# Med-RLVR: Emerging Medical Reasoning from a 3B base model via reinforcement Learning

arXiv: https://arxiv.org/abs/2502.19655 · HTML: https://mlsanity.com/paper/2502.19655/

## Key facts

- Cited by 40 papers in the map (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 11 of its 14 references that are in the map.
- First posted on arXiv 27 Feb 2025.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)

## Builds on (most cited first, 11 of 11)

- [Training language models to follow instructions with human feedback](https://mlsanity.com/paper/2203.02155/) (2022)
- [Proximal Policy Optimization Algorithms](https://mlsanity.com/paper/1707.06347/) (2017)
- [Let's Verify Step by Step](https://mlsanity.com/paper/2305.20050/) (2023)
- [High-Dimensional Continuous Control Using Generalized Advantage Estimation](https://mlsanity.com/paper/1506.02438/) (2015)
- [LiveCodeBench: Holistic and Contamination Free Evaluation of Large Language Models for Code](https://mlsanity.com/paper/2403.07974/) (2024)
- [MMLU-Pro: A More Robust and Challenging Multi-Task Language Understanding Benchmark](https://mlsanity.com/paper/2406.01574/) (2024)
- [What Disease does this Patient Have? A Large-scale Open Domain Question Answering Dataset from Medical Exams](https://mlsanity.com/paper/2009.13081/) (2020)
- [Tulu 3: Pushing Frontiers in Open Language Model Post-Training](https://mlsanity.com/paper/2411.15124/) (2024)
- [SFT Memorizes, RL Generalizes: A Comparative Study of Foundation Model Post-training](https://mlsanity.com/paper/2501.17161/) (2025)
- [Can Generalist Foundation Models Outcompete Special-Purpose Tuning? Case Study in Medicine](https://mlsanity.com/paper/2311.16452/) (2023)
- [Demystifying Long Chain-of-Thought Reasoning in LLMs](https://mlsanity.com/paper/2502.03373/) (2025)

## Built on by (most cited first, 30 of 40)

- [Rubrics as Rewards: Reinforcement Learning Beyond Verifiable Domains](https://mlsanity.com/paper/2507.17746/) (2025)
- [A Survey of Reinforcement Learning for Large Reasoning Models](https://mlsanity.com/paper/2509.08827/) (2025)
- [The Invisible Leash: Why RLVR May or May Not Escape Its Origin](https://mlsanity.com/paper/2507.14843/) (2025)
- [A Sober Look at Progress in Language Model Reasoning: Pitfalls and Paths to Reproducibility](https://mlsanity.com/paper/2504.07086/) (2025)
- [Online Rubrics Elicitation from Pairwise Comparisons](https://mlsanity.com/paper/2510.07284/) (2025)
- [QoQ-Med: Building Multimodal Clinical Foundation Models with Domain-Aware GRPO Training](https://mlsanity.com/paper/2506.00711/) (2025)
- [X-Reasoner: Towards Generalizable Reasoning Across Modalities and Domains](https://mlsanity.com/paper/2505.03981/) (2025)
- [ReasonMap: Towards Fine-Grained Visual Reasoning from Transit Maps](https://mlsanity.com/paper/2505.18675/) (2025)
- [MedAgentGym: A Scalable Agentic Training Environment for Code-Centric Reasoning in Biomedical Data Science](https://mlsanity.com/paper/2506.04405/) (2025)
- [BLEUBERI: BLEU is a surprisingly effective reward for instruction following](https://mlsanity.com/paper/2505.11080/) (2025)
- [Reinforcement Learning vs. Distillation: Understanding Accuracy and Capability in LLM Reasoning](https://mlsanity.com/paper/2505.14216/) (2025)
- [Training LLMs for EHR-Based Reasoning Tasks via Reinforcement Learning](https://mlsanity.com/paper/2505.24105/) (2025)
- [OralGPT-Omni: A Versatile Dental Multimodal Large Language Model](https://mlsanity.com/paper/2511.22055/) (2025)
- [Medical Reasoning in the Era of LLMs: A Systematic Review of Enhancement Techniques and Applications](https://mlsanity.com/paper/2508.00669/) (2025)
- [Fleming-R1: Toward Expert-Level Medical Reasoning via Reinforcement Learning](https://mlsanity.com/paper/2509.15279/) (2025)
- [OctoMed: Data Recipes for State-of-the-Art Multimodal Medical Reasoning](https://mlsanity.com/paper/2511.23269/) (2025)
- [Can Large Language Models Develop Strategic Reasoning? Post-training Insights from Learning Chess](https://mlsanity.com/paper/2507.00726/) (2025)
- [Reasoning BO: Enhancing Bayesian Optimization with Long-Context Reasoning Power of LLMs](https://mlsanity.com/paper/2505.12833/) (2025)
- [Med-U1: Incentivizing Unified Medical Reasoning in LLMs via Large-scale Reinforcement Learning](https://mlsanity.com/paper/2506.12307/) (2025)
- [MedSAM-Agent: Empowering Interactive Medical Image Segmentation with Multi-turn Agentic Reinforcement Learning](https://mlsanity.com/paper/2602.03320/) (2026)
- [Open-Medical-R1: How to Choose Data for RLVR Training at Medicine Domain](https://mlsanity.com/paper/2504.13950/) (2025)
- [DentalGPT: Incentivizing Multimodal Complex Reasoning in Dentistry](https://mlsanity.com/paper/2512.11558/) (2025)
- [Improving Clinical Diagnosis with Counterfactual Multi-Agent Reasoning](https://mlsanity.com/paper/2603.27820/) (2026)
- [Training and Evaluation of Guideline-Based Medical Reasoning in LLMs](https://mlsanity.com/paper/2512.03838/) (2025)
- [Med-REFL: Medical Reasoning Enhancement via Self-Corrected Fine-grained Reflection](https://mlsanity.com/paper/2506.13793/) (2025)
- [When Does RL Help Medical VLMs? Disentangling Vision, SFT, and RL Gains](https://mlsanity.com/paper/2603.01301/) (2026)
- [Reasoning Like an Economist: Post-Training on Economic Problems Induces Strategic Generalization in LLMs](https://mlsanity.com/paper/2506.00577/) (2025)
- [One Patient, Many Contexts: Scaling Medical AI with Contextual Intelligence](https://mlsanity.com/paper/2506.10157/) (2025)
- [RLoop: An Self-Improving Framework for Reinforcement Learning with Iterative Policy Initialization](https://mlsanity.com/paper/2511.04285/) (2025)
- [LLMs can construct powerful representations and streamline sample-efficient supervised learning](https://mlsanity.com/paper/2603.11679/) (2026)

## Abstract (arXiv)

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.