Lesson L3-2 · authored fragments (docs/43)
Primary review content — the AI-avatar narration, in order.
Before you hand your resident anything, look at what's actually in your hand. Oral meds come in a few common forms, and your first job is to know each one on sight. A tablet is a pressed-powder pill, round or oval. A caplet is a tablet shaped like a capsule so it's easier to swallow. A capsule is powder or liquid inside a two-piece shell. A gel cap is a soft, coated capsule form. Tablet, caplet, capsule, gel cap. Learn to name them, because the form tells you how the medication is meant to be given. Here's the one rule that covers most of what you'll pass: a solid oral med is swallowed whole, with water, unless the order says otherwise. That's your default. You don't crush it, you don't open it, you don't split it just because it looks big or your resident is having a hard time. Now, some forms ARE handled differently - some get crushed, some capsules get opened and sprinkled into food. But that is never your call to make on the spot. The order and the label tell you which, and we'll get to exactly how you read that later in this lesson. Today, lock in the default: swallow whole with water unless the order says otherwise. One more habit for your med pass: give the pills first. Get the solid forms in, then move to the liquids. Naming the form and knowing its default sounds simple, but it's the foundation everything else in oral meds is built on. Get the form right, and you protect your resident from the very first step.
16 of 16 critical claims are verified_by: null (Gate-2 SME sign-off pending → preview only, production-blocked under the Rule-3.6 waiver). · runtime budget: 12:00
# Concept mirror — MA.L3-2.A (Oral Forms Overview: tablet, caplet, capsule, gel cap)
> **MIRROR / NOTES ONLY.** The authoritative concept entry is **docs/42 §E, `MA.L3-2.A`**
> (Instructional Domain Model). This file is the local traceability ledger + decision queue for the
> derived-asset bundle; if it ever disagrees with docs/42, **docs/42 wins** (docs/43 §22 authority flow).
| Field | Value |
|---|---|
| `concept_id` | `MA.L3-2.A` |
| `competency_id` | `C-3.2` (Oral forms & special considerations) |
| `lesson_ids` | `[L3-2]` |
| `clinical_risk` | **Moderate** → ≥80% KC mastery (docs/42 §H "Moderate"); gateway to the **Critical** crush rule `MA.L3-2.C` |
| `medication_error_prevented` | Mishandling a dose from misreading its form (e.g., opening a capsule that shouldn't be opened, altering a form that should be swallowed whole) |
| `sme_status` | `in_review` |
| `apd_traceability_status` | sourced — `[APD]` Module 2 s59–61; gel-cap inclusion is an owner-approved add of an APD-listed form |
## Rule-3.6 author-ahead waiver (recorded 2026-07-05)
The concept is `in_review`, not `approved`. Per docs/42 §I.1 / docs/43 §4, this bundle is authored
**ahead of concept approval under a Rule-3.6 waiver** as part of the Oral Route reference build.
Consequence: **every fragment in this bundle is `sme_status: "draft"`, preview-flag only, and
production-publish-blocked** until (a) the concept reaches `approved` and (b) a Gate-2 SME sign-off is
recorded in `content_revisions.sme_signoff_*`.
## Source ledger (projects into `payload_json.sources`)
- `curriculum_source`: "APD BMA Module 2, s59–61 (oral medication forms: tablets, caplets, capsules, gel caps; give pills first) + Don Montana MAR practical (Diltiazem ER capsule specimen)"
- `form_reference`: null (no APD form governs the forms-overview concept)
| # | Claim | Tag | Source | verified_by |
|---|---|---|---|---|
| C1 | The common solid oral forms a MAP will routinely encounter are tablets, caplets, capsules, and gel caps | `[APD]` | Module 2 s59–60 | null |
| C2 | The default for a solid oral med is to swallow it whole with water unless the order says otherwise | `[APD]` | Module 2 s59 | null |
| C3 | Forms are handled differently — some are swallowed whole, some are crushed, some capsules are opened and sprinkled — and the order/label tells you which | `[APD]` | Module 2 s59–61 (the *prohibition* on altering EC/ER without an order belongs to MA.L3-2.C / s118) | null |
| C4 | Give the pills (solid oral meds) first during the med pass | `[APD]` | Module 2 s61 ("give pills first") — **`TODO(source-L32A-1)`** confirm exact s61 sequencing wording | null |
| C5 | Gel caps are one of the recognized oral forms in scope (added 2026-07-05, owner-approved) | `[APD]`-listed / owner-approved add | Module 2 s60; docs/42 §I.3.2 | null |
| C6 | Tablet = pressed-powder pill; caplet = capsule-shaped tablet; capsule = powder/liquid in a two-piece shell; gel cap = a soft/coated capsule form — recognizable on sight | `[Waiver360-added]` | Plain-language form descriptions scaffolding the APD list; not APD-verbatim definitions | null |
## Patient-safety chain (owner directive — this is a patient-safety concept)
1. **Medication error prevented:** A MAP mishandles a dose because they didn't *read the form* —
opening a capsule that should stay closed, or altering a tablet/capsule that should be swallowed
whole — releasing the medication the wrong way.
2. **Why staff make this mistake (the real reason):** New MAPs treat every pill as "just a pill" —
interchangeable. On a busy med pass, under time pressure, they grab and give without ever
registering that a capsule or gel cap can behave differently from a plain tablet. Nobody taught
them to look at the *form itself* as information; they were taught to match the name, not the shape.
3. **How the lesson/transcript prevents it:** `l32-forms-overview` builds the vocabulary first —
name and recognize tablet, caplet, capsule, and gel cap on sight, and lock in the one default
(swallow whole with water unless the order says otherwise). You can't respect a form you can't
name; this is the gateway the Critical crush rule (`MA.L3-2.C`) is built on top of.
4. **How the simulator reinforces it:** In the Don Montana MAR sim, his **Diltiazem ER capsule** is
surfaced as a teachable specimen — the learner has to *recognize* the capsule (and that it's
extended-release) and apply the swallow-whole default before the crush-rule force-fail in
`MA.L3-2.C` ever tests them. Recognition here, consequence there.
5. **How the KC verifies mastery:** `KC-L3-2-A-Q1` (`oral_forms_sorter`) makes the learner *place*
each form into its handling bucket — swallow whole / alter only with order / dissolves in place —
proving they can tell the forms apart and attach the right default, not just recite names.
## Decision queue → owner / SME (Michele + Nicole)
1. **`TODO(source-L32A-1)` — confirm "give pills first" sequencing (C4).** The concept parenthetical
cites Module 2 s61 for "give pills first." SME to confirm the exact APD wording/scope (pills before
liquids on the pass) before C4 is verified. Until then `verified_by: null` and the bundle stays
preview-only.
2. **Gel-cap default handling.** Gel caps are added as an in-scope form (owner-approved, APD-listed at
s60). This bundle asserts only the *general* swallow-whole default for gel caps — it does **not**
assert any gel-cap-specific "may be opened / must not be opened" handling, because APD s59–61 does
not specify one at the form level. SME to confirm no gel-cap-specific handling rule is required in
the overview.
3. **Cross-concept KC scope.** `KC-L3-2-A-Q1` (the forms sorter) necessarily includes a scored tablet
("alter only with order," Mod2 s30 — `MA.L3-2.B`) and a sublingual tablet ("dissolves in place,"
Mod2 s68 — `MA.L3-2.B`) so the three buckets have members. This is deliberate: MA.L3-2.A is the
lesson's forms *integrator*. SME to confirm it is acceptable for A's KC to draw representative
forms whose specific rules are owned by sibling concepts B (all same APD Module 2 source).
4. **Chewable-multivitamin option — removed (docs/42 §I.3.6).** Honored: the forms sorter contains
**no** chewable-multivitamin distractor.
5. **Crush prohibition stays in C.** This concept deliberately does **not** state the "EC/ER must
never be crushed" prohibition (Mod2 s118) — that is the Critical concept `MA.L3-2.C`. A only
establishes recognition + the swallow-whole default. Confirm the split reads correctly to SME.
## Bundle manifest + README are owned by the later lesson-aggregation step (not authored here).
Sort each oral form into how it is handled by default. Drag every form into the correct bucket.
Why: Tablets, caplets, capsules, and gel caps share one default - swallow whole with water unless the order says otherwise. A scored tablet is the exception you can act on: split it, but only when there is an order for half a dose. A sublingual tablet is never swallowed - it goes under the tongue and dissolves in place. Reading the form is what tells you which handling applies.
Error prevented: Mishandling a dose by misreading its form - opening or altering a form that should be swallowed whole, or swallowing a form that should dissolve in place.
Misconception: "All pills are interchangeable" and "a capsule can always be opened."
Entry: During the Don Montana MAR pass, when the learner picks up the Diltiazem ER capsule (med-diltiazem), the sim surfaces a brief specimen callout on the capsule form.
Mastery: >=80% - recognition teaching step; NOT a force-fail gate. The force-fail on this same specimen is the Critical crush rule (MA.L3-2.C).
Shot: MS Michele at the med cart; cut to a full-screen 'forms wall' of real-scale oral forms (tablet, caplet, capsule, gel cap) laid out in a row with default-handling labels.
Camera: Open eye-level medium shot for the framing line; cut to a flat top-down insert of the forms wall; slow lateral pan across the four forms as each is named.
Avatar: Michele on-camera for the hook ('look at what's actually in your hand'); voiceover over the forms-wall insert while naming each form and the swallow-whole default.
Visual: Real-scale forms wall with per-form default handling; establish the vocabulary the whole lesson (and the crush rule) depends on before any altering rule.
Animation: Each form flips to reveal its default handling ('swallow whole / may open with order / must chew / dissolves in place'); the swallow-whole default chip pulses once; 'give pills first' habit chip slides in at the end.
Infographic: Four labeled form cards - Tablet / Caplet / Capsule / Gel cap - each with a plain-language descriptor and a default-handling chip 'Swallow whole with water unless ordered otherwise'.
Real-scale 'forms wall' of four oral forms (tablet, caplet, capsule, gel cap) with per-form default-handling flip labels.
🖼 image prompt: Clean flat-vector top-down 'forms wall' of four labeled oral medication forms in a row - a round pressed-powder tablet, a capsule-shaped caplet, a two-piece powder-filled capsule, and a soft coated gel cap - each with a small caption card and a chip reading 'Swallow whole with water unless ordered otherwise'; neutral clinical palette, high legibility, synthetic props only, no real drug names, no logos. Form descriptions are [Waiver360-added] plain-language scaffolding; forms themselves [APD] Mod2 s59-60.
🎬 video prompt: Lateral pan across four oral forms; each form flips to reveal its default handling label ('swallow whole' / 'may open with order' / 'must chew' / 'dissolves in place'); the swallow-whole default chip pulses once; a 'give pills first' habit chip slides in; no new claims. [APD]+[Waiver360-added]
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Learner drags each form token from a source tray into one of N labeled buckets. Every form has exactly one correct bucket; the item is scored on all placements (passThreshold 'all' = every form in the right bucket, or an integer = at least that many correct). A misplaced form fires its placement-specific rationale (keyed on formId-in-bucketId) and routes to remediation.