# FT-ARM: Fine-Tuned Agentic Reflection Multimodal Language Model for Pressure Ulcer Severity Classification with Reasoning

arXiv: https://arxiv.org/abs/2510.24980 · HTML: https://mlsanity.com/paper/2510.24980/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 22 of its 50 references that are in the map.
- First posted on arXiv 28 Oct 2025.

## Builds on (most cited first, 22 of 22)

- [Language Models are Few-Shot Learners](https://mlsanity.com/paper/2005.14165/) (2020)
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- [Densely Connected Convolutional Networks](https://mlsanity.com/paper/1608.06993/) (2016)
- [Rethinking the Inception Architecture for Computer Vision](https://mlsanity.com/paper/1512.00567/) (2015)
- ["Why Should I Trust You?": Explaining the Predictions of Any Classifier](https://mlsanity.com/paper/1602.04938/) (2016)
- [MobileNetV2: Inverted Residuals and Linear Bottlenecks](https://mlsanity.com/paper/1801.04381/) (2018)
- [Finetuned Language Models Are Zero-Shot Learners](https://mlsanity.com/paper/2109.01652/) (2021)
- [Self-Refine: Iterative Refinement with Self-Feedback](https://mlsanity.com/paper/2303.17651/) (2023)
- [Aggregated Residual Transformations for Deep Neural Networks](https://mlsanity.com/paper/1611.05431/) (2016)
- [EfficientNetV2: Smaller Models and Faster Training](https://mlsanity.com/paper/2104.00298/) (2021)
- [Confounding variables can degrade generalization performance of radiological deep learning models](https://mlsanity.com/paper/1807.00431/) (2018)
- [Hidden Stratification Causes Clinically Meaningful Failures in Machine Learning for Medical Imaging](https://mlsanity.com/paper/1909.12475/) (2019)
- [What Clinicians Want: Contextualizing Explainable Machine Learning for Clinical End Use](https://mlsanity.com/paper/1905.05134/) (2019)
- [The Ultimate Guide to Fine-Tuning LLMs from Basics to Breakthroughs: An Exhaustive Review of Technologies, Research, Best Practices, Applied Research Challenges and Opportunities](https://mlsanity.com/paper/2408.13296/) (2024)
- [In-context learning enables multimodal large language models to classify cancer pathology images](https://mlsanity.com/paper/2403.07407/) (2024)
- [Agentic Medical Knowledge Graphs Enhance Medical Question Answering: Bridging the Gap Between LLMs and Evolving Medical Knowledge](https://mlsanity.com/paper/2502.13010/) (2025)
- [MMXU: A Multi-Modal and Multi-X-ray Understanding Dataset for Disease Progression](https://mlsanity.com/paper/2502.11651/) (2025)
- [Self-Refinement Strategies for LLM-based Product Attribute Value Extraction](https://mlsanity.com/paper/2501.01237/) (2025)
- [Explainable, Multi-modal Wound Infection Classification from Images Augmented with Generated Captions](https://mlsanity.com/paper/2502.20277/) (2025)

## Abstract (arXiv)

Pressure ulcers (PUs) are a serious and prevalent healthcare concern. Accurate classification of PU severity (Stages I-IV) is essential for proper treatment but remains challenging due to subtle visual distinctions and subjective interpretation, leading to variability among clinicians. Prior AI-based approaches using Convolutional Neural Networks (CNNs) and Vision Transformers (ViTs) achieved promising accuracy but offered limited interpretability. We present FT-ARM (Fine-Tuned Agentic Reflection Multimodal model), a fine-tuned multimodal large language model (MLLM) with an agentic self-reflection mechanism for pressure ulcer severity classification. Inspired by clinician-style diagnostic reassessment, FT-ARM iteratively refines its predictions by reasoning over visual features and encoded clinical knowledge from text, enhancing both accuracy and consistency. On the publicly available Pressure Injury Image Dataset (PIID), FT-ARM, fine-tuned from LLaMA 3.2 90B, achieved 85% accuracy in classifying PU stages I-IV, surpassing prior CNN-based models by +4%. Unlike earlier CNN/ViT studies that relied solely on offline evaluations, FT-ARM is designed and tested for live inference, reflecting real-time deployment conditions. Furthermore, it produces clinically grounded natural-language explanations, improving interpretability and trust. By integrating fine-tuning and reflective reasoning across multimodal inputs, FT-ARM advances the reliability, transparency, and clinical applicability of automated wound assessment systems, addressing the critical need for consistent and explainable PU staging to support improved patient care.