Zhicheng Yang

Zhangpu Li, Changhong Zou, Suxue Ma et al.

The rocketing prosperity of large language models (LLMs) in recent years has boosted the prevalence of vision-language models (VLMs) in the medical sector. In our online medical consultation scenario, a doctor responds to the texts and images provided by a patient in multiple rounds to diagnose her/his health condition, forming a multi-turn multimodal medical dialogue format. Unlike high-quality images captured by professional equipment in traditional medical visual question answering (Med-VQA), the images in our case are taken by patients' mobile phones. These images have poor quality control, with issues such as excessive background elements and the lesion area being significantly off-center, leading to degradation of vision-language alignment in the model training phase. In this paper, we propose ZALM3, a Zero-shot strategy to improve vision-language ALignment in Multi-turn Multimodal Medical dialogue. Since we observe that the preceding text conversations before an image can infer the regions of interest (RoIs) in the image, ZALM3 employs an LLM to summarize the keywords from the preceding context and a visual grounding model to extract the RoIs. The updated images eliminate unnecessary background noise and provide more effective vision-language alignment. To better evaluate our proposed method, we design a new subjective assessment metric for multi-turn unimodal/multimodal medical dialogue to provide a fine-grained performance comparison. Our experiments across three different clinical departments remarkably demonstrate the efficacy of ZALM3 with statistical significance.

Yongxin Wang, Zhicheng Yang, Meng Cao et al.

Group-relative reinforcement learning with verifiable rewards (RLVR) often wastes the most informative data it already has the failures. When all rollouts are wrong, gradients stall; when one happens to be correct, the update usually ignores why the others are close-but-wrong, and credit can be misassigned to spurious chains. We present CARE (Contrastive Anchored REflection), a failure-centric post-training framework for multimodal reasoning that turns errors into supervision. CARE combines: (i) an anchored-contrastive objective that forms a compact subgroup around the best rollout and a set of semantically proximate hard negatives, performs within-subgroup z-score normalization with negative-only scaling, and includes an all-negative rescue to prevent zero-signal batches; and (ii) Reflection-Guided Resampling (RGR), a one-shot structured self-repair that rewrites a representative failure and re-scores it with the same verifier, converting near-misses into usable positives without any test-time reflection. CARE improves accuracy and training smoothness while explicitly increasing the share of learning signal that comes from failures. On Qwen2.5-VL-7B, CARE lifts macro-averaged accuracy by 4.6 points over GRPO across six verifiable visual-reasoning benchmarks; with Qwen3-VL-8B it reaches competitive or state-of-the-art results on MathVista and MMMU-Pro under an identical evaluation protocol.