Daily Papers

Multimodal large language models (LLMs) are increasingly explored as automated evaluators in clinical settings, yet their scoring behavior on ordinal clinical scales remains poorly understood. We benchmark three frontier LLM families against supervised deep learning models for scoring Clock Drawing Test (CDT) images on two public datasets using the Shulman rubric. While fully fine-tuned Vision Transformers achieve the best calibration (MAE 0.52, within-1 accuracy 91%), zero-shot LLMs remain competitive on tolerance-based agreement (GPT-5 MAE 0.67, within-1 accuracy 92%) despite higher absolute error. However, per-score analysis reveals that all three LLM families exhibit a pronounced central tendency effect (systematic endpoint compression): predictions are systematically compressed toward the middle of the scale, with over-prediction at the low end (score 0 to 1) and under-prediction at the high end (score 5 to 4). This effect disproportionately affects the clinically critical extremes where accurate scoring most impacts screening decisions for cognitive impairment. Targeted ablations show that neither few-shot exemplars spanning the full score range nor removing clinical terminology from the prompt eliminates the effect. Our findings extend the LLM-as-a-judge bias literature from NLP evaluation to clinical assessment, and highlight the need for calibration-aware evaluation and post-hoc calibration before deploying LLM-based raters in high-stakes screening workflows.

Advances in vision-language models (VLMs) have achieved remarkable success on complex multimodal reasoning tasks, leading to the assumption that they should also excel at reading analog clocks. However, contrary to this expectation, our study reveals that reading analog clocks in real-world environments remains a significant challenge for state-of-the-art VLMs. Existing analog clock datasets are largely synthetic or planar with limited stylistic diversity and minimal background context, failing to capture the visual variability of real-world scenes. As a result, VLMs trained on such data exhibit weak spatial-temporal reasoning, frequently confusing the hour and minute hands and struggling under common visual conditions such as occlusion, lighting variation, and cluttered backgrounds. To address this issue, we introduce TickTockVQA, a human-annotated dataset containing analog clocks in diverse real-world scenarios. TickTockVQA provides explicit hour and minute annotations, and includes an AM/PM tag when it is inferable from the visual context. Furthermore, we propose Swap-DPO, a direct preference optimization based fine-tuning framework to align model reasoning toward accurate time interpretation. Experimental results demonstrate that our approach substantially enhances clock reading accuracy and robustness under real-world conditions, establishing a foundation for future research on spatial-temporal reasoning and visual understanding in VLMs.

Humans draw to facilitate reasoning: we draw auxiliary lines when solving geometry problems; we mark and circle when reasoning on maps; we use sketches to amplify our ideas and relieve our limited-capacity working memory. However, such actions are missing in current multimodal language models (LMs). Current chain-of-thought and tool-use paradigms only use text as intermediate reasoning steps. In this work, we introduce Sketchpad, a framework that gives multimodal LMs a visual sketchpad and tools to draw on the sketchpad. The LM conducts planning and reasoning according to the visual artifacts it has drawn. Different from prior work, which uses text-to-image models to enable LMs to draw, Sketchpad enables LMs to draw with lines, boxes, marks, etc., which is closer to human sketching and better facilitates reasoning. Sketchpad can also use specialist vision models during the sketching process (e.g., draw bounding boxes with object detection models, draw masks with segmentation models), to further enhance visual perception and reasoning. We experiment with a wide range of math tasks (including geometry, functions, graphs, and chess) and complex visual reasoning tasks. Sketchpad substantially improves performance on all tasks over strong base models with no sketching, yielding an average gain of 12.7% on math tasks, and 8.6% on vision tasks. GPT-4o with Sketchpad sets a new state of the art on all tasks, including V*Bench (80.3%), BLINK spatial reasoning (83.9%), and visual correspondence (80.8%). All codes and data are in https://visualsketchpad.github.io/.