Daily Papers

Large Language Models (LLMs) are increasingly being explored for clinical question answering and decision support, yet safe deployment critically requires reliable handling of patient measurements in heterogeneous clinical notes. Existing evaluations of LLMs for clinical numerical reasoning provide limited operation-level coverage, restricted primarily to arithmetic computation, and rarely assess the robustness of numerical understanding across clinical note formats. We introduce ClinicNumRobBench, a benchmark of 1,624 context-question instances with ground-truth answers that evaluates four main types of clinical numeracy: value retrieval, arithmetic computation, relational comparison, and aggregation. To stress-test robustness, ClinicNumRobBench presents longitudinal MIMIC-IV vital-sign records in three semantically equivalent representations, including a real-world note-style variant derived from the Open Patients dataset, and instantiates queries using 42 question templates. Experiments on 14 LLMs show that value retrieval is generally strong, with most models exceeding 85% accuracy, while relational comparison and aggregation remain challenging, with some models scoring below 15%. Fine-tuning on medical data can reduce numeracy relative to base models by over 30%, and performance drops under note-style variation indicate LLM sensitivity to format. ClinicNumRobBench offers a rigorous testbed for clinically reliable numerical reasoning. Code and data URL are available on https://github.com/MinhVuong2000/ClinicNumRobBench.

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

Large language models (LLMs) have garnered significant attention and widespread usage due to their impressive performance in various tasks. However, they are not without their own set of challenges, including issues such as hallucinations, factual inconsistencies, and limitations in numerical-quantitative reasoning. Evaluating LLMs in miscellaneous reasoning tasks remains an active area of research. Prior to the breakthrough of LLMs, Transformers had already proven successful in the medical domain, effectively employed for various natural language understanding (NLU) tasks. Following this trend, LLMs have also been trained and utilized in the medical domain, raising concerns regarding factual accuracy, adherence to safety protocols, and inherent limitations. In this paper, we focus on evaluating the natural language inference capabilities of popular open-source and closed-source LLMs using clinical trial reports as the dataset. We present the performance results of each LLM and further analyze their performance on a development set, particularly focusing on challenging instances that involve medical abbreviations and require numerical-quantitative reasoning. Gemini, our leading LLM, achieved a test set F1-score of 0.748, securing the ninth position on the task scoreboard. Our work is the first of its kind, offering a thorough examination of the inference capabilities of LLMs within the medical domain.

Passively collected behavioral health data from ubiquitous sensors holds significant promise to provide mental health professionals insights from patient's daily lives; however, developing analysis tools to use this data in clinical practice requires addressing challenges of generalization across devices and weak or ambiguous correlations between the measured signals and an individual's mental health. To address these challenges, we take a novel approach that leverages large language models (LLMs) to synthesize clinically useful insights from multi-sensor data. We develop chain of thought prompting methods that use LLMs to generate reasoning about how trends in data such as step count and sleep relate to conditions like depression and anxiety. We first demonstrate binary depression classification with LLMs achieving accuracies of 61.1% which exceed the state of the art. While it is not robust for clinical use, this leads us to our key finding: even more impactful and valued than classification is a new human-AI collaboration approach in which clinician experts interactively query these tools and combine their domain expertise and context about the patient with AI generated reasoning to support clinical decision-making. We find models like GPT-4 correctly reference numerical data 75% of the time, and clinician participants express strong interest in using this approach to interpret self-tracking data.

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

Large language models (LLMs) 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.

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

Large Language Models (LLMs) have attained human-level accuracy on medical question-answer (QA) benchmarks. However, their limitations in navigating open-ended clinical scenarios have recently been shown, raising concerns about the robustness and generalizability of LLM reasoning across diverse, real-world medical tasks. To probe potential LLM failure modes in clinical problem-solving, we present the medical abstraction and reasoning corpus (M-ARC). M-ARC assesses clinical reasoning through scenarios designed to exploit the Einstellung effect -- the fixation of thought arising from prior experience, targeting LLM inductive biases toward inflexible pattern matching from their training data rather than engaging in flexible reasoning. We find that LLMs, including current state-of-the-art o1 and Gemini models, perform poorly compared to physicians on M-ARC, often demonstrating lack of commonsense medical reasoning and a propensity to hallucinate. In addition, uncertainty estimation analyses indicate that LLMs exhibit overconfidence in their answers, despite their limited accuracy. The failure modes revealed by M-ARC in LLM medical reasoning underscore the need to exercise caution when deploying these models in clinical settings.

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

Math reasoning is a highly active area of Large Language Model (LLM) research because it is a hallmark of artificial intelligence. However, few works have explored how math reasoning is encoded within LLM parameters and if it is a skill that can be isolated within a model. Doing so could allow targeted intervention to improve math performance without altering non-math behavior and foster understanding of how models encode math reasoning. We introduce Math Neurosurgery (MathNeuro), a method for isolating math-specific parameters in LLMs using only forward passes. MathNeuro builds on existing work by using weights and activations to calculate parameter importance, but isolates math-specific parameters by removing those important for general language tasks. Pruning parameters MathNeuro identifies deletes a LLM's math reasoning ability without destroying its general language ability. Scaling these parameters by a small constant improves a pretrained or instruction-tuned LLM's performance by 4-17% on GSM8K while leaving non-math behavior unaltered. MathNeuro is also data efficient: most of its effectiveness holds when identifying math-specific parameters using a single sample. MathNeuro highlights the potential for future work to intervene on math-specific parameters.

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

The proliferation of Large Language Models (LLMs) in medicine has enabled impressive capabilities, yet a critical gap remains in their ability to perform systematic, transparent, and verifiable reasoning, a cornerstone of clinical practice. This has catalyzed a shift from single-step answer generation to the development of LLMs explicitly designed for medical reasoning. This paper provides the first systematic review of this emerging field. We propose a taxonomy of reasoning enhancement techniques, categorized into training-time strategies (e.g., supervised fine-tuning, reinforcement learning) and test-time mechanisms (e.g., prompt engineering, multi-agent systems). We analyze how these techniques are applied across different data modalities (text, image, code) and in key clinical applications such as diagnosis, education, and treatment planning. Furthermore, we survey the evolution of evaluation benchmarks from simple accuracy metrics to sophisticated assessments of reasoning quality and visual interpretability. Based on an analysis of 60 seminal studies from 2022-2025, we conclude by identifying critical challenges, including the faithfulness-plausibility gap and the need for native multimodal reasoning, and outlining future directions toward building efficient, robust, and sociotechnically responsible medical AI.

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

Although large language models (LLMs) have demonstrated impressive reasoning capabilities across general domains, their effectiveness in real-world clinical practice remains limited. This is likely due to their insufficient exposure to real-world clinical data during training, as such data is typically not included due to privacy concerns. To address this, we propose enhancing the clinical reasoning capabilities of LLMs by leveraging real-world clinical data. We constructed reasoning-intensive questions from a nationwide sepsis registry and fine-tuned Phi-4 on these questions using reinforcement learning, resulting in C-Reason. C-Reason exhibited strong clinical reasoning capabilities on the in-domain test set, as evidenced by both quantitative metrics and expert evaluations. Furthermore, its enhanced reasoning capabilities generalized to a sepsis dataset involving different tasks and patient cohorts, an open-ended consultations on antibiotics use task, and other diseases. Future research should focus on training LLMs with large-scale, multi-disease clinical datasets to develop more powerful, general-purpose clinical reasoning models.

Although large language models (LLMs) have been assessed for general medical knowledge using medical licensing exams, their ability to effectively support clinical decision-making tasks, such as selecting and using medical calculators, remains uncertain. Here, we evaluate the capability of both medical trainees and LLMs to recommend medical calculators in response to various multiple-choice clinical scenarios such as risk stratification, prognosis, and disease diagnosis. We assessed eight LLMs, including open-source, proprietary, and domain-specific models, with 1,009 question-answer pairs across 35 clinical calculators and measured human performance on a subset of 100 questions. While the highest-performing LLM, GPT-4o, provided an answer accuracy of 74.3% (CI: 71.5-76.9%), human annotators, on average, outperformed LLMs with an accuracy of 79.5% (CI: 73.5-85.0%). With error analysis showing that the highest-performing LLMs continue to make mistakes in comprehension (56.6%) and calculator knowledge (8.1%), our findings emphasize that humans continue to surpass LLMs on complex clinical tasks such as calculator recommendation.

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

Test-time scaling has emerged as a powerful technique for enhancing the reasoning capabilities of large language models. However, its effectiveness in medical reasoning remains uncertain, as the medical domain fundamentally differs from mathematical tasks in terms of knowledge representation and decision-making processes. In this paper, we provide the first comprehensive investigation of test-time scaling for medical reasoning and present m1, a simple yet effective approach that increases a model's medical reasoning capability at inference. Our evaluation across diverse medical tasks demonstrates that test-time scaling consistently enhances medical reasoning, enabling lightweight fine-tuned models under 10B parameters to establish new state-of-the-art performance, while our 32B model rivals previous 70B-scale medical LLMs. However, we identify an optimal reasoning token budget of approximately 4K, beyond which performance may degrade due to overthinking. Budget forcing, which extends test-time computation through iterative prompts, helps models double-check answers but does not necessarily improve the overall medical QA performance and, in some cases, even introduces errors into previously correct responses. Our case-by-case analysis identifies insufficient medical knowledge as a key bottleneck that prevents further performance gains through test-time scaling. We find that increasing data scale, improving data quality, and expanding model capacity consistently enhance medical knowledge grounding, enabling continued performance improvements, particularly on challenging medical benchmarks where smaller models reach saturation. These findings underscore fundamental differences between medical and mathematical reasoning in LLMs, highlighting that enriched medical knowledge, other than increased reasoning depth alone, is essential for realizing the benefits of test-time scaling.

Mathematical reasoning---a core ability within human intelligence---presents some unique challenges as a domain: we do not come to understand and solve mathematical problems primarily on the back of experience and evidence, but on the basis of inferring, learning, and exploiting laws, axioms, and symbol manipulation rules. In this paper, we present a new challenge for the evaluation (and eventually the design) of neural architectures and similar system, developing a task suite of mathematics problems involving sequential questions and answers in a free-form textual input/output format. The structured nature of the mathematics domain, covering arithmetic, algebra, probability and calculus, enables the construction of training and test splits designed to clearly illuminate the capabilities and failure-modes of different architectures, as well as evaluate their ability to compose and relate knowledge and learned processes. Having described the data generation process and its potential future expansions, we conduct a comprehensive analysis of models from two broad classes of the most powerful sequence-to-sequence architectures and find notable differences in their ability to resolve mathematical problems and generalize their knowledge.

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

Large language models (LLMs) have recently showcased remarkable capabilities, spanning a wide range of tasks and applications, including those in the medical domain. Models like GPT-4 excel in medical question answering but may face challenges in the lack of interpretability when handling complex tasks in real clinical settings. We thus introduce the diagnostic reasoning dataset for clinical notes (DiReCT), aiming at evaluating the reasoning ability and interpretability of LLMs compared to human doctors. It contains 511 clinical notes, each meticulously annotated by physicians, detailing the diagnostic reasoning process from observations in a clinical note to the final diagnosis. Additionally, a diagnostic knowledge graph is provided to offer essential knowledge for reasoning, which may not be covered in the training data of existing LLMs. Evaluations of leading LLMs on DiReCT bring out a significant gap between their reasoning ability and that of human doctors, highlighting the critical need for models that can reason effectively in real-world clinical scenarios.

Mathematical reasoning in Large Language Models (LLMs) is often evaluated using benchmarks with limited numerical ranges, failing to reflect real-world problem-solving across diverse scales. Furthermore, most existing evaluation methods only compare model outputs to ground-truth answers, obscuring insights into reasoning processes. To address these limitations, we introduce GSM-Ranges, a dataset generator derived from GSM8K that systematically perturbs numerical values in math problems to assess model robustness across varying numerical scales. Additionally, we propose a novel grading methodology that distinguishes between logical and non-logical errors, offering a more precise evaluation of reasoning processes beyond computational accuracy. Our experiments with various models reveal a significant increase in logical error rates-up to 14 percentage points-as numerical complexity rises, demonstrating a general weakness in reasoning with out-of-distribution numerical values. Moreover, while models demonstrate high accuracy on standalone arithmetic tasks, their performance deteriorates substantially when computations are embedded within word problems. These findings provide a comprehensive evaluation of LLMs' mathematical reasoning capabilities and inform future research directions for improving numerical generalization in language models.

Mathematical reasoning, a core aspect of human cognition, is vital across many domains, from educational problem-solving to scientific advancements. As artificial general intelligence (AGI) progresses, integrating large language models (LLMs) with mathematical reasoning tasks is becoming increasingly significant. This survey provides the first comprehensive analysis of mathematical reasoning in the era of multimodal large language models (MLLMs). We review over 200 studies published since 2021, and examine the state-of-the-art developments in Math-LLMs, with a focus on multimodal settings. We categorize the field into three dimensions: benchmarks, methodologies, and challenges. In particular, we explore multimodal mathematical reasoning pipeline, as well as the role of (M)LLMs and the associated methodologies. Finally, we identify five major challenges hindering the realization of AGI in this domain, offering insights into the future direction for enhancing multimodal reasoning capabilities. This survey serves as a critical resource for the research community in advancing the capabilities of LLMs to tackle complex multimodal reasoning tasks.

Mathematical reasoning serves as a cornerstone for assessing the fundamental cognitive capabilities of human intelligence. In recent times, there has been a notable surge in the development of Large Language Models (LLMs) geared towards the automated resolution of mathematical problems. However, the landscape of mathematical problem types is vast and varied, with LLM-oriented techniques undergoing evaluation across diverse datasets and settings. This diversity makes it challenging to discern the true advancements and obstacles within this burgeoning field. This survey endeavors to address four pivotal dimensions: i) a comprehensive exploration of the various mathematical problems and their corresponding datasets that have been investigated; ii) an examination of the spectrum of LLM-oriented techniques that have been proposed for mathematical problem-solving; iii) an overview of factors and concerns affecting LLMs in solving math; and iv) an elucidation of the persisting challenges within this domain. To the best of our knowledge, this survey stands as one of the first extensive examinations of the landscape of LLMs in the realm of mathematics, providing a holistic perspective on the current state, accomplishments, and future challenges in this rapidly evolving field.

Large reasoning models have recently made significant strides in mathematical and code reasoning, yet their success has not transferred smoothly to the medical domain. While multiple factors contribute to this disparity, a critical issue is the inadequate focus on the quality of intermediate reflection steps, which is particularly crucial in high-stakes medical scenarios. To address this challenge, we propose Med-REFL, a \textbf{Med}ical \textbf{R}easoning \textbf{E}nhancement via self-corrected \textbf{F}ine-grained ref\textbf{L}ection. Our method leverages a tree-of-thought approach to decompose medical questions into fine-grained reasoning paths, quantitatively evaluating each step and its subsequent reflections. These assessments enable automatic construction of direct preference optimization data, reducing reliance on expensive expert annotations while guiding models to identify and correct reasoning errors. Experimental results on the MedQA-USMLE benchmark demonstrate Med-REFL achieves consistent improvements, with average gains up to 4.11\%. Notably, it further boosts the state-of-the-art performance of 7B/8B models by an additional 4.13\%. Furthermore, Med-REFL exhibits strong generalization capabilities and robustness across several challenging medical question-answering datasets. Our work illustrates that prioritizing reflection quality leads to more accurate and trustworthy reasoning in medical AI applications. Checkpoints, code, and data can be found https://github.com/TianYin123/Med-REFL{here}.

Language models struggle with handling numerical data and performing arithmetic operations. We hypothesize that this limitation can be partially attributed to non-intuitive textual numbers representation. When a digit is read or generated by a causal language model it does not know its place value (e.g. thousands vs. hundreds) until the entire number is processed. To address this issue, we propose a simple adjustment to how numbers are represented by including the count of digits before each number. For instance, instead of "42", we suggest using "{2:42}" as the new format. This approach, which we term NumeroLogic, offers an added advantage in number generation by serving as a Chain of Thought (CoT). By requiring the model to consider the number of digits first, it enhances the reasoning process before generating the actual number. We use arithmetic tasks to demonstrate the effectiveness of the NumeroLogic formatting. We further demonstrate NumeroLogic applicability to general natural language modeling, improving language understanding performance in the MMLU benchmark.

Large language models (LLMs) have demonstrated remarkable capabilities in natural language understanding and generation across various domains, including medicine. We present a comprehensive evaluation of GPT-4, a state-of-the-art LLM, on medical competency examinations and benchmark datasets. GPT-4 is a general-purpose model that is not specialized for medical problems through training or engineered to solve clinical tasks. Our analysis covers two sets of official practice materials for the USMLE, a three-step examination program used to assess clinical competency and grant licensure in the United States. We also evaluate performance on the MultiMedQA suite of benchmark datasets. Beyond measuring model performance, experiments were conducted to investigate the influence of test questions containing both text and images on model performance, probe for memorization of content during training, and study probability calibration, which is of critical importance in high-stakes applications like medicine. Our results show that GPT-4, without any specialized prompt crafting, exceeds the passing score on USMLE by over 20 points and outperforms earlier general-purpose models (GPT-3.5) as well as models specifically fine-tuned on medical knowledge (Med-PaLM, a prompt-tuned version of Flan-PaLM 540B). In addition, GPT-4 is significantly better calibrated than GPT-3.5, demonstrating a much-improved ability to predict the likelihood that its answers are correct. We also explore the behavior of the model qualitatively through a case study that shows the ability of GPT-4 to explain medical reasoning, personalize explanations to students, and interactively craft new counterfactual scenarios around a medical case. Implications of the findings are discussed for potential uses of GPT-4 in medical education, assessment, and clinical practice, with appropriate attention to challenges of accuracy and safety.

A central question in artificial intelligence is the extent to which machine learning models comprehend mathematics. To address this, we propose a novel framework for measuring mathematical reasoning that moves beyond standard benchmarks to diagnose specific failure points. Our method first generates structured, step-by-step reasoning from gpt-3.5-turbo on the GSM8K dataset. We then use a more capable analyst model, gpt-4o-mini, to categorize errors and, crucially, perform an unsupervised clustering of every reasoning sentence to identify emergent "reasoning modes." This analysis reveals a cognitive profile with a stark, nonhuman-like brittleness: while the model achieves near-perfect accuracy on procedural modes like sequential calculation, its performance on modes requiring combinatorial reasoning with restrictions plummets. By identifying and quantifying the reliability of these distinct reasoning skills, our work provides a more granular method to evaluate mathematical comprehension and offers a precise roadmap for developing new capabilities and more reliable future applications.

Large Language Models (LLMs) have demonstrated impressive capabilities in natural language processing tasks, such as text generation and semantic understanding. However, their performance on numerical reasoning tasks, such as basic arithmetic, numerical retrieval, and magnitude comparison, remains surprisingly poor. This gap arises from their reliance on surface-level statistical patterns rather than understanding numbers as continuous magnitudes. Existing benchmarks primarily focus on either linguistic competence or structured mathematical problem-solving, neglecting fundamental numerical reasoning required in real-world scenarios. To bridge this gap, we propose NumericBench, a comprehensive benchmark to evaluate six fundamental numerical capabilities: number recognition, arithmetic operations, contextual retrieval, comparison, summary, and logical reasoning. NumericBench includes datasets ranging from synthetic number lists to the crawled real-world data, addressing challenges like long contexts, noise, and multi-step reasoning. Extensive experiments on state-of-the-art LLMs, including GPT-4 and DeepSeek, reveal persistent weaknesses in numerical reasoning, highlighting the urgent need to improve numerically-aware language modeling. The benchmark is released in: https://github.com/TreeAI-Lab/NumericBench.

The breakthrough of OpenAI o1 highlights the potential of enhancing reasoning to improve LLM. Yet, most research in reasoning has focused on mathematical tasks, leaving domains like medicine underexplored. The medical domain, though distinct from mathematics, also demands robust reasoning to provide reliable answers, given the high standards of healthcare. However, verifying medical reasoning is challenging, unlike those in mathematics. To address this, we propose verifiable medical problems with a medical verifier to check the correctness of model outputs. This verifiable nature enables advancements in medical reasoning through a two-stage approach: (1) using the verifier to guide the search for a complex reasoning trajectory for fine-tuning LLMs, (2) applying reinforcement learning (RL) with verifier-based rewards to enhance complex reasoning further. Finally, we introduce HuatuoGPT-o1, a medical LLM capable of complex reasoning, which outperforms general and medical-specific baselines using only 40K verifiable problems. Experiments show complex reasoning improves medical problem-solving and benefits more from RL. We hope our approach inspires advancements in reasoning across medical and other specialized domains.

Mathematical reasoning, a core ability of human intelligence, presents unique challenges for machines in abstract thinking and logical reasoning. Recent large pre-trained language models such as GPT-3 have achieved remarkable progress on mathematical reasoning tasks written in text form, such as math word problems (MWP). However, it is unknown if the models can handle more complex problems that involve math reasoning over heterogeneous information, such as tabular data. To fill the gap, we present Tabular Math Word Problems (TabMWP), a new dataset containing 38,431 open-domain grade-level problems that require mathematical reasoning on both textual and tabular data. Each question in TabMWP is aligned with a tabular context, which is presented as an image, semi-structured text, and a structured table. There are two types of questions: free-text and multi-choice, and each problem is annotated with gold solutions to reveal the multi-step reasoning process. We evaluate different pre-trained models on TabMWP, including the GPT-3 model in a few-shot setting. As earlier studies suggest, since few-shot GPT-3 relies on the selection of in-context examples, its performance is unstable and can degrade to near chance. The unstable issue is more severe when handling complex problems like TabMWP. To mitigate this, we further propose a novel approach, PromptPG, which utilizes policy gradient to learn to select in-context examples from a small amount of training data and then constructs the corresponding prompt for the test example. Experimental results show that our method outperforms the best baseline by 5.31% on the accuracy metric and reduces the prediction variance significantly compared to random selection, which verifies its effectiveness in selecting in-context examples.

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

Numerical reasoning over natural language has been a long-standing goal for the research community. However, cutting-edge language models have proven difficult to reliably generalize to a broad range of numbers, although they have shown proficiency in reasoning over common and simple numbers. In this paper, we propose a novel method to elicit and exploit the numerical reasoning knowledge hidden in pre-trained language models using simple anchor numbers. Concretely, we first leverage simple numbers as anchors to probe the implicitly inferred arithmetic expressions from language models, and then explicitly apply the expressions on complex numbers to get corresponding answers. To inversely elicit arithmetic expressions, we transform and formulate the task as an analytically solvable linear system. Experimental results on several numerical reasoning benchmarks demonstrate that our approach significantly improves numerical reasoning capabilities of existing LMs. More importantly, our approach is training-free and simply works in the inference phase, making it highly portable and achieving consistent performance benefits across a variety of language models (GPT-3, T5, BART, etc) in all zero-shot, few-shot, and fine-tuning scenarios.

Mathematical reasoning is a fundamental aspect of human intelligence and is applicable in various fields, including science, engineering, finance, and everyday life. The development of artificial intelligence (AI) systems capable of solving math problems and proving theorems has garnered significant interest in the fields of machine learning and natural language processing. For example, mathematics serves as a testbed for aspects of reasoning that are challenging for powerful deep learning models, driving new algorithmic and modeling advances. On the other hand, recent advances in large-scale neural language models have opened up new benchmarks and opportunities to use deep learning for mathematical reasoning. In this survey paper, we review the key tasks, datasets, and methods at the intersection of mathematical reasoning and deep learning over the past decade. We also evaluate existing benchmarks and methods, and discuss future research directions in this domain.

Large language models (LLMs) have exhibited remarkable capabilities across various domains and tasks, pushing the boundaries of our knowledge in learning and cognition. The latest model, OpenAI's o1, stands out as the first LLM with an internalized chain-of-thought technique using reinforcement learning strategies. While it has demonstrated surprisingly strong capabilities on various general language tasks, its performance in specialized fields such as medicine remains unknown. To this end, this report provides a comprehensive exploration of o1 on different medical scenarios, examining 3 key aspects: understanding, reasoning, and multilinguality. Specifically, our evaluation encompasses 6 tasks using data from 37 medical datasets, including two newly constructed and more challenging question-answering (QA) tasks based on professional medical quizzes from the New England Journal of Medicine (NEJM) and The Lancet. These datasets offer greater clinical relevance compared to standard medical QA benchmarks such as MedQA, translating more effectively into real-world clinical utility. Our analysis of o1 suggests that the enhanced reasoning ability of LLMs may (significantly) benefit their capability to understand various medical instructions and reason through complex clinical scenarios. Notably, o1 surpasses the previous GPT-4 in accuracy by an average of 6.2% and 6.6% across 19 datasets and two newly created complex QA scenarios. But meanwhile, we identify several weaknesses in both the model capability and the existing evaluation protocols, including hallucination, inconsistent multilingual ability, and discrepant metrics for evaluation. We release our raw data and model outputs at https://ucsc-vlaa.github.io/o1_medicine/ for future research.

Visual mathematical reasoning, as a fundamental visual reasoning ability, has received widespread attention from the Large Multimodal Models (LMMs) community. Existing benchmarks, such as MathVista and MathVerse, focus more on the result-oriented performance but neglect the underlying principles in knowledge acquisition and generalization. Inspired by human-like mathematical reasoning, we introduce WE-MATH, the first benchmark specifically designed to explore the problem-solving principles beyond end-to-end performance. We meticulously collect and categorize 6.5K visual math problems, spanning 67 hierarchical knowledge concepts and five layers of knowledge granularity. We decompose composite problems into sub-problems according to the required knowledge concepts and introduce a novel four-dimensional metric, namely Insufficient Knowledge (IK), Inadequate Generalization (IG), Complete Mastery (CM), and Rote Memorization (RM), to hierarchically assess inherent issues in LMMs' reasoning process. With WE-MATH, we conduct a thorough evaluation of existing LMMs in visual mathematical reasoning and reveal a negative correlation between solving steps and problem-specific performance. We confirm the IK issue of LMMs can be effectively improved via knowledge augmentation strategies. More notably, the primary challenge of GPT-4o has significantly transitioned from IK to IG, establishing it as the first LMM advancing towards the knowledge generalization stage. In contrast, other LMMs exhibit a marked inclination towards Rote Memorization - they correctly solve composite problems involving multiple knowledge concepts yet fail to answer sub-problems. We anticipate that WE-MATH will open new pathways for advancements in visual mathematical reasoning for LMMs. The WE-MATH data and evaluation code are available at https://github.com/We-Math/We-Math.

Recent LLMs have demonstrated remarkable performance in solving exam-like math word problems. However, the degree to which these numerical reasoning skills are effective in real-world scenarios, particularly in expert domains, is still largely unexplored. This paper introduces DocMath-Eval, a comprehensive benchmark specifically designed to evaluate the numerical reasoning and problem-solving capabilities of LLMs in the context of understanding and analyzing financial documents containing both text and tables. We evaluate a wide spectrum of 19 LLMs, including those specialized in coding and finance. We also incorporate different prompting strategies (i.e., Chain-of-Thoughts and Program-of-Thoughts) to comprehensively assess the capabilities and limitations of existing LLMs in DocMath-Eval. We found that, although the current best-performing system (i.e., GPT-4), can perform well on simple problems such as calculating the rate of increase in a financial metric within a short document context, it significantly lags behind human experts in more complex problems grounded in longer contexts. We believe DocMath-Eval can be used as a valuable benchmark to evaluate LLMs' capabilities to solve challenging numerical reasoning problems in expert domains. We will release the benchmark and code at https://github.com/yale-nlp/DocMath-Eval.

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

Though reasoning-based large language models (LLMs) have excelled in mathematics and programming, their capabilities in knowledge-intensive medical question answering remain underexplored. To address this, we introduce ReasonMed, the largest medical reasoning dataset, comprising 370k high-quality examples distilled from 1.7 million initial reasoning paths generated by various LLMs. ReasonMed is constructed through a multi-agent verification and refinement process, where we design an Error Refiner to enhance the reasoning paths by identifying and correcting error-prone steps flagged by a verifier. Leveraging ReasonMed, we systematically investigate best practices for training medical reasoning models and find that combining detailed Chain-of-Thought (CoT) reasoning with concise answer summaries yields the most effective fine-tuning strategy. Based on this strategy, we train ReasonMed-7B, which sets a new benchmark for sub-10B models, outperforming the prior best by 4.17\% and even exceeding LLaMA3.1-70B on PubMedQA by 4.60\%.

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

Large pre-trained language models (LMs) are known to encode substantial amounts of linguistic information. However, high-level reasoning skills, such as numerical reasoning, are difficult to learn from a language-modeling objective only. Consequently, existing models for numerical reasoning have used specialized architectures with limited flexibility. In this work, we show that numerical reasoning is amenable to automatic data generation, and thus one can inject this skill into pre-trained LMs, by generating large amounts of data, and training in a multi-task setup. We show that pre-training our model, GenBERT, on this data, dramatically improves performance on DROP (49.3 rightarrow 72.3 F1), reaching performance that matches state-of-the-art models of comparable size, while using a simple and general-purpose encoder-decoder architecture. Moreover, GenBERT generalizes well to math word problem datasets, while maintaining high performance on standard RC tasks. Our approach provides a general recipe for injecting skills into large pre-trained LMs, whenever the skill is amenable to automatic data augmentation.

There are two main barriers to using large language models (LLMs) in clinical reasoning. Firstly, while LLMs exhibit significant promise in Natural Language Processing (NLP) tasks, their performance in complex reasoning and planning falls short of expectations. Secondly, LLMs use uninterpretable methods to make clinical decisions that are fundamentally different from the clinician's cognitive processes. This leads to user distrust. In this paper, we present a multi-agent framework called ArgMed-Agents, which aims to enable LLM-based agents to make explainable clinical decision reasoning through interaction. ArgMed-Agents performs self-argumentation iterations via Argumentation Scheme for Clinical Discussion (a reasoning mechanism for modeling cognitive processes in clinical reasoning), and then constructs the argumentation process as a directed graph representing conflicting relationships. Ultimately, use symbolic solver to identify a series of rational and coherent arguments to support decision. We construct a formal model of ArgMed-Agents and present conjectures for theoretical guarantees. ArgMed-Agents enables LLMs to mimic the process of clinical argumentative reasoning by generating explanations of reasoning in a self-directed manner. The setup experiments show that ArgMed-Agents not only improves accuracy in complex clinical decision reasoning problems compared to other prompt methods, but more importantly, it provides users with decision explanations that increase their confidence.

Mathematical reasoning remains one of the most challenging domains for large language models (LLMs), requiring not only linguistic understanding but also structured logical deduction and numerical precision. While recent LLMs demonstrate strong general-purpose reasoning abilities, their mathematical competence across diverse languages remains underexplored. Existing benchmarks primarily focus on English or a narrow subset of high-resource languages, leaving significant gaps in assessing multilingual and cross-lingual mathematical reasoning. To address this, we introduce MathMist, a parallel multilingual benchmark for mathematical problem solving and reasoning. MathMist encompasses over 21K aligned question-answer pairs across seven languages, representing a balanced coverage of high-, medium-, and low-resource linguistic settings. The dataset captures linguistic variety, multiple types of problem settings, and solution synthesizing capabilities. We systematically evaluate a diverse suite of models, including open-source small and medium LLMs, proprietary systems, and multilingual-reasoning-focused models, under zero-shot, chain-of-thought (CoT), and code-switched reasoning paradigms. Our results reveal persistent deficiencies in LLMs' ability to perform consistent and interpretable mathematical reasoning across languages, with pronounced degradation in low-resource settings. All the codes and data are available at GitHub: https://github.com/mahbubhimel/MathMist

Advancements in LLMs have significantly expanded their capabilities across various domains. However, mathematical reasoning remains a challenging area, prompting the development of math-specific LLMs. These models typically follow a two-stage training paradigm: pre-training with math-related corpora and post-training with problem datasets for SFT. Despite these efforts, the improvements in mathematical reasoning achieved through continued pre-training (CPT) are often less significant compared to those obtained via SFT. This study addresses this discrepancy by exploring alternative strategies during the pre-training phase, focusing on the use of problem-solving data over general mathematical corpora. We investigate three primary research questions: (1) Can problem-solving data enhance the model's mathematical reasoning capabilities more effectively than general mathematical corpora during CPT? (2) Are synthetic data from the same source equally effective, and which synthesis methods are most efficient? (3) How do the capabilities developed from the same problem-solving data differ between the CPT and SFT stages, and what factors contribute to these differences? Our findings indicate that problem-solving data significantly enhances the model's mathematical capabilities compared to general mathematical corpora. We also identify effective data synthesis methods, demonstrating that the tutorship amplification synthesis method achieves the best performance. Furthermore, while SFT facilitates instruction-following abilities, it underperforms compared to CPT with the same data, which can be partially attributed to its poor learning capacity for hard multi-step problem-solving data. These insights provide valuable guidance for optimizing the mathematical reasoning capabilities of LLMs, culminating in our development of a powerful mathematical base model called JiuZhang-8B.

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

The ability to understand and work with numbers (numeracy) is critical for many complex reasoning tasks. Currently, most NLP models treat numbers in text in the same way as other tokens---they embed them as distributed vectors. Is this enough to capture numeracy? We begin by investigating the numerical reasoning capabilities of a state-of-the-art question answering model on the DROP dataset. We find this model excels on questions that require numerical reasoning, i.e., it already captures numeracy. To understand how this capability emerges, we probe token embedding methods (e.g., BERT, GloVe) on synthetic list maximum, number decoding, and addition tasks. A surprising degree of numeracy is naturally present in standard embeddings. For example, GloVe and word2vec accurately encode magnitude for numbers up to 1,000. Furthermore, character-level embeddings are even more precise---ELMo captures numeracy the best for all pre-trained methods---but BERT, which uses sub-word units, is less exact.

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

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

Numerical reasoning over text (NRoT) presents unique challenges that are not well addressed by existing pre-training objectives. We explore five sequential training schedules that adapt a pre-trained T5 model for NRoT. Our final model is adapted from T5, but further pre-trained on three datasets designed to strengthen skills necessary for NRoT and general reading comprehension before being fine-tuned on the Discrete Reasoning over Text (DROP) dataset. The training improves DROP's adjusted F1 performance (a numeracy-focused score) from 45.90 to 70.83. Our model closes in on GenBERT (72.4), a custom BERT-Base model using the same datasets with significantly more parameters. We show that training the T5 multitasking framework with multiple numerical reasoning datasets of increasing difficulty, good performance on DROP can be achieved without manually engineering partitioned functionality between distributed and symbol modules.

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

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

The emergence of advanced reasoning capabilities in Large Language Models (LLMs) marks a transformative development in healthcare applications. Beyond merely expanding functional capabilities, these reasoning mechanisms enhance decision transparency and explainability-critical requirements in medical contexts. This survey examines the transformation of medical LLMs from basic information retrieval tools to sophisticated clinical reasoning systems capable of supporting complex healthcare decisions. We provide a thorough analysis of the enabling technological foundations, with a particular focus on specialized prompting techniques like Chain-of-Thought and recent breakthroughs in Reinforcement Learning exemplified by DeepSeek-R1. Our investigation evaluates purpose-built medical frameworks while also examining emerging paradigms such as multi-agent collaborative systems and innovative prompting architectures. The survey critically assesses current evaluation methodologies for medical validation and addresses persistent challenges in field interpretation limitations, bias mitigation strategies, patient safety frameworks, and integration of multimodal clinical data. Through this survey, we seek to establish a roadmap for developing reliable LLMs that can serve as effective partners in clinical practice and medical research.

Access to the right evidence does not guarantee that large language models (LLMs) will reason with it correctly. This gap between retrieval and reasoning is especially concerning in clinical settings, where outputs must align with structured protocols. We study this gap using Written Exposure Therapy (WET) guidelines as a testbed. In evaluating model responses to curated clinician-vetted questions, we find that errors persist even when authoritative passages are provided. To address this, we propose an evaluation framework that measures accuracy, consistency, and fidelity of reasoning. Our results highlight both the potential and the risks: retrieval-augmented generation (RAG) can constrain outputs, but safe deployment requires assessing reasoning as rigorously as retrieval.

Chain-of-Thought (CoT) reasoning has proven effective in enhancing large language models by encouraging step-by-step intermediate reasoning, and recent advances have extended this paradigm to Multimodal Large Language Models (MLLMs). In the medical domain, where diagnostic decisions depend on nuanced visual cues and sequential reasoning, CoT aligns naturally with clinical thinking processes. However, Current benchmarks for medical image understanding generally focus on the final answer while ignoring the reasoning path. An opaque process lacks reliable bases for judgment, making it difficult to assist doctors in diagnosis. To address this gap, we introduce a new M3CoTBench benchmark specifically designed to evaluate the correctness, efficiency, impact, and consistency of CoT reasoning in medical image understanding. M3CoTBench features 1) a diverse, multi-level difficulty dataset covering 24 examination types, 2) 13 varying-difficulty tasks, 3) a suite of CoT-specific evaluation metrics (correctness, efficiency, impact, and consistency) tailored to clinical reasoning, and 4) a performance analysis of multiple MLLMs. M3CoTBench systematically evaluates CoT reasoning across diverse medical imaging tasks, revealing current limitations of MLLMs in generating reliable and clinically interpretable reasoning, and aims to foster the development of transparent, trustworthy, and diagnostically accurate AI systems for healthcare. Project page at https://juntaojianggavin.github.io/projects/M3CoTBench/.

The ability to precisely derive mathematical objects is a core requirement for downstream STEM applications, including mathematics, physics, and chemistry, where reasoning must culminate in formally structured expressions. Yet, current LM evaluations of mathematical and scientific reasoning rely heavily on simplified answer formats such as numerical values or multiple choice options due to the convenience of automated assessment. In this paper we provide three contributions for improving reasoning over mathematical objects: (i) we build and release training data and benchmarks for deriving mathematical objects, the Principia suite; (ii) we provide training recipes with strong LLM-judges and verifiers, where we show that on-policy judge training boosts performance; (iii) we show how on-policy training can also be used to scale test-time compute via aggregation. We find that strong LMs such as Qwen3-235B and o3 struggle on Principia, while our training recipes can bring significant improvements over different LLM backbones, while simultaneously improving results on existing numerical and MCQA tasks, demonstrating cross-format generalization of reasoning abilities.

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

Vision language models (VLMs) achieve unified modeling of images and text, enabling them to accomplish complex real-world tasks through perception, planning, and reasoning. Among these tasks, reasoning is particularly representative, with mathematical reasoning serving as a prominent example. It highlights the high-level capability of VLMs to comprehend mathematical information in images and to perform sophisticated reasoning. Recently, numerous visual mathematical reasoning benchmarks have been proposed, but they are often restricted to geometry, lack coverage of math word problems, and rarely assess reasoning across multiple images. To address these gaps, we introduce GSM8K-V, a purely visual multi-image mathematical reasoning benchmark. GSM8K-V is built by systematically mapping each sample from the widely used text-based GSM8K into visual form. Through a carefully designed automated image-generation pipeline combined with meticulous human annotation, we curate 1,319 high-quality samples. We evaluate a wide range of open-source and closed-source models on GSM8K-V. Results show that although existing VLMs have nearly saturated performance on text-based GSM8K, there remains substantial room for improvement on GSM8K-V. For example, the best-performing model, Gemini-2.5-Pro, achieves 95.22% accuracy on GSM8K but only 46.93% on GSM8K-V. We conduct a comprehensive analysis of GSM8K-V, examining the limitations of current models as well as potential directions for improvement. GSM8K-V offers a new perspective on visual mathematical reasoning and establishes a benchmark to guide the development of more robust and generalizable VLMs.

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.

Large language models (LLMs) have demonstrated remarkable capabilities in problem-solving. However, their proficiency in solving mathematical problems remains inadequate. We propose MathScale, a simple and scalable method to create high-quality mathematical reasoning data using frontier LLMs (e.g., {\tt GPT-3.5}). Inspired by the cognitive mechanism in human mathematical learning, it first extracts topics and knowledge points from seed math questions and then build a concept graph, which is subsequently used to generate new math questions. MathScale exhibits effective scalability along the size axis of the math dataset that we generate. As a result, we create a mathematical reasoning dataset (MathScaleQA) containing two million math question-answer pairs. To evaluate mathematical reasoning abilities of LLMs comprehensively, we construct {\sc MwpBench}, a benchmark of Math Word Problems, which is a collection of ten datasets (including GSM8K and MATH) covering K-12, college, and competition level math problems. We apply MathScaleQA to fine-tune open-source LLMs (e.g., LLaMA-2 and Mistral), resulting in significantly improved capabilities in mathematical reasoning. Evaluated on {\sc MwpBench}, MathScale-7B achieves state-of-the-art performance across all datasets, surpassing its best peers of equivalent size by 42.9\% in micro average accuracy and 43.7\% in macro average accuracy, respectively.

Multimodal large language models (MLLMs) have recently demonstrated remarkable reasoning abilities with reinforcement learning paradigm. Although several multimodal reasoning models have been explored in the medical domain, most of them focus exclusively on basic reasoning, which refers to shallow inference based on visual feature matching. However, real-world clinical diagnosis extends beyond basic reasoning, demanding reasoning processes that integrate heterogeneous clinical information (such as chief complaints and medical history) with multimodal medical imaging data. To bridge this gap, we introduce MM-Retinal-Reason, the first ophthalmic multimodal dataset with the full spectrum of perception and reasoning. It encompasses both basic reasoning tasks and complex reasoning tasks, aiming to enhance visual-centric fundamental reasoning capabilities and emulate realistic clinical thinking patterns. Building upon MM-Retinal-Reason, we propose OphthaReason, the first ophthalmology-specific multimodal reasoning model with step-by-step reasoning traces. To enable flexible adaptation to both basic and complex reasoning tasks, we specifically design a novel method called Uncertainty-Aware Dynamic Thinking (UADT), which estimates sample-level uncertainty via entropy and dynamically modulates the model's exploration depth using a shaped advantage mechanism. Comprehensive experiments demonstrate that our model achieves state-of-the-art performance on both basic and complex reasoning tasks, outperforming general-purpose MLLMs, medical MLLMs, RL-based medical MLLMs, and ophthalmic MLLMs by at least 24.92\%, 15.00\%, 21.20\%, and 17.66\%. Project Page: https://github.com/lxirich/OphthaReason{link}.

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

Mathematical reasoning is a cornerstone of artificial general intelligence and a primary benchmark for evaluating the capabilities of Large Language Models (LLMs). While state-of-the-art models show promise, they often falter when faced with complex problems that demand deep conceptual understanding and intricate, multi-step deliberation. To address this challenge, we introduce JT-Math-8B, a series of open-source models comprising base, instruct, and thinking versions, built upon a systematic, multi-stage optimization framework. Our pre-training corpus is a high-quality, 210B-token dataset curated through a dedicated data pipeline that uses model-based validation to ensure quality and diversity. The Instruct Model is optimized for direct, concise answers through Supervised Fine-Tuning (SFT) and a GRPO-based reinforcement learning (RL) method. The Thinking Model is trained for complex problem-solving using a Long Chain-of-Thought (Long CoT) approach, combining SFT with a novel, multi-stage RL curriculum that progressively increases task difficulty and context length up to 32K tokens. JT-Math-8B achieves state-of-the-art results among open-source models of similar size, surpassing prominent models like OpenAI's O1-mini and GPT-4o , and demonstrating superior performance on competition-level mathematics.

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

Mathematical reasoning is a cornerstone of human intelligence and a key benchmark for advanced capabilities in large language models (LLMs). However, the research community still lacks an open, large-scale, high-quality corpus tailored to the demands of math-centric LLM pre-training. We present MegaMath, an open dataset curated from diverse, math-focused sources through following practices: (1) Revisiting web data: We re-extracted mathematical documents from Common Crawl with math-oriented HTML optimizations, fasttext-based filtering and deduplication, all for acquiring higher-quality data on the Internet. (2) Recalling Math-related code data: We identified high quality math-related code from large code training corpus, Stack-V2, further enhancing data diversity. (3) Exploring Synthetic data: We synthesized QA-style text, math-related code, and interleaved text-code blocks from web data or code data. By integrating these strategies and validating their effectiveness through extensive ablations, MegaMath delivers 371B tokens with the largest quantity and top quality among existing open math pre-training datasets.

The deployment of Large Language Models (LLMs) in high-stakes clinical settings demands rigorous and reliable evaluation. However, existing medical benchmarks remain static, suffering from two critical limitations: (1) data contamination, where test sets inadvertently leak into training corpora, leading to inflated performance estimates; and (2) temporal misalignment, failing to capture the rapid evolution of medical knowledge. Furthermore, current evaluation metrics for open-ended clinical reasoning often rely on either shallow lexical overlap (e.g., ROUGE) or subjective LLM-as-a-Judge scoring, both inadequate for verifying clinical correctness. To bridge these gaps, we introduce LiveMedBench, a continuously updated, contamination-free, and rubric-based benchmark that weekly harvests real-world clinical cases from online medical communities, ensuring strict temporal separation from model training data. We propose a Multi-Agent Clinical Curation Framework that filters raw data noise and validates clinical integrity against evidence-based medical principles. For evaluation, we develop an Automated Rubric-based Evaluation Framework that decomposes physician responses into granular, case-specific criteria, achieving substantially stronger alignment with expert physicians than LLM-as-a-Judge. To date, LiveMedBench comprises 2,756 real-world cases spanning 38 medical specialties and multiple languages, paired with 16,702 unique evaluation criteria. Extensive evaluation of 38 LLMs reveals that even the best-performing model achieves only 39.2%, and 84% of models exhibit performance degradation on post-cutoff cases, confirming pervasive data contamination risks. Error analysis further identifies contextual application-not factual knowledge-as the dominant bottleneck, with 35-48% of failures stemming from the inability to tailor medical knowledge to patient-specific constraints.

Mathematical reasoning is an increasingly important indicator of large language model (LLM) capabilities, yet we lack understanding of how LLMs process even simple mathematical tasks. To address this, we reverse engineer how three mid-sized LLMs compute addition. We first discover that numbers are represented in these LLMs as a generalized helix, which is strongly causally implicated for the tasks of addition and subtraction, and is also causally relevant for integer division, multiplication, and modular arithmetic. We then propose that LLMs compute addition by manipulating this generalized helix using the "Clock" algorithm: to solve a+b, the helices for a and b are manipulated to produce the a+b answer helix which is then read out to model logits. We model influential MLP outputs, attention head outputs, and even individual neuron preactivations with these helices and verify our understanding with causal interventions. By demonstrating that LLMs represent numbers on a helix and manipulate this helix to perform addition, we present the first representation-level explanation of an LLM's mathematical capability.

Large Language Models (LLMs) solely trained on next-token prediction learn to solve a wide range of problems involving mathematical reasoning. But how does this ability evolve during training? We show the first analysis of how mathematical reasoning abilities of several open-weight LLMs develop during pre-training and post-training. To this end, we construct MathCAMPS, a synthetic dataset of novel mathematical reasoning problems grounded in 44 fine-grained skills taken from the Common Core curriculum from K to 8th grades. In one experiment, we show that mathematical skills are learned during pre-training in an order that measurably correlates with the human-designed curriculum, even though training data are randomly ordered. We also show a detailed analysis of which mathematical abilities benefit from instruction tuning, a widely used post-training method and, in contrast, which skills suffer. Our work paves the way for an empirical understanding of LLM training dynamics in relation to reasoning.

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

Recent advances in large language models (LLMs) and multimodal LLMs (MLLMs) have led to strong reasoning ability across a wide range of tasks. However, their ability to perform mathematical reasoning from spoken input remains underexplored. Prior studies on speech modality have mostly focused on factual speech understanding or simple audio reasoning tasks, providing limited insight into logical step-by-step reasoning, such as that required for mathematical problem solving. To address this gap, we introduce Spoken Math Question Answering (Spoken-MQA), a new benchmark designed to evaluate the mathematical reasoning capabilities of speech-based models, including both cascade models (ASR + LLMs) and end-to-end speech LLMs. Spoken-MQA covers a diverse set of math problems, including pure arithmetic, single-step and multi-step contextual reasoning, and knowledge-oriented reasoning problems, all presented in unambiguous natural spoken language. Through extensive experiments, we find that: (1) while some speech LLMs perform competitively on contextual reasoning tasks involving basic arithmetic, they still struggle with direct arithmetic problems; (2) current LLMs exhibit a strong bias toward symbolic mathematical expressions written in LaTex and have difficulty interpreting verbalized mathematical expressions; and (3) mathematical knowledge reasoning abilities are significantly degraded in current speech LLMs.

This paper investigates the mathematical reasoning capabilities of large language models (LLMs) using 50 newly constructed high-school-level word problems. Unlike prior studies that focus solely on answer correctness, we rigorously analyze both final answers and solution steps to identify reasoning failures. Evaluating eight state-of-the-art models - including Mixtral, Llama, Gemini, GPT-4o, and OpenAI's o1 variants - we find that while newer models (e.g., o3-mini, deepseek-r1) achieve higher accuracy, all models exhibit errors in spatial reasoning, strategic planning, and arithmetic, sometimes producing correct answers through flawed logic. Common failure modes include unwarranted assumptions, over-reliance on numerical patterns, and difficulty translating physical intuition into mathematical steps. Manual analysis reveals that models struggle with problems requiring multi-step deduction or real-world knowledge, despite possessing broad mathematical knowledge. Our results underscore the importance of evaluating reasoning processes, not just answers, and caution against overestimating LLMs' problem-solving proficiency. The study highlights persistent gaps in LLMs' generalization abilities, emphasizing the need for targeted improvements in structured reasoning and constraint handling.

Recent proprietary models (e.g., o3) have begun to demonstrate strong multimodal reasoning capabilities. Yet, most existing open-source research concentrates on training text-only reasoning models, with evaluations limited to mainly mathematical and general-domain tasks. Therefore, it remains unclear how to effectively extend reasoning capabilities beyond text input and general domains. This paper explores a fundamental research question: Is reasoning generalizable across modalities and domains? Our findings support an affirmative answer: General-domain text-based post-training can enable such strong generalizable reasoning. Leveraging this finding, we introduce X-Reasoner, a vision-language model post-trained solely on general-domain text for generalizable reasoning, using a two-stage approach: an initial supervised fine-tuning phase with distilled long chain-of-thoughts, followed by reinforcement learning with verifiable rewards. Experiments show that X-Reasoner successfully transfers reasoning capabilities to both multimodal and out-of-domain settings, outperforming existing state-of-the-art models trained with in-domain and multimodal data across various general and medical benchmarks (Figure 1). Additionally, we find that X-Reasoner's performance in specialized domains can be further enhanced through continued training on domain-specific text-only data. Building upon this, we introduce X-Reasoner-Med, a medical-specialized variant that achieves new state of the art on numerous text-only and multimodal medical benchmarks.

Mathematical reasoning models are widely deployed in education, automated tutoring, and decision support systems despite exhibiting fundamental computational instabilities. We demonstrate that state-of-the-art models (Qwen2.5-Math-7B) achieve 61% accuracy through a mixture of reliable and unreliable reasoning pathways: 18.4% of correct predictions employ stable, faithful reasoning while 81.6% emerge through computationally inconsistent pathways. Additionally, 8.8% of all predictions are silent failures -- confident yet incorrect outputs. Through comprehensive analysis using novel faithfulness metrics, we reveal: (1) reasoning quality shows weak negative correlation with correctness (r=-0.21, p=0.002), reflecting a binary classification threshold artifact rather than a monotonic inverse relationship; (2) scaling from 1.5B to 7B parameters (4.7x increase) provides zero accuracy benefit on our evaluated subset (6% of GSM8K), requiring validation on the complete benchmark; and (3) latent reasoning employs diverse computational strategies, with ~20% sharing CoT-like patterns. These findings highlight that benchmark accuracy can mask computational unreliability, demanding evaluation reforms measuring stability beyond single-sample metrics.

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.

Several recent works seek to develop foundation models specifically for medical applications, adapting general-purpose large language models (LLMs) and vision-language models (VLMs) via continued pretraining on publicly available biomedical corpora. These works typically claim that such domain-adaptive pretraining (DAPT) improves performance on downstream medical tasks, such as answering medical licensing exam questions. In this paper, we compare ten public "medical" LLMs and two VLMs against their corresponding base models, arriving at a different conclusion: all medical VLMs and nearly all medical LLMs fail to consistently improve over their base models in the zero-/few-shot prompting and supervised fine-tuning regimes for medical question-answering (QA). For instance, across all tasks and model pairs we consider in the 3-shot setting, medical LLMs only outperform their base models in 22.7% of cases, reach a (statistical) tie in 36.8% of cases, and are significantly worse than their base models in the remaining 40.5% of cases. Our conclusions are based on (i) comparing each medical model head-to-head, directly against the corresponding base model; (ii) optimizing the prompts for each model separately in zero-/few-shot prompting; and (iii) accounting for statistical uncertainty in comparisons. While these basic practices are not consistently adopted in the literature, our ablations show that they substantially impact conclusions. Meanwhile, we find that after fine-tuning on specific QA tasks, medical LLMs can show performance improvements, but the benefits do not carry over to tasks based on clinical notes. Our findings suggest that state-of-the-art general-domain models may already exhibit strong medical knowledge and reasoning capabilities, and offer recommendations to strengthen the conclusions of future studies.

Large language models have shown impressive results for multi-hop mathematical reasoning when the input question is only textual. Many mathematical reasoning problems, however, contain both text and image. With the ever-increasing adoption of vision language models (VLMs), understanding their reasoning abilities for such problems is crucial. In this paper, we evaluate the reasoning capabilities of VLMs along various axes through the lens of geometry problems. We procedurally create a synthetic dataset of geometry questions with controllable difficulty levels along multiple axes, thus enabling a systematic evaluation. The empirical results obtained using our benchmark for state-of-the-art VLMs indicate that these models are not as capable in subjects like geometry (and, by generalization, other topics requiring similar reasoning) as suggested by previous benchmarks. This is made especially clear by the construction of our benchmark at various depth levels, since solving higher-depth problems requires long chains of reasoning rather than additional memorized knowledge. We release the dataset for further research in this area.

Several recent works seek to develop foundation models specifically for medical applications, adapting general-purpose large language models (LLMs) and vision-language models (VLMs) via continued pretraining on publicly available biomedical corpora. These works typically claim that such domain-adaptive pretraining (DAPT) improves performance on downstream medical tasks, such as answering medical licensing exam questions. In this paper, we compare seven public "medical" LLMs and two VLMs against their corresponding base models, arriving at a different conclusion: all medical VLMs and nearly all medical LLMs fail to consistently improve over their base models in the zero-/few-shot prompting regime for medical question-answering (QA) tasks. For instance, across the tasks and model pairs we consider in the 3-shot setting, medical LLMs only outperform their base models in 12.1% of cases, reach a (statistical) tie in 49.8% of cases, and are significantly worse than their base models in the remaining 38.2% of cases. Our conclusions are based on (i) comparing each medical model head-to-head, directly against the corresponding base model; (ii) optimizing the prompts for each model separately; and (iii) accounting for statistical uncertainty in comparisons. While these basic practices are not consistently adopted in the literature, our ablations show that they substantially impact conclusions. Our findings suggest that state-of-the-art general-domain models may already exhibit strong medical knowledge and reasoning capabilities, and offer recommendations to strengthen the conclusions of future studies.

Advancement in Large Language Models (LLMs) reasoning capabilities enables them to solve scientific problems with enhanced efficacy. Thereby, a high-quality benchmark for comprehensive and appropriate assessment holds significance, while existing ones either confront the risk of data contamination or lack involved disciplines. To be specific, due to the data source overlap of LLMs training and static benchmark, the keys or number pattern of answers inadvertently memorized (i.e. data contamination), leading to systematic overestimation of their reasoning capabilities, especially numerical reasoning. We propose SciDA, a multidisciplinary benchmark that consists exclusively of over 1k Olympic-level numerical computation problems, allowing randomized numerical initializations for each inference round to avoid reliance on fixed numerical patterns. We conduct a series of experiments with both closed-source and open-source top-performing LLMs, and it is observed that the performance of LLMs drop significantly under random numerical initialization. Thus, we provide truthful and unbiased assessments of the numerical reasoning capabilities of LLMs. The data is available at https://huggingface.co/datasets/m-a-p/SciDA

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

Mathematical reasoning has long represented one of the most fundamental and challenging frontiers in artificial intelligence research. In recent years, large language models (LLMs) have achieved significant advances in this area. This survey examines the development of mathematical reasoning abilities in LLMs through two high-level cognitive phases: comprehension, where models gain mathematical understanding via diverse pretraining strategies, and answer generation, which has progressed from direct prediction to step-by-step Chain-of-Thought (CoT) reasoning. We review methods for enhancing mathematical reasoning, ranging from training-free prompting to fine-tuning approaches such as supervised fine-tuning and reinforcement learning, and discuss recent work on extended CoT and "test-time scaling". Despite notable progress, fundamental challenges remain in terms of capacity, efficiency, and generalization. To address these issues, we highlight promising research directions, including advanced pretraining and knowledge augmentation techniques, formal reasoning frameworks, and meta-generalization through principled learning paradigms. This survey tries to provide some insights for researchers interested in enhancing reasoning capabilities of LLMs and for those seeking to apply these techniques to other domains.

While reasoning-enhanced large language models perform strongly on English medical tasks, a persistent multilingual gap remains, with substantially weaker reasoning in local languages, limiting equitable global medical deployment. To bridge this gap, we introduce Med-CoReasoner, a language-informed co-reasoning framework that elicits parallel English and local-language reasoning, abstracts them into structured concepts, and integrates local clinical knowledge into an English logical scaffold via concept-level alignment and retrieval. This design combines the structural robustness of English reasoning with the practice-grounded expertise encoded in local languages. To evaluate multilingual medical reasoning beyond multiple-choice settings, we construct MultiMed-X, a benchmark covering seven languages with expert-annotated long-form question answering and natural language inference tasks, comprising 350 instances per language. Experiments across three benchmarks show that Med-CoReasoner improves multilingual reasoning performance by an average of 5%, with particularly substantial gains in low-resource languages. Moreover, model distillation and expert evaluation analysis further confirm that Med-CoReasoner produces clinically sound and culturally grounded reasoning traces.

CoT has significantly enhanced the reasoning ability of LLMs while it faces challenges when extended to multimodal domains, particularly in mathematical tasks. Existing MLLMs typically perform textual reasoning solely from a single static mathematical image, overlooking dynamic visual acquisition during reasoning. In contrast, humans repeatedly examine visual image and employ step-by-step reasoning to prove intermediate propositions. This strategy of decomposing the problem-solving process into key logical nodes adheres to Miller's Law in cognitive science. Inspired by this insight, we propose a ViRC framework for multimodal mathematical tasks, introducing a Reason Chunking mechanism that structures multimodal mathematical CoT into consecutive Critical Reasoning Units (CRUs) to simulate human expert problem-solving patterns. CRUs ensure intra-unit textual coherence for intermediate proposition verification while integrating visual information across units to generate subsequent propositions and support structured reasoning. To this end, we present CRUX dataset by using three visual tools and four reasoning patterns to provide explicitly annotated CRUs across multiple reasoning paths for each mathematical problem. Leveraging the CRUX dataset, we propose a progressive training strategy inspired by human cognitive learning, which includes Instructional SFT, Practice SFT, and Strategic RL, aimed at further strengthening the Reason Chunking ability of the model. The resulting ViRC-7B model achieves a 18.8% average improvement over baselines across multiple mathematical benchmarks. Code is available at https://github.com/Leon-LihongWang/ViRC.

Math reasoning is becoming an ever increasing area of focus as we scale large language models. However, even the previously-toughest evals like MATH are now close to saturated by frontier models (90.0% for o1-mini and 86.5% for Gemini 1.5 Pro). We introduce HARP, Human Annotated Reasoning Problems (for Math), consisting of 5,409 problems from the US national math competitions (A(J)HSME, AMC, AIME, USA(J)MO). Of these, 4,780 have answers that are automatically check-able (with libraries such as SymPy). These problems range six difficulty levels, with frontier models performing relatively poorly on the hardest bracket of 197 problems (average accuracy 41.1% for o1-mini, and 9.6% for Gemini 1.5 Pro). Our dataset also features multiple choices (for 4,110 problems) and an average of two human-written, ground-truth solutions per problem, offering new avenues of research that we explore briefly. We report evaluations for many frontier models and share some interesting analyses, such as demonstrating that frontier models across families intrinsically scale their inference-time compute for more difficult problems. Finally, we open source all code used for dataset construction (including scraping) and all code for evaluation (including answer checking) to enable future research at: https://github.com/aadityasingh/HARP.

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

Recent math benchmarks for large language models (LLMs) such as MathArena indicate that state-of-the-art reasoning models achieve impressive performance on mathematical competitions like AIME, with the leading model, o3-mini, achieving scores comparable to top human competitors. However, these benchmarks evaluate models solely based on final numerical answers, neglecting rigorous reasoning and proof generation which are essential for real-world mathematical tasks. To address this, we introduce the first comprehensive evaluation of full-solution reasoning for challenging mathematical problems. Using expert human annotators, we evaluated several state-of-the-art reasoning models on the six problems from the 2025 USAMO within hours of their release. Our results reveal that all tested models struggled significantly, achieving less than 5% on average. Through detailed analysis of reasoning traces, we identify the most common failure modes and find several unwanted artifacts arising from the optimization strategies employed during model training. Overall, our results suggest that current LLMs are inadequate for rigorous mathematical reasoning tasks, highlighting the need for substantial improvements in reasoning and proof generation capabilities.

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

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

Recent advancements in Large Language Models (LLMs) have sparked interest in their formal reasoning capabilities, particularly in mathematics. The GSM8K benchmark is widely used to assess the mathematical reasoning of models on grade-school-level questions. While the performance of LLMs on GSM8K has significantly improved in recent years, it remains unclear whether their mathematical reasoning capabilities have genuinely advanced, raising questions about the reliability of the reported metrics. To address these concerns, we conduct a large-scale study on several SOTA open and closed models. To overcome the limitations of existing evaluations, we introduce GSM-Symbolic, an improved benchmark created from symbolic templates that allow for the generation of a diverse set of questions. GSM-Symbolic enables more controllable evaluations, providing key insights and more reliable metrics for measuring the reasoning capabilities of models.Our findings reveal that LLMs exhibit noticeable variance when responding to different instantiations of the same question. Specifically, the performance of all models declines when only the numerical values in the question are altered in the GSM-Symbolic benchmark. Furthermore, we investigate the fragility of mathematical reasoning in these models and show that their performance significantly deteriorates as the number of clauses in a question increases. We hypothesize that this decline is because current LLMs cannot perform genuine logical reasoning; they replicate reasoning steps from their training data. Adding a single clause that seems relevant to the question causes significant performance drops (up to 65%) across all state-of-the-art models, even though the clause doesn't contribute to the reasoning chain needed for the final answer. Overall, our work offers a more nuanced understanding of LLMs' capabilities and limitations in mathematical reasoning.

Recent advances in inference time scaling with extended long chain-of thought have significantly improved the reasoning capabilities of both general and medical large language models (LLMs). However, these models tend to engage in lengthy reasoning processes regardless of the difficulty of the input question, leading to increased inference costs in real-world applications. Therefore, enabling adaptive thinking where models think less for simpler questions and think more for complex ones is critical for the effective use of medical LLMs in practice. Despite its importance, there is a lack of end-to-end approaches designed to enhance the adaptive thinking capabilities of medical LLMs while providing a comprehensive examination of the trade-off between performance and computational cost. To bridge this gap, we propose AdaThink-Med, the first end-to-end framework designed to enhance adaptive thinking ability in medical reasoning models with uncertainty-guided length calibration. AdaThink-Med first generates multiple candidate outputs for each question, evaluates the correctness and uncertainty of each candidate, and then estimates problem difficulty via an uncertainty-guided length calibration module. For outputs with low difficulty and correct answers, the framework penalizes longer reasoning paths; whereas for those with high difficulty and incorrect answers, it encourages extending the chain of thought to explore alternative solutions. On six public medical QA benchmarks, AdaThink-Med achieves up to 6.4x length reduction on average while retaining performance with only minimal degradation. Intriguingly, we observe that AdaThink-Med spontaneously develops two distinct reasoning modes, which we characterize as "non-thinking" and "thinking", demonstrating the model's ability to suppress redundant reasoning processes dynamically.

Large language models (LLMs) have obtained promising results in mathematical reasoning, which is a foundational skill for human intelligence. Most previous studies focus on improving and measuring the performance of LLMs based on textual math reasoning datasets (e.g., MATH, GSM8K). Recently, a few researchers have released English multimodal math datasets (e.g., MATHVISTA and MATH-V) to evaluate the effectiveness of large multimodal models (LMMs). In this paper, we release a Chinese multimodal math (CMM-Math) dataset, including benchmark and training parts, to evaluate and enhance the mathematical reasoning of LMMs. CMM-Math contains over 28,000 high-quality samples, featuring a variety of problem types (e.g., multiple-choice, fill-in-the-blank, and so on) with detailed solutions across 12 grade levels from elementary to high school in China. Specifically, the visual context may be present in the questions or opinions, which makes this dataset more challenging. Through comprehensive analysis, we discover that state-of-the-art LMMs on the CMM-Math dataset face challenges, emphasizing the necessity for further improvements in LMM development. We also propose a Multimodal Mathematical LMM (Math-LMM) to handle the problems with mixed input of multiple images and text segments. We train our model using three stages, including foundational pre-training, foundational fine-tuning, and mathematical fine-tuning. The extensive experiments indicate that our model effectively improves math reasoning performance by comparing it with the SOTA LMMs over three multimodal mathematical datasets.

The rapid advancements in Vision-Language Models (VLMs) have shown great potential in tackling mathematical reasoning tasks that involve visual context. Unlike humans who can reliably apply solution steps to similar problems with minor modifications, we found that SOTA VLMs like GPT-4o can consistently fail in these scenarios, revealing limitations in their mathematical reasoning capabilities. In this paper, we investigate the mathematical reasoning robustness in VLMs and evaluate how well these models perform under different variants of the same question, such as changes in visual numerical values or function graphs. While several vision-based math benchmarks have been developed to assess VLMs' problem-solving capabilities, these benchmarks contain only static sets of problems and cannot easily evaluate mathematical reasoning robustness. To fill this gap, we introduce DynaMath, a dynamic visual math benchmark designed for in-depth assessment of VLMs. DynaMath includes 501 high-quality, multi-topic seed questions, each represented as a Python program. Those programs are carefully designed and annotated to enable the automatic generation of a much larger set of concrete questions, including many different types of visual and textual variations. DynaMath allows us to evaluate the generalization ability of VLMs, by assessing their performance under varying input conditions of a seed question. We evaluated 14 SOTA VLMs with 5,010 generated concrete questions. Our results show that the worst-case model accuracy, defined as the percentage of correctly answered seed questions in all 10 variants, is significantly lower than the average-case accuracy. Our analysis emphasizes the need to study the robustness of VLMs' reasoning abilities, and DynaMath provides valuable insights to guide the development of more reliable models for mathematical reasoning.

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

Medical question-answering (QA) is a critical task for evaluating how effectively large language models (LLMs) encode clinical knowledge and assessing their potential applications in medicine. Despite showing promise on multiple-choice tests, LLMs frequently struggle with open-ended medical questions, producing responses with dangerous hallucinations or lacking comprehensive coverage of critical aspects. Existing approaches attempt to address these challenges through domain-specific fine-tuning, but this proves resource-intensive and difficult to scale across models. To improve the comprehensiveness and factuality of medical responses, we propose a novel approach utilizing structured medical reasoning. Our method guides LLMs through an seven-step cognitive process inspired by clinical diagnosis, enabling more accurate and complete answers without additional training. Experiments on the MedLFQA benchmark demonstrate that our approach achieves the highest Factuality Score of 85.8, surpassing fine-tuned models. Notably, this improvement transfers to smaller models, highlighting the method's efficiency and scalability. Our code and datasets are available.

Large language models have exhibited exceptional performance on various Natural Language Processing (NLP) tasks, leveraging techniques such as the pre-training, and instruction fine-tuning. Despite these advances, their effectiveness in medical applications is limited, due to challenges such as factual inaccuracies, reasoning abilities, and lack grounding in real-world experience. In this study, we present ClinicalGPT, a language model explicitly designed and optimized for clinical scenarios. By incorporating extensive and diverse real-world data, such as medical records, domain-specific knowledge, and multi-round dialogue consultations in the training process, ClinicalGPT is better prepared to handle multiple clinical task. Furthermore, we introduce a comprehensive evaluation framework that includes medical knowledge question-answering, medical exams, patient consultations, and diagnostic analysis of medical records. Our results demonstrate that ClinicalGPT significantly outperforms other models in these tasks, highlighting the effectiveness of our approach in adapting large language models to the critical domain of healthcare.

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

Large Language Models (LLMs) have shown the potential to significantly contribute to patient care, diagnostics, and administrative processes. Emerging biomedical LLMs address healthcare-specific challenges, including privacy demands and computational constraints. However, evaluation of these models has primarily been limited to non-clinical tasks, which do not reflect the complexity of practical clinical applications. Additionally, there has been no thorough comparison between biomedical and general-domain LLMs for clinical tasks. To fill this gap, we present the Clinical Language Understanding Evaluation (CLUE), a benchmark tailored to evaluate LLMs on real-world clinical tasks. CLUE includes two novel datasets derived from MIMIC IV discharge letters and four existing tasks designed to test the practical applicability of LLMs in healthcare settings. Our evaluation covers several biomedical and general domain LLMs, providing insights into their clinical performance and applicability. CLUE represents a step towards a standardized approach to evaluating and developing LLMs in healthcare to align future model development with the real-world needs of clinical application. We publish our evaluation and data generation scripts: https://github.com/dadaamin/CLUE

Multimodal large language models (MLLMs) have begun to demonstrate robust reasoning capabilities on general tasks, yet their application in the medical domain remains in its early stages. Constructing chain-of-thought (CoT) training data is essential for bolstering the reasoning abilities of medical MLLMs. However, existing approaches exhibit a deficiency in offering a comprehensive framework for searching and evaluating effective reasoning paths towards critical diagnosis. To address this challenge, we propose Mentor-Intern Collaborative Search (MICS), a novel reasoning-path searching scheme to generate rigorous and effective medical CoT data. MICS first leverages mentor models to initialize the reasoning, one step at a time, then prompts each intern model to continue the thinking along those initiated paths, and finally selects the optimal reasoning path according to the overall reasoning performance of multiple intern models. The reasoning performance is determined by an MICS-Score, which assesses the quality of generated reasoning paths. Eventually, we construct MMRP, a multi-task medical reasoning dataset with ranked difficulty, and Chiron-o1, a new medical MLLM devised via a curriculum learning strategy, with robust visual question-answering and generalizable reasoning capabilities. Extensive experiments demonstrate that Chiron-o1, trained on our CoT dataset constructed using MICS, achieves state-of-the-art performance across a list of medical visual question answering and reasoning benchmarks. Codes are available at GitHub - manglu097/Chiron-o1: Enhancing Step-by-Step and Verifiable Medical Reasoning in MLLMs

The integration of Large Language Models (LLMs) into healthcare holds significant potential to enhance diagnostic accuracy and support medical treatment planning. These AI-driven systems can analyze vast datasets, assisting clinicians in identifying diseases, recommending treatments, and predicting patient outcomes. This study evaluates the performance of a range of contemporary LLMs, including both open-source and closed-source models, on the 2024 Portuguese National Exam for medical specialty access (PNA), a standardized medical knowledge assessment. Our results highlight considerable variation in accuracy and cost-effectiveness, with several models demonstrating performance exceeding human benchmarks for medical students on this specific task. We identify leading models based on a combined score of accuracy and cost, discuss the implications of reasoning methodologies like Chain-of-Thought, and underscore the potential for LLMs to function as valuable complementary tools aiding medical professionals in complex clinical decision-making.

Clinical dialogue represents a complex duality requiring both the empathetic fluency of natural conversation and the rigorous precision of evidence-based medicine. While Large Language Models possess unprecedented linguistic capabilities, their architectural reliance on reactive and stateless processing often favors probabilistic plausibility over factual veracity. This structural limitation has catalyzed a paradigm shift in medical AI from generative text prediction to agentic autonomy, where the model functions as a central reasoning engine capable of deliberate planning and persistent memory. Moving beyond existing reviews that primarily catalog downstream applications, this survey provides a first-principles analysis of the cognitive architecture underpinning this shift. We introduce a novel taxonomy structured along the orthogonal axes of knowledge source and agency objective to delineate the provenance of clinical knowledge against the system's operational scope. This framework facilitates a systematic analysis of the intrinsic trade-offs between creativity and reliability by categorizing methods into four archetypes: Latent Space Clinicians, Emergent Planners, Grounded Synthesizers, and Verifiable Workflow Automators. For each paradigm, we deconstruct the technical realization across the entire cognitive pipeline, encompassing strategic planning, memory management, action execution, collaboration, and evolution to reveal how distinct architectural choices balance the tension between autonomy and safety.

Medical reasoning models (MRMs) achieve superior performance on medical benchmarks compared to medical LLMs; however, high accuracy alone is insufficient for practical deployment. One of such requirements for real-world application is robustness to varying output constraints. Specifically, posing the same medical question while requesting different answer formats should not affect the underlying correctness of the response. We investigate this phenomenon in this paper, focusing on MRMs. To quantify this behavior, we propose the metric answer-format robustness: the ability to reliably generate correct outputs across varying specified formats. We examine three representative formats: multiple-choice, open-ended question-answering, and ranked lists. Across 15 proprietary and open-weight models, we observe substantial variation in format robustness (35-100%). Furthermore, we conduct controlled fine-tuning experiments on a shared backbone with matched training data to isolate the effects of the fine-tuning paradigm. We find that supervised fine-tuning yields more stable behavior across formats, whereas reinforcement fine-tuning often exhibits higher cross-format brittleness, with the degree of instability strongly dependent on reward design. Overall, answer-format robustness in MRMs is trainable yet brittle and requires careful evaluation for practical medical use.

Large language models (LLMs) can solve an increasing number of complex reasoning tasks while making surprising mistakes in basic numerical understanding and processing (such as 9.11 > 9.9). The latter ability is essential for tackling complex arithmetic and mathematical problems and serves as a foundation for most reasoning tasks, but previous work paid little attention to it or only discussed several restricted tasks (like integer addition). In this paper, we comprehensively investigate the numerical understanding and processing ability (NUPA) of LLMs. Firstly, we introduce a benchmark covering four common numerical representations and 17 distinct numerical tasks in four major categories, resulting in 41 meaningful combinations in total. These tasks are derived from primary and secondary education curricula, encompassing nearly all everyday numerical understanding and processing scenarios, and the rules of these tasks are very simple and clear. Through the benchmark, we find that current LLMs fail frequently in many of the tasks. To study the problem, we train small models with existing and potential techniques for enhancing NUPA (such as tokenizers, PEs, and number formats), comprehensively evaluating their effectiveness using our testbed. We also finetune practical-scale LLMs on our proposed NUPA tasks and find that 1) naive finetuning can improve NUPA a lot on many but not all tasks, and 2) surprisingly, techniques designed to enhance NUPA prove ineffective for finetuning pretrained models. We further explore the impact of chain-of-thought techniques on NUPA. Our work provides a more detailed and comprehensive understanding of NUPA in LLMs. Our benchmark and code are released at https://github.com/GraphPKU/number_cookbook.

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

LLMs have demonstrated impressive performance in answering medical questions, such as passing scores on medical licensing examinations. However, medical board exam questions or general clinical questions do not capture the complexity of realistic clinical cases. Moreover, the lack of reference explanations means we cannot easily evaluate the reasoning of model decisions, a crucial component of supporting doctors in making complex medical decisions. To address these challenges, we construct two new datasets: JAMA Clinical Challenge and Medbullets. JAMA Clinical Challenge consists of questions based on challenging clinical cases, while Medbullets comprises USMLE Step 2&3 style clinical questions. Both datasets are structured as multiple-choice question-answering tasks, where each question is accompanied by an expert-written explanation. We evaluate four LLMs on the two datasets using various prompts. Experiments demonstrate that our datasets are harder than previous benchmarks. The inconsistency between automatic and human evaluations of model-generated explanations highlights the need to develop new metrics to support future research on explainable medical QA.

High-quality and carefully curated data is a cornerstone of training medical large language models, as it directly impacts both generalization and robustness to unseen clinical tasks. We investigate strategies for training and data curation to develop a robust multimodal reasoning model in the medical domain. Our work focuses on supervised fine-tuning (SFT) and explores data recipes that leverage structured reasoning traces. Using our proposed data recipe, we scale experiments to a dataset of over 8 million examples and 6.8 billion response tokens, achieving state-of-the-art performance among open-source models across diverse out-of-distribution medical benchmark tasks. Our results further indicate that curating a high-quality, diverse training dataset with varying structured reasoning trace lengths enables the fine-tuned model to self-calibrate its reasoning trajectory lengths based on the downstream task, without explicit supervision. We present key insights, describe the data curation strategy, and outline next steps toward developing robust medical vision-language reasoning system.

Current vision-language models (VLMs) in medicine are primarily designed for categorical question answering (e.g., "Is this normal or abnormal?") or qualitative descriptive tasks. However, clinical decision-making often relies on quantitative assessments, such as measuring the size of a tumor or the angle of a joint, from which physicians draw their own diagnostic conclusions. This quantitative reasoning capability remains underexplored and poorly supported in existing VLMs. In this work, we introduce MedVision, a large-scale dataset and benchmark specifically designed to evaluate and improve VLMs on quantitative medical image analysis. MedVision spans 22 public datasets covering diverse anatomies and modalities, with 30.8 million image-annotation pairs. We focus on three representative quantitative tasks: (1) detection of anatomical structures and abnormalities, (2) tumor/lesion (T/L) size estimation, and (3) angle/distance (A/D) measurement. Our benchmarks show that current off-the-shelf VLMs perform poorly on these tasks. However, with supervised fine-tuning on MedVision, we significantly enhance their performance across detection, T/L estimation, and A/D measurement, demonstrating reduced error rates and improved precision. This work provides a foundation for developing VLMs with robust quantitative reasoning capabilities in medical imaging. Code and data are available at https://medvision-vlm.github.io.

The application of large language models (LLMs) in the medical field has gained significant attention, yet their reasoning capabilities in more specialized domains like anesthesiology remain underexplored. In this paper, we systematically evaluate the reasoning capabilities of LLMs in anesthesiology and analyze key factors influencing their performance. To this end, we introduce AnesBench, a cross-lingual benchmark designed to assess anesthesiology-related reasoning across three levels: factual retrieval (System 1), hybrid reasoning (System 1.x), and complex decision-making (System 2). Through extensive experiments, we first explore how model characteristics, including model scale, Chain of Thought (CoT) length, and language transferability, affect reasoning performance. Then, we further evaluate the effectiveness of different training strategies, leveraging our curated anesthesiology-related dataset, including continuous pre-training (CPT) and supervised fine-tuning (SFT). Additionally, we also investigate how the test-time reasoning techniques, such as Best-of-N sampling and beam search, influence reasoning performance, and assess the impact of reasoning-enhanced model distillation, specifically DeepSeek-R1. We will publicly release AnesBench, along with our CPT and SFT training datasets and evaluation code at https://github.com/MiliLab/AnesBench.

Medical large language models (LLMs) research often makes bold claims, from encoding clinical knowledge to reasoning like a physician. These claims are usually backed by evaluation on competitive benchmarks; a tradition inherited from mainstream machine learning. But how do we separate real progress from a leaderboard flex? Medical LLM benchmarks, much like those in other fields, are arbitrarily constructed using medical licensing exam questions. For these benchmarks to truly measure progress, they must accurately capture the real-world tasks they aim to represent. In this position paper, we argue that medical LLM benchmarks should (and indeed can) be empirically evaluated for their construct validity. In the psychological testing literature, "construct validity" refers to the ability of a test to measure an underlying "construct", that is the actual conceptual target of evaluation. By drawing an analogy between LLM benchmarks and psychological tests, we explain how frameworks from this field can provide empirical foundations for validating benchmarks. To put these ideas into practice, we use real-world clinical data in proof-of-concept experiments to evaluate popular medical LLM benchmarks and report significant gaps in their construct validity. Finally, we outline a vision for a new ecosystem of medical LLM evaluation centered around the creation of valid benchmarks.

Large Language Models are increasingly optimized for deep reasoning, prioritizing the correct execution of complex tasks over general conversation. We investigate whether this focus on calculation creates a "tunnel vision" that ignores safety in critical situations. We introduce MortalMATH, a benchmark of 150 scenarios where users request algebra help while describing increasingly life-threatening emergencies (e.g., stroke symptoms, freefall). We find a sharp behavioral split: generalist models (like Llama-3.1) successfully refuse the math to address the danger. In contrast, specialized reasoning models (like Qwen-3-32b and GPT-5-nano) often ignore the emergency entirely, maintaining over 95 percent task completion rates while the user describes dying. Furthermore, the computational time required for reasoning introduces dangerous delays: up to 15 seconds before any potential help is offered. These results suggest that training models to relentlessly pursue correct answers may inadvertently unlearn the survival instincts required for safe deployment.

Vision-language models (VLMs) lag behind text-only language models on mathematical reasoning when the same problems are presented as images rather than text. We empirically characterize this as a modality gap: the same question in text form yields markedly higher accuracy than its visually typeset counterpart, due to compounded failures in reading dense formulas, layout, and mixed symbolic-diagrammatic context. First, we introduce VisTIRA (Vision and Tool-Integrated Reasoning Agent), a tool-integrated reasoning framework that enables structured problem solving by iteratively decomposing a given math problem (as an image) into natural language rationales and executable Python steps to determine the final answer. Second, we build a framework to measure and improve visual math reasoning: a LaTeX-based pipeline that converts chain-of-thought math corpora (e.g., NuminaMath) into challenging image counterparts, and a large set of synthetic tool-use trajectories derived from a real-world, homework-style image dataset (called SnapAsk) for fine-tuning VLMs. Our experiments show that tool-integrated supervision improves image-based reasoning, and OCR grounding can further narrow the gap for smaller models, although its benefit diminishes at scale. These findings highlight that modality gap severity inversely correlates with model size, and that structured reasoning and OCR-based grounding are complementary strategies for advancing visual mathematical reasoning.

Although recent advances in scaling large language models (LLMs) have resulted in improvements on many NLP tasks, it remains unclear whether these models trained primarily with general web text are the right tool in highly specialized, safety critical domains such as clinical text. Recent results have suggested that LLMs encode a surprising amount of medical knowledge. This raises an important question regarding the utility of smaller domain-specific language models. With the success of general-domain LLMs, is there still a need for specialized clinical models? To investigate this question, we conduct an extensive empirical analysis of 12 language models, ranging from 220M to 175B parameters, measuring their performance on 3 different clinical tasks that test their ability to parse and reason over electronic health records. As part of our experiments, we train T5-Base and T5-Large models from scratch on clinical notes from MIMIC III and IV to directly investigate the efficiency of clinical tokens. We show that relatively small specialized clinical models substantially outperform all in-context learning approaches, even when finetuned on limited annotated data. Further, we find that pretraining on clinical tokens allows for smaller, more parameter-efficient models that either match or outperform much larger language models trained on general text. We release the code and the models used under the PhysioNet Credentialed Health Data license and data use agreement.

Explaining Artificial Intelligence (AI) decisions is a major challenge nowadays in AI, in particular when applied to sensitive scenarios like medicine and law. However, the need to explain the rationale behind decisions is a main issue also for human-based deliberation as it is important to justify why a certain decision has been taken. Resident medical doctors for instance are required not only to provide a (possibly correct) diagnosis, but also to explain how they reached a certain conclusion. Developing new tools to aid residents to train their explanation skills is therefore a central objective of AI in education. In this paper, we follow this direction, and we present, to the best of our knowledge, the first multilingual dataset for Medical Question Answering where correct and incorrect diagnoses for a clinical case are enriched with a natural language explanation written by doctors. These explanations have been manually annotated with argument components (i.e., premise, claim) and argument relations (i.e., attack, support), resulting in the Multilingual CasiMedicos-Arg dataset which consists of 558 clinical cases in four languages (English, Spanish, French, Italian) with explanations, where we annotated 5021 claims, 2313 premises, 2431 support relations, and 1106 attack relations. We conclude by showing how competitive baselines perform over this challenging dataset for the argument mining task.

Large Language Models (LLMs), despite their remarkable capabilities, rely on singular, pre-dominant reasoning paradigms, hindering their performance on intricate problems that demand diverse cognitive strategies. To address this, we introduce Composite Reasoning (CR), a novel reasoning approach empowering LLMs to dynamically explore and combine multiple reasoning styles like deductive, inductive, and abductive for more nuanced problem-solving. Evaluated on scientific and medical question-answering benchmarks, our approach outperforms existing baselines like Chain-of-Thought (CoT) and also surpasses the accuracy of DeepSeek-R1 style reasoning (SR) capabilities, while demonstrating superior sample efficiency and adequate token usage. Notably, CR adaptively emphasizes domain-appropriate reasoning styles. It prioritizes abductive and deductive reasoning for medical question answering, but shifts to causal, deductive, and inductive methods for scientific reasoning. Our findings highlight that by cultivating internal reasoning style diversity, LLMs acquire more robust, adaptive, and efficient problem-solving abilities.

The evaluation of mathematical reasoning capabilities is essential for advancing Artificial General Intelligence (AGI). While Large Language Models (LLMs) have shown impressive performance in solving mathematical problems, existing benchmarks such as GSM8K and MATH present limitations, including narrow problem definitions with specific numbers and reliance on predetermined rules that hinder accurate assessments of reasoning and adaptability. This paper introduces the UTMath Benchmark, which robustly evaluates the models through extensive unit tests. It consists of 1,053 problems across 9 mathematical domains, with over 68 test cases per problem. We propose an innovative evaluation framework inspired by unit testing in software development, focusing on both accuracy and reliability of results. Furthermore, we introduce the Reasoning-to-Coding of Thoughts (RCoT) approach, which encourages LLMs to perform explicit reasoning before generating code, leading to generating more advanced solution and improved performance. Furthermore, we are releasing not only the UTMath benchmark but also the UTMath-Train training dataset (more than 70k samples), to support the community in further exploring mathematical reasoning.

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

Large Language Models (LLMs) with reasoning capabilities have recently demonstrated strong potential in medical Question Answering (QA). Existing approaches are largely English-focused and primarily rely on distillation from general-purpose LLMs, raising concerns about the reliability of their medical knowledge. In this work, we present a method to generate multilingual reasoning traces grounded in factual medical knowledge. We produce 500k traces in English, Italian, and Spanish, using a retrievalaugmented generation approach over medical information from Wikipedia. The traces are generated to solve medical questions drawn from MedQA and MedMCQA, which we extend to Italian and Spanish. We test our pipeline in both in-domain and outof-domain settings across Medical QA benchmarks, and demonstrate that our reasoning traces improve performance both when utilized via in-context learning (few-shot) and supervised fine-tuning, yielding state-of-the-art results among 8B-parameter LLMs. We believe that these resources can support the development of safer, more transparent clinical decision-support tools in multilingual settings. We release the full suite of resources: reasoning traces, translated QA datasets, Medical-Wikipedia, and fine-tuned models.

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

Mathematical reasoning is an important capability of large language models~(LLMs) for real-world applications. To enhance this capability, existing work either collects large-scale math-related texts for pre-training, or relies on stronger LLMs (\eg GPT-4) to synthesize massive math problems. Both types of work generally lead to large costs in training or synthesis. To reduce the cost, based on open-source available texts, we propose an efficient way that trains a small LLM for math problem synthesis, to efficiently generate sufficient high-quality pre-training data. To achieve it, we create a dataset using GPT-4 to distill its data synthesis capability into the small LLM. Concretely, we craft a set of prompts based on human education stages to guide GPT-4, to synthesize problems covering diverse math knowledge and difficulty levels. Besides, we adopt the gradient-based influence estimation method to select the most valuable math-related texts. The both are fed into GPT-4 for creating the knowledge distillation dataset to train the small LLM. We leverage it to synthesize 6 million math problems for pre-training our JiuZhang3.0 model, which only needs to invoke GPT-4 API 9.3k times and pre-train on 4.6B data. Experimental results have shown that JiuZhang3.0 achieves state-of-the-art performance on several mathematical reasoning datasets, under both natural language reasoning and tool manipulation settings. Our code and data will be publicly released in https://github.com/RUCAIBox/JiuZhang3.0.

The rapid advancement of reasoning capabilities in large language models (LLMs) has led to notable improvements on mathematical benchmarks. However, many of the most commonly used evaluation datasets (e.g., AIME 2024) are widely available online, making it difficult to disentangle genuine reasoning from potential memorization. Furthermore, these benchmarks do not evaluate proof-writing capabilities, which are crucial for many mathematical tasks. To address this, we introduce MathArena, a new benchmark based on the following key insight: recurring math competitions provide a stream of high-quality, challenging problems that can be used for real-time evaluation of LLMs. By evaluating models as soon as new problems are released, we effectively eliminate the risk of contamination. Using this framework, we find strong signs of contamination in AIME 2024. Nonetheless, evaluations on harder competitions, such as CMIMC 2025, demonstrate impressive reasoning capabilities in top-performing models. MathArena is also the first benchmark for proof-writing capabilities. On IMO 2025, top models achieve slightly less than 40%, demonstrating both notable progress and significant room for improvement. So far, we have evaluated over 50 models across seven competitions, totaling 162 problems. As an evolving benchmark, MathArena will continue to track the progress of LLMs on newly released competitions, ensuring rigorous and up-to-date evaluation of mathematical reasoning.

Clinical natural language processing requires methods that can address domain-specific challenges, such as complex medical terminology and clinical contexts. Recently, large language models (LLMs) have shown promise in this domain. Yet, their direct deployment can lead to privacy issues and are constrained by resources. To address this challenge, we delve into synthetic clinical text generation using LLMs for clinical NLP tasks. We propose an innovative, resource-efficient approach, ClinGen, which infuses knowledge into the process. Our model involves clinical knowledge extraction and context-informed LLM prompting. Both clinical topics and writing styles are drawn from external domain-specific knowledge graphs and LLMs to guide data generation. Our extensive empirical study across 7 clinical NLP tasks and 16 datasets reveals that ClinGen consistently enhances performance across various tasks, effectively aligning the distribution of real datasets and significantly enriching the diversity of generated training instances. We will publish our code and all the generated data in https://github.com/ritaranx/ClinGen.

Exceptional mathematical reasoning ability is one of the key features that demonstrate the power of large language models (LLMs). How to comprehensively define and evaluate the mathematical abilities of LLMs, and even reflect the user experience in real-world scenarios, has emerged as a critical issue. Current benchmarks predominantly concentrate on problem-solving capabilities, which presents a substantial risk of model overfitting and fails to accurately represent genuine mathematical reasoning abilities. In this paper, we argue that if a model really understands a problem, it should be robustly and readily applied across a diverse array of tasks. Motivated by this, we introduce MATHCHECK, a well-designed checklist for testing task generalization and reasoning robustness, as well as an automatic tool to generate checklists efficiently. MATHCHECK includes multiple mathematical reasoning tasks and robustness test types to facilitate a comprehensive evaluation of both mathematical reasoning ability and behavior testing. Utilizing MATHCHECK, we develop MATHCHECK-GSM and MATHCHECK-GEO to assess mathematical textual reasoning and multi-modal reasoning capabilities, respectively, serving as upgraded versions of benchmarks including GSM8k, GeoQA, UniGeo, and Geometry3K. We adopt MATHCHECK-GSM and MATHCHECK-GEO to evaluate over 20 LLMs and 11 MLLMs, assessing their comprehensive mathematical reasoning abilities. Our results demonstrate that while frontier LLMs like GPT-4o continue to excel in various abilities on the checklist, many other model families exhibit a significant decline. Further experiments indicate that, compared to traditional math benchmarks, MATHCHECK better reflects true mathematical abilities and represents mathematical intelligence more linearly, thereby supporting our design. On our MATHCHECK, we can easily conduct detailed behavior analysis to deeply investigate models.

Recent large language models (LLMs) have shown indications of mathematical reasoning ability. However it has not been clear how they would fare on more challenging competition-level problems. And while self-generated verbalizations of intermediate reasoning steps (i.e., chain-of-thought prompting) have been shown to be helpful, whether LLMs can make use of helpful side information such as problem-specific hints has not been investigated before. In this paper, we propose a challenging benchmark dataset for enabling such analyses. The Concept and Hint-Annotated Math Problems (CHAMP) consists of high school math competition problems, annotated with concepts, or general math facts, and hints, or problem-specific tricks. These annotations allow us to explore the effects of additional information, such as relevant hints, misleading concepts, or related problems. This benchmark is difficult, with the best model only scoring 58.1% in standard settings. With concepts and hints, performance sometimes improves, indicating that some models can make use of such side information. We further annotate model-generated solutions for their correctness. Using this corpus, we find that models often arrive at the correct final answer through wrong reasoning steps. In addition, we test whether models are able to verify these solutions, and find that most models struggle. The dataset and code are available on the project website.