# Dynamic question quality standard

Quality-standard-2 blueprints are eligible for learner runs. Older blueprints
remain stored only so signed questions and reports can be regenerated.

## Content requirements

- At least three curated case families per objective.
- One invariant `correctConceptId` across every family.
- A complete clinical vignette, focused lead-in, and coherent correlated data.
- At least six plausible distractors with an explanation for every answer.
- A complete explanation, key takeaway, USMLE pearl, review follow-up, and
  wrong-answer remediation.
- At least one authoritative reference.

Promotion validates 10,000 seeds for every quality-standard-2 blueprint. Existing
blueprint versions are immutable; content changes require a version increment.

## Blinded acceptance

Create a balanced packet of three generated variants per gold objective and the
same number of authored questions:

```text
dotnet QuestionsApi.dll export-dynamic-review \
  --source /app/content/dynamic_questions \
  --output /tmp/dynamic-review
```

Keep `answer-key.json` separate from `review-packet.json`. Two clinical reviewers
score realism, distractor quality, explanation quality, and Step 3 relevance from
1–5 and predict whether each item is authored or dynamic.

The pilot passes when there are no critical medical or ambiguity findings, every
dimension averages at least 4/5, and source-identification accuracy is no greater
than 65%. Corrections are published as a new blueprint version and reviewed again.