# Med-R1: Reinforcement Learning for Generalizable Medical Reasoning in Vision-Language Models

arXiv: https://arxiv.org/abs/2503.13939 · HTML: https://mlsanity.com/paper/2503.13939/

## Key facts

- Cited by 144 papers in the map (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 33 of its 46 references that are in the map.
- First posted on arXiv 18 Mar 2025.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)
- Multimodal LLMs / vision-language models / [Medical vision-language models](https://mlsanity.com/mllm/medical-vision-language-models/)

## Builds on (most cited first, 30 of 33)

- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [PyTorch: An Imperative Style, High-Performance Deep Learning Library](https://mlsanity.com/paper/1912.01703/) (2019)
- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [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)
- [Chain-of-Thought Prompting Elicits Reasoning in Large Language Models](https://mlsanity.com/paper/2201.11903/) (2022)
- [DeepSeekMath: Pushing the Limits of Mathematical Reasoning in Open Language Models](https://mlsanity.com/paper/2402.03300/) (2024)
- [Visual Instruction Tuning](https://mlsanity.com/paper/2304.08485/) (2023)
- [BLIP-2: Bootstrapping Language-Image Pre-training with Frozen Image Encoders and Large Language Models](https://mlsanity.com/paper/2301.12597/) (2023)
- [Qwen2.5-VL Technical Report](https://mlsanity.com/paper/2502.13923/) (2025)
- [GPT-4o System Card](https://mlsanity.com/paper/2410.21276/) (2024)
- [Qwen2-VL: Enhancing Vision-Language Model's Perception of the World at Any Resolution](https://mlsanity.com/paper/2409.12191/) (2024)
- [Deep reinforcement learning from human preferences](https://mlsanity.com/paper/1706.03741/) (2017)
- [Qwen Technical Report](https://mlsanity.com/paper/2309.16609/) (2023)
- [Gemini 1.5: Unlocking multimodal understanding across millions of tokens of context](https://mlsanity.com/paper/2403.05530/) (2024)
- [Constitutional AI: Harmlessness from AI Feedback](https://mlsanity.com/paper/2212.08073/) (2022)
- [InstructBLIP: Towards General-purpose Vision-Language Models with Instruction Tuning](https://mlsanity.com/paper/2305.06500/) (2023)
- [MiniGPT-4: Enhancing Vision-Language Understanding with Advanced Large Language Models](https://mlsanity.com/paper/2304.10592/) (2023)
- [FlashAttention-2: Faster Attention with Better Parallelism and Work Partitioning](https://mlsanity.com/paper/2307.08691/) (2023)
- [Expanding Performance Boundaries of Open-Source Multimodal Models with Model, Data, and Test-Time Scaling](https://mlsanity.com/paper/2412.05271/) (2024)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [Program of Thoughts Prompting: Disentangling Computation from Reasoning for Numerical Reasoning Tasks](https://mlsanity.com/paper/2211.12588/) (2022)
- [SFT Memorizes, RL Generalizes: A Comparative Study of Foundation Model Post-training](https://mlsanity.com/paper/2501.17161/) (2025)
- [Vision-R1: Incentivizing Reasoning Capability in Multimodal Large Language Models](https://mlsanity.com/paper/2503.06749/) (2025)
- [LLaMA-Adapter V2: Parameter-Efficient Visual Instruction Model](https://mlsanity.com/paper/2304.15010/) (2023)
- [Med-Flamingo: a Multimodal Medical Few-shot Learner](https://mlsanity.com/paper/2307.15189/) (2023)
- [PMC-VQA: Visual Instruction Tuning for Medical Visual Question Answering](https://mlsanity.com/paper/2305.10415/) (2023)
- [HuatuoGPT-Vision, Towards Injecting Medical Visual Knowledge into Multimodal LLMs at Scale](https://mlsanity.com/paper/2406.19280/) (2024)
- [OmniMedVQA: A New Large-Scale Comprehensive Evaluation Benchmark for Medical LVLM](https://mlsanity.com/paper/2402.09181/) (2024)
- [MedVLM-R1: Incentivizing Medical Reasoning Capability of Vision-Language Models (VLMs) via Reinforcement Learning](https://mlsanity.com/paper/2502.19634/) (2025)

## Built on by (most cited first, 30 of 144)

- [Video-R1: Reinforcing Video Reasoning in MLLMs](https://mlsanity.com/paper/2503.21776/) (2025)
- [Lingshu: A Generalist Foundation Model for Unified Multimodal Medical Understanding and Reasoning](https://mlsanity.com/paper/2506.07044/) (2025)
- [Thinking with Images for Multimodal Reasoning: Foundations, Methods, and Future Frontiers](https://mlsanity.com/paper/2506.23918/) (2025)
- [The Invisible Leash: Why RLVR May or May Not Escape Its Origin](https://mlsanity.com/paper/2507.14843/) (2025)
- [Perception, Reason, Think, and Plan: A Survey on Large Multimodal Reasoning Models](https://mlsanity.com/paper/2505.04921/) (2025)
- [NoisyRollout: Reinforcing Visual Reasoning with Data Augmentation](https://mlsanity.com/paper/2504.13055/) (2025)
- [JudgeLRM: Large Reasoning Models as a Judge](https://mlsanity.com/paper/2504.00050/) (2025)
- [Training a Scientific Reasoning Model for Chemistry](https://mlsanity.com/paper/2506.17238/) (2025)
- [An Empirical Study on Reinforcement Learning for Reasoning-Search Interleaved LLM Agents](https://mlsanity.com/paper/2505.15117/) (2025)
- [SophiaVL-R1: Reinforcing MLLMs Reasoning with Thinking Reward](https://mlsanity.com/paper/2505.17018/) (2025)
- [Think or Not Think: A Study of Explicit Thinking in Rule-Based Visual Reinforcement Fine-Tuning](https://mlsanity.com/paper/2503.16188/) (2025)
- [Patho-R1: A Multimodal Reinforcement Learning-Based Pathology Expert Reasoner](https://mlsanity.com/paper/2505.11404/) (2025)
- [QoQ-Med: Building Multimodal Clinical Foundation Models with Domain-Aware GRPO Training](https://mlsanity.com/paper/2506.00711/) (2025)
- [Drive-R1: Bridging Reasoning and Planning in VLMs for Autonomous Driving with Reinforcement Learning](https://mlsanity.com/paper/2506.18234/) (2025)
- [Jigsaw-R1: A Study of Rule-based Visual Reinforcement Learning with Jigsaw Puzzles](https://mlsanity.com/paper/2505.23590/) (2025)
- [ChestX-Reasoner: Advancing Radiology Foundation Models with Reasoning through Step-by-Step Verification](https://mlsanity.com/paper/2504.20930/) (2025)
- [X-Reasoner: Towards Generalizable Reasoning Across Modalities and Domains](https://mlsanity.com/paper/2505.03981/) (2025)
- [On the Effect of Negative Gradient in Group Relative Deep Reinforcement Optimization](https://mlsanity.com/paper/2505.18830/) (2025)
- [Real-World Doctor Agent with Proactive Consultation through Multi-Agent Reinforcement Learning](https://mlsanity.com/paper/2505.19630/) (2025)
- [MedVLThinker: Simple Baselines for Multimodal Medical Reasoning](https://mlsanity.com/paper/2508.02669/) (2025)
- [MedAgentGym: A Scalable Agentic Training Environment for Code-Centric Reasoning in Biomedical Data Science](https://mlsanity.com/paper/2506.04405/) (2025)
- [SportR: A Benchmark for Multimodal Large Language Model Reasoning in Sports](https://mlsanity.com/paper/2511.06499/) (2025)
- [Improving Medical Reasoning with Curriculum-Aware Reinforcement Learning](https://mlsanity.com/paper/2505.19213/) (2025)
- [Chiron-o1: Igniting Multimodal Large Language Models towards Generalizable Medical Reasoning via Mentor-Intern Collaborative Search](https://mlsanity.com/paper/2506.16962/) (2025)
- [MedMO: Grounding and Understanding Multimodal Large Language Model for Medical Images](https://mlsanity.com/paper/2602.06965/) (2026)
- [Reinforcement Fine-Tuning Powers Reasoning Capability of Multimodal Large Language Models](https://mlsanity.com/paper/2505.18536/) (2025)
- [Training LLMs for EHR-Based Reasoning Tasks via Reinforcement Learning](https://mlsanity.com/paper/2505.24105/) (2025)
- [LLaDA-MedV: Exploring Large Language Diffusion Models for Biomedical Image Understanding](https://mlsanity.com/paper/2508.01617/) (2025)
- [Think Twice to See More: Iterative Visual Reasoning in Medical VLMs](https://mlsanity.com/paper/2510.10052/) (2025)
- [AVATAR: Reinforcement Learning to See, Hear, and Reason Over Video](https://mlsanity.com/paper/2508.03100/) (2025)

## Abstract (arXiv)

Vision-language models (VLMs) have achieved impressive progress in natural image reasoning, yet their potential in medical imaging remains underexplored. Medical vision-language tasks demand precise understanding and clinically coherent answers, which are difficult to achieve due to the complexity of medical data and the scarcity of high-quality expert annotations. These challenges limit the effectiveness of conventional supervised fine-tuning (SFT) and Chain-of-Thought (CoT) strategies that work well in general domains. To address these challenges, we propose Med-R1, a reinforcement learning (RL)-enhanced vision-language model designed to improve generalization and reliability in medical reasoning. Built on the DeepSeek strategy, Med-R1 adopts Group Relative Policy Optimization (GRPO) to encourage reward-guided learning beyond static annotations. We comprehensively evaluate Med-R1 across eight distinct medical imaging modalities. Med-R1 achieves a 29.94% improvement in average accuracy over its base model Qwen2-VL-2B, and even outperforms Qwen2-VL-72B-a model with 36x more parameters. To assess cross-task generalization, we further evaluate Med-R1 on five question types. Med-R1 outperforms Qwen2-VL-2B by 32.06% in question-type generalization, also surpassing Qwen2-VL-72B. We further explore the thinking process in Med-R1, a crucial component for the success of Deepseek-R1. Our results show that omitting intermediate rationales (No-Thinking-Med-R1) not only improves in-domain and cross-domain generalization with less training, but also challenges the assumption that more reasoning always helps. These findings suggest that in medical VQA, it is not reasoning itself, but its quality and domain alignment, that determine effectiveness. Together, these results highlight that RL improves medical reasoning and generalization, enabling efficient and reliable VLMs for real-world deployment.