Fine-grained List-wise Alignment for Generative Medication Recommendation

Accurate and safe medication recommendations are critical for effective clinical decision-making, especially in multimorbidity cases. However, existing systems rely on point-wise prediction paradigms that overlook synergistic drug effects and potential adverse drug-drug interactions (DDIs). We propose FLAME, a fine-grained list-wise alignment framework for large language models (LLMs), enabling drug-by-drug generation of drug lists. FLAME formulates recommendation as a sequential decision process, where each step adds or removes a single drug. To provide fine-grained learning signals, we devise step-wise Group Relative Policy Optimization (GRPO) with potential-based reward shaping, which explicitly models DDIs and optimizes the contribution of each drug to the overall prescription. Furthermore, FLAME enhances patient modeling by integrating structured clinical knowledge and collaborative information into the representation space of LLMs. Experiments on benchmark datasets demonstrate that FLAME achieves state-of-the-art performance, delivering superior accuracy, controllable safety-accuracy trade-offs, and strong generalization across diverse clinical scenarios. Our code is available at https://github.com/cxfann/Flame.

RVTBench: A Benchmark for Visual Reasoning Tasks

Visual reasoning, the capability to interpret visual input in response to implicit text query through multi-step reasoning, remains a challenge for deep learning models due to the lack of relevant benchmarks. Previous work in visual reasoning has primarily focused on reasoning segmentation, where models aim to segment objects based on implicit text queries. This paper introduces reasoning visual tasks (RVTs), a unified formulation that extends beyond traditional video reasoning segmentation to a diverse family of visual language reasoning problems, which can therefore accommodate multiple output formats including bounding boxes, natural language descriptions, and question-answer pairs. Correspondingly, we identify the limitations in current benchmark construction methods that rely solely on large language models (LLMs), which inadequately capture complex spatial-temporal relationships and multi-step reasoning chains in video due to their reliance on token representation, resulting in benchmarks with artificially limited reasoning complexity. To address this limitation, we propose a novel automated RVT benchmark construction pipeline that leverages digital twin (DT) representations as structured intermediaries between perception and the generation of implicit text queries. Based on this method, we construct RVTBench, a RVT benchmark containing 3,896 queries of over 1.2 million tokens across four types of RVT (segmentation, grounding, VQA and summary), three reasoning categories (semantic, spatial, and temporal), and four increasing difficulty levels, derived from 200 video sequences. Finally, we propose RVTagent, an agent framework for RVT that allows for zero-shot generalization across various types of RVT without task-specific fine-tuning.

Process-Supervised LLM Recommenders via Flow-guided Tuning

While large language models (LLMs) are increasingly adapted for recommendation systems via supervised fine-tuning (SFT), this approach amplifies popularity bias due to its likelihood maximization objective, compromising recommendation diversity and fairness. To address this, we present Flow-guided fine-tuning recommender (Flower), which replaces SFT with a Generative Flow Network (GFlowNet) framework that enacts process supervision through token-level reward propagation. Flower's key innovation lies in decomposing item-level rewards into constituent token rewards, enabling direct alignment between token generation probabilities and their reward signals. This mechanism achieves three critical advancements: (1) popularity bias mitigation and fairness enhancement through empirical distribution matching, (2) preservation of diversity through GFlowNet's proportional sampling, and (3) flexible integration of personalized preferences via adaptable token rewards. Experiments demonstrate Flower's superior distribution-fitting capability and its significant advantages over traditional SFT in terms of fairness, diversity, and accuracy, highlighting its potential to improve LLM-based recommendation systems. The implementation is available via https://github.com/Mr-Peach0301/Flower

Addressing Overprescribing Challenges: Fine-Tuning Large Language Models for Medication Recommendation Tasks

Medication recommendation systems have garnered attention within healthcare for their potential to deliver personalized and efficacious drug combinations based on patient's clinical data. However, existing methodologies encounter challenges in adapting to diverse Electronic Health Records (EHR) systems and effectively utilizing unstructured data, resulting in limited generalization capabilities and suboptimal performance. Recently, interest is growing in harnessing Large Language Models (LLMs) in the medical domain to support healthcare professionals and enhance patient care. Despite the emergence of medical LLMs and their promising results in tasks like medical question answering, their practical applicability in clinical settings, particularly in medication recommendation, often remains underexplored. In this study, we evaluate both general-purpose and medical-specific LLMs for medication recommendation tasks. Our findings reveal that LLMs frequently encounter the challenge of overprescribing, leading to heightened clinical risks and diminished medication recommendation accuracy. To address this issue, we propose Language-Assisted Medication Recommendation (LAMO), which employs a parameter-efficient fine-tuning approach to tailor open-source LLMs for optimal performance in medication recommendation scenarios. LAMO leverages the wealth of clinical information within clinical notes, a resource often underutilized in traditional methodologies. As a result of our approach, LAMO outperforms previous state-of-the-art methods by over 10% in internal validation accuracy. Furthermore, temporal and external validations demonstrate LAMO's robust generalization capabilities across various temporal and hospital contexts. Additionally, an out-of-distribution medication recommendation experiment demonstrates LAMO's remarkable accuracy even with medications outside the training data.