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MedCausalX: Adaptive Causal Reasoning with Self-Reflection for Trustworthy Medical Vision-Language Models

arXiv:2603.23085v1 Announce Type: new Abstract: Vision-Language Models (VLMs) have enabled interpretable medical diagnosis by integrating visual perception with linguistic reasoning. Yet, existing medical chain-of-thought (CoT) models lack explicit mechanisms to represent and enforce causal reasoning, leaving them vulnerable to spurious correlations and limiting their clinical reliability. We pinpoint three core challenges in medical CoT reasoning: how to adaptively trigger causal correction, construct high-quality causal-spurious contrastive samples, and maintain causal consistency across reasoning trajectories. To address these challenges, we propose MedCausalX, an end-to-end framework explicitly models causal reasoning chains in medical VLMs. We first introduce the CRMed dataset providing fine-grained anatomical annotations, structured causal reasoning chains, and counterfactual variants that guide the learning of causal relationships beyond superficial correlations. Building upon CRMed, MedCausalX employs a two-stage adaptive reflection architecture equipped with $\langle$causal$\rangle$ and $\langle$verify$\rangle$ tokens, enabling the model to autonomously determine when and how to perform causal analysis and verification. Finally, a trajectory-level causal correction objective optimized through error-attributed reinforcement learning refines the reasoning chain, allowing the model to distinguish genuine causal dependencies from shortcut associations. Extensive experiments on multiple benchmarks show that MedCausalX consistently outperforms state-of-the-art methods, improving diagnostic consistency by +5.4 points, reducing hallucination by over 10 points, and attaining top spatial grounding IoU, thereby setting a new standard for causally grounded medical reasoning.
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Real-Time Aligned Reward Model beyond Semantics

arXiv:2601.22664v3 Announce Type: replace Abstract: Reinforcement Learning from Human Feedback (RLHF) is a pivotal technique for aligning large language models (LLMs) with human preferences, yet it is susceptible to reward overoptimization, in which policy models overfit to the reward model, exploit spurious reward patterns instead of faithfully capturing human intent. Prior mitigations primarily relies on surface semantic information and fails to efficiently address the misalignment between the reward model (RM) and the policy model caused by continuous policy distribution shifts. This inevitably leads to an increasing reward discrepancy, exacerbating reward overoptimization. To address these limitations, we introduce R2M (Real-Time Aligned Reward Model), a novel lightweight RLHF framework. R2M goes beyond vanilla reward models that solely depend on the semantic representations of a pretrained LLM. Instead, it leverages the evolving hidden states of the policy (namely policy feedback) to align with the real-time distribution shift of the policy during the RL process. This work points to a promising new direction for improving the performance of reward models through real-time utilization of feedback from policy models.
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Adaptive Batch-Wise Sample Scheduling for Direct Preference Optimization

arXiv:2506.17252v4 Announce Type: replace-cross Abstract: Direct Preference Optimization (DPO) has emerged as an effective approach for aligning large language models (LLMs) with human preferences. However, its performance is highly dependent on the quality of the underlying human preference data. To address this bottleneck, prior work has explored various data selection strategies, but these methods often overlook the impact of the evolving states of the language model during the optimization process. In this paper, we introduce a novel problem: Sample Scheduling for DPO, which aims to dynamically and adaptively schedule training samples based on the model's evolving batch-wise states throughout preference optimization. To solve this problem, we propose SamS, an efficient and effective algorithm that adaptively selects samples in each training batch based on the LLM's learning feedback to maximize the potential generalization performance. Notably, without modifying the core DPO algorithm, simply integrating SamS significantly improves performance across tasks, with minimal additional computational overhead. This work points to a promising new direction for improving LLM alignment through batch-wise sample selection, with potential generalization to RLHF and broader supervised learning paradigms.
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Does Your Reasoning Model Implicitly Know When to Stop Thinking?

arXiv:2602.08354v2 Announce Type: replace Abstract: Recent advancements in large reasoning models (LRMs) have greatly improved their capabilities on complex reasoning tasks through Long Chains of Thought (CoTs). However, this approach often results in substantial redundancy, impairing computational efficiency and causing significant delays in real-time applications. Recent studies show that longer reasoning chains are frequently uncorrelated with correctness and can even be detrimental to accuracy. In a further in-depth analysis of this phenomenon, we surprisingly uncover and empirically verify that LRMs implicitly know the appropriate time to stop thinking, while this capability is obscured by current sampling paradigms. Motivated by this, we introduce SAGE (Self-Aware Guided Efficient Reasoning), a novel sampling paradigm that unleashes this efficient reasoning potential. Furthermore, integrating SAGE as mixed sampling into group-based reinforcement learning (SAGE-RL) enables SAGE-RL to effectively incorporate SAGE-discovered efficient reasoning patterns into standard pass@1 inference, markedly enhancing both the reasoning accuracy and efficiency of LRMs across multiple challenging mathematical benchmarks.
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