Confidence Calibration for Multimodal LLMs: An Empirical Study through Medical VQA

Multimodal Large Language Models (MLLMs) show great potential in medical tasks, but their elicited confidence often misaligns with actual accuracy, potentially leading to misdiagnosis or overlooking correct advice. This study presents the first comprehensive analysis of the relationship between accuracy and confidence in medical MLLMs. It proposes a novel method that combines Multi-Strategy Fusion-Based Interrogation (MS-FBI) with auxiliary expert LLM assessment, aiming to improve confidence calibration in Medical Visual Question Answering (VQA). Experiments demonstrate that our method reduces the Expected Calibration Error (ECE) by an average of 40\% across three Medical VQA datasets, significantly enhancing MLLMs' reliability. The findings highlight the importance of domain-specific calibration for MLLMs in healthcare, offering a more trustworthy solution for AI-assisted diagnosis.

Linking Perception, Confidence and Accuracy in MLLMs

Recent advances in Multi-modal Large Language Models (MLLMs) have predominantly focused on enhancing visual perception to improve accuracy. However, a critical question remains unexplored: Do models know when they do not know? Through a probing experiment, we reveal a severe confidence miscalibration problem in MLLMs. To address this, we propose Confidence-Driven Reinforcement Learning (CDRL), which uses original-noise image pairs and a novel confidence-based reward to enhance perceptual sensitivity and robustly calibrate the model's confidence. Beyond training benefits, calibrated confidence enables more effective test-time scaling as a free lunch. We further propose Confidence-Aware Test-Time Scaling (CA-TTS), which dynamically coordinates Self-Consistency, Self-Reflection, and Visual Self-Check modules guided by confidence signals. An Expert Model acts in multiple roles (e.g., Planner, Critic, Voter) to schedule these modules and provide external verification. Our integrated framework establishes new state-of-the-art results with consistent 8.8% gains across four benchmarks. More ablation studies demonstrate the effectiveness of each module and scaling superiority.

Unmasking Reasoning Processes: A Process-aware Benchmark for Evaluating Structural Mathematical Reasoning in LLMs

Recent large language models (LLMs) achieve near-saturation accuracy on many established mathematical reasoning benchmarks, raising concerns about their ability to diagnose genuine reasoning competence. This saturation largely stems from the dominance of template-based computation and shallow arithmetic decomposition in existing datasets, which underrepresent reasoning skills such as multi-constraint coordination, constructive logical synthesis, and spatial inference. To address this gap, we introduce ReasoningMath-Plus, a benchmark of 150 carefully curated problems explicitly designed to evaluate structural reasoning. Each problem emphasizes reasoning under interacting constraints, constructive solution formation, or non-trivial structural insight, and is annotated with a minimal reasoning skeleton to support fine-grained process-level evaluation. Alongside the dataset, we introduce HCRS (Hazard-aware Chain-based Rule Score), a deterministic step-level scoring function, and train a Process Reward Model (PRM) on the annotated reasoning traces. Empirically, while leading models attain relatively high final-answer accuracy (up to 5.8/10), HCRS-based holistic evaluation yields substantially lower scores (average 4.36/10, best 5.14/10), showing that answer-only metrics can overestimate reasoning robustness.