Benchmarking Direct Preference Optimization for Medical Large Vision–Language Models

Abstract

Large vision-language models (LVLMs) are gaining traction in clinical tasks such as diagnostic support, report generation, and medical question answering. Among post-training techniques, Direct Preference Optimization (DPO) has shown promise in aligning model outputs with human preferences, yet its effectiveness in high-stakes medical contexts remains underexplored. In this work, we present the first systematic evaluation of nine DPO variants applied to two leading medical LVLMs, LLaVA-Med and HuatuoGPT-Vision. We benchmark these models on five curated datasets covering diverse clinical tasks. Evaluations include both automated metrics and expert assessments. Our results show that while DPO improves alignment and reduces severe hallucinations, it yields inconsistent gains over supervised fine-tuning. We further introduce DPO variant that better handles visual misinterpretations and enhances clinical understanding. These findings reveal both the potential and limitations of DPO in medical AI. To support future research, we will release all DPO training data, model checkpoints, and expert annotations upon acceptance.