# Does medical specialization of VLMs enhance discriminative power?: A comprehensive investigation through feature distribution analysis

arXiv: https://arxiv.org/abs/2601.14774 · HTML: https://mlsanity.com/paper/2601.14774/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Medical vision-language models, one of 16 directions in Multimodal LLMs / vision-language models.
- Builds on 48 of its 84 references that are in the map.
- First posted on arXiv 21 Jan 2026.

## Placed in

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

## Builds on (most cited first, 30 of 48)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [Very Deep Convolutional Networks for Large-Scale Image Recognition](https://mlsanity.com/paper/1409.1556/) (2014)
- [Swin Transformer: Hierarchical Vision Transformer using Shifted Windows](https://mlsanity.com/paper/2103.14030/) (2021)
- [A Simple Framework for Contrastive Learning of Visual Representations](https://mlsanity.com/paper/2002.05709/) (2020)
- [Visual Instruction Tuning](https://mlsanity.com/paper/2304.08485/) (2023)
- [Improved Baselines with Visual Instruction Tuning](https://mlsanity.com/paper/2310.03744/) (2023)
- [Sigmoid Loss for Language Image Pre-Training](https://mlsanity.com/paper/2303.15343/) (2023)
- [UMAP: Uniform Manifold Approximation and Projection for Dimension Reduction](https://mlsanity.com/paper/1802.03426/) (2018)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [Big Self-Supervised Models are Strong Semi-Supervised Learners](https://mlsanity.com/paper/2006.10029/) (2020)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [Vision-Language Models for Vision Tasks: A Survey](https://mlsanity.com/paper/2304.00685/) (2023)
- [RISE: Randomized Input Sampling for Explanation of Black-box Models](https://mlsanity.com/paper/1806.07421/) (2018)
- [MedMNIST v2 -- A large-scale lightweight benchmark for 2D and 3D biomedical image classification](https://mlsanity.com/paper/2110.14795/) (2021)
- [Contrastive Learning of Medical Visual Representations from Paired Images and Text](https://mlsanity.com/paper/2010.00747/) (2020)
- [LLaVA-NeXT-Interleave: Tackling Multi-image, Video, and 3D in Large Multimodal Models](https://mlsanity.com/paper/2407.07895/) (2024)
- [Skin Lesion Analysis Toward Melanoma Detection: A Challenge at the 2017 International Symposium on Biomedical Imaging (ISBI), Hosted by the International Skin Imaging Collaboration (ISIC)](https://mlsanity.com/paper/1710.05006/) (2017)
- [Winoground: Probing Vision and Language Models for Visio-Linguistic Compositionality](https://mlsanity.com/paper/2204.03162/) (2022)
- [BiomedCLIP: a multimodal biomedical foundation model pretrained from fifteen million scientific image-text pairs](https://mlsanity.com/paper/2303.00915/) (2023)
- [MedGemma Technical Report](https://mlsanity.com/paper/2507.05201/) (2025)
- [EVA-02: A Visual Representation for Neon Genesis](https://mlsanity.com/paper/2303.11331/) (2023)
- [BCN20000: Dermoscopic Lesions in the Wild](https://mlsanity.com/paper/1908.02288/) (2019)
- [PMC-CLIP: Contrastive Language-Image Pre-training using Biomedical Documents](https://mlsanity.com/paper/2303.07240/) (2023)
- [Generalist Foundation Models from a Multimodal Dataset for 3D Computed Tomography](https://mlsanity.com/paper/2403.17834/) (2024)
- [Learning Visual Features from Large Weakly Supervised Data](https://mlsanity.com/paper/1511.02251/) (2015)
- [Parametric UMAP embeddings for representation and semi-supervised learning](https://mlsanity.com/paper/2009.12981/) (2020)
- [CXR-CLIP: Toward Large Scale Chest X-ray Language-Image Pre-training](https://mlsanity.com/paper/2310.13292/) (2023)
- [MedTrinity-25M: A Large-scale Multimodal Dataset with Multigranular Annotations for Medicine](https://mlsanity.com/paper/2408.02900/) (2024)

## Abstract (arXiv)

This study investigates the feature representations produced by publicly available open source medical vision-language models (VLMs). While medical VLMs are expected to capture diagnostically relevant features, their learned representations remain underexplored, and standard evaluations like classification accuracy do not fully reveal if they acquire truly discriminative, lesion-specific features. Understanding these representations is crucial for revealing medical image structures and improving downstream tasks in medical image analysis. This study aims to investigate the feature distributions learned by medical VLMs and evaluate the impact of medical specialization. We analyze the feature distribution of multiple image modalities extracted by some representative medical VLMs across lesion classification datasets on multiple modalities. These distributions were compared them with non-medical VLMs to assess the domain-specific medical training. Our experiments showed that medical VLMs can extract discriminative features that are effective for medical classification tasks. Moreover, it was found that non-medical VLMs with recent improvement with contextual enrichment such as LLM2CLIP produce more refined feature representations. Our results imply that enhancing text encoder is more crucial than training intensively on medical images when developing medical VLMs. Notably, non-medical models are particularly vulnerable to biases introduced by overlaied text strings on images. These findings underscore the need for careful consideration on model selection according to downstream tasks besides potential risks in inference due to background biases such as textual information in images.