MedFrameQA: A Multi-Image Medical VQA Benchmark for Clinical Reasoning

Abstract

Real-world clinical practice demands multi-image comparative reasoning, yet current medical benchmarks remain limited to single-frame interpretation. We present MedFrameQA, the first benchmark explicitly designed to test multi-image medical VQA through educationally-validated diagnostic sequences. To construct this dataset, we develop a scalable pipeline that leverages narrative transcripts from medical education videos to align visual frames with textual concepts, automatically producing 2,851 high-quality multi-image VQA pairs with explicit, transcript-grounded reasoning chains. Our evaluation of 11 advanced MLLMs (including reasoning models) exposes severe deficiencies in multi-image synthesis, where accuracies mostly fall below 50% and exhibit instability across varying image counts. Error analysis demonstrates that models often treat images as isolated instances, failing to track pathological progression or cross-reference anatomical shifts. MedFrameQA provides a rigorous standard for evaluating the next generation of MLLMs in handling complex, temporally grounded medical narratives.