MedHEB: Benchmarking Medical Embeddings Across Heterogeneous Clinical Evidence

Multimodal large language models (MLLMs) achieve strong performance on benchmarks that evaluate text, image, or video understanding separately. However, these settings do not assess a critical real-world requirement, which involves retrieving relevant evidence from large, heterogeneous multimodal corpora prior to reasoning. Most existing benchmarks restrict retrieval to small, single-modality candidate sets, substantially simplifying the search space and overstating end-to-end reliability. To address this gap, we introduce MultiHaystack, the first benchmark designed to evaluate both retrieval and reasoning under large-scale, cross-modal conditions. MultiHaystack comprises over 46,000 multimodal retrieval candidates across documents, images, and videos, along with 747 open yet verifiable questions. Each question is grounded in a unique validated evidence item within the retrieval pool, requiring evidence localization across modalities and fine-grained reasoning. In our study, we find that models perform competitively when provided with the corresponding evidence, but their performance drops sharply when required to retrieve that evidence from the full corpus. Additionally, even the strongest retriever, E5-V, achieves only 40.8% Recall@1, while state-of-the-art MLLMs such as GPT-5 experience a significant drop in reasoning accuracy from 80.86% when provided with the corresponding evidence to 51.4% under top-5 retrieval. These results indicate that multimodal retrieval over heterogeneous pools remains a primary bottleneck for MLLMs, positioning MultiHaystack as a valuable testbed that highlights underlying limitations obscured by small-scale evaluations and promotes retrieval-centric advances in multimodal systems.

Multimodal large language models (MLLMs) demonstrate considerable potential in clinical diagnostics, a domain that inherently requires synthesizing complex visual and textual data alongside consulting authoritative medical literature. However, existing benchmarks primarily evaluate MLLMs in end-to-end answering scenarios. This limits the ability to disentangle a model's foundational multimodal reasoning from its proficiency in evidence retrieval and application. We introduce the Clinical Understanding and Retrieval Evaluation (CURE) benchmark. Comprising $500$ multimodal clinical cases mapped to physician-cited reference literature, CURE evaluates reasoning and retrieval under controlled evidence settings to disentangle their respective contributions. We evaluate state-of-the-art MLLMs across distinct evidence-gathering paradigms in both closed-ended and open-ended diagnosis tasks. Evaluations reveal a stark dichotomy: while advanced models demonstrate clinical reasoning proficiency when supplied with physician reference evidence (achieving up to $73.4\%$ accuracy on differential diagnosis), their performance substantially declines (as low as $25.4\%$) when reliant on independent retrieval mechanisms. This disparity highlights the dual challenges of effectively integrating multimodal clinical evidence and retrieving precise supporting literature. CURE is publicly available at https://github.com/yanniangu/CURE.

Medical concept extraction from electronic health records underpins many downstream applications, yet remains challenging because medically meaningful concepts are frequently implied rather than explicitly stated in medical narratives. Existing benchmarks with human-annotated evidence spans underscore the importance of grounding extracted concepts in medical text. However, they predominantly focus on explicitly stated concepts instead of implicit concepts. We present MedicalBench, a benchmark for medical concept extraction with evidence grounding that evaluates implicit medical reasoning. MedicalBench formulates medical concept extraction as a verification task over medical note-concept pairs, coupled with sentence-level evidence identification. Built from MIMIC-IV discharge summaries and human-verified ICD-10 codes, the dataset is curated through a multi-stage large language model (LLM) triage pipeline followed by medical annotation and expert review. It deliberately includes implicit positives, semantically confusable negatives, and cases where LLM judgments disagree with medical expert assessments. We define two complementary evaluation tasks: (1) medical concept extraction and (2) sentence-level evidence retrieval, enabling assessment of both correctness and interpretability. Benchmarking state-of-the-art LLMs reveals that performance remains modest, highlighting the difficulty of extracting implicitly expressed concepts. We further show that performance is largely invariant to note length, indicating that MedicalBench isolates reasoning difficulty rather than superficial confounders. MedicalBench provides the first systematic benchmark for implicit, evidence-grounded medical concept extraction, offering a foundation for developing medical language models that can both identify medically relevant concepts and justify their predictions in a transparent and medically faithful manner.