CARE: Confidence-Aware Reasoning for Reliable Medical VQA

Reinforcement Fine-Tuning (RFT) has enabled medical Multimodal Large Language Models (MLLMs) to produce Chain-of-Thought (CoT) reasoning for visual question answering, yet these models suffer from confidence miscalibration---a systematic gap between expressed certainty and actual diagnostic accuracy that undermines clinical trust. We propose CARE, a Confidence-Aware medical REasoning framework that jointly optimizes accuracy and calibration through a dual-stage pipeline. First, a scalable Medical-CoT synthesis provides structured cold-start data for Supervised Fine-Tuning. Second, Group Relative Policy Optimization (GRPO) with a novel Confidence-Aware Reward (CAR) mechanism ties the model's confidence to diagnostic correctness within the reward signal. Across three Medical VQA benchmarks, CARE achieves the highest diagnostic accuracy while obtaining the lowest Expected Calibration Error and Hallucination Rate, establishing a foundation for trustworthy clinical decision support. Our code is available at https://github.com/anotherbricki/CARE.