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原文摘要

Multimodal biomedical Vision-Language Models (VLMs) exhibit immense potential in the field of Continual Learning (CL). However, they confront a core dilemma: how to preserve fine-grained intra-modality features while bridging the significant domain gap across different modalities. To address this challenge, we propose a comprehensive framework. Leveraging our 18-million multimodal and comprehensive medical retrieval database derived from PubMed scientific papers, we pioneer the integration of Retrieval-Augmented Generation (RAG) into CL. Specifically, we employ a multi-modal, multi-layer RAG system that provides real-time guidance for model fine-tuning through dynamic, on-demand knowledge retrieval. Building upon this, we introduce a dynamic knowledge distillation framework. This framework precisely resolves the aforementioned core dilemma by dynamically modulating the importance of the parameter space, the granularity of the distilled knowledge, and the data distribution of the reference dataset in accordance with the required level of detail. To thoroughly validate the clinical value of our strategy, we have designed a more rigorous Medical Generalist Task Incremental Learning (MGTIL) benchmark. This benchmark is engineered to simultaneously evaluate the model's capacity for adaptation to significant domain shifts, retention of subtle intra-domain features, and real-time learning of novel and complex medical tasks. Our method achieves stable SOTA results across all metrics, with https://github.com/CZZZZZZZZZZZZZZZZZ/PRIMED code available.