@inproceedings{liu-etal-2026-scaling,
title = "Scaling is Not All You Need: Clinical-Oriented Reinforcement Learning Makes Parameter-Efficient Clinical Reasoning",
author = "Liu, Chi and
Shu, Yan and
Chen, Mengzhuo and
Piao, Hongming and
Duan, Zhijian and
Li, Derek and
Dai, Bryan",
editor = "Liakata, Maria and
Moreira, Viviane P. and
Zhang, Jiajun and
Jurgens, David",
booktitle = "Findings of the {A}ssociation for {C}omputational {L}inguistics: {ACL} 2026",
month = jul,
year = "2026",
address = "San Diego, California, United States",
publisher = "Association for Computational Linguistics",
url = "https://aclanthology.org/2026.findings-acl.741/",
pages = "15056--15068",
ISBN = "979-8-89176-395-1",
abstract = "While large language models show promise in medical applications, achieving expert-level clinical reasoning efficiently remains challenging due to the need for massive amounts of manually labeled data and large-scale models. To address this challenge, we propose Clinical-Oriented Reinforcement Learning (CORL), the first fully open-source, end-to-end reinforcement learning training pipeline in the clinical reasoning domain, incorporating a Reasoning-Oriented Data Strategy (RODS) based on topological synthesis, CoT cold-start, and two-stage reinforcement learning. Through CORL, we trained the Fleming-R1 series of models. Among them, Fleming-R1-7B significantly outperforms models of comparable size while approaching or even surpassing certain 32B and 72B models. Fleming-R1-32B achieves near-parity with GPT-4o and outperforms the strongest open-source alternatives up to 671B in MedXpertQA. This demonstrates that in clinical reasoning field, a meticulously designed training pipeline holds greater importance than scaling model size alone. Data and Models are available at https://github.com/UbiquantAI/Fleming-R1 and https://huggingface.co/collections/IQuestLab/fleming."
}<?xml version="1.0" encoding="UTF-8"?>
<modsCollection xmlns="http://www.loc.gov/mods/v3">
<mods ID="liu-etal-2026-scaling">
<titleInfo>
<title>Scaling is Not All You Need: Clinical-Oriented Reinforcement Learning Makes Parameter-Efficient Clinical Reasoning</title>
</titleInfo>
<name type="personal">
<namePart type="given">Chi</namePart>
<namePart type="family">Liu</namePart>
<role>
<roleTerm authority="marcrelator" type="text">author</roleTerm>
</role>
</name>
<name type="personal">
<namePart type="given">Yan</namePart>
<namePart type="family">Shu</namePart>
<role>
<roleTerm authority="marcrelator" type="text">author</roleTerm>
</role>
</name>
<name type="personal">
<namePart type="given">Mengzhuo</namePart>
<namePart type="family">Chen</namePart>
<role>
<roleTerm authority="marcrelator" type="text">author</roleTerm>
</role>
</name>
<name type="personal">
<namePart type="given">Hongming</namePart>
<namePart type="family">Piao</namePart>
<role>
<roleTerm authority="marcrelator" type="text">author</roleTerm>
</role>
</name>
<name type="personal">
<namePart type="given">Zhijian</namePart>
<namePart type="family">Duan</namePart>
<role>
<roleTerm authority="marcrelator" type="text">author</roleTerm>
</role>
</name>
<name type="personal">
<namePart type="given">Derek</namePart>
<namePart type="family">Li</namePart>
<role>
<roleTerm authority="marcrelator" type="text">author</roleTerm>
</role>
</name>
<name type="personal">
<namePart type="given">Bryan</namePart>
<namePart type="family">Dai</namePart>
<role>
<roleTerm authority="marcrelator" type="text">author</roleTerm>
</role>
</name>
<originInfo>
<dateIssued>2026-07</dateIssued>
</originInfo>
<typeOfResource>text</typeOfResource>
<relatedItem type="host">
<titleInfo>
<title>Findings of the Association for Computational Linguistics: ACL 2026</title>
</titleInfo>
<name type="personal">
<namePart type="given">Maria</namePart>
<namePart type="family">Liakata</namePart>
<role>
<roleTerm authority="marcrelator" type="text">editor</roleTerm>
</role>
</name>
<name type="personal">
<namePart type="given">Viviane</namePart>
<namePart type="given">P</namePart>
<namePart type="family">Moreira</namePart>
<role>
<roleTerm authority="marcrelator" type="text">editor</roleTerm>
</role>
</name>
<name type="personal">
<namePart type="given">Jiajun</namePart>
<namePart type="family">Zhang</namePart>
<role>
<roleTerm authority="marcrelator" type="text">editor</roleTerm>
</role>
</name>
<name type="personal">
<namePart type="given">David</namePart>
<namePart type="family">Jurgens</namePart>
<role>
<roleTerm authority="marcrelator" type="text">editor</roleTerm>
</role>
</name>
<originInfo>
<publisher>Association for Computational Linguistics</publisher>
<place>
<placeTerm type="text">San Diego, California, United States</placeTerm>
</place>
</originInfo>
<genre authority="marcgt">conference publication</genre>
<identifier type="isbn">979-8-89176-395-1</identifier>
</relatedItem>
<abstract>While large language models show promise in medical applications, achieving expert-level clinical reasoning efficiently remains challenging due to the need for massive amounts of manually labeled data and large-scale models. To address this challenge, we propose Clinical-Oriented Reinforcement Learning (CORL), the first fully open-source, end-to-end reinforcement learning training pipeline in the clinical reasoning domain, incorporating a Reasoning-Oriented Data Strategy (RODS) based on topological synthesis, CoT cold-start, and two-stage reinforcement learning. Through CORL, we trained the Fleming-R1 series of models. Among them, Fleming-R1-7B significantly outperforms models of comparable size while approaching or even surpassing certain 32B and 72B models. Fleming-R1-32B achieves near-parity with GPT-4o and outperforms the strongest open-source alternatives up to 671B in MedXpertQA. This demonstrates that in clinical reasoning field, a meticulously designed training pipeline holds greater importance than scaling model size alone. Data and Models are available at https://github.com/UbiquantAI/Fleming-R1 and https://huggingface.co/collections/IQuestLab/fleming.</abstract>
<identifier type="citekey">liu-etal-2026-scaling</identifier>
<location>
<url>https://aclanthology.org/2026.findings-acl.741/</url>
</location>
<part>
<date>2026-07</date>
<extent unit="page">
<start>15056</start>
<end>15068</end>
</extent>
</part>
</mods>
</modsCollection>
%0 Conference Proceedings
%T Scaling is Not All You Need: Clinical-Oriented Reinforcement Learning Makes Parameter-Efficient Clinical Reasoning
%A Liu, Chi
%A Shu, Yan
%A Chen, Mengzhuo
%A Piao, Hongming
%A Duan, Zhijian
%A Li, Derek
%A Dai, Bryan
%Y Liakata, Maria
%Y Moreira, Viviane P.
%Y Zhang, Jiajun
%Y Jurgens, David
%S Findings of the Association for Computational Linguistics: ACL 2026
%D 2026
%8 July
%I Association for Computational Linguistics
%C San Diego, California, United States
%@ 979-8-89176-395-1
%F liu-etal-2026-scaling
%X While large language models show promise in medical applications, achieving expert-level clinical reasoning efficiently remains challenging due to the need for massive amounts of manually labeled data and large-scale models. To address this challenge, we propose Clinical-Oriented Reinforcement Learning (CORL), the first fully open-source, end-to-end reinforcement learning training pipeline in the clinical reasoning domain, incorporating a Reasoning-Oriented Data Strategy (RODS) based on topological synthesis, CoT cold-start, and two-stage reinforcement learning. Through CORL, we trained the Fleming-R1 series of models. Among them, Fleming-R1-7B significantly outperforms models of comparable size while approaching or even surpassing certain 32B and 72B models. Fleming-R1-32B achieves near-parity with GPT-4o and outperforms the strongest open-source alternatives up to 671B in MedXpertQA. This demonstrates that in clinical reasoning field, a meticulously designed training pipeline holds greater importance than scaling model size alone. Data and Models are available at https://github.com/UbiquantAI/Fleming-R1 and https://huggingface.co/collections/IQuestLab/fleming.
%U https://aclanthology.org/2026.findings-acl.741/
%P 15056-15068
Markdown (Informal)
[Scaling is Not All You Need: Clinical-Oriented Reinforcement Learning Makes Parameter-Efficient Clinical Reasoning](https://aclanthology.org/2026.findings-acl.741/) (Liu et al., Findings 2026)
ACL
- Chi Liu, Yan Shu, Mengzhuo Chen, Hongming Piao, Zhijian Duan, Derek Li, and Bryan Dai. 2026. Scaling is Not All You Need: Clinical-Oriented Reinforcement Learning Makes Parameter-Efficient Clinical Reasoning. In Findings of the Association for Computational Linguistics: ACL 2026, pages 15056–15068, San Diego, California, United States. Association for Computational Linguistics.