When Does RL Help Medical VLMs? Disentangling Vision, SFT, and RL Gains

Reinforcement learning (RL) is increasingly used to post-train medical Vision-Language Models (VLMs), yet it remains unclear whether RL improves medical visual reasoning or mainly sharpens behaviors already induced by supervised fine-tuning (SFT). We present a controlled study that disentangles these effects along three axes: vision, SFT, and RL. Using MedMNIST as a multi-modality testbed, we probe visual perception by benchmarking VLM vision towers against vision-only baselines, quantify reasoning support and sampling efficiency via Accuracy@1 versus Pass@K, and evaluate when RL closes the support gap and how gains transfer across modalities. We find that RL is most effective when the model already has non-trivial support (high Pass@K): it primarily sharpens the output distribution, improving Acc@1 and sampling efficiency, while SFT expands support and makes RL effective. Based on these findings, we propose a boundary-aware recipe and instantiate it by RL post-training an OctoMed-initialized model on a small, balanced subset of PMC multiple-choice VQA, achieving strong average performance across six medical VQA benchmarks.

Advancing Medical Representation Learning Through High-Quality Data

Despite the growing scale of medical Vision-Language datasets, the impact of dataset quality on model performance remains under-explored. We introduce Open-PMC, a high-quality medical dataset from PubMed Central, containing 2.2 million image-text pairs, enriched with image modality annotations, subfigures, and summarized in-text references. Notably, the in-text references provide richer medical context, extending beyond the abstract information typically found in captions. Through extensive experiments, we benchmark Open-PMC against larger datasets across retrieval and zero-shot classification tasks. Our results show that dataset quality-not just size-drives significant performance gains. We complement our benchmark with an in-depth analysis of feature representation. Our findings highlight the crucial role of data curation quality in advancing multimodal medical AI. We release Open-PMC, along with the trained models and our codebase.

Similarity-Aware Token Pruning: Your VLM but Faster

The computational demands of Vision Transformers (ViTs) and Vision-Language Models (VLMs) remain a significant challenge due to the quadratic complexity of self-attention. While token pruning offers a promising solution, existing methods often introduce training overhead or fail to adapt dynamically across layers. We present SAINT, a training-free token pruning framework that leverages token similarity and a graph-based formulation to dynamically optimize pruning rates and redundancy thresholds. Through systematic analysis, we identify a universal three-stage token evolution process (aligner-explorer-aggregator) in transformers, enabling aggressive pruning in early stages without sacrificing critical information. For ViTs, SAINT doubles the throughput of ViT-H/14 at 224px with only 0.6% accuracy loss on ImageNet-1K, surpassing the closest competitor by 0.8%. For VLMs, we apply SAINT in three modes: ViT-only, LLM-only, and hybrid. SAINT reduces LLaVA-13B's tokens by 75%, achieving latency comparable to LLaVA-7B with less than 1% performance loss across benchmarks. Our work establishes a unified, practical framework for efficient inference in ViTs and VLMs.