# Fleming-VL: Towards Universal Medical Visual Reasoning with Multimodal LLMs

arXiv: https://arxiv.org/abs/2511.00916 · HTML: https://mlsanity.com/paper/2511.00916/

## Key facts

- Cited by 11 papers in the map (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 22 of its 53 references that are in the map.
- First posted on arXiv 2 Nov 2025.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)
- Multimodal LLMs / vision-language models / [Medical vision-language models](https://mlsanity.com/mllm/medical-vision-language-models/)

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

- [DeepSeekMath: Pushing the Limits of Mathematical Reasoning in Open Language Models](https://mlsanity.com/paper/2402.03300/) (2024)
- [DeepSeek-R1: Incentivizing Reasoning Capability in LLMs via Reinforcement Learning](https://mlsanity.com/paper/2501.12948/) (2025)
- [Qwen2-VL: Enhancing Vision-Language Model's Perception of the World at Any Resolution](https://mlsanity.com/paper/2409.12191/) (2024)
- [InternVL3: Exploring Advanced Training and Test-Time Recipes for Open-Source Multimodal Models](https://mlsanity.com/paper/2504.10479/) (2025)
- [MiniCPM-V: A GPT-4V Level MLLM on Your Phone](https://mlsanity.com/paper/2408.01800/) (2024)
- [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)
- [Lingshu: A Generalist Foundation Model for Unified Multimodal Medical Understanding and Reasoning](https://mlsanity.com/paper/2506.07044/) (2025)
- [M3D: Advancing 3D Medical Image Analysis with Multi-Modal Large Language Models](https://mlsanity.com/paper/2404.00578/) (2024)
- [Medical Graph RAG: Towards Safe Medical Large Language Model via Graph Retrieval-Augmented Generation](https://mlsanity.com/paper/2408.04187/) (2024)
- [MedICaT: A Dataset of Medical Images, Captions, and Textual References](https://mlsanity.com/paper/2010.06000/) (2020)
- [Med3DVLM: An Efficient Vision-Language Model for 3D Medical Image Analysis](https://mlsanity.com/paper/2503.20047/) (2025)
- [LLaVA-Surg: Towards Multimodal Surgical Assistant via Structured Surgical Video Learning](https://mlsanity.com/paper/2408.07981/) (2024)
- [MMedPO: Aligning Medical Vision-Language Models with Clinical-Aware Multimodal Preference Optimization](https://mlsanity.com/paper/2412.06141/) (2024)
- [OmniV-Med: Scaling Medical Vision-Language Model for Universal Visual Understanding](https://mlsanity.com/paper/2504.14692/) (2025)
- [3D-CT-GPT: Generating 3D Radiology Reports through Integration of Large Vision-Language Models](https://mlsanity.com/paper/2409.19330/) (2024)
- [SurgVidLM: Towards Multi-grained Surgical Video Understanding with Large Language Model](https://mlsanity.com/paper/2506.17873/) (2025)
- [Fleming-R1: Toward Expert-Level Medical Reasoning via Reinforcement Learning](https://mlsanity.com/paper/2509.15279/) (2025)
- [MedGen: Unlocking Medical Video Generation by Scaling Granularly-annotated Medical Videos](https://mlsanity.com/paper/2507.05675/) (2025)
- [MedPix 2.0: A Comprehensive Multimodal Biomedical Data set for Advanced AI Applications with Retrieval Augmented Generation and Knowledge Graphs](https://mlsanity.com/paper/2407.02994/) (2024)
- [ExGra-Med: Extended Context Graph Alignment for Medical Vision-Language Models](https://mlsanity.com/paper/2410.02615/) (2024)
- [SurgLLM: A Versatile Large Multimodal Model with Spatial Focus and Temporal Awareness for Surgical Video Understanding](https://mlsanity.com/paper/2509.00357/) (2025)

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

- [MedMO: Grounding and Understanding Multimodal Large Language Model for Medical Images](https://mlsanity.com/paper/2602.06965/) (2026)
- [Clinical Cognition Alignment for Gastrointestinal Diagnosis with Multimodal LLMs](https://mlsanity.com/paper/2603.20698/) (2026)
- [MedCTA: A Benchmark for Clinical Tool Agents](https://mlsanity.com/paper/2606.11702/) (2026)
- [Can Multimodal Large Language Models Understand OCT?](https://mlsanity.com/paper/2607.16609/) (2026)
- [VITAL: Visual-Semantic Dual Supervision for Enhanced and Interpretable Latent Reasoning in Medical MLLMs](https://mlsanity.com/paper/2605.28422/) (2026)
- [Towards Enhancing 3D Spatial Reasoning in Medical Multimodal Large Language Models](https://mlsanity.com/paper/2607.13860/) (2026)
- [Location-Aware Fine-Grained Representation Learning for Medical Vision Foundation Models](https://mlsanity.com/paper/2608.00976/) (2026)
- [CARE: Confidence-Aware Reasoning for Reliable Medical VQA](https://mlsanity.com/paper/2608.10964/) (2026)
- [Counterfactual Anatomy-guided Spatial-Temporal Decoding for Annotation-Free Hallucination Mitigation in Medical VLMs](https://mlsanity.com/paper/2608.17427/) (2026)
- [Volumetric Radiology AI in the Era of Multimodal Large Language Models](https://mlsanity.com/paper/2608.20549/) (2026)
- [AnesTRACE: Benchmarking Intraoperative Anesthesia from Multimodal Perception to Multi-step Decision-Making](https://mlsanity.com/paper/2609.32740/) (2026)

## Abstract (arXiv)

Multimodal Large Language Models (MLLMs) have demonstrated remarkable effectiveness in various general-domain scenarios, such as visual question answering and image captioning. Recently, researchers have increasingly focused on empowering MLLMs with medical conversational abilities, which hold significant promise for clinical applications. However, medical data presents unique challenges due to its heterogeneous nature -- encompassing diverse modalities including 2D images, 3D volumetric scans, and temporal video sequences. The substantial domain gap and data format inconsistencies across these modalities have hindered the development of unified medical MLLMs. To address these challenges, we propose Fleming-VL, a unified end-to-end framework for comprehensive medical visual understanding across heterogeneous modalities. Fleming-VL tackles this problem from a data-centric perspective through three key strategies: (1) scaling up pretraining by integrating long-context data from both natural and medical-specific domains; (2) complementing fine-tuning with rare medical data, including holistic video analysis and underrepresented 2D modalities such as ultrasound and dermoscopy images; (3) extending existing evaluation frameworks to incorporate 3D volumetric and video understanding benchmarks. Through supervised fine-tuning (SFT) and group relative policy optimization (GRPO), we develop Fleming-VL in multiple model scales. Extensive experiments demonstrate that Fleming-VL achieves state-of-the-art performance across multiple benchmarks, including medical VQA, video QA, and 3D medical image understanding. We publicly release Fleming-VL to promote transparent, reproducible, and auditable progress in medical AI.