Jean-Benoit Delbrouck, Justin Xu, Johannes Moll, Alois Thomas, Zhihong Chen, Sophie Ostmeier, Asfandyar Azhar, Kelvin Zhenghao Li, Andrew Johnston, Christian Bluethgen, Eduardo Pontes Reis, Mohamed S Muneer, Maya Varma, Curtis Langlotz. Proceedings of the 63rd Annual Meeting of the Association for Computational Linguistics (Volume 1: Long Papers). 2025.

Johannes Moll, Louisa Fay, Asfandyar Azhar, Sophie Ostmeier, Sergios Gatidis, Tim C. Lueth, Curtis Langlotz, Jean-Benoit Delbrouck. Proceedings of the 2025 Conference on Empirical Methods in Natural Language Processing. 2025.

Multimodal in-context learning (ICL) remains underexplored despite significant potential for domains such as medicine. Clinicians routinely encounter diverse, specialized tasks requiring adaptation from limited examples, such as drawing insights from a few relevant prior cases or considering a constrained set of differential diagnoses. While multimodal large language models (MLLMs) have shown advances in medical visual question answering (VQA), their ability to learn multimodal tasks from context is largely unknown. We introduce SMMILE, the first expert-driven multimodal ICL benchmark for medical tasks. Eleven medical experts curated problems, each including a multimodal query and multimodal in-context examples as task demonstrations. SMMILE encompasses 111 problems (517 question-image-answer triplets) covering 6 medical specialties and 13 imaging modalities. We further introduce SMMILE++, an augmented variant with 1038 permuted problems. A comprehensive evaluation of 15 MLLMs demonstrates that most models exhibit moderate to poor multimodal ICL ability in medical tasks. In open-ended evaluations, ICL contributes only an 8% average improvement over zero-shot on SMMILE and 9.4% on SMMILE++. We observe a susceptibility for irrelevant in-context examples: even a single noisy or irrelevant example can degrade performance by up to 9.5%. Moreover, we observe that MLLMs are affected by a recency bias, where placing the most relevant example last can lead to substantial performance improvements of up to 71%. Our findings highlight critical limitations and biases in current MLLMs when learning multimodal medical tasks from context. SMMILE is available at https://smmile-benchmark.github.io.

Vision-language models (VLMs) have made great strides in addressing temporal understanding tasks, which involve characterizing visual changes across a sequence of images. However, recent works have suggested that when making predictions, VLMs may rely on static feature biases, such as background or object features, rather than dynamic visual changes. Static feature biases are a type of shortcut and can contribute to systematic prediction errors on downstream tasks; as a result, identifying and characterizing error-inducing static feature biases is critical prior to real-world model deployment. Existing approaches for identifying such systematic failure modes in trained models (i) are typically designed for non-temporal settings and (ii) are challenging to evaluate in temporal settings due to the lack of quantitative evaluation frameworks. In this work, we address these challenges by introducing TRoVe, an automated approach for discovering error-inducing static feature biases learned by temporal VLMs. Given a trained VLM and an annotated validation dataset associated with a downstream classification task, TRoVe extracts candidate static features from the dataset and scores each feature by (i) the effect of the feature on classification errors as well as (ii) the extent to which the VLM relies on the feature when making predictions. In order to quantitatively evaluate TRoVe, we introduce an evaluation framework consisting of 101 trained temporal VLMs paired with ground-truth annotations for learned static feature biases. We use this framework to demonstrate that TRoVe can accurately identify error-inducing static feature biases in VLMs, achieving a 28.6% improvement over the closest baseline. Finally, we apply TRoVe to 7 off-the-shelf VLMs and 2 temporal understanding tasks, surfacing previously-unknown static feature biases and demonstrating that knowledge of learned biases can aid in improving model performance at test time. Our code is available at https://github.com/Stanford-AIMI/TRoVe.

Fine-tuned vision-language models (VLMs) often capture spurious correlations between image features and textual attributes, resulting in degraded zero-shot performance at test time. Existing approaches for addressing spurious correlations (i) primarily operate at the global image-level rather than intervening directly on fine-grained image features and (ii) are predominantly designed for unimodal settings. In this work, we present RaVL, which takes a fine-grained perspective on VLM robustness by discovering and mitigating spurious correlations using local image features rather than operating at the global image level. Given a fine-tuned VLM, RaVL first discovers spurious correlations by leveraging a region-level clustering approach to identify precise image features contributing to zero-shot classification errors. Then, RaVL mitigates the identified spurious correlation with a novel region-aware loss function that enables the VLM to focus on relevant regions and ignore spurious relationships during fine-tuning. We evaluate RaVL on 654 VLMs with various model architectures, data domains, and learned spurious correlations. Our results show that RaVL accurately discovers (191% improvement over the closest baseline) and mitigates (8.2% improvement on worst-group image classification accuracy) spurious correlations. Qualitative evaluations on general-domain and medical-domain VLMs confirm our findings.

Vision-language models (VLMs), such as CLIP and ALIGN, are generally trained on datasets consisting of image-caption pairs obtained from the web. However, real-world multimodal datasets, such as healthcare data, are significantly more complex: each image (e.g. X-ray) is often paired with text (e.g. physician report) that describes many distinct attributes occurring in fine-grained regions of the image. We refer to these samples as exhibiting high pairwise complexity, since each image-text pair can be decomposed into a large number of region-attribute pairings. The extent to which VLMs can capture fine-grained relationships between image regions and textual attributes when trained on such data has not been previously evaluated. The first key contribution of this work is to demonstrate through systematic evaluations that as the pairwise complexity of the training dataset increases, standard VLMs struggle to learn region-attribute relationships, exhibiting performance degradations of up to 37% on retrieval tasks. In order to address this issue, we introduce ViLLA as our second key contribution. ViLLA, which is trained to capture fine-grained region-attribute relationships from complex datasets, involves two components: (a) a lightweight, self-supervised mapping model to decompose image-text samples into region-attribute pairs, and (b) a contrastive VLM to learn representations from generated region-attribute pairs. We demonstrate with experiments across four domains (synthetic, product, medical, and natural images) that ViLLA outperforms comparable VLMs on fine-grained reasoning tasks, such as zero-shot object detection (up to 3.6 AP50 points on COCO and 0.6 mAP points on LVIS) and retrieval (up to 14.2 R-Precision points1

The radiology report is the main form of communication between radiologists and other clinicians. Prior work in natural language processing in radiology reports has shown the value of developing methods tailored for individual tasks such as identifying reports with critical results or disease detection. Meanwhile, English and biomedical natural language understanding benchmarks such as the General Language Understanding and Evaluation as well as Biomedical Language Understanding and Reasoning Benchmark have motivated the development of models that can be easily adapted to address many tasks in those domains. Here, we characterize the radiology report as a distinct domain and introduce RaLEs, the Radiology Language Evaluations, as a benchmark for natural language understanding and generation in radiology. RaLEs is comprised of seven natural language understanding and generation evaluations including the extraction of anatomical and disease entities and their relations, procedure selection, and report summarization. We characterize the performance of models designed for the general, biomedical, clinical and radiology domains across these tasks. We find that advances in the general and biomedical domains do not necessarily translate to radiology, and that improved models from the general domain can perform comparably to smaller clinical-specific models. The limited performance of existing pre-trained models on RaLEs highlights the opportunity to improve domain-specific self-supervised models for natural language processing in radiology. We propose RaLEs as a benchmark to promote and track the development of such domain-specific radiology language models.

In state-of-the-art Neural Machine Translation (NMT), an attention mechanism is used during decoding to enhance the translation.At every step, the decoder uses this mechanism to focus on different parts of the source sentence to gather the most useful information before outputting its target word.Recently, the effectiveness of the attention mechanism has also been explored for multimodal tasks, where it becomes possible to focus both on sentence parts and image regions that they describe.In this paper, we compare several attention mechanism on the multimodal translation task (English, image → German) and evaluate the ability of the model to make use of images to improve translation.We surpass state-of-the-art scores on the Multi30k data set, we nevertheless identify and report different misbehavior of the machine while translating.