Xing Shen

Prompt4Trust: A Reinforcement Learning Prompt Augmentation Framework for Clinically-Aligned Confidence Calibration in Multimodal Large Language Models

Multimodal large language models (MLLMs) hold considerable promise for applications in healthcare. However, their deployment in safety-criti… (see more)cal settings is hindered by two key limitations: (i) sensitivity to prompt design, and (ii) a tendency to generate incorrect responses with high confidence. As clinicians may rely on a model's stated confidence to gauge the reliability of its predictions, it is especially important that when a model expresses high confidence, it is also highly accurate. We introduce Prompt4Trust, the first reinforcement learning (RL) framework for prompt augmentation targeting confidence calibration in MLLMs. A lightweight LLM is trained to produce context-aware auxiliary prompts that guide a downstream task MLLM to generate responses in which the expressed confidence more accurately reflects predictive accuracy. Unlike conventional calibration techniques, Prompt4Trust specifically prioritizes aspects of calibration most critical for safe and trustworthy clinical decision-making. Beyond improvements driven by this clinically motivated calibration objective, our proposed method also improves task accuracy, achieving state-of-the-art medical visual question answering (VQA) performance on the PMC-VQA benchmark, which is composed of multiple-choice questions spanning diverse medical imaging modalities. Moreover, our framework trained with a small downstream task MLLM showed promising zero-shot generalization to larger MLLMs in our experiments, suggesting the potential for scalable calibration without the associated computational costs. This work demonstrates the potential of automated yet human-aligned prompt engineering for improving the the trustworthiness of MLLMs in safety critical settings. Our codebase can be found at https://github.com/xingbpshen/prompt4trust.

2025-07-12

ArXiv (preprint)

doi.org

arxiv.org

Exposing and Mitigating Calibration Biases and Demographic Unfairness in MLLM Few-Shot In-Context Learning for Medical Image Classification

Xing Shen

Justin Szeto

Mingyang Li

Hengguan Huang

Tal Arbel

Multimodal large language models (MLLMs) have enormous potential to perform few-shot in-context learning in the context of medical image ana… (see more)lysis. However, safe deployment of these models into real-world clinical practice requires an in-depth analysis of the accuracies of their predictions, and their associated calibration errors, particularly across different demographic subgroups. In this work, we present the first investigation into the calibration biases and demographic unfairness of MLLMs'predictions and confidence scores in few-shot in-context learning for medical image classification. We introduce CALIN, an inference-time calibration method designed to mitigate the associated biases. Specifically, CALIN estimates the amount of calibration needed, represented by calibration matrices, using a bi-level procedure: progressing from the population level to the subgroup level prior to inference. It then applies this estimation to calibrate the predicted confidence scores during inference. Experimental results on three medical imaging datasets: PAPILA for fundus image classification, HAM10000 for skin cancer classification, and MIMIC-CXR for chest X-ray classification demonstrate CALIN's effectiveness at ensuring fair confidence calibration in its prediction, while improving its overall prediction accuracies and exhibiting minimum fairness-utility trade-off. Our codebase can be found at https://github.com/xingbpshen/medical-calibration-fairness-mllm.

2025-06-29

ArXiv (preprint)

doi.org

arxiv.org

Exposing and Mitigating Calibration Biases and Demographic Unfairness in MLLM Few-Shot In-Context Learning for Medical Image Classification

Xing Shen

Justin Szeto

Mingyang Li

Hengguan Huang

Tal Arbel

2025-06-01

arXiv (published)