Investigating and Mitigating Catastrophic Forgetting in Medical Knowledge Injection through Internal Knowledge Augmentation Learning

Large Language Models (LLMs) are expected to possess comprehensive medical knowledge to support real-world clinical applications. While domain-specific fine-tuning effectively injects medical knowledge into LLMs, it often causes catastrophic forgetting of previously acquired knowledge and instruction-following capabilities. In this paper, we investigate this issue and reveal a pattern of proximity-dependent forgetting: knowledge that is semantically or topically close to the injected content is more likely to be forgotten, while unrelated knowledge shows minimal degradation. Moreover, we observe that existing mitigation techniques fail to address this type of forgetting effectively. Motivated by this observation and inspired by human learning mechanisms, we proposeInternAL (\Internal Knowledge Augmentation Learning), a novel approach that leverages LLMs' own internal knowledge to mitigate forgetting. InternAL first probes internal knowledge closely related to the injection by prompting the model with questions derived from the injected knowledge. This knowledge is then used to augment the original injection dataset, guiding the model to retain related prior knowledge during training. Experimental results on multiple LLMs (LLaMA, Qwen) demonstrate that InternAL significantly mitigates proximity-related forgetting while maintaining strong knowledge injection performance. Our findings provide new insights into the nature of catastrophic forgetting in medical knowledge injection and highlight a promising direction for robust domain adaptation in LLMs. Code and datasets are available at https://github.com/THUMLP/InternAL.