ViSTA: A Simple Bridge Extends Visual Alignment to Clinical Time-Series Understanding in Multimodal LLMs

Longitudinal clinical notes contain rich evidence of how patients evolve over time, but converting this signal into training supervision for clinical prediction remains challenging. We extend Foresight Learning to clinical prediction by converting time-ordered MIMIC-III notes into examples consisting of past patient context, a natural-language question about a possible future event, and a label resolved from later documentation. This process yields 6,900 prediction examples from 702 admissions across medications, procedures, organ support, microbiology, and mortality. A small LoRA adapter trained on these examples improves over the prompted base model, reducing expected calibration error from 0.1269 to 0.0398 and Brier score from 0.199 to 0.145, while slightly outperforming GPT-5 point estimates on held-out questions. The approach enables reusable clinical prediction supervision from longitudinal notes without hand-engineered structured features or endpoint-specific classifiers.

The reasoning gap between large and compact vision-language models (VLMs) limits the deployment of medical AI on portable clinical devices. Compact VLMs of 2--4B parameters can run on resource-constrained hardware but lack the multi-step reasoning capacity needed for interpretable clinical decision support. Existing knowledge distillation methods transfer answers without the reasoning process behind them. Medical visual question answering (VQA) serves as a testbed for this problem, as it requires models to integrate visual evidence with clinical knowledge through structured reasoning chains. We introduce LiteMedCoT-VL, a pipeline that transfers chain-of-thought reasoning from a 235B teacher model to 2B student models through LoRA-based fine-tuning on explanation-enriched training data. All inference is conducted without image captions by default, simulating the clinical scenario in which a physician interprets a medical image directly without an accompanying radiology report. On the PMC-VQA benchmark, LiteMedCoT-VL achieves 64.9% accuracy, exceeding the zero-shot Qwen3-VL-4B baseline of 53.9% by 11.0 percentage points and outperforming all published baselines. This result indicates that a 2B model with reasoning distillation can match or exceed models with twice the parameters. Visual grounding analysis shows that the model relies on image content rather than exploiting textual priors. Our code is publicly available at https://anonymous.4open.science/r/LiteMedCoT-VL.

Medical time series (MedTS) underpin many clinical classification tasks, yet existing methods usually represent them only as numerical sequences and underuse the morphology that is explicit in waveform inspection. To bridge this gap, we introduce Vision-Informed Retrieval (ViRe), which uses a frozen VLM-derived waveform representation as a morphology-aware Query to guide retrieval from raw numerical MedTS features. Specifically, a Vision Query is extracted using pre-trained vision-language models (VLMs) to obtain morphology-aware priors from waveform plots. A tailored attention-based cross-modal retrieval mechanism then uses the Vision Query to select morphology-relevant temporal and channel evidence from the numerical representation. ViRe demonstrates strong effectiveness against ten established baselines, yielding an overall 6.42% relative improvement over the previous state of the art across six public benchmarks. Code, training scripts, and reproducibility materials are publicly available in the GitHub Repository: https://github.com/Levi-Ackman/ViRe.