Abstract
Reinforcement learning (RL) with rule-based reward functions has recently shown great promise in enhancing the reasoning depth and generalization ability of vision-language models (VLMs), while maintaining computational efficiency. In spite of these advances, its adoption in medical imaging remains limited. Current reinforcement fine-tuning (RFT) efforts in this field mainly focus on closed-ended visual question answering (VQA), restricting their applicability to realistic clinical reasoning. However, open-ended medical VQA better mirrors clinical diagnostic workflows but remains underexplored. Although several studies have attempted to bridge the two formats through semantically guided RL, model-driven semantic rewards often suffer from reward collapse, where responses with distinct semantics yield nearly identical scores. To overcome this limitation, we introduce Adaptive Reinforcement for Medical Reasoning (ARMed), a novel RL framework tailored for open-ended medical VQA. ARMed firs