# OmniMed-Jev: Calibrating LVLM Confidence for Trustworthy Medical Multimodal Decisions via System One

arXiv: https://arxiv.org/abs/2610.00381 · HTML: https://mlsanity.com/paper/2610.00381/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 67 of its 106 references that are in the map.
- First posted on arXiv 30 Sep 2026.

## Builds on (most cited first, 30 of 67)

- [On Calibration of Modern Neural Networks](https://mlsanity.com/paper/1706.04599/) (2017)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [Calibrate Before Use: Improving Few-Shot Performance of Language Models](https://mlsanity.com/paper/2102.09690/) (2021)
- [What Disease does this Patient Have? A Large-scale Open Domain Question Answering Dataset from Medical Exams](https://mlsanity.com/paper/2009.13081/) (2020)
- [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)
- [Selective Classification for Deep Neural Networks](https://mlsanity.com/paper/1705.08500/) (2017)
- [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)
- [Teaching Models to Express Their Uncertainty in Words](https://mlsanity.com/paper/2205.14334/) (2022)
- [MedMNIST v2 -- A large-scale lightweight benchmark for 2D and 3D biomedical image classification](https://mlsanity.com/paper/2110.14795/) (2021)
- [MedMCQA : A Large-scale Multi-Subject Multi-Choice Dataset for Medical domain Question Answering](https://mlsanity.com/paper/2203.14371/) (2022)
- [SLAKE: A Semantically-Labeled Knowledge-Enhanced Dataset for Medical Visual Question Answering](https://mlsanity.com/paper/2102.09542/) (2021)
- [Med-Flamingo: a Multimodal Medical Few-shot Learner](https://mlsanity.com/paper/2307.15189/) (2023)
- [Consistent Estimators for Learning to Defer to an Expert](https://mlsanity.com/paper/2006.01862/) (2020)
- [BiomedGPT: A Generalist Vision-Language Foundation Model for Diverse Biomedical Tasks](https://mlsanity.com/paper/2305.17100/) (2023)
- [Beyond Binary Rewards: Training LMs to Reason About Their Uncertainty](https://mlsanity.com/paper/2507.16806/) (2025)
- [Taming Overconfidence in LLMs: Reward Calibration in RLHF](https://mlsanity.com/paper/2410.09724/) (2024)
- [What Large Language Models Know and What People Think They Know](https://mlsanity.com/paper/2401.13835/) (2024)
- [Large Language Models Must Be Taught to Know What They Don't Know](https://mlsanity.com/paper/2406.08391/) (2024)
- [A Vision-Language Foundation Model to Enhance Efficiency of Chest X-ray Interpretation](https://mlsanity.com/paper/2401.12208/) (2024)
- [Learning to Defer to Multiple Experts: Consistent Surrogate Losses, Confidence Calibration, and Conformal Ensembles](https://mlsanity.com/paper/2210.16955/) (2022)
- [Calibrating Language Models with Adaptive Temperature Scaling](https://mlsanity.com/paper/2409.19817/) (2024)
- [Rewarding Doubt: A Reinforcement Learning Approach to Calibrated Confidence Expression of Large Language Models](https://mlsanity.com/paper/2503.02623/) (2025)
- [Towards a clinically accessible radiology foundation model: open-access and lightweight, with automated evaluation](https://mlsanity.com/paper/2403.08002/) (2024)
- [RLCD: Reinforcement Learning from Contrastive Distillation for Language Model Alignment](https://mlsanity.com/paper/2307.12950/) (2023)
- [ConfTuner: Training Large Language Models to Express Their Confidence Verbally](https://mlsanity.com/paper/2508.18847/) (2025)
- [ChestX-Det10: Chest X-ray Dataset on Detection of Thoracic Abnormalities](https://mlsanity.com/paper/2006.10550/) (2020)
- [JEV-as-a-Judge: Accept When Confident, Escalate When Unsure](https://mlsanity.com/paper/2609.26550/) (2026)
- [Restoring Calibration for Aligned Large Language Models: A Calibration-Aware Fine-Tuning Approach](https://mlsanity.com/paper/2505.01997/) (2025)

## Abstract (arXiv)

Medical models are judged not only on correctness, but on whether reported confidence matches actual accuracy. Generalist multimodal medical models have expanded what a single model can perceive, yet they still express bounded decisions such as diagnoses, findings or cell counts as generated text, so the reported probability reflects the next token rather than the decision itself. Motivated by decision-native interfaces such as Jev, we introduce OmniMed-Jev, which represents each medical decision as a Choice, Noul or Score decision over a runtime-supplied candidate set and returns a full distribution over that set: mutually exclusive classes, binary presence of a finding, or a bounded ordered value. The design is omni in three respects: it accepts diverse imaging modalities, covers different prediction tasks, and expresses them through one candidate-conditioned probability model, so heterogeneous outputs become comparable probabilities rather than task-specific strings. In an interface-controlled comparison against a generative baseline trained on the same backbone, data and schedule, OmniMed-Jev's reported probabilities track observed correctness far more closely, reducing calibration error by up to an order of magnitude and reliability error by up to two, while point-prediction performance remains comparable; counting is the one family where the generative baseline stays ahead. Making the decision distribution the model's output is not a format change but what turns reported numbers into probabilities that mean what they say. These results support explicit decision modeling as a way to make reported confidence meaningful within the evaluated tasks, and they are not evidence of clinical readiness: the comparison cannot separate the interface from associated training differences, which we state alongside the results. Code is available at github.com/lytang63/OmniMed-Jev.