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

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

BOTM: Echocardiography Segmentation via Bi-directional Optimal Token Matching

Existed echocardiography segmentation methods often suffer from anatomical inconsistency challenge caused by shape variation, partial observation and region ambiguity with similar intensity across 2D echocardiographic sequences, resulting in false positive segmentation with anatomical defeated structures in challenging low signal-to-noise ratio conditions. To provide a strong anatomical guarantee across different echocardiographic frames, we propose a novel segmentation framework named BOTM (Bi-directional Optimal Token Matching) that performs echocardiography segmentation and optimal anatomy transportation simultaneously. Given paired echocardiographic images, BOTM learns to match two sets of discrete image tokens by finding optimal correspondences from a novel anatomical transportation perspective. We further extend the token matching into a bi-directional cross-transport attention proxy to regulate the preserved anatomical consistency within the cardiac cyclic deformation in temporal domain. Extensive experimental results show that BOTM can generate stable and accurate segmentation outcomes (e.g. -1.917 HD on CAMUS2H LV, +1.9% Dice on TED), and provide a better matching interpretation with anatomical consistency guarantee.

Enhancing Abnormality Grounding for Vision Language Models with Knowledge Descriptions

Visual Language Models (VLMs) have demonstrated impressive capabilities in visual grounding tasks. However, their effectiveness in the medical domain, particularly for abnormality detection and localization within medical images, remains underexplored. A major challenge is the complex and abstract nature of medical terminology, which makes it difficult to directly associate pathological anomaly terms with their corresponding visual features. In this work, we introduce a novel approach to enhance VLM performance in medical abnormality detection and localization by leveraging decomposed medical knowledge. Instead of directly prompting models to recognize specific abnormalities, we focus on breaking down medical concepts into fundamental attributes and common visual patterns. This strategy promotes a stronger alignment between textual descriptions and visual features, improving both the recognition and localization of abnormalities in medical images.We evaluate our method on the 0.23B Florence-2 base model and demonstrate that it achieves comparable performance in abnormality grounding to significantly larger 7B LLaVA-based medical VLMs, despite being trained on only 1.5% of the data used for such models. Experimental results also demonstrate the effectiveness of our approach in both known and previously unseen abnormalities, suggesting its strong generalization capabilities.

SuPreME: A Supervised Pre-training Framework for Multimodal ECG Representation Learning

Cardiovascular diseases are a leading cause of death and disability worldwide. Electrocardiogram (ECG) recordings are critical for diagnosing and monitoring cardiac health, but obtaining large-scale annotated ECG datasets is labor-intensive and time-consuming. Recent ECG Self-Supervised Learning (eSSL) methods mitigate this by learning features without extensive labels but fail to capture fine-grained clinical semantics and require extensive task-specific fine-tuning. To address these challenges, we propose $\textbf{SuPreME}$, a $\textbf{Su}$pervised $\textbf{Pre}$-training framework for $\textbf{M}$ultimodal $\textbf{E}$CG representation learning. SuPreME applies Large Language Models (LLMs) to extract structured clinical entities from free-text ECG reports, filter out noise and irrelevant content, enhance clinical representation learning, and build a high-quality, fine-grained labeled dataset. By using text-based cardiac queries instead of traditional categorical labels, SuPreME enables zero-shot classification of unseen diseases without additional fine-tuning. We evaluate SuPreME on six downstream datasets covering 127 cardiac conditions, achieving superior zero-shot AUC performance over state-of-the-art eSSL and multimodal methods by over 1.96\%. Results demonstrate the effectiveness of SuPreME in leveraging structured, clinically relevant knowledge for high-quality ECG representations. All code and data will be released upon acceptance.

Knowledge-enhanced Multimodal ECG Representation Learning with Arbitrary-Lead Inputs

Recent advances in multimodal ECG representation learning center on aligning ECG signals with paired free-text reports. However, suboptimal alignment persists due to the complexity of medical language and the reliance on a full 12-lead setup, which is often unavailable in under-resourced settings. To tackle these issues, we propose **K-MERL**, a knowledge-enhanced multimodal ECG representation learning framework. **K-MERL** leverages large language models to extract structured knowledge from free-text reports and employs a lead-aware ECG encoder with dynamic lead masking to accommodate arbitrary lead inputs. Evaluations on six external ECG datasets show that **K-MERL** achieves state-of-the-art performance in zero-shot classification and linear probing tasks, while delivering an average **16%** AUC improvement over existing methods in partial-lead zero-shot classification.

Machine learning for modelling unstructured grid data in computational physics: a review

Unstructured grid data are essential for modelling complex geometries and dynamics in computational physics. Yet, their inherent irregularity presents significant challenges for conventional machine learning (ML) techniques. This paper provides a comprehensive review of advanced ML methodologies designed to handle unstructured grid data in high-dimensional dynamical systems. Key approaches discussed include graph neural networks, transformer models with spatial attention mechanisms, interpolation-integrated ML methods, and meshless techniques such as physics-informed neural networks. These methodologies have proven effective across diverse fields, including fluid dynamics and environmental simulations. This review is intended as a guidebook for computational scientists seeking to apply ML approaches to unstructured grid data in their domains, as well as for ML researchers looking to address challenges in computational physics. It places special focus on how ML methods can overcome the inherent limitations of traditional numerical techniques and, conversely, how insights from computational physics can inform ML development. To support benchmarking, this review also provides a summary of open-access datasets of unstructured grid data in computational physics. Finally, emerging directions such as generative models with unstructured data, reinforcement learning for mesh generation, and hybrid physics-data-driven paradigms are discussed to inspire future advancements in this evolving field.

Fire-Image-DenseNet (FIDN) for predicting wildfire burnt area using remote sensing data

Predicting the extent of massive wildfires once ignited is essential to reduce the subsequent socioeconomic losses and environmental damage, but challenging because of the complexity of fire behaviour. Existing physics-based models are limited in predicting large or long-duration wildfire events. Here, we develop a deep-learning-based predictive model, Fire-Image-DenseNet (FIDN), that uses spatial features derived from both near real-time and reanalysis data on the environmental and meteorological drivers of wildfire. We trained and tested this model using more than 300 individual wildfires that occurred between 2012 and 2019 in the western US. In contrast to existing models, the performance of FIDN does not degrade with fire size or duration. Furthermore, it predicts final burnt area accurately even in very heterogeneous landscapes in terms of fuel density and flammability. The FIDN model showed higher accuracy, with a mean squared error (MSE) about 82% and 67% lower than those of the predictive models based on cellular automata (CA) and the minimum travel time (MTT) approaches, respectively. Its structural similarity index measure (SSIM) averages 97%, outperforming the CA and FlamMap MTT models by 6% and 2%, respectively. Additionally, FIDN is approximately three orders of magnitude faster than both CA and MTT models. The enhanced computational efficiency and accuracy advancements offer vital insights for strategic planning and resource allocation for firefighting operations.

DYffCast: Regional Precipitation Nowcasting Using IMERG Satellite Data. A case study over South America

Climate change is increasing the frequency of extreme precipitation events, making weather disasters such as flooding and landslides more likely. The ability to accurately nowcast precipitation is therefore becoming more critical for safeguarding society by providing immediate, accurate information to decision makers. Motivated by the recent success of generative models at precipitation nowcasting, this paper: extends the DYffusion framework to this task and evaluates its performance at forecasting IMERG satellite precipitation data up to a 4-hour horizon; modifies the DYffusion framework to improve its ability to model rainfall data; and introduces a novel loss function that combines MSE, MAE and the LPIPS perceptual score. In a quantitative evaluation of forecasts up to a 4-hour horizon, the modified DYffusion framework trained with the novel loss outperforms four competitor models. It has the highest CSI scores for weak, moderate, and heavy rain thresholds and retains an LPIPS score $<$ 0.2 for the entire roll-out, degrading the least as lead-time increases. The proposed nowcasting model demonstrates visually stable and sharp forecasts up to a 2-hour horizon on a heavy rain case study. Code is available at https://github.com/Dseal95/DYffcast.

Can Medical Vision-Language Pre-training Succeed with Purely Synthetic Data?

Medical Vision-Language Pre-training (MedVLP) has made significant progress in enabling zero-shot tasks for medical image understanding. However, training MedVLP models typically requires large-scale datasets with paired, high-quality image-text data, which are scarce in the medical domain. Recent advancements in Large Language Models (LLMs) and diffusion models have made it possible to generate large-scale synthetic image-text pairs. This raises the question: *Can MedVLP succeed using purely synthetic data?* To address this, we use off-the-shelf generative models to create synthetic radiology reports and paired Chest X-ray (CXR) images, and propose an automated pipeline to build a diverse, high-quality synthetic dataset, enabling a rigorous study that isolates model and training settings, focusing entirely from the data perspective. Our results show that MedVLP models trained *exclusively on synthetic data* outperform those trained on real data by **3.8%** in averaged AUC on zero-shot classification. Moreover, using a combination of synthetic and real data leads to a further improvement of **9.07%**. Additionally, MedVLP models trained on synthetic or mixed data consistently outperform those trained on real data in zero-shot grounding, as well as in fine-tuned classification and segmentation tasks. Our analysis suggests MedVLP trained on well-designed synthetic data can outperform models trained on real datasets, which may be limited by low-quality samples and long-tailed distributions.

FMBench: Benchmarking Fairness in Multimodal Large Language Models on Medical Tasks

Advancements in Multimodal Large Language Models (MLLMs) have significantly improved medical task performance, such as Visual Question Answering (VQA) and Report Generation (RG). However, the fairness of these models across diverse demographic groups remains underexplored, despite its importance in healthcare. This oversight is partly due to the lack of demographic diversity in existing medical multimodal datasets, which complicates the evaluation of fairness. In response, we propose FMBench, the first benchmark designed to evaluate the fairness of MLLMs performance across diverse demographic attributes. FMBench has the following key features: 1: It includes four demographic attributes: race, ethnicity, language, and gender, across two tasks, VQA and RG, under zero-shot settings. 2: Our VQA task is free-form, enhancing real-world applicability and mitigating the biases associated with predefined choices. 3: We utilize both lexical metrics and LLM-based metrics, aligned with clinical evaluations, to assess models not only for linguistic accuracy but also from a clinical perspective. Furthermore, we introduce a new metric, Fairness-Aware Performance (FAP), to evaluate how fairly MLLMs perform across various demographic attributes. We thoroughly evaluate the performance and fairness of eight state-of-the-art open-source MLLMs, including both general and medical MLLMs, ranging from 7B to 26B parameters on the proposed benchmark. We aim for FMBench to assist the research community in refining model evaluation and driving future advancements in the field. All data and code will be released upon acceptance.