Meeting ARC-PA Standards (6th edition) with Aquifer

This blog was updated June 2026 to match the 6th edition of the standards and current Aquifer cases.

The Killer B’s Updated

Meeting the requirements for accreditation is an ongoing challenge for PA programs. The program curriculum must prepare students to provide patient-centered care and to work collaboratively on interprofessional teams. Not only must the curriculum include applied medical, behavioral, and social sciences; health policy and professional practice issues; patient assessment and clinical medicine; and supervised clinical practice – it also requires a strong foundation in evidence-based medicine and health information technology.

PA curriculum must be consistent with program competencies and enable all students to meet the program’s learning outcomes. In doing all of this, PA curricula must place a heavy emphasis on the need to remain current in the face of an ever-changing clinical environment.

Currently serving close to 100 physician assistant programs (and over 150 U.S. allopathic medical schools), Aquifer is a trusted tool in health professions education. Aquifer’s teaching and learning tools can help programs of all shapes and sizes meet many of the ARC-PA Standards.

Resources & Strategies Map

Covering Hard to Teach ARC-PA Standards

The Resources and Strategies Map, created by the Aquifer PA Task Force and updated by the PA Affinity Group, displays links between difficult-to-teach ARC-PA standards and Aquifer resources.

The Resources and Strategies Map includes over 70 difficult-to-address ARC-PA topics, mapped to the relevant ARC-PA Standards and PAEA Core Competencies for New PA Graduates. The map also includes the relevant Aquifer content and suggested teaching strategies. For more information on PA resources, visit: aquifer.org/pa.

Section B: Curriculum and Instruction

B1 Curriculum

B1.01c Biomedical and Clinical Sciences

How Aquifer Helps

Integrated Illness Scripts are designed specifically to promote cognitive integration and provide a framework for learners to link basic science and clinical knowledge. Building on the traditional illness script format, Integrated Illness Scripts (IIS) embed basic science core concepts and causal mechanisms within each clinical feature and display the connections visually through Mechanism of Disease Maps. A variety of rich, fully-developed active learning sessions are available to accompany Integrated Illness Scripts to extend the learning to case-based learning or other didactic sessions.

Ready-to-use IIS Activity Cards provide simple ways to use Integrated Illness Scripts (IIS) to help students link basic science and clinical knowledge for better, safer clinical decisions. Based on proven learning theory, ready-made Activity Cards are quick and easy to drop into your classroom session or to drive discussion in clinic. Activities range from 5 minutes to 30 minutes long, with many activities including handouts like fillable Mechanism of Disease Maps. IIS Activity Cards can be assigned to students as pre-work or they can be used in class or clinic.

The Aquifer Sciences Curriculum is the first nationally-developed and publicly available curriculum that comprehensively outlines the core basic sciences concepts that must be understood and mastered by health professions learners in order to provide safe, routine patient care. The curriculum is freely available and provides an ideal tool for those undergoing curricular planning.

B1.04 Comparable and Equivalent Access to Learning

How Aquifer Helps

Aquifer cases provide comparable learning experiences across training sites, at various times of year, and when didactic instruction is conducted at geographically separate locations. This allows for educational equivalency of didactic course content and standardization of the availability of patients and key conditions in supervised clinical practice experiences (SCPEs). Students have access to cases from all didactic geographic locations and training sites, facilitating student placement in rural and community settings as well as other distance settings.

B2 Didactic Curriculum

B2.03, B2.08a & B2.08b Covering the Lifespan, Acuity & All Organ Systems

How Aquifer Helps

Aquifer courses provide practice with virtual patients at all stages, from birth, through childhood and adulthood, to end of life. With courses in Pediatrics, Family Medicine, Internal Medicine, Geriatrics, Obstetrics & Gynecology, Neurology, Palliative Care, Psychiatry, Radiology, and Trauma-Infomed Care, Aquifer covers the full continuum of care.

Several virtual patient cases address wellness and preventive care, including Family Medicine Cases 1 & 2; Pediatrics Cases 2, 3, 4, 5 & 6; Internal Medicine Cases 13 & 14; and Geriatrics Case 13. All cases provide students the opportunity to practice clinical reasoning for common medical conditions, including interpreting abnormal clinical findings, developing differential diagnoses, selecting appropriate diagnostic tests, and developing treatment plans.

Rather than providing rote, depersonalized clinical data, Aquifer virtual patients are deliberately designed to illustrate a variety of socioeconomic backgrounds in order to teach students how biopsychosocial factors interact to impact patients’ health.

The searchable content library allows faculty to filter by clinical discipline, organ system, patient age, location (i.e., emergency department, inpatient, outpatient), symptom, condition, and clinical focus (i.e., diagnosis, workup, management, etc.). This allows faculty to easily find the cases or Integrated Illness Scripts they need to fit their curriculum and to meet accreditation standards.

B2.04 Communication Skills

How Aquifer Helps

There is a wide variety of rich tools to support educators and students in this area. All Aquifer cases model communication between students, patients, preceptors, and other members of the care team.

The four modules in Aquifer Oral Presentation Skills teach the focused, problem-based inpatient case presentation given during work rounds, where brevity and clinical decision-making are prioritized. Modules have been proven to be as effective as in-person teaching.

Aquifer cases can also act as a standardized patient activity. Since faculty can easily view the details of the case, rich feedback can be provided on presentations to develop skills in students.

Write SOAP notes
Practice handoffs
Present a case as if on rounds

Many Aquifer cases include the opportunity for students to write a summary statement, which can be viewed by faculty and compared to the expert answer in the reports. To bridge the gap in providing feedback, Aquifer has developed an AI-powered system that evaluates student-submitted summary statements in our virtual patient cases. The system is a digital clinical preceptor, providing structured feedback. The AI compares the student’s statement against a validated rubric, assessing clarity, completeness, and diagnostic accuracy. It references an expert-crafted summary statement for each case, highlighting missing key details, identifying unnecessary elements, and suggesting improvements in clinical reasoning.

There are several cases that specifically focus on communicating with patients and their families around serious illness and other complex conditions:

Advance care planning (Geriatrics 27 & Palliative Care 04)
Family meetings (Palliative Care 03 uses the SPIKES framework for breaking bad news)
Use of interpretation services and the LEARN model for patient-clinician communication (Social Determinants of Health 02)
Reduced comprehension ability due to emotional triggers (Trauma-informed Care 03)

B2.05 & B3.05f Clinical Reasoning and Problem-Solving Abilities

How Aquifer Helps

Aquifer patient cases are evidence-based, peer-reviewed and include screening guidelines, risk calculators and references to supporting literature. They provide students multiple opportunities to practice evidence-based clinical problem-solving through embedded questions and to receive expert feedback on their work through answer comments and teaching points. In most cases, students practice differential diagnoses, critical thinking, and evidence appraisal. Many cases require students to synthesize the information and write a summary statement.

In many Family Medicine, Internal Medicine, and Pediatrics cases, students are asked to write out a one to three sentence summary statement that mimics the communication skills they need on rounds, calling consults, and writing patient progress notes. Writing a summary statement requires the synthesis of complex patient information, pushing the student to determine what pieces of information are important to create a differential diagnosis. This process acts as a surrogate for clinical reasoning skills, and a review of this work can be a window into the development of these skills and a useful tool for discussion and delivery of formative feedback.

Additional teaching tools, designed to accompany the cases, can enhance these skills as well, including:

The Case Analysis Tool is a structured worksheet to be completed in small groups or by students working on their own, as they work through an Aquifer case, allowing faculty to provide feedback on clinical reasoning skills.
Other active learning sessions created to accompany Aquifer cases further support this aspect of critical judgment.

B2.06 Diverse Patient Populations & Social Determinants of Health

How Aquifer Helps

Following a thorough review of all existing Aquifer cases according to our peer-reviewed and published criteria (Academic Medicine), our cases continue to be regularly reviewed based on these principles by teams of medical educators to ensure that current best practices are consistently integrated across our content library.

Aquifer’s three Social Determinants of Health (SDOH) Cases and accompanying active learning modules build a foundational understanding of SDOH and teach evidence-based strategies to help improve health outcomes and access for patients. The overview and resources module provides an understanding of how cultural beliefs and community culture affect health outcomes and strategies for improving clinician-patient interactions. The two virtual patient cases provide an opportunity for students to learn in the context of a realistic patient scenario and practice the application of the information in a safe space, working through patient and family interactions, as well as practice using the tools when caring for a patient. In addition to the SDOH cases, Pediatrics 03 defines social and structural determinants of health as well as strategies for addressing these factors within well-child visits. Geriatrics 10 addresses sexuality in older adults.

Aquifer Diagnostic Excellence cases (02 & 07) include teaching on cognitive bias, with supporting active learning sessions to drive discussions and enhance learning through sharing experiences.

Palliative Care 05 and Geriatrics 21 place a unique emphasis on spiritual assessment and support, helping students understand the difference between spirituality and religion in patient care.

B2.07 Patient Interviewing, Evaluation, Diagnosis, Management, Patient Education & Referral Across All Age Groups

How Aquifer Helps

Aquifer cases cover the full lifespan and take the time to walk learners through a complete patient encounter, from taking a history and conducting a physical exam, through diagnosis and testing, to creating a management plan. Many cases include details about follow-up visits. Aquifer’s proven pedagogy walks learners through each step of the process with in-depth explanations, asking questions that require students to apply their knowledge along the way and providing detailed answer explanations.

Aquifer cases are ideal for use in the flipped classroom format. Didactic/pre-clinical students find it helpful to go through cases together in class or small groups using the Case Analysis Tool (CAT). Similarly, students can also work on Aquifer cases in class in small groups (or solo) using the Case Debriefing Tool (CAT). Cases can be used as standardized patients to build assignments to meet your learning objectives. Cases are also ideal springboards for discussion in small groups, PBL, or TBL sessions.

The new Virtual Patient Encounters (VPE) provide students with the opportunity to build interview skills as they engage with a virtual patient. Students are encouraged to approach the conversation as they would with a real patient, asking appropriate questions to gather the clinical information needed to make decisions. Individualized, research-based feedback after the interview is complete creates a true virtual precepting experience. Feedback is designed to help students learn and improve clinical interviewing skills. Currently, this prototype is available in the following cases: Family Medicine (05 & 23), Geriatrics (03, 15 & 16), Internal Medicine (01 & 09), Neurology (11 & 13), Obstetrics/Gynecology (Gyn 02 & 03), Pediatrics (09 & 12), and Psychiatry (03 & 05).

B2.08d Psychiatric/Behavioral Conditions

How Aquifer Helps

The Psychiatry course involves a variety of teaching points and objectives that address key aspects of mental health care. Topics covered include collecting information for consultations, ensuring safety when dealing with agitated patients, starting the interview process, assessing suicide risk, and inquiring about psychosis and manic symptoms. The course emphasizes controlling the interview process and obtaining collateral information. Aquifer cases cover a broad range of psychiatric conditions including schizophrenia, schizoaffective disorder, bipolar with psychotic features, major depressive disorder with psychotic features, personality disorder, and substance-induced psychotic disorder.

B2.08e & B2.11a Palliative and End-of-Life Care

How Aquifer Helps

Foundational skills in communication, symptom management, transitions of care, and interprofessional collaborations are critical in improving the quality of life of patients with serious illnesses–but most health professions students don’t receive standardized education in these key principles of primary palliative care. Palliative Care cases can be used to help prepare learners to provide high-quality patient-centered care. Part of the Clinical Excellence Case Sets, the Palliative Care course begins with a primer on the principles of palliative care. Cases are shorter than the traditional Signature Courses (e.g., Family Medicine) ranging from 15 to 25 minutes in length and apply the principles of palliative care in clinical scenarios. Topics include advanced care planning, interprofessional roles and responsibilities in palliative care, and pharmacologic pain management, as well as death, dying and bereavement.

B2.08f Provision of Medical Care through Telehealth/Telemedicine

How Aquifer Helps

The Telemedicine course explores the principles and practices of telemedicine, focusing on the delivery of healthcare through technology at a distance. The four cases are short, ranging from 10 to 20 minutes in duration, and the course includes a primer on the principles of telemedicine.

B2.10 Interprofessional Patient-Centered Teams

How Aquifer Helps

Aquifer cases can significantly help meet accreditation standards for preparing students to work collaboratively in interprofessional, patient-centered teams. Here's how:

Holistic, Interprofessional Care:
Aquifer cases, such as those in palliative care (cases 01, 05 and 12), illustrate the importance of interprofessional teams where professionals with different training contribute to holistic, person-centered care plans. This approach ensures that all aspects of a person's needs—medical, psychological/emotional, social, and spiritual are addressed.
Understanding and Collaboration:
Students are encouraged to interact with various healthcare professionals to better understand their roles and responsibilities within the team. This interaction fosters effective communication and enables students to engage in collaborative care, which is crucial for team-based care approaches. Aquifer cases that focus heavily on this area include:
- Geriatrics 21: 70-year-old female with symptomatic end-stage COPD: An Interprofessional Case. This is designed specifically to explore interprofessional roles.
- Geriatrics 23: 70-year-old female and hazards of hospitalization: Transitions of Care and Discharge. This case focuses on planning for geriatric inpatients. It is also an excellent case for exploring the role of interprofessional teams.
Skill Set Diversity:
Cases highlight how interprofessional team members like physicians, advanced practice providers, nurses, social workers, chaplains, and therapists work together. This diversity of skills and perspectives is necessary to provide comprehensive care and enhance patient outcomes.
Patient-Centered Approach:
The creation of a unified care plan through interprofessional discussion, with input from the patient and family, is emphasized in these cases. It enables students to see firsthand the impact of collaborative, patient-centered planning and decision-making.
Principles and Coordination:
Aquifer cases underscore the principle of interprofessional collaboration and care coordination, essential in delivering patient-centered care by mobilizing services efficiently. This is particularly emphasized in palliative care settings.

These elements prepare students not just to function within interprofessional teams but to thrive, recognizing the value each team member brings to patient care.

B2.11 Social & Behavioral Sciences

How Aquifer Helps

Aquifer cases through their detailed scenarios and guidance effectively support instruction of social and behavioral sciences. Here are some key ways they contribute:

Death, dying, and bereavement cases provide students with skills to recognize common signs and symptoms of the dying process, such as changes in respiration and consciousness, and offer approaches for managing end-of-life symptoms like pain and dyspnea. They emphasize the importance of effective communication with patients and their families during the dying process. Cases underscore the need to elicit patients' and families' cultural values and practices related to end-of-life care and incorporate these into the care plan to ensure culturally sensitive practice. Students are guided in understanding normative grief and bereavement reactions, recognizing the need for bereavement resources, and determining when a specialty referral is necessary. Reflection on personal experiences with loss help students to develop self-care practices essential for handling the emotional demands of caring for dying patients. Students learn procedural tasks such as death pronouncement and the importance of expressing condolences, which are critical in providing comprehensive support to families.
Human sexuality cases provide students with experience eliciting a sexual history. They often include teachings on appropriate terminology regarding gender identity and sexual orientation, promoting linguistic inclusivity and understanding in clinical practice. Geriatrics 08 focuses on obtaining a comprehensive sexual history and includes information about sexual orientation and gender identity. The case highlights the importance of using inclusive language and being sensitive to cultural and personal factors influencing patients' comfort in disclosing their sexual histories. The case also educates students about the discrimination older LGBTQ patients might have faced, making them wary of discussing their sexuality. Students are informed about community resources that can assist LGBTQ patients, as well as legal issues such as advance directives, estate planning, and healthcare rights. This knowledge ensures a comprehensive psychosocial evaluation and support for patients.
Psychosocial effects of illness stress and injury cases highlight how socioeconomic factors, personal losses, and chronic stress can exacerbate physical symptoms and complicate health management. Students are taught to assess psychosocial stressors and implement coping strategies such as stress management techniques and engagement with supportive resources. Effective communication skills are emphasized for discussing the interactions between stress, trauma, and health with patients, using nontechnical language to ensure understanding and compliance. Emphasizing the neurobiological and behavioral impacts of stress, cases explore the impact of trauma and stress on the autonomic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis. For example, the effects of stress on childhood asthma are illustrated by how chronic stress can amplify an inflammatory response and worsen health outcomes. In the Trauma-Informed Care cases, students learn to use trauma-informed strategies to help patients manage stress and its effects.
Substance use disorders Aquifer cases incorporate a focus on both identifying and managing substance use disorders effectively. For example, Obstetrics 07 focuses on managing a patient with opioid use disorder on buprenorphine maintenance therapy during pregnancy, discussing the complexity of treating opioid use while considering the effects on both the mother and the newborn. The focus of Internal Medicine 11 is on a patient with a history of intravenous drug use and ongoing alcohol use. The case discusses hepatitis C management alongside the use of the AUDIT-C screening tool for alcohol use disorder. Internal Medicine 26 examines the psychosocial and medical complexities in managing a patient with alcohol use disorder, covering aspects like ethylene glycol toxicity and the influence of homelessness on substance accessibility.
Identification and prevention of violence cases address topics, focusing on intimate partner violence (IPV), trauma-informed care, and patient-centered strategies. Many cases include guidelines and structures for screening patients for intimate partner violence. Cases emphasize the importance of proper documentation in cases of suspected domestic abuse. They provide guidance on how to safely document abuse-related findings while maintaining patient confidentiality. Students learn to use trauma-informed, patient-centered approaches to care for patients experiencing violence and toxic stress. The role of collaborating with experts such as sexual assault nurse examiners and IPV advocates is highlighted to provide comprehensive care and minimize the retraumatization of survivors. Cases include guidance on developing safety plans and utilizing community resources.

B2.12 Instruction about Basic Counseling

How Aquifer Helps

A number of cases include learning objectives around adherence to treatment plans and the incorporation of appropriate psychosocial, cultural health literacy, and family data into the management plan. These include:

Family Medicine 06: The focus here is on counseling patients about lifestyle modifications and the importance of adhering to prescribed treatments in managing chronic conditions.
Pediatrics 03: Reviews assessing social determinants, family supports, and tailoring counseling/education to families’ needs and literacy.
Internal Medicine 08: This case emphasizes the importance of medication adherence and the role of motivational interviewing in helping patients manage their complex treatment plans.

Cases related to basic counseling aimed at helping patients modify their behaviors to adopt more healthful patterns include:

Family Medicine 01: Highlights the development of a health-promotion plan, use of motivational interviewing, weight-loss counseling, and smoking cessation strategies.
Family Medicine 02: Discusses motivational interviewing, the Five A’s and stages-of-change frameworks, and counseling on smoking cessation, diet, and exercise.
Internal Medicine 16: This case focuses on counseling strategies for weight loss, highlighting behavior modification techniques to achieve healthier lifestyle patterns.

Trauma-Informed Care cases can be used to address learning objectives around helping patients develop coping strategies. Cases highlight the use of patient-centered communication skills and motivational interviewing principles to help patients understand the adverse effects of maladaptive coping behaviors. There is a focus on how to communicate effectively with patients from diverse backgrounds. These include:

Trauma-Informed Care 05: 8-year-old with asthma
Trauma-Informed Care 08: 58-year-old with gastrointestinal symptoms

Cases that involve basic counseling focused on patient-centered and culturally sensitive approaches include:

Geriatrics 26: Applies Kleinman’s explanatory model, working with interpreters/cultural brokers, and building therapeutic alliances across cultural differences.
Trauma-Informed Care 02: Models patient-centered, trauma-informed counseling approaches that are sensitive to cultural and psychosocial context.

Additional teaching that meets these Standards is also found throughout the Aquifer Signature cases.

B2.16a, b & d Patient Safety, Prevention of Medical Errors, and Risk Management

How Aquifer Helps

Diagnostic Excellence offers six virtual patient cases (6-20 minutes each) that teach students about cognitive processes and system issues leading to diagnostic errors. The course covers foundational content on diagnosis, contributing factors, and error mitigation strategies, encouraging reflection on personal experiences. Each case includes a 60-minute classroom session with activities, discussion questions, and worksheets.

High-Value Care cases are related to risk management in several ways. These cases highlight risk management as an integral part of delivering high-value care by minimizing potential harms and optimizing resources.

Case 02: Making diagnostic testing count examines inappropriate testing risks, using statistical tools to weigh test benefits, harms, and costs, preventing false positives, unnecessary costs, and patient anxiety.
Case 05: High-value care in the inpatient setting covers managing risks from hospital-associated infections, surgical procedures, and transfusions through risk assessment and infection control.
Case 09: Redefining value at end of life addresses risks of over-screening and over-treatment in terminally ill patients by tailoring care to reduce unnecessary interventions.

B3 Clinical Curriculum

B3.01d, B3.02b, B3.03, B3.04, B3.05a, B3.05f & B3.06

How Aquifer Helps

Enhancing the Range of Clinical Encounters

According to ARC-PA, supervised clinical practice experiences (SCPEs) should include direct patient care, meet the program-defined learning outcomes, and be of sufficient breadth and depth to prepare students for the clinical practice of medicine. In addition to caring for patients, PA programs may be able to use virtual experiences, simulation, or other technology to meet some of the program-defined learning outcomes for SCPEs. (ARC-PA Compliance Manual 6th edition).

Aquifer courses and cases can be integrated into the clinical experience to enhance and supplement the student’s bedside experience. Content is derived from the core curriculum of Aquifer’s collaborating national medical educational organizations. Every Aquifer course contains cases that explore the diagnosis and treatment of common acute and chronic illnesses, as well as health maintenance visits and visits across the lifespan and in a variety of settings.

Cases are developed and maintained by teams of leading medical educators, including PAs, who collaborate with their national education organizations to build evidence-based courses that model realistic clinical experiences, preceptor interactions, and teaching. Engaged in continuous practice of their clinical reasoning skills and problem-solving abilities, students move through the stages of a patient’s presentation, assuming the role of a virtual student working with a preceptor, from eliciting the chief complaint to taking a history, performing a physical exam, composing an assessment, formulating a differential diagnosis, and on to diagnostic testing and management. Cases include results of diagnostic testing, screening and prevention guidelines, videos, audio, and images to support a complete patient encounter.

There are numerous ways to classify the spectrum of patients to be seen. With the Aquifer Content Library, it’s easy to search cases to find the content you need and assign it to students.

For example, the search and filters can cover:

Ages/developmental stages
Diagnosis
Symptom
Clinical discipline
Body system
Clinical setting/location
Clinical focus

Suggested methods for assigning cases include:

Assign strategically selected cases at the beginning of the rotation to:
- prepare students to see patients with conditions they are likely to encounter
- fill known clinical gaps
Assign cases individually throughout the clerkship, based on a review of each student’s clinical logs.
A combination of both.
Cases can also be used as part of a remediation plan for struggling learners.

Documentation Method

Student Course Reports, only accessible to people with specific administrative privileges in Aquifer’s platform, shows the detailed progress of an individual student in each case in a course, including:

The cases the student has completed, partially completed, or not yet begun
Percent of case completed
Time from case start to completion
Low time check mark if the case was completed in less than 25% of the recommended time
Additional details on the date the case was started, completed, and last accessed
Summary Statements and Expert Comments on summary statements submitted by students for cases that require them

B4 Assessment

B4.01 The program must conduct frequent, objective, and documented evaluations of student performance

How Aquifer Helps

Aquifer has a variety of tools that support formative feedback and allow identification of student deficiencies so they can be addressed in a timely manner. Many cases require students to write a summary statement, which is visible in faculty reports alongside an expert comment, providing an opportunity for faculty to provide feedback on developing clinical communication skills.

The Case Analysis Tool (CAT) is a structured worksheet to be completed by the student as they work through an Aquifer case, designed to enhance the development of clinical reasoning skills. The CAT helps students by walking them through each step of the Aquifer case and aiding in organizing their clinical reasoning and problem-solving abilities. Using it in conjunction with Aquifer cases helps students better explain their decision-making and learn to navigate clinical situations independently. The CAT can be used as a graded assignment or to provide formative feedback to students.

The Internal Medicine Clinical Decision-Making Exam (formerly the Key Features Exam) assesses students’ clinical decision-making skills. This proctored exam, validated in a 2019 study, published as "Validity Evidence for a Brief Online Key Features Examination in the Internal Medicine Clerkship," focuses on critical decisions in diagnosis and management, evaluating students' ability to prioritize diagnoses, select necessary data, and identify appropriate management for patients with undifferentiated symptoms.

Calibrate is an unproctored formative assessment designed for learning, using test-enhanced learning and spaced repetition. It promotes self-directed learning in clinical students, developing higher-order thinking and problem-solving. Calibrate offers a common tool and objective data to align students and faculty, facilitating mid-clerkship feedback. Detailed reports reveal faculty-student knowledge gaps and certainty misalignment, enabling effective coaching and structured remediation. Calibrate is available for family medicine, geriatrics, internal medicine, neurology, OB/GYN, pediatrics, and radiology, with psychiatry available as of summer 2026.

PracticeSmart is a customizable quiz builder with over 1,000 (and growing) clinically-focused questions, explanations, and certainty ratings to help students identify knowledge gaps. It promotes self-directed learning by linking questions and explanations to Aquifer's case content. It complements Aquifer Calibrate assessments and is accessible to students with subscribed content.