Fleming-R1: Toward Expert-Level Medical Reasoning via Reinforcement Learning

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.

Reasoning on a Budget: A Survey of Adaptive and Controllable Test-Time Compute in LLMs

Large language models (LLMs) have rapidly progressed into general-purpose agents capable of solving a broad spectrum of tasks. However, current models remain inefficient at reasoning: they apply fixed inference-time compute regardless of task complexity, often overthinking simple problems while underthinking hard ones. This survey presents a comprehensive review of efficient test-time compute (TTC) strategies, which aim to improve the computational efficiency of LLM reasoning. We introduce a two-tiered taxonomy that distinguishes between L1-controllability, methods that operate under fixed compute budgets, and L2-adaptiveness, methods that dynamically scale inference based on input difficulty or model confidence. We benchmark leading proprietary LLMs across diverse datasets, highlighting critical trade-offs between reasoning performance and token usage. Compared to prior surveys on efficient reasoning, our review emphasizes the practical control, adaptability, and scalability of TTC methods. Finally, we discuss emerging trends such as hybrid thinking models and identify key challenges for future work towards making LLMs more computationally efficient, robust, and responsive to user constraints.