# GSCo: Towards Generalizable AI in Medicine via Generalist-Specialist Collaboration

arXiv: https://arxiv.org/abs/2404.15127 · HTML: https://mlsanity.com/paper/2404.15127/

## Key facts

- Cited by 34 papers in the map (data through 14 Oct 2026).
- Builds on 20 of its 70 references that are in the map.
- First posted on arXiv 23 Apr 2024.

## Builds on (most cited first, 20 of 20)

- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [Llama 2: Open Foundation and Fine-Tuned Chat Models](https://mlsanity.com/paper/2307.09288/) (2023)
- [InternVL: Scaling up Vision Foundation Models and Aligning for Generic Visual-Linguistic Tasks](https://mlsanity.com/paper/2312.14238/) (2023)
- [PaLM 2 Technical Report](https://mlsanity.com/paper/2305.10403/) (2023)
- [Gemini: A Family of Highly Capable Multimodal Models](https://mlsanity.com/paper/2312.11805/) (2023)
- [REPLUG: Retrieval-Augmented Black-Box Language Models](https://mlsanity.com/paper/2301.12652/) (2023)
- [OpenFlamingo: An Open-Source Framework for Training Large Autoregressive Vision-Language Models](https://mlsanity.com/paper/2308.01390/) (2023)
- [PathVQA: 30000+ Questions for Medical Visual Question Answering](https://mlsanity.com/paper/2003.10286/) (2020)
- [PMC-VQA: Visual Instruction Tuning for Medical Visual Question Answering](https://mlsanity.com/paper/2305.10415/) (2023)
- [Towards Generalist Foundation Model for Radiology by Leveraging Web-scale 2D&3D Medical Data](https://mlsanity.com/paper/2308.02463/) (2023)
- [ChatCAD: Interactive Computer-Aided Diagnosis on Medical Image using Large Language Models](https://mlsanity.com/paper/2302.07257/) (2023)
- [PMC-LLaMA: Towards Building Open-source Language Models for Medicine](https://mlsanity.com/paper/2304.14454/) (2023)
- [Reliable, Adaptable, and Attributable Language Models with Retrieval](https://mlsanity.com/paper/2403.03187/) (2024)
- [The Neglected Tails in Vision-Language Models](https://mlsanity.com/paper/2401.12425/) (2024)
- [OphGLM: Training an Ophthalmology Large Language-and-Vision Assistant based on Instructions and Dialogue](https://mlsanity.com/paper/2306.12174/) (2023)
- [RadAdapt: Radiology Report Summarization via Lightweight Domain Adaptation of Large Language Models](https://mlsanity.com/paper/2305.01146/) (2023)
- [RAR: Retrieving And Ranking Augmented MLLMs for Visual Recognition](https://mlsanity.com/paper/2403.13805/) (2024)
- [SnapNTell: Enhancing Entity-Centric Visual Question Answering with Retrieval Augmented Multimodal LLM](https://mlsanity.com/paper/2403.04735/) (2024)
- [Improving Medical Multi-modal Contrastive Learning with Expert Annotations](https://mlsanity.com/paper/2403.10153/) (2024)
- [Memory-based Cross-modal Semantic Alignment Network for Radiology Report Generation](https://mlsanity.com/paper/2404.00588/) (2024)

## Built on by (most cited first, 30 of 34)

- [Lingshu: A Generalist Foundation Model for Unified Multimodal Medical Understanding and Reasoning](https://mlsanity.com/paper/2506.07044/) (2025)
- [GMAI-MMBench: A Comprehensive Multimodal Evaluation Benchmark Towards General Medical AI](https://mlsanity.com/paper/2408.03361/) (2024)
- [RULE: Reliable Multimodal RAG for Factuality in Medical Vision Language Models](https://mlsanity.com/paper/2407.05131/) (2024)
- [Large-Scale 3D Medical Image Pre-training with Geometric Context Priors](https://mlsanity.com/paper/2410.09890/) (2024)
- [PathAgent: Toward Interpretable Analysis of Whole-slide Pathology Images via Large Language Model-based Agentic Reasoning](https://mlsanity.com/paper/2511.17052/) (2025)
- [Self-eXplainable AI for Medical Image Analysis: A Survey and New Outlooks](https://mlsanity.com/paper/2410.02331/) (2024)
- [UMIT: Unifying Medical Imaging Tasks via Vision-Language Models](https://mlsanity.com/paper/2503.15892/) (2025)
- [How Well Can Modern LLMs Act as Agent Cores in Radiology Environments?](https://mlsanity.com/paper/2412.09529/) (2024)
- [UniBiomed: A Universal Foundation Model for Grounded Biomedical Image Interpretation](https://mlsanity.com/paper/2504.21336/) (2025)
- [Improving Representation of High-frequency Components for Medical Visual Foundation Models](https://mlsanity.com/paper/2407.14651/) (2024)
- [From Text to Multimodality: Exploring the Evolution and Impact of Large Language Models in Medical Practice](https://mlsanity.com/paper/2410.01812/) (2024)
- [DDaTR: Dynamic Difference-aware Temporal Residual Network for Longitudinal Radiology Report Generation](https://mlsanity.com/paper/2505.03401/) (2025)
- [PRS-Med: Position Reasoning Segmentation in Medical Imaging](https://mlsanity.com/paper/2505.11872/) (2025)
- [MoMA: A Mixture-of-Multimodal-Agents Architecture for Enhancing Clinical Prediction Modelling](https://mlsanity.com/paper/2508.05492/) (2025)
- [A Chain of Diagnosis Framework for Accurate and Explainable Radiology Report Generation](https://mlsanity.com/paper/2508.09566/) (2025)
- [ShizhenGPT: Towards Multimodal LLMs for Traditional Chinese Medicine](https://mlsanity.com/paper/2508.14706/) (2025)
- [PathNavigate: A Training-Free Pathology Agent with Surprise-Guided Scan and Shared Slide Memory for Whole-Slide Image VQA](https://mlsanity.com/paper/2605.23559/) (2026)
- [MedHallTune: An Instruction-Tuning Benchmark for Mitigating Medical Hallucination in Vision-Language Models](https://mlsanity.com/paper/2502.20780/) (2025)
- [Constructing Ophthalmic MLLM for Positioning-diagnosis Collaboration Through Clinical Cognitive Chain Reasoning](https://mlsanity.com/paper/2507.17539/) (2025)
- [When Models Learn to Ask Why: Adaptive Causal Reasoning for Trustworthy Medical Vision-Language Models](https://mlsanity.com/paper/2603.23085/) (2026)
- [From Generalist to Specialist: Adapting Vision Language Models via Task-Specific Visual Instruction Tuning](https://mlsanity.com/paper/2410.06456/) (2024)
- [Learnable Token Sparsification for Efficient Gigapixel Whole Slide Image Reasoning](https://mlsanity.com/paper/2606.08641/) (2026)
- [MMedExpert-R1: Strengthening Multimodal Medical Reasoning via Domain-Specific Adaptation and Clinical Guideline Reinforcement](https://mlsanity.com/paper/2601.10949/) (2026)
- [ClinFusion: A Vision-Centric Multimodal LLM System for Holistic Medical Understanding](https://mlsanity.com/paper/2607.24743/) (2026)
- [Automated Structured Radiology Report Generation with Rich Clinical Context](https://mlsanity.com/paper/2510.00428/) (2025)
- [Med-VRAgent: A Framework for Medical Visual Reasoning-Enhanced Agents](https://mlsanity.com/paper/2510.18424/) (2025)
- [Anatomy-R1: Enhancing Anatomy Reasoning in Multimodal Large Language Models via Anatomical Similarity Curriculum and Group Diversity Augmentation](https://mlsanity.com/paper/2512.19512/) (2025)
- [Glance and Focus Reinforcement for Pan-cancer Screening](https://mlsanity.com/paper/2601.19103/) (2026)
- [LVLM-Aware Multimodal Retrieval for RAG-Based Medical Diagnosis with General-Purpose Models](https://mlsanity.com/paper/2508.17394/) (2025)
- [EVLF-FM: Explainable Vision Language Foundation Model for Medicine](https://mlsanity.com/paper/2509.24231/) (2025)

## Abstract (arXiv)

Generalist foundation models (GFMs) are renowned for their exceptional capability and flexibility in effectively generalizing across diverse tasks and modalities. In the field of medicine, while GFMs exhibit superior generalizability based on their extensive intrinsic knowledge as well as proficiency in instruction following and in-context learning, specialist models excel in precision due to their domain knowledge. In this work, for the first time, we explore the synergy between the GFM and specialist models, to enable precise medical image analysis on a broader scope. Specifically, we propose a cooperative framework, Generalist-Specialist Collaboration (GSCo), which consists of two stages, namely the construction of GFM and specialists, and collaborative inference on downstream tasks. In the construction stage, we develop MedDr, the largest open-source GFM tailored for medicine, showcasing exceptional instruction-following and in-context learning capabilities. Meanwhile, a series of lightweight specialists are crafted for downstream tasks with low computational cost. In the collaborative inference stage, we introduce two cooperative mechanisms, Mixture-of-Expert Diagnosis and Retrieval-Augmented Diagnosis, to harvest the generalist's in-context learning abilities alongside the specialists' domain expertise. For a comprehensive evaluation, we curate a large-scale benchmark featuring 28 datasets and about 250,000 images. Extensive results demonstrate that MedDr consistently outperforms state-of-the-art GFMs on downstream datasets. Furthermore, GSCo exceeds both GFMs and specialists across all out-of-domain disease diagnosis datasets. These findings indicate a significant paradigm shift in the application of GFMs, transitioning from separate models for specific tasks to a collaborative approach between GFMs and specialists, thereby advancing the frontiers of generalizable AI in medicine.