# Rethinking Test-Time Scaling for Medical AI: Model and Task-Aware Strategies for LLMs and VLMs

arXiv: https://arxiv.org/abs/2506.13102 · HTML: https://mlsanity.com/paper/2506.13102/

## Key facts

- Cited by 3 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 55 references that are in the map.
- First posted on arXiv 16 Jun 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)

- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [Proximal Policy Optimization Algorithms](https://mlsanity.com/paper/1707.06347/) (2017)
- [Llama 2: Open Foundation and Fine-Tuned Chat Models](https://mlsanity.com/paper/2307.09288/) (2023)
- [DeepSeekMath: Pushing the Limits of Mathematical Reasoning in Open Language Models](https://mlsanity.com/paper/2402.03300/) (2024)
- [DeepSeek-R1: Incentivizing Reasoning Capability in LLMs via Reinforcement Learning](https://mlsanity.com/paper/2501.12948/) (2025)
- [Qwen2.5-VL Technical Report](https://mlsanity.com/paper/2502.13923/) (2025)
- [Qwen2.5 Technical Report](https://mlsanity.com/paper/2412.15115/) (2024)
- [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)
- [Gemini 1.5: Unlocking multimodal understanding across millions of tokens of context](https://mlsanity.com/paper/2403.05530/) (2024)
- [Gemma 3 Technical Report](https://mlsanity.com/paper/2503.19786/) (2025)
- [s1: Simple test-time scaling](https://mlsanity.com/paper/2501.19393/) (2025)
- [PubMedQA: A Dataset for Biomedical Research Question Answering](https://mlsanity.com/paper/1909.06146/) (2019)
- [OpenAI o1 System Card](https://mlsanity.com/paper/2412.16720/) (2024)
- [Yi: Open Foundation Models by 01.AI](https://mlsanity.com/paper/2403.04652/) (2024)
- [LLaVA-CoT: Let Vision Language Models Reason Step-by-Step](https://mlsanity.com/paper/2411.10440/) (2024)
- [Reasoning Models Don't Always Say What They Think](https://mlsanity.com/paper/2505.05410/) (2025)
- [HuatuoGPT-o1, Towards Medical Complex Reasoning with LLMs](https://mlsanity.com/paper/2412.18925/) (2024)
- [KTO: Model Alignment as Prospect Theoretic Optimization](https://mlsanity.com/paper/2402.01306/) (2024)
- [MedXpertQA: Benchmarking Expert-Level Medical Reasoning and Understanding](https://mlsanity.com/paper/2501.18362/) (2025)
- [HuatuoGPT-Vision, Towards Injecting Medical Visual Knowledge into Multimodal LLMs at Scale](https://mlsanity.com/paper/2406.19280/) (2024)
- [MedVLM-R1: Incentivizing Medical Reasoning Capability of Vision-Language Models (VLMs) via Reinforcement Learning](https://mlsanity.com/paper/2502.19634/) (2025)
- [Med-R1: Reinforcement Learning for Generalizable Medical Reasoning in Vision-Language Models](https://mlsanity.com/paper/2503.13939/) (2025)
- [xGen-MM (BLIP-3): A Family of Open Large Multimodal Models](https://mlsanity.com/paper/2408.08872/) (2024)
- [Revisiting the Test-Time Scaling of o1-like Models: Do they Truly Possess Test-Time Scaling Capabilities?](https://mlsanity.com/paper/2502.12215/) (2025)
- [m1: Unleash the Potential of Test-Time Scaling for Medical Reasoning with Large Language Models](https://mlsanity.com/paper/2504.00869/) (2025)
- [Inference-Time Scaling for Complex Tasks: Where We Stand and What Lies Ahead](https://mlsanity.com/paper/2504.00294/) (2025)
- [QoQ-Med: Building Multimodal Clinical Foundation Models with Domain-Aware GRPO Training](https://mlsanity.com/paper/2506.00711/) (2025)
- [O1 Replication Journey -- Part 3: Inference-time Scaling for Medical Reasoning](https://mlsanity.com/paper/2501.06458/) (2025)
- [MedS3: Towards Medical Slow Thinking with Self-Evolved Soft Dual-sided Process Supervision](https://mlsanity.com/paper/2501.12051/) (2025)

## Built on by (most cited first, 3 of 3)

- [AutoMedic: An Automated Evaluation Framework for Clinical Conversational Agents with Medical Dataset Grounding](https://mlsanity.com/paper/2512.10195/) (2025)
- [Scalable Stewardship of an LLM-Assisted Clinical Benchmark with Physician Oversight](https://mlsanity.com/paper/2512.19691/) (2025)
- [EVADE: Evidence-Verified Agentic Diagnosis with Escape](https://mlsanity.com/paper/2608.18833/) (2026)

## Abstract (arXiv)

Test-time scaling has recently emerged as a promising approach for enhancing the reasoning capabilities of large language models or vision-language models during inference. Although a variety of test-time scaling strategies have been proposed, and interest in their application to the medical domain is growing, many critical aspects remain underexplored, including their effectiveness for vision-language models and the identification of optimal strategies for different settings. In this paper, we conduct a comprehensive investigation of test-time scaling in the medical domain. We evaluate its impact on both large language models and vision-language models, considering factors such as model size, inherent model characteristics, and task complexity. Finally, we assess the robustness of these strategies under user-driven factors, such as misleading information embedded in prompts. Our findings offer practical guidelines for the effective use of test-time scaling in medical applications and provide insights into how these strategies can be further refined to meet the reliability and interpretability demands of the medical domain.