While reinforcement learning from verifiable rewards (RLVR) has been proven highly effective for enhancing reasoning, its application to medical visual question answering (Med-VQA) is hampered by models producing reasoning inconsistent with either the visual evidence or the final answer. Our analysis reveals a critical flaw in RLVR training: it paradoxically encourages models to disregard visual evidence and generate answers that contradict their own reasoning. This degradation is most pronounced in specialized medical modalities (e.g., Fundus, Ultrasound) where base VLMs lack robust understanding, a failure we attribute to a flawed reward mechanism exacerbated by the scarcity of diverse training data. To tackle this, we introduce Med-Zero-17K, a large-scale dataset spanning over 30 modalities and 24 clinically relevant tasks, and the Multi-Consistency Reward (MCR) framework, which explicitly rewards both perceptual grounding and logical coherence. Extensive experiments validate our approach: integrating MCR into the RLVR framework delivers robust performance gains. This success stems from our crucial finding that rewarding internal consistency is significantly more effective than attempting to judge reasoning correctness. Furthermore, MCR proves highly versatile, exhibiting strong generalization across diverse VLM backbones, compatibility with RL algorithms like GRPO and DPO, and extending its effectiveness to 3D VQA tasks and R1-style training paradigms. Code and dataset will be released.

Key Information Extraction (KIE) from real-world documents remains challenging due to substantial variations in layout structures, visual quality, and task-specific information requirements. Recent Large Multimodal Models (LMMs) have shown promising potential for performing end-to-end KIE directly from document images. To enable a comprehensive and systematic evaluation across realistic and diverse application scenarios, we introduce UNIKIE-BENCH, a unified benchmark designed to rigorously evaluate the KIE capabilities of LMMs. UNIKIE-BENCH consists of two complementary tracks: a constrained-category KIE track with scenario-predefined schemas that reflect practical application needs, and an open-category KIE track that extracts any key information that is explicitly present in the document. Experiments on 15 state-of-the-art LMMs reveal substantial performance degradation under diverse schema definitions, long-tail key fields, and complex layouts, along with pronounced performance disparities across different document types and scenarios. These findings underscore persistent challenges in grounding accuracy and layout-aware reasoning for LMM-based KIE. All codes and datasets are available at https://github.com/NEUIR/UNIKIE-BENCH.