arXiv AI By Hongyu Bai, Jiaqi Zeng, Chunzheng Zhu

Aligning Medical Vision Language Models at the Capability Boundary with Entropy Adaptive Rubric Grounding

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The paper introduces MedCBR, a two‑stage alignment framework for medical vision‑language models that improves diagnostic reasoning at the capability boundary. First, it uses Difficulty Weighted Boundary Preference Optimization (DBPO) to focus learning on counterfactual boundary cases, and second, it applies Entropy Gated Grounded Policy Optimization (EGPO) to reward anatomical grounding and reasoning fidelity while mitigating rubric noise. Experiments on six medical benchmarks demonstrate consistent accuracy gains, especially on challenging differential diagnosis tasks, with the combined stages delivering super‑additive improvements.

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