Haozhen Gong

Haozhen Gong, Xiaozhong Ji, Yuansen Liu et al.

MLLMs MLLMs are beginning to appear in clinical workflows, but their ability to perform complex medical reasoning remains unclear. We present Med-CMR, a fine-grained Medical Complex Multimodal Reasoning benchmark. Med-CMR distinguishes from existing counterparts by three core features: 1) Systematic capability decomposition, splitting medical multimodal reasoning into fine-grained visual understanding and multi-step reasoning to enable targeted evaluation; 2) Challenging task design, with visual understanding across three key dimensions (small-object detection, fine-detail discrimination, spatial understanding) and reasoning covering four clinically relevant scenarios (temporal prediction, causal reasoning, long-tail generalization, multi-source integration); 3) Broad, high-quality data coverage, comprising 20,653 Visual Question Answering (VQA) pairs spanning 11 organ systems and 12 imaging modalities, validated via a rigorous two-stage (human expert + model-assisted) review to ensure clinical authenticity. We evaluate 18 state-of-the-art MLLMs with Med-CMR, revealing GPT-5 as the top-performing commercial model: 57.81 accuracy on multiple-choice questions (MCQs) and a 48.70 open-ended score, outperforming Gemini 2.5 Pro (49.87 MCQ accuracy, 45.98 open-ended score) and leading open-source model Qwen3-VL-235B-A22B (49.34 MCQ accuracy, 42.62 open-ended score). However, specialized medical MLLMs do not reliably outperform strong general models, and long-tail generalization emerges as the dominant failure mode. Med-CMR thus provides a stress test for visual-reasoning integration and rare-case robustness in medical MLLMs, and a rigorous yardstick for future clinical systems.

Hanqi Jiang, Junhao Chen, Yi Pan et al.

Medical vision--language models (VLMs) are usually evaluated on intact image--question pairs, but trustworthy clinical use requires a stronger property: a model must recognise when the evidential basis for an answer has failed. We study this through silent failures under perturbed evidence, where a vision-required medical question is paired with a false premise, wording perturbation, knowledge-only rewrite, or ROI-corrupted image, yet the model returns a fluent non-refusal answer. We introduce medvigil, a 300-case evaluation suite drawn from four public medical VQA sources, supervised end to end by four board-certified radiologists: every gold answer, refusal option, candidate-answer set, paraphrase, false-premise trap, ROI box, and clinical risk tier is clinician-authored. Two attending radiologists annotate every case in parallel, a senior radiologist consolidates the released manifest, and a separate fourth radiologist independent of construction answers every probe to provide the human reference baseline. The release contains 2{,}556 MCQ probes, 240 counterfactual triplets, physician-adjudicated risk-tier and answerability flags, ROI boxes, and a paired open-ended variant. We report seven correctness-conditioned audit metrics that summarise into the medvigil Composite Score (MCS), and audit 16 vision-capable models plus two text-only baselines. The independent radiologist scores MCS 83.3 at silent-failure rate 5.8%, leaving a 14.1-point composite headroom above the strongest audited model (Claude Opus 4.7 at 69.2). The benchmark and evaluation harness are publicly released.