@inproceedings{liu-etal-2026-scaling-need,
    title = "Scaling is Not All You Need: Clinical-Oriented Reinforcement Learning Makes Parameter-Efficient Clinical Reasoning",
    author = "Liu, Chi  and
      Shu, Yan  and
      Chen, Mengzhuo  and
      Piao, Hongming  and
      Duan, Zhijian  and
      Li, Derek  and
      Dai, Bryan",
    editor = "Liakata, Maria  and
      Moreira, Viviane P.  and
      Zhang, Jiajun  and
      Jurgens, David",
    booktitle = "Findings of the {A}ssociation for {C}omputational {L}inguistics: {ACL} 2026",
    month = jul,
    year = "2026",
    address = "San Diego, California, United States",
    publisher = "Association for Computational Linguistics",
    url = "https://preview.aclanthology.org/ingest-acl/2026.findings-acl.741/",
    pages = "15056--15068",
    ISBN = "979-8-89176-395-1",
    abstract = "While large language models show promise in medical applications, achieving expert-level clinical reasoning efficiently remains challenging due to the need for massive amounts of manually labeled data and large-scale models. To address this challenge, we propose Clinical-Oriented Reinforcement Learning (CORL), the first fully open-source, end-to-end reinforcement learning training pipeline in the clinical reasoning domain, incorporating a Reasoning-Oriented Data Strategy (RODS) based on topological synthesis, CoT cold-start, and two-stage reinforcement learning. Through CORL, we trained the Fleming-R1 series of models. Among them, Fleming-R1-7B significantly outperforms models of comparable size while approaching or even surpassing certain 32B and 72B models. Fleming-R1-32B achieves near-parity with GPT-4o and outperforms the strongest open-source alternatives up to 671B in MedXpertQA. This demonstrates that in clinical reasoning field, a meticulously designed training pipeline holds greater importance than scaling model size alone. Data and Models are available at https://github.com/UbiquantAI/Fleming-R1 and https://huggingface.co/collections/IQuestLab/fleming."
}