skills/hoc-y/references/learner-levels.md

# Learner levels Y1–Y6

> **Áp dụng cho học tập:** Mọi "ca", "bệnh nhân", "xử trí", "xét nghiệm" hay "decision" bên dưới chỉ là dữ kiện thuộc **tình huống hoàn toàn giả định, không có người bệnh thật**. Đọc cùng `educational-boundaries.md`; không sử dụng các gợi ý này trong chăm sóc, hồ sơ hoặc quyết định y tế thực tế.


Use the year as a proxy for expected depth, never as a rigid rule. If the learner demonstrates stronger or weaker mastery, adapt in real time.

## Y1 — Foundations
Focus: anatomy, histology, physiology, biochemistry, terminology, normal structure/function.

Teaching moves:
- build one clear mental model first;
- use spatial/causal relations;
- define new terms before using them heavily;
- use simple clinical anchors only to make foundations memorable;
- test recognition and explanation more than management.

Avoid:
- specialist-level disease lists;
- guideline detail;
- long differentials;
- management algorithms without foundation.

## Y2 — Mechanisms
Focus: pathology, microbiology, immunology, pharmacology, mechanisms of disease.

Teaching moves:
- connect normal → abnormal → manifestation;
- contrast mechanisms that produce similar findings;
- emphasize pharmacologic mechanism, indication logic, major safety concepts rather than prescription minutiae unless specifically taught.

## Y3 — Bridge to clinical medicine
Focus: symptoms, syndromes, bedside data, basic investigations, mechanism-to-presentation.

Teaching moves:
- start using problem representation;
- connect symptom/sign → mechanism → likely system/process;
- introduce differential diagnosis as prioritized categories;
- explain why a basic test is ordered.

## Y4 — Core clinical reasoning
Focus: common presentations, prioritized differential, investigations, initial management under supervision.

Teaching moves:
- cases should require selection, not mere recall;
- ask what is most likely, most dangerous, and what changes management;
- connect tests to decisions;
- use SBA-style questions often.

## Y5 — Integration
Focus: severity, complications, treatment choices, reassessment, multi-problem patients.

Teaching moves:
- introduce uncertainty and competing priorities;
- ask for management sequence and reassessment endpoints;
- integrate communication, disposition and escalation.

## Y6 — Readiness for supervised practice
Focus: prioritization, first steps, stabilization, escalation, handover, safety, uncertainty.

Teaching moves:
- time-sensitive scenarios;
- ask “what would you do first and why?”;
- require recognition of limits and when to call for help;
- practice concise handover and safety-netting;
- do not imply unsupervised prescribing/procedural autonomy.

## Priority emphasis by year
- **Y1–Y2:** Must know often includes foundational structure/function and mechanism; Must not miss is mainly major safety concepts and obvious red flags when clinically anchored.
- **Y3:** Must know expands to signs & symptoms, syndrome recognition and basic investigations.
- **Y4–Y6:** Must not miss becomes more prominent: instability, dangerous differentials, escalation, contraindications, complications and reassessment.

## Adaptive rule
Increase complexity when the learner is consistently correct **and** reasoning is coherent, independent and transferable. If repeated errors occur, identify whether the gap is recognition/signs & symptoms, mechanism, or basic-science prerequisite; repair the narrowest missing layer, then retest with a new example.

## Clinical Learning Ladder entry points
Use these as defaults, not rigid boundaries:

| Year | Typical entry | Typical forward target |
|---|---|---|
| Y1 | Basic science | Mechanism + simple clinical anchor |
| Y2 | Basic science / Mechanism | Signs & Symptoms |
| Y3 | Mechanism / Signs & Symptoms | Syndrome + basic Investigation |
| Y4 | Signs & Symptoms / Syndrome | Differential + Investigation |
| Y5 | Syndrome / Differential | Management + Reassessment |
| Y6 | Syndrome / Differential or Management | Prioritization + Reassessment + escalation |

If the learner demonstrates a prerequisite gap, step backward only as far as needed. If the learner demonstrates secure mastery, skip forward. Performance overrides year.