arXiv:2512.00818v2 Announce Type: replace Abstract: 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.

arXiv:2603.08412v1 Announce Type: cross Abstract: Reinforcement Learning from Human Feedback (RLHF) assumes annotator preferences reflect stable internal states. We challenge this through three experiments spanning the preference pipeline. In a human choice blindness study, 91% of surreptitiously swapped preferences go undetected, extending choice blindness to third-person evaluative comparison of unfamiliar text. Testing fifteen LLM judges as potential replacements, we find detection relies on shallow text matching rather than genuine self-monitoring: removing prior reasoning from context causes blindness to surge from near-zero to over 50%, while explicit social pressure induces near-universal compliance. In a dose-response experiment across two architectures from 86M to 2B parameters, one-sixth to one-third of labels must be corrupted before the reward signal halves, yet standard pairwise accuracy remains virtually unchanged. A Best-of-N evaluation confirms this translates to downstream policy degradation: at 50% corruption, reward-guided selection produces no improvement over random sampling, while the proxy model reports monotonically increasing scores. Together, these results reveal a preference construction problem: the signal entering RLHF is shaped by elicitation context in ways that neither human metacognition, LLM self-monitoring, nor standard evaluation metrics can detect.