# Efficiency in Focus: LayerNorm as a Catalyst for Fine-tuning Medical Visual Language Pre-trained Models

arXiv: https://arxiv.org/abs/2404.16385 · HTML: https://mlsanity.com/paper/2404.16385/

## Key facts

- Cited by 11 papers in the map (data through 14 Oct 2026).
- Placed in Medical vision-language models, one of 16 directions in Multimodal LLMs / vision-language models.
- Builds on 29 of its 46 references that are in the map.
- First posted on arXiv 25 Apr 2024.

## Placed in

- Multimodal LLMs / vision-language models / [Medical vision-language models](https://mlsanity.com/mllm/medical-vision-language-models/)

## Builds on (most cited first, 29 of 29)

- [BERT: Pre-training of Deep Bidirectional Transformers for Language Understanding](https://mlsanity.com/paper/1810.04805/) (2018)
- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [Language Models are Few-Shot Learners](https://mlsanity.com/paper/2005.14165/) (2020)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [BLIP: Bootstrapping Language-Image Pre-training for Unified Vision-Language Understanding and Generation](https://mlsanity.com/paper/2201.12086/) (2022)
- [Prefix-Tuning: Optimizing Continuous Prompts for Generation](https://mlsanity.com/paper/2101.00190/) (2021)
- [The Power of Scale for Parameter-Efficient Prompt Tuning](https://mlsanity.com/paper/2104.08691/) (2021)
- [InstructBLIP: Towards General-purpose Vision-Language Models with Instruction Tuning](https://mlsanity.com/paper/2305.06500/) (2023)
- [Align before Fuse: Vision and Language Representation Learning with Momentum Distillation](https://mlsanity.com/paper/2107.07651/) (2021)
- [ChestX-ray8: Hospital-scale Chest X-ray Database and Benchmarks on Weakly-Supervised Classification and Localization of Common Thorax Diseases](https://mlsanity.com/paper/1705.02315/) (2017)
- [LLaMA-Adapter: Efficient Fine-tuning of Language Models with Zero-init Attention](https://mlsanity.com/paper/2303.16199/) (2023)
- [DoRA: Weight-Decomposed Low-Rank Adaptation](https://mlsanity.com/paper/2402.09353/) (2024)
- [GPT Understands, Too](https://mlsanity.com/paper/2103.10385/) (2021)
- [Parameter-Efficient Fine-Tuning for Large Models: A Comprehensive Survey](https://mlsanity.com/paper/2403.14608/) (2024)
- [SLAKE: A Semantically-Labeled Knowledge-Enhanced Dataset for Medical Visual Question Answering](https://mlsanity.com/paper/2102.09542/) (2021)
- [VL-Adapter: Parameter-Efficient Transfer Learning for Vision-and-Language Tasks](https://mlsanity.com/paper/2112.06825/) (2021)
- [Multi-Modal Masked Autoencoders for Medical Vision-and-Language Pre-Training](https://mlsanity.com/paper/2209.07098/) (2022)
- [The Expressive Power of Low-Rank Adaptation](https://mlsanity.com/paper/2310.17513/) (2023)
- [Parameter-efficient Model Adaptation for Vision Transformers](https://mlsanity.com/paper/2203.16329/) (2022)
- [Overcoming Data Limitation in Medical Visual Question Answering](https://mlsanity.com/paper/1909.11867/) (2019)
- [MedICaT: A Dataset of Medical Images, Captions, and Textual References](https://mlsanity.com/paper/2010.06000/) (2020)
- [Tuning LayerNorm in Attention: Towards Efficient Multi-Modal LLM Finetuning](https://mlsanity.com/paper/2312.11420/) (2023)
- [Multiple Meta-model Quantifying for Medical Visual Question Answering](https://mlsanity.com/paper/2105.08913/) (2021)
- [AIDE: A Vision-Driven Multi-View, Multi-Modal, Multi-Tasking Dataset for Assistive Driving Perception](https://mlsanity.com/paper/2307.13933/) (2023)
- [Towards Multimodal Sentiment Analysis Debiasing via Bias Purification](https://mlsanity.com/paper/2403.05023/) (2024)
- [Robust Emotion Recognition in Context Debiasing](https://mlsanity.com/paper/2403.05963/) (2024)
- [VL-PET: Vision-and-Language Parameter-Efficient Tuning via Granularity Control](https://mlsanity.com/paper/2308.09804/) (2023)
- [Text-oriented Modality Reinforcement Network for Multimodal Sentiment Analysis from Unaligned Multimodal Sequences](https://mlsanity.com/paper/2307.13205/) (2023)

## Built on by (most cited first, 11 of 11)

- [MedVLM-R1: Incentivizing Medical Reasoning Capability of Vision-Language Models (VLMs) via Reinforcement Learning](https://mlsanity.com/paper/2502.19634/) (2025)
- [Reinforcement Learning Meets Large Language Models: A Survey of Advancements and Applications Across the LLM Lifecycle](https://mlsanity.com/paper/2509.16679/) (2025)
- [PediatricsGPT: Large Language Models as Chinese Medical Assistants for Pediatric Applications](https://mlsanity.com/paper/2405.19266/) (2024)
- [Asynchronous Multimodal Video Sequence Fusion via Learning Modality-Exclusive and -Agnostic Representations](https://mlsanity.com/paper/2407.04955/) (2024)
- [MindWatcher: Toward Smarter Multimodal Tool-Integrated Reasoning](https://mlsanity.com/paper/2512.23412/) (2025)
- [OrthoDoc: Multimodal Large Language Model for Assisting Diagnosis in Computed Tomography](https://mlsanity.com/paper/2409.09052/) (2024)
- [SatireDecoder: Visual Cascaded Decoupling for Enhancing Satirical Image Comprehension](https://mlsanity.com/paper/2512.00582/) (2025)
- [MM-Snowball: Evaluating and Mitigating Hallucination Snowballing in Multimodal Multi-Turn Dialogue](https://mlsanity.com/paper/2606.00622/) (2026)
- [Reinforced Curriculum Pre-Alignment for Domain-Adaptive VLMs](https://mlsanity.com/paper/2602.10740/) (2026)
- [LSP-ST: Ladder Shape-Biased Side-Tuning for Robust Infrared Small Target Detection](https://mlsanity.com/paper/2504.14481/) (2025)
- [Decoupling Vision and Language: Codebook Anchored Visual Adaptation](https://mlsanity.com/paper/2602.19449/) (2026)

## Abstract (arXiv)

In the realm of Medical Visual Language Models (Med-VLMs), the quest for universal efficient fine-tuning mechanisms remains paramount, especially given researchers in interdisciplinary fields are often extremely short of training resources, yet largely unexplored. Given the unique challenges in the medical domain, such as limited data scope and significant domain-specific requirements, evaluating and adapting Parameter-Efficient Fine-Tuning (PEFT) methods specifically for Med-VLMs is essential. Most of the current PEFT methods on Med-VLMs have yet to be comprehensively investigated but mainly focus on adding some components to the model's structure or input. However, fine-tuning intrinsic model components often yields better generality and consistency, and its impact on the ultimate performance of Med-VLMs has been widely overlooked and remains understudied. In this paper, we endeavour to explore an alternative to traditional PEFT methods, especially the impact of fine-tuning LayerNorm layers, FFNs and Attention layers on the Med-VLMs. Our comprehensive studies span both small-scale and large-scale Med-VLMs, evaluating their performance under various fine-tuning paradigms across tasks such as Medical Visual Question Answering and Medical Imaging Report Generation. The findings reveal unique insights into the effects of intrinsic parameter fine-tuning methods on fine-tuning Med-VLMs to downstream tasks and expose fine-tuning solely the LayerNorm layers not only surpasses the efficiency of traditional PEFT methods but also retains the model's accuracy and generalization capabilities across a spectrum of medical downstream tasks. The experiments show LayerNorm fine-tuning's superior adaptability and scalability, particularly in the context of large-scale Med-VLMs.