# CURA: Clinical Uncertainty Risk Alignment for Language Model-Based Risk Prediction

arXiv: https://arxiv.org/abs/2604.14651 · HTML: https://mlsanity.com/paper/2604.14651/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Medical LLM alignment, one of 10 directions in LLM alignment / RLHF / preference optimisation.
- Builds on 24 of its 49 references that are in the map.
- First posted on arXiv 16 Apr 2026.

## Placed in

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

## Builds on (most cited first, 24 of 24)

- [On Calibration of Modern Neural Networks](https://mlsanity.com/paper/1706.04599/) (2017)
- [Dropout as a Bayesian Approximation: Representing Model Uncertainty in Deep Learning](https://mlsanity.com/paper/1506.02142/) (2015)
- [Simple and Scalable Predictive Uncertainty Estimation using Deep Ensembles](https://mlsanity.com/paper/1612.01474/) (2016)
- [What Uncertainties Do We Need in Bayesian Deep Learning for Computer Vision?](https://mlsanity.com/paper/1703.04977/) (2017)
- [BioBERT: a pre-trained biomedical language representation model for biomedical text mining](https://mlsanity.com/paper/1901.08746/) (2019)
- [Language Models (Mostly) Know What They Know](https://mlsanity.com/paper/2207.05221/) (2022)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [Publicly Available Clinical BERT Embeddings](https://mlsanity.com/paper/1904.03323/) (2019)
- [A Review of Uncertainty Quantification in Deep Learning: Techniques, Applications and Challenges](https://mlsanity.com/paper/2011.06225/) (2020)
- [Just Ask for Calibration: Strategies for Eliciting Calibrated Confidence Scores from Language Models Fine-Tuned with Human Feedback](https://mlsanity.com/paper/2305.14975/) (2023)
- [Teaching Models to Express Their Uncertainty in Words](https://mlsanity.com/paper/2205.14334/) (2022)
- [Capabilities of GPT-4 on Medical Challenge Problems](https://mlsanity.com/paper/2303.13375/) (2023)
- [BioGPT: Generative Pre-trained Transformer for Biomedical Text Generation and Mining](https://mlsanity.com/paper/2210.10341/) (2022)
- [ClinicalBERT: Modeling Clinical Notes and Predicting Hospital Readmission](https://mlsanity.com/paper/1904.05342/) (2019)
- [Beyond temperature scaling: Obtaining well-calibrated multiclass probabilities with Dirichlet calibration](https://mlsanity.com/paper/1910.12656/) (2019)
- [Multitask learning and benchmarking with clinical time series data](https://mlsanity.com/paper/1703.07771/) (2017)
- [Taming Overconfidence in LLMs: Reward Calibration in RLHF](https://mlsanity.com/paper/2410.09724/) (2024)
- [Navigating the Grey Area: How Expressions of Uncertainty and Overconfidence Affect Language Models](https://mlsanity.com/paper/2302.13439/) (2023)
- [On Verbalized Confidence Scores for LLMs](https://mlsanity.com/paper/2412.14737/) (2024)
- [Efficient Test-Time Scaling via Self-Calibration](https://mlsanity.com/paper/2503.00031/) (2025)
- [BPO: Towards Balanced Preference Optimization between Knowledge Breadth and Depth in Alignment](https://mlsanity.com/paper/2411.10914/) (2024)
- [Efficient Process Reward Model Training via Active Learning](https://mlsanity.com/paper/2504.10559/) (2025)
- [Optimizing Language Model's Reasoning Abilities with Weak Supervision](https://mlsanity.com/paper/2405.04086/) (2024)
- [(Un)fairness in Post-operative Complication Prediction Models](https://mlsanity.com/paper/2011.02036/) (2020)

## Abstract (arXiv)

Clinical language models (LMs) are increasingly applied to support clinical risk prediction from free-text notes, yet their uncertainty estimates often remain poorly calibrated and clinically unreliable. In this work, we propose Clinical Uncertainty Risk Alignment (CURA), a framework that aligns clinical LM-based risk estimates and uncertainty with both individual error likelihoods and cohort-level ambiguities. CURA first fine-tunes domain-specific clinical LMs to obtain task-adapted patient embeddings, and then performs uncertainty fine-tuning of a multi-head classifier using a bi-level uncertainty objective. Specifically, an individual-level calibration term aligns predictive uncertainty with each patient's likelihood of error, while a cohort-aware regularizer pulls risk estimates toward event rates in their local neighborhoods in the embedding space and places extra weight on ambiguous cohorts near the decision boundary. We further show that this cohort-aware term can be interpreted as a cross-entropy loss with neighborhood-informed soft labels, providing a label-smoothing view of our method. Extensive experiments on MIMIC-IV clinical risk prediction tasks across various clinical LMs show that CURA consistently improves calibration metrics without substantially compromising discrimination. Further analysis illustrates that CURA reduces overconfident false reassurance and yields more trustworthy uncertainty estimates for downstream clinical decision support.