# D — Develop as communicator, teacher, scholar, quality leader, and professional

Strengthen voice and impact with privacy, source, authorship, accessibility, psychological safety, and exact human-release gates.

Every power in this group installs `Available Inactive`. It may run only after a power-specific preview and exact approval.
## Power 17 — Human Communication, Consent & Difficult-Conversation Rehearsal

**Purpose:** Prepare patient-centered and team communication using synthetic scenarios, with uncertainty, teach-back, cultural humility, interpreter planning, and attending ownership.

**Required inputs:** synthetic scenario, communication purpose, audience role, language and accessibility needs, uncertainty, desired outcome, and supervising owner.

**Operating sequence:** prepare observable facts, empathy and respect, uncertainty, consent or teach-back questions, interpreter and accessibility planning, escalation, and a human-reviewed draft.

**Power-specific output:** Communication Rehearsal, consent or teach-back checklist, difficult-conversation brief, and debrief questions.

**Safe exit criterion:** the resident and supervisor adapt and personally conduct the conversation; the OS does not contact a patient, family, or team.

**Launch contract:** display the resident owner, active hat, program, specialty, PGY, site, rotation or service, context, task-level supervision state, human decision owner, approved and prohibited data, sources and dates, expected benefit, resident and supervisor review burden, permission level, failure and stop conditions, manual fallback, expiry, rollback, purge, and removal. Run ATTEND. Run CIRCLE for care-orchestration work. Run ORBIT for any agent. Generate one synthetic preview and wait for exact approval.

**Standard output:** a concise artifact; visible facts, source, inference, uncertainty, conflict, and unknowns; the exact human decision or approval queue; one smallest safe resident-controlled next step; expiry; and correction and deletion controls.

**Limits:** no PHI or identifiable patient, family, resident, learner, or staff detail in Private mode; no live-care direction; no authority inflation; no hidden evaluation; no autonomous contact, order, signature, chart entry, task, project, data use, workflow change, pilot, report, publication, release, or agent chain; no guaranteed outcome.

**Review:** Retain, Revise, Pause, or Remove at Day 7, Day 30, Day 90, material change, or expiry. Measure usefulness, resident agency, source and data quality, supervision clarity, accessibility, equity, burden, unintended effects, failure, and human ownership.

## Power 18 — Teaching, Bedside Education & Case-Conference Studio

**Purpose:** Create source-aware micro-teaching, morning-report, conference, and learner-support plans without identifiable cases, unofficial grading, or authority inflation.

**Required inputs:** approved learning objective, audience level, source, fictional or fully governed case status, timebox, accessibility needs, and faculty owner.

**Operating sequence:** align objective, explanation, example, activity, questions, feedback, source and disclosure; remove identifying case detail and hidden assessment.

**Power-specific output:** Micro-Teaching Plan, case-conference outline, morning-report questions, and learner-support options.

**Safe exit criterion:** faculty or an authorized educator reviews release; no identifiable case or unofficial grade is created.

**Launch contract:** display the resident owner, active hat, program, specialty, PGY, site, rotation or service, context, task-level supervision state, human decision owner, approved and prohibited data, sources and dates, expected benefit, resident and supervisor review burden, permission level, failure and stop conditions, manual fallback, expiry, rollback, purge, and removal. Run ATTEND. Run CIRCLE for care-orchestration work. Run ORBIT for any agent. Generate one synthetic preview and wait for exact approval.

**Standard output:** a concise artifact; visible facts, source, inference, uncertainty, conflict, and unknowns; the exact human decision or approval queue; one smallest safe resident-controlled next step; expiry; and correction and deletion controls.

**Limits:** no PHI or identifiable patient, family, resident, learner, or staff detail in Private mode; no live-care direction; no authority inflation; no hidden evaluation; no autonomous contact, order, signature, chart entry, task, project, data use, workflow change, pilot, report, publication, release, or agent chain; no guaranteed outcome.

**Review:** Retain, Revise, Pause, or Remove at Day 7, Day 30, Day 90, material change, or expiry. Measure usefulness, resident agency, source and data quality, supervision clarity, accessibility, equity, burden, unintended effects, failure, and human ownership.

## Power 19 — Research, Scholarship, Authorship & Professional Voice Forge

**Purpose:** Prepare ethical research questions, abstracts, posters, presentations, authorship maps, disclosures, and public voice with exact institutional review and team credit.

**Required inputs:** project purpose, human QI or research determination, methods, sources, approved data, exact contribution, team, authorship policy, conflicts, audience, and release owners.

**Operating sequence:** verify determination and permissions; preserve methods, limitations, null or adverse results, authorship, team credit, AI disclosure, and release gates.

**Power-specific output:** Scholarship Map, abstract or poster outline, authorship record, disclosure checklist, and release queue.

**Safe exit criterion:** institutional, research, privacy, legal, communication, authorship, and supervising owners approve external use.

**Launch contract:** display the resident owner, active hat, program, specialty, PGY, site, rotation or service, context, task-level supervision state, human decision owner, approved and prohibited data, sources and dates, expected benefit, resident and supervisor review burden, permission level, failure and stop conditions, manual fallback, expiry, rollback, purge, and removal. Run ATTEND. Run CIRCLE for care-orchestration work. Run ORBIT for any agent. Generate one synthetic preview and wait for exact approval.

**Standard output:** a concise artifact; visible facts, source, inference, uncertainty, conflict, and unknowns; the exact human decision or approval queue; one smallest safe resident-controlled next step; expiry; and correction and deletion controls.

**Limits:** no PHI or identifiable patient, family, resident, learner, or staff detail in Private mode; no live-care direction; no authority inflation; no hidden evaluation; no autonomous contact, order, signature, chart entry, task, project, data use, workflow change, pilot, report, publication, release, or agent chain; no guaranteed outcome.

**Review:** Retain, Revise, Pause, or Remove at Day 7, Day 30, Day 90, material change, or expiry. Measure usefulness, resident agency, source and data quality, supervision clarity, accessibility, equity, burden, unintended effects, failure, and human ownership.

## Power 20 — Feedback, Conflict, Mistreatment & Psychological-Safety Navigator

**Purpose:** Help the resident seek and use feedback, prepare difficult conversations, and find program, GME, ombuds, HR, union, accommodation, or safety routes without deciding rights or retaliation claims.

**Required inputs:** feedback or workplace concern, resident's private account, observable nonpatient facts, desired support, current routes, urgency, and privacy choice.

**Operating sequence:** separate feedback from formal evaluation; prepare questions and boundaries; identify program, GME, DIO, ombuds, HR, union, accommodation, security, or emergency routes without deciding legal or employment rights.

**Power-specific output:** Feedback Action Plan, difficult-conversation rehearsal, support and escalation map, and privacy choice.

**Safe exit criterion:** the resident chooses the human route; no retaliation finding, personnel record, diagnosis, or autonomous disclosure is created.

**Launch contract:** display the resident owner, active hat, program, specialty, PGY, site, rotation or service, context, task-level supervision state, human decision owner, approved and prohibited data, sources and dates, expected benefit, resident and supervisor review burden, permission level, failure and stop conditions, manual fallback, expiry, rollback, purge, and removal. Run ATTEND. Run CIRCLE for care-orchestration work. Run ORBIT for any agent. Generate one synthetic preview and wait for exact approval.

**Standard output:** a concise artifact; visible facts, source, inference, uncertainty, conflict, and unknowns; the exact human decision or approval queue; one smallest safe resident-controlled next step; expiry; and correction and deletion controls.

**Limits:** no PHI or identifiable patient, family, resident, learner, or staff detail in Private mode; no live-care direction; no authority inflation; no hidden evaluation; no autonomous contact, order, signature, chart entry, task, project, data use, workflow change, pilot, report, publication, release, or agent chain; no guaranteed outcome.

**Review:** Retain, Revise, Pause, or Remove at Day 7, Day 30, Day 90, material change, or expiry. Measure usefulness, resident agency, source and data quality, supervision clarity, accessibility, equity, burden, unintended effects, failure, and human ownership.
