Position, Not Provenance: Separating Reasoning Mediation from Sycophancy in Medical Vision-Language Models
Medical vision-language models (VLMs) generate chain-of-thought (CoT) reasoning before answering clinical questions, but whether this reasoning causally influences predictions remains unclear. We present CoT-Mediate, a behavioral framework that perturbs a single clinically meaningful attribute within a model's own generated reasoning and measures whether the resulting prediction follows the edited reasoning. Our framework combines a dual-arm protocol comparing re-prompted evidence with prefix-forced continuation, together with a provenance-controlled intervention that varies only the attributed source of identical reasoning to disentangle reasoning mediation from sycophancy. We evaluate L...
| Authors | Supratik Bhowal, Subhrajyoti Basu, Aritra Gir Mahanta et al. |
|---|---|
| Primary category | cs.LG |
| Published | 29 July 2026 |
| Last updated at source | 29 July 2026 |
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