Medical Large Vision-Language Models (Med-LVLMs) often exhibit suboptimal attention distribution on visual inputs, leading to hallucinated or inaccurate outputs. Existing methods primarily rely on inference-time interventions, which are limited in attention adaptation or require additional supervision. To address this, we propose A³Tune, a novel fine-tuning framework for Automatic Attention Alignment Tuning. ATune leverages zero-shot weak labels from SAM, refines them into prompt-aware labels using BioMedCLIP, and then selectively modifies visually-critical attention heads to improve alignment while minimizing interference. Additionally, we introduce a A³MoE module, enabling adaptive parameter selection for attention tuning across diverse prompts and images. Extensive experiments on medical VQA and report generation benchmarks show that A³Tune outperforms state-of-the-art baselines, achieving enhanced attention distributions and performance in Med-LVLMs.

Large vision-language models (LVLMs) have achieved impressive results in visual question-answering and reasoning tasks through vision instruction tuning on specific datasets. However, there remains significant room for improvement in aligning visual and language modalities. Existing methods often depend on external models or data, leading to uncontrollable and unstable alignment results. In this paper, we propose SIMA, a self-improvement framework that enhances visual and language modality alignment without external dependencies. SIMA leverages existing vision instruction tuning datasets to self-generate responses, incorporating an in-context self-critic mechanism that constructs preference pairs for tuning. Crucially, our approach allows LVLMs to act as critics by designing effective critic prompts, eliminating the need for additional fine-tuning with external instruction data. We introduce three novel visual metrics within the self-critic process to guide judgement, significantly improving the accuracy of self-critic. Through extensive experiments across 14 hallucination and comprehensive benchmarks, we demonstrate that SIMA significantly improves LVLM’s performance and outperforms previous approaches, achieving superior modality alignment.

Large language models (LLMs) can learn vast amounts of knowledge from diverse domains during pre-training. However, long-tail knowledge from specialized domains is often scarce and underrepresented, rarely appearing in the models’ memorization. Prior work has shown that in-context learning (ICL) with retriever augmentation can help LLMs better capture long-tail knowledge, reducing their reliance on pre-trained data. Despite these advances, we observe that LLM predictions for long-tail questions remain uncertain to variations in retrieved samples. To take advantage of the uncertainty in ICL for guiding LLM predictions toward correct answers on long-tail samples, we propose a reinforcement learning-based dynamic uncertainty ranking method for retrieval-augmented ICL that accounts for the varying impact of each retrieved sample on LLM predictions. Our approach prioritizes more informative and stable samples while demoting misleading ones, updating rankings based on the feedback from the LLM w.r.t. each retrieved sample. To enhance training efficiency and reduce query costs, we introduce a learnable dynamic ranking threshold, adjusted when the model encounters negative prediction shifts. Experimental results on various question-answering datasets from different domains show that our method outperforms the best baseline by 2.76%, with a notable 5.96% boost in accuracy on long-tail questions that elude zero-shot inference. Our code is available at https://github.com/Yu-shuyan/uncertian_ranker.