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Aug 4

Case-Grounded Evidence Verification: A Framework for Constructing Evidence-Sensitive Supervision

Evidence-grounded reasoning requires more than attaching retrieved text to a prediction: a model should make decisions that depend on whether the provided evidence supports the target claim. In practice, this often fails because supervision is weak, evidence is only loosely tied to the claim, and evaluation does not test evidence dependence directly. We introduce case-grounded evidence verification, a general framework in which a model receives a local case context, external evidence, and a structured claim, and must decide whether the evidence supports the claim for that case. Our key contribution is a supervision construction procedure that generates explicit support examples together with semantically controlled non-support examples, including counterfactual wrong-state and topic-related negatives, without manual evidence annotation. We instantiate the framework in radiology and train a standard verifier on the resulting support task. The learned verifier substantially outperforms both case-only and evidence-only baselines, remains strong under correct evidence, and collapses when evidence is removed or swapped, indicating genuine evidence dependence. This behavior transfers across unseen evidence articles and an external case distribution, though performance degrades under evidence-source shift and remains sensitive to backbone choice. Overall, the results suggest that a major bottleneck in evidence grounding is not only model capacity, but the lack of supervision that encodes the causal role of evidence.

  • 5 authors
·
Apr 9

Evolving Diagnostic Agents in a Virtual Clinical Environment

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

Unmasking On-Policy Distillation: Where It Helps, Where It Hurts, and Why

On-policy distillation offers dense, per-token supervision for training reasoning models; however, it remains unclear under which conditions this signal is beneficial and under which it is detrimental. Which teacher model should be used, and in the case of self-distillation, which specific context should serve as the supervisory signal? Does the optimal choice vary from one token to the next? At present, addressing these questions typically requires costly training runs whose aggregate performance metrics obscure the dynamics at the level of individual tokens. We introduce a training-free diagnostic framework that operates at the highest resolution: per token, per question, and per teacher. We derive an ideal per-node gradient defined as the parameter update that maximally increases the student's probability of success. We then develop a scalable targeted-rollout algorithm to estimate this gradient efficiently, even for long chains of intermediate thoughts. The gradient alignment score, defined as the cosine similarity between this ideal gradient and any given distillation gradient, quantifies the extent to which a particular configuration approximates the ideal signal. Across a range of self-distillation settings and external teacher models, we observe that distillation guidance exhibits substantially higher alignment with the ideal on incorrect rollouts than on correct ones, where the student already performs well and the teacher's signal tends to become noisy. Furthermore, we find that the optimal distillation context depends jointly on the student model's capacity and the target task, and that no single universally effective configuration emerges. These findings motivate the use of per-task, per-token diagnostic analyses for distillation.

apple Apple
·
May 10 1

CoT Information: Improved Sample Complexity under Chain-of-Thought Supervision

Learning complex functions that involve multi-step reasoning poses a significant challenge for standard supervised learning from input-output examples. Chain-of-thought (CoT) supervision, which provides intermediate reasoning steps together with the final output, has emerged as a powerful empirical technique, underpinning much of the recent progress in the reasoning capabilities of large language models. This paper develops a statistical theory of learning under CoT supervision. A key characteristic of the CoT setting, in contrast to standard supervision, is the mismatch between the training objective (CoT risk) and the test objective (end-to-end risk). A central part of our analysis, distinguished from prior work, is explicitly linking those two types of risk to achieve sharper sample complexity bounds. This is achieved via the *CoT information measure* I_{D, h_star}^{CoT}(epsilon; calH), which quantifies the additional discriminative power gained from observing the reasoning process. The main theoretical results demonstrate how CoT supervision can yield significantly faster learning rates compared to standard E2E supervision. Specifically, it is shown that the sample complexity required to achieve a target E2E error epsilon scales as d/I_{D, h_star}^{CoT}(epsilon; calH), where d is a measure of hypothesis class complexity, which can be much faster than standard d/epsilon rates. Information-theoretic lower bounds in terms of the CoT information are also obtained. Together, these results suggest that CoT information is a fundamental measure of statistical complexity for learning under chain-of-thought supervision.

  • 3 authors
·
May 21, 2025

Bucketing the Good Apples: A Method for Diagnosing and Improving Causal Abstraction

We present a method for diagnosing interpretation in neural networks by identifying an input subspace where a proposed interpretation is highly faithful. Our method is particularly useful for causal-abstraction-style interpretability, where a high-level causal hypothesis is evaluated by interchange interventions. Rather than treating interchange intervention accuracy as a single global summary, we refine this framework by partitioning the input space into well-interpreted and under-interpreted regions according to pairwise interchange-intervention behavior. This turns causal abstraction from a purely global evaluation into a more diagnostic tool: it not only measures whether an interpretation works, but also reveals where it works, where it fails, and what distinguishes the two cases. This diagnostic view also provides practical heuristics for improving interpretations. By analyzing the structure of the well-interpreted and under-interpreted regions, we can identify missing distinctions in a high-level hypothesis, discover previously unmodeled intermediate variables, and combine complementary partial interpretations into a stronger one. We instantiate this idea as a simple four-step recipe and show that it yields informative error analyses across multiple causal abstraction settings. In a toy logic task, recursively applying the recipe recovers a high-level hypothesis from scratch. More broadly, our results suggest that partitioning the input space is a useful step toward more precise, constructive, and scalable mechanistic interpretability.

  • 5 authors
·
May 3

Skin-R1: Toward Trustworthy Clinical Reasoning for Dermatological Diagnosis

The emergence of vision-language models (VLMs) has opened new possibilities for clinical reasoning and has shown promising performance in dermatological diagnosis. However, their trustworthiness and clinical utility are often limited by three major factors: (1) Data heterogeneity, where diverse datasets lack consistent diagnostic labels and clinical concept annotations; (2) Absence of grounded diagnostic rationales, leading to a scarcity of reliable reasoning supervision; and (3) Limited scalability and generalization, as models trained on small, densely annotated datasets struggle to transfer nuanced reasoning to large, sparsely-annotated ones. To address these limitations, we propose SkinR1, a novel dermatological VLM that combines deep, textbook-based reasoning with the broad generalization capabilities of reinforcement learning (RL). SkinR1 systematically resolves the key challenges through a unified, end-to-end framework. First, we design a textbook-based reasoning generator that synthesizes high-fidelity, hierarchy-aware, and differential-diagnosis (DDx)-informed trajectories, providing reliable expert-level supervision. Second, we leverage the constructed trajectories for supervised fine-tuning (SFT) empowering the model with grounded reasoning ability. Third, we develop a novel RL paradigm that, by incorporating the hierarchical structure of diseases, effectively transfers these grounded reasoning patterns to large-scale, sparse data. Extensive experiments on multiple dermatology datasets demonstrate that SkinR1 achieves superior diagnostic accuracy. The ablation study demonstrates the importance of the reasoning foundation instilled by SFT.

  • 7 authors
·
Nov 18, 2025 1

Why Supervised Fine-Tuning Fails to Learn: A Systematic Study of Incomplete Learning in Large Language Models

Supervised Fine-Tuning (SFT) is the standard approach for adapting large language models (LLMs) to downstream tasks. However, we observe a persistent failure mode: even after convergence, models often fail to correctly reproduce a subset of their own supervised training data. We refer to this behavior as the Incomplete Learning Phenomenon(ILP). This paper presents the first systematic study of ILP in LLM fine-tuning. We formalize ILP as post-training failure to internalize supervised instances and demonstrate its prevalence across multiple model families, domains, and datasets. Through controlled analyses, we identify five recurrent sources of incomplete learning: (1) missing prerequisite knowledge in the pre-trained model, (2) conflicts between SFT supervision and pre-training knowledge, (3) internal inconsistencies within SFT data, (4) left-side forgetting during sequential fine-tuning, and (5) insufficient optimization for rare or complex patterns. We introduce a diagnostic-first framework that maps unlearned samples to these causes using observable training and inference signals, and study several targeted mitigation strategies as causal interventions. Experiments on Qwen, LLaMA, and OLMo2 show that incomplete learning is widespread and heterogeneous, and that improvements in aggregate metrics can mask persistent unlearned subsets. The findings highlight the need for fine-grained diagnosis of what supervised fine-tuning fails to learn, and why.

Tencent-Hunyuan Tencent Hunyuan
·
Apr 23

Unifying Self-Supervised Clustering and Energy-Based Models

Self-supervised learning excels at learning representations from large amounts of data. At the same time, generative models offer the complementary property of learning information about the underlying data generation process. In this study, we aim at establishing a principled connection between these two paradigms and highlight the benefits of their complementarity. In particular, we perform an analysis of self-supervised learning objectives, elucidating the underlying probabilistic graphical models and presenting a standardized methodology for their derivation from first principles. The analysis suggests a natural means of integrating self-supervised learning with likelihood-based generative models. We instantiate this concept within the realm of cluster-based self-supervised learning and energy models, introducing a lower bound proven to reliably penalize the most important failure modes and unlocking full unification. Our theoretical findings are substantiated through experiments on synthetic and real-world data, including SVHN, CIFAR10, and CIFAR100, demonstrating that our objective function allows to jointly train a backbone network in a discriminative and generative fashion, consequently outperforming existing self-supervised learning strategies in terms of clustering, generation and out-of-distribution detection performance by a wide margin. We also demonstrate that the solution can be integrated into a neuro-symbolic framework to tackle a simple yet non-trivial instantiation of the symbol grounding problem. The code is publicly available at https://github.com/emsansone/GEDI.

  • 2 authors
·
Dec 29, 2023

Conditional Coverage Diagnostics for Conformal Prediction

Evaluating conditional coverage remains one of the most persistent challenges in assessing the reliability of predictive systems. Although conformal methods can give guarantees on marginal coverage, no method can guarantee to produce sets with correct conditional coverage, leaving practitioners without a clear way to interpret local deviations. To overcome sample-inefficiency and overfitting issues of existing metrics, we cast conditional coverage estimation as a classification problem. Conditional coverage is violated if and only if some classifier can achieve lower risk than the target coverage. Through the choice of a (proper) loss function, the resulting risk difference gives a conservative estimate of natural miscoverage measures such as L1 and L2 distance, and can even separate the effects of over- and under-coverage, and non-constant target coverages. We call the resulting family of metrics excess risk of the target coverage (ERT). We show experimentally that the use of modern classifiers provides much higher statistical power than simple classifiers underlying established metrics like CovGap. Additionally, we use our metric to benchmark different conformal prediction methods. Finally, we release an open-source package for ERT as well as previous conditional coverage metrics. Together, these contributions provide a new lens for understanding, diagnosing, and improving the conditional reliability of predictive systems.

  • 4 authors
·
May 28

ChestX-Reasoner: Advancing Radiology Foundation Models with Reasoning through Step-by-Step Verification

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

  • 6 authors
·
Apr 29, 2025

Aligning Language Models with Observational Data: Opportunities and Risks from a Causal Perspective

Large language models are being widely used across industries to generate content that contributes directly to key performance metrics, such as conversion rates. Pretrained models, however, often fall short when it comes to aligning with human preferences or optimizing for business objectives. As a result, fine-tuning with good-quality labeled data is essential to guide models to generate content that achieves better results. Controlled experiments, like A/B tests, can provide such data, but they are often expensive and come with significant engineering and logistical challenges. Meanwhile, companies have access to a vast amount of historical (observational) data that remains underutilized. In this work, we study the challenges and opportunities of fine-tuning LLMs using observational data. We show that while observational outcomes can provide valuable supervision, directly fine-tuning models on such data can lead them to learn spurious correlations. We present empirical evidence of this issue using various real-world datasets and propose DeconfoundLM, a method that explicitly removes the effect of known confounders from reward signals. Using simulation experiments, we demonstrate that DeconfoundLM improves the recovery of causal relationships and mitigates failure modes found in fine-tuning methods that ignore or naively incorporate confounding variables. Our findings highlight that while observational data presents risks, with the right causal corrections, it can be a powerful source of signal for LLM alignment. Please refer to the project page for code and related resources.

  • 1 authors
·
May 30, 2025

MixSD: Mixed Contextual Self-Distillation for Knowledge Injection

Supervised fine-tuning (SFT) is widely used to inject new knowledge into language models, but it often degrades pretrained capabilities such as reasoning and general-domain performance. We argue this forgetting arises because fine-tuning targets from humans or external systems diverge from the model's autoregressive distribution, forcing the optimizer to imitate low-probability token sequences. To address this problem, we propose MixSD, a simple external-teacher-free method for distribution-aligned knowledge injection. Instead of training on fixed targets, MixSD constructs supervision dynamically by mixing tokens from two conditionals of the base model itself: an expert conditional that observes the injected fact in context, and a naive conditional that reflects the model's original prior. The resulting supervision sequences preserve the factual learning signal while remaining substantially closer to the base model's distribution. We evaluate MixSD on two synthetic corpora that we construct to study factual recall and arithmetic function acquisition in a controlled setting, together with established benchmarks for open-domain factual question answering and knowledge editing. Across multiple model scales and settings, MixSD consistently achieves a better memorization-retention trade-off compared to SFT and on-policy self distillation baselines, retaining up to 100% of the base model's held-out capability while maintaining near-perfect training accuracy, whereas standard SFT retains as little as 1%. We further show that MixSD produces substantially lower-NLL supervision targets under the base model and reduces harmful movement along Fisher-sensitive parameter directions. These results suggest that aligning supervision with the model's native generation distribution is a simple and effective principle for knowledge injection that mitigates catastrophic forgetting.

An Explainable Diagnostic Framework for Neurodegenerative Dementias via Reinforcement-Optimized LLM Reasoning

The differential diagnosis of neurodegenerative dementias is a challenging clinical task, mainly because of the overlap in symptom presentation and the similarity of patterns observed in structural neuroimaging. To improve diagnostic efficiency and accuracy, deep learning-based methods such as Convolutional Neural Networks and Vision Transformers have been proposed for the automatic classification of brain MRIs. However, despite their strong predictive performance, these models find limited clinical utility due to their opaque decision making. In this work, we propose a framework that integrates two core components to enhance diagnostic transparency. First, we introduce a modular pipeline for converting 3D T1-weighted brain MRIs into textual radiology reports. Second, we explore the potential of modern Large Language Models (LLMs) to assist clinicians in the differential diagnosis between Frontotemporal dementia subtypes, Alzheimer's disease, and normal aging based on the generated reports. To bridge the gap between predictive accuracy and explainability, we employ reinforcement learning to incentivize diagnostic reasoning in LLMs. Without requiring supervised reasoning traces or distillation from larger models, our approach enables the emergence of structured diagnostic rationales grounded in neuroimaging findings. Unlike post-hoc explainability methods that retrospectively justify model decisions, our framework generates diagnostic rationales as part of the inference process-producing causally grounded explanations that inform and guide the model's decision-making process. In doing so, our framework matches the diagnostic performance of existing deep learning methods while offering rationales that support its diagnostic conclusions.

  • 6 authors
·
May 26, 2025 2

Med-OPD: Improving Medical Vision-Language Models via Evidence-Aware On-Policy Distillation

Medical Vision-Language Models (Med-VLMs) require reliable reasoning from fine-grained visual evidence, yet existing models can produce plausible clinical answers by relying on language priors or medical templates rather than truly attending to diagnosis-critical regions. On-Policy Distillation (OPD) offers dense token-level supervision on student-generated trajectories and provides a privacy-compatible means of capability transfer without requiring the redistribution of raw patient data. However, standard OPD uniformly distills all tokens, causing sparse evidence-dependent tokens to be diluted by abundant clinical narrative tokens. Inspired by the success of OPD in the large language model community, we propose Med-OPD, to our knowledge the first unified post-training framework that integrates on-policy distillation with medical evidence-aware supervision for Med-VLMs. We introduce Medical Evidence Advantage (MEA), a teacher-grounded counterfactual signal that uses an answer-aware hint to focus teacher scoring on evidence supporting the target diagnosis, and measures each token's dependence on medical visual evidence by comparing teacher likelihoods under the original and evidence-degraded imaging modalities. Based on MEA, Med-OPD redistributes the distillation signal at both the token and trajectory levels, emphasizing diagnosis-critical tokens and evidence-reliant rollouts. Experiments on OmniMedVQA subsets show that Med-OPD consistently outperforms SFT and standard OPD across CT, MRI, Disease Diagnosis, and Lesion Grading. These results demonstrate that evidence-aware distillation can better strengthen medical VLMs' reliance on key visual evidence and improve reliable multimodal medical reasoning. The source code and data is publicly available at: https://github.com/yunhang8658/MedOPD.git

  • 6 authors
·
Jul 13

MedExAgent: Training LLM Agents to Ask, Examine, and Diagnose in Noisy Clinical Environments

Real-world clinical diagnosis is a complex process in which the doctor is required to obtain information from both interaction with the patient and conducting medical exams. Additionally, the doctor needs to adapt to different patient personas, as well as noisy and incomplete information that can happen at any time during the process. However, existing benchmarks for medical LLMs and methods for automatic diagnosis largely simplify this process by reducing it to single-turn question answering, noise-free conversations, or sequential exam making, etc., ignoring the interactive and uncertain nature of clinical diagnosis. In this paper, we aim to address this gap by formalizing clinical diagnosis as a Partially Observable Markov Decision Process (POMDP) with three action types: questioning the patient, ordering medical exams as tool calls, and issuing a diagnosis. We also introduce a systematic noise model comprising seven patient noise types and three exam noise types. Using our proposed environment, we train an effective diagnosis agent, MedExAgent, through a two-stage pipeline that first performs supervised finetuning on synthetic conversations structured after the Calgary-Cambridge model for clinical interviews, and then applies DAPO to optimize a composite reward capturing diagnostic accuracy, tool call quality, and exam cost including financial cost and patient discomfort. Through extensive experiments and ablation studies, we demonstrate that MedExAgent achieves diagnostic performance comparable to larger models while maintaining cost-efficient examination strategies.

  • 5 authors
·
May 7

Incorporating Surrogate Gradient Norm to Improve Offline Optimization Techniques

Offline optimization has recently emerged as an increasingly popular approach to mitigate the prohibitively expensive cost of online experimentation. The key idea is to learn a surrogate of the black-box function that underlines the target experiment using a static (offline) dataset of its previous input-output queries. Such an approach is, however, fraught with an out-of-distribution issue where the learned surrogate becomes inaccurate outside the offline data regimes. To mitigate this, existing offline optimizers have proposed numerous conditioning techniques to prevent the learned surrogate from being too erratic. Nonetheless, such conditioning strategies are often specific to particular surrogate or search models, which might not generalize to a different model choice. This motivates us to develop a model-agnostic approach instead, which incorporates a notion of model sharpness into the training loss of the surrogate as a regularizer. Our approach is supported by a new theoretical analysis demonstrating that reducing surrogate sharpness on the offline dataset provably reduces its generalized sharpness on unseen data. Our analysis extends existing theories from bounding generalized prediction loss (on unseen data) with loss sharpness to bounding the worst-case generalized surrogate sharpness with its empirical estimate on training data, providing a new perspective on sharpness regularization. Our extensive experimentation on a diverse range of optimization tasks also shows that reducing surrogate sharpness often leads to significant improvement, marking (up to) a noticeable 9.6% performance boost. Our code is publicly available at https://github.com/cuong-dm/IGNITE

  • 4 authors
·
Mar 6, 2025

Guiding Through Complexity: What Makes Good Supervision for Hard Reasoning Tasks?

How can "weak teacher models" such as average human annotators or existing AI systems, effectively supervise LLMs to improve performance on hard reasoning tasks, especially those that challenge and requires expertise or daily practice from the teacher models? In this paper, we seek for empirical answers to this question by investigating various data-driven strategies that offer supervision data at different quality levels upon tasks of varying complexity. Two intuitive strategies emerge for teacher models to provide supervision during alignment training: 1) using lower-quality supervision from complete tasks that match the difficulty of the target reasoning tasks, and 2) leveraging higher-quality supervision from easier subtasks that are less challenging. Interestingly, we find that even when the outcome error rate for hard task supervision is high (e.g., 90\%), training on such data can outperform perfectly correct supervision on easier subtasks on multiple hard math benchmarks. We further identify a more critical factor influencing training performance: step-wise error rates, which indicate the severity of errors in solutions. Specifically, training on hard task supervision with the same outcome error rates but disparate step-wise error rates can lead to a 30\% accuracy gap on MATH benchmark. Our results also reveal that supplementing hard task supervision with the corresponding subtask supervision can yield notable performance improvements than simply combining rephrased hard full task supervision, suggesting new avenues for data augmentation. Data and code are released at https://github.com/hexuan21/Weak-to-Strong.

  • 3 authors
·
Oct 27, 2024

Learning Diagnostic Reasoning for Decision Support in Toxicology

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

  • 6 authors
·
Mar 30

DDXPlus: A New Dataset For Automatic Medical Diagnosis

There has been a rapidly growing interest in Automatic Symptom Detection (ASD) and Automatic Diagnosis (AD) systems in the machine learning research literature, aiming to assist doctors in telemedicine services. These systems are designed to interact with patients, collect evidence about their symptoms and relevant antecedents, and possibly make predictions about the underlying diseases. Doctors would review the interactions, including the evidence and the predictions, collect if necessary additional information from patients, before deciding on next steps. Despite recent progress in this area, an important piece of doctors' interactions with patients is missing in the design of these systems, namely the differential diagnosis. Its absence is largely due to the lack of datasets that include such information for models to train on. In this work, we present a large-scale synthetic dataset of roughly 1.3 million patients that includes a differential diagnosis, along with the ground truth pathology, symptoms and antecedents for each patient. Unlike existing datasets which only contain binary symptoms and antecedents, this dataset also contains categorical and multi-choice symptoms and antecedents useful for efficient data collection. Moreover, some symptoms are organized in a hierarchy, making it possible to design systems able to interact with patients in a logical way. As a proof-of-concept, we extend two existing AD and ASD systems to incorporate the differential diagnosis, and provide empirical evidence that using differentials as training signals is essential for the efficiency of such systems or for helping doctors better understand the reasoning of those systems.

  • 5 authors
·
May 18, 2022

DR.BENCH: Diagnostic Reasoning Benchmark for Clinical Natural Language Processing

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

  • 7 authors
·
Sep 29, 2022

Seeing Like Radiologists: Context- and Gaze-Guided Vision-Language Pretraining for Chest X-rays

Despite recent advances in medical vision-language pretraining, existing models still struggle to capture the diagnostic workflow: radiographs are typically treated as context-agnostic images, while radiologists' gaze -- a crucial cue for visual reasoning -- remains largely underexplored by existing methods. These limitations hinder the modeling of disease-specific patterns and weaken cross-modal alignment. To bridge this gap, we introduce CoGaze, a Context- and Gaze-guided vision-language pretraining framework for chest X-rays. We first propose a context-infused vision encoder that models how radiologists integrate clinical context -- including patient history, symptoms, and diagnostic intent -- to guide diagnostic reasoning. We then present a multi-level supervision paradigm that (1) enforces intra- and inter-modal semantic alignment through hybrid-positive contrastive learning, (2) injects diagnostic priors via disease-aware cross-modal representation learning, and (3) leverages radiologists' gaze as probabilistic priors to guide attention toward diagnostically salient regions. Extensive experiments demonstrate that CoGaze consistently outperforms state-of-the-art methods across diverse tasks, achieving up to +2.0% CheXbertF1 and +1.2% BLEU2 for free-text and structured report generation, +23.2% AUROC for zero-shot classification, and +12.2% Precision@1 for image-text retrieval. Code is available at https://github.com/mk-runner/CoGaze.

  • 8 authors
·
Mar 26

Search-R2: Enhancing Search-Integrated Reasoning via Actor-Refiner Collaboration

Search-integrated reasoning enables language agents to transcend static parametric knowledge by actively querying external sources. However, training these agents via reinforcement learning is hindered by the multi-scale credit assignment problem: existing methods typically rely on sparse, trajectory-level rewards that fail to distinguish between high-quality reasoning and fortuitous guesses, leading to redundant or misleading search behaviors. To address this, we propose Search-R2, a novel Actor-Refiner collaboration framework that enhances reasoning through targeted intervention, with both components jointly optimized during training. Our approach decomposes the generation process into an Actor, which produces initial reasoning trajectories, and a Meta-Refiner, which selectively diagnoses and repairs flawed steps via a 'cut-and-regenerate' mechanism. To provide fine-grained supervision, we introduce a hybrid reward design that couples outcome correctness with a dense process reward quantifying the information density of retrieved evidence. Theoretically, we formalize the Actor-Refiner interaction as a smoothed mixture policy, proving that selective correction yields strict performance gains over strong baselines. Extensive experiments across various general and multi-hop QA datasets demonstrate that Search-R2 consistently outperforms strong RAG and RL-based baselines across model scales, achieving superior reasoning accuracy with minimal overhead.

Incentivizing Strong Reasoning from Weak Supervision

Large language models (LLMs) have demonstrated impressive performance on reasoning-intensive tasks, but enhancing their reasoning abilities typically relies on either reinforcement learning (RL) with verifiable signals or supervised fine-tuning (SFT) with high-quality long chain-of-thought (CoT) demonstrations, both of which are expensive. In this paper, we study a novel problem of incentivizing the reasoning capacity of LLMs without expensive high-quality demonstrations and reinforcement learning. We investigate whether the reasoning capabilities of LLMs can be effectively incentivized via supervision from significantly weaker models. We further analyze when and why such weak supervision succeeds in eliciting reasoning abilities in stronger models. Our findings show that supervision from significantly weaker reasoners can substantially improve student reasoning performance, recovering close to 94% of the gains of expensive RL at a fraction of the cost. Experiments across diverse benchmarks and model architectures demonstrate that weak reasoners can effectively incentivize reasoning in stronger student models, consistently improving performance across a wide range of reasoning tasks. Our results suggest that this simple weak-to-strong paradigm is a promising and generalizable alternative to costly methods for incentivizing strong reasoning capabilities at inference-time in LLMs. The code is publicly available at https://github.com/yuanyige/w2sr.

  • 7 authors
·
May 26, 2025

Electrocardiogram-Language Model for Few-Shot Question Answering with Meta Learning

Electrocardiogram (ECG) interpretation requires specialized expertise, often involving synthesizing insights from ECG signals with complex clinical queries posed in natural language. The scarcity of labeled ECG data coupled with the diverse nature of clinical inquiries presents a significant challenge for developing robust and adaptable ECG diagnostic systems. This work introduces a novel multimodal meta-learning method for few-shot ECG question answering, addressing the challenge of limited labeled data while leveraging the rich knowledge encoded within large language models (LLMs). Our LLM-agnostic approach integrates a pre-trained ECG encoder with a frozen LLM (e.g., LLaMA and Gemma) via a trainable fusion module, enabling the language model to reason about ECG data and generate clinically meaningful answers. Extensive experiments demonstrate superior generalization to unseen diagnostic tasks compared to supervised baselines, achieving notable performance even with limited ECG leads. For instance, in a 5-way 5-shot setting, our method using LLaMA-3.1-8B achieves accuracy of 84.6%, 77.3%, and 69.6% on single verify, choose and query question types, respectively. These results highlight the potential of our method to enhance clinical ECG interpretation by combining signal processing with the nuanced language understanding capabilities of LLMs, particularly in data-constrained scenarios.

  • 5 authors
·
Oct 18, 2024

Towards Exact Computation of Inductive Bias

Much research in machine learning involves finding appropriate inductive biases (e.g. convolutional neural networks, momentum-based optimizers, transformers) to promote generalization on tasks. However, quantification of the amount of inductive bias associated with these architectures and hyperparameters has been limited. We propose a novel method for efficiently computing the inductive bias required for generalization on a task with a fixed training data budget; formally, this corresponds to the amount of information required to specify well-generalizing models within a specific hypothesis space of models. Our approach involves modeling the loss distribution of random hypotheses drawn from a hypothesis space to estimate the required inductive bias for a task relative to these hypotheses. Unlike prior work, our method provides a direct estimate of inductive bias without using bounds and is applicable to diverse hypothesis spaces. Moreover, we derive approximation error bounds for our estimation approach in terms of the number of sampled hypotheses. Consistent with prior results, our empirical results demonstrate that higher dimensional tasks require greater inductive bias. We show that relative to other expressive model classes, neural networks as a model class encode large amounts of inductive bias. Furthermore, our measure quantifies the relative difference in inductive bias between different neural network architectures. Our proposed inductive bias metric provides an information-theoretic interpretation of the benefits of specific model architectures for certain tasks and provides a quantitative guide to developing tasks requiring greater inductive bias, thereby encouraging the development of more powerful inductive biases.

  • 5 authors
·
Jun 22, 2024

Debate Helps Weak-to-Strong Generalization

Common methods for aligning already-capable models with desired behavior rely on the ability of humans to provide supervision. However, future superhuman models will surpass the capability of humans. Therefore, humans will only be able to weakly supervise superhuman models. This expected deficiency of human evaluation would weaken the safety of future AI systems. Scalable oversight and weak-to-strong generalization are two complementary approaches to tackle this issue. In this paper, we attempt to combine the strengths of these two approaches to further improve alignment. Specifically, we investigate ways of improving human supervision with a strong pretrained model and then supervise the strong model with enhanced weak human supervision. To make iterative empirical progress, we consider an analogy: can we use a strong model to improve weak model supervision and then use it to supervise the strong model? We empirically test it by finetuning a small weak model on ground truth labels with the additional help from a large strong model, and then finetuning the strong model on labels generated by the weak model. We find that debate can assist a weak model in extracting trustworthy information from an untrustworthy strong model, which provides leverage as context on samples when training a weak model. We also show that an ensemble of weak models helps exploit long arguments generated by strong model debaters and obtain a more robust supervision estimate. Extensive experiments on the OpenAI weak-to-strong NLP benchmarks show that the combination approach leads to better alignment, which indicates that debate has the potential to help weak-to-strong generalization.

  • 3 authors
·
Jan 21, 2025 2

On the Provable Advantage of Unsupervised Pretraining

Unsupervised pretraining, which learns a useful representation using a large amount of unlabeled data to facilitate the learning of downstream tasks, is a critical component of modern large-scale machine learning systems. Despite its tremendous empirical success, the rigorous theoretical understanding of why unsupervised pretraining generally helps remains rather limited -- most existing results are restricted to particular methods or approaches for unsupervised pretraining with specialized structural assumptions. This paper studies a generic framework, where the unsupervised representation learning task is specified by an abstract class of latent variable models Phi and the downstream task is specified by a class of prediction functions Psi. We consider a natural approach of using Maximum Likelihood Estimation (MLE) for unsupervised pretraining and Empirical Risk Minimization (ERM) for learning downstream tasks. We prove that, under a mild ''informative'' condition, our algorithm achieves an excess risk of mathcal{O}(mathcal{C_Phi/m} + mathcal{C_Psi/n}) for downstream tasks, where C_Phi, C_Psi are complexity measures of function classes Phi, Psi, and m, n are the number of unlabeled and labeled data respectively. Comparing to the baseline of mathcal{O}(mathcal{C_{Phi circ Psi}/n}) achieved by performing supervised learning using only the labeled data, our result rigorously shows the benefit of unsupervised pretraining when m gg n and C_{Phicirc Psi} > C_Psi. This paper further shows that our generic framework covers a wide range of approaches for unsupervised pretraining, including factor models, Gaussian mixture models, and contrastive learning.

  • 4 authors
·
Mar 2, 2023

Quark Medical Alignment: A Holistic Multi-Dimensional Alignment and Collaborative Optimization Paradigm

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

  • 13 authors
·
Feb 12

Zero-shot and Few-shot Learning with Knowledge Graphs: A Comprehensive Survey

Machine learning especially deep neural networks have achieved great success but many of them often rely on a number of labeled samples for supervision. As sufficient labeled training data are not always ready due to e.g., continuously emerging prediction targets and costly sample annotation in real world applications, machine learning with sample shortage is now being widely investigated. Among all these studies, many prefer to utilize auxiliary information including those in the form of Knowledge Graph (KG) to reduce the reliance on labeled samples. In this survey, we have comprehensively reviewed over 90 papers about KG-aware research for two major sample shortage settings -- zero-shot learning (ZSL) where some classes to be predicted have no labeled samples, and few-shot learning (FSL) where some classes to be predicted have only a small number of labeled samples that are available. We first introduce KGs used in ZSL and FSL as well as their construction methods, and then systematically categorize and summarize KG-aware ZSL and FSL methods, dividing them into different paradigms such as the mapping-based, the data augmentation, the propagation-based and the optimization-based. We next present different applications, including not only KG augmented prediction tasks such as image classification, question answering, text classification and knowledge extraction, but also KG completion tasks, and some typical evaluation resources for each task. We eventually discuss some challenges and open problems from different perspectives.

  • 8 authors
·
Dec 18, 2021

Think Twice to See More: Iterative Visual Reasoning in Medical VLMs

Medical vision-language models (VLMs) excel at image-text understanding but typically rely on a single-pass reasoning that neglects localized visual cues. In clinical practice, however, human experts iteratively scan, focus, and refine the regions of interest before reaching a final diagnosis. To narrow this machine-human perception gap, we introduce ViTAR, a novel VLM framework that emulates the iterative reasoning process of human experts through a cognitive chain of "think-act-rethink-answer". ViTAR treats medical images as interactive objects, enabling models to engage multi-step visual reasoning. To support this approach, we curate a high-quality instruction dataset comprising 1K interactive examples that encode expert-like diagnostic behaviors. In addition, a 16K visual question answering training data has been curated towards fine-grained visual diagnosis. We introduce a two-stage training strategy that begins with supervised fine-tuning to guide cognitive trajectories, followed by the reinforcement learning to optimize decision-making. Extensive evaluations demonstrate that ViTAR outperforms strong state-of-the-art models. Visual attention analysis reveals that from the "think" to "rethink" rounds, ViTAR increasingly anchors visual grounding to clinically critical regions and maintains high attention allocation to visual tokens during reasoning, providing mechanistic insight into its improved performance. These findings demonstrate that embedding expert-style iterative thinking chains into VLMs enhances both performance and trustworthiness of medical AI.

  • 9 authors
·
Oct 11, 2025

Learning from Weakly-labeled Web Videos via Exploring Sub-Concepts

Learning visual knowledge from massive weakly-labeled web videos has attracted growing research interests thanks to the large corpus of easily accessible video data on the Internet. However, for video action recognition, the action of interest might only exist in arbitrary clips of untrimmed web videos, resulting in high label noises in the temporal space. To address this issue, we introduce a new method for pre-training video action recognition models using queried web videos. Instead of trying to filter out, we propose to convert the potential noises in these queried videos to useful supervision signals by defining the concept of Sub-Pseudo Label (SPL). Specifically, SPL spans out a new set of meaningful "middle ground" label space constructed by extrapolating the original weak labels during video querying and the prior knowledge distilled from a teacher model. Consequently, SPL provides enriched supervision for video models to learn better representations. SPL is fairly simple and orthogonal to popular teacher-student self-training frameworks without extra training cost. We validate the effectiveness of our method on four video action recognition datasets and a weakly-labeled image dataset to study the generalization ability. Experiments show that SPL outperforms several existing pre-training strategies using pseudo-labels and the learned representations lead to competitive results when fine-tuning on HMDB-51 and UCF-101 compared with recent pre-training methods.

  • 8 authors
·
Jan 11, 2021

Beyond Distillation: Pushing the Limits of Medical LLM Reasoning with Minimalist Rule-Based RL

Improving performance on complex tasks and enabling interpretable decision making in large language models (LLMs), especially for clinical applications, requires effective reasoning. Yet this remains challenging without supervised fine-tuning (SFT) on costly chain-of-thought (CoT) data distilled from closed-source models (e.g., GPT-4o). In this work, we present AlphaMed, the first medical LLM to show that reasoning capability can emerge purely through reinforcement learning (RL), using minimalist rule-based rewards on public multiple-choice QA datasets, without relying on SFT or distilled CoT data. AlphaMed achieves state-of-the-art results on six medical QA benchmarks, outperforming models trained with conventional SFT+RL pipelines. On challenging benchmarks (e.g., MedXpert), AlphaMed even surpasses larger or closed-source models such as DeepSeek-V3-671B and Claude-3.5-Sonnet. To understand the factors behind this success, we conduct a comprehensive data-centric analysis guided by three questions: (i) Can minimalist rule-based RL incentivize reasoning without distilled CoT supervision? (ii) How do dataset quantity and diversity impact reasoning? (iii) How does question difficulty shape the emergence and generalization of reasoning? Our findings show that dataset informativeness is a key driver of reasoning performance, and that minimalist RL on informative, multiple-choice QA data is effective at inducing reasoning without CoT supervision. We also observe divergent trends across benchmarks, underscoring limitations in current evaluation and the need for more challenging, reasoning-oriented medical QA benchmarks.

  • 9 authors
·
May 23, 2025 2

COLEP: Certifiably Robust Learning-Reasoning Conformal Prediction via Probabilistic Circuits

Conformal prediction has shown spurring performance in constructing statistically rigorous prediction sets for arbitrary black-box machine learning models, assuming the data is exchangeable. However, even small adversarial perturbations during the inference can violate the exchangeability assumption, challenge the coverage guarantees, and result in a subsequent decline in empirical coverage. In this work, we propose a certifiably robust learning-reasoning conformal prediction framework (COLEP) via probabilistic circuits, which comprise a data-driven learning component that trains statistical models to learn different semantic concepts, and a reasoning component that encodes knowledge and characterizes the relationships among the trained models for logic reasoning. To achieve exact and efficient reasoning, we employ probabilistic circuits (PCs) within the reasoning component. Theoretically, we provide end-to-end certification of prediction coverage for COLEP in the presence of bounded adversarial perturbations. We also provide certified coverage considering the finite size of the calibration set. Furthermore, we prove that COLEP achieves higher prediction coverage and accuracy over a single model as long as the utilities of knowledge models are non-trivial. Empirically, we show the validity and tightness of our certified coverage, demonstrating the robust conformal prediction of COLEP on various datasets, including GTSRB, CIFAR10, and AwA2. We show that COLEP achieves up to 12% improvement in certified coverage on GTSRB, 9% on CIFAR-10, and 14% on AwA2.

  • 4 authors
·
Mar 17, 2024