% F1 score in the 10-disease multi-label classification task.

The paradigm of Multimodal Large Language Models (MLLMs) offers a promising blueprint for advancing the electromagnetic (EM) domain. However, prevailing approaches often deviate from the native MLLM paradigm, instead using task-specific or pipelined architectures that lead to fundamental limitations in model performance and generalization. Fully realizing the MLLM potential in EM domain requires overcoming three main challenges: (1) Data. The scarcity of high-quality datasets with paired EM signals and descriptive text annotations used for MLLMs pre-training; (2) Benchmark. The absence of comprehensive benchmarks to systematically evaluate and compare the performance of models on EM signal-to-text tasks; (3) Model. A critical fragility in low Signal-to-Noise Ratio (SNR) environments, where critical signal features can be obscured, leading to significant performance degradation. To address these challenges, we introduce a tripartite contribution to establish a foundation for MLLMs in the EM domain. First, to overcome data scarcity, we construct and release EM-100k, a large-scale dataset comprising over 100,000 EM signal-text pairs. Second, to enable rigorous and standardized evaluation, we propose EM-Bench, the most comprehensive benchmark featuring diverse downstream tasks spanning from perception to reasoning. Finally, to tackle the core modeling challenge, we present MERLIN, a novel training framework designed not only to align low-level signal representations with high-level semantic text, but also to explicitly enhance model robustness and performance in challenging low-SNR environments. Comprehensive experiments validate our method, showing that MERLIN is state-of-the-art in the EM-Bench and exhibits remarkable robustness in low-SNR settings.

Large language models (LLMs) still produce plausible-sounding but ungrounded factual claims, a problem that worsens in multi-turn dialogue as context grows and early errors cascade. We introduce HalluHard, a challenging multi-turn hallucination benchmark with 950 seed questions spanning four high-stakes domains: legal cases, research questions, medical guidelines, and coding. We operationalize groundedness by requiring inline citations for factual assertions. To support reliable evaluation in open-ended settings, we propose a judging pipeline that iteratively retrieves evidence via web search. It can fetch, filter, and parse full-text sources (including PDFs) to assess whether cited material actually supports the generated content. Across a diverse set of frontier proprietary and open-weight models, hallucinations remain substantial even with web search (approx 30% for the strongest configuration, Opus-4.5 with web search), with content-grounding errors persisting at high rates. Finally, we show that hallucination behavior is shaped by model capacity, turn position, effective reasoning, and the type of knowledge required.

Reacting to sudden physical hazards (catching a slipping plate, dodging a falling knife) is both a meaningful test of embodied intelligence and a hard requirement for deploying multimodal large language models (MLLMs) as the decision coreof household robots. Existing evaluations, however, probe intuitive physics passively through question answering over videos, or target deliberate, long-horizon tasks such as navigation and rearrangement; none measure whether a model can turn physical understanding into immediate, safety-critical action. We introduce ReactHuman, the first physics-grounded benchmark for human-like reactive decision-making, in which the evaluated MLLM acts as the brain of a simulated humanoid facing sudden household hazards; it spans 17 event families and over 1,000 bit-for-bit reproducible scenes with exact, annotation-free ground truth derived from 240 Hz rigid-body simulation, including adversarial objects whose appearance contradicts their physics (a foam anvil, a steel apple). We further design a five-metric suite that scores each reaction along three axes: reasonable, safe, and physically grounded. We physically execute every committed plan so that decisions have observable consequences. With this harness we evaluate seven representative MLLMs. Results show that reactive safety is far from solved: models mishandle roughly one hazard in three, act from fixed dispositions rather than the observed scene, trust appearance over motion, and miss interception points at meter scale even when the chosen action is correct; none of these failures shrink with model scale. ReactHuman thus offers both a fine-grained diagnosis and a scalable training signal toward physically grounded, safety-aware embodied agents. The benchmark can be found here: https://huggingface.co/datasets/Alan123/reacthuman-benchmark-scaled

Medical Multimodal Large Language Models (Med-MLLMs) require egocentric clinical intent understanding for real-world deployment, yet existing benchmarks fail to evaluate this critical capability. To address these challenges, we introduce MedGaze-Bench, the first benchmark leveraging clinician gaze as a Cognitive Cursor to assess intent understanding across surgery, emergency simulation, and diagnostic interpretation. Our benchmark addresses three fundamental challenges: visual homogeneity of anatomical structures, strict temporal-causal dependencies in clinical workflows, and implicit adherence to safety protocols. We propose a Three-Dimensional Clinical Intent Framework evaluating: (1) Spatial Intent: discriminating precise targets amid visual noise, (2) Temporal Intent: inferring causal rationale through retrospective and prospective reasoning, and (3) Standard Intent: verifying protocol compliance through safety checks. Beyond accuracy metrics, we introduce Trap QA mechanisms to stress-test clinical reliability by penalizing hallucinations and cognitive sycophancy. Experiments reveal current MLLMs struggle with egocentric intent due to over-reliance on global features, leading to fabricated observations and uncritical acceptance of invalid instructions.

Fast Healthcare Interoperability Resources (FHIR) is the dominant standard for interoperable exchange of healthcare data. In FHIR, electronic health records form a directed graph of resources. Answering clinically meaningful questions over FHIR requires agents to perform multi-step reasoning, filtering, and aggregation across multiple resource types. Prior work shows that even tool-augmented LLM agents (retrieval, code execution, multi-turn planning) often select the wrong resources or violate traversal constraints. We study this problem in the context of FHIR-AgentBench, a benchmark for realistic question answering over real-world hospital data, and frame reasoning on FHIR as a sequential decision-making problem over a queryable structured graph. We implement a multi-turn CodeAct agent and post-train it with reinforcement learning using a custom harness and tools. A LLM Judge provides execution-grounded rewards. Compared to prompt-based, closed-model baselines, RL post-training improves performance while enforcing data-integrity constraints. Empirically, our approach improves answer correctness from 50% (o4-mini) to 77% on FHIR-AgentBench using a smaller and cheaper Qwen3-8B model. We present an end-to-end post-training pipeline (environment building, harness construction, model training and custom evaluation) that reliably improves multi-turn reasoning over structured clinical graphs.

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

One important challenge of applying deep learning to electronic health records (EHR) is the complexity of their multimodal structure. EHR usually contains a mixture of structured (codes) and unstructured (free-text) data with sparse and irregular longitudinal features -- all of which doctors utilize when making decisions. In the deep learning regime, determining how different modality representations should be fused together is a difficult problem, which is often addressed by handcrafted modeling and intuition. In this work, we extend state-of-the-art neural architecture search (NAS) methods and propose MUltimodal Fusion Architecture SeArch (MUFASA) to simultaneously search across multimodal fusion strategies and modality-specific architectures for the first time. We demonstrate empirically that our MUFASA method outperforms established unimodal NAS on public EHR data with comparable computation costs. In addition, MUFASA produces architectures that outperform Transformer and Evolved Transformer. Compared with these baselines on CCS diagnosis code prediction, our discovered models improve top-5 recall from 0.88 to 0.91 and demonstrate the ability to generalize to other EHR tasks. Studying our top architecture in depth, we provide empirical evidence that MUFASA's improvements are derived from its ability to both customize modeling for each data modality and find effective fusion strategies.

Medical calculators are fundamental to quantitative, evidence-based clinical practice. However, their real-world use is an adaptive, multi-stage process, requiring proactive EHR data acquisition, scenario-dependent calculator selection, and multi-step computation, whereas current benchmarks focus only on static single-step calculations with explicit instructions. To address these limitations, we introduce MedMCP-Calc, the first benchmark for evaluating LLMs in realistic medical calculator scenarios through Model Context Protocol (MCP) integration. MedMCP-Calc comprises 118 scenario tasks across 4 clinical domains, featuring fuzzy task descriptions mimicking natural queries, structured EHR database interaction, external reference retrieval, and process-level evaluation. Our evaluation of 23 leading models reveals critical limitations: even top performers like Claude Opus 4.5 exhibit substantial gaps, including difficulty selecting appropriate calculators for end-to-end workflows given fuzzy queries, poor performance in iterative SQL-based database interactions, and marked reluctance to leverage external tools for numerical computation. Performance also varies considerably across clinical domains. Building on these findings, we develop CalcMate, a fine-tuned model incorporating scenario planning and tool augmentation, achieving state-of-the-art performance among open-source models. Benchmark and Codes are available in https://github.com/SPIRAL-MED/MedMCP-Calc.

Recruitment applications span diverse operations, from drafting job descriptions and interpreting queries to organizing profiles, assessing fit, and recommending candidates and jobs. Systematic LLM evaluation therefore requires task coverage that reflects this range of business needs. We introduce EHR-Bench, an open Chinese benchmark comprising twelve tasks across six capability families and five recruitment scenarios. The tasks cover generation, extraction, classification, retrieval, semantic similarity, and reciprocal ranking within one evaluation framework. An internal recruitment dataset guides task definitions, the occupation taxonomy and sampling targets, output requirements, and scoring protocols. Following these specifications, we construct 8,336 task instances from public materials and controlled augmentation, with source-aware expert review and documented provenance. We evaluate twelve LLMs through task-level, capability-level, and aggregate comparisons. Closely ranked models exhibit distinct task strengths, and performance varies across input sources, reference evidence, and candidate pools. Five shared models retain the same observed Overall ordering on a private operational reference, with variation in capability and task correspondence. EHR-Bench provides a reproducible foundation for systematic model assessment, task-specific model selection, and further research on LLMs for recruitment. The project repository is available at https://github.com/EhrBench/EHR-Bench.

Objective: To determine if a realistic, but computationally efficient model of the electrocardiogram can be used to pre-train a deep neural network (DNN) with a wide range of morphologies and abnormalities specific to a given condition - T-wave Alternans (TWA) as a result of Post-Traumatic Stress Disorder, or PTSD - and significantly boost performance on a small database of rare individuals. Approach: Using a previously validated artificial ECG model, we generated 180,000 artificial ECGs with or without significant TWA, with varying heart rate, breathing rate, TWA amplitude, and ECG morphology. A DNN, trained on over 70,000 patients to classify 25 different rhythms, was modified the output layer to a binary class (TWA or no-TWA, or equivalently, PTSD or no-PTSD), and transfer learning was performed on the artificial ECG. In a final transfer learning step, the DNN was trained and cross-validated on ECG from 12 PTSD and 24 controls for all combinations of using the three databases. Main results: The best performing approach (AUROC = 0.77, Accuracy = 0.72, F1-score = 0.64) was found by performing both transfer learning steps, using the pre-trained arrhythmia DNN, the artificial data and the real PTSD-related ECG data. Removing the artificial data from training led to the largest drop in performance. Removing the arrhythmia data from training provided a modest, but significant, drop in performance. The final model showed no significant drop in performance on the artificial data, indicating no overfitting. Significance: In healthcare, it is common to only have a small collection of high-quality data and labels, or a larger database with much lower quality (and less relevant) labels. The paradigm presented here, involving model-based performance boosting, provides a solution through transfer learning on a large realistic artificial database, and a partially relevant real database.

The demand for emergency department (ED) services is increasing across the globe, particularly during the current COVID-19 pandemic. Clinical triage and risk assessment have become increasingly challenging due to the shortage of medical resources and the strain on hospital infrastructure caused by the pandemic. As a result of the widespread use of electronic health records (EHRs), we now have access to a vast amount of clinical data, which allows us to develop predictive models and decision support systems to address these challenges. To date, however, there are no widely accepted benchmark ED triage prediction models based on large-scale public EHR data. An open-source benchmarking platform would streamline research workflows by eliminating cumbersome data preprocessing, and facilitate comparisons among different studies and methodologies. In this paper, based on the Medical Information Mart for Intensive Care IV Emergency Department (MIMIC-IV-ED) database, we developed a publicly available benchmark suite for ED triage predictive models and created a benchmark dataset that contains over 400,000 ED visits from 2011 to 2019. We introduced three ED-based outcomes (hospitalization, critical outcomes, and 72-hour ED reattendance) and implemented a variety of popular methodologies, ranging from machine learning methods to clinical scoring systems. We evaluated and compared the performance of these methods against benchmark tasks. Our codes are open-source, allowing anyone with MIMIC-IV-ED data access to perform the same steps in data processing, benchmark model building, and experiments. This study provides future researchers with insights, suggestions, and protocols for managing raw data and developing risk triaging tools for emergency care.

In clinical radiology reports, doctors capture important information about the patient's health status. They convey their observations from raw medical imaging data about the inner structures of a patient. As such, formulating reports requires medical experts to possess wide-ranging knowledge about anatomical regions with their normal, healthy appearance as well as the ability to recognize abnormalities. This explicit grasp on both the patient's anatomy and their appearance is missing in current medical image-processing systems as annotations are especially difficult to gather. This renders the models to be narrow experts e.g. for identifying specific diseases. In this work, we recover this missing link by adding human anatomy into the mix and enable the association of content in medical reports to their occurrence in associated imagery (medical phrase grounding). To exploit anatomical structures in this scenario, we present a sophisticated automatic pipeline to gather and integrate human bodily structures from computed tomography datasets, which we incorporate in our PAXRay: A Projected dataset for the segmentation of Anatomical structures in X-Ray data. Our evaluation shows that methods that take advantage of anatomical information benefit heavily in visually grounding radiologists' findings, as our anatomical segmentations allow for up to absolute 50% better grounding results on the OpenI dataset as compared to commonly used region proposals. The PAXRay dataset is available at https://constantinseibold.github.io/paxray/.

Despite the remarkable progress in the development of predictive models for healthcare, applying these algorithms on a large scale has been challenging. Algorithms trained on a particular task, based on specific data formats available in a set of medical records, tend to not generalize well to other tasks or databases in which the data fields may differ. To address this challenge, we propose General Healthcare Predictive Framework (GenHPF), which is applicable to any EHR with minimal preprocessing for multiple prediction tasks. GenHPF resolves heterogeneity in medical codes and schemas by converting EHRs into a hierarchical textual representation while incorporating as many features as possible. To evaluate the efficacy of GenHPF, we conduct multi-task learning experiments with single-source and multi-source settings, on three publicly available EHR datasets with different schemas for 12 clinically meaningful prediction tasks. Our framework significantly outperforms baseline models that utilize domain knowledge in multi-source learning, improving average AUROC by 1.2%P in pooled learning and 2.6%P in transfer learning while also showing comparable results when trained on a single EHR dataset. Furthermore, we demonstrate that self-supervised pretraining using multi-source datasets is effective when combined with GenHPF, resulting in a 0.6%P AUROC improvement compared to models without pretraining. By eliminating the need for preprocessing and feature engineering, we believe that this work offers a solid framework for multi-task and multi-source learning that can be leveraged to speed up the scaling and usage of predictive algorithms in healthcare.