# SafeMed-R1: Adversarial Reinforcement Learning for Generalizable and Robust Medical Reasoning in Vision-Language Models

arXiv: https://arxiv.org/abs/2512.19317 · HTML: https://mlsanity.com/paper/2512.19317/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 13 of its 25 references that are in the map.
- First posted on arXiv 22 Dec 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, 13 of 13)

- [Adam: A Method for Stochastic Optimization](https://mlsanity.com/paper/1412.6980/) (2014)
- [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)
- [Qwen3 Technical Report](https://mlsanity.com/paper/2505.09388/) (2025)
- [Qwen2.5 Technical Report](https://mlsanity.com/paper/2412.15115/) (2024)
- [Trust Region Policy Optimization](https://mlsanity.com/paper/1502.05477/) (2015)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (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)
- [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)
- [RARL: Improving Medical VLM Reasoning and Generalization with Reinforcement Learning and LoRA under Data and Hardware Constraints](https://mlsanity.com/paper/2506.06600/) (2025)

## Abstract (arXiv)

Vision--Language Models (VLMs) show significant promise for Medical Visual Question Answering (VQA), yet their deployment in clinical settings is hindered by severe vulnerability to adversarial attacks. Standard adversarial training, while effective for simpler tasks, often degrades both generalization performance and the quality of generated clinical reasoning. We introduce SafeMed-R1, a hybrid defense framework that ensures robust performance while preserving high-quality, interpretable medical reasoning. SafeMed-R1 employs a two-stage approach: at training time, we integrate Adversarial Training with Group Relative Policy Optimization (AT-GRPO) to explicitly robustify the reasoning process against worst-case perturbations; at inference time, we augment the model with Randomized Smoothing to provide certified L2-norm robustness guarantees. We evaluate SafeMed-R1 on the OmniMedVQA benchmark across eight medical imaging modalities comprising over 88,000 samples. Our experiments reveal that standard fine-tuned VLMs, despite achieving 95% accuracy on clean inputs, collapse to approximately 25% under PGD attacks. In contrast, SafeMed-R1 maintains 84.45% accuracy under the same adversarial conditions, representing a 59 percentage point improvement in robustness. Furthermore, we demonstrate that models trained with explicit chain-of-thought reasoning exhibit superior adversarial robustness compared to instruction-only variants, suggesting a synergy between interpretability and security in medical AI systems.