MedHorizon: Towards Long-context Medical Video Understanding in the Wild

High-stakes clinical use of large vision-language models (LVLMs) requires reasoning that is grounded in visual evidence and clinical knowledge, not just correct final answers. We introduce OpenMedReason, a large-scale, open multimodal medical reasoning corpus comprising approximately 450K image-question-answer instances whose reasoning traces are primarily derived from curated biomedical, human-authored scientific articles. OpenMedReason provides high-fidelity supervision beyond synthetic chains of thought, covering diverse medical domain vision modalities such as radiological scans, microscopic images, visible light photographs, charts, and others. We complement it with OpenMedReason-Bench, a held-out benchmark that allows fine-grained evaluation of LVLMs along three complementary axes of capability, including perception, medical knowledge, and rationale, enabling diagnostic evaluation beyond final-answer accuracy. OpenMedReason is a rich training resource that exhibits its effectiveness in both supervised fine-tuning (SFT) and reinforcement-based alignment. Training with OpenMedReason yields a 20% average improvement in VQA accuracy over the base model and achieves performance within 4.2% of the strongest comparable-scale medical LVLMs. Fine-grained performance analysis confirms that the gains are not concentrated in any single axis: OpenMedReason improves perception, medical knowledge, and rationale jointly, and its reasoning traces are preferred over those of the base model in 86.1% of pairwise comparisons. We release the code and dataset at huggingface.co/datasets/neginb/OpenMedReason.

Multimodal Large Language Models have demonstrated impressive video understanding, yet their ability to reason over long-form narratives is often masked by visual-centric evaluations and inefficient context processing. Existing benchmarks over-rely on visual heuristics while marginalizing auditory cues, effectively reducing models to "silent observers" that bypass genuine cross-modal reasoning. Moreover, standard dense sampling creates an evidence-context trade-off: increasing frames to capture evidence inevitably leads to attention distraction and token explosion. To bridge these gaps, we present Video-HolmesV2, a novel benchmark designed for Deep Audio-Visual Coupling. Unlike previous works, it enforces an Evidence-Based Evaluation, requiring models to justify answers with precise spatio-temporal audio-visual evidence, thereby reducing confounding effects of guessing and hallucinated evidence. To support this, we introduce: (1) a Multi-Model Cross-Verification pipeline to ensure task rigor; (2) a Spatio-temporal Evidence-Aware Metric for fine-grained calibration. Furthermore, we propose an Audio-Text Guided Token Compression framework. By fusing task intent with auditory anchors, our method distills high-value reasoning cues to mitigate long-context noise. In our evaluation, even strong proprietary models achieve below 60% accuracy, while our approach outperforms comparable open-source omni-models.

Video understanding is being rapidly transformed by multimodal large language models (MLLMs), as research moves from short clips to long, multimodal, and knowledge-intensive video scenarios. These scenarios require models to handle sparse evidence, long-range dependencies, multimodal alignment, and reliable inference under limited computational budgets. This work presents a human-view perspective on LLM-based video understanding, organized around three functional abilities: watching, remembering, and reasoning. Rather than treating video tasks as isolated benchmarks, this view provides a unified structure for analyzing how video MLLMs acquire evidence, preserve context, and produce grounded outputs. We introduce a formulation that characterizes video understanding systems by their perceptual representations, memory states, reasoning traces, and final predictions. Based on this formulation, we identify challenges in spatio-temporal perception, efficient long-video processing, memory modeling, streaming understanding, and faithful reasoning. Representative methods are organized by their roles in video MLLM systems. Watching covers fine-grained, comprehensive, audio-visual, and efficient perception. Remembering includes offline and streaming memory, while reasoning covers text-only reasoning and thinking with videos. We further examine application domains such as egocentric, sports, instructional, medical, and narrative videos, and cover training datasets and evaluation benchmarks across task types, supervision formats, modalities, and capability dimensions. Finally, we outline open problems and future directions for scalable, memory-aware, and evidence-grounded video intelligence. Related works will be continuously traced at https://github.com/marinero4972/Awesome-HumanView-VideoUnderstanding.