# Overconfidence and Calibration in Medical VQA: Empirical Findings and Hallucination-Aware Mitigation

arXiv: https://arxiv.org/abs/2604.02543 · HTML: https://mlsanity.com/paper/2604.02543/

## Key facts

- Cited by 6 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 53 of its 78 references that are in the map.
- First posted on arXiv 2 Apr 2026.

## 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 53)

- [Chain-of-Thought Prompting Elicits Reasoning in Large Language Models](https://mlsanity.com/paper/2201.11903/) (2022)
- [Judging LLM-as-a-Judge with MT-Bench and Chatbot Arena](https://mlsanity.com/paper/2306.05685/) (2023)
- [Self-Consistency Improves Chain of Thought Reasoning in Language Models](https://mlsanity.com/paper/2203.11171/) (2022)
- [On Calibration of Modern Neural Networks](https://mlsanity.com/paper/1706.04599/) (2017)
- [InternVL: Scaling up Vision Foundation Models and Aligning for Generic Visual-Linguistic Tasks](https://mlsanity.com/paper/2312.14238/) (2023)
- [Qwen-VL: A Versatile Vision-Language Model for Understanding, Localization, Text Reading, and Beyond](https://mlsanity.com/paper/2308.12966/) (2023)
- [DeBERTa: Decoding-enhanced BERT with Disentangled Attention](https://mlsanity.com/paper/2006.03654/) (2020)
- [Language Models (Mostly) Know What They Know](https://mlsanity.com/paper/2207.05221/) (2022)
- [Gemma 3 Technical Report](https://mlsanity.com/paper/2503.19786/) (2025)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [Calibrate Before Use: Improving Few-Shot Performance of Language Models](https://mlsanity.com/paper/2102.09690/) (2021)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [Can LLMs Express Their Uncertainty? An Empirical Evaluation of Confidence Elicitation in LLMs](https://mlsanity.com/paper/2306.13063/) (2023)
- [Semantic Uncertainty: Linguistic Invariances for Uncertainty Estimation in Natural Language Generation](https://mlsanity.com/paper/2302.09664/) (2023)
- [Just Ask for Calibration: Strategies for Eliciting Calibrated Confidence Scores from Language Models Fine-Tuned with Human Feedback](https://mlsanity.com/paper/2305.14975/) (2023)
- [Mitigating Object Hallucinations in Large Vision-Language Models through Visual Contrastive Decoding](https://mlsanity.com/paper/2311.16922/) (2023)
- [TinyLlama: An Open-Source Small Language Model](https://mlsanity.com/paper/2401.02385/) (2024)
- [LLaVA-NeXT-Interleave: Tackling Multi-image, Video, and 3D in Large Multimodal Models](https://mlsanity.com/paper/2407.07895/) (2024)
- [BiomedCLIP: a multimodal biomedical foundation model pretrained from fifteen million scientific image-text pairs](https://mlsanity.com/paper/2303.00915/) (2023)
- [SLAKE: A Semantically-Labeled Knowledge-Enhanced Dataset for Medical Visual Question Answering](https://mlsanity.com/paper/2102.09542/) (2021)
- [Measuring Calibration in Deep Learning](https://mlsanity.com/paper/1904.01685/) (2019)
- [PMC-VQA: Visual Instruction Tuning for Medical Visual Question Answering](https://mlsanity.com/paper/2305.10415/) (2023)
- [INSIDE: LLMs' Internal States Retain the Power of Hallucination Detection](https://mlsanity.com/paper/2402.03744/) (2024)
- [Calibration of Pre-trained Transformers](https://mlsanity.com/paper/2003.07892/) (2020)
- [PadChest: A large chest x-ray image dataset with multi-label annotated reports](https://mlsanity.com/paper/1901.07441/) (2019)
- [Generating with Confidence: Uncertainty Quantification for Black-box Large Language Models](https://mlsanity.com/paper/2305.19187/) (2023)
- [Towards Generalist Biomedical AI](https://mlsanity.com/paper/2307.14334/) (2023)
- [A Survey of Confidence Estimation and Calibration in Large Language Models](https://mlsanity.com/paper/2311.08298/) (2023)
- [Judging the Judges: Evaluating Alignment and Vulnerabilities in LLMs-as-Judges](https://mlsanity.com/paper/2406.12624/) (2024)
- [Deep Think with Confidence](https://mlsanity.com/paper/2508.15260/) (2025)

## Built on by (most cited first, 6 of 6)

- [Confident but Unreliable: A Behavioral Safety Audit of Vision-Language Models on Brain MRI](https://mlsanity.com/paper/2608.02790/) (2026)
- [EVADE: Evidence-Verified Agentic Diagnosis with Escape](https://mlsanity.com/paper/2608.18833/) (2026)
- [Separating Capability from Confidence: Grounded Dual-State Calibration for GRPO-Trained Medical Vision-Language Models](https://mlsanity.com/paper/2609.06419/) (2026)
- [MedTRACE: Tool-Augmented Multimodal Clinical Reasoning Agents for Evidence-Grounded Decision-Making](https://mlsanity.com/paper/2609.14823/) (2026)
- [OmniMed-Jev: Calibrating LVLM Confidence for Trustworthy Medical Multimodal Decisions via System One](https://mlsanity.com/paper/2610.00381/) (2026)
- [ARISE: Adaptive Agentic Reasoning with Image-grounded Self-Evaluation for Interpretable IBD Assessment](https://mlsanity.com/paper/2610.04777/) (2026)

## Abstract (arXiv)

As vision-language models (VLMs) are increasingly deployed in clinical decision support, more than accuracy is required: knowing when to trust their predictions is equally critical. Yet, a comprehensive and systematic investigation into the overconfidence of these models remains notably scarce in the medical domain. We address this gap through a comprehensive empirical study of confidence calibration in VLMs, spanning three model families (Qwen3-VL, InternVL3, LLaVA-NeXT), three model scales (2B--38B), and multiple confidence estimation prompting strategies, across three medical visual question answering (VQA) benchmarks. Our study yields three key findings: First, overconfidence persists across model families and is not resolved by scaling or prompting, such as chain-of-thought and verbalized confidence variants. Second, simple post-hoc calibration approaches, such as Platt scaling, reduce calibration error and consistently outperform the prompt-based strategy. Third, due to their (strict) monotonicity, these post-hoc calibration methods are inherently limited in improving the discriminative quality of predictions, leaving AUROC at the same level. Motivated by these findings, we investigate hallucination-aware calibration (HAC), which incorporates vision-grounded hallucination detection signals as complementary inputs to refine confidence estimates. We find that leveraging these hallucination signals improves both calibration and AUROC, with the largest gains on open-ended questions. On closed-ended questions, format-specific signals such as the logit margin show more informative. Overall, our findings suggest post-hoc calibration as standard practice for medical VLM deployment over raw confidence estimates, and highlight the practical usefulness of hallucination signals to enable more reliable use of VLMs in medical VQA.