Trustworthy Medical Multimodal Large Language Models: Taxonomy, Evaluation, and Benchmarks

The integration of Multimodal Large Language Models (MLLMs) into healthcare has the potential to drive a considerable advancement toward many AI use cases in medicine, offering transformative capabilities across hierarchical levels of clinical granularity, ranging from microscopic tissue analysis over organ level imaging and individual patient modeling to population-level health surveillance. However, such integration into clinical practice is constrained by a multifaceted “trustworthiness gap”: the mismatch between the raw capabilities demonstrated by Medical MLLMs in controlled experiments and their reliability, fairness, safety, privacy protection, explainability, and regulatory accountability required for clinical deployment in the real world. This gap requires systematic examination of both model behavior and clinical risk across the full lifecycle of Medical MLLM development and use. In this paper, we survey the existing literature on methods, evaluation, and benchmarks of trustworthiness research in Medical MLLMs. We first establish a multi-scale clinical landscape across tissue, organ, individual, and population levels to categorize current models, providing critical insights into the interplay between data heterogeneity and clinical task requirements. Subsequently, we propose a holistic, six-dimensional taxonomy of trustworthiness, comprising truthfulness, robustness, fairness, safety, privacy, and explainability. Using this taxonomy, we critically analyze existing literature to elicit recurring Medical MLLM trustworthiness failure modes and suggest appropriate remediation strategies. Furthermore, our survey enumerates open challenges in evaluating trustworthiness by means of traditional automated metrics, frontier “LLM-as-a-Judge” methods and expert-centric assessment protocols. As a response to these challenges we identify emerging research directions including dynamic and workflow-oriented evaluations for interactive Medical MLLMs. We aim for this work to serve as a systematic guide for researchers and practitioners aiming to develop the next generation of trustworthy medical AI by achieving clinically acceptable reliability through technological innovations. Project Link: https://github.com/junyuanM/Trustworthy-Medical-MLLMs-Survey.