# ClinAlign: Scaling Healthcare Alignment from Clinician Preference

arXiv: https://arxiv.org/abs/2602.09653 · HTML: https://mlsanity.com/paper/2602.09653/

## Key facts

- Cited by 2 papers in the map (data through 14 Oct 2026).
- Placed in Medical LLM alignment, one of 10 directions in LLM alignment / RLHF / preference optimisation.
- Builds on 16 of its 22 references that are in the map.
- First posted on arXiv 10 Feb 2026.

## Placed in

- LLM alignment / RLHF / preference optimisation / [Medical LLM alignment](https://mlsanity.com/alignment/medical-llm-alignment/)

## Builds on (most cited first, 16 of 16)

- [DeepSeekMath: Pushing the Limits of Mathematical Reasoning in Open Language Models](https://mlsanity.com/paper/2402.03300/) (2024)
- [HybridFlow: A Flexible and Efficient RLHF Framework](https://mlsanity.com/paper/2409.19256/) (2024)
- [Chatbot Arena: An Open Platform for Evaluating LLMs by Human Preference](https://mlsanity.com/paper/2403.04132/) (2024)
- [WildChat: 1M ChatGPT Interaction Logs in the Wild](https://mlsanity.com/paper/2405.01470/) (2024)
- [From Crowdsourced Data to High-Quality Benchmarks: Arena-Hard and BenchBuilder Pipeline](https://mlsanity.com/paper/2406.11939/) (2024)
- [Rubrics as Rewards: Reinforcement Learning Beyond Verifiable Domains](https://mlsanity.com/paper/2507.17746/) (2025)
- [ChatDoctor: A Medical Chat Model Fine-Tuned on a Large Language Model Meta-AI (LLaMA) Using Medical Domain Knowledge](https://mlsanity.com/paper/2303.14070/) (2023)
- [HuatuoGPT-o1, Towards Medical Complex Reasoning with LLMs](https://mlsanity.com/paper/2412.18925/) (2024)
- [WildBench: Benchmarking LLMs with Challenging Tasks from Real Users in the Wild](https://mlsanity.com/paper/2406.04770/) (2024)
- [A Question-Entailment Approach to Question Answering](https://mlsanity.com/paper/1901.08079/) (2019)
- [Reward Shaping to Mitigate Reward Hacking in RLHF](https://mlsanity.com/paper/2502.18770/) (2025)
- [HelpSteer3-Preference: Open Human-Annotated Preference Data across Diverse Tasks and Languages](https://mlsanity.com/paper/2505.11475/) (2025)
- [LLM-driven Multimodal Target Volume Contouring in Radiation Oncology](https://mlsanity.com/paper/2311.01908/) (2023)
- [InfiMed-ORBIT: Aligning LLMs on Open-Ended Complex Tasks via Rubric-Based Incremental Training](https://mlsanity.com/paper/2510.15859/) (2025)
- [Enhancing the Medical Context-Awareness Ability of LLMs via Multifaceted Self-Refinement Learning](https://mlsanity.com/paper/2511.10067/) (2025)
- [Multidimensional Rubric-oriented Reward Model Learning via Geometric Projection Reference Constraints](https://mlsanity.com/paper/2511.16139/) (2025)

## Built on by (most cited first, 2 of 2)

- [1% of Tokens Can Be Enough: On Gradient Estimation in On-Policy Distillation](https://mlsanity.com/paper/2609.24432/) (2026)
- [Cura 1T: Specialized Model for Agentic Healthcare](https://mlsanity.com/paper/2607.15314/) (2026)

## Abstract (arXiv)

Although large language models (LLMs) demonstrate expert-level medical knowledge, aligning their open-ended outputs with fine-grained clinician preferences remains challenging. Existing methods often rely on coarse objectives or unreliable automated judges that are weakly grounded in professional guidelines. We propose a two-stage framework to address this gap. First, we introduce HealthRubrics, a dataset of 7,034 physician-verified preference examples in which clinicians refine LLM-drafted rubrics to meet rigorous medical standards. Second, we distill these rubrics into HealthPrinciples: 119 broadly reusable, clinically grounded principles organized by clinical dimensions, enabling scalable supervision beyond manual annotation. We use HealthPrinciples for (1) offline alignment by synthesizing rubrics for unlabeled queries and (2) an inference-time tool for guided self-revision. A 30B-A3B model trained with our framework achieves 33.4% on HealthBench-Hard, outperforming much larger models including Deepseek-R1 and o3, establishing a resource-efficient baseline for clinical alignment.