A simpler competing hypothesis on MedFrameQA is tested: methods that remain tightly aligned with the benchmark's final answer objective should be the strongest robust adaptation family once evaluation is controlled across fixed splits, matched budgets, repeated seeds, and calibration.
Abstract
Multi-frame medical VQA appears to reward increasingly complex adaptation: controller-style inference, localization-aware reranking, static hard-negative mixing, and staged continuation all appear plausible from first principles. We test a simpler competing hypothesis on MedFrameQA: methods that remain tightly aligned with the benchmark's final answer objective should be the strongest \emph{robust} adaptation family once evaluation is controlled across fixed splits, matched budgets, repeated seeds, and calibration. We compare controller-based methods, scaffold evolution, static mixed supervision, continuation-heavy variants, and direct answer-only supervised fine-tuning (SFT). The strongest robust family is direct decoder-only answer SFT on MedGemma-1.5-4B. Empirically, this family yields substantial improvements in held-out report accuracy over frozen baselines while remaining remarkably stable across repeated seeds and matched controls, ensuring our claims reflect true family-level robustness rather than an isolated hyperparameter peak. Furthermore, post-hoc calibration effectively repairs confidence estimation without compromising accuracy, and the core approach transfers consistently to secondary backbones like Qwen2.5-VL-3B. The main result is therefore not that a complex auxiliary mechanism wins, but that objective-aligned direct answer SFT is the strongest robust adaptation family we found for MedFrameQA. By establishing this strong, minimalist baseline, we hope to redirect community focus toward fundamentally robust optimization rather than architectural complexity.
As large multimodal models (LMMs) become increasingly integrated into clinical workflows, robust evaluation and alignment mechanisms are critical to ensure their reliability in decision support. Existing reward models (RMs) typically reduce preference supervision to scalar scores, limiting transparency and diagnostic insight. In this work, we introduce MedJudge, a multimodal medical reward modeling method that supports interpretable, evidence-grounded, and clinically-aligned decision evaluation. Given a clinical query (text and image) and candidate responses, MedJudge outputs both strict pairwise preferences and concise rationales, enabling transparent verification and inference-time reranking. To overcome the lack of high-quality supervision data, we construct a large-scale synthetic dataset with five complementary generation heuristics, and compare three training paradigms—scalar (BT), supervised (SFT), and reasoning-augmented SFT (SFT-R)—across 8 open-source models. Our comprehensive experiments show that while all methods improve over baseline, SFT-R provides comparable accuracy with richer explanations, and BT achieves the strongest overall performance. Beyond decision accuracy, we propose UMLS-based Concept Overlap (UCO) to evaluate explanation quality, measuring concept-level alignment with clinician expectations. Compared to BERTScore, UCO better reflects human preferences across multiple statistical tests. We further show that our BT-trained judges improve Best-of-4 answer selection by up to 2.75%, demonstrating practical utility in clinical inference-time decision reranking. Our results establish MedJudge as an effective, interpretable, and clinically grounded framework for multimodal medical reward modeling and evaluation. Our code, data and scripts are available at https://github.com/yunhonghe1021/MedJudge.
Yunhong He, Kai Zhang, Jiarong Qian et al.· Proceedings of the 32nd ACM...· 0 citations
For institution-constrained clinical QA, in-domain teacher-supervised fine-tuning was the most reliable evaluated adaptation path, and public-benchmark transfer was not a dependable proxy for local utility in the primary internal comparison.
Gao-Yuan Du, D. Dimitriadis, Xueping Li· Journal of Biomedical Inform...· 0 citations
Medical vision-language models (MVLMs) promise broad zero-shot generalization, yet their reliability collapses when confronted with unseen modalities and domains, precisely where clinical robustness matters most. To address this gap, we revisit test-time modality generalization from the perspective of Mixture-of-Experts (MoE) and ask: can experts route-and-adapt without any optimization during inference? We identify a fundamental specialization-generalization dilemma at test time, where blindly aggregating modality experts dilutes modality-specific knowledge, while selecting one highly confident expert risks mismatch under shift. To address this, we propose MoBE: a fully optimization-free framework that performs dynamic expert selection and adaptation at test time. MoBE combines entropy-guided dynamic routing in MoE settings with expert-wise Bayesian adaptation, enabling experts to update their confidence and adapt online without gradient updates. Without parametric updates, MoBE augments a static MVLM with test-time routing and online statistics, achieving average accuracy gains of +4.72, +7.17, and +4.3 over state-of-the-art TTA methods across seen, unseen, and heterogeneous medical benchmarks, highlighting the effectiveness of training-free expert adaptation for robust modality generalization.
Raza Imam, Darakshan Rashid, Yutong Xie et al.· 0 citations
Adapting deep learning models to profound clinical heterogeneity typically relies on parameter-efficient fine-tuning (PEFT) to avoid the severe overfitting associated with full end-to-end network updates. Although PEFT successfully navigates limited data scenarios, it inherently forces the training of a separate, isolated adapter for every specific diagnostic task. Consolidating these isolated adapters into a single generalist network risks negative transfer, as optimization gradients from conflicting visual domains interfere. To address this, we propose MoPET, a mixture-of-experts (MoE) method that uses a learned sparse router to direct each input through a small subset of low-rank PEFT experts injected into a frozen foundation model, sharing capacity across datasets while limiting cross-domain gradient conflict. Through selected evaluations on the MedMNIST benchmark, we first establish that PEFT outperforms full network updates, improving average accuracy from 86.50% to 88.97%. We then show that a single MoPET model consolidates four heterogeneous datasets into one network, improving average accuracy over the best isolated PEFT adapters (93.46% versus 92.83%). Finally, we show that co-training with auxiliary datasets improves accuracy on data-constrained clinical targets, raising average target accuracy over the strongest isolated adapter from 81.58% to 83.58%. Our source code is publicly available at https://github.com/sdoerrich97/mopet.
Sebastian Doerrich, Daniel Würtinger, Francesco Di Salvo et al.· 0 citations
Reliable evaluation of vision-language models (VLMs) and medical vision-language models (Medical-VLMs) requires calibrated confidence, particularly under realistic clinical conditions. However, existing efforts mainly focused on improving accuracy, leaving calibration in the medical domain underexplored. To this end, we propose MVC-Bench, a calibration-centric benchmark for medical image classification with VLMs and Medical-VLMs. MVC-Bench assesses the calibration across three axes: (i) robustness to modality, backbone, and domain shift (ii) effectiveness of calibration strategies and prompt-tuning methods (iii) stability under prompt-template and random-seed variations. The benchmark covers eight different backbones, three medical modalities, including fundus imaging, histopathology, and chest X-ray under in-domain and domain shift settings. It compares post-hoc calibration, train-time calibration, and zero-shot inference methods, together with six prompt-tuning methods. Across more than 1638 controlled experiments, we report accuracy and Expected Calibration Error (ECE) as primary metrics, and further report results with complementary calibration measures, including Maximum Calibration Error (MCE) and Adaptive Calibration Error (ACE). We further investigate the underlying causes of miscalibration in VLMs and Medical-VLMs and propose a simple train-time calibration method, Multi-Class Margin (MCM) regularization, which achieves lowest ECE on 10 out of 12 settings in in-domain and remains competitive under domain shifts. Collectively, MVC-Bench provides a structured evaluation framework and actionable guidance for improving calibration in safety-critical medical workflows.
Compact medical-image classifiers need efficiency and interpretable evidence, yet these goals are often addressed separately. We introduce qZACH-ViT, a quantization-aware extension of the zero-token (CLS-token-free), position-free ZACH-ViT backbone with recursive intrinsic patch-level class evidence. We also introduce Recursive Attribution-Stabilized Optimization (RASO), which norm-matches classification and attribution gradients and removes attribution components that conflict with classification. We evaluate four controlled conditions on seven MedMNIST datasets using 50 training images per class and ten fixed seeds, completing 280 runs. All 210 qZACH-ViT checkpoints are converted to executable mixed-precision ONNX INT8 graphs containing 16 signed INT8 MatMulInteger projections with INT32 accumulation. Deployed mixed-precision INT8 qZACH-ViT with Adam improves the FP32 ZACH-ViT baseline mean on all seven datasets, with a mean paired gain of 0.0313 in the dataset-specific primary metric; qZACH-ViT with RASO yields a mean gain of 0.0368. Across 964,920 source-to-INT8 test comparisons, prediction agreement is 99.9751\%, with a mean absolute primary-metric change of 0.000133 and a maximum of 0.004386. Across 3,600 matched intrinsic maps, mean cosine similarity is 0.999955, mean rank correlation is 0.9944, and mean top-10\% overlap is 0.9692. ONNX artifacts are 70.0\% smaller than source checkpoints and provide $1.41\times$ and $2.39\times$ end-to-end CPU speedups with one and four threads. RASO significantly reduces sufficiency error and improves input-noise stability over Adam with the same attribution loss, but does not dominate every predictive or explainable artificial intelligence (XAI) metric. These results establish qZACH-ViT as a deployable compact intrinsically explainable model and RASO as a targeted stability-oriented optimization procedure.
Athanasios Angelakis· arXiv.org· 0 citations
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