@inproceedings{wang-etal-2026-cura,
title = "{CURA}: Clinical Uncertainty Risk Alignment for Language Model{--}Based Risk Prediction",
author = "Wang, Sizhe and
Xu, Ziqi and
Najjuuko, Claire and
Alba, Charles and
Lu, Chenyang",
editor = "Liakata, Maria and
Moreira, Viviane P. and
Zhang, Jiajun and
Jurgens, David",
booktitle = "Proceedings of the 64th Annual Meeting of the {A}ssociation for {C}omputational {L}inguistics (Volume 1: Long Papers)",
month = jul,
year = "2026",
address = "San Diego, California, United States",
publisher = "Association for Computational Linguistics",
url = "https://aclanthology.org/2026.acl-long.1567/",
pages = "34000--34018",
ISBN = "979-8-89176-390-6",
abstract = "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."
}<?xml version="1.0" encoding="UTF-8"?>
<modsCollection xmlns="http://www.loc.gov/mods/v3">
<mods ID="wang-etal-2026-cura">
<titleInfo>
<title>CURA: Clinical Uncertainty Risk Alignment for Language Model–Based Risk Prediction</title>
</titleInfo>
<name type="personal">
<namePart type="given">Sizhe</namePart>
<namePart type="family">Wang</namePart>
<role>
<roleTerm authority="marcrelator" type="text">author</roleTerm>
</role>
</name>
<name type="personal">
<namePart type="given">Ziqi</namePart>
<namePart type="family">Xu</namePart>
<role>
<roleTerm authority="marcrelator" type="text">author</roleTerm>
</role>
</name>
<name type="personal">
<namePart type="given">Claire</namePart>
<namePart type="family">Najjuuko</namePart>
<role>
<roleTerm authority="marcrelator" type="text">author</roleTerm>
</role>
</name>
<name type="personal">
<namePart type="given">Charles</namePart>
<namePart type="family">Alba</namePart>
<role>
<roleTerm authority="marcrelator" type="text">author</roleTerm>
</role>
</name>
<name type="personal">
<namePart type="given">Chenyang</namePart>
<namePart type="family">Lu</namePart>
<role>
<roleTerm authority="marcrelator" type="text">author</roleTerm>
</role>
</name>
<originInfo>
<dateIssued>2026-07</dateIssued>
</originInfo>
<typeOfResource>text</typeOfResource>
<relatedItem type="host">
<titleInfo>
<title>Proceedings of the 64th Annual Meeting of the Association for Computational Linguistics (Volume 1: Long Papers)</title>
</titleInfo>
<name type="personal">
<namePart type="given">Maria</namePart>
<namePart type="family">Liakata</namePart>
<role>
<roleTerm authority="marcrelator" type="text">editor</roleTerm>
</role>
</name>
<name type="personal">
<namePart type="given">Viviane</namePart>
<namePart type="given">P</namePart>
<namePart type="family">Moreira</namePart>
<role>
<roleTerm authority="marcrelator" type="text">editor</roleTerm>
</role>
</name>
<name type="personal">
<namePart type="given">Jiajun</namePart>
<namePart type="family">Zhang</namePart>
<role>
<roleTerm authority="marcrelator" type="text">editor</roleTerm>
</role>
</name>
<name type="personal">
<namePart type="given">David</namePart>
<namePart type="family">Jurgens</namePart>
<role>
<roleTerm authority="marcrelator" type="text">editor</roleTerm>
</role>
</name>
<originInfo>
<publisher>Association for Computational Linguistics</publisher>
<place>
<placeTerm type="text">San Diego, California, United States</placeTerm>
</place>
</originInfo>
<genre authority="marcgt">conference publication</genre>
<identifier type="isbn">979-8-89176-390-6</identifier>
</relatedItem>
<abstract>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.</abstract>
<identifier type="citekey">wang-etal-2026-cura</identifier>
<location>
<url>https://aclanthology.org/2026.acl-long.1567/</url>
</location>
<part>
<date>2026-07</date>
<extent unit="page">
<start>34000</start>
<end>34018</end>
</extent>
</part>
</mods>
</modsCollection>
%0 Conference Proceedings
%T CURA: Clinical Uncertainty Risk Alignment for Language Model–Based Risk Prediction
%A Wang, Sizhe
%A Xu, Ziqi
%A Najjuuko, Claire
%A Alba, Charles
%A Lu, Chenyang
%Y Liakata, Maria
%Y Moreira, Viviane P.
%Y Zhang, Jiajun
%Y Jurgens, David
%S Proceedings of the 64th Annual Meeting of the Association for Computational Linguistics (Volume 1: Long Papers)
%D 2026
%8 July
%I Association for Computational Linguistics
%C San Diego, California, United States
%@ 979-8-89176-390-6
%F wang-etal-2026-cura
%X 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.
%U https://aclanthology.org/2026.acl-long.1567/
%P 34000-34018
Markdown (Informal)
[CURA: Clinical Uncertainty Risk Alignment for Language Model–Based Risk Prediction](https://aclanthology.org/2026.acl-long.1567/) (Wang et al., ACL 2026)
ACL