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To Agree or To Be Right? The Grounding-Sycophancy Tradeoff in Medical Vision-Language Models

arXiv:2603.22623v1 Announce Type: cross Abstract: Vision-language models (VLMs) adapted to the medical domain have shown strong performance on visual question answering benchmarks, yet their robustness against two critical failure modes, hallucination and sycophancy, remains poorly understood, particularly in combination. We evaluate six VLMs (three general-purpose, three medical-specialist) on three medical VQA datasets and uncover a grounding-sycophancy tradeoff: models with the lowest hallucination propensity are the most sycophantic, while the most pressure-resistant model hallucinates more than all medical-specialist models. To characterize this tradeoff, we propose three metrics: L-VASE, a logit-space reformulation of VASE that avoids its double-normalization; CCS, a confidence-calibrated sycophancy score that penalizes high-confidence capitulation; and Clinical Safety Index (CSI), a unified safety index that combines grounding, autonomy, and calibration via a geometric mean. Across 1,151 test cases, no model achieves a CSI above 0.35, indicating that none of the evaluated 7-8B parameter VLMs is simultaneously well-grounded and robust to social pressure. Our findings suggest that joint evaluation of both properties is necessary before these models can be considered for clinical use. Code is available at https://github.com/UTSA-VIRLab/AgreeOrRight
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Toward Faithful Segmentation Attribution via Benchmarking and Dual-Evidence Fusion

arXiv:2603.22624v1 Announce Type: cross Abstract: Attribution maps for semantic segmentation are almost always judged by visual plausibility. Yet looking convincing does not guarantee that the highlighted pixels actually drive the model's prediction, nor that attribution credit stays within the target region. These questions require a dedicated evaluation protocol. We introduce a reproducible benchmark that tests intervention-based faithfulness, off-target leakage, perturbation robustness, and runtime on Pascal VOC and SBD across three pretrained backbones. To further demonstrate the benchmark, we propose Dual-Evidence Attribution (DEA), a lightweight correction that fuses gradient evidence with region-level intervention signals through agreement-weighted fusion. DEA increases emphasis where both sources agree and retains causal support when gradient responses are unstable. Across all completed runs, DEA consistently improves deletion-based faithfulness over gradient-only baselines and preserves strong robustness, at the cost of additional compute from intervention passes. The benchmark exposes a faithfulness-stability tradeoff among attribution families that is entirely hidden under visual evaluation, providing a foundation for principled method selection in segmentation explainability. Code is available at https://github.com/anmspro/DEA.
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