# RT FORGE 180-lesson program: authoring and release contract The approved scope is 180 distinct lessons using the 50-case library across twelve areas. All 180 slots now have draft teaching content: 174 newly authored lessons plus six preserved Acute Respiratory Failure pilot lessons, each counted once. All twelve areas are authored across their agreed slots. Twelve separate 15-question unit reviews do not increase the 180-lesson count. The new bank contains 870 lesson decisions and 180 review questions, with 4,200 option rationales. Authored content remains formative faculty development and requires review against this contract. Counts and catalog coverage establish neither clinical quality nor the availability of every source case runtime. Independent clinical, distractor and visual review and empirical difficulty calibration remain pending; student release is false. ## Instruction Every lesson has a distinct clinical decision, bounded objectives, a short physiological explanation, interactive recognition/interpretation, an intervention, a visible response, reassessment, automated feedback, and an independent transfer problem. Understand → Recognize → Interpret → Intervene → Reassess → Reflect. Foundation, Application and Integration describe increasing complexity within an area; they do not license repeated content with different titles. Cross-case lessons identify the contribution of each case. Keep patient identity consistent within an encounter and explicitly identify a separate simulator patient. No required essays or manual grading. A learner must act and interpret; reading, opening a model or accumulating minutes is not mastery. Do not invent durations. Let the authored work and observed pilot use establish time estimates. ## Assessment Use four clinically credible, mutually distinguishable options with one best answer under the stated conditions. Distractors represent a plausible error of mechanism, prioritization, timing, measurement or escalation. Similar grammar, specificity and length; no joke choices, absolute-word giveaways, repeated correct phrasing, answer-revealing headings or hints before commitment. Require integration of at least two meaningful findings where clinically appropriate. Avoid diagnosis and treatment cues in the transfer title. Randomize option order while preserving stable option IDs and answer/rationale alignment. Provide a separate explanation for every option. Explain why a reasonable action is less appropriate *now*, and what evidence would make it appropriate. Independent transfer changes the data/context and cannot duplicate guided practice. Retried practice cannot overwrite the first-attempt mastery result. Use up to 15 original NBRC-style questions per instructional unit; the earlier 19 guided decisions and 15 questions describe the existing six-lesson pilot, not a universal per-lesson quota. NBRC mappings are proposed until checked against the official current outline; do not label content NBRC endorsed. ## Visuals and accessibility Use the established dark clinical workspace, cyan action hierarchy, patient-specific evidence, clear observation/decision/reassessment stages, consistent navigation, and readable numeric units. A purposeful visual teaches a mechanism or decision. Source and license real radiographs, ECGs and waveform references; do not use generated pictures as diagnostic evidence. Do not display generic adult anatomy as neonatal/pediatric anatomy. Clearly indicate clickable controls, focus state, selection, disabled state, and submission feedback. Verify at phone and desktop widths: no horizontal overflow, cropped options, hidden commit controls, or unreadable plots. Support keyboard use and semantic labels. Do not fabricate patient images or vitals merely to fill a layout. ## Integration boundaries RT FORGE Patient Simulator is for encounters, assessment/intervention, patient change, rescue and longitudinal reassessment. Resolve actual case availability before offering a launch. Case catalogs and runtime-disabled previews are not substitutes for a working encounter. Ventilator Simulator is for mode-specific controls, measured pressures/volumes, waveforms, holds, support transitions and clinical consequences. Each mode lesson includes physiology, clinical application, waveform interpretation and troubleshooting. A standalone launch supplies no completion or grade evidence unless a verified result bridge exists. The existing Elena assignment retains its own defined bridge. Lung Model is for anatomy, regional ventilation/perfusion, obstruction, structural damage, fluid, recruitment and modeled treatment response. Its illustrative state is separate from a simulator patient. It does not generate a patient ABG, blood pressure, drug prescription, neonatal physiology or validated outcome prediction. Embedded formative workshops accept state only from the expected same-origin iframe and attempt; treatment, reassessment and affected-region zoom are required before post-model interpretation. Model exploration evidence is distinct from correctness. ## Records and release Store lesson/content version, attempt, first response, all selected option IDs, feedback, simulator/model evidence, practice completion and transfer mastery separately. Local browser storage is a provisional learning record, not an LMS grade, cross-device identity or faculty analytics service. No combined score without a defined, reviewed weighting and compatible evidence contracts. Release states: blueprint → authored → content reviewed → distractor reviewed → visual verified → integration verified → faculty reviewed → student released. A counting/schema test cannot sign off clinical content, question difficulty, visual quality, or external clinical validation. No silent promotion. Each authored lesson needs primary sources, explicit source-to-claim mapping, review dates, scope/limitations and an independent reviewer record before student release. The current catalog and pilot remain faculty development. ## Current source anchors - AARC Patient–Ventilator Assessment (2024): https://www.aarc.org/wp-content/uploads/2024/10/patient-ventilator-assessment-aarc-cpg.pdf — plateau, tidal volume/PBW, PEEP/auto-PEEP and bedside assessment. - ATS ARDS guideline update (2024): https://pmc.ncbi.nlm.nih.gov/articles/PMC10870893/ — protective support and PEEP/recruitment boundaries; no routine prolonged recruitment maneuver in the workshop. - AARC guideline directory: https://www.aarc.org/resource/clinical-practice-guidelines/ — source queue for oxygen, suctioning, liberation, pediatric asthma and airway care. - NBRC content outlines: https://www.nbrc.org/contentoutlines/ — mapping source; detailed 180-lesson alignment remains pending. - Living-lung mechanism assumptions and limits: ../faculty/LIVING-LUNG-CALIBRATION.md. ## Delivery order Preserve the six authored lessons and their existing exercises. Integrate model workshops into gas exchange, mechanics and ARDS first. Expand in coherent clinical units, prioritizing assessment/ABG/oxygen, obstruction/airway care, ventilation and liberation, then age-specific care and integration. Author and review each unit's teaching, interactions, visuals, transfer problems and review questions together. Do not fill the remaining planned lessons with generated variants of a single lesson or question template. Current source review also includes the 2026 ATS noninvasive respiratory-support guideline and 2026 AHA/ACC multisociety acute-PE guideline, linked with claim boundaries in the authored bank. Older source anchors are retained where their specific measurement/response guidance is used; they are not represented as the newest comprehensive modality guidance.