Tandem: Riding Together with Large and Small Language Models for Efficient Reasoning

Recent advancements in large language models (LLMs) have catalyzed the rise of reasoning-intensive inference paradigms, where models perform explicit step-by-step reasoning before generating final answers. While such approaches improve answer quality and interpretability, they incur substantial computational overhead due to the prolonged generation sequences. In this paper, we propose Tandem, a novel collaborative framework that synergizes large and small language models (LLMs and SLMs) to achieve high-quality reasoning with significantly reduced computational cost. Specifically, the LLM serves as a strategic coordinator, efficiently generating a compact set of critical reasoning insights. These insights are then used to guide a smaller, more efficient SLM in executing the full reasoning process and delivering the final response. To balance efficiency and reliability, Tandem introduces a cost-aware termination mechanism that adaptively determines when sufficient reasoning guidance has been accumulated, enabling early stopping of the LLM's generation. Experiments on mathematical reasoning and code generation benchmarks demonstrate that Tandem reduces computational costs by approximately 40% compared to standalone LLM reasoning, while achieving superior or competitive performance. Furthermore, the sufficiency classifier trained on one domain transfers effectively to others without retraining. The code is available at: https://github.com/Applied-Machine-Learning-Lab/ACL2026_Tandem.

Can Agents Distinguish Visually Hard-to-Separate Diseases in a Zero-Shot Setting? A Pilot Study

The rapid progress of multimodal large language models (MLLMs) has led to increasing interest in agent-based systems. While most prior work in medical imaging concentrates on automating routine clinical workflows, we study an underexplored yet clinically significant setting: distinguishing visually hard-to-separate diseases in a zero-shot setting. We benchmark representative agents on two imaging-only proxy diagnostic tasks, (1) melanoma vs. atypical nevus and (2) pulmonary edema vs. pneumonia, where visual features are highly confounded despite substantial differences in clinical management. We introduce a multi-agent framework based on contrastive adjudication. Experimental results show improved diagnostic performance (an 11-percentage-point gain in accuracy on dermoscopy data) and reduced unsupported claims on qualitative samples, although overall performance remains insufficient for clinical deployment. We acknowledge the inherent uncertainty in human annotations and the absence of clinical context, which further limit the translation to real-world settings. Within this controlled setting, this pilot study provides preliminary insights into zero-shot agent performance in visually confounded scenarios.

VasGuideNet: Vascular Topology-Guided Couinaud Liver Segmentation with Structural Contrastive Loss

Accurate Couinaud liver segmentation is critical for preoperative surgical planning and tumor localization.However, existing methods primarily rely on image intensity and spatial location cues, without explicitly modeling vascular topology. As a result, they often produce indistinct boundaries near vessels and show limited generalization under anatomical variability.We propose VasGuideNet, the first Couinaud segmentation framework explicitly guided by vascular topology. Specifically, skeletonized vessels, Euclidean distance transform (EDT)--derived geometry, and k-nearest neighbor (kNN) connectivity are encoded into topology features using Graph Convolutional Networks (GCNs). These features are then injected into a 3D encoder--decoder backbone via a cross-attention fusion module. To further improve inter-class separability and anatomical consistency, we introduce a Structural Contrastive Loss (SCL) with a global memory bank.On Task08_HepaticVessel and our private LASSD dataset, VasGuideNet achieves Dice scores of 83.68% and 76.65% with RVDs of 1.68 and 7.08, respectively. It consistently outperforms representative baselines including UNETR, Swin UNETR, and G-UNETR++, delivering higher Dice/mIoU and lower RVD across datasets, demonstrating its effectiveness for anatomically consistent segmentation. Code is available at https://github.com/Qacket/VasGuideNet.git.

SRVAU-R1: Enhancing Video Anomaly Understanding via Reflection-Aware Learning

Multi-modal large language models (MLLMs) have demonstrated significant progress in reasoning capabilities and shown promising effectiveness in video anomaly understanding (VAU) tasks. However, existing MLLM-based approaches remain largely focused on surface-level descriptions of anomalies, lacking deep reasoning over abnormal behaviors like explicit self-reflection and self-correction. To address that, we propose Self-Reflection-Enhanced Reasoning for Video Anomaly Understanding (SRVAU-R1), a reflection-aware learning framework that incorporates reflection in MLLM reasoning. Specifically, SRVAU-R1 introduces the first reflection-oriented Chain-of-Thought dataset tailored for VAU, providing structured supervision with initial reasoning, self-reflection, and revised reasoning. Based on that, it includes a novel reflection-aware learning paradigm with supervised fine-tuning and reinforcement fine-tuning to enhance multi-modal reasoning for VAU. Extensive experiments on multiple video anomaly benchmarks demonstrate that SRVAU-R1 consistently outperforms existing methods, achieving significant improvements in both temporal anomaly localization accuracy and reasoning quality.

Improving Alignment in LVLMs with Debiased Self-Judgment

The rapid advancements in Large Language Models (LLMs) and Large Visual-Language Models (LVLMs) have opened up new opportunities for integrating visual and linguistic modalities. However, effectively aligning these modalities remains challenging, often leading to hallucinations--where generated outputs are not grounded in the visual input--and raising safety concerns across various domains. Existing alignment methods, such as instruction tuning and preference tuning, often rely on external datasets, human annotations, or complex post-processing, which limit scalability and increase costs. To address these challenges, we propose a novel approach that generates the debiased self-judgment score, a self-evaluation metric created internally by the model without relying on external resources. This enables the model to autonomously improve alignment. Our method enhances both decoding strategies and preference tuning processes, resulting in reduced hallucinations, enhanced safety, and improved overall capability. Empirical results show that our approach significantly outperforms traditional methods, offering a more effective solution for aligning LVLMs.

SynthTextEval: Synthetic Text Data Generation and Evaluation for High-Stakes Domains

We present SynthTextEval, a toolkit for conducting comprehensive evaluations of synthetic text. The fluency of large language model (LLM) outputs has made synthetic text potentially viable for numerous applications, such as reducing the risks of privacy violations in the development and deployment of AI systems in high-stakes domains. Realizing this potential, however, requires principled consistent evaluations of synthetic data across multiple dimensions: its utility in downstream systems, the fairness of these systems, the risk of privacy leakage, general distributional differences from the source text, and qualitative feedback from domain experts. SynthTextEval allows users to conduct evaluations along all of these dimensions over synthetic data that they upload or generate using the toolkit's generation module. While our toolkit can be run over any data, we highlight its functionality and effectiveness over datasets from two high-stakes domains: healthcare and law. By consolidating and standardizing evaluation metrics, we aim to improve the viability of synthetic text, and in-turn, privacy-preservation in AI development.

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.

UniCAD: Efficient and Extendable Architecture for Multi-Task Computer-Aided Diagnosis System

The growing complexity and scale of visual model pre-training have made developing and deploying multi-task computer-aided diagnosis (CAD) systems increasingly challenging and resource-intensive. Furthermore, the medical imaging community lacks an open-source CAD platform to enable the rapid creation of efficient and extendable diagnostic models. To address these issues, we propose UniCAD, a unified architecture that leverages the robust capabilities of pre-trained vision foundation models to seamlessly handle both 2D and 3D medical images while requiring only minimal task-specific parameters. UniCAD introduces two key innovations: (1) Efficiency: A low-rank adaptation strategy is employed to adapt a pre-trained visual model to the medical image domain, achieving performance on par with fully fine-tuned counterparts while introducing only 0.17% trainable parameters. (2) Plug-and-Play: A modular architecture that combines a frozen foundation model with multiple plug-and-play experts, enabling diverse tasks and seamless functionality expansion. Building on this unified CAD architecture, we establish an open-source platform where researchers can share and access lightweight CAD experts, fostering a more equitable and efficient research ecosystem. Comprehensive experiments across 12 diverse medical datasets demonstrate that UniCAD consistently outperforms existing methods in both accuracy and deployment efficiency. The source code and project page are available at https://mii-laboratory.github.io/UniCAD/.

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.

Med-LEGO: Editing and Adapting toward Generalist Medical Image Diagnosis

The adoption of visual foundation models has become a common practice in computer-aided diagnosis (CAD). While these foundation models provide a viable solution for creating generalist medical AI, privacy concerns make it difficult to pre-train or continuously update such models across multiple domains and datasets, leading many studies to focus on specialist models. To address this challenge, we propose Med-LEGO, a training-free framework that enables the seamless integration or updating of a generalist CAD model by combining multiple specialist models, similar to assembling LEGO bricks. Med-LEGO enhances LoRA (low-rank adaptation) by incorporating singular value decomposition (SVD) to efficiently capture the domain expertise of each specialist model with minimal additional parameters. By combining these adapted weights through simple operations, Med-LEGO allows for the easy integration or modification of specific diagnostic capabilities without the need for original data or retraining. Finally, the combined model can be further adapted to new diagnostic tasks, making it a versatile generalist model. Our extensive experiments demonstrate that Med-LEGO outperforms existing methods in both cross-domain and in-domain medical tasks while using only 0.18% of full model parameters. These merged models show better convergence and generalization to new tasks, providing an effective path toward generalist medical AI.