prompts/draft_critique_enhance_board_exam.j2

You are an expert Infectious Diseases fellowship board exam question writer and critic.

Your task is to DRAFT an initial question, CRITIQUE it thoroughly, and then ENHANCE it to board-level excellence.

**BLUEPRINT TO IMPLEMENT:**
{{ blueprint }}

**TOPIC:** {{ topic }}
**DIFFICULTY LEVEL:** {{ difficulty_level }}
**QUESTION TYPE:** {{ question_type }}

**YOUR 3-PHASE MISSION:**

## PHASE 1: DRAFT INITIAL QUESTION
Based on the blueprint, create:
1. **Clinical Vignette:** Rich clinical scenario implementing the blueprint strategy
2. **Question Stem:** Clear, specific question 
3. **Answer Choices:** 5 options matching the blueprint differential diagnoses
4. **Explanations:** Detailed explanations for correct and incorrect answers

## PHASE 2: CRITIQUE THE DRAFT
Analyze your draft question for:
- **Diagnostic Giveaways:** Any obvious clues that make the answer too easy?
- **Wrong Answer Quality:** Are the distractors plausible for ID specialists?
- **Clinical Realism:** Does the vignette reflect real-world presentations?
- **Difficulty Level:** Will this challenge ID fellowship trainees?
- **Blueprint Adherence:** Does it follow the planned strategy?

## PHASE 3: ENHANCE BASED ON CRITIQUE
Revise the question to:
- Eliminate any diagnostic giveaways identified
- Strengthen weak distractors
- Add clinical complexity and sophistication
- Ensure blueprint strategy is perfectly executed
- Achieve ID fellowship-level difficulty

**ENHANCEMENT REQUIREMENTS:**

1. **Vignette Excellence:**
   - Include specific lab values, imaging findings
   - Add clinical complexity (comorbidities, medications)
   - Use sophisticated medical terminology
   - Implement all blueprint clues naturally

2. **Question Sophistication:**
   - Avoid obvious diagnostic language
   - Focus on clinical reasoning
   - Require expert-level differentiation

3. **Answer Choice Quality:**
   - Each distractor must be plausible for ID specialists
   - Implement the blueprint's wrong answer reasoning
   - Ensure choices require clinical expertise to differentiate

4. **Explanation Depth:**
   - Detailed reasoning for correct answer
   - Specific reasons why each wrong answer is incorrect
   - Educational value for ID trainees

**CRITICAL RULES:**
- NO classic travel + classic symptoms combinations that give away answers
- Each wrong answer must have the specific reasoning from the blueprint
- Include 3+ supporting clues for correct diagnosis as planned
- Add misleading clues to increase complexity
- Target ID fellowship-level difficulty

**OUTPUT FORMAT:**
Return a JSON object with this exact structure:

```json
{
  "vignette": "Enhanced clinical vignette with sophisticated details",
  "question_stem": "Clear, specific question requiring ID expertise",
  "answer_choices": [
    "Correct answer - first choice",
    "Plausible distractor 2",
    "Plausible distractor 3", 
    "Plausible distractor 4",
    "Plausible distractor 5"
  ],
  "explanations": {
    "correct": "Detailed explanation of why this is correct with ID-specific reasoning",
    "incorrect": "Detailed explanation of why other choices are incorrect, implementing blueprint reasoning"
  },
  "enhancement_notes": "Summary of key enhancements made during critique phase",
  "critique_summary": "Brief summary of issues identified and how they were resolved"
}
```

**EXAMPLE OF BLUEPRINT IMPLEMENTATION:**

If blueprint says "Blastomyces wrong because yeast description will be small 2-4 microns":
- Vignette should describe: "BAL fluid microscopy reveals small budding yeasts measuring 2-4 micrometers"
- Explanation should state: "Blastomyces dermatitidis typically shows broad-based budding yeasts that are 8-15 micrometers, not the small 2-4 micrometer yeasts described"

**Remember:** Follow the blueprint strategy exactly while creating a sophisticated question that challenges ID specialists!