Toward Effective Reinforcement Learning Fine-Tuning for Medical VQA in Vision-Language Models

Recently, reinforcement learning (RL)-based tuning has shifted the trajectory of Multimodal Large Language Models (MLLMs), particularly following the introduction of Group Relative Policy Optimization (GRPO). However, directly applying it to medical tasks remains challenging for achieving clinically grounded model behavior. Motivated by the need to align model response with clinical expectations, we investigate four critical dimensions that affect the effectiveness of RL-based tuning in medical visual question answering (VQA): base model initialization strategy, the role of medical semantic alignment, the impact of length-based rewards on long-chain reasoning, and the influence of bias. We conduct extensive experiments to analyze these factors for medical MLLMs, providing new insights into how models are domain-specifically fine-tuned. Additionally, our results also demonstrate that GRPO-based RL tuning consistently outperforms standard supervised fine-tuning (SFT) in both accuracy and reasoning quality.

DRA-GRPO: Exploring Diversity-Aware Reward Adjustment for R1-Zero-Like Training of Large Language Models

Recent advances in reinforcement learning for language model post-training, such as Group Relative Policy Optimization (GRPO), have shown promise in low-resource settings. However, GRPO typically relies on solution-level and scalar reward signals that fail to capture the semantic diversity among sampled completions. This leads to what we identify as a diversity-quality inconsistency, where distinct reasoning paths may receive indistinguishable rewards. To address this limitation, we propose $\textit{Diversity-aware Reward Adjustment}$ (DRA), a method that explicitly incorporates semantic diversity into the reward computation. DRA uses Submodular Mutual Information (SMI) to downweight redundant completions and amplify rewards for diverse ones. This encourages better exploration during learning, while maintaining stable exploitation of high-quality samples. Our method integrates seamlessly with both GRPO and its variant DR.~GRPO, resulting in $\textit{DRA-GRPO}$ and $\textit{DGA-DR.~GRPO}$. We evaluate our method on five mathematical reasoning benchmarks and find that it outperforms recent strong baselines. It achieves state-of-the-art performance with an average accuracy of 58.2%, using only 7,000 fine-tuning samples and a total training cost of approximately $55. The code is available at https://github.com/xiwenc1/DRA-GRPO.

FIC-TSC: Learning Time Series Classification with Fisher Information Constraint

Analyzing time series data is crucial to a wide spectrum of applications, including economics, online marketplaces, and human healthcare. In particular, time series classification plays an indispensable role in segmenting different phases in stock markets, predicting customer behavior, and classifying worker actions and engagement levels. These aspects contribute significantly to the advancement of automated decision-making and system optimization in real-world applications. However, there is a large consensus that time series data often suffers from domain shifts between training and test sets, which dramatically degrades the classification performance. Despite the success of (reversible) instance normalization in handling the domain shifts for time series regression tasks, its performance in classification is unsatisfactory. In this paper, we propose \textit{FIC-TSC}, a training framework for time series classification that leverages Fisher information as the constraint. We theoretically and empirically show this is an efficient and effective solution to guide the model converge toward flatter minima, which enhances its generalizability to distribution shifts. We rigorously evaluate our method on 30 UEA multivariate and 85 UCR univariate datasets. Our empirical results demonstrate the superiority of the proposed method over 14 recent state-of-the-art methods.

Talk Before You Retrieve: Agent-Led Discussions for Better RAG in Medical QA

Medical question answering (QA) is a reasoning-intensive task that remains challenging for large language models (LLMs) due to hallucinations and outdated domain knowledge. Retrieval-Augmented Generation (RAG) provides a promising post-training solution by leveraging external knowledge. However, existing medical RAG systems suffer from two key limitations: (1) a lack of modeling for human-like reasoning behaviors during information retrieval, and (2) reliance on suboptimal medical corpora, which often results in the retrieval of irrelevant or noisy snippets. To overcome these challenges, we propose Discuss-RAG, a plug-and-play module designed to enhance the medical QA RAG system through collaborative agent-based reasoning. Our method introduces a summarizer agent that orchestrates a team of medical experts to emulate multi-turn brainstorming, thereby improving the relevance of retrieved content. Additionally, a decision-making agent evaluates the retrieved snippets before their final integration. Experimental results on four benchmark medical QA datasets show that Discuss-RAG consistently outperforms MedRAG, especially significantly improving answer accuracy by up to 16.67% on BioASQ and 12.20% on PubMedQA. The code is available at: https://github.com/LLM-VLM-GSL/Discuss-RAG.

A BERT-Style Self-Supervised Learning CNN for Disease Identification from Retinal Images

In the field of medical imaging, the advent of deep learning, especially the application of convolutional neural networks (CNNs) has revolutionized the analysis and interpretation of medical images. Nevertheless, deep learning methods usually rely on large amounts of labeled data. In medical imaging research, the acquisition of high-quality labels is both expensive and difficult. The introduction of Vision Transformers (ViT) and self-supervised learning provides a pre-training strategy that utilizes abundant unlabeled data, effectively alleviating the label acquisition challenge while broadening the breadth of data utilization. However, ViT's high computational density and substantial demand for computing power, coupled with the lack of localization characteristics of its operations on image patches, limit its efficiency and applicability in many application scenarios. In this study, we employ nn-MobileNet, a lightweight CNN framework, to implement a BERT-style self-supervised learning approach. We pre-train the network on the unlabeled retinal fundus images from the UK Biobank to improve downstream application performance. We validate the results of the pre-trained model on Alzheimer's disease (AD), Parkinson's disease (PD), and various retinal diseases identification. The results show that our approach can significantly improve performance in the downstream tasks. In summary, this study combines the benefits of CNNs with the capabilities of advanced self-supervised learning in handling large-scale unlabeled data, demonstrating the potential of CNNs in the presence of label scarcity.

How Effective Can Dropout Be in Multiple Instance Learning ?

Multiple Instance Learning (MIL) is a popular weakly-supervised method for various applications, with a particular interest in histological whole slide image (WSI) classification. Due to the gigapixel resolution of WSI, applications of MIL in WSI typically necessitate a two-stage training scheme: first, extract features from the pre-trained backbone and then perform MIL aggregation. However, it is well-known that this suboptimal training scheme suffers from "noisy" feature embeddings from the backbone and inherent weak supervision, hindering MIL from learning rich and generalizable features. However, the most commonly used technique (i.e., dropout) for mitigating this issue has yet to be explored in MIL. In this paper, we empirically explore how effective the dropout can be in MIL. Interestingly, we observe that dropping the top-k most important instances within a bag leads to better performance and generalization even under noise attack. Based on this key observation, we propose a novel MIL-specific dropout method, termed MIL-Dropout, which systematically determines which instances to drop. Experiments on five MIL benchmark datasets and two WSI datasets demonstrate that MIL-Dropout boosts the performance of current MIL methods with a negligible computational cost. The code is available at https://github.com/ChongQingNoSubway/MILDropout.

FM-LoRA: Factorized Low-Rank Meta-Prompting for Continual Learning

How to adapt a pre-trained model continuously for sequential tasks with different prediction class labels and domains and finally learn a generalizable model across diverse tasks is a long-lasting challenge. Continual learning (CL) has emerged as a promising approach to leverage pre-trained models (e.g., Transformers) for sequential tasks. While many existing CL methods incrementally store additional learned structures, such as Low-Rank Adaptation (LoRA) adapters or prompts and sometimes even preserve features from previous samples to maintain performance. This leads to unsustainable parameter growth and escalating storage costs as the number of tasks increases. Moreover, current approaches often lack task similarity awareness, which further hinders the models ability to effectively adapt to new tasks without interfering with previously acquired knowledge. To address these challenges, we propose FM-LoRA, a novel and efficient low-rank adaptation method that integrates both a dynamic rank selector (DRS) and dynamic meta-prompting (DMP). This framework allocates model capacity more effectively across tasks by leveraging a shared low-rank subspace critical for preserving knowledge, thereby avoiding continual parameter expansion. Extensive experiments on various CL benchmarks, including ImageNet-R, CIFAR100, and CUB200 for class-incremental learning (CIL), and DomainNet for domain-incremental learning (DIL), with Transformers backbone demonstrate that FM-LoRA effectively mitigates catastrophic forgetting while delivering robust performance across a diverse range of tasks and domains.

Prompt-OT: An Optimal Transport Regularization Paradigm for Knowledge Preservation in Vision-Language Model Adaptation

Vision-language models (VLMs) such as CLIP demonstrate strong performance but struggle when adapted to downstream tasks. Prompt learning has emerged as an efficient and effective strategy to adapt VLMs while preserving their pre-trained knowledge. However, existing methods still lead to overfitting and degrade zero-shot generalization. To address this challenge, we propose an optimal transport (OT)-guided prompt learning framework that mitigates forgetting by preserving the structural consistency of feature distributions between pre-trained and fine-tuned models. Unlike conventional point-wise constraints, OT naturally captures cross-instance relationships and expands the feasible parameter space for prompt tuning, allowing a better trade-off between adaptation and generalization. Our approach enforces joint constraints on both vision and text representations, ensuring a holistic feature alignment. Extensive experiments on benchmark datasets demonstrate that our simple yet effective method can outperform existing prompt learning strategies in base-to-novel generalization, cross-dataset evaluation, and domain generalization without additional augmentation or ensemble techniques. The code is available at https://github.com/ChongQingNoSubway/Prompt-OT

RetinalGPT: A Retinal Clinical Preference Conversational Assistant Powered by Large Vision-Language Models

Recently, Multimodal Large Language Models (MLLMs) have gained significant attention for their remarkable ability to process and analyze non-textual data, such as images, videos, and audio. Notably, several adaptations of general-domain MLLMs to the medical field have been explored, including LLaVA-Med. However, these medical adaptations remain insufficiently advanced in understanding and interpreting retinal images. In contrast, medical experts emphasize the importance of quantitative analyses for disease detection and interpretation. This underscores a gap between general-domain and medical-domain MLLMs: while general-domain MLLMs excel in broad applications, they lack the specialized knowledge necessary for precise diagnostic and interpretative tasks in the medical field. To address these challenges, we introduce \textit{RetinalGPT}, a multimodal conversational assistant for clinically preferred quantitative analysis of retinal images. Specifically, we achieve this by compiling a large retinal image dataset, developing a novel data pipeline, and employing customized visual instruction tuning to enhance both retinal analysis and enrich medical knowledge. In particular, RetinalGPT outperforms MLLM in the generic domain by a large margin in the diagnosis of retinal diseases in 8 benchmark retinal datasets. Beyond disease diagnosis, RetinalGPT features quantitative analyses and lesion localization, representing a pioneering step in leveraging LLMs for an interpretable and end-to-end clinical research framework. The code is available at https://github.com/Retinal-Research/RetinalGPT

EyeBench: A Call for More Rigorous Evaluation of Retinal Image Enhancement

Over the past decade, generative models have achieved significant success in enhancement fundus images.However, the evaluation of these models still presents a considerable challenge. A comprehensive evaluation benchmark for fundus image enhancement is indispensable for three main reasons: 1) The existing denoising metrics (e.g., PSNR, SSIM) are hardly to extend to downstream real-world clinical research (e.g., Vessel morphology consistency). 2) There is a lack of comprehensive evaluation for both paired and unpaired enhancement methods, along with the need for expert protocols to accurately assess clinical value. 3) An ideal evaluation system should provide insights to inform future developments of fundus image enhancement. To this end, we propose a novel comprehensive benchmark, EyeBench, to provide insights that align enhancement models with clinical needs, offering a foundation for future work to improve the clinical relevance and applicability of generative models for fundus image enhancement. EyeBench has three appealing properties: 1) multi-dimensional clinical alignment downstream evaluation: In addition to evaluating the enhancement task, we provide several clinically significant downstream tasks for fundus images, including vessel segmentation, DR grading, denoising generalization, and lesion segmentation. 2) Medical expert-guided evaluation design: We introduce a novel dataset that promote comprehensive and fair comparisons between paired and unpaired methods and includes a manual evaluation protocol by medical experts. 3) Valuable insights: Our benchmark study provides a comprehensive and rigorous evaluation of existing methods across different downstream tasks, assisting medical experts in making informed choices. Additionally, we offer further analysis of the challenges faced by existing methods. The code is available at \url{https://github.com/Retinal-Research/EyeBench}