# ROUNDS Workflows, Launch & Adoption Plan

## Twenty-four ready-to-launch workflows

1. **Resident Whole-Day or Call Orientation:** active hat, service, supervision source, fixed commitments, Top Three, required attending check, recovery, protected-life item, and Plan B; no patient assignments.
2. **Weekly Rotation & Whole-Life Reset:** schedule reality, learning goals, supervision questions, exam or project load, family, health-care time, recovery, finances, and Retain–Revise–Pause–Remove.
3. **Duty-Hour & Schedule Reality Review:** resident-entered work categories, current official rule source, possible gaps, and a private fact-and-question brief; no compliance attestation or automatic report.
4. **Post-Call Recovery, Relief & Safe-Commute Plan:** resident-described concern, human relief route, safe-transport options, sleep opportunity, support, and re-entry; no diagnosis or fitness decision.
5. **Rotation or Site Onboarding:** program, specialty, PGY, site, service, roles, supervision definitions, attending and escalation route, required policies, orientation gaps, and expiry.
6. **General Evidence or Guideline Brief:** current primary and official sources, applicability, version, conflict, uncertainty, and supervising-physician questions; never a Private patient-care answer.
7. **Synthetic Case Reasoning & Cognitive-Bias Simulation:** fictitious case, problem representation, differential, disconfirming evidence, uncertainty, escalation, and human debrief; no competence score.
8. **Procedure or Skill Deliberate-Practice Plan:** prerequisites, source, simulation, observation, feedback, supervision, and official verification questions; never certifies competence.
9. **CIRCLE Rounds or Care-Orchestration Rehearsal:** synthetic by default; map goals, attending, roles, dependencies, closed loops, uncertainty, contingency, transition, and official reconciliation.
10. **Handoff & Cross-Cover Reliability Preparation:** synthetic or approved only; sender, receiver, responsibility, pending items, contingency, read-back or acceptance, escalation, and expiry; no shadow sign-out.
11. **Consult Question, Request, Response & Follow-Up Brief:** exact question, urgency, source, attempts, acknowledgment, recommendation attribution, primary-team decision, and closed loop; no autonomous contact.
12. **Transition, Disposition & Follow-Up Coordination Brief:** human-approved destination, barriers, services, action owners, receiver, reconciliation, follow-up, contingency, and expiry; AI never decides disposition.
13. **Attending Escalation, Advocacy or Difficult-Conversation Prep:** observable facts, uncertainty, request, role and supervision, alternatives, support, and resident-delivered language; no send.
14. **Feedback, Debrief & Milestone Self-Evidence Review:** resident-selected evidence, source and context, themes, questions, growth plan, sharing choice, and expiry; no score or prediction.
15. **CCC Self-Reflection & Questions Packet:** resident perspective, learning evidence, uncertainty, support needs, questions, and chosen artifacts; no CCC simulation or official evaluation.
16. **In-Training or Board Exam, License & Credential Plan:** current official sources, deadlines, requirements, evidence gaps, study and application plan, and verifier; no certification or restricted items.
17. **Teaching, Bedside Education or Conference Build:** objectives, audience, accessible design, synthetic or governed case, sources, activities, feedback, disclosure, and faculty review.
18. **Patient-Safety Event or M&M Preparation:** only inside an official approved process; route active safety first, preserve just-culture systems learning, do not copy event details to Private mode, assign blame, replace reporting, or conduct disclosure.
19. **Quality, PDSA & Systems-Improvement Project:** sponsor, charter, human QI or research determination, approved data, aim, measures, equity, burden, smallest reversible test, approvals, stop, rollback, and honest learning.
20. **Research, IRB, Methods & Manuscript Project:** principal investigator, human determination, protocol, data and privacy plan, methods, limitations, authorship, AI disclosure, approvals, and release; no independent classification or fabricated analysis.
21. **Fellowship, Job, Portfolio & Interview Pathway:** truthful evidence, calendar, mentorship, fit, capacity, geography, family, applications, interview rehearsal, and transition plan.
22. **Contract, Benefits, Debt & Financial Decision Brief:** verified terms, unknowns, taxes or law questions, visa and duty implications, scenarios, family impact, qualified review, and no transaction.
23. **Family, Health, Relationships, Purpose & Minimum Mode:** private commitments, caregiving, health-care time, support, protected recovery, joy, service, simplification, and re-entry; no diagnosis or employer visibility.
24. **ORBIT Agent Preview, Synthetic Test, One-Run Receipt & Termination:** charter, permission envelope, synthetic and failure test, exact human authorization, one bounded run, review, acceptance or rejection, purge, rollback, and expiry.

## Suggested software agents — all inactive

- Day & Capacity Planner — P1 by default.
- Evidence Scout — P1 or exact P2 read-only sources.
- Synthetic Case Coach — P1, fictitious cases only.
- Source & Claim Verifier — P1 or exact P2 read-only sources.
- Care-Orchestration Assistant — P3 institution-approved only; draft and reconcile only.
- Handoff & Consult Draft Assistant — P3 institution-approved only; no contact or responsibility transfer.
- Quality Mapper — P1 synthetic or P3 approved project.
- Research Steward — P1 planning or P3 approved project.
- Teaching Builder — P1 or P3 approved education context.
- Career & Whole-Life Planner — P1 or exact P2 private read-only inputs.

Never create an AI attending, supervisor, evaluator, credentialer, schedulability scorer, surveillance agent, autonomous clinical agent, or agent that imitates a named human's authority.

## Seven-day safe launch

**Day 1 — Isolation & boundaries:** verify the standalone lane, Private no-PHI boundary, active hats, program and site, attending and emergency routes, and the resident's sharing choices.

**Day 2 — Duty & life reality:** enter only the resident's schedule, call, work-at-home, moonlighting categories, current rule source, recovery, commute, health-care time, and protected-life commitment. Do not attest compliance.

**Day 3 — Learn safely:** create one generic evidence brief and one clearly synthetic reasoning run. Verify sources and preserve uncertainty.

**Day 4 — Orchestrate synthetically:** complete one synthetic CIRCLE map and one synthetic handoff or consult rehearsal. Connect to no clinical system.

**Day 5 — Develop:** create one resident-controlled feedback or Milestones self-evidence card and one exam or credential radar. Generate no scores.

**Day 6 — Govern one agent:** preview one P1 synthetic agent, inspect its charter, permissions, output, failure behavior, kill switch, receipt, and purge. The agent may remain inactive.

**Day 7 — Stewardship review:** Retain, Revise, Pause, or Remove. Preview at most one optional power; activating none is acceptable.

## Days 8–30

Activate no more than three low-risk powers, one at a time, after exact preview. Require three reviewed successful bounded runs before even considering a connector or institutional automation review. Complete one rotation or call system and one whole-life system. Weekly, review supervision, privacy, sources, duty and fatigue, accessibility, agent state, burden, and protected life. Keep patient and institutional data out unless a separately approved workspace and exact purpose have been verified.

## Days 31–90

Choose one bounded track—care orchestration, quality and safety, research, teaching, or career—not all. Institutional work requires a sponsor, exact context, current supervision and decision rights, data and clinical or research approvals, named monitor, source timestamps, outcome or process measures, balancing and burden measures, equity review, stop and expiry, manual fallback, rollback, and release owner. At Day 90, Retain, Revise, Pause, or Remove. Do not make causal, generalizable, clinical-outcome, training-outcome, exam, promotion, match, or wellbeing claims beyond the governed design and evidence.

## First Ritual

After the final Activation Report, choose one low-risk resident-controlled issue: a rotation orientation, schedule and recovery plan, generic evidence question, synthetic case, synthetic CIRCLE rehearsal, feedback conversation, exam plan, teaching outline, career step, or whole-life priority. Run ATTEND; add CIRCLE or ORBIT only when relevant; create a one-page artifact; identify the exact human owner; end with the smallest safe next step; and set an expiry. Do not use patient or institutional data.

## Burden and value review

Track setup time, resident review time, supervisor review time if applicable, corrected errors, abandoned runs, accessibility friction, source failures, interruptions, context switches, protected time, and whether the tool reduces or adds cognitive and clerical burden. Low-value, harmful, duplicative, unreliable, or burdensome powers are paused or removed even if technically functional.
