Medical calculators are fundamental to quantitative, evidence-based clinical practice. However, their real-world use is an adaptive, multi-stage process, requiring proactive EHR data acquisition, scenario-dependent calculator selection, and multi-step computation, whereas current benchmarks focus only on static single-step calculations with explicit instructions. To address these limitations, we introduce MedMCP-Calc, the first benchmark for evaluating LLMs in realistic medical calculator scenarios through Model Context Protocol (MCP) integration. MedMCP-Calc comprises 118 scenario tasks across 4 clinical domains, featuring fuzzy task descriptions mimicking natural queries, structured EHR database interaction, external reference retrieval, and process-level evaluation. Our evaluation of 23 leading models reveals critical limitations: even top performers like GPT-5 exhibit substantial gaps, including difficulty selecting appropriate calculators for end-to-end workflows given fuzzy queries, poor performance in iterative SQL-based database interactions, and marked reluctance to leverage external tools for numerical computation. Performance also varies considerably across clinical domains. Building on these findings, we develop CalcMate, a fine-tuned model incorporating scenario planning and tool augmentation, achieving state-of-the-art performance among open-source models.

Large vision-language models (LVLMs) have shown great promise in medical applications, particularly in visual question answering (MedVQA) and diagnosis from medical images. However, existing datasets and models often fail to consider critical aspects of medical diagnostics, such as the integration of historical records and the analysis of disease progression over time. In this paper, we introduce MMXU (Multimodal and MultiX-ray Understanding), a novel dataset for MedVQA that focuses on identifying changes in specific regions between two patient visits. Unlike previous datasets that primarily address single-image questions, MMXU enables multi-image questions, incorporating both current and historical patient data. We demonstrate the limitations of current LVLMs in identifying disease progression on MMXU-test, even those that perform well on traditional benchmarks. To address this, we propose a MedRecord-Augmented Generation (MAG) approach, incorporating both global and regional historical records.Our experiments show that integrating historical records significantly enhances diagnostic accuracy by at least 20%, bridging the gap between current LVLMs and human expert performance. Additionally, we fine-tune models with MAG on MMXU-dev, which demonstrates notable improvements. We hope this work could illuminate the avenue of advancing the use of LVLMs in medical diagnostics by emphasizing the importance of historical context in interpreting medical images.Our dataset is released at github.

Large language models (LLMs) have showcased remarkable capabilities as autonomous agents when augmented with external tools. Equipped with fixed tool sets, LLMs struggle with addressing diverse user inquiries in open-world tasks. To evaluate and boost the performance of LLMs in dealing with complex demands in the real-world, we propose open-world function calling, where LLMs need to retrieve suitable tools from a pre-defined external tool library and use retrieved tools to resolve the user’s problem. We introduce Meta-Tool, a versatile and plug-and-play tool retrieval system as the access of LLMs to external tool library. Drawing inspiration from the myriad of enhanced approaches associated with Retrieval-Augmented Generation (RAG), Meta-Tool employs a hypothesize-retrieve-invoke framework. We further propose Meta-Bench, a comprehensive benchmark for evaluating LLMs in open-world function calling and associated tasks. Meta-Bench encompasses 2,800 dialogues and 7,361 tools, spanning ten distinct scenarios to provide robust and diverse test categories. In conjunction, we present MT-LLaMA, a finetuned version of LLaMA-3.1, which exhibits remarkable performance improvements. Our empirical experiments reveal that Meta-Tool significantly enhances the ability of advanced LLMs to retrieve and leverage the most suitable tools compared to previous tool retrieval methods. Moreover, our fine-tuning enables even smaller-sized LLMs to achieve comparable even exceeding results to GPT-4o. Both the benchmark and the model are made publicly available at https://github.com/qinshengqian/Meta-Tool to foster further research and development in the field.