Instruction-Free Tuning of Large Vision Language Models for Medical Instruction Following

Large vision language models (LVLMs) have demonstrated impressive performance across a wide range of tasks. These capabilities largely stem from visual instruction tuning, which fine-tunes models on datasets consisting of curated image-instruction-output triplets. However, in the medical domain, constructing large-scale, high-quality instruction datasets is particularly challenging due to the need for specialized expert knowledge. To address this issue, we propose an instruction-free tuning approach that reduces reliance on handcrafted instructions, leveraging only image-description pairs for fine-tuning. Specifically, we introduce a momentum proxy instruction as a replacement for curated text instructions, which preserves the instruction-following capability of the pre-trained LVLM while promoting updates to parameters that remain valid during inference. Consequently, the fine-tuned LVLM can flexibly respond to domain-specific instructions, even though explicit instructions are absent during fine-tuning. Additionally, we incorporate a response shuffling strategy to mitigate the model's over-reliance on previous words, facilitating more effective fine-tuning. Our approach achieves state-of-the-art accuracy on multiple-choice visual question answering tasks across SKINCON, WBCAtt, CBIS, and MIMIC-CXR datasets, significantly enhancing the fine-tuning efficiency of LVLMs in medical domains.