Medical multimodal large language models (MLLMs) can perform well on existing medical visual question answering (MedVQA) benchmarks, but their training data often does not match clinical diagnosis. Most supervision is organized around isolated images or short QA pairs, leaving two structures weakly specified: how evidence leads to a decision, and how views, series, modalities, and patient context from the same case are linked. We introduce MultiViewDx, a partly physician-validated multimodal instruction dataset for evidence-linked multi-view medical imaging diagnosis. Multi-ViewDx uses the clinical case as the supervision unit. It links imaging studies with patient context, normalizes heterogeneous reports into an evidence-linked workflow (evidence → findings → differential discussion → diagnosis), and uses a unified image-text retriever to constrain instruction synthesis to source-supported evidence. It covers X-ray, CT, MRI, ultrasound, histopathology, and other clinical visual sources. We fine-tune MultiViewDx-8B-AN and evaluate it on both existing MedVQA benchmarks and real-world case-based diagnostic reasoning. Across four MedVQA benchmarks, it achieves the best average accuracy among compared systems (79.0%), outperforming HuatuoGPT-Vision-34B (66.7%) and Claude3-Opus (55.7%). Beyond Med-VQA, on JAMA Clinical Challenge cases, it receives the strongest overall rating under a physician-designed rubric for key clinical points, diagnostic inference, and evidence grounding. Controlled ablations and clinician evaluation show that both case-level multi-view organization and evidence-linked reasoning targets contribute to the gain.1

Despite recent progress in context compression, we identify a fundamental memorization-utilization gap where models can compress context with near-perfect fidelity yet fail to effectively utilize these compressed representations for downstream tasks. We address this with a holistic training paradigm spanning pretraining, instruction tuning, and reinforcement learning, built upon an average pooling compression. Our key innovation uses outcome-based RL to enable implicit expansion: the model learns to adaptively unfold task-relevant details during generation, interleaving reconstruction with reasoning. We achieve near-lossless 16x context compression (≈5.3x decoder sequence-length reduction in our current implementation) across 7B and 32B models, recovering over 98% of full-context QA performance and outperforming prior methods by 11 points. Our 32B model demonstrates strong out-of-distribution and length generalization, robustly scaling to 120k-token contexts despite training on no more than 4k tokens, matching full-context performance on NIAH, LongBench v2, and multi-hop reasoning. We verify the implicit expansion behavior in experiments.

Reinforcement learning (RL) for large language models (LLMs) typically requires clear reward signals, which are often unavailable for open-ended (OE) questions where answer evaluation is ambiguous without scalable expert labeling. We investigate whether LLMs benefit from training on mixed data with varying reward clarity. Our approach combines Multiple-choice questions (MCQs), which offer clear binary rewards, with OE questions, for which we use simpler, potentially noisy rewards such as Jaccard similarity or LLM-based evaluators. We hypothesize that MCQs can stabilize training when mixed with OE questions. Our experiments show this mixed-data approach consistently improves medical question-answering performance across model scales.

Large language models (LLMs) often struggle with factual accuracy in knowledge-intensive domains like healthcare. We introduce LEAF (Learning and Evaluation Augmented by Fact-Checking), a framework for improving LLM factuality in medical question answering. LEAF comprises three components: (1) RAFE, a robust fact-checking system using open-source LLMs and domain-specific retrieval to evaluate response accuracy; (2) Fact-Check-then-RAG, which leverages fact-checking results to guide retrieval without parameter updates; and (3) Learning from Fact Check, enabling self-training through supervised fine-tuning or preference-based learning using fact-checking as pseudo-labels. Experimental results show that RAFE outperforms Factcheck-GPT in detecting inaccuracies, Fact-Check-then-RAG effectively corrects errors, and Learning from Fact Check improves performance without labeled data. In a real-world healthcare deployment with proprietary medical documents, LEAF achieved an 83% improvement in factuality scores, demonstrating practical applicability for adapting general-purpose LLMs to organization-specific knowledge. Our framework provides a scalable solution for industrial applications requiring high factual accuracy.