# Synergizing Discriminative Exemplars and Self-Refined Experience for MLLM-based In-Context Learning in Medical Diagnosis

arXiv: https://arxiv.org/abs/2603.27737 · HTML: https://mlsanity.com/paper/2603.27737/

## 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 19 of its 28 references that are in the map.
- First posted on arXiv 29 Mar 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, 19 of 19)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [Swin Transformer: Hierarchical Vision Transformer using Shifted Windows](https://mlsanity.com/paper/2103.14030/) (2021)
- [A ConvNet for the 2020s](https://mlsanity.com/paper/2201.03545/) (2022)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [SigLIP 2: Multilingual Vision-Language Encoders with Improved Semantic Understanding, Localization, and Dense Features](https://mlsanity.com/paper/2502.14786/) (2025)
- [MedMNIST v2 -- A large-scale lightweight benchmark for 2D and 3D biomedical image classification](https://mlsanity.com/paper/2110.14795/) (2021)
- [MedGemma Technical Report](https://mlsanity.com/paper/2507.05201/) (2025)
- [BiomedGPT: A Generalist Vision-Language Foundation Model for Diverse Biomedical Tasks](https://mlsanity.com/paper/2305.17100/) (2023)
- [Hulu-Med: A Transparent Generalist Model towards Holistic Medical Vision-Language Understanding](https://mlsanity.com/paper/2510.08668/) (2025)
- [Vision-Language Models Can Self-Improve Reasoning via Reflection](https://mlsanity.com/paper/2411.00855/) (2024)
- [Training-Free Group Relative Policy Optimization](https://mlsanity.com/paper/2510.08191/) (2025)
- [In-context learning enables multimodal large language models to classify cancer pathology images](https://mlsanity.com/paper/2403.07407/) (2024)
- [Show and Segment: Universal Medical Image Segmentation via In-Context Learning](https://mlsanity.com/paper/2503.19359/) (2025)
- [MMRAG: Multi-Mode Retrieval-Augmented Generation with Large Language Models for Biomedical In-Context Learning](https://mlsanity.com/paper/2502.15954/) (2025)
- [A Probabilistic Inference Scaling Theory for LLM Self-Correction](https://mlsanity.com/paper/2508.16456/) (2025)
- [Exposing and Mitigating Calibration Biases and Demographic Unfairness in MLLM Few-Shot In-Context Learning for Medical Image Classification](https://mlsanity.com/paper/2506.23298/) (2025)
- [K-Prism: A Knowledge-Guided and Prompt Integrated Universal Medical Image Segmentation Model](https://mlsanity.com/paper/2509.25594/) (2025)
- [Active Prompt Tuning Enables Gpt-40 To Do Efficient Classification Of Microscopy Images](https://mlsanity.com/paper/2411.02639/) (2024)

## Abstract (arXiv)

General Multimodal Large Language Models (MLLMs) often underperform in capturing domain-specific nuances in medical diagnosis, trailing behind fully supervised baselines. Although fine-tuning provides a remedy, the high costs of expert annotation and massive computational overhead limit its scalability. To bridge this gap without updating the weights of the pre-trained backbone of the MLLM, we propose a Clinician Mimetic Workflow. This is a novel In-Context Learning (ICL) framework designed to synergize Discriminative Exemplar Coreset Selection (DECS) and Self-Refined Experience Summarization (SRES). Specifically, DECS simulates a clinician's ability to reference "anchor cases" by selecting discriminative visual coresets from noisy data at the computational level; meanwhile, SRES mimics the cognition and reflection in clinical diagnosis by distilling diverse rollouts into a dynamic textual Experience Bank. Extensive evaluation across all 12 datasets of the MedMNIST 2D benchmark demonstrates that our method outperforms zero-shot general and medical MLLMs. Simultaneously, it achieves performance levels comparable to fully supervised vision models and domain-specific fine-tuned MLLMs, setting a new benchmark for parameter-efficient medical in-context learning. Our code is available at an anonymous repository: https://anonymous.4open.science/r/Synergizing-Discriminative-Exemplars-and-Self-Refined-Experience-ED74.