# Benchmarking Direct Preference Optimization for Medical Large Vision-Language Models

arXiv: https://arxiv.org/abs/2601.17918 · HTML: https://mlsanity.com/paper/2601.17918/

## Key facts

- Cited by 1 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 22 of its 43 references that are in the map.
- First posted on arXiv 25 Jan 2026.

## Placed in

- Multimodal LLMs / vision-language models / [Medical vision-language models](https://mlsanity.com/mllm/medical-vision-language-models/)
- LLM alignment / RLHF / preference optimisation / [Medical LLM alignment](https://mlsanity.com/alignment/medical-llm-alignment/)

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

- [Judging LLM-as-a-Judge with MT-Bench and Chatbot Arena](https://mlsanity.com/paper/2306.05685/) (2023)
- [Direct Preference Optimization: Your Language Model is Secretly a Reward Model](https://mlsanity.com/paper/2305.18290/) (2023)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [FActScore: Fine-grained Atomic Evaluation of Factual Precision in Long Form Text Generation](https://mlsanity.com/paper/2305.14251/) (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)
- [Contrastive Preference Optimization: Pushing the Boundaries of LLM Performance in Machine Translation](https://mlsanity.com/paper/2401.08417/) (2024)
- [How Language Model Hallucinations Can Snowball](https://mlsanity.com/paper/2305.13534/) (2023)
- [Beyond Hallucinations: Enhancing LVLMs through Hallucination-Aware Direct Preference Optimization](https://mlsanity.com/paper/2311.16839/) (2023)
- [PMC-CLIP: Contrastive Language-Image Pre-training using Biomedical Documents](https://mlsanity.com/paper/2303.07240/) (2023)
- [Aligning Modalities in Vision Large Language Models via Preference Fine-tuning](https://mlsanity.com/paper/2402.11411/) (2024)
- [Silkie: Preference Distillation for Large Visual Language Models](https://mlsanity.com/paper/2312.10665/) (2023)
- [HealthGPT: A Medical Large Vision-Language Model for Unifying Comprehension and Generation via Heterogeneous Knowledge Adaptation](https://mlsanity.com/paper/2502.09838/) (2025)
- [Quilt-LLaVA: Visual Instruction Tuning by Extracting Localized Narratives from Open-Source Histopathology Videos](https://mlsanity.com/paper/2312.04746/) (2023)
- [Detecting and Mitigating Hallucination in Large Vision Language Models via Fine-Grained AI Feedback](https://mlsanity.com/paper/2404.14233/) (2024)
- [Enhancing Visual-Language Modality Alignment in Large Vision Language Models via Self-Improvement](https://mlsanity.com/paper/2405.15973/) (2024)
- [Enhancing Large Vision Language Models with Self-Training on Image Comprehension](https://mlsanity.com/paper/2405.19716/) (2024)
- [CLIP-DPO: Vision-Language Models as a Source of Preference for Fixing Hallucinations in LVLMs](https://mlsanity.com/paper/2408.10433/) (2024)
- [Surgical-LVLM: Learning to Adapt Large Vision-Language Model for Grounded Visual Question Answering in Robotic Surgery](https://mlsanity.com/paper/2405.10948/) (2024)
- [Insights into Alignment: Evaluating DPO and its Variants Across Multiple Tasks](https://mlsanity.com/paper/2404.14723/) (2024)
- [MMedPO: Aligning Medical Vision-Language Models with Clinical-Aware Multimodal Preference Optimization](https://mlsanity.com/paper/2412.06141/) (2024)
- [MedHEval: Benchmarking Hallucinations and Mitigation Strategies in Medical Large Vision-Language Models](https://mlsanity.com/paper/2503.02157/) (2025)

## Built on by (most cited first, 1 of 1)

- [Analyzing and Improving Fine-grained Preference Optimization in Medical LVLMs](https://mlsanity.com/paper/2606.12590/) (2026)

## Abstract (arXiv)

Large Vision-Language Models (LVLMs) hold significant promise for medical applications, yet their deployment is often constrained by insufficient alignment and reliability. While Direct Preference Optimization (DPO) has emerged as a potent framework for refining model responses, its efficacy in high-stakes medical contexts remains underexplored, lacking the rigorous empirical groundwork necessary to guide future methodological advances. To bridge this gap, we present the first comprehensive examination of diverse DPO variants within the medical domain, evaluating nine distinct formulations across two medical LVLMs: LLaVA-Med and HuatuoGPT-Vision. Our results reveal several critical limitations: current DPO approaches often yield inconsistent gains over supervised fine-tuning, with their efficacy varying significantly across different tasks and backbones. Furthermore, they frequently fail to resolve fundamental visual misinterpretation errors. Building on these insights, we present a targeted preference construction strategy as a proof-of-concept that explicitly addresses visual misinterpretation errors frequently observed in existing DPO models. This design yields a 3.6% improvement over the strongest existing DPO baseline on visual question-answering tasks. To support future research, we release our complete framework, including all training data, model checkpoints, and our codebase at https://github.com/dmis-lab/med-vlm-dpo.