# Just how sure are you? Improving Verbalized Uncertainty Calibration in Medical VQA

arXiv: https://arxiv.org/abs/2606.27023 · HTML: https://mlsanity.com/paper/2606.27023/

## Key facts

- Cited by 3 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 22 of its 35 references that are in the map.
- First posted on arXiv 25 Jun 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, 22 of 22)

- [On Calibration of Modern Neural Networks](https://mlsanity.com/paper/1706.04599/) (2017)
- [Qwen2-VL: Enhancing Vision-Language Model's Perception of the World at Any Resolution](https://mlsanity.com/paper/2409.12191/) (2024)
- [Can LLMs Express Their Uncertainty? An Empirical Evaluation of Confidence Elicitation in LLMs](https://mlsanity.com/paper/2306.13063/) (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)
- [Teaching Models to Express Their Uncertainty in Words](https://mlsanity.com/paper/2205.14334/) (2022)
- [MedXpertQA: Benchmarking Expert-Level Medical Reasoning and Understanding](https://mlsanity.com/paper/2501.18362/) (2025)
- [OmniMedVQA: A New Large-Scale Comprehensive Evaluation Benchmark for Medical LVLM](https://mlsanity.com/paper/2402.09181/) (2024)
- [Taming Overconfidence in LLMs: Reward Calibration in RLHF](https://mlsanity.com/paper/2410.09724/) (2024)
- [SaySelf: Teaching LLMs to Express Confidence with Self-Reflective Rationales](https://mlsanity.com/paper/2405.20974/) (2024)
- [VL-Uncertainty: Detecting Hallucination in Large Vision-Language Model via Uncertainty Estimation](https://mlsanity.com/paper/2411.11919/) (2024)
- [Rewarding Doubt: A Reinforcement Learning Approach to Calibrated Confidence Expression of Large Language Models](https://mlsanity.com/paper/2503.02623/) (2025)
- [MARS: Meaning-Aware Response Scoring for Uncertainty Estimation in Generative LLMs](https://mlsanity.com/paper/2402.11756/) (2024)
- [ConfTuner: Training Large Language Models to Express Their Confidence Verbally](https://mlsanity.com/paper/2508.18847/) (2025)
- [Finetuning Language Models to Emit Linguistic Expressions of Uncertainty](https://mlsanity.com/paper/2409.12180/) (2024)
- [Restoring Calibration for Aligned Large Language Models: A Calibration-Aware Fine-Tuning Approach](https://mlsanity.com/paper/2505.01997/) (2025)
- [Do Not Design, Learn: A Trainable Scoring Function for Uncertainty Estimation in Generative LLMs](https://mlsanity.com/paper/2406.11278/) (2024)
- [Enhancing Confidence Expression in Large Language Models Through Learning from Past Experience](https://mlsanity.com/paper/2404.10315/) (2024)
- [SteerConf: Steering LLMs for Confidence Elicitation](https://mlsanity.com/paper/2503.02863/) (2025)
- [Seeing is Believing, but How Much? A Comprehensive Analysis of Verbalized Calibration in Vision-Language Models](https://mlsanity.com/paper/2505.20236/) (2025)
- [Enhancing Language Model Factuality via Activation-Based Confidence Calibration and Guided Decoding](https://mlsanity.com/paper/2406.13230/) (2024)
- [Object-Level Verbalized Confidence Calibration in Vision-Language Models via Semantic Perturbation](https://mlsanity.com/paper/2504.14848/) (2025)
- [Enhancing Uncertainty Estimation in LLMs with Expectation of Aggregated Internal Belief](https://mlsanity.com/paper/2509.01564/) (2025)

## Built on by (most cited first, 3 of 3)

- [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)
- [Uncertainty Quantification for LLM Agents: A Taxonomy, an Evaluation Protocol, and an Empirical Study](https://mlsanity.com/paper/2609.07395/) (2026)

## Abstract (arXiv)

Multimodal large language models (MLLMs) applied to Medical Visual Question Answering (VQA) tend to produce overconfident outputs regardless of actual correctness, and existing verbalized confidence calibration methods, developed primarily for text only LLMs, do not account for the multimodal nature of medical image understanding. This work proposes a training based framework that finetunes MLLMs to improve their calibration using a composite loss function combining a Brier style calibration term, an anchor regularizer that prevents confidence collapse toward extreme values, a contrastive image text alignment term, and a KL based model stabilization term. The alignment signal is derived from a 2 × 2 factorial perturbation design that crosses image presence with text integrity, probing the reliance of the model on visual modality input versus language priors. Finally, a top K KL divergence regularizer is used to protect the answering ability of the model during finetuning. Across three Medical VQA benchmarks and two architectures (MedGemma 4B IT and Qwen2 VL 7B Instruct), our method reduces calibration error by 60% or more, and improves discrimination by 26% or more, while preserving predictive accuracy. On average across benchmarks, the technique outperforms prompting based, sampling based, and training based approaches, and ablation experiments confirm that each component of the loss function is indeed necessary for improving the calibration. All code for the experiments is publicly available.