# CARE: Confidence-Aware Reasoning for Reliable Medical VQA

arXiv: https://arxiv.org/abs/2608.10964 · HTML: https://mlsanity.com/paper/2608.10964/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 19 of its 22 references that are in the map.
- First posted on arXiv 11 Aug 2026.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)
- Multimodal LLMs / vision-language models / [Medical vision-language models](https://mlsanity.com/mllm/medical-vision-language-models/)

## Builds on (most cited first, 19 of 19)

- [DeepSeekMath: Pushing the Limits of Mathematical Reasoning in Open Language Models](https://mlsanity.com/paper/2402.03300/) (2024)
- [On Calibration of Modern Neural Networks](https://mlsanity.com/paper/1706.04599/) (2017)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [Tulu 3: Pushing Frontiers in Open Language Model Post-Training](https://mlsanity.com/paper/2411.15124/) (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)
- [SFT Memorizes, RL Generalizes: A Comparative Study of Foundation Model Post-training](https://mlsanity.com/paper/2501.17161/) (2025)
- [PathVQA: 30000+ Questions for Medical Visual Question Answering](https://mlsanity.com/paper/2003.10286/) (2020)
- [SLAKE: A Semantically-Labeled Knowledge-Enhanced Dataset for Medical Visual Question Answering](https://mlsanity.com/paper/2102.09542/) (2021)
- [From System 1 to System 2: A Survey of Reasoning Large Language Models](https://mlsanity.com/paper/2502.17419/) (2025)
- [Towards Large Reasoning Models: A Survey of Reinforced Reasoning with Large Language Models](https://mlsanity.com/paper/2501.09686/) (2025)
- [Lingshu: A Generalist Foundation Model for Unified Multimodal Medical Understanding and Reasoning](https://mlsanity.com/paper/2506.07044/) (2025)
- [MedVLM-R1: Incentivizing Medical Reasoning Capability of Vision-Language Models (VLMs) via Reinforcement Learning](https://mlsanity.com/paper/2502.19634/) (2025)
- [Med-R1: Reinforcement Learning for Generalizable Medical Reasoning in Vision-Language Models](https://mlsanity.com/paper/2503.13939/) (2025)
- [MedVLThinker: Simple Baselines for Multimodal Medical Reasoning](https://mlsanity.com/paper/2508.02669/) (2025)
- [Chiron-o1: Igniting Multimodal Large Language Models towards Generalizable Medical Reasoning via Mentor-Intern Collaborative Search](https://mlsanity.com/paper/2506.16962/) (2025)
- [MedMO: Grounding and Understanding Multimodal Large Language Model for Medical Images](https://mlsanity.com/paper/2602.06965/) (2026)
- [Fleming-VL: Towards Universal Medical Visual Reasoning with Multimodal LLMs](https://mlsanity.com/paper/2511.00916/) (2025)
- [Confidence Calibration for Multimodal LLMs: An Empirical Study through Medical VQA](https://mlsanity.com/paper/2606.19950/) (2026)

## Abstract (arXiv)

Reinforcement Fine-Tuning (RFT) has enabled medical Multimodal Large Language Models (MLLMs) to produce Chain-of-Thought (CoT) reasoning for visual question answering, yet these models suffer from textitconfidence miscalibration---a systematic gap between expressed certainty and actual diagnostic accuracy that undermines clinical trust. We propose CARE, a Confidence-Aware medical REasoning framework that jointly optimizes accuracy and calibration through a dual-stage pipeline. First, a scalable Medical-CoT synthesis provides structured cold-start data for Supervised Fine-Tuning. Second, Group Relative Policy Optimization (GRPO) with a novel Confidence-Aware Reward (CAR) mechanism ties the model's confidence to diagnostic correctness within the reward signal. Across three Medical VQA benchmarks, CARE achieves the highest diagnostic accuracy while obtaining the lowest Expected Calibration Error and Hallucination Rate, establishing a foundation for trustworthy clinical decision support. Our code is available at https://github.com/anotherbricki/CARE.