Open-Medical-R1: How to Choose Data for RLVR Training at Medicine Domain

This paper explores optimal data selection strategies for Reinforcement Learning with Verified Rewards (RLVR) training in the medical domain. While RLVR has shown exceptional potential for enhancing reasoning capabilities in large language models, most prior implementations have focused on mathematics and logical puzzles, with limited exploration of domain-specific applications like medicine. We investigate four distinct data sampling strategies from MedQA-USMLE: random sampling (baseline), and filtering using Phi-4, Gemma-3-27b-it, and Gemma-3-12b-it models. Using Gemma-3-12b-it as our base model and implementing Group Relative Policy Optimization (GRPO), we evaluate performance across multiple benchmarks including MMLU, GSM8K, MMLU-Pro, and CMMLU. Our findings demonstrate that models trained on filtered data generally outperform those trained on randomly selected samples. Notably, training on self-filtered samples (using Gemma-3-12b-it for filtering) achieved superior performance in medical domains but showed reduced robustness across different benchmarks, while filtering with larger models from the same series yielded better overall robustness. These results provide valuable insights into effective data organization strategies for RLVR in specialized domains and highlight the importance of thoughtful data selection in achieving optimal performance. You can access our repository (https://github.com/Qsingle/open-medical-r1) to get the codes.

AfriMed-QA: A Pan-African, Multi-Specialty, Medical Question-Answering Benchmark Dataset

Recent advancements in large language model(LLM) performance on medical multiple choice question (MCQ) benchmarks have stimulated interest from healthcare providers and patients globally. Particularly in low-and middle-income countries (LMICs) facing acute physician shortages and lack of specialists, LLMs offer a potentially scalable pathway to enhance healthcare access and reduce costs. However, their effectiveness in the Global South, especially across the African continent, remains to be established. In this work, we introduce AfriMed-QA, the first large scale Pan-African English multi-specialty medical Question-Answering (QA) dataset, 15,000 questions (open and closed-ended) sourced from over 60 medical schools across 16 countries, covering 32 medical specialties. We further evaluate 30 LLMs across multiple axes including correctness and demographic bias. Our findings show significant performance variation across specialties and geographies, MCQ performance clearly lags USMLE (MedQA). We find that biomedical LLMs underperform general models and smaller edge-friendly LLMs struggle to achieve a passing score. Interestingly, human evaluations show a consistent consumer preference for LLM answers and explanations when compared with clinician answers.

MedMobile: A mobile-sized language model with expert-level clinical capabilities

Language models (LMs) have demonstrated expert-level reasoning and recall abilities in medicine. However, computational costs and privacy concerns are mounting barriers to wide-scale implementation. We introduce a parsimonious adaptation of phi-3-mini, MedMobile, a 3.8 billion parameter LM capable of running on a mobile device, for medical applications. We demonstrate that MedMobile scores 75.7% on the MedQA (USMLE), surpassing the passing mark for physicians (~60%), and approaching the scores of models 100 times its size. We subsequently perform a careful set of ablations, and demonstrate that chain of thought, ensembling, and fine-tuning lead to the greatest performance gains, while unexpectedly retrieval augmented generation fails to demonstrate significant improvements

Improving Retrieval-Augmented Generation in Medicine with Iterative Follow-up Questions

The emergent abilities of large language models (LLMs) have demonstrated great potential in solving medical questions. They can possess considerable medical knowledge, but may still hallucinate and are inflexible in the knowledge updates. While Retrieval-Augmented Generation (RAG) has been proposed to enhance the medical question-answering capabilities of LLMs with external knowledge bases, it may still fail in complex cases where multiple rounds of information-seeking are required. To address such an issue, we propose iterative RAG for medicine (i-MedRAG), where LLMs can iteratively ask follow-up queries based on previous information-seeking attempts. In each iteration of i-MedRAG, the follow-up queries will be answered by a vanilla RAG system and they will be further used to guide the query generation in the next iteration. Our experiments show the improved performance of various LLMs brought by i-MedRAG compared with vanilla RAG on complex questions from clinical vignettes in the United States Medical Licensing Examination (USMLE), as well as various knowledge tests in the Massive Multitask Language Understanding (MMLU) dataset. Notably, our zero-shot i-MedRAG outperforms all existing prompt engineering and fine-tuning methods on GPT-3.5, achieving an accuracy of 69.68\% on the MedQA dataset. In addition, we characterize the scaling properties of i-MedRAG with different iterations of follow-up queries and different numbers of queries per iteration. Our case studies show that i-MedRAG can flexibly ask follow-up queries to form reasoning chains, providing an in-depth analysis of medical questions. To the best of our knowledge, this is the first-of-its-kind study on incorporating follow-up queries into medical RAG.

Capabilities of Gemini Models in Medicine

Excellence in a wide variety of medical applications poses considerable challenges for AI, requiring advanced reasoning, access to up-to-date medical knowledge and understanding of complex multimodal data. Gemini models, with strong general capabilities in multimodal and long-context reasoning, offer exciting possibilities in medicine. Building on these core strengths of Gemini, we introduce Med-Gemini, a family of highly capable multimodal models that are specialized in medicine with the ability to seamlessly use web search, and that can be efficiently tailored to novel modalities using custom encoders. We evaluate Med-Gemini on 14 medical benchmarks, establishing new state-of-the-art (SoTA) performance on 10 of them, and surpass the GPT-4 model family on every benchmark where a direct comparison is viable, often by a wide margin. On the popular MedQA (USMLE) benchmark, our best-performing Med-Gemini model achieves SoTA performance of 91.1% accuracy, using a novel uncertainty-guided search strategy. On 7 multimodal benchmarks including NEJM Image Challenges and MMMU (health & medicine), Med-Gemini improves over GPT-4V by an average relative margin of 44.5%. We demonstrate the effectiveness of Med-Gemini's long-context capabilities through SoTA performance on a needle-in-a-haystack retrieval task from long de-identified health records and medical video question answering, surpassing prior bespoke methods using only in-context learning. Finally, Med-Gemini's performance suggests real-world utility by surpassing human experts on tasks such as medical text summarization, alongside demonstrations of promising potential for multimodal medical dialogue, medical research and education. Taken together, our results offer compelling evidence for Med-Gemini's potential, although further rigorous evaluation will be crucial before real-world deployment in this safety-critical domain.

Few shot chain-of-thought driven reasoning to prompt LLMs for open ended medical question answering

Large Language models (LLMs) have demonstrated significant potential in transforming healthcare by automating tasks such as clinical documentation, information retrieval, and decision support. In this aspect, carefully engineered prompts have emerged as a powerful tool for using LLMs for medical scenarios, e.g., patient clinical scenarios. In this paper, we propose a modified version of the MedQA-USMLE dataset, which is subjective, to mimic real-life clinical scenarios. We explore the Chain of Thought (CoT) reasoning based on subjective response generation for the modified MedQA-USMLE dataset with appropriate LM-driven forward reasoning for correct responses to the medical questions. Keeping in mind the importance of response verification in the medical setting, we utilize a reward training mechanism whereby the language model also provides an appropriate verified response for a particular response to a clinical question. In this regard, we also include human-in-the-loop for different evaluation aspects. We develop better in-contrast learning strategies by modifying the 5-shot-codex-CoT-prompt from arXiv:2207.08143 for the subjective MedQA dataset and developing our incremental-reasoning prompt. Our evaluations show that the incremental reasoning prompt performs better than the modified codex prompt in certain scenarios. We also show that greedy decoding with the incremental reasoning method performs better than other strategies, such as prompt chaining and eliminative reasoning.

To Generate or to Retrieve? On the Effectiveness of Artificial Contexts for Medical Open-Domain Question Answering

Medical open-domain question answering demands substantial access to specialized knowledge. Recent efforts have sought to decouple knowledge from model parameters, counteracting architectural scaling and allowing for training on common low-resource hardware. The retrieve-then-read paradigm has become ubiquitous, with model predictions grounded on relevant knowledge pieces from external repositories such as PubMed, textbooks, and UMLS. An alternative path, still under-explored but made possible by the advent of domain-specific large language models, entails constructing artificial contexts through prompting. As a result, "to generate or to retrieve" is the modern equivalent of Hamlet's dilemma. This paper presents MedGENIE, the first generate-then-read framework for multiple-choice question answering in medicine. We conduct extensive experiments on MedQA-USMLE, MedMCQA, and MMLU, incorporating a practical perspective by assuming a maximum of 24GB VRAM. MedGENIE sets a new state-of-the-art (SOTA) in the open-book setting of each testbed, even allowing a small-scale reader to outcompete zero-shot closed-book 175B baselines while using up to 706$\times$ fewer parameters. Overall, our findings reveal that generated passages are more effective than retrieved counterparts in attaining higher accuracy.

SM70: A Large Language Model for Medical Devices

We are introducing SM70, a 70 billion-parameter Large Language Model that is specifically designed for SpassMed's medical devices under the brand name 'JEE1' (pronounced as G1 and means 'Life'). This large language model provides more accurate and safe responses to medical-domain questions. To fine-tune SM70, we used around 800K data entries from the publicly available dataset MedAlpaca. The Llama2 70B open-sourced model served as the foundation for SM70, and we employed the QLoRA technique for fine-tuning. The evaluation is conducted across three benchmark datasets - MEDQA - USMLE, PUBMEDQA, and USMLE - each representing a unique aspect of medical knowledge and reasoning. The performance of SM70 is contrasted with other notable LLMs, including Llama2 70B, Clinical Camel 70 (CC70), GPT 3.5, GPT 4, and Med-Palm, to provide a comparative understanding of its capabilities within the medical domain. Our results indicate that SM70 outperforms several established models in these datasets, showcasing its proficiency in handling a range of medical queries, from fact-based questions derived from PubMed abstracts to complex clinical decision-making scenarios. The robust performance of SM70, particularly in the USMLE and PUBMEDQA datasets, suggests its potential as an effective tool in clinical decision support and medical information retrieval. Despite its promising results, the paper also acknowledges the areas where SM70 lags behind the most advanced model, GPT 4, thereby highlighting the need for further development, especially in tasks demanding extensive medical knowledge and intricate reasoning.

Knowledge Solver: Teaching LLMs to Search for Domain Knowledge from Knowledge Graphs

Large language models (LLMs), such as ChatGPT and GPT-4, are versatile and can solve different tasks due to their emergent ability and generalizability. However, LLMs sometimes lack domain-specific knowledge to perform tasks, which would also cause hallucination during inference. In some previous works, additional modules like graph neural networks (GNNs) are trained on retrieved knowledge from external knowledge bases, aiming to mitigate the problem of lacking domain-specific knowledge. However, incorporating additional modules: 1) would need retraining additional modules when encountering novel domains; 2) would become a bottleneck since LLMs' strong abilities are not fully utilized for retrieval. In this paper, we propose a paradigm, termed Knowledge Solver (KSL), to teach LLMs to search for essential knowledge from external knowledge bases by harnessing their own strong generalizability. Specifically, we design a simple yet effective prompt to transform retrieval into a multi-hop decision sequence, which empowers LLMs with searching knowledge ability in zero-shot manner. Additionally, KSL is able to provide complete retrieval paths and therefore increase explainability of LLMs' reasoning processes. We conduct experiments on three datasets: CommonsenseQA, OpenbookQA, and MedQA-USMLE, and found that our approach improves LLM baseline performance by a relatively large margin.

Knowledge-Augmented Reasoning Distillation for Small Language Models in Knowledge-Intensive Tasks

Large Language Models (LLMs) have shown promising performance in knowledge-intensive reasoning tasks that require a compound understanding of knowledge. However, deployment of the LLMs in real-world applications can be challenging due to their high computational requirements and concerns on data privacy. Previous studies have focused on building task-specific small language models (LMs) by fine-tuning them with labeled data or distilling LLMs. However, these approaches are ill-suited for knowledge-intensive reasoning tasks due to the limited capacity of small LMs in memorizing the knowledge required. Motivated by our theoretical analysis on memorization, we propose Knowledge-Augmented Reasoning Distillation (KARD), a novel method that fine-tunes small LMs to generate rationales with augmented knowledge retrieved from an external knowledge base. Moreover, we further propose a neural reranker to obtain documents relevant to rationale generation. We empirically show that KARD significantly improves the performance of small T5 and Flan-T5 models on the challenging knowledge-intensive reasoning datasets, namely MedQA-USMLE and StrategyQA. Notably, our method makes the 250M models achieve superior performance against the fine-tuned 3B models, having 12 times larger parameters, on both MedQA-USMLE and StrategyQA benchmarks.