The advancement of Large Vision-Language Models (LVLMs) has propelled their application in the medical field. However, Medical LVLMs (Med-LVLMs) encounter factuality challenges due to modality misalignment, where the models prioritize textual knowledge over visual input, leading to hallucinations that contradict information in medical images. Previous attempts to enhance modality alignment in Med-LVLMs through preference optimization have inadequately mitigated clinical relevance in preference data, making these samples easily distinguishable and reducing alignment effectiveness. To address this challenge, we propose MMedPO, a novel multimodal medical preference optimization approach that considers the clinical relevance of preference samples to enhance Med-LVLM alignment. MMedPO curates multimodal preference data by introducing two types of dispreference: (1) plausible hallucinations injected through target Med-LVLMs or GPT-4o to produce medically inaccurate responses, and (2) lesion region neglect achieved through local lesion-noising, disrupting visual understanding of critical areas. We then calculate clinical relevance for each sample based on scores from multiple Med-LLMs and visual tools, and integrate these scores into the preference optimization process as weights, enabling effective alignment. Our experiments demonstrate that MMedPO significantly enhances factual accuracy in Med-LVLMs, achieving substantial improvements over existing preference optimization methods by averaging 14.2% and 51.7% across the Med-VQA and report generation tasks. Our code are available in https://github.com/aiming-lab/MMedPO.

Large language models (LLMs), such as GPT series models, have received substantial attention due to their impressive capabilities for generating and understanding human-level language. More recently, LLMs have emerged as an innovative and powerful adjunct in the medical field, transforming traditional practices and heralding a new era of enhanced healthcare services. This survey provides a comprehensive overview of Medical Large Language Models (Med-LLMs), outlining their evolution from general to the medical-specific domain (i.e, Technology and Application), as well as their transformative impact on healthcare (e.g., Trustworthiness and Safety). Concretely, starting from the fundamental history and technology of LLMs, we first delve into the progressive adaptation and refinements of general LLM models in the medical domain, especially emphasizing the advanced algorithms that boost the LLMs' performance in handling complicated medical environments, including clinical reasoning, knowledge graph, retrieval-augmented generation, human alignment, and multi-modal learning. Secondly, we explore the extensive applications of Med-LLMs across domains such as clinical decision support, report generation, and medical education, illustrating their potential to streamline healthcare services and augment patient outcomes. Finally, recognizing the imperative and responsible innovation, we discuss the challenges of ensuring fairness, accountability, privacy, and robustness in Med-LLMs applications. Finally, we conduct a concise discussion for anticipating possible future trajectories of Med-LLMs, identifying avenues for the prudent expansion of Med-LLMs. By consolidating above-mentioned insights, this review seeks to provide a comprehensive investigation of the potential strengths and limitations of Med-LLMs for professionals and researchers, ensuring a responsible landscape in the healthcare setting.