Daily Papers

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

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

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

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/

This paper presents a systematic study on enabling medical reasoning models (MRMs) to generate ranked lists of answers for open-ended questions. Clinical decision-making rarely relies on a single answer but instead considers multiple options, reducing the risks of narrow perspectives. Yet current MRMs are typically trained to produce only one answer, even in open-ended settings. We propose an alternative format: ranked lists and investigate two approaches: prompting and fine-tuning. While prompting is a cost-effective way to steer an MRM's response, not all MRMs generalize well across different answer formats: choice, short text, and list answers. Based on our prompting findings, we train and evaluate MRMs using supervised fine-tuning (SFT) and reinforcement fine-tuning (RFT). SFT teaches a model to imitate annotated responses, and RFT incentivizes exploration through the responses that maximize a reward. We propose new reward functions targeted at ranked-list answer formats, and conduct ablation studies for RFT. Our results show that while some SFT models generalize to certain answer formats, models trained with RFT are more robust across multiple formats. We also present a case study on a modified MedQA with multiple valid answers, finding that although MRMs might fail to select the benchmark's preferred ground truth, they can recognize valid answers. To the best of our knowledge, this is the first systematic investigation of approaches for enabling MRMs to generate answers as ranked lists. We hope this work provides a first step toward developing alternative answer formats that are beneficial beyond single answers in medical domains.

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

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

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

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

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.

Medical Vision-Language Models (VLMs) are prone to hallucinations, compromising clinical reliability. While reinforcement learning methods like Group Relative Policy Optimization (GRPO) offer a low-cost alignment solution, their reliance on sparse, outcome-based rewards inadvertently encourages models to "overthink" -- generating verbose, convoluted, and unverifiable Chain-of-Thought reasoning to justify answers. This focus on outcomes obscures factual errors and poses significant safety risks. To address this, we propose CheXPO-v2, a novel alignment framework that shifts from outcome to process supervision. Our core innovation is a Knowledge Graph Consistency Reward mechanism driven by Entity-Relation Matching. By explicitly parsing reasoning steps into structured "Disease, Relation, Anatomy" triplets, we provide fine-grained supervision that penalizes incoherent logic and hallucinations at the atomic level. Integrating this with a hard-example mining strategy, our approach significantly outperforms GRPO and state-of-the-art models on benchmarks like MIMIC-CXR-VQA. Crucially, CheXPO-v2 achieves new state-of-the-art accuracy using only 5k samples, demonstrating exceptional data efficiency while producing clinically sound and verifiable reasoning. The project source code is publicly available at: https://github.com/ecoxial2007/CheX-Phi4MM.

While Large Language Models (LLMs) excel at generating human-like text, aligning their outputs with complex, qualitative goals like pedagogical soundness remains a significant challenge. Standard reinforcement learning techniques often rely on slow and expensive LLM-as-a-judge evaluations or on brittle, keyword-based metrics like ROUGE, which fail to capture the semantic essence of a high-quality explanation. In this work, we introduce a novel approach to reward shaping within the Group Relative Policy Optimisation (GRPO) framework. Our central contribution is the use of a small, efficient encoder-only transformer as a semantic reward model. This model provides a dense, semantically rich reward signal based on the cosine similarity between a generated explanation and a ground-truth reference, guiding the policy towards explanations that are not just factually correct but also structurally and conceptually aligned with expert reasoning. We apply this method to the task of training a model for the Italian medical-school entrance examinations, following standard domain-adaptive continued pre-training (CPT) and supervised fine-tuning (SFT). Our results demonstrate that GRPO with our proposed semantic reward significantly improves explanation faithfulness and clarity over a strong SFT baseline, showcasing the power of using lightweight encoder models for nuanced reward shaping in complex generation tasks

Equipping agents with the capacity to justify made decisions using supporting evidence represents a cornerstone of accountable decision-making. Furthermore, ensuring that justifications are in line with human expectations and societal norms is vital, especially in high-stakes situations such as healthcare. In this work, we propose the use of a debate-based reward model for reinforcement learning agents, where the outcome of a zero-sum debate game quantifies the justifiability of a decision in a particular state. This reward model is then used to train a justifiable policy, whose decisions can be more easily corroborated with supporting evidence. In the debate game, two argumentative agents take turns providing supporting evidence for two competing decisions. Given the proposed evidence, a proxy of a human judge evaluates which decision is better justified. We demonstrate the potential of our approach in learning policies for prescribing and justifying treatment decisions of septic patients. We show that augmenting the reward with the feedback signal generated by the debate-based reward model yields policies highly favored by the judge when compared to the policy obtained solely from the environment rewards, while hardly sacrificing any performance. Moreover, in terms of the overall performance and justifiability of trained policies, the debate-based feedback is comparable to the feedback obtained from an ideal judge proxy that evaluates decisions using the full information encoded in the state. This suggests that the debate game outputs key information contained in states that is most relevant for evaluating decisions, which in turn substantiates the practicality of combining our approach with human-in-the-loop evaluations. Lastly, we showcase that agents trained via multi-agent debate learn to propose evidence that is resilient to refutations and closely aligns with human preferences.

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

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

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

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

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

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

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

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

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

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

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

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

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

Large Reasoning Models (LRMs) have introduced a new paradigm in AI by enabling models to ``think before responding" via chain-of-thought reasoning. However, the absence of open and reproducible recipes for building reasoning-centric medical LMMs hinders community-wide research, analysis, and comparison. In this paper, we present MedVLThinker, a suite of simple yet strong baselines. Our fully open recipe consists of: (1) systematic data curation for both text-only and image-text medical data, filtered according to varying levels of reasoning difficulty, and (2) two training paradigms: Supervised Fine-Tuning (SFT) on distilled reasoning traces and Reinforcement Learning with Verifiable Rewards (RLVR) based on final answer correctness. Across extensive experiments on the Qwen2.5-VL model family (3B, 7B) and six medical QA benchmarks, we find that RLVR consistently and significantly outperforms SFT. Additionally, under the RLVR framework, a key, counter-intuitive finding is that training on our curated text-only reasoning data provides a more substantial performance boost than training on multimodal image-text data. Our best open 7B model, trained using the RLVR recipe on text-only data, establishes a new state-of-the-art on existing public VQA benchmarks, surpassing all previous open-source medical LMMs. Furthermore, scaling our model to 32B achieves performance on par with the proprietary GPT-4o. We release all curated data, models, and code to provide the community with a strong, open foundation for future research in multimodal medical reasoning.

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

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

Multimodal Large Language Models (MLLMs) have demonstrated impressive capabilities in understanding common visual elements, largely due to their large-scale datasets and advanced training strategies. However, their effectiveness in medical applications remains limited due to the inherent discrepancies between data and tasks in medical scenarios and those in the general domain. Concretely, existing medical MLLMs face the following critical limitations: (1) limited coverage of medical knowledge beyond imaging, (2) heightened susceptibility to hallucinations due to suboptimal data curation processes, (3) lack of reasoning capabilities tailored for complex medical scenarios. To address these challenges, we first propose a comprehensive data curation procedure that (1) efficiently acquires rich medical knowledge data not only from medical imaging but also from extensive medical texts and general-domain data; and (2) synthesizes accurate medical captions, visual question answering (VQA), and reasoning samples. As a result, we build a multimodal dataset enriched with extensive medical knowledge. Building on the curated data, we introduce our medical-specialized MLLM: Lingshu. Lingshu undergoes multi-stage training to embed medical expertise and enhance its task-solving capabilities progressively. Besides, we preliminarily explore the potential of applying reinforcement learning with verifiable rewards paradigm to enhance Lingshu's medical reasoning ability. Additionally, we develop MedEvalKit, a unified evaluation framework that consolidates leading multimodal and textual medical benchmarks for standardized, fair, and efficient model assessment. We evaluate the performance of Lingshu on three fundamental medical tasks, multimodal QA, text-based QA, and medical report generation. The results show that Lingshu consistently outperforms the existing open-source multimodal models on most tasks ...

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

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

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.

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

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

Following the success of Proximal Policy Optimization (PPO) for Reinforcement Learning from Human Feedback (RLHF), new techniques such as Sequence Likelihood Calibration (SLiC) and Direct Policy Optimization (DPO) have been proposed that are offline in nature and use rewards in an indirect manner. These techniques, in particular DPO, have recently become the tools of choice for LLM alignment due to their scalability and performance. However, they leave behind important features of the PPO approach. Methods such as SLiC or RRHF make use of the Reward Model (RM) only for ranking/preference, losing fine-grained information and ignoring the parametric form of the RM (eg., Bradley-Terry, Plackett-Luce), while methods such as DPO do not use even a separate reward model. In this work, we propose a novel approach, named BRAIn, that re-introduces the RM as part of a distribution matching approach.BRAIn considers the LLM distribution conditioned on the assumption of output goodness and applies Bayes theorem to derive an intractable posterior distribution where the RM is explicitly represented. BRAIn then distills this posterior into an amortized inference network through self-normalized importance sampling, leading to a scalable offline algorithm that significantly outperforms prior art in summarization and AntropicHH tasks. BRAIn also has interesting connections to PPO and DPO for specific RM choices.

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

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

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

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

This paper explores the advancements and applications of large-scale models in the medical field, with a particular focus on Medical Large Models (MedLMs). These models, encompassing Large Language Models (LLMs), Vision Models, 3D Large Models, and Multimodal Models, are revolutionizing healthcare by enhancing disease prediction, diagnostic assistance, personalized treatment planning, and drug discovery. The integration of graph neural networks in medical knowledge graphs and drug discovery highlights the potential of Large Graph Models (LGMs) in understanding complex biomedical relationships. The study also emphasizes the transformative role of Vision-Language Models (VLMs) and 3D Large Models in medical image analysis, anatomical modeling, and prosthetic design. Despite the challenges, these technologies are setting new benchmarks in medical innovation, improving diagnostic accuracy, and paving the way for personalized healthcare solutions. This paper aims to provide a comprehensive overview of the current state and future directions of large models in medicine, underscoring their significance in advancing global health.

Automatically synthesizing dense rewards from natural language descriptions is a promising paradigm in reinforcement learning (RL), with applications to sparse reward problems, open-ended exploration, and hierarchical skill design. Recent works have made promising steps by exploiting the prior knowledge of large language models (LLMs). However, these approaches suffer from important limitations: they are either not scalable to problems requiring billions of environment samples, due to requiring LLM annotations for each observation, or they require a diverse offline dataset, which may not exist or be impossible to collect. In this work, we address these limitations through a combination of algorithmic and systems-level contributions. We propose \oni, a distributed architecture that simultaneously learns an RL policy and an intrinsic reward function using LLM feedback. Our approach annotates the agent's collected experience via an asynchronous LLM server, which is then distilled into an intrinsic reward model. We explore a range of algorithmic choices for reward modeling with varying complexity, including hashing, classification, and ranking models. By studying their relative tradeoffs, we shed light on questions regarding intrinsic reward design for sparse reward problems. Our approach achieves state-of-the-art performance across a range of challenging, sparse reward tasks from the NetHack Learning Environment in a simple unified process, solely using the agent's gathered experience, without requiring external datasets. We make our code available at https://github.com/facebookresearch/oni.

The integration of Large Language Models (LLMs) into healthcare promises to transform medical diagnostics, research, and patient care. Yet, the progression of medical LLMs faces obstacles such as complex training requirements, rigorous evaluation demands, and the dominance of proprietary models that restrict academic exploration. Transparent, comprehensive access to LLM resources is essential for advancing the field, fostering reproducibility, and encouraging innovation in healthcare AI. We present Hippocrates, an open-source LLM framework specifically developed for the medical domain. In stark contrast to previous efforts, it offers unrestricted access to its training datasets, codebase, checkpoints, and evaluation protocols. This open approach is designed to stimulate collaborative research, allowing the community to build upon, refine, and rigorously evaluate medical LLMs within a transparent ecosystem. Also, we introduce Hippo, a family of 7B models tailored for the medical domain, fine-tuned from Mistral and LLaMA2 through continual pre-training, instruction tuning, and reinforcement learning from human and AI feedback. Our models outperform existing open medical LLMs models by a large-margin, even surpassing models with 70B parameters. Through Hippocrates, we aspire to unlock the full potential of LLMs not just to advance medical knowledge and patient care but also to democratize the benefits of AI research in healthcare, making them available across the globe.

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

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

The professionalism of a human doctor in outpatient service depends on two core abilities: the ability to make accurate medical decisions and the medical consultation skill to conduct strategic, empathetic patient inquiry. Existing Large Language Models (LLMs) have achieved remarkable accuracy on medical decision-making benchmarks. However, they often lack the ability to conduct the strategic and empathetic consultation, which is essential for real-world clinical scenarios. To address this gap, we propose Doctor-R1, an AI doctor agent trained to master both of the capabilities by ask high-yield questions and conduct strategic multi-turn inquiry to guide decision-making. Our framework introduces three key components: a multi-agent interactive environment, a two-tiered reward architecture that separately optimizes clinical decision-making and communicative inquiry skills, and an experience repository to ground policy learning in high-quality prior trajectories. We evaluate Doctor-R1 on OpenAI's HealthBench and MAQuE, assessed across multi-facet metrics, such as communication quality, user experience, and task accuracy. Remarkably, Doctor-R1 surpasses state-of-the-art open-source specialized LLMs by a substantial margin with higher parameter efficiency and outperforms powerful proprietary models. Furthermore, the human evaluations show a strong preference for Doctor-R1 to generate human-preferred clinical dialogue, demonstrating the effectiveness of the framework.

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

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

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

Large language models (LLMs) represent a transformative class of AI tools capable of revolutionizing various aspects of healthcare by generating human-like responses across diverse contexts and adapting to novel tasks following human instructions. Their potential application spans a broad range of medical tasks, such as clinical documentation, matching patients to clinical trials, and answering medical questions. In this primer paper, we propose an actionable guideline to help healthcare professionals more efficiently utilize LLMs in their work, along with a set of best practices. This approach consists of several main phases, including formulating the task, choosing LLMs, prompt engineering, fine-tuning, and deployment. We start with the discussion of critical considerations in identifying healthcare tasks that align with the core capabilities of LLMs and selecting models based on the selected task and data, performance requirements, and model interface. We then review the strategies, such as prompt engineering and fine-tuning, to adapt standard LLMs to specialized medical tasks. Deployment considerations, including regulatory compliance, ethical guidelines, and continuous monitoring for fairness and bias, are also discussed. By providing a structured step-by-step methodology, this tutorial aims to equip healthcare professionals with the tools necessary to effectively integrate LLMs into clinical practice, ensuring that these powerful technologies are applied in a safe, reliable, and impactful manner.

Generative reward models (also known as LLMs-as-judges), which use large language models (LLMs) to evaluate answer quality, are increasingly adopted in reinforcement learning with verifiable rewards (RLVR). They are often preferred over rigid rule-based metrics, especially for complex reasoning tasks involving free-form outputs. In this paradigm, an LLM is typically prompted to compare a candidate answer against a ground-truth reference and assign a binary reward indicating correctness. Despite the seeming simplicity of this comparison task, we find that generative reward models exhibit surprising vulnerabilities to superficial manipulations: non-word symbols (e.g., ":" or ".") or reasoning openers like "Thought process:" and "Let's solve this problem step by step." can often lead to false positive rewards. We demonstrate that this weakness is widespread across LLMs, datasets, and prompt formats, posing a serious threat for core algorithmic paradigms that rely on generative reward models, such as rejection sampling, preference optimization, and RLVR. To mitigate this issue, we introduce a simple yet effective data augmentation strategy and train a new generative reward model with substantially improved robustness. Our findings highlight the urgent need for more reliable LLM-based evaluation methods. We release our robust, general-domain reward model and its synthetic training data at https://huggingface.co/sarosavo/Master-RM and https://huggingface.co/datasets/sarosavo/Master-RM.

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

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

We posit that to achieve superhuman agents, future models require superhuman feedback in order to provide an adequate training signal. Current approaches commonly train reward models from human preferences, which may then be bottlenecked by human performance level, and secondly these separate frozen reward models cannot then learn to improve during LLM training. In this work, we study Self-Rewarding Language Models, where the language model itself is used via LLM-as-a-Judge prompting to provide its own rewards during training. We show that during Iterative DPO training that not only does instruction following ability improve, but also the ability to provide high-quality rewards to itself. Fine-tuning Llama 2 70B on three iterations of our approach yields a model that outperforms many existing systems on the AlpacaEval 2.0 leaderboard, including Claude 2, Gemini Pro, and GPT-4 0613. While only a preliminary study, this work opens the door to the possibility of models that can continually improve in both axes.

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

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

We generalise the problem of reward modelling (RM) for reinforcement learning (RL) to handle non-Markovian rewards. Existing work assumes that human evaluators observe each step in a trajectory independently when providing feedback on agent behaviour. In this work, we remove this assumption, extending RM to capture temporal dependencies in human assessment of trajectories. We show how RM can be approached as a multiple instance learning (MIL) problem, where trajectories are treated as bags with return labels, and steps within the trajectories are instances with unseen reward labels. We go on to develop new MIL models that are able to capture the time dependencies in labelled trajectories. We demonstrate on a range of RL tasks that our novel MIL models can reconstruct reward functions to a high level of accuracy, and can be used to train high-performing agent policies.

Visual Information Extraction (VIE) converts unstructured document images into structured formats like JSON, critical for medical applications such as report analysis and online consultations. Traditional methods rely on OCR and language models, while end-to-end multimodal models offer direct JSON generation. However, domain-specific schemas and high annotation costs limit their effectiveness in medical VIE. We base our approach on the Reinforcement Learning with Verifiable Rewards (RLVR) framework to address these challenges using only 100 annotated samples. Our approach ensures dataset diversity, a balanced precision-recall reward mechanism to reduce hallucinations and improve field coverage, and innovative sampling strategies to enhance reasoning capabilities. Fine-tuning Qwen2.5-VL-7B with our RLVR method, we achieve state-of-the-art performance on medical VIE tasks, significantly improving F1, precision, and recall. While our models excel on tasks similar to medical datasets, performance drops on dissimilar tasks, highlighting the need for domain-specific optimization. Case studies further demonstrate the value of reasoning during training and inference for VIE.

In precision medicine, quantitative multi-omic features, topological context, and textual biological knowledge play vital roles in identifying disease-critical signaling pathways and targets. Existing pipelines capture only part of these-numerical omics ignore topological context, text-centric LLMs lack quantitative grounded reasoning, and graph-only models underuse node semantics and the generalization of LLMs-limiting mechanistic interpretability. Although Process Reward Models (PRMs) aim to guide reasoning in LLMs, they remain limited by unreliable intermediate evaluation, and vulnerability to reward hacking with computational cost. These gaps motivate integrating quantitative multi-omic signals, topological structure with node annotations, and literature-scale text via LLMs, using subgraph reasoning as the principle bridge linking numeric evidence, topological knowledge and language context. Therefore, we propose GALAX (Graph Augmented LAnguage model with eXplainability), an innovative framework that integrates pretrained Graph Neural Networks (GNNs) into Large Language Models (LLMs) via reinforcement guided by a Graph Process Reward Model (GPRM), which generates disease-relevant subgraphs in a step-wise manner initiated by an LLM and iteratively evaluated by a pretrained GNN, enabling process-level supervision without explicit intermediate reasoning annotations. As an application, we also introduced Target-QA, a benchmark combining CRISPR-identified targets, multi-omic profiles, and biomedical graph knowledge across diverse cancer cell lines, which enables GNN pretraining for supervising step-wise graph construction and supports long-context reasoning over text-numeric graphs (TNGs), providing a scalable and biologically grounded framework for explainable, reinforcement-guided subgraph reasoning toward reliable and interpretable target and pathway discovery in precision medicine.

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

Universal medical image segmentation models have emerged as a promising paradigm due to their strong generalizability across diverse tasks, showing great potential for a wide range of clinical applications. This potential has been partly driven by the success of general-purpose vision models such as the Segment Anything Model (SAM), which has inspired the development of various fine-tuned variants for medical segmentation tasks. However, fine-tuned variants like MedSAM are trained on comparatively limited medical imaging data that often suffers from heterogeneity, scarce annotations, and distributional shifts. These challenges limit their ability to generalize across a wide range of medical segmentation tasks. In this regard, we propose MedSAMix, a training-free model merging method that integrates the strengths of both generalist models (e.g., SAM) and specialist models (e.g., MedSAM) for medical image segmentation. In contrast to traditional model merging approaches that rely on manual configuration and often result in suboptimal outcomes, we propose a zero-order optimization method to automatically discover optimal layer-wise merging solutions. Furthermore, for clinical applications, we develop two regimes to meet the demand of domain-specificity and generalizability in different scenarios by single-task optimization and multi-objective optimization respectively. Extensive evaluations on 25 medical segmentation tasks demonstrate that MedSAMix effectively mitigates model bias and consistently improves performance in both domain-specific accuracy and generalization, achieving improvements of 6.67% on specialized tasks and 4.37% on multi-task evaluations.

Reward modeling is a key step in building safe foundation models when applying reinforcement learning from human feedback (RLHF) to align Large Language Models (LLMs). However, reward modeling based on the Bradley-Terry (BT) model assumes a global reward function, failing to capture the inherently diverse and heterogeneous human preferences. Hence, such oversimplification limits LLMs from supporting personalization and pluralistic alignment. Theoretically, we show that when human preferences follow a mixture distribution of diverse subgroups, a single BT model has an irreducible error. While existing solutions, such as multi-objective learning with fine-grained annotations, help address this issue, they are costly and constrained by predefined attributes, failing to fully capture the richness of human values. In this work, we introduce MiCRo, a two-stage framework that enhances personalized preference learning by leveraging large-scale binary preference datasets without requiring explicit fine-grained annotations. In the first stage, MiCRo introduces context-aware mixture modeling approach to capture diverse human preferences. In the second stage, MiCRo integrates an online routing strategy that dynamically adapts mixture weights based on specific context to resolve ambiguity, allowing for efficient and scalable preference adaptation with minimal additional supervision. Experiments on multiple preference datasets demonstrate that MiCRo effectively captures diverse human preferences and significantly improves downstream personalization.

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

AI co-scientists are emerging as a tool to assist human researchers in achieving their research goals. A crucial feature of these AI co-scientists is the ability to generate a research plan given a set of aims and constraints. The plan may be used by researchers for brainstorming, or may even be implemented after further refinement. However, language models currently struggle to generate research plans that follow all constraints and implicit requirements. In this work, we study how to leverage the vast corpus of existing research papers to train language models that generate better research plans. We build a scalable, diverse training corpus by automatically extracting research goals and goal-specific grading rubrics from papers across several domains. We then train models for research plan generation via reinforcement learning with self-grading. A frozen copy of the initial policy acts as the grader during training, with the rubrics creating a generator-verifier gap that enables improvements without external human supervision. To validate this approach, we conduct a study with human experts for machine learning research goals, spanning 225 hours. The experts prefer plans generated by our finetuned Qwen3-30B-A3B model over the initial model for 70% of research goals, and approve 84% of the automatically extracted goal-specific grading rubrics. To assess generality, we also extend our approach to research goals from medical papers, and new arXiv preprints, evaluating with a jury of frontier models. Our finetuning yields 12-22% relative improvements and significant cross-domain generalization, proving effective even in problem settings like medical research where execution feedback is infeasible. Together, these findings demonstrate the potential of a scalable, automated training recipe as a step towards improving general AI co-scientists.

Large Language Models (LLMs) have made substantial strides in structured tasks through Reinforcement Learning (RL), demonstrating proficiency in mathematical reasoning and code generation. However, applying RL in broader domains like chatbots and content generation -- through the process known as Reinforcement Learning from Human Feedback (RLHF) -- presents unique challenges. Reward models in RLHF are critical, acting as proxies that evaluate the alignment of LLM outputs with human intent. Despite advancements, the development of reward models is hindered by challenges such as computational heavy training, costly evaluation, and therefore poor reproducibility. We advocate for using embedding-based input in reward model research as an accelerated solution to those challenges. By leveraging embeddings for reward modeling, we can enhance reproducibility, reduce computational demands on hardware, improve training stability, and significantly reduce training and evaluation costs, hence facilitating fair and efficient comparisons in this active research area. We then show a case study of reproducing existing reward model ensemble research using embedding-based reward models. We discussed future avenues for research, aiming to contribute to safer and more effective LLM deployments.

Foundation models are becoming valuable tools in medicine. Yet despite their promise, the best way to leverage Large Language Models (LLMs) in complex medical tasks remains an open question. We introduce a novel multi-agent framework, named Medical Decision-making Agents (MDAgents) that helps address this gap by automatically assigning a collaboration structure to a team of LLMs. The assigned solo or group collaboration structure is tailored to the medical task at hand, emulating real-world medical decision-making processes adapted to tasks of varying complexities. We evaluate our framework and baseline methods using state-of-the-art LLMs across a suite of real-world medical knowledge and medical diagnosis benchmarks, including a comparison of LLMs' medical complexity classification against human physicians. MDAgents achieved the best performance in seven out of ten benchmarks on tasks requiring an understanding of medical knowledge and multi-modal reasoning, showing a significant improvement of up to 4.2% (p < 0.05) compared to previous methods' best performances. Ablation studies reveal that MDAgents effectively determines medical complexity to optimize for efficiency and accuracy across diverse medical tasks. Notably, the combination of moderator review and external medical knowledge in group collaboration resulted in an average accuracy improvement of 11.8%. Our code can be found at https://github.com/mitmedialab/MDAgents.

Reward modeling lies at the core of reinforcement learning from human feedback (RLHF), yet most existing reward models rely on scalar or pairwise judgments that fail to capture the multifaceted nature of human preferences. Recent studies have explored rubrics-as-rewards (RaR) that uses structured natural language criteria that capture multiple dimensions of response quality. However, producing rubrics that are both reliable and scalable remains a key challenge. In this work, we introduce OpenRubrics, a diverse, large-scale collection of (prompt, rubric) pairs for training rubric-generation and rubric-based reward models. To elicit discriminative and comprehensive evaluation signals, we introduce Contrastive Rubric Generation (CRG), which derives both hard rules (explicit constraints) and principles (implicit qualities) by contrasting preferred and rejected responses. We further improve reliability by enforcing preference-label consistency via rejection sampling to remove noisy rubrics. Across multiple reward-modeling benchmarks, our rubric-based reward model, Rubric-RM, surpasses strong size-matched baselines by 6.8%. These gains transfer to policy models on instruction-following and biomedical benchmarks. Our results show that rubrics provide scalable alignment signals that narrow the gap between costly human evaluation and automated reward modeling, enabling a new principle-driven paradigm for LLM alignment.

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

Reinforcement learning from human feedback (RLHF) has become a key method for aligning large language models (LLMs) with human preferences through the use of reward models. However, traditional reward models typically generate point estimates, which oversimplify the diversity and complexity of human values and preferences. In this paper, we introduce Quantile Reward Models (QRMs), a novel approach to reward modeling that learns a distribution over rewards instead of a single scalar value. Our method uses quantile regression to estimate a full, potentially multimodal distribution over preferences, providing a more powerful and nuanced representation of preferences. This distributional approach can better capture the diversity of human values, addresses label noise, and accommodates conflicting preferences by modeling them as distinct modes in the distribution. Our experimental results show that QRM outperforms comparable traditional point-estimate models on RewardBench. Furthermore, we demonstrate that the additional information provided by the distributional estimates can be utilized in downstream applications, such as risk-aware reinforcement learning, resulting in LLM policies that generate fewer extremely negative responses. Our code and model are released at https://github.com/Nicolinho/QRM.

Reinforcement Learning from Human Feedback (RLHF) has become a dominating strategy in steering Language Models (LMs) towards human values/goals. The key to the strategy is employing a reward model ({varphi}) which can reflect a latent reward model with humans. While this strategy has proven to be effective, the training methodology requires a lot of human preference annotation (usually of the order of tens of thousands) to train {varphi}. Such large-scale preference annotations can be achievable if the reward model can be ubiquitously used. However, human values/goals are subjective and depend on the nature of the task. This poses a challenge in collecting diverse preferences for downstream applications. To address this, we propose a novel methodology to infuse domain knowledge into {varphi}, which reduces the size of preference annotation required. We validate our approach in E-Commerce Opinion Summarization, with a significant reduction in dataset size (just 940 samples) while advancing the state-of-the-art. Our contributions include a novel Reward Modelling technique, a new dataset (PromptOpinSumm) for Opinion Summarization, and a human preference dataset (OpinPref). The proposed methodology opens avenues for efficient RLHF, making it more adaptable to diverse applications with varying human values. We release the artifacts for usage under MIT License.

Purpose: With advancements in Large Language Models (LLMs) for healthcare, the need arises for competitive open-source models to protect the public interest. This work contributes to the field of open medical LLMs by optimizing key stages of data preprocessing and training, while showing how to improve model safety (through DPO) and efficacy (through RAG). The evaluation methodology used, which includes four different types of tests, defines a new standard for the field. The resultant models, shown to be competitive with the best private alternatives, are released with a permisive license. Methods: Building on top of strong base models like Llama 3.1 and Qwen 2.5, Aloe Beta uses a custom dataset to enhance public data with synthetic Chain of Thought examples. The models undergo alignment with Direct Preference Optimization, emphasizing ethical and policy-aligned performance in the presence of jailbreaking attacks. Evaluation includes close-ended, open-ended, safety and human assessments, to maximize the reliability of results. Results: Recommendations are made across the entire pipeline, backed by the solid performance of the Aloe Family. These models deliver competitive performance across healthcare benchmarks and medical fields, and are often preferred by healthcare professionals. On bias and toxicity, the Aloe Beta models significantly improve safety, showing resilience to unseen jailbreaking attacks. For a responsible release, a detailed risk assessment specific to healthcare is attached to the Aloe Family models. Conclusion: The Aloe Beta models, and the recipe that leads to them, are a significant contribution to the open-source medical LLM field, offering top-of-the-line performance while maintaining high ethical requirements. This work sets a new standard for developing and reporting aligned LLMs in healthcare.

The primary obstacle for applying reinforcement learning (RL) to real-world robotics is the design of effective reward functions. While recently learning-based Process Reward Models (PRMs) are a promising direction, they are often hindered by two fundamental limitations: their reward models lack step-aware understanding and rely on single-view perception, leading to unreliable assessments of fine-grained manipulation progress; and their reward shaping procedures are theoretically unsound, often inducing a semantic trap that misguides policy optimization. To address these, we introduce Dopamine-Reward, a novel reward modeling method for learning a general-purpose, step-aware process reward model from multi-view inputs. At its core is our General Reward Model (GRM), trained on a vast 3,400+ hour dataset, which leverages Step-wise Reward Discretization for structural understanding and Multi-Perspective Reward Fusion to overcome perceptual limitations. Building upon Dopamine-Reward, we propose Dopamine-RL, a robust policy learning framework that employs a theoretically-sound Policy-Invariant Reward Shaping method, which enables the agent to leverage dense rewards for efficient self-improvement without altering the optimal policy, thereby fundamentally avoiding the semantic trap. Extensive experiments across diverse simulated and real-world tasks validate our approach. GRM achieves state-of-the-art accuracy in reward assessment, and Dopamine-RL built on GRM significantly improves policy learning efficiency. For instance, after GRM is adapted to a new task in a one-shot manner from a single expert trajectory, the resulting reward model enables Dopamine-RL to improve the policy from near-zero to 95% success with only 150 online rollouts (approximately 1 hour of real robot interaction), while retaining strong generalization across tasks. Project website: https://robo-dopamine.github.io

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

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

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

High-quality preference data is essential for aligning foundation models with human values through preference learning. However, manual annotation of such data is often time-consuming and costly. Recent methods often adopt a self-rewarding approach, where the target model generates and annotates its own preference data, but this can lead to inaccuracies since the reward model shares weights with the target model, thereby amplifying inherent biases. To address these issues, we propose Anyprefer, a framework designed to synthesize high-quality preference data for aligning the target model. Anyprefer frames the data synthesis process as a cooperative two-player Markov Game, where the target model and the judge model collaborate together. Here, a series of external tools are introduced to assist the judge model in accurately rewarding the target model's responses, mitigating biases in the rewarding process. In addition, a feedback mechanism is introduced to optimize prompts for both models, enhancing collaboration and improving data quality. The synthesized data is compiled into a new preference dataset, Anyprefer-V1, consisting of 58K high-quality preference pairs. Extensive experiments show that Anyprefer significantly improves model alignment performance across four main applications, covering 21 datasets, achieving average improvements of 18.55% in five natural language generation datasets, 3.66% in nine vision-language understanding datasets, 30.05% in three medical image analysis datasets, and 16.00% in four visuo-motor control tasks.

In aligning large language models (LLMs), reward models have played an important role, but are standardly trained as discriminative models and rely only on labeled human preference data. In this paper, we explore methods that train reward models using both unlabeled and labeled data. Building on the generative models in LLMs, we develop a generative reward model that is first trained via large-scale unsupervised learning and then fine-tuned via supervised learning. We also show that by using label smoothing, we are in fact optimizing a regularized pairwise ranking loss. This result, in turn, provides a new view of training reward models, which links generative models and discriminative models under the same class of training objectives. The outcome of these techniques is a foundation reward model, which can be applied to a wide range of tasks with little or no further fine-tuning effort. Extensive experiments show that this model generalizes well across several tasks, including response ranking, reinforcement learning from human feedback, and task adaptation with fine-tuning, achieving significant performance improvements over several strong baseline models.

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

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.

In medical scenarios, effectively retrieving external knowledge and leveraging it for rigorous logical reasoning is of significant importance. Despite their potential, existing work has predominantly focused on enhancing either retrieval or reasoning capabilities of the models in isolation, with little attention given to their joint optimization, which leads to limited coordination between the two processes. Additionally, current methods rely heavily on supervised fine-tuning (SFT), which can cause models to memorize existing problem-solving pathways, thereby restricting their generalization ability when confronted with novel problem contexts. Furthermore, while some studies have explored to improve retrieval-augmented reasoning in general domains via reinforcement learning, their reward function designs do not adequately capture the specific demands of the medical domain. To address these challenges, we introduce **Med-R^3**, a **Med**ical **R**etrieval-augmented **R**easoning framework driven by progressive **R**einforcement learning. In this framework, we first develop the model's ability to perform logical reasoning over medical problems. Subsequently, on the basis of this foundation, we adaptively optimize the retrieval capability to better align with the characteristics of knowledge corpus and external information utilization throughout the reasoning process. Finally, we conduct joint optimization of the model's retrieval and reasoning coordination. Extensive experiments indicate that **Med-R^3** could achieve state-of-the-art performances, with LLaMA3.1-8B-Instruct + Med-R^3 surpassing closed-sourced GPT-4o-mini by 3.93\% at a comparable parameter scale, while Qwen2.5-14B augmented with Med-R^3 shows a more substantial gain of 13.53\%.

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

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.

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.

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

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.

Multimodal Reward Models (MM-RMs) are crucial for aligning Large Language Models (LLMs) with human preferences, particularly as LLMs increasingly interact with multimodal data. However, we find that MM-RMs trained on existing datasets often struggle to generalize to out-of-distribution data due to their reliance on unimodal spurious correlations, primarily text-only shortcuts within the training distribution, which prevents them from leveraging true multimodal reward functions. To address this, we introduce a Shortcut-aware MM-RM learning algorithm that mitigates this issue by dynamically reweighting training samples, shifting the distribution toward better multimodal understanding, and reducing dependence on unimodal spurious correlations. Our experiments demonstrate significant improvements in generalization, downstream task performance, and scalability, establishing a more robust framework for multimodal reward modeling.

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

Significant progress in reward modeling over recent years has been driven by a paradigm shift from task-specific designs towards generalist reward models. Despite this trend, developing effective reward models remains a fundamental challenge: the heavy reliance on large-scale labeled preference data. Pre-training on abundant unlabeled data offers a promising direction, but existing approaches fall short of instilling explicit reasoning into reward models. To bridge this gap, we propose a self-training approach that leverages unlabeled data to elicit reward reasoning in reward models. Based on this approach, we develop GRAM-R^2, a generative reward model trained to produce not only preference labels but also accompanying reward rationales. GRAM-R^2 can serve as a foundation model for reward reasoning and can be applied to a wide range of tasks with minimal or no additional fine-tuning. It can support downstream applications such as response ranking and task-specific reward tuning. Experiments on response ranking, task adaptation, and reinforcement learning from human feedback demonstrate that GRAM-R^2 consistently delivers strong performance, outperforming several strong discriminative and generative baselines.

With the rapid development of artificial intelligence, large language models (LLMs) have shown promising capabilities in mimicking human-level language comprehension and reasoning. This has sparked significant interest in applying LLMs to enhance various aspects of healthcare, ranging from medical education to clinical decision support. However, medicine involves multifaceted data modalities and nuanced reasoning skills, presenting challenges for integrating LLMs. This paper provides a comprehensive review on the applications and implications of LLMs in medicine. It begins by examining the fundamental applications of general-purpose and specialized LLMs, demonstrating their utilities in knowledge retrieval, research support, clinical workflow automation, and diagnostic assistance. Recognizing the inherent multimodality of medicine, the review then focuses on multimodal LLMs, investigating their ability to process diverse data types like medical imaging and EHRs to augment diagnostic accuracy. To address LLMs' limitations regarding personalization and complex clinical reasoning, the paper explores the emerging development of LLM-powered autonomous agents for healthcare. Furthermore, it summarizes the evaluation methodologies for assessing LLMs' reliability and safety in medical contexts. Overall, this review offers an extensive analysis on the transformative potential of LLMs in modern medicine. It also highlights the pivotal need for continuous optimizations and ethical oversight before these models can be effectively integrated into clinical practice. Visit https://github.com/mingze-yuan/Awesome-LLM-Healthcare for an accompanying GitHub repository containing latest papers.

Modeling human preferences is crucial for aligning foundation models with human values. Traditional reward modeling methods, such as the Bradley-Terry (BT) reward model, fall short in expressiveness, particularly in addressing intransitive preferences. Although supervised pair preference models (PairPM) can express general preferences, their implementation is highly ad-hoc and cannot guarantee a consistent preference probability of compared pairs. Additionally, they impose high computational costs due to their quadratic query complexity when comparing multiple responses. In this paper, we introduce preference representation learning, an approach that embeds responses into a latent space to capture intricate preference structures efficiently, achieving linear query complexity. Additionally, we propose preference score-based General Preference Optimization (GPO), which generalizes reward-based reinforcement learning from human feedback. Experimental results show that our General Preference representation model (GPM) outperforms the BT reward model on the RewardBench benchmark with a margin of up to 5.6% and effectively models cyclic preferences where any BT reward model behaves like a random guess. Furthermore, evaluations on downstream tasks such as AlpacaEval2.0 and MT-Bench, following the language model post-training with GPO and our general preference model, reveal substantial performance improvements with margins up to 9.3%. These findings indicate that our method may enhance the alignment of foundation models with nuanced human values. The code is available at https://github.com/general-preference/general-preference-model.

Large language models (LLMs) fine-tuned by reinforcement learning from human feedback (RLHF) are becoming more widely deployed. We coin the term Implicit Reward Model (IRM) to refer to the changes that occur to an LLM during RLHF that result in high-reward generations. We interpret IRMs, and measure their divergence from the RLHF reward model used in the fine-tuning process that induced them. By fitting a linear function to an LLM's IRM, a reward model with the same type signature as the RLHF reward model is constructed, allowing for direct comparison. Additionally, we validate our construction of the IRM through cross-comparison with classifications of features generated by an LLM based on their relevance to the RLHF reward model. Better comprehending IRMs can help minimize discrepencies between LLM behavior and training objectives, which we believe to be an essential component of the safety and alignment of LLMs.

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

In reinforcement learning from human feedback, it is common to optimize against a reward model trained to predict human preferences. Because the reward model is an imperfect proxy, optimizing its value too much can hinder ground truth performance, in accordance with Goodhart's law. This effect has been frequently observed, but not carefully measured due to the expense of collecting human preference data. In this work, we use a synthetic setup in which a fixed "gold-standard" reward model plays the role of humans, providing labels used to train a proxy reward model. We study how the gold reward model score changes as we optimize against the proxy reward model using either reinforcement learning or best-of-n sampling. We find that this relationship follows a different functional form depending on the method of optimization, and that in both cases its coefficients scale smoothly with the number of reward model parameters. We also study the effect on this relationship of the size of the reward model dataset, the number of reward model and policy parameters, and the coefficient of the KL penalty added to the reward in the reinforcement learning setup. We explore the implications of these empirical results for theoretical considerations in AI alignment.

Reinforcement Learning from Human Feedback (RLHF) has emerged as a important paradigm for aligning large language models (LLMs) with human preferences during post-training. This framework typically involves two stages: first, training a reward model on human preference data, followed by optimizing the language model using reinforcement learning algorithms. However, current RLHF approaches may constrained by two limitations. First, existing RLHF frameworks often rely on Bradley-Terry models to assign scalar rewards based on pairwise comparisons of individual responses. However, this approach imposes significant challenges on reward model (RM), as the inherent variability in prompt-response pairs across different contexts demands robust calibration capabilities from the RM. Second, reward models are typically initialized from generative foundation models, such as pre-trained or supervised fine-tuned models, despite the fact that reward models perform discriminative tasks, creating a mismatch. This paper introduces Pairwise-RL, a RLHF framework that addresses these challenges through a combination of generative reward modeling and a pairwise proximal policy optimization (PPO) algorithm. Pairwise-RL unifies reward model training and its application during reinforcement learning within a consistent pairwise paradigm, leveraging generative modeling techniques to enhance reward model performance and score calibration. Experimental evaluations demonstrate that Pairwise-RL outperforms traditional RLHF frameworks across both internal evaluation datasets and standard public benchmarks, underscoring its effectiveness in improving alignment and model behavior.

Reinforcement Learning from Human Feedback significantly enhances Natural Language Processing by aligning language models with human expectations. A critical factor in this alignment is the strength of reward models used during training. This study explores whether stronger reward models invariably lead to better language models. In this paper, through experiments on relevance, factuality, and completeness tasks using the QA-FEEDBACK dataset and reward models based on Longformer, we uncover a surprising paradox: language models trained with moderately accurate reward models outperform those guided by highly accurate ones. This challenges the widely held belief that stronger reward models always lead to better language models, and opens up new avenues for future research into the key factors driving model performance and how to choose the most suitable reward models. Code and additional details are available at https://github.com/EIT-NLP/AccuracyParadox-RLHF.

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

Reinforcement learning from human feedback usually models preferences using a reward model that does not distinguish between people. We argue that this is unlikely to be a good design choice in contexts with high potential for disagreement, like in the training of large language models. We propose a method to specialise a reward model to a person or group of people. Our approach builds on the observation that individual preferences can be captured as a linear combination of a set of general reward features. We show how to learn such features and subsequently use them to quickly adapt the reward model to a specific individual, even if their preferences are not reflected in the training data. We present experiments with large language models comparing the proposed architecture with a non-adaptive reward model and also adaptive counterparts, including models that do in-context personalisation. Depending on how much disagreement there is in the training data, our model either significantly outperforms the baselines or matches their performance with a simpler architecture and more stable training.

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

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

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

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

Large Multimodal Models (LMMs) are increasingly capable of answering medical questions that require joint reasoning over images and text, yet training general medical VQA systems is impeded by the lack of large, openly usable, high-quality corpora. We present MedVLSynther, a rubric-guided generator-verifier framework that synthesizes high-quality multiple-choice VQA items directly from open biomedical literature by conditioning on figures, captions, and in-text references. The generator produces self-contained stems and parallel, mutually exclusive options under a machine-checkable JSON schema; a multi-stage verifier enforces essential gates (self-containment, single correct answer, clinical validity, image-text consistency), awards fine-grained positive points, and penalizes common failure modes before acceptance. Applying this pipeline to PubMed Central yields MedSynVQA: 13,087 audited questions over 14,803 images spanning 13 imaging modalities and 28 anatomical regions. Training open-weight LMMs with reinforcement learning using verifiable rewards improves accuracy across six medical VQA benchmarks, achieving averages of 55.85 (3B) and 58.15 (7B), with up to 77.57 on VQA-RAD and 67.76 on PathVQA, outperforming strong medical LMMs. A Ablations verify that both generation and verification are necessary and that more verified data consistently helps, and a targeted contamination analysis detects no leakage from evaluation suites. By operating entirely on open literature and open-weight models, MedVLSynther offers an auditable, reproducible, and privacy-preserving path to scalable medical VQA training data.

Recent studies have demonstrated the strong empirical performance of diffusion models on discrete sequences across domains from natural language to biological sequence generation. For example, in the protein inverse folding task, conditional diffusion models have achieved impressive results in generating natural-like sequences that fold back into the original structure. However, practical design tasks often require not only modeling a conditional distribution but also optimizing specific task objectives. For instance, we may prefer protein sequences with high stability. To address this, we consider the scenario where we have pre-trained discrete diffusion models that can generate natural-like sequences, as well as reward models that map sequences to task objectives. We then formulate the reward maximization problem within discrete diffusion models, analogous to reinforcement learning (RL), while minimizing the KL divergence against pretrained diffusion models to preserve naturalness. To solve this RL problem, we propose a novel algorithm, DRAKES, that enables direct backpropagation of rewards through entire trajectories generated by diffusion models, by making the originally non-differentiable trajectories differentiable using the Gumbel-Softmax trick. Our theoretical analysis indicates that our approach can generate sequences that are both natural-like and yield high rewards. While similar tasks have been recently explored in diffusion models for continuous domains, our work addresses unique algorithmic and theoretical challenges specific to discrete diffusion models, which arise from their foundation in continuous-time Markov chains rather than Brownian motion. Finally, we demonstrate the effectiveness of DRAKES in generating DNA and protein sequences that optimize enhancer activity and protein stability, respectively, important tasks for gene therapies and protein-based therapeutics.

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

Reward modeling in large language models is susceptible to reward hacking, causing models to latch onto superficial features such as the tendency to generate lists or unnecessarily long responses. In reinforcement learning from human feedback (RLHF) and more generally during post-training flawed reward signals often lead to outputs that optimize for these spurious correlates instead of genuine quality or correctness. We propose Context-Aware Reward Modeling (CARMO), a novel approach that first generates dynamic, context-relevant criteria to ground the reward model before producing reward scores. Unlike prior methods that rely on static rubrics, CARMO leverages large language models (LLMs) to adaptively create evaluation criteria such as logical consistency, clarity, and depth tailored to the user query. Our theoretical analysis shows that such criteria generation can mitigate reward hacking. We further demonstrate that CARMO can be distilled into smaller models, reducing the computational cost of alignment. We establish a new state-of-the-art performance in zero-shot settings for generative models, achieving a 2.1\% improvement on Reward Bench. Furthermore, alignment performed on the CARMO-curated preference dataset achieves 22.5\% and 21.1\% LC-WR and WR, respectively, on Mistral-Base (7B).

Large language models (LLMs) trained with Reinforcement Learning from Human Feedback (RLHF) have demonstrated remarkable capabilities, but their underlying reward functions and decision-making processes remain opaque. This paper introduces a novel approach to interpreting LLMs by applying inverse reinforcement learning (IRL) to recover their implicit reward functions. We conduct experiments on toxicity-aligned LLMs of varying sizes, extracting reward models that achieve up to 80.40% accuracy in predicting human preferences. Our analysis reveals key insights into the non-identifiability of reward functions, the relationship between model size and interpretability, and potential pitfalls in the RLHF process. We demonstrate that IRL-derived reward models can be used to fine-tune new LLMs, resulting in comparable or improved performance on toxicity benchmarks. This work provides a new lens for understanding and improving LLM alignment, with implications for the responsible development and deployment of these powerful systems.

Recent advances in medical large language models (LLMs), multimodal models, and agents demand evaluation frameworks that reflect real clinical workflows and safety constraints. We present MedBench v4, a nationwide, cloud-based benchmarking infrastructure comprising over 700,000 expert-curated tasks spanning 24 primary and 91 secondary specialties, with dedicated tracks for LLMs, multimodal models, and agents. Items undergo multi-stage refinement and multi-round review by clinicians from more than 500 institutions, and open-ended responses are scored by an LLM-as-a-judge calibrated to human ratings. We evaluate 15 frontier models. Base LLMs reach a mean overall score of 54.1/100 (best: Claude Sonnet 4.5, 62.5/100), but safety and ethics remain low (18.4/100). Multimodal models perform worse overall (mean 47.5/100; best: GPT-5, 54.9/100), with solid perception yet weaker cross-modal reasoning. Agents built on the same backbones substantially improve end-to-end performance (mean 79.8/100), with Claude Sonnet 4.5-based agents achieving up to 85.3/100 overall and 88.9/100 on safety tasks. MedBench v4 thus reveals persisting gaps in multimodal reasoning and safety for base models, while showing that governance-aware agentic orchestration can markedly enhance benchmarked clinical readiness without sacrificing capability. By aligning tasks with Chinese clinical guidelines and regulatory priorities, the platform offers a practical reference for hospitals, developers, and policymakers auditing medical AI.

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

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.

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

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

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

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

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

Recent advances in aligning Large Language Models with human preferences have benefited from larger reward models and better preference data. However, most of these methodologies rely on the accuracy of the reward model. The reward models used in Reinforcement Learning with Human Feedback (RLHF) are typically learned from small datasets using stochastic optimization algorithms, making them prone to high variability. We illustrate the inconsistencies between reward models empirically on numerous open-source datasets. We theoretically show that the fluctuation of the reward models can be detrimental to the alignment problem because the derived policies are more overfitted to the reward model and, hence, are riskier if the reward model itself is uncertain. We use concentration of measure to motivate an uncertainty-aware, conservative algorithm for policy optimization. We show that such policies are more risk-averse in the sense that they are more cautious of uncertain rewards. We theoretically prove that our proposed methodology has less risk than the vanilla method. We corroborate our theoretical results with experiments based on designing an ensemble of reward models. We use this ensemble of reward models to align a language model using our methodology and observe that our empirical findings match our theoretical predictions.

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

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

Large pretrained models are showing increasingly better performance in reasoning and planning tasks across different modalities, opening the possibility to leverage them for complex sequential decision making problems. In this paper, we investigate the capabilities of Large Language Models (LLMs) for reinforcement learning (RL) across a diversity of interactive domains. We evaluate their ability to produce decision-making policies, either directly, by generating actions, or indirectly, by first generating reward models to train an agent with RL. Our results show that, even without task-specific fine-tuning, LLMs excel at reward modeling. In particular, crafting rewards through artificial intelligence (AI) feedback yields the most generally applicable approach and can enhance performance by improving credit assignment and exploration. Finally, in environments with unfamiliar dynamics, we explore how fine-tuning LLMs with synthetic data can significantly improve their reward modeling capabilities while mitigating catastrophic forgetting, further broadening their utility in sequential decision-making tasks.

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.

Foundation models, specifically Large Language Models (LLMs), have lately gained wide-spread attention and adoption. Reinforcement Learning with Human Feedback (RLHF) involves training a reward model to capture desired behaviors, which is then used to align LLM's. These reward models are additionally used at inference-time to estimate LLM responses' adherence to those desired behaviors. However, there is little work measuring how robust these reward models are to distribution shifts. In this work, we evaluate how reward model performance - measured via accuracy and calibration (i.e. alignment between accuracy and confidence) - is affected by distribution shift. We show novel calibration patterns and accuracy drops due to OOD prompts and responses, and that the reward model is more sensitive to shifts in responses than prompts. Additionally, we adapt an OOD detection technique commonly used in classification to the reward model setting to detect these distribution shifts in prompts and responses.