Beyond Captions: Context-Grounded Reconstruction for Biomedical Multimodal Continued Pretraining

Biomedical figures are explained not by captions alone but by body-text passages that discuss them. Yet current multimodal corpora typically reduce figures to isolated image-caption pairs, discarding this crucial context. Existing pipelines either omit this context or append it without enforcing the figure references that support each attachment, which can create unsupported image-text attachments and incoherent discourse. We introduce context-grounded reconstruction, a source-grounded framework that converts PubMed Central Open Access (PMC-OA) records into referentially coherent interleaved sequences. It recovers captions and source text, attaches context only through article-native figure references, repairs non-contiguous context, and prunes unsupported images. Starting from these reconstructed sequences, PMC-InterCPT first filters records for text quality and medical relevance, then applies evidence-aware allocation to form a 9.63B-token corpus for continued pretraining (CPT) of generative medical MLLMs. With fixed supervised fine-tuning (SFT), PMC-InterCPT improves Qwen3.5-4B-Base by 1.46 medical-average points and 3.11 general/scientific-average points over a token-matched raw source control, and surpasses a 42% larger raw-data run. Gains transfer to Qwen3.5-2B-Base and LLaVA-OneVision-1.5-4B-Base. Controlled ablations show that context-grounded reconstruction, rather than simply appending article context, is central to useful biomedical multimodal CPT.