Does medical specialization of VLMs enhance discriminative power?: A comprehensive investigation through feature distribution analysis

This study investigates the feature representations produced by publicly available open source medical vision-language models (VLMs). While medical VLMs are expected to capture diagnostically relevant features, their learned representations remain underexplored, and standard evaluations like classification accuracy do not fully reveal if they acquire truly discriminative, lesion-specific features. Understanding these representations is crucial for revealing medical image structures and improving downstream tasks in medical image analysis. This study aims to investigate the feature distributions learned by medical VLMs and evaluate the impact of medical specialization. We analyze the feature distribution of multiple image modalities extracted by some representative medical VLMs across lesion classification datasets on multiple modalities. These distributions were compared them with non-medical VLMs to assess the domain-specific medical training. Our experiments showed that medical VLMs can extract discriminative features that are effective for medical classification tasks. Moreover, it was found that non-medical VLMs with recent improvement with contextual enrichment such as LLM2CLIP produce more refined feature representations. Our results imply that enhancing text encoder is more crucial than training intensively on medical images when developing medical VLMs. Notably, non-medical models are particularly vulnerable to biases introduced by overlaied text strings on images. These findings underscore the need for careful consideration on model selection according to downstream tasks besides potential risks in inference due to background biases such as textual information in images.

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A short version paper of this research has been accepted for The IEEE International Symposium on Biomedical Imaging (ISBI) 2026