{
  "schemaVersion": 1,
  "reportStatus": "coverage-audit-in-progress",
  "generatedOn": "2026-07-12",
  "source": {
    "outlineVersion": "2026",
    "effectiveAsOf": "2026-07-12",
    "outlineUrl": "https://www.usmle.org/sites/default/files/2022-01/USMLE_Content_Outline_0.pdf",
    "specificationsUrl": "https://www.usmle.org/exam-resources/step-1-materials/step-1-content-outline-and-specifications",
    "tasksUrl": "https://www.usmle.org/sites/default/files/2022-01/USMLE_Physician_Tasks_Competencies_2.pdf",
    "tasksVersion": "2025",
    "tasksSha256": "15ccc90db23dd37ee3121257a6c65640dff95e659aceab2d8553f9e2e83c27fd",
    "sampleItemsUrl": "https://www.usmle.org/exam-resources/step-1-materials/step-1-sample-test-questions",
    "sampleItemsPdfUrl": "https://www.usmle.org/sites/default/files/2021-10/Step_1_Sample_Items.pdf",
    "sampleItemsVersion": "April 2026",
    "provenance": "Official USMLE public-release materials"
  },
  "statement": "PulseQ does not currently claim complete USMLE Step 1 coverage or First Aid/Kaplan equivalence.",
  "officialInventory": {
    "domains": 18,
    "modules": 161,
    "outlineUnits": 1681,
    "atomicObjectives": 1681,
    "provisionallyMappedModules": 1681,
    "unresolvedModuleMappings": 0,
    "highPriorityObjectives": 1113,
    "physicianReviewedObjectives": 0,
    "systemSpecifications": 11,
    "disciplines": 11,
    "tasks": 4
  },
  "currentCatalog": {
    "topics": 24,
    "anchors": 436,
    "partiallyMappedAnchors": 283,
    "awaitingReviewAnchors": 153,
    "unmappedAnchors": 0,
    "provisionallyMappedAnchors": 402,
    "unresolvedObjectiveMappings": 0,
    "physicianReviewedAnchors": 0,
    "provisionallyReachedObjectives": 252,
    "supplementalObjectives": 34
  },
  "objectiveStatuses": {
    "covered": 0,
    "partiallyCovered": 0,
    "missing": 0,
    "duplicated": 0,
    "awaitingPhysicianReview": 1681
  },
  "diversity": {
    "passingHighPriorityObjectives": 0,
    "requiredHighPriorityObjectives": 1113,
    "rule": "At least two independently authored and approved Standard/Pro cases across at least two reasoning axes; Exercise anchors and cosmetic variants do not count."
  },
  "crossSystem": {
    "cells": 198,
    "relevantCells": 131,
    "reviewedCells": 0
  },
  "itemFormats": [
    {
      "id": "vignette-one-best-answer",
      "label": "Paragraph vignette, one-best-answer",
      "sourcePages": [
        3
      ],
      "required": true,
      "anchorCount": 436,
      "status": "exercise-only-unreviewed"
    },
    {
      "id": "chart-tabular-one-best-answer",
      "label": "Structured patient chart, one-best-answer",
      "sourcePages": [
        3,
        4,
        5
      ],
      "required": true,
      "anchorCount": 8,
      "status": "calibration-unpublished"
    },
    {
      "id": "graphic-pictorial",
      "label": "Graphic or pictorial interpretation",
      "sourcePages": [
        3,
        6
      ],
      "required": true,
      "anchorCount": 1,
      "status": "exercise-only-unreviewed"
    },
    {
      "id": "audio-multimedia",
      "label": "Audio or multimedia finding",
      "sourcePages": [
        6
      ],
      "required": true,
      "anchorCount": 0,
      "status": "missing"
    }
  ],
  "physicianReview": {
    "valid": true,
    "errors": [],
    "verifiedPhysicians": 0,
    "approvedObjectives": 0,
    "approvedOfficialObjectives": 0,
    "approvedSupplementalObjectives": 0,
    "approvedAnchors": 0,
    "approvedQuestionSamples": 0,
    "requiredQuestionSamples": 44,
    "unreviewedHighPriority": 1113,
    "signedOff": false
  },
  "releaseChecks": [
    {
      "id": "official-taxonomy-versioned",
      "label": "Official systems, disciplines, tasks, and source version are recorded",
      "passed": true
    },
    {
      "id": "generation-frozen",
      "label": "Blind question expansion is frozen",
      "passed": true
    },
    {
      "id": "official-objectives-mapped",
      "label": "Every official-derived objective is mapped to a reviewed module",
      "passed": false
    },
    {
      "id": "official-content-coverage",
      "label": "Every official-derived objective has reviewed learner content or an approved remediation",
      "passed": false
    },
    {
      "id": "existing-anchors-mapped",
      "label": "Every existing anchor is mapped and reviewed at objective level",
      "passed": false
    },
    {
      "id": "high-priority-diversity",
      "label": "High-priority objectives have multiple distinct reviewed forms",
      "passed": false
    },
    {
      "id": "cross-system-discipline-audit",
      "label": "Cross-system disciplines are audited in every relevant system",
      "passed": false
    },
    {
      "id": "official-item-formats",
      "label": "Official vignette, chart, pictorial, and multimedia formats are represented and reviewed",
      "passed": false
    },
    {
      "id": "module-integrity",
      "label": "Modules are unique, correctly labeled, and physician-validated",
      "passed": false
    },
    {
      "id": "physician-signoff",
      "label": "Qualified physician review is signed off",
      "passed": false
    },
    {
      "id": "public-coverage-report",
      "label": "Coverage status and limitations are visible to users",
      "passed": true
    }
  ],
  "domainRows": [
    {
      "id": "human-development",
      "label": "Human Development",
      "modules": 4,
      "directlyMappedAnchors": 16,
      "awaitingReviewAnchors": 55,
      "status": "partial"
    },
    {
      "id": "immune-system",
      "label": "Immune System",
      "modules": 7,
      "directlyMappedAnchors": 16,
      "awaitingReviewAnchors": 99,
      "status": "partial"
    },
    {
      "id": "blood-lymphoreticular",
      "label": "Blood & Lymphoreticular System",
      "modules": 7,
      "directlyMappedAnchors": 16,
      "awaitingReviewAnchors": 121,
      "status": "partial"
    },
    {
      "id": "behavioral-health",
      "label": "Behavioral Health",
      "modules": 11,
      "directlyMappedAnchors": 16,
      "awaitingReviewAnchors": 77,
      "status": "partial"
    },
    {
      "id": "nervous-special-senses",
      "label": "Nervous System & Special Senses",
      "modules": 18,
      "directlyMappedAnchors": 22,
      "awaitingReviewAnchors": 99,
      "status": "partial"
    },
    {
      "id": "skin-subcutaneous",
      "label": "Skin & Subcutaneous Tissue",
      "modules": 7,
      "directlyMappedAnchors": 16,
      "awaitingReviewAnchors": 77,
      "status": "partial"
    },
    {
      "id": "musculoskeletal-system",
      "label": "Musculoskeletal System",
      "modules": 6,
      "directlyMappedAnchors": 16,
      "awaitingReviewAnchors": 77,
      "status": "partial"
    },
    {
      "id": "cardiovascular-system",
      "label": "Cardiovascular System",
      "modules": 15,
      "directlyMappedAnchors": 16,
      "awaitingReviewAnchors": 77,
      "status": "partial"
    },
    {
      "id": "respiratory-system",
      "label": "Respiratory System",
      "modules": 11,
      "directlyMappedAnchors": 40,
      "awaitingReviewAnchors": 77,
      "status": "partial"
    },
    {
      "id": "gastrointestinal-system",
      "label": "Gastrointestinal System",
      "modules": 12,
      "directlyMappedAnchors": 22,
      "awaitingReviewAnchors": 77,
      "status": "partial"
    },
    {
      "id": "renal-urinary-system",
      "label": "Renal & Urinary System",
      "modules": 8,
      "directlyMappedAnchors": 16,
      "awaitingReviewAnchors": 77,
      "status": "partial"
    },
    {
      "id": "pregnancy-puerperium",
      "label": "Pregnancy, Childbirth, & the Puerperium",
      "modules": 7,
      "directlyMappedAnchors": 0,
      "awaitingReviewAnchors": 93,
      "status": "awaiting-review"
    },
    {
      "id": "female-reproductive-breast",
      "label": "Female and Transgender Reproductive System & Breast",
      "modules": 8,
      "directlyMappedAnchors": 0,
      "awaitingReviewAnchors": 93,
      "status": "awaiting-review"
    },
    {
      "id": "male-reproductive",
      "label": "Male and Transgender Reproductive System",
      "modules": 6,
      "directlyMappedAnchors": 0,
      "awaitingReviewAnchors": 93,
      "status": "awaiting-review"
    },
    {
      "id": "endocrine-system",
      "label": "Endocrine System",
      "modules": 9,
      "directlyMappedAnchors": 22,
      "awaitingReviewAnchors": 99,
      "status": "partial"
    },
    {
      "id": "multisystem-processes",
      "label": "Multisystem Processes & Disorders",
      "modules": 12,
      "directlyMappedAnchors": 17,
      "awaitingReviewAnchors": 115,
      "status": "partial"
    },
    {
      "id": "biostatistics-population-health",
      "label": "Biostatistics, Epidemiology/Population Health, & Interpretation of the Medical Literature",
      "modules": 9,
      "directlyMappedAnchors": 16,
      "awaitingReviewAnchors": 33,
      "status": "partial"
    },
    {
      "id": "social-sciences",
      "label": "Social Sciences",
      "modules": 4,
      "directlyMappedAnchors": 16,
      "awaitingReviewAnchors": 33,
      "status": "partial"
    }
  ],
  "knownRisks": [
    {
      "id": "official-outline-non-exhaustive",
      "severity": "critical",
      "status": "open",
      "evidence": "The official USMLE outline states that its examples are non-exhaustive and that no single examination includes every listed topic.",
      "remediation": "Qualified physicians review each domain for foundational omissions and approve, add, merge, or reject supplemental objectives.",
      "requiredBeforeCoverageClaim": true
    },
    {
      "id": "objective-mappings-unreviewed",
      "severity": "critical",
      "status": "open",
      "evidence": "All objective-to-module and anchor-to-objective mappings are algorithmic candidates; zero have physician approval.",
      "remediation": "Complete the objective and anchor review sheets with verified physician credentials and rationales.",
      "requiredBeforeCoverageClaim": true
    },
    {
      "id": "high-priority-diversity-gap",
      "severity": "critical",
      "status": "open",
      "evidence": "Most high-priority objectives lack two independently authored anchors across distinct reasoning axes.",
      "remediation": "After priority validation, create only verified gap-closing forms and repeat medical review.",
      "requiredBeforeCoverageClaim": true
    },
    {
      "id": "chart-format-gap",
      "severity": "high",
      "status": "open",
      "evidence": "PulseQ has eight structured chart/table calibration fixtures, but they are unpublished and have not completed medical and style review.",
      "remediation": "Review the new calibration set, remediate rejected cases, and approve a representative chart-format inventory before publication.",
      "requiredBeforeCoverageClaim": true
    },
    {
      "id": "audio-multimedia-gap",
      "severity": "high",
      "status": "open",
      "evidence": "The official interactive testing experience includes an audio finding; PulseQ has no reviewed audio/multimedia inventory.",
      "remediation": "Define accessibility, playback, authoring, and physician-review standards for multimedia items.",
      "requiredBeforeCoverageClaim": true
    },
    {
      "id": "commercial-equivalence-unlicensed",
      "severity": "critical",
      "status": "controlled",
      "evidence": "First Aid and Kaplan were not used as coverage authorities and PulseQ has no recorded license to reproduce or claim equivalence to either product.",
      "remediation": "Continue prohibiting reproduction and equivalence claims unless written licensing permission is recorded and legally reviewed.",
      "requiredBeforeCoverageClaim": false
    },
    {
      "id": "source-version-drift",
      "severity": "high",
      "status": "controlled",
      "evidence": "USMLE content, competencies, sample formats, and test software can change after the recorded audit date.",
      "remediation": "Verify official sources on a scheduled cadence; a changed source hash or version invalidates sign-off until a reviewed diff is complete.",
      "requiredBeforeCoverageClaim": true
    }
  ]
}