# The Limited Impact of Medical Adaptation of Large Language and Vision-Language Models

arXiv: https://arxiv.org/abs/2411.08870 · HTML: https://mlsanity.com/paper/2411.08870/

## Key facts

- Cited by 9 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 26 of its 91 references that are in the map.
- First posted on arXiv 13 Nov 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, 26 of 26)

- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [LLaMA: Open and Efficient Foundation Language Models](https://mlsanity.com/paper/2302.13971/) (2023)
- [Llama 2: Open Foundation and Fine-Tuned Chat Models](https://mlsanity.com/paper/2307.09288/) (2023)
- [Mistral 7B](https://mlsanity.com/paper/2310.06825/) (2023)
- [The Pile: An 800GB Dataset of Diverse Text for Language Modeling](https://mlsanity.com/paper/2101.00027/) (2020)
- [What Disease does this Patient Have? A Large-scale Open Domain Question Answering Dataset from Medical Exams](https://mlsanity.com/paper/2009.13081/) (2020)
- [Galactica: A Large Language Model for Science](https://mlsanity.com/paper/2211.09085/) (2022)
- [OpenFlamingo: An Open-Source Framework for Training Large Autoregressive Vision-Language Models](https://mlsanity.com/paper/2308.01390/) (2023)
- [BiomedCLIP: a multimodal biomedical foundation model pretrained from fifteen million scientific image-text pairs](https://mlsanity.com/paper/2303.00915/) (2023)
- [PathVQA: 30000+ Questions for Medical Visual Question Answering](https://mlsanity.com/paper/2003.10286/) (2020)
- [SLAKE: A Semantically-Labeled Knowledge-Enhanced Dataset for Medical Visual Question Answering](https://mlsanity.com/paper/2102.09542/) (2021)
- [Med-Flamingo: a Multimodal Medical Few-shot Learner](https://mlsanity.com/paper/2307.15189/) (2023)
- [Towards Expert-Level Medical Question Answering with Large Language Models](https://mlsanity.com/paper/2305.09617/) (2023)
- [BioMistral: A Collection of Open-Source Pretrained Large Language Models for Medical Domains](https://mlsanity.com/paper/2402.10373/) (2024)
- [MedAlpaca -- An Open-Source Collection of Medical Conversational AI Models and Training Data](https://mlsanity.com/paper/2304.08247/) (2023)
- [MEDITRON-70B: Scaling Medical Pretraining for Large Language Models](https://mlsanity.com/paper/2311.16079/) (2023)
- [OpenChat: Advancing Open-source Language Models with Mixed-Quality Data](https://mlsanity.com/paper/2309.11235/) (2023)
- [Capabilities of Gemini Models in Medicine](https://mlsanity.com/paper/2404.18416/) (2024)
- [Holistic Evaluation of Language Models](https://mlsanity.com/paper/2211.09110/) (2022)
- [BioMedGPT: Open Multimodal Generative Pre-trained Transformer for BioMedicine](https://mlsanity.com/paper/2308.09442/) (2023)
- [Advancing Multimodal Medical Capabilities of Gemini](https://mlsanity.com/paper/2405.03162/) (2024)
- [Med42-v2: A Suite of Clinical LLMs](https://mlsanity.com/paper/2408.06142/) (2024)
- [BioMedLM: A 2.7B Parameter Language Model Trained On Biomedical Text](https://mlsanity.com/paper/2403.18421/) (2024)
- [Clinical Camel: An Open Expert-Level Medical Language Model with Dialogue-Based Knowledge Encoding](https://mlsanity.com/paper/2305.12031/) (2023)
- [Med42 -- Evaluating Fine-Tuning Strategies for Medical LLMs: Full-Parameter vs. Parameter-Efficient Approaches](https://mlsanity.com/paper/2404.14779/) (2024)
- [EHRNoteQA: An LLM Benchmark for Real-World Clinical Practice Using Discharge Summaries](https://mlsanity.com/paper/2402.16040/) (2024)

## Built on by (most cited first, 9 of 9)

- [ALFA: Aligning LLMs to Ask Good Questions A Case Study in Clinical Reasoning](https://mlsanity.com/paper/2502.14860/) (2025)
- [SFT Doesn't Always Hurt General Capabilities: Revisiting Domain-Specific Fine-Tuning in LLMs](https://mlsanity.com/paper/2509.20758/) (2025)
- [Benchmarking Visual Language Models on Standardized Visualization Literacy Tests](https://mlsanity.com/paper/2503.16632/) (2025)
- [Keeping Medical AI Healthy and Trustworthy: A Review of Detection and Correction Methods for System Degradation](https://mlsanity.com/paper/2506.17442/) (2025)
- [MMBU: A Massive Multi-modal Biomedical Understanding Benchmark to Probe the Perception Capabilities of Vision-Language Models](https://mlsanity.com/paper/2606.06696/) (2026)
- [KidneyTalk-open: No-code Deployment of a Private Large Language Model with Medical Documentation-Enhanced Knowledge Database for Kidney Disease](https://mlsanity.com/paper/2503.04153/) (2025)
- [Diagnosing our datasets: How does my language model learn clinical information?](https://mlsanity.com/paper/2505.15024/) (2025)
- [LVLM-Aware Multimodal Retrieval for RAG-Based Medical Diagnosis with General-Purpose Models](https://mlsanity.com/paper/2508.17394/) (2025)
- [Applying Language Models in Clinical Medicine: Recent Trends and Perspectives](https://mlsanity.com/paper/2609.34780/) (2026)

## Abstract (arXiv)

Several recent works seek to adapt general-purpose large language models (LLMs) and vision-language models (VLMs) for medical applications through continued pretraining on publicly available biomedical corpora. These works typically claim that such domain-adaptive pretraining improves performance on various downstream medical tasks, such as answering medical exam questions. In this paper, we compare ten "medical" LLMs and two VLMs against their corresponding base models, arriving at a different conclusion: all medical VLMs and nearly all medical LLMs fail to consistently improve over their base models in the zero-/few-shot prompting and supervised fine-tuning regimes for medical question answering (QA). For instance, on clinical-note-based QA tasks in the 3-shot setting, medical LLMs outperform their base models in only 26.7% of cases, reach a (statistical) tie in 16.7% of cases, and perform significantly worse in the remaining 56.7% of cases. Our conclusions are based on (i) comparing each medical model directly against its base model; (ii) optimizing the prompts for each model separately in zero-/few-shot prompting; and (iii) accounting for statistical uncertainty in comparisons. Our findings suggest that state-of-the-art general-domain models may already exhibit strong medical knowledge and reasoning capabilities, and offer recommendations to strengthen the conclusions of future studies.