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.

Reinforcement Learning with Human Feedback (RLHF) is the key to the success of large language models (LLMs) in recent years. In this work, we first introduce the concepts of knowledge breadth and knowledge depth, which measure the comprehensiveness and depth of an LLM or knowledge source respectively. We reveal that the imbalance in the number of prompts and responses can lead to a potential disparity in breadth and depth learning within alignment tuning datasets by showing that even a simple uniform method for balancing the number of instructions and responses can lead to significant improvements. Building on this, we further propose Balanced Preference Optimization (BPO), designed to dynamically augment the knowledge depth of each sample. BPO is motivated by the observation that the usefulness of knowledge varies across samples, necessitating tailored learning of knowledge depth. To achieve this, we introduce gradient-based clustering, estimating the knowledge informativeness and usefulness of each augmented sample based on the model’s optimization direction. Our experimental results across various benchmarks demonstrate that BPO outperforms other baseline methods in alignment tuning while maintaining training efficiency. Furthermore, we conduct a detailed analysis of each component of BPO, providing guidelines for future research in preference data optimization.

Although fine-tuning Large Language Models (LLMs) with multilingual data can rapidly enhance the multilingual capabilities of LLMs, they still exhibit a performance gap between the dominant language (e.g., English) and non-dominant ones due to the imbalance of training data across languages. To further enhance the performance of non-dominant languages, we propose ShifCon, a Shift-based multilingual Contrastive framework that aligns the internal forward process of other languages toward that of the dominant one. Specifically, it shifts the representations of non-dominant languages into the dominant language subspace, allowing them to access relatively rich information encoded in the model parameters. The enriched representations are then shifted back into their original language subspace before generation. Moreover, we introduce a subspace distance metric to pinpoint the optimal layer area for shifting representations and employ multilingual contrastive learning to further enhance the alignment of representations within this area. Experiments demonstrate that our ShifCon framework significantly enhances the performance of non-dominant languages, particularly for low-resource ones. Further analysis offers extra insights to verify the effectiveness of ShifCon and propel future research.