Geometry-Aware Distillation for Prompt Tuning Biomedical Vision-Language Models
Authors: Tran Dinh Tien, Zhiqiang Shen
Organizations: Department of Machine Learning Mohamed bin Zayed University of Artificial Intelligence
Abstract
Current prompt-based and adapter-based tuning of vision-language models (VLMs) is attractive for medical imaging, where clinical data sensitivity favors frozen backbones and annotations are limited. However, these methods typically optimize only the ground-truth class, treating all other classes as equally incorrect, ignoring clinically meaningful class relations and yielding unstable decision boundaries in limited-supervision settings. We propose Omni-Geometry Knowledge Distillation (OGKD), a new framework that injects class-relation structure into the teacher to produce directional targets that preserve the ground truth while respecting inter-class geometry. Using these targets, we develop two distillation losses: Global Geometry-Aware Distillation (GAD) operates on the global image token, and Label-Guided Geometry Distillation (LGD) applies the same geometry to attentive patch tokens to improve fine-grained alignment. Across comprehensive experiments and analyses on 11 widely-used medical datasets for base-to-novel and few-shot evaluations, our OGKD achieves substantially better performance, consistently improving accuracy by an average absolute gain of 1.7%-2.8% over all prior state-of-the-art VLM adaptation counterparts. It also robustly generalizes to unseen classes and yields more reliable predictions than other approaches. Our code is available at https://github.com/tientrandinh/OGKD.
Medical Vision-Language Models (VLMs) exhibit strong zero-shot performance, yet their effectiveness still declines on out-of-distribution (OOD) data due to domain shifts and class bias inherited from large-scale pretraining. Existing few-shot adaptation methods typically introduce additional trainable components, which can be unstable in extremely low-data regimes (e.g., 1-shot), and lack robustness on different medical data. We present TCLA, a purely training-free few-shot adaptation method for Medical VLMs, which is fast and model-agnostic. TCLA corrects inference logits based on a small set of support samples, boosting pretrained VLMs performance by improving inter-class deconfusion and reducing domain shift. Extensive experiments on nine datasets across multiple medical imaging modalities including X-ray, Ultrasound, MRI, CT, Histopathology, demonstrate that TCLA consistently improves OOD performance of Medical VLMs and, in most of cases, outperforms existing training-based adaptation methods.
Biomedical Vision--Language Models (VLMs) have shown remarkable promise in few-shot medical diagnosis but face a critical bottleneck: \textit{fragility to prompt variations}.Existing adaptation frameworks typically optimize visual and textual prompts as independent streams, relying on ideal ``Golden Prompts''. In clinical reality, where descriptions are often noisy and heterogeneous, this modality isolation leads to unstable cross-modal alignment. To address this, we propose BiomedAP, a vision-informed dual-anchor framework with gated cross-modal fusion.BiomedAP enforces synergistic alignment through two mechanisms: (1) Gated Cross-Modal Fusion, which enables layer-wise interaction between modalities, acting as a dynamic noise regulator to suppress irrelevant textual cues; and (2) a Dual-Anchor Constraint that regularizes learnable prompts toward stable semantic centroids derived from both expert templates (High Anchors) and few-shot visual prototypes (Low Anchors). Extensive experiments across 11 benchmarks demonstrate that BiomedAP consistently surpasses baselines, achieving competitive few-shot accuracy and markedly enhanced robustness under prompt perturbations. Our code is available at: https://github.com/tongdiedie/BiomedAP. Keywords: Vision-Language Models; Prompt Learning; Parameter-Efficient Fine-Tuning; Few-shot Learning
Knowledge distillation offers an efficient route to transfer a task-adapted vision-language teacher to a compact student. The training target in current vision-language distillation methods is typically constructed from the teacher prediction and applied uniformly to all training samples, making it unreliable under class and domain shifts. In this paper, we argue that distillation target construction should be treated as a dynamic training decision rather than a fixed recipe. To this end, we propose OnPoKD, an on-policy distillation framework for vision-language model adaptation. To the best of our knowledge, OnPoKD is the first framework that applies on-policy distillation to vision-language model adaptation by learning target construction as a policy decision. OnPoKD learns a lightweight controller that constructs sample-wise adaptive targets using reliability and disagreement cues from the teacher model, student model, and zero-shot prior. Instead of relying on a fixed teacher prediction, the controller dynamically balances teacher supervision, zero-shot prior guidance, and hard-label anchoring through bounded policy actions, allowing the distillation target to adapt to varying sample reliability and training stages. The policy controller is updated with validation feedback, encouraging target construction to optimize transferability rather than merely fitting the training distribution. Since the controller is only used during training, OnPoKD can be seamlessly integrated into existing vision-language distillation pipelines while preserving the original inference architecture and test-time cost. Extensive experiments on Base-to-novel generalization and Cross-dataset transfer benchmarks show that OnPoKD consistently improves over strong vision-language distillation baselines.