Wenbo Hu

Existing medical reasoning benchmarks for vision-language models primarily focus on analyzing a patient’s condition based on an image from a *single* visit. However, this setting deviates significantly from real-world clinical practice, where doctors typically refer to a patient’s historical conditions to provide a comprehensive assessment by tracking their changes over time. In this paper, we introduce TemMed-Bench, a multi-task benchmark designed for analyzing changes in patients’ conditions between different clinical visits, which challenges large vision-language models (LVLMs) to reason over **tem**poral **med**ical images. TemMed-Bench consists of a test set comprising three tasks – visual question-answering (VQA), report generation, and image-pair selection – and a supplementary knowledge corpus of over 17,000 instances. With TemMed-Bench, we conduct an evaluation of twelve LVLMs, comprising six proprietary and six open-source models. Our results show that most LVLMs lack the ability to analyze patients’ condition changes over temporal medical images. To enhance the tracking of condition changes, we explore augmenting the input with both retrieved visual and textual modalities in the medical domain. We also show that multi-modal retrieval augmentation yields notably higher performance gains than no retrieval and textual retrieval alone across most models on our benchmark, with the VQA task showing an average improvement of 2.59%. Overall, we compose a benchmark grounded on real-world clinical practice, and it reveals LVLMs’ limitations in temporal medical image reasoning, as well as highlighting the use of multi-modal retrieval augmentation as a potentially promising direction worth exploring to address this challenge.

Group Relative Policy Optimization (GRPO) has emerged as the de facto Reinforcement Learning (RL) objective driving recent advancements in Multimodal Large Language Models. However, extending this success to open-source multimodal generalist models remains heavily constrained by two primary challenges: the extreme variance in reward topologies across diverse visual tasks, and the inherent difficulty of balancing fine-grained perception with multi-step reasoning capabilities. To address these issues, we introduce Gaussian GRPO (G$^2$RPO), a novel RL training objective that replaces standard linear scaling with non-linear distributional matching. By mathematically forcing the advantage distribution of any given task to strictly converge to a standard normal distribution, $\mathcal{N}(0,1)$, G$^2$RPO promotes advantage-scale equity across tasks, mitigates vulnerabilities to heavy-tail outliers, and offers symmetric update for positive and negative rewards. Leveraging the enhanced training stability provided by G$^2$RPO, we introduce two task-level shaping mechanisms to seamlessly balance perception and reasoning. First, response length shaping dynamically elicits extended reasoning chains for complex queries while enforce direct outputs to bolster visual grounding. Second, entropy shaping tightly bounds the model's exploration zone, effectively preventing both entropy collapse and entropy explosion. Integrating these methodologies, we present OpenVLThinkerV2, a highly robust, general-purpose multimodal model. Extensive evaluations across 18 diverse benchmarks demonstrate its superior performance over strong open-source and leading proprietary frontier models.