Medical visual question answering (VQA) is a crucial task in clinical AI, yet its evaluation has so far centered almost exclusively on English, limiting its relevance to linguistically diverse patients and clinicians. Recent multilingual medical VQA benchmarks show that large vision-language models (LVLMs) degrade in non-English languages, but lack a fine-grained analysis of how cross-lingual variation affects the distinct capabilities that medical VQA requires. To this end, we construct a multilingual medical VQA benchmark over eight languages, organized into four representative scenarios that isolate the core capabilities medical VQA requires. Evaluating five open- and closed-source LVLMs, we find that cross-lingual degradation is not uniform but highly scenario-dependent. We therefore propose MedVL-XLRepE, a training-free scenario-aware representation engineering method, leveraging LVLMs’ superior English medical VQA capability to steer non-English representations toward their English counterparts at inference time. Across three LVLMs and eight languages, MedVL-XLRepE consistently mitigates cross-lingual degradation, with gains of up to 6.33%.

Multi-agent collaboration has emerged as a pivotal paradigm for addressing complex, distributed tasks in large language model (LLM)-driven applications. While prior research has focused on high-level architectural frameworks, the granular mechanisms governing agents—critical to performance and scalability—remain underexplored. This study systematically investigates four dimensions of collaboration strategies: (1) agent governance, (2) participation control, (3) interaction dynamics, and (4) dialogue history management. Through rigorous experimentation under two context-dependent scenarios—Distributed Evidence Integration (DEI) and Structured Evidence Synthesis (SES)—we quantify the impact of these strategies on both task accuracy and computational efficiency. Our findings reveal that centralized governance, instructor-led participation, ordered interaction patterns, and instructor-curated context summarization collectively optimize the trade-off between decision quality and resource utilization with the support of the proposed Token-Accuracy Ratio (TAR). This work establishes a foundation for designing adaptive, scalable multi-agent systems, shifting the focus from structural novelty to strategic interaction mechanics.