# Beyond Classification Accuracy: Neural-MedBench and the Need for Deeper Reasoning Benchmarks

arXiv: https://arxiv.org/abs/2509.22258 · HTML: https://mlsanity.com/paper/2509.22258/

## 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 17 of its 42 references that are in the map.
- First posted on arXiv 26 Sep 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, 17 of 17)

- [BERTScore: Evaluating Text Generation with BERT](https://mlsanity.com/paper/1904.09675/) (2019)
- [Gemini 2.5: Pushing the Frontier with Advanced Reasoning, Multimodality, Long Context, and Next Generation Agentic Capabilities](https://mlsanity.com/paper/2507.06261/) (2025)
- [CLIPScore: A Reference-free Evaluation Metric for Image Captioning](https://mlsanity.com/paper/2104.08718/) (2021)
- [Qwen-VL: A Versatile Vision-Language Model for Understanding, Localization, Text Reading, and Beyond](https://mlsanity.com/paper/2308.12966/) (2023)
- [The Liver Tumor Segmentation Benchmark (LiTS)](https://mlsanity.com/paper/1901.04056/) (2019)
- [PathVQA: 30000+ Questions for Medical Visual Question Answering](https://mlsanity.com/paper/2003.10286/) (2020)
- [MedGemma Technical Report](https://mlsanity.com/paper/2507.05201/) (2025)
- [CheXbert: Combining Automatic Labelers and Expert Annotations for Accurate Radiology Report Labeling Using BERT](https://mlsanity.com/paper/2004.09167/) (2020)
- [RadGraph: Extracting Clinical Entities and Relations from Radiology Reports](https://mlsanity.com/paper/2106.14463/) (2021)
- [Lingshu: A Generalist Foundation Model for Unified Multimodal Medical Understanding and Reasoning](https://mlsanity.com/paper/2506.07044/) (2025)
- [HuatuoGPT-Vision, Towards Injecting Medical Visual Knowledge into Multimodal LLMs at Scale](https://mlsanity.com/paper/2406.19280/) (2024)
- [Towards Generalist Foundation Model for Radiology by Leveraging Web-scale 2D&3D Medical Data](https://mlsanity.com/paper/2308.02463/) (2023)
- [MedicalAgentsBench for Complex Medical Reasoning: Comparing Internalized Reasoning Models versus Externalized Agent-based Frameworks](https://mlsanity.com/paper/2503.07459/) (2025)
- [LLMEval-Med: A Real-world Clinical Benchmark for Medical LLMs with Physician Validation](https://mlsanity.com/paper/2506.04078/) (2025)
- [DiagnosisArena: Benchmarking Diagnostic Reasoning for Large Language Models](https://mlsanity.com/paper/2505.14107/) (2025)
- [RAD-Bench: Evaluating Large Language Models Capabilities in Retrieval Augmented Dialogues](https://mlsanity.com/paper/2409.12558/) (2024)
- [MedGR2: Breaking the Data Barrier for Medical Reasoning via Generative Reward Learning](https://mlsanity.com/paper/2508.20549/) (2025)

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

- [MME-CoF-Pro: Evaluating Reasoning Coherence in Video Generative Models with Text and Visual Hints](https://mlsanity.com/paper/2603.20194/) (2026)
- [NeuroVLM-Bench: Evaluation of Vision-Enabled Large Language Models for Clinical Reasoning in Neurological Disorders](https://mlsanity.com/paper/2603.24846/) (2026)
- [Evo-PI: Aligning Medical Reasoning via Evolving Principle-Guided Supervision](https://mlsanity.com/paper/2606.31800/) (2026)

## Abstract (arXiv)

Recent advances in vision-language models (VLMs) have achieved remarkable performance on standard medical benchmarks, yet their true clinical reasoning ability remains unclear. Existing datasets predominantly emphasize classification accuracy, creating an evaluation illusion in which models appear proficient while still failing at high-stakes diagnostic reasoning. We introduce Neural-MedBench, a compact yet reasoning-intensive benchmark specifically designed to probe the limits of multimodal clinical reasoning in neurology. Neural-MedBench integrates multi-sequence MRI scans, structured electronic health records, and clinical notes, and encompasses three core task families: differential diagnosis, lesion recognition, and rationale generation. To ensure reliable evaluation, we develop a hybrid scoring pipeline that combines LLM-based graders, clinician validation, and semantic similarity metrics. Through systematic evaluation of state-of-the-art VLMs, including GPT-4o, Claude-4, and MedGemma, we observe a sharp performance drop compared to conventional datasets. Error analysis shows that reasoning failures, rather than perceptual errors, dominate model shortcomings. Our findings highlight the necessity of a Two-Axis Evaluation Framework: breadth-oriented large datasets for statistical generalization, and depth-oriented, compact benchmarks such as Neural-MedBench for reasoning fidelity. We release Neural-MedBench at https://neuromedbench.github.io/ as an open and extensible diagnostic testbed, which guides the expansion of future benchmarks and enables rigorous yet cost-effective assessment of clinically trustworthy AI.