Daily Papers

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

Model-free and reinforcement learning-based adaptive filtering methods are gaining traction for denoising in dynamic, non-stationary environments such as wireless signal channels, biomedical monitoring, and sensor networks. Traditional filters such as LMS, RLS, Wiener, and Kalman are often limited by assumptions of stationarity, the need for exact noise statistics, or fragile parameter tuning. This paper proposes an adaptive filtering framework using Proximal Policy Optimization (PPO), guided by a composite reward that balances SNR improvement, MSE reduction, and residual smoothness. We frame adaptive filtering as a Markov decision process and train a PPO agent to adjust filter coefficients directly in response to changing noise. Experiments on synthetic nonstationary signals with diverse noise types show that the PPO agent generalizes beyond its training distribution. Moreover, real-world analysis is made and evaluated on ECG recordings from the MIT-BIH Noise Stress Test Database corrupted by baseline wander, electrode motion, and muscle artifacts. The learned PPO policy achieves real-time inference and slightly outperforms strong classical baselines on ECG denoising. These results demonstrate the viability of policy-gradient reinforcement learning as a computationally efficient and flexible tool for adaptive filtering in nonlinear, time-varying dynamical systems.

Accurate peak detection across diverse cardiac physiological signals, including the Electrocardiogram (ECG), Photoplethysmogram (PPG), Ballistocardiogram (BCG), and Bodyseismography (BSG), is fundamental for cardiovascular monitoring but is often hindered by artifacts and signal variability. Conventional algorithms are typically engineered with expert knowledge for a single signal modality, limiting their generalizability. Conversely, deep learning-based methods often lack interpretability, limiting transparency for expert verification and hindering expert-computer interaction. To address these limitations, we introduce Peak-Detector, a novel framework that leverages instruction-tuned Large Language Models (LLMs) for robust, cross-modal, and explainable peak detection. A core innovation of our framework is a "peak-representation" technique that transforms time-series data into a condensed format, preserving critical event information while significantly reducing signal length. This representation provides a crucial inductive bias, guiding the LLM to reason over physiologically meaningful events rather than raw, noisy data. The model is optimized through a two-stage process: supervised fine-tuning (SFT) followed by reinforcement learning (RL) with a multi-objective reward function. The model's self-explanation capabilities are cultivated by fine-tuning on a custom-built Peak-Explanation dataset. Across four modalities-ECG, PPG, BCG, and BSG-spanning seven datasets (six public benchmarks plus one real-world cohort), Peak-Detector demonstrates strong cross-modal performance, achieving best or tied-best detection under clinically relevant temporal tolerance. Beyond accuracy, the generated rationales surface failure modes and support verification and error analysis.

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.

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.

Reward functions are central in reinforcement learning (RL), guiding agents towards optimal decision-making. The complexity of RL tasks requires meticulously designed reward functions that effectively drive learning while avoiding unintended consequences. Effective reward design aims to provide signals that accelerate the agent's convergence to optimal behavior. Crafting rewards that align with task objectives, foster desired behaviors, and prevent undesirable actions is inherently challenging. This thesis delves into the critical role of reward signals in RL, highlighting their impact on the agent's behavior and learning dynamics and addressing challenges such as delayed, ambiguous, or intricate rewards. In this thesis work, we tackle different aspects of reward shaping. First, we address the problem of designing informative and interpretable reward signals from a teacher's/expert's perspective (teacher-driven). Here, the expert, equipped with the optimal policy and the corresponding value function, designs reward signals that expedite the agent's convergence to optimal behavior. Second, we build on this teacher-driven approach by introducing a novel method for adaptive interpretable reward design. In this scenario, the expert tailors the rewards based on the learner's current policy, ensuring alignment and optimal progression. Third, we propose a meta-learning approach, enabling the agent to self-design its reward signals online without expert input (agent-driven). This self-driven method considers the agent's learning and exploration to establish a self-improving feedback loop.

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

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.

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.

A promising approach for improving reasoning in large language models is to use process reward models (PRMs). PRMs provide feedback at each step of a multi-step reasoning trace, potentially improving credit assignment over outcome reward models (ORMs) that only provide feedback at the final step. However, collecting dense, per-step human labels is not scalable, and training PRMs from automatically-labeled data has thus far led to limited gains. To improve a base policy by running search against a PRM or using it as dense rewards for reinforcement learning (RL), we ask: "How should we design process rewards?". Our key insight is that, to be effective, the process reward for a step should measure progress: a change in the likelihood of producing a correct response in the future, before and after taking the step, corresponding to the notion of step-level advantages in RL. Crucially, this progress should be measured under a prover policy distinct from the base policy. We theoretically characterize the set of good provers and our results show that optimizing process rewards from such provers improves exploration during test-time search and online RL. In fact, our characterization shows that weak prover policies can substantially improve a stronger base policy, which we also observe empirically. We validate our claims by training process advantage verifiers (PAVs) to predict progress under such provers, and show that compared to ORMs, test-time search against PAVs is >8% more accurate, and 1.5-5times more compute-efficient. Online RL with dense rewards from PAVs enables one of the first results with 5-6times gain in sample efficiency, and >6% gain in accuracy, over ORMs.

The aim of Reinforcement Learning (RL) in real-world applications is to create systems capable of making autonomous decisions by learning from their environment through trial and error. This paper emphasizes the importance of reward engineering and reward shaping in enhancing the efficiency and effectiveness of reinforcement learning algorithms. Reward engineering involves designing reward functions that accurately reflect the desired outcomes, while reward shaping provides additional feedback to guide the learning process, accelerating convergence to optimal policies. Despite significant advancements in reinforcement learning, several limitations persist. One key challenge is the sparse and delayed nature of rewards in many real-world scenarios, which can hinder learning progress. Additionally, the complexity of accurately modeling real-world environments and the computational demands of reinforcement learning algorithms remain substantial obstacles. On the other hand, recent advancements in deep learning and neural networks have significantly improved the capability of reinforcement learning systems to handle high-dimensional state and action spaces, enabling their application to complex tasks such as robotics, autonomous driving, and game playing. This paper provides a comprehensive review of the current state of reinforcement learning, focusing on the methodologies and techniques used in reward engineering and reward shaping. It critically analyzes the limitations and recent advancements in the field, offering insights into future research directions and potential applications in various domains.

Beat-level Electrocardiography (ECG) arrhythmia detection aims to assign an arrhythmia class to each beat in a recording, yet many existing systems treat beats as isolated local instances. This is limiting because beat labels often depend on multi-beat rhythm context, including timing, compensatory pauses, and beat-to-beat morphological consistency. We present DeepArrhythmia, a tool-grounded multimodal framework for segment-contextualized beat-level ECG arrhythmia classification. Given a multi-beat ECG segment, DeepArrhythmia combines the raw ECG signal and a rendered waveform image, localizes R peaks to identify beat instances, and produces structured beat-level predictions. The framework decouples physiological measurement from evidence integration using specialized tools for beat localization, numerical rhythm--morphology extraction, and morphology-focused textual analysis. DeepArrhythmia uses segment-level confidence to route between minimal and rich evidence states, since richer physiological evidence is not uniformly useful. This agentic design integrates rhythm context, explicit physiological grounding, and selective evidence acquisition for decision making.

Reinforcement learning is increasingly used for code-centric tasks. These tasks include code generation, summarization, understanding, repair, testing, and optimization. This trend is growing faster with large language models and autonomous agents. A key challenge is how to design reward signals that make sense for software. In many RL problems, the reward is a clear number. In software, this is often not possible. The goal is rarely a single numeric objective. Instead, rewards are usually proxies. Common proxies check if the code compiles, passes tests, or satisfies quality metrics. Many reward designs have been proposed for code-related tasks. However, the work is scattered across areas and papers. There is no single survey that brings these approaches together and shows the full landscape of reward design for RL in software. In this survey, we provide the first systematic and comprehensive review of reward engineering for RL in software tasks. We focus on existing methods and techniques. We structure the literature along three complementary dimensions, summarizing the reward-design choices within each. We conclude with challenges and recommendations in the reward design space for SE tasks.

Explanations for AI models in high-stakes domains like medicine often lack verifiability, which can hinder trust. To address this, we propose an interactive agent that produces explanations through an auditable sequence of actions. The agent learns a policy to strategically seek external visual evidence to support its diagnostic reasoning. This policy is optimized using reinforcement learning, resulting in a model that is both efficient and generalizable. Our experiments show that this action-based reasoning process significantly improves calibrated accuracy, reducing the Brier score by 18\% compared to a non-interactive baseline. To validate the faithfulness of the agent's explanations, we introduce a causal intervention method. By masking the visual evidence the agent chooses to use, we observe a measurable degradation in its performance (DeltaBrier=+0.029), confirming that the evidence is integral to its decision-making process. Our work provides a practical framework for building AI systems with verifiable and faithful reasoning capabilities.

We present a general convergent class of reinforcement learning algorithms that is founded on two distinct principles: (1) mapping value estimates to a different space using arbitrary functions from a broad class, and (2) linearly decomposing the reward signal into multiple channels. The first principle enables incorporating specific properties into the value estimator that can enhance learning. The second principle, on the other hand, allows for the value function to be represented as a composition of multiple utility functions. This can be leveraged for various purposes, e.g. dealing with highly varying reward scales, incorporating a priori knowledge about the sources of reward, and ensemble learning. Combining the two principles yields a general blueprint for instantiating convergent algorithms by orchestrating diverse mapping functions over multiple reward channels. This blueprint generalizes and subsumes algorithms such as Q-Learning, Log Q-Learning, and Q-Decomposition. In addition, our convergence proof for this general class relaxes certain required assumptions in some of these algorithms. Based on our theory, we discuss several interesting configurations as special cases. Finally, to illustrate the potential of the design space that our theory opens up, we instantiate a particular algorithm and evaluate its performance on the Atari suite.

While reinforcement learning with verifiable rewards (RLVR) has advanced LLM reasoning in structured domains like mathematics and programming, its application to general-domain reasoning tasks remains challenging due to the absence of verifiable reward signals. To this end, methods like Reinforcement Learning with Reference Probability Reward (RLPR) have emerged, leveraging the probability of generating the final answer as a reward signal. However, these outcome-focused approaches neglect crucial step-by-step supervision of the reasoning process itself. To address this gap, we introduce Probabilistic Process Supervision (P2S), a novel self-supervision framework that provides fine-grained process rewards without requiring a separate reward model or human-annotated reasoning steps. During reinforcement learning, P2S synthesizes and filters a high-quality reference reasoning chain (gold-CoT). The core of our method is to calculate a Path Faithfulness Reward (PFR) for each reasoning step, which is derived from the conditional probability of generating the gold-CoT's suffix, given the model's current reasoning prefix. Crucially, this PFR can be flexibly integrated with any outcome-based reward, directly tackling the reward sparsity problem by providing dense guidance. Extensive experiments on reading comprehension and medical Question Answering benchmarks show that P2S significantly outperforms strong baselines.

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.

Despite their widespread use, the role of reward models in shaping reinforcement learning is poorly understood. Reward models offer a tempting promise: they automatically estimate response quality in the absence of verifiers or human judges. Unlike "verifiable rewards" which typically produce binary scores, reward models typically produce continuous scores, allowing them to be sensitive to fine-grained differences in responses. However, we show this apparent strength is a serious weakness: many popular reward models are oversensitive, assigning different scores to equally good responses. Theoretically, we show that seemingly perfect reward models can be highly oversensitive; empirically, this oversensitivity can lead to bad policies. In place of existing notions of "reward model accuracy," we propose evaluating reward models using distinct measures of "discriminative ability" and "specificity" (the complement of oversensitivity). As a solution, we describe a training-free algorithm that uses Monte Carlo dropout on any neural reward model to produce discrete reward clusters. Theoretically, we prove there exist discretizations that reduce oversensitivity at minimal expense of discriminative ability; empirically we show, in both controlled and natural RL settings, that discretizing rewards leads to less reward hacking and better policies than training on the original rewards.

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

Audio reasoning is essential for machine understanding of the acoustic world. Reinforcement learning with verifiable rewards can elicit such reasoning, yet existing reward designs are complementary in their limitations: outcome-based rewards supervise only the final answer and let the model reach it without attending to the audio, whereas process-based rewards score the reasoning itself but rely on coarse, hand-crafted, and fixed criteria that neither adapt to each question nor stay grounded in the acoustic evidence. Moreover, questions differ in what they demand, with some hinging on perception and others on multi-step reasoning, and any static criterion weakens as the policy improves. Supervising the reasoning process with fine-grained, audio-grounded, and adaptive rewards is therefore crucial, yet challenging since such rewards are impractical to design by hand for every sample. To this end, we introduce AudioRubrics, a reinforcement learning framework that supervises audio reasoning with self-evolving, audio-grounded rubric rewards. AudioRubrics synthesizes per-sample rubrics from the raw waveform and, conditioned on the model's own rollouts, regenerates and reweights criteria per group, supplying a continuous learning signal that keeps targeting the current policy's weaknesses as static criteria saturate. Comprehensive evaluations across three audio reasoning benchmarks reveal that AudioRubrics substantially outperforms a wide range of open-source and training-based baselines. Furthermore, our analysis shows that the gains scale with the capability of the rubric generator and judge, and AudioRubrics converges to a stable reasoning length that avoids both degenerate collapse and unbounded growth. The improvement in audio perception further demonstrates the effectiveness of anchoring supervision in the acoustic evidence. Our project page is available at https://audiorubrics.github.io.

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.

While Reinforcement Learning (RL) has advanced LLM reasoning, applying it to long-context scenarios is hindered by sparsity of outcome rewards. This limitation fails to penalize ungrounded "lucky guesses," leaving the critical process of needle-in-a-haystack evidence retrieval largely unsupervised. To address this, we propose EAPO (Evidence-Augmented Policy Optimization). We first establish the Evidence-Augmented Reasoning paradigm, validating via Tree-Structured Evidence Sampling that precise evidence extraction is the decisive bottleneck for long-context reasoning. Guided by this insight, EAPO introduces a specialized RL algorithm where a reward model computes a Group-Relative Evidence Reward, providing dense process supervision to explicitly improve evidence quality. To sustain accurate supervision throughout training, we further incorporate an Adaptive Reward-Policy Co-Evolution mechanism. This mechanism iteratively refines the reward model using outcome-consistent rollouts, sharpening its discriminative capability to ensure precise process guidance. Comprehensive evaluations across eight benchmarks demonstrate that EAPO significantly enhances long-context reasoning performance compared to SOTA baselines.

Reinforcement learning (RL) has become a standard paradigm for refining large language models (LLMs) beyond pre-training and instruction tuning. A prominent line of work is RL with verifiable rewards (RLVR), which leverages automatically verifiable outcomes (e.g., correctness or executability) to generate reward signals. While efficient, this framework faces two key limitations: First, its binary feedback is too sparse to capture the quality of the reasoning process. Second, its coarse-grained rewards potentially lead to vanishing gradients. Inspired by observations from human learning, we introduce a RL technique that integrates verifiable outcomes with the model's own confidence estimates. This joint design enriches the reward signal, providing finer-grained feedback and implicitly supervising the reasoning process. Experimental results demonstrate that our proposed method enhances RL performance across multiple datasets and reduces token consumption during inference, while incurring negligible additional training cost. Moreover, it can be used as a plug-in module to enhance other state-of-the-art RL methods.

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.

Recent work on reinforcement learning with verifiable rewards (RLVR) has shown that large language models (LLMs) can be substantially improved using outcome-level verification signals, such as unit tests for code or exact-match checks for mathematics. In parallel, process supervision has long been explored as a way to shape the intermediate reasoning behaviour of LLMs, but existing approaches rely on neural judges to score chain-of-thought steps, leaving them vulnerable to opacity, bias, and reward hacking. To address this gap, we introduce Verifiable Process Reward Models (VPRMs), a reinforcement-learning framework in which intermediate reasoning steps are checked by deterministic, rule-based verifiers. We apply VPRMs to risk-of-bias assessment for medical evidence synthesis, a domain where guideline-defined criteria and rule-based decision paths enable programmatic verification of reasoning traces. Across multiple datasets, we find that VPRMs generate reasoning that adheres closely to domain rules and achieve substantially higher coherence between step-level decisions and final labels. Results show that VPRMs achieve up to 20% higher F1 than state-of-the-art models and 6.5% higher than verifiable outcome rewards, with substantial gains in evidence grounding and logical coherence.

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.

Electrocardiography (ECG) offers critical cardiovascular insights, such as identifying arrhythmias and myocardial ischemia, but enabling automated systems to answer complex clinical questions directly from ECG signals (ECG-QA) remains a significant challenge. Current approaches often lack robust multimodal reasoning capabilities or rely on generic architectures ill-suited for the nuances of physiological signals. We introduce Q-Heart, a novel multimodal framework designed to bridge this gap. Q-Heart leverages a powerful, adapted ECG encoder and integrates its representations with textual information via a specialized ECG-aware transformer-based mapping layer. Furthermore, Q-Heart leverages dynamic prompting and retrieval of relevant historical clinical reports to guide tuning the language model toward knowledge-aware ECG reasoning. Extensive evaluations on the benchmark ECG-QA dataset show Q-Heart achieves state-of-the-art performance, outperforming existing methods by a 4% improvement in exact match accuracy. Our work demonstrates the effectiveness of combining domain-specific architectural adaptations with knowledge-augmented LLM instruction tuning for complex physiological ECG analysis, paving the way for more capable and potentially interpretable clinical patient care systems.

Reinforcement learning (RL) tasks are typically framed as Markov Decision Processes (MDPs), assuming that decisions are made at fixed time intervals. However, many applications of great importance, including healthcare, do not satisfy this assumption, yet they are commonly modelled as MDPs after an artificial reshaping of the data. In addition, most healthcare (and similar) problems are offline by nature, allowing for only retrospective studies. To address both challenges, we begin by discussing the Semi-MDP (SMDP) framework, which formally handles actions of variable timings. We next present a formal way to apply SMDP modifications to nearly any given value-based offline RL method. We use this theory to introduce three SMDP-based offline RL algorithms, namely, SDQN, SDDQN, and SBCQ. We then experimentally demonstrate that only these SMDP-based algorithms learn the optimal policy in variable-time environments, whereas their MDP counterparts do not. Finally, we apply our new algorithms to a real-world offline dataset pertaining to warfarin dosing for stroke prevention and demonstrate similar results.

As models increasingly leverage multi-step reasoning strategies to solve complex problems, supervising the logical validity of these intermediate steps has become a critical research challenge. Process reward models address this by providing step-by-step feedback, but current approaches have two major drawbacks: they typically function as classifiers without providing explanations, and their reliance on supervised fine-tuning with static datasets limits generalization. Inspired by recent advances, we reframe stepwise reward modeling from a classification task to a reasoning task itself. We thus propose a generative judge that reasons about the policy model's reasoning steps (i.e., meta-reasons), outputting thinking tokens before delivering a final verdict. Our model, StepWiser, is trained by reinforcement learning using relative outcomes of rollouts. We show it provides (i) better judgment accuracy on intermediate steps than existing methods; (ii) can be used to improve the policy model at training time; and (iii) improves inference-time search.

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.

Where do learning signals come from when there is no ground truth in post-training? We propose turning exploration into supervision through Compute as Teacher (CaT), which converts the model's own exploration at inference-time into reference-free supervision by synthesizing a single reference from a group of parallel rollouts and then optimizing toward it. Concretely, the current policy produces a group of rollouts; a frozen anchor (the initial policy) reconciles omissions and contradictions to estimate a reference, turning extra inference-time compute into a teacher signal. We turn this into rewards in two regimes: (i) verifiable tasks use programmatic equivalence on final answers; (ii) non-verifiable tasks use self-proposed rubrics-binary, auditable criteria scored by an independent LLM judge, with reward given by the fraction satisfied. Unlike selection methods (best-of-N, majority, perplexity, or judge scores), synthesis may disagree with the majority and be correct even when all rollouts are wrong; performance scales with the number of rollouts. As a test-time procedure, CaT improves Gemma 3 4B, Qwen 3 4B, and Llama 3.1 8B (up to +27% on MATH-500; +12% on HealthBench). With reinforcement learning (CaT-RL), we obtain further gains (up to +33% and +30%), with the trained policy surpassing the initial teacher signal.

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.

Reward models (RMs) play a critical role in enhancing the reasoning performance of LLMs. For example, they can provide training signals to finetune LLMs during reinforcement learning (RL) and help select the best answer from multiple candidates during inference. In this paper, we provide a systematic introduction to RMs, along with a comprehensive survey of their applications in LLM reasoning. We first review fundamental concepts of RMs, including their architectures, training methodologies, and evaluation techniques. Then, we explore their key applications: (1) guiding generation and selecting optimal outputs during LLM inference, (2) facilitating data synthesis and iterative self-improvement for LLMs, and (3) providing training signals in RL-based finetuning. Finally, we discuss critical open questions regarding the selection, generalization, evaluation, and enhancement of RMs, based on existing research and our own empirical findings. Our analysis aims to provide actionable insights for the effective deployment and advancement of RMs for LLM reasoning.

Invasive coronary angiography (CAG) is the gold standard for diagnosing coronary artery disease, but interpretation varies substantially among observers. Existing AI systems can improve consistency but lack auditable decision processes and are limited in comprehensive open-ended assessment, undermining clinician trust and clinical adoption readiness. We developed CARDEA, a unified large vision-language model that serves as the inference core of a CAG pipeline. It was trained solely on public datasets and closed-ended tasks in three stages: visual feature alignment, a self-distilled Chain-of-Box (CoB) cold start, and reinforcement learning with verifiable rewards (RLVR) with a CoB reward encouraging bounding-box use in the reasoning trace. We assessed its two study-level diagnoses, dominance classification and complexity assessment, against a dedicated classifier and two interventional cardiologists. Report generation was excluded from training and evaluated zero-shot across stages on an external cohort using vessel-severity macro-F_1. CARDEA trailed the classifier on in-distribution dominance but drew level under domain shift (accuracy, 0.91 [95% confidence interval (CI), 0.86 to 0.95]) and was comparable to the cardiologists on complexity assessment (accuracy, 0.90 [CI, 0.82 to 0.97]). Only RLVR improved zero-shot report generation, raising its vessel-severity macro-F_1 (0.686 [CI, 0.664 to 0.707]) above the untuned base model (0.513) and over twice the always-normal floor (0.312). CARDEA runs an end-to-end CAG pipeline from raw multi-view videos through keyframe selection to study-level diagnosis while exposing auditable spatial evidence behind its conclusions. RLVR on verifiable closed-ended tasks surfaced open-ended reporting ability that supervised imitation did not. Clinical use requires prospective validation against expert cardiologists.

Medical image segmentation is evolving from task-specific models toward generalizable frameworks. Recent research leverages Multi-modal Large Language Models (MLLMs) as autonomous agents, employing reinforcement learning with verifiable reward (RLVR) to orchestrate specialized tools like the Segment Anything Model (SAM). However, these approaches often rely on single-turn, rigid interaction strategies and lack process-level supervision during training, which hinders their ability to fully exploit the dynamic potential of interactive tools and leads to redundant actions. To bridge this gap, we propose MedSAM-Agent, a framework that reformulates interactive segmentation as a multi-step autonomous decision-making process. First, we introduce a hybrid prompting strategy for expert-curated trajectory generation, enabling the model to internalize human-like decision heuristics and adaptive refinement strategies. Furthermore, we develop a two-stage training pipeline that integrates multi-turn, end-to-end outcome verification with a clinical-fidelity process reward design to promote interaction parsimony and decision efficiency. Extensive experiments across 6 medical modalities and 21 datasets demonstrate that MedSAM-Agent achieves state-of-the-art performance, effectively unifying autonomous medical reasoning with robust, iterative optimization. Code is available https://github.com/CUHK-AIM-Group/MedSAM-Agent{here}.

Large reasoning models (LRMs) have recently shown promise in solving complex math problems when optimized with Reinforcement Learning (RL). But conventional approaches rely on outcome-only rewards that provide sparse feedback, resulting in inefficient optimization process. In this work, we investigate the function of process reward models (PRMs) to accelerate the RL training for LRMs. We propose a novel intrinsic signal-driven generative process evaluation mechanism operating at the thought level to address major bottlenecks in RL-based training. Specifically, instead of requiring PRMs to know how to solve problems, our method uses intrinsic signals in solutions to judge stepwise correctness and aggregate contiguous correct/incorrect steps into coherent 'thought' units. This structured, thought-level rewards enable more reliable credit assignment by reducing ambiguity in step segmentation and alleviating reward hacking. We further introduce a capability-adaptive reward mechanism that dynamically balances exploration and exploitation based on the LRM's current proficiency, guiding learning without stifling creative trial-and-error. These innovations are integrated into a new off-policy RL algorithm, TP-GRPO, which extends grouped proximal optimization with process-based rewards and improves training efficiency. Experiments on 1.5B and 7B parameter LRMs demonstrate that our method achieves higher problem-solving accuracy with significantly fewer training samples than outcome-only reward baselines. The results validate that well-structured process rewards can substantially accelerate LRM optimization in math reasoning tasks. Code is available at https://github.com/cs-holder/tp_grpo.

Reinforcement Learning from Verifiable Rewards (RLVR) has emerged as a powerful paradigm for enhancing the complex reasoning capabilities of Large Reasoning Models. However, standard outcome-based supervision suffers from a critical limitation that penalizes trajectories that are largely correct but fail due to several missteps as heavily as completely erroneous ones. This coarse feedback signal causes the model to discard valuable largely correct rollouts, leading to a degradation in rollout diversity that prematurely narrows the exploration space. Process Reward Models have demonstrated efficacy in providing reliable step-wise verification for test-time scaling, naively integrating these signals into RLVR as dense rewards proves ineffective.Prior methods attempt to introduce off-policy guided whole-trajectory replacement that often outside the policy model's distribution, but still fail to utilize the largely correct rollouts generated by the model itself and thus do not effectively mitigate the narrowing of the exploration space. To address these issues, we propose SCOPE (Step-wise Correction for On-Policy Exploration), a novel framework that utilizes Process Reward Models to pinpoint the first erroneous step in suboptimal rollouts and applies fine-grained, step-wise off-policy rectification. By applying precise refinement on partially correct rollout, our method effectively salvages partially correct trajectories and increases diversity score by 13.5%, thereby sustaining a broad exploration space. Extensive experiments demonstrate that our approach establishes new state-of-the-art results, achieving an average accuracy of 46.6% on math reasoning and exhibiting robust generalization with 53.4% accuracy on out-of-distribution reasoning tasks.

Reinforcement learning (RL) has enabled machine learning models to achieve significant advances in many fields. Most recently, RL has empowered frontier language models to solve challenging math, science, and coding problems. However, central to any RL algorithm is the reward function, and reward engineering is a notoriously difficult problem in any domain. In this paper, we propose RENT: Reinforcement Learning via Entropy Minimization -- a fully unsupervised RL method that requires no external reward or ground-truth answers, and instead uses the model's entropy of its underlying distribution as an intrinsic reward. We find that by reinforcing the chains of thought that yield high model confidence on its generated answers, the model improves its reasoning ability. In our experiments, we showcase these improvements on an extensive suite of commonly-used reasoning benchmarks, including GSM8K, MATH500, AMC, AIME, and GPQA, and models of varying sizes from the Qwen, Mistral, and Llama families. The generality of our unsupervised learning method lends itself to applicability in a wide range of domains where external supervision is unavailable.

Process reward models (PRMs) that provide dense, step-level feedback have shown promise for reinforcement learning, yet their adoption remains limited by the need for expensive step-level annotations or ground truth references. We propose SPARK: a three-stage framework where in the first stage a generator model produces diverse solutions and a verifier model evaluates them using parallel scaling (self-consistency) and sequential scaling (meta-critique). In the second stage, we use these verification outputs as synthetic training data to fine-tune generative process reward models, which subsequently serve as reward signals during training. We show that aggregating multiple independent verifications at the step level produces training data for process reward models that surpass ground-truth outcome supervision, achieving 67.5 F1 on ProcessBench (a benchmark for identifying erroneous steps in mathematical reasoning) compared to 66.4 for reference-guided training and 61.9 for GPT-4o. In the final stage, we apply our generative PRM with chain-of-thought verification (PRM-CoT) as the reward model in RL experiments on mathematical reasoning, and introduce format constraints to prevent reward hacking. Using Qwen2.5-Math-7B, we achieve 47.4% average accuracy across six mathematical reasoning benchmarks, outperforming ground-truth-based RLVR (43.9%). Our work enables reference-free RL training that exceeds ground-truth methods, opening new possibilities for domains lacking verifiable answers or accessible ground truth.

Correcting health misinformation in dialogue requires more than producing a factual rebuttal: users differ in what they know, what they believe, and what they need to hear, so an effective intervention often depends on first asking the right clarifying question. Yet existing methods either respond immediately or probe indiscriminately, treating clarification as either unnecessary or always beneficial. We propose Reward-Optimized Probe-and-Respond (RO-PnR), a framework that learns when asking is worth its cost. At each turn, RO-PnR chooses between probing for more information and committing to a final correction, guided by a turn-level reward that weighs the expected gain from probing against its interaction cost. To capture how user heterogeneity affects probing value, we model each simulated user with a latent state along health literacy and belief commitment. Experiments show that RO-PnR achieves the highest cost-adjusted utility across three health-misinformation datasets and three base models, using 30% fewer turns than always-probe baselines.

Large language models (LLMs) have shown promise in performing complex multi-step reasoning, yet they continue to struggle with mathematical reasoning, often making systematic errors. A promising solution is reinforcement learning (RL) guided by reward models, particularly those focusing on process rewards, which score each intermediate step rather than solely evaluating the final outcome. This approach is more effective at guiding policy models towards correct reasoning trajectories. In this work, we propose an entropy-regularized process reward model (ER-PRM) that integrates KL-regularized Markov Decision Processes (MDP) to balance policy optimization with the need to prevent the policy from shifting too far from its initial distribution. We derive a novel reward construction method based on the theoretical results. Our theoretical analysis shows that we could derive the optimal reward model from the initial policy sampling. Our empirical experiments on the MATH and GSM8K benchmarks demonstrate that ER-PRM consistently outperforms existing process reward models, achieving 1% improvement on GSM8K and 2-3% improvement on MATH under best-of-N evaluation, and more than 1% improvement under RLHF. These results highlight the efficacy of entropy-regularization in enhancing LLMs' reasoning capabilities.

Reasoning in large language models is typically trained via supervised fine-tuning (SFT) on expert traces, often framed as knowledge distillation, or reinforcement learning (RL) with outcome-based verifiable rewards. However, SFT focuses on imitation rather than optimisation, while outcome-based RL requires a well-defined reward function. We propose an inverse reinforcement learning (IRL) framework that learns (partially) dense token-level reasoning reward models directly from expert demonstrations. We show that this learned reward serves a dual purpose: (1) as a dense training signal that optimises policies to reason more effectively, outperforming SFT baselines on GSM8K (79\% vs. 56\%) and MedReason (74\% vs. 65\%); and (2) as an inference-time assistant that improves performance via reward-guided reranking, yielding gains of up to 12 percentage points on Llama3 architectures. Furthermore, our dense rewards provide interpretable, step-wise diagnostics that can indicate the location of logical errors. This work proposes a process-level reasoning learning framework from data, bridging the gap between imitation and reinforcement learning for reasoning.

We show that reinforcement learning with verifiable rewards (RLVR) can elicit strong mathematical reasoning in certain models even with spurious rewards that have little, no, or even negative correlation with the correct answer. For example, RLVR improves MATH-500 performance for Qwen2.5-Math-7B in absolute points by 21.4% (random reward), 13.8% (format reward), 24.1% (incorrect label), 26.0% (1-shot RL), and 27.1% (majority voting) -- nearly matching the 29.1% gained with ground truth rewards. However, the spurious rewards that work for Qwen often fail to yield gains with other model families like Llama3 or OLMo2. In particular, we find code reasoning -- thinking in code without actual code execution -- to be a distinctive Qwen2.5-Math behavior that becomes significantly more frequent after RLVR, from 65% to over 90%, even with spurious rewards. Overall, we hypothesize that, given the lack of useful reward signal, RLVR must somehow be surfacing useful reasoning representations learned during pretraining, although the exact mechanism remains a topic for future work. We suggest that future RLVR research should possibly be validated on diverse models rather than a single de facto choice, as we show that it is easy to get significant performance gains on Qwen models even with completely spurious reward signals.

Developing 3D vision-language models with robust clinical reasoning remains a challenge due to the inherent complexity of volumetric medical imaging, the tendency of models to overfit superficial report patterns, and the lack of interpretability-aware reward designs. In this paper, we propose Med3D-R1, a reinforcement learning framework with a two-stage training process: Supervised Fine-Tuning (SFT) and Reinforcement Learning (RL). During SFT stage, we introduce a residual alignment mechanism to bridge the gap between high-dimensional 3D features and textual embeddings, and an abnormality re-weighting strategy to emphasize clinically informative tokens and reduce structural bias in reports. In RL stage, we redesign the consistency reward to explicitly promote coherent, step-by-step diagnostic reasoning. We evaluate our method on medical multiple-choice visual question answering using two 3D diagnostic benchmarks, CT-RATE and RAD-ChestCT, where our model attains state-of-the-art accuracies of 41.92\% on CT-RATE and 44.99\% on RAD-ChestCT. These results indicate improved abnormality diagnosis and clinical reasoning and outperform prior methods on both benchmarks. Overall, our approach holds promise for enhancing real-world diagnostic workflows by enabling more reliable and transparent 3D medical vision-language systems.

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.

Process reward models enable fine-grained, step-level evaluation of LLMs, yet building them for agentic settings remains prohibitively difficult: long-horizon interactions, irreversible actions, and stochastic environment feedback make both human annotation and Monte Carlo estimation infeasible at scale. In this work, we show that reinforcement learning (RL) post-training already provides the ingredients for effective step-level scoring, eliminating the need for dedicated reward model training altogether. Concretely, we derive an implicit advantage under a general stochastic Markov decision process, which we term progress advantage -- log-probability ratio between the RL-trained policy and its reference policy exactly recovers the optimal advantage function. This formulation makes the resulting signal annotation-free, domain-agnostic, and available as a byproduct of the standard RL post-training pipeline. We validate the effectiveness of the progress advantage across three different applications: test-time scaling, uncertainty quantification, and failure attribution on five benchmarks and four model families. Across all settings, it consistently outperforms confidence-based baselines and, despite requiring no task-specific training, surpasses dedicated trained reward models. We complement these results with deeper analyses on characteristics of progress advantage, offering practical guidance for adoption in real-world agentic systems.

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.

Reasoning in knowledge-intensive domains remains challenging as intermediate steps are often not locally verifiable: unlike math or code, evaluating step correctness may require synthesizing clues across large external knowledge sources. As a result, subtle errors can propagate through reasoning traces, potentially never to be detected. Prior work has proposed process reward models (PRMs), including retrieval-augmented variants, but these methods operate post hoc, scoring completed trajectories, which prevents their integration into dynamic inference procedures. Here, we introduce Process Reward Agents (PRA), a test-time method for providing domain-grounded, online, step-wise rewards to a frozen policy. In contrast to prior retrieval-augmented PRMs, PRA enables search-based decoding to rank and prune candidate trajectories at every generation step. Experiments on multiple medical reasoning benchmarks demonstrate that PRA consistently outperforms strong baselines, achieving 80.8% accuracy on MedQA with Qwen3-4B, a new state of the art at the 4B scale. Importantly, PRA generalizes to unseen frozen policy models ranging from 0.5B to 8B parameters, improving their accuracy by up to 25.7% without any policy model updates. More broadly, PRA suggests a paradigm in which frozen reasoners are decoupled from domain-specific reward modules, allowing the deployment of new backbones in complex domains without retraining.

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.

While recent advances have boosted LM proficiency in linguistic benchmarks, LMs consistently struggle to reason correctly on complex tasks like mathematics. We turn to Reinforcement Learning from Human Feedback (RLHF) as a method with which to shape model reasoning processes. In particular, we explore two reward schemes, outcome-supervised reward models (ORMs) and process-supervised reward models (PRMs), to optimize for logical reasoning. Our results show that the fine-grained reward provided by PRM-based methods enhances accuracy on simple mathematical reasoning (GSM8K) while, unexpectedly, reducing performance in complex tasks (MATH). Furthermore, we show the critical role reward aggregation functions play in model performance. Providing promising avenues for future research, our study underscores the need for further exploration into fine-grained reward modeling for more reliable language models.

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

Specifying rewards for reinforcement learned (RL) agents is challenging. Preference-based RL (PbRL) mitigates these challenges by inferring a reward from feedback over sets of trajectories. However, the effectiveness of PbRL is limited by the amount of feedback needed to reliably recover the structure of the target reward. We present the PRIor Over Rewards (PRIOR) framework, which incorporates priors about the structure of the reward function and the preference feedback into the reward learning process. Imposing these priors as soft constraints on the reward learning objective reduces the amount of feedback required by half and improves overall reward recovery. Additionally, we demonstrate that using an abstract state space for the computation of the priors further improves the reward learning and the agent's performance.

Exploration in sparse reward environments remains one of the key challenges of model-free reinforcement learning. Instead of solely relying on extrinsic rewards provided by the environment, many state-of-the-art methods use intrinsic rewards to encourage exploration. However, we show that existing methods fall short in procedurally-generated environments where an agent is unlikely to visit a state more than once. We propose a novel type of intrinsic reward which encourages the agent to take actions that lead to significant changes in its learned state representation. We evaluate our method on multiple challenging procedurally-generated tasks in MiniGrid, as well as on tasks with high-dimensional observations used in prior work. Our experiments demonstrate that this approach is more sample efficient than existing exploration methods, particularly for procedurally-generated MiniGrid environments. Furthermore, we analyze the learned behavior as well as the intrinsic reward received by our agent. In contrast to previous approaches, our intrinsic reward does not diminish during the course of training and it rewards the agent substantially more for interacting with objects that it can control.

We introduce MediX-R1, an open-ended Reinforcement Learning (RL) framework for medical multimodal large language models (MLLMs) that enables clinically grounded, free-form answers beyond multiple-choice formats. MediX-R1 fine-tunes a baseline vision-language backbone with Group Based RL and a composite reward tailored for medical reasoning: an LLM-based accuracy reward that judges semantic correctness with a strict YES/NO decision, a medical embedding-based semantic reward to capture paraphrases and terminology variants, and lightweight format and modality rewards that enforce interpretable reasoning and modality recognition. This multi-signal design provides stable, informative feedback for open-ended outputs where traditional verifiable or MCQ-only rewards fall short. To measure progress, we propose a unified evaluation framework for both text-only and image+text tasks that uses a Reference-based LLM-as-judge in place of brittle string-overlap metrics, capturing semantic correctness, reasoning, and contextual alignment. Despite using only sim51K instruction examples, MediX-R1 achieves excellent results across standard medical LLM (text-only) and VLM (image + text) benchmarks, outperforming strong open-source baselines and delivering particularly large gains on open-ended clinical tasks. Our results demonstrate that open-ended RL with comprehensive reward signals and LLM-based evaluation is a practical path toward reliable medical reasoning in multimodal models. Our trained models, curated datasets and source code are available at https://medix.cvmbzuai.com

Graphical User Interface (GUI) agents have emerged as a promising paradigm for intelligent systems that perceive and interact with graphical interfaces visually. Yet supervised fine-tuning alone cannot handle long-horizon credit assignment, distribution shifts, and safe exploration in irreversible environments, making Reinforcement Learning (RL) a central methodology for advancing automation. In this work, we present the first comprehensive overview of the intersection between RL and GUI agents, and examine how this research direction may evolve toward digital inhabitants. We propose a principled taxonomy that organizes existing methods into Offline RL, Online RL, and Hybrid Strategies, and complement it with analyses of reward engineering, data efficiency, and key technical innovations. Our analysis reveals several emerging trends: the tension between reliability and scalability is motivating the adoption of composite, multi-tier reward architectures; GUI I/O latency bottlenecks are accelerating the shift toward world-model-based training, which can yield substantial performance gains; and the spontaneous emergence of System-2-style deliberation suggests that explicit reasoning supervision may not be necessary when sufficiently rich reward signals are available. We distill these findings into a roadmap covering process rewards, continual RL, cognitive architectures, and safe deployment, aiming to guide the next generation of robust GUI automation and its agent-native infrastructure.

Reinforcement Learning with Verifiable reward (RLVR) on preference data has become the mainstream approach for training Generative Reward Models (GRMs). Typically in pairwise rewarding tasks, GRMs generate reasoning chains ending with critiques and preference labels, and RLVR then relies on the correctness of the preference labels as the training reward. However, in this paper, we demonstrate that such binary classification tasks make GRMs susceptible to guessing correct outcomes without sound critiques. Consequently, these spurious successes introduce substantial noise into the reward signal, thereby impairing the effectiveness of reinforcement learning. To address this issue, we propose Reward Modeling from Natural Language Human Feedback (RM-NLHF), which leverages natural language feedback to obtain process reward signals, thereby mitigating the problem of limited solution space inherent in binary tasks. Specifically, we compute the similarity between GRM-generated and human critiques as the training reward, which provides more accurate reward signals than outcome-only supervision. Additionally, considering that human critiques are difficult to scale up, we introduce Meta Reward Model (MetaRM) which learns to predict process reward from datasets with human critiques and then generalizes to data without human critiques. Experiments on multiple benchmarks demonstrate that our method consistently outperforms state-of-the-art GRMs trained with outcome-only reward, confirming the superiority of integrating natural language over binary human feedback as supervision.

Reinforcement Learning with Verifiable Rewards (RLVR) demonstrates promising potential in advancing the reasoning capabilities of LLMs. However, its success remains largely confined to mathematical and code domains. This primary limitation stems from the heavy reliance on domain-specific verifiers, which results in prohibitive complexity and limited scalability. To address the challenge, our key observation is that LLM's intrinsic probability of generating a correct free-form answer directly indicates its own evaluation of the reasoning reward (i.e., how well the reasoning process leads to the correct answer). Building on this insight, we propose RLPR, a simple verifier-free framework that extrapolates RLVR to broader general domains. RLPR uses the LLM's own token probability scores for reference answers as the reward signal and maximizes the expected reward during training. We find that addressing the high variance of this noisy probability reward is crucial to make it work, and propose prob-to-reward and stabilizing methods to ensure a precise and stable reward from LLM intrinsic probabilities. Comprehensive experiments in four general-domain benchmarks and three mathematical benchmarks show that RLPR consistently improves reasoning capabilities in both areas for Gemma, Llama, and Qwen based models. Notably, RLPR outperforms concurrent VeriFree by 7.6 points on TheoremQA and 7.5 points on Minerva, and even surpasses strong verifier-model-dependent approaches General-Reasoner by 1.6 average points across seven benchmarks.

This paper proposes a novel reinforcement learning (RL) framework for credit underwriting that tackles ungeneralizable contextual challenges. We adapt RL principles for credit scoring, incorporating action space renewal and multi-choice actions. Our work demonstrates that the traditional underwriting approach aligns with the RL greedy strategy. We introduce two new RL-based credit underwriting algorithms to enable more informed decision-making. Simulations show these new approaches outperform the traditional method in scenarios where the data aligns with the model. However, complex situations highlight model limitations, emphasizing the importance of powerful machine learning models for optimal performance. Future research directions include exploring more sophisticated models alongside efficient exploration mechanisms.

Reward models (RMs) provide critical feedback signals for LLM post-training, notably in reinforced fine-tuning (RFT) and reinforcement learning (RL) pipelines. However, current reward evaluation relies on heterogeneous criteria such as rule-based verifiers, ground-truth references, procedural checklists, and complex rubrics, where a unified mechanism to integrate all types of evidence remains unexplored. To this end, we propose Skill Reward Model (Skill-RM), a unified framework that reformulates reward modeling as the execution of a reusable Reward-Evaluation Skill. By treating reward computation as a structured agentic task, Skill-RM provides a consistent interface to orchestrate heterogeneous resources, dynamically selecting and aggregating evidence tailored to the specific requirements of each input. This approach enables the reward model to move beyond static evaluation, ensuring consistency and transparency across diverse tasks. Extensive experiments on reward benchmarks and downstream applications, including best-of-N selection and reinforcement learning, demonstrate that Skill-RM consistently outperforms traditional judge baselines. Our findings suggest that Skill-RM not only provides a unified solution for reward modeling but also achieves superior performance through the strategic and dynamic orchestration of evidence. The code is at https://github.com/Qwen-Applications/Skill-RM.

Enabling human stakeholders to specify reward functions that lead to their desired outcomes is a key challenge in deploying reinforcement learning agents. Preference-based methods such as online RLHF can reduce the burden of manual reward design, but they require repeatedly training policies, sampling trajectories from the real world, and eliciting feedback, making them impractical in settings where environment interaction is computationally expensive or unsafe. We introduce Experience-Free Autonomous Reward Specification (EARS), a method for learning reward functions from preferences without environment interaction. Our approach uses a structured LLM-mediated process to construct a small set of expressive reward features from a task description and the environment observation space, then strategically samples imagined trajectories in this feature space and learns feature weights from preferences over the imagined trajectory pairs. We evaluate on three long-horizon domains: pandemic lockdown regulation design, insulin administration for diabetes patients, and autonomous vehicle control on a highway. We compare EARS to baselines that also enable reward specification without environment interaction--namely, methods that directly prompt an LLM to generate a reward function. When learning from either ground-truth preference labels or preferences labeled by a LLM, EARS designs reward functions that are more aligned with the ground truth reward function that produced the preferences or LLM context than these baselines. These results suggest that preference-based reward specification remains effective without environment sampling, enabling practical reward design in settings where collecting real trajectories is costly or infeasible.

Reinforcement Learning (RL) has emerged as a mainstream paradigm for training Mobile GUI Agents, yet it struggles with the temporal credit assignment problem inherent in long-horizon tasks. A primary challenge lies in the trade-off between reward fidelity and density: outcome reward offers high fidelity but suffers from signal sparsity, while process reward provides dense supervision but remains prone to bias and reward hacking. To resolve this conflict, we propose the Adaptive Milestone Reward (ADMIRE) mechanism. ADMIRE constructs a verifiable, adaptive reward system by anchoring trajectory to milestones, which are dynamically distilled from successful explorations. Crucially, ADMIRE integrates an asymmetric credit assignment strategy that denoises successful trajectories and scaffolds failed trajectories. Extensive experiments demonstrate that ADMIRE consistently yields over 10% absolute improvement in success rate across different base models on AndroidWorld. Moreover, the method exhibits robust generalizability, achieving strong performance across diverse RL algorithms and heterogeneous environments such as web navigation and embodied tasks.

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

Large language models (LLMs) show strong capabilities in general reasoning but typically lack reliability in scientific domains like quantum mechanics, which demand strict adherence to physical constraints. This limitation arises from the scarcity of verifiable training resources and the inadequacy of coarse feedback signals in standard alignment paradigms. To address the data challenge, we introduce QuantumQA, a large-scale dataset constructed via a task-adaptive strategy and a hybrid verification protocol that combines deterministic solvers with semantic auditing to guarantee scientific rigor. Building on this foundation, we propose the verification-aware reward model (VRM) tailored for Reinforcement Learning with Verifiable Rewards (RLVR), which employs an adaptive reward fusion (ARF) mechanism to dynamically integrate deterministic signals from a scientific execution suite (SES) with multidimensional semantic evaluations for precise supervision. Experimental results demonstrate that our method consistently outperforms baselines and general-purpose preference models. Notably, our optimized 8B model achieves performance competitive with proprietary models, validating that incorporating verifiable, rule-based feedback into the reinforcement learning loop offers a parameter-efficient alternative to pure scaling.

In the Reinforcement Learning (RL) framework, the learning is guided through a reward signal. This means that in situations of sparse rewards the agent has to focus on exploration, in order to discover which action, or set of actions leads to the reward. RL agents usually struggle with this. Exploration is the focus of Quality-Diversity (QD) methods. In this thesis, we approach the problem of sparse rewards with these algorithms, and in particular with Novelty Search (NS). This is a method that only focuses on the diversity of the possible policies behaviors. The first part of the thesis focuses on learning a representation of the space in which the diversity of the policies is evaluated. In this regard, we propose the TAXONS algorithm, a method that learns a low-dimensional representation of the search space through an AutoEncoder. While effective, TAXONS still requires information on when to capture the observation used to learn said space. For this, we study multiple ways, and in particular the signature transform, to encode information about the whole trajectory of observations. The thesis continues with the introduction of the SERENE algorithm, a method that can efficiently focus on the interesting parts of the search space. This method separates the exploration of the search space from the exploitation of the reward through a two-alternating-steps approach. The exploration is performed through NS. Any discovered reward is then locally exploited through emitters. The third and final contribution combines TAXONS and SERENE into a single approach: STAX. Throughout this thesis, we introduce methods that lower the amount of prior information needed in sparse rewards settings. These contributions are a promising step towards the development of methods that can autonomously explore and find high-performance policies in a variety of sparse rewards settings.

We present an approach called Q-probing to adapt a pre-trained language model to maximize a task-specific reward function. At a high level, Q-probing sits between heavier approaches such as finetuning and lighter approaches such as few shot prompting, but can also be combined with either. The idea is to learn a simple linear function on a model's embedding space that can be used to reweight candidate completions. We theoretically show that this sampling procedure is equivalent to a KL-constrained maximization of the Q-probe as the number of samples increases. To train the Q-probes we consider either reward modeling or a class of novel direct policy learning objectives based on importance weighted policy gradients. With this technique, we see gains in domains with ground-truth rewards (code generation) as well as implicit rewards defined by preference data, even outperforming finetuning in data-limited regimes. Moreover, a Q-probe can be trained on top of an API since it only assumes access to sampling and embeddings. Code: https://github.com/likenneth/q_probe .

As autonomous agents become adept at understanding and interacting with graphical user interface (GUI) environments, a new era of automated task execution is emerging. Recent studies have demonstrated that Reinforcement Learning (RL) can effectively enhance agents' performance in dynamic interactive GUI environments. However, these methods face two key limitations: (1) they overlook the significant variation in difficulty across different GUI tasks by treating the entire training data as a uniform set, which hampers the agent's ability to adapt its learning process; and (2) most approaches collapse task-specific nuances into a single, coarse reward, leaving the agent with a uniform signal that yields inefficient policy updates. To address these limitations, we propose CRAFT-GUI, a curriculum learning framework based on Group Relative Policy Optimization (GRPO) that explicitly accounts for the varying difficulty across trajectories. To enable more fine-grained policy optimization, we design a reward function that combines simple rule-based signals with model-judged evaluation, providing richer and more nuanced feedback during training. Experimental results demonstrate that our method achieves significant improvements over previous state-of-the-art approaches, outperforming them by 5.6% on public benchmarks Android Control and 10.3% on our internal online benchmarks, respectively. These findings empirically validate the effectiveness of integrating reinforcement learning with curriculum learning in GUI interaction tasks.

Reinforcement learning is the method of choice to train models in sampling-based setups with binary outcome feedback, such as navigation, code generation, and mathematical problem solving. In such settings, models implicitly induce a likelihood over correct rollouts. However, we observe that reinforcement learning does not maximize this likelihood, and instead optimizes only a lower-order approximation. Inspired by this observation, we introduce Maximum Likelihood Reinforcement Learning (MaxRL), a sampling-based framework to approximate maximum likelihood using reinforcement learning techniques. MaxRL addresses the challenges of non-differentiable sampling by defining a compute-indexed family of sample-based objectives that interpolate between standard reinforcement learning and exact maximum likelihood as additional sampling compute is allocated. The resulting objectives admit a simple, unbiased policy-gradient estimator and converge to maximum likelihood optimization in the infinite-compute limit. Empirically, we show that MaxRL Pareto-dominates existing methods in all models and tasks we tested, achieving up to 20x test-time scaling efficiency gains compared to its GRPO-trained counterpart. We also observe MaxRL to scale better with additional data and compute. Our results suggest MaxRL is a promising framework for scaling RL training in correctness based settings.

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.

Reinforcement learning with verifiable rewards (RLVR) succeeds in reasoning tasks (e.g., math and code) by checking the final verifiable answer (i.e., a verifiable dot signal). However, extending this paradigm to open-ended generation is challenging because there is no unambiguous ground truth. Relying on single-dot supervision often leads to inefficiency and reward hacking. To address these issues, we propose reinforcement learning with verifiable reference-based rewards (RLVRR). Instead of checking the final answer, RLVRR extracts an ordered linguistic signal from high-quality references (i.e, reward chain). Specifically, RLVRR decomposes rewards into two dimensions: content, which preserves deterministic core concepts (e.g., keywords), and style, which evaluates adherence to stylistic properties through LLM-based verification. In this way, RLVRR combines the exploratory strength of RL with the efficiency and reliability of supervised fine-tuning (SFT). Extensive experiments on more than 10 benchmarks with Qwen and Llama models confirm the advantages of our approach. RLVRR (1) substantially outperforms SFT trained with ten times more data and advanced reward models, (2) unifies the training of structured reasoning and open-ended generation, and (3) generalizes more effectively while preserving output diversity. These results establish RLVRR as a principled and efficient path toward verifiable reinforcement learning for general-purpose LLM alignment. We release our code and data at https://github.com/YJiangcm/RLVRR.

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.

Conventional reinforcement learning strategies for visual generation typically employ sample-wise reward functions, yet this practice frequently results in reward hacking that degrades image diversity and introduces visual anomalies. To address these limitations, we present a novel framework that finetunes generative models using distribution-wise rewards, ensuring better alignment with real-world data distributions. Unlike rewards that evaluate samples individually, distribution-wise reward accounts for the data distribution of the samples, mitigating the mode collapse problem that occurs when all samples optimize towards the same direction independently. To overcome the prohibitive computational cost of estimating these rewards, we introduce a subset-replace strategy that efficiently provides reward signals by updating only a small subset of a generated reference set. Additionally, we apply RL to optimize post-hoc model merging coefficients, potentially mitigating the train-inference inconsistency caused by introducing stochastic differential equation (SDE) in regular RL practices. Extensive experiments show our approach significantly improves FID-50K across various base models, from 8.30 to 5.77 for SiT and from 3.74 to 3.52 for EDM2. Qualitative evaluation also confirms that our method enhances perceptual quality while preserving sample diversity.

The development of autonomous agents for complex, long-horizon tasks is a central goal in AI. However, dominant training paradigms face a critical limitation: reinforcement learning (RL) methods that optimize solely for final task success often reinforce flawed or inefficient reasoning paths, a problem we term inefficient exploration. This leads to agents that are brittle and fail to generalize, as they learn to find solutions without learning how to reason coherently. To address this, we introduce RLVMR, a novel framework that integrates dense, process-level supervision into end-to-end RL by rewarding verifiable, meta-reasoning behaviors. RLVMR equips an agent to explicitly tag its cognitive steps, such as planning, exploration, and reflection, and provides programmatic, rule-based rewards for actions that contribute to effective problem-solving. These process-centric rewards are combined with the final outcome signal and optimized using a critic-free policy gradient method. On the challenging ALFWorld and ScienceWorld benchmarks, RLVMR achieves new state-of-the-art results, with our 7B model reaching an 83.6% success rate on the most difficult unseen task split. Our analysis confirms these gains stem from improved reasoning quality, including significant reductions in redundant actions and enhanced error recovery, leading to more robust, efficient, and interpretable agents.

Reinforcement learning with verifiable rewards (RLVR) has emerged to be a predominant paradigm for mathematical reasoning tasks, offering stable improvements in reasoning ability. However, Outcome Reward Models (ORMs) in RLVR are too coarse-grained to distinguish flawed reasoning within correct answers or valid reasoning within incorrect answers. This lack of granularity introduces noisy and misleading gradients significantly and hinders further progress in reasoning process quality. While Process Reward Models (PRMs) offer fine-grained guidance for intermediate steps, they frequently suffer from inaccuracies and are susceptible to reward hacking. To resolve this dilemma, we introduce PRocess cOnsistency Filter (PROF), an effective data process curation method that harmonizes noisy, fine-grained process rewards with accurate, coarse-grained outcome rewards. Rather than naively blending PRM and ORM in the objective function (arXiv:archive/2506.18896), PROF leverages their complementary strengths through consistency-driven sample selection. Our approach retains correct responses with higher averaged process values and incorrect responses with lower averaged process values, while maintaining positive/negative training sample balance. Extensive experiments demonstrate that our method not only consistently improves the final accuracy over 4% compared to the blending approaches, but also strengthens the quality of intermediate reasoning steps. Codes and training recipes are available at https://github.com/Chenluye99/PROF.

Recent Large Language Models (LLMs) and Large Vision-Language Models (LVLMs) increasingly use Reinforcement Learning (RL) for post-pretraining, such as RL with Verifiable Rewards (RLVR) for objective tasks and RL from Human Feedback (RLHF) for subjective tasks. However, RLHF incurs high costs and potential reward-policy mismatch due to reliance on human preferences, while RLVR still wastes supervision by discarding rollouts and correctness signals after each update. To address these challenges, we introduce the Synergistic Policy And Reward Co-Evolving Framework (SPARK), an efficient, on-policy, and stable method that builds on RLVR. Instead of discarding rollouts and correctness data, SPARK recycles this valuable information to simultaneously train the model itself as a generative reward model. This auxiliary training uses a mix of objectives, such as pointwise reward score, pairwise comparison, and evaluation conditioned on further-reflection responses, to teach the model to evaluate and improve its own responses. Our process eliminates the need for a separate reward model and costly human preference data. SPARK creates a positive co-evolving feedback loop: improved reward accuracy yields better policy gradients, which in turn produce higher-quality rollouts that further refine the reward model. Our unified framework supports test-time scaling via self-reflection without external reward models and their associated costs. We show that SPARK achieves significant performance gains on multiple LLM and LVLM models and multiple reasoning, reward models, and general benchmarks. For example, SPARK-VL-7B achieves an average 9.7% gain on 7 reasoning benchmarks, 12.1% on 2 reward benchmarks, and 1.5% on 8 general benchmarks over the baselines, demonstrating robustness and broad generalization.

In reinforcement learning (RL), an agent learns to perform a task by interacting with an environment and receiving feedback (a numerical reward) for its actions. However, the assumption that rewards are always observable is often not applicable in real-world problems. For example, the agent may need to ask a human to supervise its actions or activate a monitoring system to receive feedback. There may even be a period of time before rewards become observable, or a period of time after which rewards are no longer given. In other words, there are cases where the environment generates rewards in response to the agent's actions but the agent cannot observe them. In this paper, we formalize a novel but general RL framework - Monitored MDPs - where the agent cannot always observe rewards. We discuss the theoretical and practical consequences of this setting, show challenges raised even in toy environments, and propose algorithms to begin to tackle this novel setting. This paper introduces a powerful new formalism that encompasses both new and existing problems and lays the foundation for future research.

Existing automatic 3D image segmentation methods usually fail to meet the clinic use. Many studies have explored an interactive strategy to improve the image segmentation performance by iteratively incorporating user hints. However, the dynamic process for successive interactions is largely ignored. We here propose to model the dynamic process of iterative interactive image segmentation as a Markov decision process (MDP) and solve it with reinforcement learning (RL). Unfortunately, it is intractable to use single-agent RL for voxel-wise prediction due to the large exploration space. To reduce the exploration space to a tractable size, we treat each voxel as an agent with a shared voxel-level behavior strategy so that it can be solved with multi-agent reinforcement learning. An additional advantage of this multi-agent model is to capture the dependency among voxels for segmentation task. Meanwhile, to enrich the information of previous segmentations, we reserve the prediction uncertainty in the state space of MDP and derive an adjustment action space leading to a more precise and finer segmentation. In addition, to improve the efficiency of exploration, we design a relative cross-entropy gain-based reward to update the policy in a constrained direction. Experimental results on various medical datasets have shown that our method significantly outperforms existing state-of-the-art methods, with the advantage of fewer interactions and a faster convergence.

Reinforcement Learning with Verifiable Rewards (RLVR) has recently emerged as a promising framework for improving reasoning abilities in Large Language Models (LLMs). However, policy optimized with binary verification prone to overlook potential valuable exploration in reasoning trajectory. In view of heavy annotation cost of golden Process Reward Models (PRMs), recent works attempt using auxiliary signals for reward shaping of process tokens, involving entropy and likelihood collected from logit space. In this work, we offer a novel perspective on shaping RLVR with flow rewards derived from latent space, and propose RLFR, where the flow fields of model latents are constructed from either off-policy high-quality data and on-policy rejection sampling data, and the velocity deviations of policy latents within it are quantified to serve as a reward signal. RLFR first demonstrates that a well-established flow field can be a sound environment for reward signal collection, highlighting the expressive latent space is much underexplored. Moreover, RLFR is able to compress any off-policy expert data as reference for constituting reward signals, and we show that the efficient context dependence compressed within the hidden states are utilized, rather than individual token-level denotation for context comprehending. Experiments on both language and multimodal reasoning benchmarks demonstrate the reliability of flow rewards, and suggesting a promising paradigm for reward shaping with auxiliary signals.

Reinforcement Learning with Verifiable Rewards (RLVR) is a powerful paradigm for enhancing the reasoning ability of Large Language Models (LLMs). Yet current RLVR methods often explore poorly, leading to premature convergence and entropy collapse. To address this challenge, we introduce Curiosity-Driven Exploration (CDE), a framework that leverages the model's own intrinsic sense of curiosity to guide exploration. We formalize curiosity with signals from both the actor and the critic: for the actor, we use perplexity over its generated response, and for the critic, we use the variance of value estimates from a multi-head architecture. Both signals serve as an exploration bonus within the RLVR framework to guide the model. Our theoretical analysis shows that the actor-wise bonus inherently penalizes overconfident errors and promotes diversity among correct responses; moreover, we connect the critic-wise bonus to the well-established count-based exploration bonus in RL. Empirically, our method achieves an approximate +3 point improvement over standard RLVR using GRPO/PPO on AIME benchmarks. Further analysis identifies a calibration collapse mechanism within RLVR, shedding light on common LLM failure modes.

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.

Agentic Reinforcement Learning (Agentic RL) has achieved notable success in enabling agents to perform complex reasoning and tool use. However, most methods still relies on sparse outcome-based reward for training. Such feedback fails to differentiate intermediate reasoning quality, leading to suboptimal training results. In this paper, we introduce Agent Reasoning Reward Model (Agent-RRM), a multi-faceted reward model that produces structured feedback for agentic trajectories, including (1) an explicit reasoning trace , (2) a focused critique that provides refinement guidance by highlighting reasoning flaws, and (3) an overall score that evaluates process performance. Leveraging these signals, we systematically investigate three integration strategies: Reagent-C (text-augmented refinement), Reagent-R (reward-augmented guidance), and Reagent-U (unified feedback integration). Extensive evaluations across 12 diverse benchmarks demonstrate that Reagent-U yields substantial performance leaps, achieving 43.7% on GAIA and 46.2% on WebWalkerQA, validating the effectiveness of our reasoning reward model and training schemes. Code, models, and datasets are all released to facilitate future research.

Reinforcement learning from verifiable rewards (RLVR) has improved the reasoning abilities of large language models (LLMs), but most existing approaches rely on sparse outcome-level feedback. This sparsity creates a credit assignment challenge in long-horizon agentic reasoning: a trajectory may fail despite containing many correct intermediate decisions, or succeed despite containing flawed ones. In this work, we study a class of densely-verifiable agentic reasoning problems, where intermediate actions can be objectively checked by symbolic or algorithmic oracles. We propose Verifiable Process Rewards (VPR), a framework that converts such oracles into dense turn-level supervision for reinforcement learning, and instantiate it in three representative settings: search-based verification for dynamic deduction, constraint-based verification for logical reasoning, and posterior-based verification for probabilistic inference. We further provide a theoretical analysis showing that dense verifier-grounded rewards can improve long-horizon credit assignment by providing more localized learning signals, with the benefit depending on the reliability of the verifier. Empirically, VPR outperforms outcome-level reward and rollout-based process reward baselines across controlled environments, and more importantly, transfers to both general and agentic reasoning benchmarks, suggesting that verifiable process supervision can foster general reasoning skills applicable beyond the training environments. Our results indicate that VPR is a promising approach for enhancing LLM agents whenever reliable intermediate verification is available, while also highlighting its dependence on oracle quality and the open challenge of extending VPR to less structured, open-ended environments.

Recent advances in large reasoning models (LRMs) have shown that reinforcement learning with verifiable rewards (RLVR) can substantially improve reasoning in mathematics and code, where outcomes can be checked automatically. Extending this progress to open-ended and agentic tasks remains difficult because reliable rewards are harder to obtain and direct human supervision cannot keep pace with the scale and complexity of model-generated experience. This paper studies how LRMs can continue to improve as human supervision gradually recedes from the learning loop. We examine two connected dimensions of this problem. The reward axis traces the development from per-instance human judgments to reusable verifiers and rewards that operate even without human feedback. The experience axis examines how learning can progress from human-curated tasks and environments toward self-generated curricula, constructed environments, and autonomous co-evolution. We connect these dimensions through a five-level ladder from L0 to L4 that identifies which parts of the learning process remain under continued human control. Our analysis further highlights the risks introduced by increasingly autonomous rewards and experience generation, including reward hacking, feedback drift, curriculum collapse, and environment errors. Consequently, we also provide the evaluation around three complementary objects: policy capability, feedback fidelity, and experience quality. This analysis provides a structured account of current approaches to scaling LRMs beyond human supervision and the open problems involved in developing self-sustaining learning systems toward superintelligence. Furthermore, we maintain a continuously updated https://github.com/visitworld123/Awesome-Scaling-LRM-Beyond-Human-Supervision{GitHub repository} to track the latest advances.

Reinforcement learning with verifiable rewards has rapidly advanced reasoning in vision--language models. However, for chest X-ray report generation, the standard rewards (i.e. exact-match accuracy and step-level processes) are incompatible because the reports consist of unordered and orthogonal findings, rather than a causal reasoning chain. We address this gap with a set-based view: each report is split into sentences and embedded by a frozen sentence transformer, yielding unordered embedding sets. We propose the use of set-to-set distances between generated and reference embeddings as continuous, permutation-invariant rewards. Across two datasets and three vision--language models (Qwen3-VL-2B/4B, Gemma3-4B), post-training with set-to-set distance based rewards via GRPO consistently outperforms supervised fine-tuning and exact-match GRPO on all headline metrics (BERTScore, RadGraph F1 and CheXbert F1 by average \%6.80, \%7.82 and \%4.45 relative improvements respectively). The same set distances also enable test-time best-of-N selection: scoring candidates by their distance to training-report embeddings outperforms random selection on our trained models as well as three closed-source LLMs (Mistral-Small, Gemini-2.5 Flash-Lite, GPT-4o-mini) with on average \%16.4 relative improvement on BERTScore. Used as a streaming signal, they support a more efficient form of test-time scaling: pruning low-scoring candidates mid-generation reduces generated tokens by over 50\% while preserving the Findings quality of full best-of-N selection. Together these results establish set-distance rewards as a unified signal for both post-training and test-time scaling in chest X-ray report generation. Our code is publicly https://anonymous.4open.science/r/Set-Distance-Rewards-CXR-BFDA{available}.

Heart disease remains a significant threat to human health. As a non-invasive diagnostic tool, the electrocardiogram (ECG) is one of the most widely used methods for cardiac screening. However, the scarcity of high-quality ECG data, driven by privacy concerns and limited medical resources, creates a pressing need for effective ECG signal generation. Existing approaches for generating ECG signals typically rely on small training datasets, lack comprehensive evaluation frameworks, and overlook potential applications beyond data augmentation. To address these challenges, we propose DiffuSETS, a novel framework capable of generating ECG signals with high semantic alignment and fidelity. DiffuSETS accepts various modalities of clinical text reports and patient-specific information as inputs, enabling the creation of clinically meaningful ECG signals. Additionally, to address the lack of standardized evaluation in ECG generation, we introduce a comprehensive benchmarking methodology to assess the effectiveness of generative models in this domain. Our model achieve excellent results in tests, proving its superiority in the task of ECG generation. Furthermore, we showcase its potential to mitigate data scarcity while exploring novel applications in cardiology education and medical knowledge discovery, highlighting the broader impact of our work.

This paper examines the exploration-exploitation trade-off in reinforcement learning with verifiable rewards (RLVR), a framework for improving the reasoning of Large Language Models (LLMs). Recent studies suggest that RLVR can elicit strong mathematical reasoning in LLMs through two seemingly paradoxical mechanisms: spurious rewards, which suppress exploitation by rewarding outcomes unrelated to the ground truth, and entropy minimization, which suppresses exploration by pushing the model toward more confident and deterministic outputs, highlighting a puzzling dynamic: both discouraging exploitation and discouraging exploration improve reasoning performance, yet the underlying principles that reconcile these effects remain poorly understood. We focus on two fundamental questions: (i) how policy entropy relates to performance, and (ii) whether spurious rewards yield gains, potentially through the interplay of clipping bias and model contamination. Our results show that clipping bias under spurious rewards reduces policy entropy, leading to more confident and deterministic outputs, while entropy minimization alone is insufficient for improvement. We further propose a reward-misalignment model explaining why spurious rewards can enhance performance beyond contaminated settings. Our findings clarify the mechanisms behind spurious-reward benefits and provide principles for more effective RLVR training.

Large reasoning models (LRMs) are typically trained using reinforcement learning with verifiable reward (RLVR) to enhance their reasoning abilities. In this paradigm, policies are updated using both positive and negative self-generated rollouts, which correspond to distinct sample polarities. In this paper, we provide a systematic investigation into how these sample polarities affect RLVR training dynamics and behaviors. We find that positive samples sharpen existing correct reasoning patterns, while negative samples encourage exploration of new reasoning paths. We further explore how adjusting the advantage values of positive and negative samples at both the sample level and the token level affects RLVR training. Based on these insights, we propose an Adaptive and Asymmetric token-level Advantage shaping method for Policy Optimization, namely A3PO, that more precisely allocates advantage signals to key tokens across different polarities. Experiments across five reasoning benchmarks demonstrate the effectiveness of our approach.

Recent RL methods have substantially improved the reasoning abilities of LLMs. Existing reward designs mainly follow two paradigms: (1) Reinforcement learning with verifiable rewards (RLVR) derives outcome signals from executable checks or ground-truth answers, but provides limited guidance for intermediate reasoning behaviors. (2) Rubrics-as-reward (RaR) goes beyond final-answer checking by using natural-language rubrics to assess reasoning quality and task compliance, but often requires instance-specific rubrics and substantial design effort. To address these issues, we introduce Metacognition-as-Reward (MaR), a metacognition-inspired RL framework that guides LLM reasoning through two general process dimensions: i) metacognitive knowledge, which identifies task-relevant information without hand-crafted instance-specific rubrics, and ii) metacognitive regulation, which plans and adjusts the reasoning process to provide reward guidance beyond final-answer outcomes. MaR scaffolds model rollouts into explicit metacognitive components and optimizes them with a trajectory-level reward over task knowledge coverage, regulation fidelity, and final-answer correctness. In this way, MaR extends reward feedback to reasoning trajectories while grounding the reward signals in general metacognitive dimensions. Experiments on 22 benchmarks show that MaR consistently improves model performance, achieving up to a 7.7% gain over the base model and up to an 11.0% gain over vanilla DAPO. Notably, Qwen3.5-9B + MaR narrows the gap to frontier models, surpassing GPT-OSS-120B on overall average and outperforming stronger models on several individual benchmarks. Process-level analysis further shows substantial improvements in reasoning process quality. MaR also generalizes to out-of-domain datasets, where MaR-trained models improve over their corresponding base models on average.

While Large Language Models (LLMs) can generate fluent text, producing high-quality creative stories remains challenging. Reinforcement Learning (RL) offers a promising solution but faces two critical obstacles: designing reliable reward signals for subjective storytelling quality and mitigating training instability. This paper introduces the Reinforcement Learning for Creative Storytelling (RLCS) framework to systematically address both challenges. First, we develop a Generative Reward Model (GenRM) that provides multi-dimensional analysis and explicit reasoning about story preferences, trained through supervised fine-tuning on demonstrations with reasoning chains distilled from strong teacher models, followed by GRPO-based refinement on expanded preference data. Second, we introduce an entropy-based reward shaping strategy that dynamically prioritizes learning on confident errors and uncertain correct predictions, preventing overfitting on already-mastered patterns. Experiments demonstrate that GenRM achieves 68\% alignment with human creativity judgments, and RLCS significantly outperforms strong baselines including Gemini-2.5-Pro in overall story quality. This work provides a practical pipeline for applying RL to creative domains, effectively navigating the dual challenges of reward modeling and training stability.

Diffusion models are powerful generative models that allow for precise control over the characteristics of the generated samples. While these diffusion models trained on large datasets have achieved success, there is often a need to introduce additional controls in downstream fine-tuning processes, treating these powerful models as pre-trained diffusion models. This work presents a novel method based on reinforcement learning (RL) to add such controls using an offline dataset comprising inputs and labels. We formulate this task as an RL problem, with the classifier learned from the offline dataset and the KL divergence against pre-trained models serving as the reward functions. Our method, CTRL (Conditioning pre-Trained diffusion models with Reinforcement Learning), produces soft-optimal policies that maximize the abovementioned reward functions. We formally demonstrate that our method enables sampling from the conditional distribution with additional controls during inference. Our RL-based approach offers several advantages over existing methods. Compared to classifier-free guidance, it improves sample efficiency and can greatly simplify dataset construction by leveraging conditional independence between the inputs and additional controls. Additionally, unlike classifier guidance, it eliminates the need to train classifiers from intermediate states to additional controls. The code is available at https://github.com/zhaoyl18/CTRL.

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.

Reward specification plays a central role in reinforcement learning (RL), guiding the agent's behavior. To express non-Markovian rewards, formalisms such as reward machines have been introduced to capture dependencies on histories. However, traditional reward machines lack the ability to model precise timing constraints, limiting their use in time-sensitive applications. In this paper, we propose timed reward machines (TRMs), which are an extension of reward machines that incorporate timing constraints into the reward structure. TRMs enable more expressive specifications with tunable reward logic, for example, imposing costs for delays and granting rewards for timely actions. We study model-free RL frameworks (i.e., tabular Q-learning) for learning optimal policies with TRMs under digital and real-time semantics. Our algorithms integrate the TRM into learning via abstractions of timed automata, and employ counterfactual-imagining heuristics that exploit the structure of the TRM to improve the search. Experimentally, we demonstrate that our algorithm learns policies that achieve high rewards while satisfying the timing constraints specified by the TRM on popular RL benchmarks. Moreover, we conduct comparative studies of performance under different TRM semantics, along with ablations that highlight the benefits of counterfactual-imagining.

Reward models play a critical role in guiding large language models toward outputs that align with human expectations. However, an open challenge remains in effectively utilizing test-time compute to enhance reward model performance. In this work, we introduce Reward Reasoning Models (RRMs), which are specifically designed to execute a deliberate reasoning process before generating final rewards. Through chain-of-thought reasoning, RRMs leverage additional test-time compute for complex queries where appropriate rewards are not immediately apparent. To develop RRMs, we implement a reinforcement learning framework that fosters self-evolved reward reasoning capabilities without requiring explicit reasoning traces as training data. Experimental results demonstrate that RRMs achieve superior performance on reward modeling benchmarks across diverse domains. Notably, we show that RRMs can adaptively exploit test-time compute to further improve reward accuracy. The pretrained reward reasoning models are available at https://huggingface.co/Reward-Reasoning.

As large language models (LLMs) advance in conversational and reasoning capabilities, their practical application in healthcare has become a critical research focus. However, there is a notable gap between the performance of medical LLMs on static benchmarks such as USMLE and their utility in real-world clinical decision-making. This discrepancy arises because traditional exams fail to capture the dynamic, interactive nature of medical consultations. To address this challenge, we introduce a novel dynamic verification framework that moves beyond static answer verifier, establishing a large-scale, high-fidelity interactive reinforcement learning system. Our framework comprises two key components: a Patient Simulator that creates realistic clinical environments using de-identified medical records, and a Clinical Rubrics Generator that dynamically produces multi-dimensional evaluation metrics. Building on this foundation, we develop Baichuan-M2, a 32B-parameter medical augmented reasoning model trained through a multi-stage reinforcement learning strategy with an improved Group Relative Policy Optimization (GRPO) algorithm. Evaluated on HealthBench, Baichuan-M2 outperforms all other open-source models and most advanced closed-source counterparts, achieving a score above 32 on the challenging HealthBench Hard benchmark-previously exceeded only by GPT-5. Our work demonstrates that robust dynamic verifier system is essential for aligning LLM capabilities with practical clinical applications, establishing a new Pareto front in the performance-parameter trade-off for medical AI deployment.

Two main challenges in Reinforcement Learning (RL) are designing appropriate reward functions and ensuring the safety of the learned policy. To address these challenges, we present a theoretical framework for Inverse Reinforcement Learning (IRL) in constrained Markov decision processes. From a convex-analytic perspective, we extend prior results on reward identifiability and generalizability to both the constrained setting and a more general class of regularizations. In particular, we show that identifiability up to potential shaping (Cao et al., 2021) is a consequence of entropy regularization and may generally no longer hold for other regularizations or in the presence of safety constraints. We also show that to ensure generalizability to new transition laws and constraints, the true reward must be identified up to a constant. Additionally, we derive a finite sample guarantee for the suboptimality of the learned rewards, and validate our results in a gridworld environment.

Reinforcement learning (RL) is a framework for solving sequential decision-making problems. In this work, we demonstrate that, surprisingly, RL emerges during the inference time of large language models (LLMs), a phenomenon we term in-context RL (ICRL). To reveal this capability, we introduce a simple multi-round prompting framework, we call ICRL prompting, for inference-time self-improvement. The goal of ICRL prompting is to guide LLMs to perform reinforcement learning during inference for self-improvement on a given task. After each response, the model receives numerical scalar feedback, denoted as a reward. In the next round, we prompt the LLM again together with a context that concatenates all prior responses and their associated rewards. We consistently observe that response quality improves as the context grows. In other words, the LLM can optimize scalar reward signals during inference, exhibiting behavior analogous to reinforcement learning. We evaluate ICRL prompting on Game of 24, creative writing, ScienceWorld, and Olympiad-level math competitions (AIME and HMMT), demonstrating significant improvements over baselines such as Self-Refine and Reflexion. Notably, even when the reward signals are generated by the same LLM, ICRL prompting still improves performance, highlighting a promising new paradigm for test-time scaling.

Most algorithms in reinforcement learning (RL) require that the objective is formalised with a Markovian reward function. However, it is well-known that certain tasks cannot be expressed by means of an objective in the Markov rewards formalism, motivating the study of alternative objective-specification formalisms in RL such as Linear Temporal Logic and Multi-Objective Reinforcement Learning. To date, there has not yet been any thorough analysis of how these formalisms relate to each other in terms of their expressivity. We fill this gap in the existing literature by providing a comprehensive comparison of 17 salient objective-specification formalisms. We place these formalisms in a preorder based on their expressive power, and present this preorder as a Hasse diagram. We find a variety of limitations for the different formalisms, and argue that no formalism is both dominantly expressive and straightforward to optimise with current techniques. For example, we prove that each of Regularised RL, (Outer) Nonlinear Markov Rewards, Reward Machines, Linear Temporal Logic, and Limit Average Rewards can express a task that the others cannot. The significance of our results is twofold. First, we identify important expressivity limitations to consider when specifying objectives for policy optimization. Second, our results highlight the need for future research which adapts reward learning to work with a greater variety of formalisms, since many existing reward learning methods assume that the desired objective takes a Markovian form. Our work contributes towards a more cohesive understanding of the costs and benefits of different RL objective-specification formalisms.

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.

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

Recent advances in general medical AI have made significant strides, but existing models often lack the reasoning capabilities needed for complex medical decision-making. This paper presents GMAI-VL-R1, a multimodal medical reasoning model enhanced by reinforcement learning (RL) to improve its reasoning abilities. Through iterative training, GMAI-VL-R1 optimizes decision-making, significantly boosting diagnostic accuracy and clinical support. We also develop a reasoning data synthesis method, generating step-by-step reasoning data via rejection sampling, which further enhances the model's generalization. Experimental results show that after RL training, GMAI-VL-R1 excels in tasks such as medical image diagnosis and visual question answering. While the model demonstrates basic memorization with supervised fine-tuning, RL is crucial for true generalization. Our work establishes new evaluation benchmarks and paves the way for future advancements in medical reasoning models. Code, data, and model will be released at https://github.com/uni-medical/GMAI-VL-R1{this link}.

Learning to solve tasks from a sparse reward signal is a major challenge for standard reinforcement learning (RL) algorithms. However, in the real world, agents rarely need to solve sparse reward tasks entirely from scratch. More often, we might possess prior experience to draw on that provides considerable guidance about which actions and outcomes are possible in the world, which we can use to explore more effectively for new tasks. In this work, we study how prior data without reward labels may be used to guide and accelerate exploration for an agent solving a new sparse reward task. We propose a simple approach that learns a reward model from online experience, labels the unlabeled prior data with optimistic rewards, and then uses it concurrently alongside the online data for downstream policy and critic optimization. This general formula leads to rapid exploration in several challenging sparse-reward domains where tabula rasa exploration is insufficient, including the AntMaze domain, Adroit hand manipulation domain, and a visual simulated robotic manipulation domain. Our results highlight the ease of incorporating unlabeled prior data into existing online RL algorithms, and the (perhaps surprising) effectiveness of doing so.

Offline Reinforcement Learning (ORL) offers a robust solution to training agents in applications where interactions with the environment must be strictly limited due to cost, safety, or lack of accurate simulation environments. Despite its potential to facilitate deployment of artificial agents in the real world, Offline Reinforcement Learning typically requires very many demonstrations annotated with ground-truth rewards. Consequently, state-of-the-art ORL algorithms can be difficult or impossible to apply in data-scarce scenarios. In this paper we propose a simple but effective Reward Model that can estimate the reward signal from a very limited sample of environment transitions annotated with rewards. Once the reward signal is modeled, we use the Reward Model to impute rewards for a large sample of reward-free transitions, thus enabling the application of ORL techniques. We demonstrate the potential of our approach on several D4RL continuous locomotion tasks. Our results show that, using only 1\% of reward-labeled transitions from the original datasets, our learned reward model is able to impute rewards for the remaining 99\% of the transitions, from which performant agents can be learned using Offline Reinforcement Learning.

Treatment reasoning underpins every therapeutic decision, integrating disease context, comorbidities, medications, contraindications, and evolving biomedical knowledge to select an appropriate therapy. It is inherently iterative: candidates are weighed against many constraints, revised as evidence emerges, and grounded in verifiable sources. Here we introduce ATHENA-R1, an AI agent for treatment reasoning across all FDA approved drugs since 1939, trained by reinforcement learning over a universe of 212 biomedical tools. At each step it identifies missing information, selects and runs relevant tools, and incorporates the evidence. To train it without human-annotated traces, we build a two-level self-learning framework: multi-agent systems construct the tools, tasks, and reasoning trajectories for supervised fine-tuning, then reinforcement learning with scientific feedback rewards reasoning quality (evidence gathering, grounded tool use, logical non-redundancy). Across five benchmarks of 3,168 drug reasoning tasks and 456 patient treatment cases, ATHENA-R1 outperforms language models and tool-use systems, reaching 94.7% accuracy on open-ended drug reasoning and 82.9% on treatment reasoning, 17.8 and 10.7 points above GPT-5. In blinded evaluations by experts from 28 rare disease organizations, it is preferred over reference models on all criteria, and physicians rated it favorably on complex hospitalized cardiovascular and infectious-disease cases. Adverse-event hypotheses it generated, tested in electronic health records from 5.4 million patients, reached adjusted odds ratios of 1.48-1.84, with no elevation among negative controls. Because it requires knowing what evidence to seek before concluding, treatment reasoning has long been hard for AI; we show it can be reframed as a learnable process of iterative evidence gathering that reinforcement learning can train AI to perform.

Reinforcement learning (RL) with verifiable rewards (RLVR) has shown promising results in mathematical reasoning and coding tasks where well-structured reference answers are available. However, its applicability to broader domains remains underexplored. In this work, we study the extension of RLVR to more diverse domains such as medicine, chemistry, psychology, and economics. We observe high agreement in binary judgments across different large language models (LLMs) when objective reference answers exist, which challenges the necessity of large-scale annotation for training domain-specific reward models. To address the limitations of binary rewards when handling unstructured reference answers, we further incorporate model-based soft scoring into RLVR to improve its flexibility. Our experiments show that a distilled generative reward model can serve as an effective cross-domain verifier, providing reliable reward signals for RL without requiring domain-specific annotations. By fine-tuning a base 7B model using various RL algorithms against our reward model, we obtain policies that outperform state-of-the-art open-source aligned LLMs such as Qwen2.5-72B-Instruct and DeepSeek-R1-Distill-Qwen-32B by a large margin, across domains in free-form answer settings. This also strengthens RLVR's robustness and scalability, highlighting its potential for real-world applications with noisy or weak labels.

In medical education, physicians convert academic knowledge into clinical expertise through residency: years of training across thousands of encounters, with diverse sources of feedback and progressively greater autonomy. Much of clinical reasoning relies on the patient encounter, a dialogue in which a clinician elicits history, refines diagnostic hypotheses, and decides management under uncertainty. While large language models (LLMs) excel on static medical benchmarks, methods to optimize the full sequence of clinical decisions remain underdeveloped. We present ResidencyRL, a reinforcement learning (RL) method for training clinical artificial intelligence (AI) agents through simulated multi-turn clinical encounters (up to 60 dialogue turns and 8 tool calls per trajectory). ResidencyRL pairs the policy agent with LLM simulators capable of complex, adversarial behaviors, training against a structured reward aligned to diagnostic accuracy, management quality, communication, documentation, and safety. On held-out evaluations, the ResidencyRL agent improves diagnostic accuracy by 7.0% under adversarial conditions (88.0% vs. 81.0%) and reduces missed red flag rates by 31%, demonstrating rigorous mitigation of premature closure. Blinded expert clinicians validated these gains, preferring the trained agent in 87.6% of side-by-side comparisons. The procedural competencies transfer to unseen benchmarks: the agent outperforms the base model across all six clinical axes of the AMIE multi-visit benchmark, and shows consistent directional improvements on AgentClinic and CRAFT-MD. Our findings demonstrate that sequential clinical decision-making can be effectively learned through multi-turn RL in simulation, yielding robust, generalizable capabilities, paving the way towards clinical mastery. Prospective validation with real-world workflows remains necessary to establish clinical utility.

Existing agents for solving tasks such as ML engineering rely on prompting powerful language models. As a result, these agents do not improve with more experience. In this paper, we show that agents backed by weaker models that improve via reinforcement learning (RL) can outperform agents backed by much larger, but static models. We identify two major challenges with RL in this setting. First, actions can take a variable amount of time (e.g., executing code for different solutions), which leads to asynchronous policy gradient updates that favor faster but suboptimal solutions. To tackle variable-duration actions, we propose duration-aware gradient updates in a distributed asynchronous RL framework to amplify high-cost but high-reward actions. Second, using only test split performance as a reward provides limited feedback. A program that is nearly correct is treated the same as one that fails entirely. To address this, we propose environment instrumentation to offer partial credit, distinguishing almost-correct programs from those that fail early (e.g., during data loading). Environment instrumentation uses a separate static language model to insert print statement to an existing program to log the agent's experimental progress, from which partial credit can be extracted as reward signals for learning. Our experimental results on MLEBench suggest that performing gradient updates on a much smaller model (Qwen2.5-3B) trained with RL outperforms prompting a much larger model (Claude-3.5-Sonnet) with agent scaffolds, by an average of 22% across 12 Kaggle tasks.

Intravascular ultrasound (IVUS) offers a unique perspective in the treatment of vascular diseases by creating a sequence of ultrasound-slices acquired from within the vessel. However, unlike conventional hand-held ultrasound, the thin catheter only provides room for a small number of physical channels for signal transfer from a transducer-array at the tip. For continued improvement of image quality and frame rate, we present the use of deep reinforcement learning to deal with the current physical information bottleneck. Valuable inspiration has come from the field of magnetic resonance imaging (MRI), where learned acquisition schemes have brought significant acceleration in image acquisition at competing image quality. To efficiently accelerate IVUS imaging, we propose a framework that utilizes deep reinforcement learning for an optimal adaptive acquisition policy on a per-frame basis enabled by actor-critic methods and Gumbel top-K sampling.

Electrocardiogram (ECG) interpretation is essential for cardiovascular disease diagnosis, but current automated systems often struggle with transparency and generalization to unseen conditions. To address this, we introduce ZETA, a zero-shot multimodal framework designed for interpretable ECG diagnosis aligned with clinical workflows. ZETA uniquely compares ECG signals against structured positive and negative clinical observations, which are curated through an LLM-assisted, expert-validated process, thereby mimicking differential diagnosis. Our approach leverages a pre-trained multimodal model to align ECG and text embeddings without disease-specific fine-tuning. Empirical evaluations demonstrate ZETA's competitive zero-shot classification performance and, importantly, provide qualitative and quantitative evidence of enhanced interpretability, grounding predictions in specific, clinically relevant positive and negative diagnostic features. ZETA underscores the potential of aligning ECG analysis with structured clinical knowledge for building more transparent, generalizable, and trustworthy AI diagnostic systems. We will release the curated observation dataset and code to facilitate future research.

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.

Despite the success of reinforcement learning for large language models, a common failure mode is reduced sampling diversity, where the policy repeatedly generates similar erroneous behaviors. Classical entropy regularization encourages randomness under the current policy, but does not explicitly discourage recurrent failure patterns across rollouts. We propose MEDS, a Memory-Enhanced Dynamic reward Shaping framework that incorporates historical behavioral signals into reward design. By storing and leveraging intermediate model representations, we capture features of past rollouts and use density-based clustering to identify frequently recurring error patterns. Rollouts assigned to more prevalent error clusters are penalized more heavily, encouraging broader exploration while reducing repeated mistakes. Across five datasets and three base models, MEDS consistently improves average performance over existing baselines, achieving gains of up to 4.13 pass@1 points and 4.37 pass@128 points. Additional analyses using both LLM-based annotations and quantitative diversity metrics show that MEDS increases behavioral diversity during sampling.

Specifying reward signals that allow agents to learn complex behaviors is a long-standing challenge in reinforcement learning. A promising approach is to extract preferences for behaviors from unlabeled videos, which are widely available on the internet. We present Video Prediction Rewards (VIPER), an algorithm that leverages pretrained video prediction models as action-free reward signals for reinforcement learning. Specifically, we first train an autoregressive transformer on expert videos and then use the video prediction likelihoods as reward signals for a reinforcement learning agent. VIPER enables expert-level control without programmatic task rewards across a wide range of DMC, Atari, and RLBench tasks. Moreover, generalization of the video prediction model allows us to derive rewards for an out-of-distribution environment where no expert data is available, enabling cross-embodiment generalization for tabletop manipulation. We see our work as starting point for scalable reward specification from unlabeled videos that will benefit from the rapid advances in generative modeling. Source code and datasets are available on the project website: https://escontrela.me/viper

Reinforcement Learning with Verifiable Rewards (RLVR) has improved the reasoning abilities of Large Language Models (LLMs) by using rule-based binary feedback, helping to mitigate reward hacking. However, current RLVR methods typically treat whole responses as single actions, assigning the same reward to every token. This coarse-grained feedback hampers precise credit assignment, making it hard for models to identify which reasoning steps lead to success or failure, and often results in suboptimal policies and inefficient learning. Methods like PPO provide credit assignment through value estimation, but often yield inaccurate and unverifiable signals due to limited sampling. On the other hand, methods using Process Reward Models can provide step-by-step judgments for each reasoning step, but they require high-quality process supervision labels and are time-consuming when applied in online reinforcement learning (RL). To overcome these limitations, we introduce a simple but efficient method Credit Assignment Policy Optimization (CAPO). Given a reasoning response rollout from the policy model, CAPO directly leverages an off-the-shelf, general-purpose LLM as a Generative Process Reward Model (LLM-as-GenPRM) to generate all step-wise critique by one pass, thereby providing verifiable token-level rewards to refine the tokens that were originally assigned identical rule-based rewards. This enables more fine-grained credit assignment in an effective way. Furthermore, to enhance the accuracy and robustness of CAPO, we employ voting mechanisms that scale with the number of generated critiques. Extensive experiments using different backbones like Llama and Qwen models and in different sizes show that CAPO consistently outperforms supervised learning-based and RL-based fine-tuning methods across six challenging mathematical benchmarks and three out-of-domain benchmarks.

Electrocardiography (ECG) signals are often degraded by noise, which complicates diagnosis in clinical and wearable settings. This study proposes a diffusion-based framework for ECG noise quantification via reconstruction-based anomaly detection, addressing annotation inconsistencies and the limited generalizability of conventional methods. We introduce a distributional evaluation using the Wasserstein-1 distance (W_1), comparing the reconstruction error distributions between clean and noisy ECGs to mitigate inconsistent annotations. Our final model achieved robust noise quantification using only three reverse diffusion steps. The model recorded a macro-average W_1 score of 1.308 across the benchmarks, outperforming the next-best method by over 48%. External validations demonstrated strong generalizability, supporting the exclusion of low-quality segments to enhance diagnostic accuracy and enable timely clinical responses to signal degradation. The proposed method enhances clinical decision-making, diagnostic accuracy, and real-time ECG monitoring capabilities, supporting future advancements in clinical and wearable ECG applications.

Recent advances in medical multi-modal models focus on specialized image analysis like dermatology, pathology, or radiology. However, they do not fully capture the complexity of real-world clinical diagnostics, which involve heterogeneous inputs and require ongoing contextual understanding during patient-physician interactions. To bridge this gap, we introduce PulseMind, a new family of multi-modal diagnostic models that integrates a systematically curated dataset, a comprehensive evaluation benchmark, and a tailored training framework. Specifically, we first construct a diagnostic dataset, MediScope, which comprises 98,000 real-world multi-turn consultations and 601,500 medical images, spanning over 10 major clinical departments and more than 200 sub-specialties. Then, to better reflect the requirements of real-world clinical diagnosis, we develop the PulseMind Benchmark, a multi-turn diagnostic consultation benchmark with a four-dimensional evaluation protocol comprising proactiveness, accuracy, usefulness, and language quality. Finally, we design a training framework tailored for multi-modal clinical diagnostics, centered around a core component named Comparison-based Reinforcement Policy Optimization (CRPO). Compared to absolute score rewards, CRPO uses relative preference signals from multi-dimensional com-parisons to provide stable and human-aligned training guidance. Extensive experiments demonstrate that PulseMind achieves competitive performance on both the diagnostic consultation benchmark and public medical benchmarks.

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

Reinforcement learning from human feedback (RLHF) has become a powerful post-training paradigm for aligning large language models with human preferences. A core challenge in RLHF is constructing accurate reward signals, where the conventional Bradley-Terry reward models (BT RMs) often suffer from sensitivity to data size and coverage, as well as vulnerability to reward hacking. Generative reward models (GenRMs) offer a more robust alternative by generating chain-of-thought (CoT) rationales followed by a final reward. However, existing GenRMs rely on shallow, vertically scaled reasoning, limiting their capacity to handle nuanced or complex (e.g., reasoning-intensive) tasks. Moreover, their pairwise preference outputs are incompatible with standard RLHF algorithms that require pointwise reward signals. In this work, we introduce Think-RM, a training framework that enables long-horizon reasoning in GenRMs by modeling an internal thinking process. Rather than producing structured, externally provided rationales, Think-RM generates flexible, self-guided reasoning traces that support advanced capabilities such as self-reflection, hypothetical reasoning, and divergent reasoning. To elicit these reasoning abilities, we first warm-up the models by supervised fine-tuning (SFT) over long CoT data. We then further improve the model's long-horizon abilities by rule-based reinforcement learning (RL). In addition, we propose a novel pairwise RLHF pipeline that directly optimizes policies using pairwise preference rewards, eliminating the need for pointwise reward conversion and enabling more effective use of Think-RM outputs. Experiments show that Think-RM achieves state-of-the-art results on RM-Bench, outperforming both BT RM and vertically scaled GenRM by 8%. When combined with our pairwise RLHF pipeline, it demonstrates superior end-policy performance compared to traditional approaches.

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

For multi-agent reinforcement learning systems (MARLS), the problem formulation generally involves investing massive reward engineering effort specific to a given problem. However, this effort often cannot be translated to other problems; worse, it gets wasted when system dynamics change drastically. This problem is further exacerbated in sparse reward scenarios, where a meaningful heuristic can assist in the policy convergence task. We propose GOVerned Reward Engineering Kernels (GOV-REK), which dynamically assign reward distributions to agents in MARLS during its learning stage. We also introduce governance kernels, which exploit the underlying structure in either state or joint action space for assigning meaningful agent reward distributions. During the agent learning stage, it iteratively explores different reward distribution configurations with a Hyperband-like algorithm to learn ideal agent reward models in a problem-agnostic manner. Our experiments demonstrate that our meaningful reward priors robustly jumpstart the learning process for effectively learning different MARL problems.

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.

Recent advances in large reasoning models highlight Reinforcement Learning with Verifiable Rewards (RLVR) as a promising method for enhancing AI's capabilities, particularly in solving complex logical tasks. However, it remains unclear whether RLVR truly expands a model's reasoning boundary or merely amplifies high-reward outputs that the base model already knows for improved precision. This study presents a theoretical and empirical investigation that provides fresh insights into the potential limits of RLVR. First, we offer a new theoretical perspective that RLVR is constrained by the base model's support-unable to sample solutions with zero initial probability-and operates as a conservative reweighting mechanism that may restrict the discovery of entirely original solutions. We also identify an entropy-reward tradeoff: while RLVR reliably enhances precision, it may progressively narrow exploration and potentially overlook correct yet underrepresented solutions. Extensive empirical experiments validate that while RLVR consistently improves pass@1, the shrinkage of empirical support generally outweighs the expansion of empirical support under larger sampling budgets, failing to recover correct answers that were previously accessible to the base model. Interestingly, we also observe that while RLVR sometimes increases token-level entropy, resulting in greater uncertainty at each generation step, answer-level entropy declines, indicating that these seemingly more uncertain paths ultimately converge onto a smaller set of distinct answers. Taken together, these findings reveal potential limits of RLVR in extending reasoning horizons. Breaking this invisible leash may require future algorithmic innovations such as explicit exploration mechanisms or hybrid strategies that seed probability mass into underrepresented solution regions.

Recent reinforcement learning (RL) methods have substantially enhanced the planning capabilities of Large Language Models (LLMs), yet the theoretical basis for their effectiveness remains elusive. In this work, we investigate RL's benefits and limitations through a tractable graph-based abstraction, focusing on policy gradient (PG) and Q-learning methods. Our theoretical analyses reveal that supervised fine-tuning (SFT) may introduce co-occurrence-based spurious solutions, whereas RL achieves correct planning primarily through exploration, underscoring exploration's role in enabling better generalization. However, we also show that PG suffers from diversity collapse, where output diversity decreases during training and persists even after perfect accuracy is attained. By contrast, Q-learning provides two key advantages: off-policy learning and diversity preservation at convergence. We further demonstrate that careful reward design is necessary to prevent reward hacking in Q-learning. Finally, applying our framework to the real-world planning benchmark Blocksworld, we confirm that these behaviors manifest in practice.