Developer Documentation

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    "name": "The New PE Classification: A to E",
    "description": "Bramwell Method microlearning activity on classifying acute pulmonary embolism using the 2026 AHA/ACC five-category system (Categories A–E).",
    "activity_type": null,
    "delivery_format": "enduring",
    "format": "bramwell",
    "delivery_style": "Case-based microlearning",
    "learning_objectives": [
      "Classify acute pulmonary embolism using the 2026 AHA/ACC five-category system.",
      "Match each category to its initial management pathway.",
      "Recognize when escalation to advanced therapy is indicated."
    ],
    "accreditation": {
      "credits": [
        {
          "id": "cme-1",
          "name": "Physician CME",
          "profession": "physician",
          "credit_type": "AMA PRA Category 1 Credit(s)™",
          "credit_type_slug": "ama-pra-cat1",
          "credit_hours": 0.25,
          "accredited_provider": "Example Joint Providership",
          "provider_statement": "This activity has been planned and implemented in accordance with the accreditation requirements and policies of the ACCME."
        }
      ],
      "total_credit_hours": 0.25,
      "accreditation_statement": "Accredited for 0.25 AMA PRA Category 1 Credit™.",
      "commercial_support": "None",
      "disclosure_summary": "All planners and faculty have disclosed no relevant financial relationships.",
      "release_date": "2026-01-01",
      "expiration_date": "2027-01-01"
    },
    "landing_page": {
      "statementOfNeed": "Acute PE classification drives management, yet the five-category system is unevenly applied.",
      "estimatedTime": "15 minutes",
      "targetAudience": [
        "Physicians",
        "Nurse Practitioners",
        "Physician Assistants",
        "Pharmacists"
      ],
      "howToEarnCredit": "Complete the microlearning, submit the evaluation, and download your certificate.",
      "hardwareSoftwareRequirements": "Modern browser with a stable internet connection."
    },
    "confidence_baseline": {
      "id": "confidence-baseline",
      "prompt": "Before you start, how confident are you in classifying acute PE severity?",
      "min": 1,
      "max": 5,
      "minLabel": "Not at all confident",
      "maxLabel": "Very confident"
    },
    "evaluation_questions": [
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        "id": "eval-overall-quality",
        "question": "The activity was:",
        "type": "single-select",
        "options": [
          "Excellent",
          "Very Good",
          "Good",
          "Fair",
          "Poor"
        ],
        "category": "satisfaction",
        "mooreLevel": 1,
        "required": true
      }
    ],
    "total_phases": 5,
    "phases": [
      {
        "id": "phase-hook",
        "title": "Meet the Patient",
        "type": "introduction",
        "required": true,
        "order": 0,
        "components": [
          {
            "id": "phase-hook-html",
            "type": "html",
            "content": "<h2>15 minutes. Four decisions.</h2><p>Meet Carlos — 55, presents with acute dyspnea, O₂ sat 93% on room air, BP 118/74. CT angiography confirms bilateral pulmonary emboli. Troponin I is elevated. Bedside echo shows RV dilation with an RV:LV ratio >0.9, but he is hemodynamically stable. Walk his workup in four decisions.</p>"
          }
        ]
      },
      {
        "id": "phase-decisions",
        "title": "Four Clinical Decisions",
        "type": "pre-assessment",
        "required": true,
        "order": 1,
        "components": [
          {
            "id": "phase-decisions-mcq",
            "type": "mcq",
            "questions": [
              {
                "id": "m1",
                "type": "multiple-choice",
                "matchId": "m1",
                "options": [
                  "Category C — elevated biomarkers/RV dysfunction, no hemodynamic failure",
                  "Category B — low risk, symptomatic",
                  "Submassive PE (legacy terminology)",
                  "Category D — incipient cardiopulmonary failure"
                ],
                "question": "Carlos, 55, acute PE, troponin elevated, RV:LV >0.9, BP 118/74. How do you classify his PE under the 2026 guideline?",
                "difficulty": "intermediate",
                "mooreLevel": 3,
                "deliveryStyle": "embedded",
                "outcomeMetric": "knowledge"
              },
              {
                "id": "d2",
                "type": "multiple-choice",
                "matchId": "d2",
                "options": [
                  "Yes — Category C requires inpatient monitoring",
                  "No — he is hemodynamically stable and can go home",
                  "Only if he fails a 6-hour observation period",
                  "Only if D-dimer exceeds 4,000 ng/mL"
                ],
                "question": "Does Carlos require hospitalization?",
                "difficulty": "intermediate",
                "mooreLevel": 3,
                "deliveryStyle": "embedded",
                "outcomeMetric": "knowledge"
              },
              {
                "id": "d3",
                "type": "multiple-choice",
                "matchId": "d3",
                "options": [
                  "DOAC (e.g., rivaroxaban or apixaban)",
                  "Warfarin with heparin bridge",
                  "Unfractionated heparin drip alone",
                  "Aspirin plus clopidogrel"
                ],
                "question": "What is the preferred anticoagulant class for Carlos?",
                "difficulty": "intermediate",
                "mooreLevel": 3,
                "deliveryStyle": "embedded",
                "outcomeMetric": "knowledge"
              },
              {
                "id": "d4",
                "type": "multiple-choice",
                "matchId": "d4",
                "options": [
                  "Yes — Class 1 recommendation for complex PE with RV dysfunction",
                  "No — PERT is only for Category E with cardiac arrest",
                  "Only after 48 hours of failed anticoagulation",
                  "Only if systemic thrombolysis is the plan"
                ],
                "question": "Should you activate PERT for Carlos?",
                "difficulty": "intermediate",
                "mooreLevel": 3,
                "deliveryStyle": "embedded",
                "outcomeMetric": "knowledge"
              }
            ]
          }
        ]
      },
      {
        "id": "phase-teach",
        "title": "What the Guideline Says",
        "type": "content",
        "required": true,
        "order": 2,
        "components": [
          {
            "id": "phase-teach-avatar",
            "type": "talking-avatar",
            "title": "Faculty walkthrough: classifying Carlos",
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            "duration_seconds": 96
          },
          {
            "id": "phase-teach-html",
            "type": "html",
            "content": "<h3>Decision 1 — Classify PE severity: Category C</h3><p>The 2026 AHA/ACC guideline introduces a <strong>five-category clinical classification</strong> that replaces the legacy massive/submassive/low-risk model [1]:</p><ul><li><strong>Category A</strong> — Asymptomatic (incidental PE): normal hemodynamics, no symptoms, negative biomarkers.</li><li><strong>Category B</strong> — Low risk: symptomatic but normal RV function, negative biomarkers.</li><li><strong>Category C</strong> — Elevated biomarkers and/or RV dysfunction <em>without</em> hemodynamic compromise.</li><li><strong>Category D</strong> — Incipient cardiopulmonary failure: hemodynamic instability not yet refractory.</li><li><strong>Category E</strong> — Cardiopulmonary failure with persistent hypotension or cardiac arrest.</li></ul><p>Carlos has elevated troponin, RV dilation (RV:LV >0.9), and stable blood pressure — he is <strong>Category C</strong> [1].</p><h3>Decision 2 — Does Carlos need hospitalization? Yes</h3><p>Category C patients require inpatient monitoring because they carry an elevated short-term risk of hemodynamic deterioration. The 2026 guideline recommends hospitalization with serial reassessment for all Category C, D, and E patients [1]. Only Category A (and select Category B) patients may be considered for early or home discharge.</p><h3>Decision 3 — Anticoagulate with a DOAC</h3><p>The 2026 guideline recommends <strong>DOACs over vitamin K antagonists</strong> for acute PE in patients without contraindications (active cancer requiring LMWH, antiphospholipid syndrome, severe renal impairment CrCl <15 mL/min) [1]. Carlos has no contraindication — start a DOAC today. Rivaroxaban (15 mg BID × 21 days, then 20 mg daily) and apixaban (10 mg BID × 7 days, then 5 mg BID) do not require heparin bridging [1].</p><h3>Decision 4 — Activate PERT for Category C with RV dysfunction</h3><p>The 2026 guideline elevates the <strong>Pulmonary Embolism Response Team (PERT) to a Class 1 recommendation</strong> for complex PE [1]. Carlos’s RV dilation and elevated troponin place him at risk of deterioration. Activating PERT brings pulmonology, interventional radiology, cardiology, and critical care to the table in real time to determine whether anticoagulation alone is sufficient or whether catheter-directed therapy should be prepared [1,3]. Over 100 medical centers participate in the National PERT Consortium, yet most U.S. hospitals still lack a formal PERT [3].</p>"
          },
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            "video_status": "pending"
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      },
      {
        "id": "phase-check",
        "title": "Confirm Your Knowledge",
        "type": "post-assessment",
        "required": true,
        "order": 3,
        "debrief_readout": {
          "title": "Before vs. after — your matched item",
          "confidenceKeys": {
            "baselineId": "confidence-baseline"
          },
          "matches": [
            {
              "matchId": "m1",
              "label": "Which category describes elevated biomarkers with stable hemodynamics?"
            }
          ]
        },
        "components": [
          {
            "id": "phase-check-mcq",
            "type": "mcq",
            "questions": [
              {
                "id": "posttest-m1",
                "type": "multiple-choice",
                "matchId": "m1",
                "options": [
                  "Category C — elevated biomarkers/RV dysfunction, no hemodynamic failure",
                  "Category B — low risk, symptomatic",
                  "Submassive PE (legacy terminology)",
                  "Category D — incipient cardiopulmonary failure"
                ],
                "question": "Carlos, 55, acute PE, troponin elevated, RV:LV >0.9, BP 118/74. How do you classify his PE under the 2026 guideline?",
                "difficulty": "intermediate",
                "mooreLevel": 3,
                "deliveryStyle": "embedded",
                "outcomeMetric": "knowledge"
              },
              {
                "id": "posttest-d2",
                "type": "multiple-choice",
                "matchId": "d2",
                "options": [
                  "Yes — Category C requires inpatient monitoring",
                  "No — he is hemodynamically stable and can go home",
                  "Only if he fails a 6-hour observation period",
                  "Only if D-dimer exceeds 4,000 ng/mL"
                ],
                "question": "Does Carlos require hospitalization?",
                "difficulty": "intermediate",
                "mooreLevel": 3,
                "deliveryStyle": "embedded",
                "outcomeMetric": "knowledge"
              },
              {
                "id": "posttest-d3",
                "type": "multiple-choice",
                "matchId": "d3",
                "options": [
                  "DOAC (e.g., rivaroxaban or apixaban)",
                  "Warfarin with heparin bridge",
                  "Unfractionated heparin drip alone",
                  "Aspirin plus clopidogrel"
                ],
                "question": "What is the preferred anticoagulant class for Carlos?",
                "difficulty": "intermediate",
                "mooreLevel": 3,
                "deliveryStyle": "embedded",
                "outcomeMetric": "knowledge"
              },
              {
                "id": "posttest-d4",
                "type": "multiple-choice",
                "matchId": "d4",
                "options": [
                  "Yes — Class 1 recommendation for complex PE with RV dysfunction",
                  "No — PERT is only for Category E with cardiac arrest",
                  "Only after 48 hours of failed anticoagulation",
                  "Only if systemic thrombolysis is the plan"
                ],
                "question": "Should you activate PERT for Carlos?",
                "difficulty": "intermediate",
                "mooreLevel": 3,
                "deliveryStyle": "embedded",
                "outcomeMetric": "knowledge"
              },
              {
                "id": "m1",
                "type": "multiple-choice",
                "matchId": "m1",
                "options": [
                  "Category B — low risk",
                  "Category C — elevated biomarkers/RV dysfunction without hemodynamic failure",
                  "Category D — incipient cardiopulmonary failure",
                  "Category E — cardiopulmonary failure"
                ],
                "question": "A 60-year-old presents with acute PE: troponin elevated, echo shows RV:LV ratio 1.0, BP 122/78. Which 2026 classification applies?",
                "badgeLabel": "MATCHED TO DECISION 1",
                "difficulty": "intermediate",
                "mooreLevel": 3,
                "outcomeMetric": "knowledge"
              }
            ]
          }
        ]
      },
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        "id": "phase-commit",
        "title": "Commit to Change",
        "type": "evaluation",
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        "order": 4,
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            "id": "phase-commit-evaluation",
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                "id": "eval-overall-quality",
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                "options": [
                  "Excellent",
                  "Very Good",
                  "Good",
                  "Fair",
                  "Poor"
                ],
                "category": "satisfaction",
                "question": "The activity was:",
                "required": true,
                "mooreLevel": 1,
                "outcomeMetric": "satisfaction",
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                  "Poor"
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                "scale": null
              },
              {
                "id": "eval-fair-balanced",
                "type": "yes-no",
                "category": "bias",
                "question": "The activity was fair and balanced:",
                "required": true,
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                "outcomeMetric": "bias",
                "response_type": "yes-no",
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              {
                "id": "eval-evidence-based",
                "type": "yes-no",
                "category": "evidence",
                "question": "The activity content was evidence based:",
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                "outcomeMetric": "evidence",
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              },
              {
                "id": "eval-disclosures-shown",
                "type": "yes-no",
                "category": "disclosure",
                "question": "The author’s relevant financial relationships (or lack thereof) were disclosed:",
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              },
              {
                "id": "eval-confidence-post",
                "max": 5,
                "min": 1,
                "step": 1,
                "type": "slider",
                "category": "confidence",
                "maxLabel": "Very confident",
                "minLabel": "Not at all confident",
                "question": "After this activity, how confident are you in classifying acute PE using the 2026 five-category system?",
                "required": true,
                "mooreLevel": 2,
                "outcomeMetric": "confidence",
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              },
              {
                "id": "commit-to-change",
                "type": "multi-select",
                "options": [
                  "Apply the A–E classification instead of massive/submassive/low-risk",
                  "Hospitalize all Category C patients with serial reassessment",
                  "Start a DOAC as first-line anticoagulation for eligible PE patients",
                  "Activate PERT for Category C patients with RV dysfunction",
                  "Establish or join a PERT at my institution",
                  "Other"
                ],
                "category": "commitment-to-change",
                "question": "Commit to change — select every action you will take for the next patient like Carlos (choose one or more):",
                "required": true,
                "mooreLevel": 3,
                "outcomeMetric": "intent",
                "response_type": "multi-select",
                "response_options": [
                  "Apply the A–E classification instead of massive/submassive/low-risk",
                  "Hospitalize all Category C patients with serial reassessment",
                  "Start a DOAC as first-line anticoagulation for eligible PE patients",
                  "Activate PERT for Category C patients with RV dysfunction",
                  "Establish or join a PERT at my institution",
                  "Other"
                ],
                "scale": null
              }
            ]
          }
        ]
      }
    ],
    "debrief": {
      "caseTakeaway": "<p>Carlos’s PE is not ‘submassive’ anymore — it’s <strong>Category C</strong>. The 2026 AHA/ACC five-category system (A–E) gives every PE a letter that maps directly to disposition, anticoagulation, and escalation. Carlos’s elevated troponin and RV dilation without hemodynamic compromise put him squarely in Category C: admit, start a DOAC, and activate PERT to decide whether anticoagulation alone is enough or catheter-directed therapy should be on standby [1].</p><h3>What to do differently for your next patient like Carlos</h3><ul><li><strong>Classify, don’t label.</strong> Replace ‘massive/submassive/low-risk’ with Categories A–E at the point of diagnosis.</li><li><strong>Hospitalize C, D, and E.</strong> Only Category A (and select Category B) patients may be considered for home or early discharge.</li><li><strong>Start DOAC first line</strong> unless the patient has active cancer, antiphospholipid syndrome, or CrCl <15 mL/min.</li><li><strong>Activate PERT early</strong> for Category C with RV dysfunction, and for all Category D and E patients.</li></ul><h3>When to escalate</h3><p>If Carlos deteriorates — falling BP, rising lactate, worsening RV function — he reclassifies to Category D. PERT should already be at the table to pivot to catheter-directed therapy or systemic thrombolysis.</p>",
      "answerKeyHtml": "",
      "nextStepsHtml": ""
    },
    "references": [
      {
        "doi": "10.1161/CIR.0000000000001415",
        "year": 2026,
        "title": "2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults",
        "number": "1",
        "authors": [
          "Defined Authorship Committee"
        ],
        "journal": "Circulation"
      },
      {
        "doi": "10.1093/eurheartj/ehz405",
        "year": 2020,
        "title": "2019 ESC Guidelines for the Diagnosis and Management of Acute Pulmonary Embolism",
        "number": "2",
        "authors": [
          "Konstantinides SV",
          "Meyer G",
          "Becattini C",
          "et al."
        ],
        "journal": "Eur Heart J"
      },
      {
        "url": "https://pertconsortium.org",
        "year": 2025,
        "title": "Pulmonary Embolism Response Team Database: 12,346 Patients Across 35 Institutions, 2015–2024",
        "number": "3",
        "authors": [
          "National PERT Consortium"
        ],
        "journal": "pertconsortium.org"
      },
      {
        "doi": "10.3389/fmed.2025.1708409",
        "year": 2025,
        "title": "Catheter-Directed Therapy for Acute Pulmonary Embolism: Evidence, Gaps, and Future Directions",
        "number": "4",
        "authors": [
          "Bikdeli B",
          "Mazzeffi MA",
          "Engstrom BI",
          "et al."
        ],
        "journal": "Front Med"
      },
      {
        "doi": "10.1016/S2213-2600(23)00093-2",
        "year": 2023,
        "title": "Chronic Thromboembolic Pulmonary Hypertension and Post-PE Syndrome",
        "number": "5",
        "authors": [
          "Klok FA",
          "Barco S",
          "Konstantinides SV"
        ],
        "journal": "Lancet Respir Med"
      }
    ],
    "series": {
      "series_id": "bramwell-2026-acute-pe-management-series-41953f",
      "name": "2026 Acute PE Management Series",
      "description": "Five 15-minute Bramwell Method microlearnings translating the landmark 2026 AHA/ACC Pulmonary Embolism Guideline — the new five-category clinical classification, safe ED discharge for asymptomatic PE, DOAC selection and dosing, the Class 1 PERT recommendation, and structured post-PE follow-up for chronic thromboembolic disease — into point-of-care decisions. Designed for emergency physicians, hospitalists, pulmonologists, NPs, PAs, and pharmacists who diagnose and manage acute PE.",
      "position": 1,
      "total": 5,
      "modules": [
        {
          "course_id": "00000000-0000-4000-8000-000000000001",
          "title": "The New PE Classification: A to E",
          "status": "available",
          "position": 1
        },
        {
          "course_id": "00000000-0000-4000-8000-000000000002",
          "title": "Category A PE: Home from the ED",
          "status": "available",
          "position": 2
        },
        {
          "course_id": "00000000-0000-4000-8000-000000000003",
          "title": "DOACs: Choosing and Dosing for Acute PE",
          "status": "available",
          "position": 3
        },
        {
          "course_id": "00000000-0000-4000-8000-000000000004",
          "title": "PERT Class 1: Building and Using Your PE Response Team",
          "status": "available",
          "position": 4
        },
        {
          "course_id": "00000000-0000-4000-8000-000000000005",
          "title": "Post-PE Syndrome: The Follow-Up Nobody Is Doing",
          "status": "available",
          "position": 5
        }
      ]
    },
    "media_expires_at": "2026-08-18T04:39:00.000Z"
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}