# SURE-VQA: Systematic Understanding of Robustness Evaluation in Medical VQA Tasks

arXiv: https://arxiv.org/abs/2411.19688 · HTML: https://mlsanity.com/paper/2411.19688/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Placed in Medical vision-language models, one of 16 directions in Multimodal LLMs / vision-language models.
- Builds on 34 of its 51 references that are in the map.
- First posted on arXiv 29 Nov 2024.

## Placed in

- Multimodal LLMs / vision-language models / [Medical vision-language models](https://mlsanity.com/mllm/medical-vision-language-models/)

## Builds on (most cited first, 30 of 34)

- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [Visual Instruction Tuning](https://mlsanity.com/paper/2304.08485/) (2023)
- [The Power of Scale for Parameter-Efficient Prompt Tuning](https://mlsanity.com/paper/2104.08691/) (2021)
- [Making the V in VQA Matter: Elevating the Role of Image Understanding in Visual Question Answering](https://mlsanity.com/paper/1612.00837/) (2016)
- [G-Eval: NLG Evaluation using GPT-4 with Better Human Alignment](https://mlsanity.com/paper/2303.16634/) (2023)
- [Shortcut Learning in Deep Neural Networks](https://mlsanity.com/paper/2004.07780/) (2020)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [Are We on the Right Way for Evaluating Large Vision-Language Models?](https://mlsanity.com/paper/2403.20330/) (2024)
- [Few-Shot Parameter-Efficient Fine-Tuning is Better and Cheaper than In-Context Learning](https://mlsanity.com/paper/2205.05638/) (2022)
- [Can Large Language Models Be an Alternative to Human Evaluations?](https://mlsanity.com/paper/2305.01937/) (2023)
- [Measuring Robustness to Natural Distribution Shifts in Image Classification](https://mlsanity.com/paper/2007.00644/) (2020)
- [SLAKE: A Semantically-Labeled Knowledge-Enhanced Dataset for Medical Visual Question Answering](https://mlsanity.com/paper/2102.09542/) (2021)
- [Large Language Models Are State-of-the-Art Evaluators of Translation Quality](https://mlsanity.com/paper/2302.14520/) (2023)
- [Med-Flamingo: a Multimodal Medical Few-shot Learner](https://mlsanity.com/paper/2307.15189/) (2023)
- [Towards Expert-Level Medical Question Answering with Large Language Models](https://mlsanity.com/paper/2305.09617/) (2023)
- [GPTScore: Evaluate as You Desire](https://mlsanity.com/paper/2302.04166/) (2023)
- [VL-Adapter: Parameter-Efficient Transfer Learning for Vision-and-Language Tasks](https://mlsanity.com/paper/2112.06825/) (2021)
- [Causality matters in medical imaging](https://mlsanity.com/paper/1912.08142/) (2019)
- [Common pitfalls and recommendations for using machine learning to detect and prognosticate for COVID-19 using chest radiographs and CT scans](https://mlsanity.com/paper/2008.06388/) (2020)
- [SCARF: Self-Supervised Contrastive Learning using Random Feature Corruption](https://mlsanity.com/paper/2106.15147/) (2021)
- [GREEN: Generative Radiology Report Evaluation and Error Notation](https://mlsanity.com/paper/2405.03595/) (2024)
- [The Effect of Natural Distribution Shift on Question Answering Models](https://mlsanity.com/paper/2004.14444/) (2020)
- [Revisiting Out-of-distribution Robustness in NLP: Benchmark, Analysis, and LLMs Evaluations](https://mlsanity.com/paper/2306.04618/) (2023)
- [Beyond Question-Based Biases: Assessing Multimodal Shortcut Learning in Visual Question Answering](https://mlsanity.com/paper/2104.03149/) (2021)
- [Roses Are Red, Violets Are Blue... but Should Vqa Expect Them To?](https://mlsanity.com/paper/2006.05121/) (2020)
- [Visual Question Answering: Datasets, Algorithms, and Future Challenges](https://mlsanity.com/paper/1610.01465/) (2016)
- [Parameter-Efficient Fine-Tuning for Medical Image Analysis: The Missed Opportunity](https://mlsanity.com/paper/2305.08252/) (2023)
- [EHRXQA: A Multi-Modal Question Answering Dataset for Electronic Health Records with Chest X-ray Images](https://mlsanity.com/paper/2310.18652/) (2023)
- [MM-SHAP: A Performance-agnostic Metric for Measuring Multimodal Contributions in Vision and Language Models & Tasks](https://mlsanity.com/paper/2212.08158/) (2022)
- [Benchmarking Robustness of Adaptation Methods on Pre-trained Vision-Language Models](https://mlsanity.com/paper/2306.02080/) (2023)

## Built on by (most cited first, 1 of 1)

- [Predictive Entropy as a Joint Screen for Error and Paraphrase Instability in Medical Vision-Language Models](https://mlsanity.com/paper/2604.08941/) (2026)

## Abstract (arXiv)

Vision-Language Models (VLMs) have great potential in medical tasks, like Visual Question Answering (VQA), where they could act as interactive assistants for both patients and clinicians. Yet their robustness to distribution shifts on unseen data remains a key concern for safe deployment. Evaluating such robustness requires a controlled experimental setup that allows for systematic insights into the model's behavior. However, we demonstrate that current setups fail to offer sufficiently thorough evaluations. To address this gap, we introduce a novel framework, called SURE-VQA, centered around three key requirements to overcome current pitfalls and systematically analyze VLM robustness: 1) Since robustness on synthetic shifts does not necessarily translate to real-world shifts, it should be measured on real-world shifts that are inherent to the VQA data; 2) Traditional token-matching metrics often fail to capture underlying semantics, necessitating the use of large language models (LLMs) for more accurate semantic evaluation; 3) Model performance often lacks interpretability due to missing sanity baselines, thus meaningful baselines should be reported that allow assessing the multimodal impact on the VLM. To demonstrate the relevance of this framework, we conduct a study on the robustness of various Fine-Tuning (FT) methods across three medical datasets with four types of distribution shifts. Our study highlights key insights into robustness: 1) No FT method consistently outperforms others in robustness, and 2) robustness trends are more stable across FT methods than across distribution shifts. Additionally, we find that simple sanity baselines that do not use the image data can perform surprisingly well and confirm LoRA as the best-performing FT method on in-distribution data. Code is provided at https://github.com/IML-DKFZ/sure-vqa.