# Quark Medical Alignment: A Holistic Multi-Dimensional Alignment and Collaborative Optimization Paradigm

arXiv: https://arxiv.org/abs/2602.11661 · HTML: https://mlsanity.com/paper/2602.11661/

## 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 41 of its 47 references that are in the map.
- First posted on arXiv 12 Feb 2026.

## Placed in

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

## Builds on (most cited first, 30 of 41)

- [Training language models to follow instructions with human feedback](https://mlsanity.com/paper/2203.02155/) (2022)
- [DeepSeekMath: Pushing the Limits of Mathematical Reasoning in Open Language Models](https://mlsanity.com/paper/2402.03300/) (2024)
- [Qwen3 Technical Report](https://mlsanity.com/paper/2505.09388/) (2025)
- [Let's Verify Step by Step](https://mlsanity.com/paper/2305.20050/) (2023)
- [Training a Helpful and Harmless Assistant with Reinforcement Learning from Human Feedback](https://mlsanity.com/paper/2204.05862/) (2022)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [Group Sequence Policy Optimization](https://mlsanity.com/paper/2507.18071/) (2025)
- [Beyond the 80/20 Rule: High-Entropy Minority Tokens Drive Effective Reinforcement Learning for LLM Reasoning](https://mlsanity.com/paper/2506.01939/) (2025)
- [Generative Verifiers: Reward Modeling as Next-Token Prediction](https://mlsanity.com/paper/2408.15240/) (2024)
- [Rubrics as Rewards: Reinforcement Learning Beyond Verifiable Domains](https://mlsanity.com/paper/2507.17746/) (2025)
- [From r to Q^*: Your Language Model is Secretly a Q-Function](https://mlsanity.com/paper/2404.12358/) (2024)
- [Inference-Time Scaling for Generalist Reward Modeling](https://mlsanity.com/paper/2504.02495/) (2025)
- [Mitigating the Alignment Tax of RLHF](https://mlsanity.com/paper/2309.06256/) (2023)
- [RM-R1: Reward Modeling as Reasoning](https://mlsanity.com/paper/2505.02387/) (2025)
- [OpenRubrics: Towards Scalable Synthetic Rubric Generation for Reward Modeling and LLM Alignment](https://mlsanity.com/paper/2510.07743/) (2025)
- [Reinforcement Learning with Rubric Anchors](https://mlsanity.com/paper/2508.12790/) (2025)
- [Baichuan-M2: Scaling Medical Capability with Large Verifier System](https://mlsanity.com/paper/2509.02208/) (2025)
- [Chasing the Tail: Effective Rubric-based Reward Modeling for Large Language Model Post-Training](https://mlsanity.com/paper/2509.21500/) (2025)
- [Agentic Reward Modeling: Integrating Human Preferences with Verifiable Correctness Signals for Reliable Reward Systems](https://mlsanity.com/paper/2502.19328/) (2025)
- [AdvancedIF: Rubric-Based Benchmarking and Reinforcement Learning for Advancing LLM Instruction Following](https://mlsanity.com/paper/2511.10507/) (2025)
- [Online Rubrics Elicitation from Pairwise Comparisons](https://mlsanity.com/paper/2510.07284/) (2025)
- [MedCaseReasoning: Evaluating and learning diagnostic reasoning from clinical case reports](https://mlsanity.com/paper/2505.11733/) (2025)
- [LLMEval-Med: A Real-world Clinical Benchmark for Medical LLMs with Physician Validation](https://mlsanity.com/paper/2506.04078/) (2025)
- [Generalist Reward Models: Found Inside Large Language Models](https://mlsanity.com/paper/2506.23235/) (2025)
- [Training AI Co-Scientists Using Rubric Rewards](https://mlsanity.com/paper/2512.23707/) (2025)
- [Optimizing Safe and Aligned Language Generation: A Multi-Objective GRPO Approach](https://mlsanity.com/paper/2503.21819/) (2025)
- [Med-PRM: Medical Reasoning Models with Stepwise, Guideline-verified Process Rewards](https://mlsanity.com/paper/2506.11474/) (2025)
- [Learning to Optimize Multi-Objective Alignment Through Dynamic Reward Weighting](https://mlsanity.com/paper/2509.11452/) (2025)
- [Inverse Reinforcement Learning with Dynamic Reward Scaling for LLM Alignment](https://mlsanity.com/paper/2503.18991/) (2025)
- [User Feedback in Human-LLM Dialogues: A Lens to Understand Users But Noisy as a Learning Signal](https://mlsanity.com/paper/2507.23158/) (2025)

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

- [QuarkMedBench: A Real-World Scenario Driven Benchmark for Evaluating Large Language Models](https://mlsanity.com/paper/2603.13691/) (2026)
- [QuarkMedSearch: A Long-Horizon Deep Search Agent for Exploring Medical Intelligence](https://mlsanity.com/paper/2604.12867/) (2026)

## Abstract (arXiv)

While reinforcement learning for large language model alignment has progressed rapidly in recent years, transferring these paradigms to high-stakes medical question answering reveals a fundamental paradigm mismatch. Reinforcement Learning from Human Feedback relies on preference annotations that are prohibitively expensive and often fail to reflect the absolute correctness of medical facts. Reinforcement Learning from Verifiable Rewards lacks effective automatic verifiers and struggles to handle complex clinical contexts. Meanwhile, medical alignment requires the simultaneous optimization of correctness, safety, and compliance, yet multi-objective heterogeneous reward signals are prone to scale mismatch and optimization conflicts. To address these challenges, we propose a robust medical alignment paradigm. We first construct a holistic multi-dimensional medical alignment matrix that decomposes alignment objectives into four categories: fundamental capabilities, expert knowledge, online feedback, and format specifications. Within each category, we establish a closed loop of where observable metrics inform attributable diagnosis, which in turn drives optimizable rewards, thereby providing fine-grained, high-resolution supervision signals for subsequent iterative optimization. To resolve gradient domination and optimization instability problem caused by heterogeneous signals, we further propose a unified optimization mechanism. This mechanism employs Reference-Frozen Normalization to align reward scales and implements a Tri-Factor Adaptive Dynamic Weighting strategy to achieve collaborative optimization that is weakness-oriented, risk-prioritized, and redundancy-reducing. Experimental results demonstrate the effectiveness of our proposed paradigm in real-world medical scenario evaluations, establishing a new paradigm for complex alignment in vertical domains.