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

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 $2 \times 2$ 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.

Are complicated loss functions necessary for teaching LLMs to reason?

Recent advances in large language models (LLMs) highlight the importance of post training techniques for improving reasoning and mathematical ability. Group Relative Policy Optimization (GRPO) has shown promise in this domain by combining group relative advantage estimation, PPO style clipping, and KL regularization. However, its complexity raises the question of whether all components are necessary for fostering reasoning behaviors. We conduct a systematic analysis of GRPO and identify two key findings: (1) incorporating negative feedback is essential training solely on actions above a baseline limits learning; and (2) PPO style constraints, such as policy ratio clipping, are not required to improve mathematical reasoning or performance. Building on these insights, we propose REINFORCE with Group Relative Advantage (RGRA), a simplified variant that retains group relative advantage estimation but removes PPO style clipping and policy ratio terms. Experiments across standard mathematical benchmarks indicate that RGRA has the potential to achieve stronger performance than GRPO. Our results suggest that simpler REINFORCE based approaches can effectively enhance reasoning in LLMs, offering a more transparent and efficient alternative to GRPO.