Qianchu Liu

Shruthi Bannur, Stephanie Hyland, Qianchu Liu et al. · cambridge, microsoft-research

Self-supervised learning in vision-language processing exploits semantic alignment between imaging and text modalities. Prior work in biomedical VLP has mostly relied on the alignment of single image and report pairs even though clinical notes commonly refer to prior images. This does not only introduce poor alignment between the modalities but also a missed opportunity to exploit rich self-supervision through existing temporal content in the data. In this work, we explicitly account for prior images and reports when available during both training and fine-tuning. Our approach, named BioViL-T, uses a CNN-Transformer hybrid multi-image encoder trained jointly with a text model. It is designed to be versatile to arising challenges such as pose variations and missing input images across time. The resulting model excels on downstream tasks both in single- and multi-image setups, achieving state-of-the-art performance on (I) progression classification, (II) phrase grounding, and (III) report generation, whilst offering consistent improvements on disease classification and sentence-similarity tasks. We release a novel multi-modal temporal benchmark dataset, MS-CXR-T, to quantify the quality of vision-language representations in terms of temporal semantics. Our experimental results show the advantages of incorporating prior images and reports to make most use of the data.

Qianchu Liu, Stephanie Hyland, Shruthi Bannur et al. · cambridge, microsoft-research

The recent success of general-domain large language models (LLMs) has significantly changed the natural language processing paradigm towards a unified foundation model across domains and applications. In this paper, we focus on assessing the performance of GPT-4, the most capable LLM so far, on the text-based applications for radiology reports, comparing against state-of-the-art (SOTA) radiology-specific models. Exploring various prompting strategies, we evaluated GPT-4 on a diverse range of common radiology tasks and we found GPT-4 either outperforms or is on par with current SOTA radiology models. With zero-shot prompting, GPT-4 already obtains substantial gains ($\approx$ 10% absolute improvement) over radiology models in temporal sentence similarity classification (accuracy) and natural language inference ($F_1$). For tasks that require learning dataset-specific style or schema (e.g. findings summarisation), GPT-4 improves with example-based prompting and matches supervised SOTA. Our extensive error analysis with a board-certified radiologist shows GPT-4 has a sufficient level of radiology knowledge with only occasional errors in complex context that require nuanced domain knowledge. For findings summarisation, GPT-4 outputs are found to be overall comparable with existing manually-written impressions.

Fangyu Liu, Qianchu Liu, Shruthi Bannur et al. · cambridge, deepmind

Label scarcity is a bottleneck for improving task performance in specialised domains. We propose a novel compositional transfer learning framework (DoT5 - domain compositional zero-shot T5) for zero-shot domain transfer. Without access to in-domain labels, DoT5 jointly learns domain knowledge (from MLM of unlabelled in-domain free text) and task knowledge (from task training on more readily available general-domain data) in a multi-task manner. To improve the transferability of task training, we design a strategy named NLGU: we simultaneously train NLG for in-domain label-to-data generation which enables data augmentation for self-finetuning and NLU for label prediction. We evaluate DoT5 on the biomedical domain and the resource-lean subdomain of radiology, focusing on NLI, text summarisation and embedding learning. DoT5 demonstrates the effectiveness of compositional transfer learning through multi-task learning. In particular, DoT5 outperforms the current SOTA in zero-shot transfer by over 7 absolute points in accuracy on RadNLI. We validate DoT5 with ablations and a case study demonstrating its ability to solve challenging NLI examples requiring in-domain expertise.

Qianchu Liu, Sheng Zhang, Guanghui Qin et al. · microsoft-research

Frontier models have demonstrated remarkable capabilities in understanding and reasoning with natural-language text, but they still exhibit major competency gaps in multimodal understanding and reasoning especially in high-value verticals such as biomedicine. Medical imaging report generation is a prominent example. Supervised fine-tuning can substantially improve performance, but they are prone to overfitting to superficial boilerplate patterns. In this paper, we introduce Universal Report Generation (UniRG) as a general framework for medical imaging report generation. By leveraging reinforcement learning as a unifying mechanism to directly optimize for evaluation metrics designed for end applications, UniRG can significantly improve upon supervised fine-tuning and attain durable generalization across diverse institutions and clinical practices. We trained UniRG-CXR on publicly available chest X-ray (CXR) data and conducted a thorough evaluation in CXR report generation with rigorous evaluation scenarios. On the authoritative ReXrank benchmark, UniRG-CXR sets new overall SOTA, outperforming prior state of the art by a wide margin.

Qianchu Liu, Sheng Zhang, Guanghui Qin et al. · microsoft-research

Recent proprietary models (e.g., o3) have begun to demonstrate strong multimodal reasoning capabilities. Yet, most existing open-source research concentrates on training text-only reasoning models, with evaluations limited to mainly mathematical and general-domain tasks. Therefore, it remains unclear how to effectively extend reasoning capabilities beyond text input and general domains. This paper explores a fundamental research question: Is reasoning generalizable across modalities and domains? Our findings support an affirmative answer: General-domain text-based post-training can enable such strong generalizable reasoning. Leveraging this finding, we introduce X-Reasoner, a vision-language model post-trained solely on general-domain text for generalizable reasoning, using a two-stage approach: an initial supervised fine-tuning phase with distilled long chain-of-thoughts, followed by reinforcement learning with verifiable rewards. Experiments show that X-Reasoner successfully transfers reasoning capabilities to both multimodal and out-of-domain settings, outperforming existing state-of-the-art models trained with in-domain and multimodal data across various general and medical benchmarks (Figure 1). Additionally, we find that X-Reasoner's performance in specialized domains can be further enhanced through continued training on domain-specific text-only data. Building upon this, we introduce X-Reasoner-Med, a medical-specialized variant that achieves new state of the art on numerous text-only and multimodal medical benchmarks.

Timothy Ossowski, Sheng Zhang, Qianchu Liu et al.

High-quality and carefully curated data is a cornerstone of training medical large language models, as it directly impacts both generalization and robustness to unseen clinical tasks. We investigate strategies for training and data curation to develop a robust multimodal reasoning model in the medical domain. Our work focuses on supervised fine-tuning (SFT) and explores data recipes that leverage structured reasoning traces. Using our proposed data recipe, we scale experiments to a dataset of over 8 million examples and 6.8 billion response tokens, achieving state-of-the-art performance among open-source models across diverse out-of-distribution medical benchmark tasks. Our results further indicate that curating a high-quality, diverse training dataset with varying structured reasoning trace lengths enables the fine-tuned model to self-calibrate its reasoning trajectory lengths based on the downstream task, without explicit supervision. We present key insights, describe the data curation strategy, and outline next steps toward developing robust medical vision-language reasoning system.

James Y. Huang, Sheng Zhang, Qianchu Liu et al.

Large Language Models (LLMs) have demonstrated remarkable capabilities in challenging, knowledge-intensive reasoning tasks. However, extending LLMs to perceive and reason over a new modality (e.g., vision), often requires costly development of large-scale vision language models (VLMs) with LLMs as backbones. Smaller VLMs are more efficient and adaptable but often lack the broad knowledge and reasoning capabilities of frontier LLMs. In this work, we propose BeMyEyes, a modular, multi-agent framework for extending LLMs to multimodal reasoning by orchestrating collaboration between efficient, adaptable VLMs as perceivers and powerful LLMs as reasoners through conversations. We then introduce a data synthesis and supervised fine-tuning pipeline to train the perceiver agent to effectively collaborate with the reasoner agent. By combining the complementary strengths of perception and reasoning agents, BeMyEyes avoids the need for training large-scale multimodal models, preserves the generalization and reasoning capabilities of LLMs, and allows flexible extension to new domains and modalities. Experiments show that our framework unlocks the multimodal reasoning capabilities for LLMs, enabling a lightweight and fully open-source solution, i.e. equipping text-only DeepSeek-R1 with Qwen2.5-VL-7B perceiver, to outperform large-scale proprietary VLMs such as GPT-4o on a wide range of knowledge-intensive multimodal tasks. These results demonstrate the effectiveness, modularity, and scalability of our multi-agent approach for building future multimodal reasoning systems.

Edoardo Maria Ponti, Goran Glavaš, Olga Majewska et al.

In order to simulate human language capacity, natural language processing systems must be able to reason about the dynamics of everyday situations, including their possible causes and effects. Moreover, they should be able to generalise the acquired world knowledge to new languages, modulo cultural differences. Advances in machine reasoning and cross-lingual transfer depend on the availability of challenging evaluation benchmarks. Motivated by both demands, we introduce Cross-lingual Choice of Plausible Alternatives (XCOPA), a typologically diverse multilingual dataset for causal commonsense reasoning in 11 languages, which includes resource-poor languages like Eastern Apurímac Quechua and Haitian Creole. We evaluate a range of state-of-the-art models on this novel dataset, revealing that the performance of current methods based on multilingual pretraining and zero-shot fine-tuning falls short compared to translation-based transfer. Finally, we propose strategies to adapt multilingual models to out-of-sample resource-lean languages where only a small corpus or a bilingual dictionary is available, and report substantial improvements over the random baseline. The XCOPA dataset is freely available at github.com/cambridgeltl/xcopa.

Sheng Zhang, Qianchu Liu, Guanghui Qin et al. · microsoft-research

Reinforcement learning from verifiable rewards (RLVR) has recently gained attention for its ability to elicit self-evolved reasoning capabilitie from base language models without explicit reasoning supervisions, as demonstrated by DeepSeek-R1. While prior work on RLVR has primarily focused on mathematical and coding domains, its applicability to other tasks and domains remains unexplored. In this work, we investigate whether medical reasoning can emerge from RLVR. We introduce Med-RLVR as an initial study of RLVR in the medical domain leveraging medical multiple-choice question answering (MCQA) data as verifiable labels. Our results demonstrate that RLVR is not only effective for math and coding but also extends successfully to medical question answering. Notably, Med-RLVR achieves performance comparable to traditional supervised fine-tuning (SFT) on in-distribution tasks while significantly improving out-of-distribution generalization, with an 8-point accuracy gain. Further analysis of training dynamics reveals that, with no explicit reasoning supervision, reasoning emerges from the 3B-parameter base model. These findings underscore the potential of RLVR in domains beyond math and coding, opening new avenues for its application in knowledge-intensive fields such as medicine.

Cliff Wong, Sam Preston, Qianchu Liu et al. · microsoft-research

A significant fraction of real-world patient information resides in unstructured clinical text. Medical abstraction extracts and normalizes key structured attributes from free-text clinical notes, which is the prerequisite for a variety of important downstream applications, including registry curation, clinical trial operations, and real-world evidence generation. Prior medical abstraction methods typically resort to building attribute-specific models, each of which requires extensive manual effort such as rule creation or supervised label annotation for the individual attribute, thus limiting scalability. In this paper, we show that existing frontier models already possess the universal abstraction capability for scaling medical abstraction to a wide range of clinical attributes. We present UniMedAbstractor (UMA), a unifying framework for zero-shot medical abstraction with a modular, customizable prompt template and the selection of any frontier large language models. Given a new attribute for abstraction, users only need to conduct lightweight prompt adaptation in UMA to adjust the specification in natural languages. Compared to traditional methods, UMA eliminates the need for attribute-specific training labels or handcrafted rules, thus substantially reducing the development time and cost. We conducted a comprehensive evaluation of UMA in oncology using a wide range of marquee attributes representing the cancer patient journey. These include relatively simple attributes typically specified within a single clinical note (e.g. performance status), as well as complex attributes requiring sophisticated reasoning across multiple notes at various time points (e.g. tumor staging). Based on a single frontier model such as GPT-4o, UMA matched or even exceeded the performance of state-of-the-art attribute-specific methods, each of which was tailored to the individual attribute.

Yu Gu, Jingjing Fu, Xiaodong Liu et al.

Large frontier models like GPT-5 now achieve top scores on medical benchmarks. But our stress tests tell a different story. Leading systems often guess correctly even when key inputs like images are removed, flip answers under trivial prompt changes, and fabricate convincing yet flawed reasoning. These aren't glitches; they expose how today's benchmarks reward test-taking tricks over medical understanding. We evaluate six flagship models across six widely used benchmarks and find that high leaderboard scores hide brittleness and shortcut learning. Through clinician-guided rubric evaluation, we show that benchmarks vary widely in what they truly measure yet are treated interchangeably, masking failure modes. We caution that medical benchmark scores do not directly reflect real-world readiness. If we want AI to earn trust in healthcare, we must demand more than leaderboard wins and must hold systems accountable for robustness, sound reasoning, and alignment with real medical demands.

Raj Sanjay Shah, Lei Xu, Qianchu Liu et al.

Behavioral therapy notes are important for both legal compliance and patient care. Unlike progress notes in physical health, quality standards for behavioral therapy notes remain underdeveloped. To address this gap, we collaborated with licensed therapists to design a comprehensive rubric for evaluating therapy notes across key dimensions: completeness, conciseness, and faithfulness. Further, we extend a public dataset of behavioral health conversations with therapist-written notes and LLM-generated notes, and apply our evaluation framework to measure their quality. We find that: (1) A rubric-based manual evaluation protocol offers more reliable and interpretable results than traditional Likert-scale annotations. (2) LLMs can mimic human evaluators in assessing completeness and conciseness but struggle with faithfulness. (3) Therapist-written notes often lack completeness and conciseness, while LLM-generated notes contain hallucination. Surprisingly, in a blind test, therapists prefer and judge LLM-generated notes to be superior to therapist-written notes.

Emily Alsentzer, Marie-Laure Charpignon, Bill Chen et al.

The 6th Annual Conference on Health, Inference, and Learning (CHIL 2025), hosted by the Association for Health Learning and Inference (AHLI), was held in person on June 25-27, 2025, at the University of California, Berkeley, in Berkeley, California, USA. As part of this year's program, we hosted Research Roundtables to catalyze collaborative, small-group dialogue around critical, timely topics at the intersection of machine learning and healthcare. Each roundtable was moderated by a team of senior and junior chairs who fostered open exchange, intellectual curiosity, and inclusive engagement. The sessions emphasized rigorous discussion of key challenges, exploration of emerging opportunities, and collective ideation toward actionable directions in the field. In total, eight roundtables were held by 19 roundtable chairs on topics of "Explainability, Interpretability, and Transparency," "Uncertainty, Bias, and Fairness," "Causality," "Domain Adaptation," "Foundation Models," "Learning from Small Medical Data," "Multimodal Methods," and "Scalable, Translational Healthcare Solutions."

Qianchu Liu, Diana McCarthy, Anna Korhonen

State-of-the-art pretrained contextualized models (PCM) eg. BERT use tasks such as WiC and WSD to evaluate their word-in-context representations. This inherently assumes that performance in these tasks reflect how well a model represents the coupled word and context semantics. We question this assumption by presenting the first quantitative analysis on the context-word interaction being tested in major contextual lexical semantic tasks. To achieve this, we run probing baselines on masked input, and propose measures to calculate and visualize the degree of context or word biases in existing datasets. The analysis was performed on both models and humans. Our findings demonstrate that models are usually not being tested for word-in-context semantics in the same way as humans are in these tasks, which helps us better understand the model-human gap. Specifically, to PCMs, most existing datasets fall into the extreme ends (the retrieval-based tasks exhibit strong target word bias while WiC-style tasks and WSD show strong context bias); In comparison, humans are less biased and achieve much better performance when both word and context are available than with masked input. We recommend our framework for understanding and controlling these biases for model interpretation and future task design.

Qianchu Liu, Fangyu Liu, Nigel Collier et al.

Recent work indicated that pretrained language models (PLMs) such as BERT and RoBERTa can be transformed into effective sentence and word encoders even via simple self-supervised techniques. Inspired by this line of work, in this paper we propose a fully unsupervised approach to improving word-in-context (WiC) representations in PLMs, achieved via a simple and efficient WiC-targeted fine-tuning procedure: MirrorWiC. The proposed method leverages only raw texts sampled from Wikipedia, assuming no sense-annotated data, and learns context-aware word representations within a standard contrastive learning setup. We experiment with a series of standard and comprehensive WiC benchmarks across multiple languages. Our proposed fully unsupervised MirrorWiC models obtain substantial gains over off-the-shelf PLMs across all monolingual, multilingual and cross-lingual setups. Moreover, on some standard WiC benchmarks, MirrorWiC is even on-par with supervised models fine-tuned with in-task data and sense labels.

Qianchu Liu, Edoardo M. Ponti, Diana McCarthy et al.

Capturing word meaning in context and distinguishing between correspondences and variations across languages is key to building successful multilingual and cross-lingual text representation models. However, existing multilingual evaluation datasets that evaluate lexical semantics "in-context" have various limitations. In particular, 1) their language coverage is restricted to high-resource languages and skewed in favor of only a few language families and areas, 2) a design that makes the task solvable via superficial cues, which results in artificially inflated (and sometimes super-human) performances of pretrained encoders, on many target languages, which limits their usefulness for model probing and diagnostics, and 3) little support for cross-lingual evaluation. In order to address these gaps, we present AM2iCo (Adversarial and Multilingual Meaning in Context), a wide-coverage cross-lingual and multilingual evaluation set; it aims to faithfully assess the ability of state-of-the-art (SotA) representation models to understand the identity of word meaning in cross-lingual contexts for 14 language pairs. We conduct a series of experiments in a wide range of setups and demonstrate the challenging nature of AM2iCo. The results reveal that current SotA pretrained encoders substantially lag behind human performance, and the largest gaps are observed for low-resource languages and languages dissimilar to English.