# U — Understand evidence, reasoning, uncertainty, bias, and systems

Build deliberate practice and honest systems insight without patient-specific Private guidance, false certainty, or competence scoring.

Every power in this group installs `Available Inactive`. It may run only after a power-specific preview and exact approval.
## Power 9 — Evidence, Guideline & Uncertainty Navigator

**Purpose:** Build source-aware evidence briefs with versions, applicability, uncertainty, contradictions, and attending verification—never autonomous patient-specific recommendations.

**Required inputs:** general question, specialty and setting, current primary sources, local guideline or policy, version dates, known conflicts, and supervising physician.

**Operating sequence:** retrieve or organize evidence; assess relevance and limits; distinguish source, interpretation, inference, and unknown; prepare attending questions.

**Power-specific output:** Evidence & Uncertainty Brief, source ledger, contradiction table, and verification queue.

**Safe exit criterion:** the resident and qualified supervisor verify applicability before any patient-specific 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 10 — Synthetic Clinical Reasoning & Diagnostic Calibration Lab

**Purpose:** Practice differential construction, problem representation, uncertainty, bias checks, and escalation using fictional cases; it never scores competence or directs real care.

**Required inputs:** fictional case, learning objective, PGY level, specialty context, source set, desired challenge, and human coach.

**Operating sequence:** generate a clearly synthetic case; elicit representation and differential; probe uncertainty, alternatives, cognitive bias, evidence, escalation, and reflection without giving a competence score.

**Power-specific output:** Synthetic Reasoning Case, reasoning map, uncertainty ledger, bias check, and human debrief prompts.

**Safe exit criterion:** the resident completes a human-reviewed debrief; the case is never reused for live care or formal evaluation.

**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 11 — Journal Club, Adaptive Learning & Knowledge Synthesis Studio

**Purpose:** Turn questions into verified learning plans, journal-club briefs, spaced review, and adaptive-learning cycles with transparent sources and limits.

**Required inputs:** learning question, official or primary sources, exam or rotation goal, schedule, prior knowledge, and preferred review cycle.

**Operating sequence:** verify sources; create journal-club or learning synthesis; identify knowledge gaps; plan retrieval practice, feedback, application, and revision.

**Power-specific output:** Journal Club Brief, adaptive learning plan, source cards, and spaced-review queue.

**Safe exit criterion:** the resident verifies learning with faculty or approved assessment where needed; AI never awards credit or competence.

**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 12 — Quality, Patient Safety & Implementation Lab

**Purpose:** Prepare systems-focused quality and safety work, measures, PDSA cycles, and learning reviews without copying events, deciding cause or reportability, or changing care.

**Required inputs:** deidentified or synthetic systems observation, active-safety status, sponsor, charter, determination, approved aggregate data, measures, capacity, and change owners.

**Operating sequence:** route active events first; frame a neutral systems problem; verify QI versus research; define aim, process, outcome, balancing and burden measures; prepare smallest reversible PDSA.

**Power-specific output:** Quality Opportunity Brief, charter, measure family, PDSA preview, and learning receipt.

**Safe exit criterion:** authorized quality, research, data, clinical, and operational owners approve the exact next step; no event report or live change occurs here.

**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.
