Prevalence calibration as shortcut mitigation

Vision-language models, such as contrastive language-image pre-training (CLIP)-based approaches, have reached state-of-the-art (SOTA) results in medical artificial intelligence. However, recent work reveals that CLIP-based models remain vulnerable to shortcuts. We investigate how real-world shortcuts manifest across different layers of the medical CLIP-based model, MedCLIP, and its vision encoder, a frozen ResNet-50. We attach 17 linear classification probes to the intermediate layers of the ResNet-50 and train them on three different dataset configurations and targets: NIH-CXR14 (pneumothorax) and PadChest (cardiomegaly and pneumothorax). This setup allows us to observe model behaviour during evaluation using subgroup-based calibration and layer-wise confidence curves. We find that the final linear probes achieve a high AUROC but poor calibration in the models. The layer-wise confidence analyses suggest that shortcuts emerge at different depths. Patterns consistent with localised shortcuts, such as drains, appear at later layers, while patterns consistent with diffuse shortcuts, such as scanner-specific noise patterns, emerge earlier, aligning with previous work. Finally, we conduct a manual analysis of the images, which reveals data quality issues in both NIH-CXR14 and PadChest. Our findings underscore that even SOTA models remain vulnerable to shortcuts, and the need for high-quality and well-annotated datasets to draw solid conclusions. Code can be found on our GitHub: https://github.com/nikodice4/MedCLIP_shortcuts.

Shortcut mitigation strategies commonly rely on training data annotations, group-balanced held-out data or the presence of all groups, i.e., all combinations of (spurious) attributes and classes, in the training data. However, these requirements are rarely met in practice. We instead propose a method for targeted model analysis to identify a small set of instances in which the model relies on spurious attributes. Using that set and following ``this feature should not be used for prediction'' reasoning, we identify highly relevant neurons in an intermediate layer and regularize their impact. This ensures that models learn to depend on informative features rather than being right for the wrong reasons, thereby improving robustness without requiring additional balanced held-out data or annotations.

Estimating the prevalence of a category in a population using imperfect measurement devices (diagnostic tests, classifiers, or large language models) is fundamental to science, public health, and online trust and safety. Standard approaches correct for known device error rates but assume these rates remain stable across populations. We show this assumption fails under covariate shift and that multicalibration, which enforces calibration conditional on the input features rather than just on average, is sufficient for unbiased prevalence estimation under such shift. Standard calibration and quantification methods fail to provide this guarantee. Our work connects recent theoretical work on fairness to a longstanding measurement problem spanning nearly all academic disciplines. A simulation confirms that standard methods exhibit bias growing with shift magnitude, while a multicalibrated estimator maintains near-zero bias. While we focus the discussion mostly on LLMs, our theoretical results apply to any classification model. Two empirical applications -- estimating employment prevalence across U.S. states using the American Community Survey, and classifying political texts across four countries using an LLM -- demonstrate that multicalibration substantially reduces bias in practice, while highlighting that calibration data should cover the key feature dimensions along which target populations may differ.