Benchmarking Open-Source Vision Language Models in Orthopedic In-Training Examination: A Comparison with Residents, Domain-Specific Evaluation, and Parameter Scaling

Smaller models offer reduced accuracy in exchange for lower hardware requirements. Spine and pediatric domains remain consistently areas of underperformance across all models. Model selection should be based on domain-specific benchmark results to balance clinical needs with hardware limitations. While promising, open-source VLMs currently require further refinement and validation before they can be reliably applied in clinical or educational settings.