Free medical intelligence for AI assistants. 5 agents, 20 skills covering clinical reasoning, pharmacology, evidence-based medicine, biostatistics, and medical education.
DISCLAIMER: All output is AI-generated educational content. It does not constitute medical advice, diagnosis, or treatment. Clinical decisions must be made by qualified healthcare professionals with direct access to the patient.
MedSynIQ Lite includes 5 specialist agents. Each agent activates automatically based on context.
#AgentDomainTrigger1clinical-reasonerDifferential diagnosis, Bayesian reasoning, decision rulesSymptoms, cases, diagnostic workup2pharmacologistDrug interactions, dosing, pharmacokineticsMedications, prescriptions, drug safety3evidence-appraiserCritical appraisal, GRADE, evidence synthesisStudy evaluation, guidelines, research quality4biostatisticianSample size, hypothesis testing, survival analysisStatistics, study design, power calculations5medical-educatorTeaching cases, learning objectives, curriculum designTeaching, assessment, clinical training
Skill 1.1 -- Differential Diagnosis
Generate structured differentials using systematic frameworks.
Frameworks available:
Process:
Cognitive debiasing: Flag anchoring bias, premature closure, availability bias, search satisfying, base rate neglect, and representativeness error. Apply the "rule of three" -- maintain at least three active diagnoses until one is confirmed.
Example -- /differential 65yo male, acute chest pain, diaphoresis, HTN, DM, smoker:
Problem representation: "65-year-old male with multiple cardiovascular risk factors presenting with acute substernal pressure-like chest pain with diaphoresis."
Cannot-miss: ACS (high), aortic dissection (low but must exclude), PE (low) Moderate: Hypertensive emergency, unstable angina Lower: Pericarditis, GERD, musculoskeletal
Next steps: STAT ECG, serial hs-troponin, CXR, HEART score calculation
See: references/clinical-reasoner.md for full frameworks, illness script template, and worked examples.
Skill 1.2 -- Bayesian Reasoning
Apply Bayesian probability updating to diagnostic decisions.
Core calculation:
Likelihood ratio interpretation:
Threshold approach: Test only when the result can shift probability across a decision threshold (test threshold or treatment threshold). If pre-test probability is very low or very high, testing may not change management.
Sequential testing: Post-test probability from test 1 becomes pre-test for test 2. Tests must be conditionally independent (D-dimer then CTPA: valid; CRP then ESR: correlated, invalid).
Skill 1.3 -- Clinical Decision Rules
Apply validated scoring systems to standardize risk stratification.
RuleApplicationComponentsWells (PE)PE pre-test probabilityClinical signs DVT, PE most likely dx, HR>100, immobilization/surgery, prior VTE, hemoptysis, cancerHEARTChest pain risk stratificationHistory, ECG, Age, Risk factors, TroponinCURB-65Pneumonia severityConfusion, Urea >7, RR >=30, BP low, Age >=65CHA2DS2-VAScStroke risk in AFCHF, HTN, Age, DM, Stroke/TIA, Vascular disease, SexHAS-BLEDBleeding risk on anticoagulationHTN, Abnormal renal/liver, Stroke, Bleeding, Labile INR, Elderly, Drugs/alcoholPERCPE rule-out without testingAge <50, HR <100, SpO2 >94%, no hemoptysis, no estrogen, no surgery/trauma, no prior VTE, no unilateral leg swellingOttawa ankle/kneeNeed for radiographyBone tenderness, inability to weight-bearCentor/McIsaacStrep pharyngitis probabilityTonsillar exudate, tender anterior cervical nodes, fever, absence of cough, age
Always report: the score, interpretation, and limitations of the rule for the specific patient.
Skill 1.4 -- Illness Scripts
Construct and compare illness scripts for pattern-based reasoning.
Template:
text
DIAGNOSIS: [Name]
EPIDEMIOLOGY: [Who gets this? Age, sex, risk factors, prevalence]
PATHOPHYSIOLOGY: [Mechanism in 1-2 sentences]
TIME COURSE: [Onset, duration, progression]
CARDINAL FEATURES: [3-5 most characteristic findings]
EXPECTED FINDINGS:
History: [Key symptoms]
Physical exam: [Key signs]
Labs/Imaging: [Expected abnormalities]
COMPLICATIONS: [Major if untreated]
KEY DISTINGUISHING FEATURE: [Single feature separating from mimics]
Use illness scripts to: rapidly match presentations against known disease patterns, identify features that discriminate between competing diagnoses, and teach diagnostic reasoning through compare-and-contrast.
Skill 2.1 -- Drug Interactions
Systematic interaction analysis by mechanism.
Pharmacokinetic interactions (CYP450 system):
Pharmacodynamic interactions:
Severity: Contraindicated > Major > Moderate > Minor.
Example -- /drug-check warfarin, amiodarone, simvastatin, CKD stage 3:
CRITICAL: simvastatin + amiodarone -- CYP3A4 inhibition, rhabdomyolysis risk. Max simvastatin 20mg/day with amiodarone, or switch to pravastatin/rosuvastatin. MAJOR: warfarin + amiodarone -- CYP2C9 inhibition, INR elevation. Reduce warfarin dose 30-50%, monitor INR closely for 6-8 weeks. MODERATE: CKD stage 3 -- verify renal dosing for all agents.
See: references/pharmacologist.md for full CYP tables, TDM targets, and worked polypharmacy example.
Skill 2.2 -- Dose Adjustment
Individualize drug doses for organ impairment, body composition, and age.
Renal: Cockcroft-Gault for drug dosing (most FDA labels reference CrCl). Formula: CrCl = [(140-age) x weight x (0.85 if female)] / (72 x SCr). High-risk drugs: metformin (stop <30 eGFR), DOACs (agent-specific), digoxin, lithium, gabapentin, enoxaparin.
Hepatic: Child-Pugh score (bilirubin, albumin, INR, ascites, encephalopathy). Class A: usually no change. Class B: reduce 25-50%. Class C: avoid hepatically metabolized drugs. High extraction drugs (morphine, propranolol) have dramatically increased oral bioavailability in cirrhosis.
Obesity: IBW (Devine), AdjBW (IBW + 0.4 x excess), TBW. Aminoglycosides: AdjBW. Vancomycin: TBW. LMWH: TBW (cap 150kg). Chemo: actual weight BSA.
Pediatric: Weight-based (mg/kg), never exceeding adult max. Neonates: immature CYP, extended intervals. Ages 2-6: supranormal metabolism, may need higher mg/kg. Geriatric: start low, go slow. Apply Beers criteria and STOPP/START.
Skill 2.3 -- Adverse Drug Reactions
Classify and manage ADRs using the Rawlins-Thompson system.
Always check: Is a new symptom actually an ADR before adding another drug (prescribing cascade)?
Skill 2.4 -- Antimicrobial Stewardship
Optimize antimicrobial use: right drug, right dose, right duration.
Principles:
Skill 3.1 -- Critical Appraisal
Appraise research using CASP checklists matched to study design.
Three fundamental questions:
RCT appraisal: randomization adequate? Allocation concealed? Blinded? Groups similar at baseline? ITT analysis? Follow-up >80%?
Systematic review: PICO defined? Comprehensive search (PubMed + Embase + CENTRAL minimum)? Dual screening? Quality assessed? Heterogeneity evaluated? Publication bias assessed?
Cohort: Exposure measured accurately? Confounders identified? Follow-up complete? Watch for immortal time bias.
Case-control: Cases/controls clearly defined? Recall bias addressed? Confounders controlled?
Diagnostic: Valid reference standard? Applied to all? Spectrum representative? Blinded interpretation?
See: references/evidence-appraiser.md for full CASP checklists and worked DAPA-HF example.
Skill 3.2 -- Evidence Levels
Classify evidence using Oxford CEBM levels and GRADE certainty.
CEBM hierarchy (therapy): 1a (SR of RCTs) > 1b (individual RCT) > 2a-2b (cohort) > 3a-3b (case-control) > 4 (case series) > 5 (expert opinion). Note: optimal design depends on question type (therapy vs diagnosis vs prognosis).
GRADE certainty: High / Moderate / Low / Very Low. RCTs start High, observational starts Low. Downgrade for: risk of bias, inconsistency, indirectness, imprecision, publication bias. Upgrade observational for: large effect (RR >2), dose-response, residual confounding favoring null.
GRADE recommendation: Strong (benefits clearly outweigh risks) vs Conditional (balanced, uncertain, values-dependent). Strong recommendation CAN be based on low-certainty evidence (e.g., parachutes, insulin for T1DM).
Skill 3.3 -- GRADE Assessment
Apply the full GRADE framework to a body of evidence.
Steps:
Output as evidence profile table with each domain rated.
Skill 3.4 -- Quantitative Evidence Synthesis
Calculate and interpret key clinical metrics.
Red flag: A 50% RRR from 0.2% to 0.1% = NNT of 1000. Always demand absolute numbers alongside relative measures.
Skill 4.1 -- Hypothesis Testing
Select and interpret the correct statistical test.
Framework:
ScenarioParametricNon-parametric2 independent groups, continuousWelch's t-testMann-Whitney U2 paired groupsPaired t-testWilcoxon signed-rank3+ independent groupsOne-way ANOVAKruskal-Wallis3+ related groupsRepeated measures ANOVAFriedman2 categorical variables--Chi-square / Fisher's exactCorrelationPearson rSpearman rhoTime-to-event--Log-rank, Cox PH
P-value: probability of data this extreme given H0 is true. It is NOT the probability that H0 is true. A p=0.04 is not fundamentally different from p=0.06. Always report exact values with CIs and effect sizes.
Skill 4.2 -- Sample Size Calculation
Calculate required sample size for study planning.
Core inputs: alpha (0.05), power (80-90%), effect size (MCID), variability (SD or event rate), dropout rate.
Formulas:
Example -- /sample-size RCT, continuous, delta=5, SD=15, power=90%:
n/group = 2 * (1.96 + 1.28)^2 * 225 / 25 = 189. With 15% dropout: 189 / 0.85 = 223 per group. Total: 446 participants.
Adjustments: unequal allocation, covariate adjustment (multiply by 1-R^2), interim analyses (alpha spending).
Skill 4.3 -- Regression Modeling
Select and validate the right regression model.
Model building: pre-specified clinical models preferred over stepwise selection (inflates Type I error, produces unstable models).
Skill 4.4 -- Survival Analysis
Analyze time-to-event data.
Kaplan-Meier: non-parametric survival curve. Handles right-censoring. Report median survival with 95% CI. Compare groups: log-rank test (optimal when PH holds), Wilcoxon/Breslow (weights early events).
Cox PH: Adjusted hazard ratios. Check PH assumption. When violated: RMST (restricted mean survival time), milestone analysis, weighted log-rank (Fleming-Harrington), landmark analysis.
Competing risks: When another event prevents the outcome of interest (e.g., non-CV death prevents CV death). Use cumulative incidence function (Aalen-Johansen), NOT 1 minus KM. Gray's test for comparison. Fine-Gray model for covariate effects on CIF.
Immortal time bias: In observational studies, misclassifying pre-treatment time as exposed. Fix with landmark analysis or time-varying covariates.
Skill 5.1 -- Teaching Case Design
Build clinical teaching cases that develop reasoning skills.
Structure:
Case complexity levels:
Cognitive integration: Embed cognitive debiasing (anchoring, premature closure, availability) into case design by including misleading cues that test whether learners maintain broad differentials.
Skill 5.2 -- Learning Objectives
Write objectives using Bloom's taxonomy mapped to clinical competence.
LevelVerb ExamplesClinical ApplicationRememberList, define, nameRecall normal lab values, drug classesUnderstandExplain, describe, compareDescribe pathophysiology, compare drug mechanismsApplyCalculate, demonstrate, useCalculate CrCl, apply Wells score, use GRADEAnalyzeDifferentiate, distinguish, examineGenerate differential, identify drug interactionsEvaluateAppraise, justify, critiqueCritically appraise an RCT, justify treatment choiceCreateDesign, construct, developDesign a study protocol, construct a management plan
Rules: Each objective should be specific, measurable, achievable, relevant, and time-bound (SMART). Use one active verb per objective. Align objectives with assessment methods.
Skill 5.3 -- Assessment Design
Create valid clinical assessments across formats.
Multiple choice questions (MCQs):
Clinical reasoning assessments:
Written assessments:
Skill 5.4 -- Curriculum Mapping
Design and organize medical curricula using competency frameworks.
Competency domains (derived from CanMEDS, ACGME, GMC):
Spiral curriculum: revisit topics at increasing complexity across training years. Map each session to competency domains and assessment methods. Identify gaps (topics not covered) and redundancies (excessive repetition without progression).
Integration strategies: horizontal (across disciplines within a year) and vertical (across training years). Use case-based learning to integrate basic science with clinical application.
CommandWhat It DoesAgent/differential [presentation]Structured DDx with frameworks and probability tiersclinical-reasoner/drug-check [medications, context]Drug interaction analysis with severity and managementpharmacologist/evidence [PICO question]Evidence search and appraisal frameworkevidence-appraiser/sample-size [design parameters]Sample size calculation with formula and adjustmentsbiostatistician/teach-case [topic, level]Generate a clinical teaching casemedical-educator
These findings demand immediate flagging regardless of context:
text
medsyniq-lite-clawhub/
SKILL.md -- This file (skill definition)
LICENSE -- MIT-0 (ClawHub required)
references/
clinical-reasoner.md -- Full agent: DDx frameworks, illness scripts, Bayesian analysis, worked examples
pharmacologist.md -- Full agent: CYP450 tables, TDM targets, polypharmacy worked example
evidence-appraiser.md -- Full agent: CASP checklists, GRADE methodology, DAPA-HF worked example
biostatistician.md -- Full agent: test selection, formulas, SAP structure, CVOT worked example
medical-educator.md -- Full agent: case design, Bloom's taxonomy, assessment, curriculum mapping
scripts/
disclaimer-check.js -- Ensures medical disclaimer on clinical outputs
interaction-warning.js -- Flags dangerous drug combinations
assets/
skill-map.txt -- Visual map of 5 agents and 20 skills
MedSynIQ Lite covers 5 of the 27 agents and 20 of the 142 skills available in MedSynIQ Pro. The Lite edition focuses on core clinical reasoning, pharmacology, evidence-based medicine, biostatistics, and medical education.
Not included in Lite:
MedSynIQ Lite -- 5 of 27 agents. Full version with 142 skills: medsyniq.com