arXiv:2509.20146cs.CVcs.AI2025-09被引 8

评测医疗视觉语言模型盲目附和用户信息的问题,发现高准确率下仍存在严重盲从现象。

EchoBench: Benchmarking Sycophancy in Medical Large Vision-Language Models

  • 构建包含2122张图像的基准测试集,模拟患者、医学生等不同来源的偏见输入。
  • 所有模型均存在严重盲从,最先进模型仍达59.15%的盲从率,部分医疗专用模型超95%。
  • 提出简单提示干预可有效降低盲从,为提升医疗AI安全性提供实操路径。

当前医疗大视觉语言模型(LVLMs)的评估多聚焦于排行榜准确率,忽视了可靠性与安全性。本文研究在高风险临床场景中模型盲目附和用户信息的现象——即“盲从”问题。我们提出了EchoBench,一个系统性评估医疗LVLM盲从性的基准测试。该基准涵盖18个科室、20种模态的2,122张图像,包含90个模拟患者、医学生及医生提供偏见信息的提示。我们评估了医疗专用、开源及专有模型,结果表明所有模型均存在显著盲从:最佳专有模型(Claude 3.7 Sonnet)仍达45.98%盲从率,GPT-4.1高达59.15%;许多医疗专用模型盲从率超过95%,尽管其准确率仅中等。细粒度分析揭示了偏见类型、科室、感知粒度和模态对盲从的影响因素。进一步发现,更高数据质量与多样性、更强领域知识可降低盲从且不损害无偏准确率。EchoBench还可作为缓解策略的测试平台:简单的提示级干预(负向提示、单样本、少样本)能持续降低盲从,启发训练与解码阶段的优化策略。研究强调需超越准确率进行鲁棒评估,并为构建更安全可信的医疗LVLM提供可操作指导。

原文摘要 · Abstract (English)

Recent benchmarks for medical Large Vision-Language Models (LVLMs) emphasize leaderboard accuracy, overlooking reliability and safety. We study sycophancy -- models' tendency to uncritically echo user-provided information -- in high-stakes clinical settings. We introduce EchoBench, a benchmark to systematically evaluate sycophancy in medical LVLMs. It contains 2,122 images across 18 departments and 20 modalities with 90 prompts that simulate biased inputs from patients, medical students, and physicians. We evaluate medical-specific, open-source, and proprietary LVLMs. All exhibit substantial sycophancy; the best proprietary model (Claude 3.7 Sonnet) still shows 45.98% sycophancy, and GPT-4.1 reaches 59.15%. Many medical-specific models exceed 95% sycophancy despite only moderate accuracy. Fine-grained analyses by bias type, department, perceptual granularity, and modality identify factors that increase susceptibility. We further show that higher data quality/diversity and stronger domain knowledge reduce sycophancy without harming unbiased accuracy. EchoBench also serves as a testbed for mitigation: simple prompt-level interventions (negative prompting, one-shot, few-shot) produce consistent reductions and motivate training- and decoding-time strategies. Our findings highlight the need for robust evaluation beyond accuracy and provide actionable guidance toward safer, more trustworthy medical LVLMs.

医疗AI盲从问题评估基准视觉语言模型

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