Recent advances such as Chain-of-Thought prompting have significantly improved large language models (LLMs) in zero-shot medical reasoning. However, prompting-based methods often remain shallow and unstable, while fine-tuned medical LLMs suffer from poor generalization under distribution shifts and limited adaptability to unseen clinical scenarios. To address these limitations, we present TAGS, a test-time framework that combines a broadly capable generalist with a domain-specific specialist to offer complementary perspectives without any model fine-tuning or parameter updates. To support this generalist–specialist reasoning process, we introduce two auxiliary modules: a hierarchical retrieval mechanism that provides multi-scale exemplars by selecting examples based on both semantic and rationale-level similarity, and a reliability scorer that evaluates reasoning consistency to guide final answer aggregation. TAGS achieves strong performance across nine MedQA benchmarks, boosting GPT-4o accuracy by 13.8%, DeepSeek-R1 by 16.8%, and improving a vanilla 7B model from 14.1% to 23.9%. These results surpass several fine-tuned medical LLMs, without any parameter updates.

The increasing integration of large language models (LLMs) into mental health applications necessitates robust frameworks for evaluating professional safety alignment. Current evaluative approaches primarily rely on refusal-based safety signals, which offer limited insight into the nuanced behaviors required in clinical practice. In mental health, clinically inadequate refusals can be perceived as unempathetic and discourage help-seeking. To address this gap, we move beyond refusal-centric metrics and introduce PsychEthicsBench, the first principle-grounded benchmark based on Australian psychology and psychiatry guidelines, designed to evaluate LLMs’ ethical knowledge and behavioral responses through multiple-choice and open-ended tasks with fine-grained ethicality annotations. Empirical results across 14 models reveal that refusal rates are poor indicators of ethical behavior, revealing a significant divergence between safety triggers and clinical appropriateness. Notably, we find that domain-specific fine-tuning can degrade ethical robustness, as several specialized models underperform their base backbones in ethical alignment. PsychEthicsBench provides a foundation for systematic, jurisdiction-aware evaluation of LLMs in mental health, encouraging more responsible development in this domain.

Recent multimodal large language models (MLLMs) have demonstrated significant potential in open-ended conversation, generating more accurate and personalized responses. However, their abilities to memorize, recall, and reason in sustained interactions within real-world scenarios remain underexplored. This paper introduces MMRC, a Multi-Modal Real-world Conversation benchmark for evaluating six core open-ended abilities of MLLMs: information extraction, multi-turn reasoning, information update, image management, memory recall, and answer refusal. With data collected from real-world scenarios, MMRC comprises 5,120 conversations and 28,720 corresponding manually labeled questions, posing a significant challenge to existing MLLMs. Evaluations on 20 MLLMs in MMRC indicate an accuracy drop during open-ended interactions. We identify four common failure patterns: long-term memory degradation, inadequacies in updating factual knowledge, accumulated assumption of error propagation, and reluctance to “say no.” To mitigate these issues, we propose a simple yet effective NOTE-TAKING strategy, which can record key information from the conversation and remind the model during its responses, enhancing conversational capabilities. Experiments across six MLLMs demonstrate significant performance improvements.