Before
Assessment:
Pneumonia.
Plan:
Antibiotics. Oxygen. Monitor.
Correct, and almost useless to the next clinician. It records a conclusion without the reasoning that led there, and a plan nobody can act on or escalate from.
Before your first U.S. rotation, observership or residency
Make your first U.S. clinical day feel familiar
Work real fictional patient charts, write the H&P, SOAP, or discharge note, and get attending-style feedback on your reasoning, safety, organization, and plan, all before your first impression is on the line.
2 free cases · 2 free graded notes · no credit card · fictional patients only
- H&P, SOAP & discharge notes
- Rubric feedback on 7 dimensions
- Built for your first rotation
- Fictional patients only
The hidden curriculum
Exams prepare you for questions. Rotations test your workflow.
You can know the medicine and still hesitate when the chart opens. What belongs in the HPI and what belongs in the assessment? How much ROS is too much? What does a plan need to contain before an attending trusts it? Nobody teaches that part. You are expected to already know it.
“Will my note sound U.S.-style?”
Practise the structure, phrasing, and problem-based thinking before a rotation, not during one.
“What if I miss something important?”
Feedback names the safety gaps, the missing data, and the parts of the plan that stop short.
“What will the attending think?”
See how your reasoning reads from the evaluator's side, against the same rubric every time.
“I know the medicine. The workflow is different.”
Rehearse chart review, documentation, orders, and reconciliation in one continuous loop.
If you have never written a U.S.-style H&P before, you are not behind. You just need somewhere safe to learn the structure before you are standing in front of a team.
How it works
Review the chart. Write the note. Get attending-style feedback.
The same loop you will run on a real service, minus the consequences of getting it wrong the first time.
Review the chart
Vitals and trends, problem list, home medications, allergies, labs with high/low flags, imaging, prior notes, and the care team, laid out the way a real EHR lays them out.
Write the note
Chief complaint, HPI, ROS, PMH, exam, labs, assessment, and plan. Dot-phrase scaffolds give you the skeleton; the reasoning has to be yours.
Get attending-style feedback
Scored against the case's rubric, with the specific elements you missed, the safety concerns you left open, rewrite suggestions, and an ideal note to compare against.
Chest Pain Admission · H&P
Fictional patientJames T. · 58 male · Chest pain for 2 hours
HR
96
BP
148/92
SpO2
97%
Troponin I: 0.08 ng/mL (high)
ECG: 1mm ST depression, V4-V6
HPI: Substernal chest pressure, radiates to left arm, diaphoresis...
Every note is graded on the same 7 dimensions
- Completeness
- Organization
- Clinical Reasoning
- Assessment & Plan Quality
- Documentation Style
- Case Fact Alignment
- Safety
You see the score for each one, not a single number. Replay the case and the same rubric tells you whether you actually improved.
What changes
Strong notes are not longer. They are clearer.
The same fictional pneumonia admission, documented two ways.
After
Assessment:
Community-acquired pneumonia with mild hypoxia, supported by fever, productive cough, leukocytosis, and right lower-lobe infiltrate. Currently hemodynamically stable without shock physiology.
Plan:
Start antibiotics per local protocol, continue oxygen and wean as tolerated, trend respiratory status and WBC, follow cultures if obtained, and reassess for worsening hypoxia, hypotension, confusion, or persistent fever.
Same diagnosis. Now it shows what the evidence was, what the patient is not, and what would change the plan, so the next clinician can pick it up.
The goal is not a longer note. It is a note that shows clinical reasoning and can guide whoever reads it next.
What you practise
The notes you are actually expected to write.
A growing library of fictional internal medicine cases, across the three documentation types you will be handed first.
H&P
Build the full patient story, differential, problem list, and initial inpatient plan.
SOAP
Show what changed overnight, interpret the trend, and write today's problem-based plan.
Discharge Summary
Summarise the hospital course, medication changes, pending results, follow-up, and return precautions.
Clinic follow-up, consult, and ED decision-making notes are taught in the Learning Hub today; simulation cases for them are not built yet.
You are not the only one
Nobody is born knowing how a U.S. chart is supposed to be filled in.
Plenty of people know the medicine and have still never been shown how a U.S. team expects a note to be structured. These are the concerns we hear most.
Representative concerns, not user testimonials. We will publish real quotes once learners give permission.
“I had studied for exams for years, but nobody actually taught me how to write a U.S.-style H&P.”
The structure is a skill you can learn separately from the medicine.
“I did not know what belonged in the HPI versus the assessment.”
Feedback that names the section, not just the mistake, makes the boundary obvious.
“I knew the diagnosis. I did not know how to make my note sound clinically organized.”
Comparing against an ideal note shows the gap faster than being told about it.
“I matched, but I was still worried about day one.”
Opening a chart and starting a note stops being the unfamiliar part.
“Clerkships start in three weeks and I have never written a real note.”
The structure can be practised before anyone is watching you do it.
Learning Hub
Learn the note. Then prove it in simulation.
A growing curriculum on the anatomy of strong U.S. documentation: how to write a concise HPI, summarise labs without dumping data, build an assessment that shows reasoning, and write a plan that is specific and safe.
Foundations
What a U.S. note is for, and who actually reads it
Note Sections
HPI, ROS, exam, labs, assessment and plan, one at a time
Note Types
H&P, SOAP, discharge, consult, clinic and ED
Clinical Reasoning
Turning findings into an assessment you can defend
Common Mistakes
The errors attendings flag most, and why
Before/After Notes
The same note written weakly and well, side by side
Rubric & Scoring
How your note is judged, before it is judged
Practice Drills
Short exercises on one section at a time
Why this matters
Residency readiness is more than exam scores.
Exams and certification open doors. Clinical performance is how you walk through them. Once you are on a U.S. service, people notice how you gather information, document it, reason about it, communicate it, and respond when someone corrects you.
ECFMG certification is central to how IMG qualifications are evaluated for entry into U.S. graduate medical education.
ECFMGThe AAMC's Core Entrustable Professional Activities, the tasks expected of a new resident on day one, include documenting a clinical encounter in the patient record.
AAMCProgram directors weigh more than exam scores. Ranking decisions also draw on interpersonal skills, interview interactions, and feedback from residents who worked with you.
NRMP
To be clear about what this is not. This platform does not guarantee interviews, letters, rank position, or Match outcomes, and it is not endorsed by or affiliated with any of the organizations above. It gives you a place to practise clinical documentation and workflow, the skills that matter during U.S. clinical training.
Questions
The things people ask before signing up.
- Is this a real EMR?
- No. It is an educational simulation using entirely fictional patients. It is not a medical device, not an electronic health record, and not for real patient care.
- Can I enter real patient information?
- Never. Submissions are screened for likely real-patient information and blocked when the screen is confident, but the rule stands regardless of the screen: fictional patients only.
- Will this guarantee residency or interviews?
- No. It is practice for documentation and clinical workflow. Anyone promising you a Match outcome is selling you something they cannot deliver.
- Who is this for?
- It was built for IMGs preparing for USCE, observerships, externships, residency or fellowship, and that is still the audience it fits best. It works just as well for a U.S. medical student before clerkships, or any incoming intern who wants the documentation workflow to be familiar rather than new.
- What feedback do I actually get?
- A score on each rubric dimension with the reasoning behind it, the specific elements you left out, safety concerns graded by severity, section-level rewrite suggestions, and an ideal note to compare against.
- Is a real attending reading my note?
- No. The feedback is generated by an AI model grading your note against the rubric written for that specific case, then set beside an ideal note authored for it. "Attending-style" describes the rubric and the tone, not a human reviewer. It is a learning aid, and like any model it can be incomplete or wrong.
- What if I am early in my preparation?
- Start with a Level 1 case and the Learning Hub foundations. The Level 1 cases exist to teach the shape of the note before the medicine gets complicated.
- What if I already have clinical experience?
- Go straight to Level 2 and 3, where the patient is unstable or the diagnosis is genuinely uncertain, and use replays to push your rubric scores up.
- Does this replace real U.S. clinical experience?
- No, and it is not meant to. It helps you arrive at that experience already knowing the workflow.
Walk into your next rotation with the workflow already practised.
Open a fictional patient chart, write the note, and get feedback while the stakes are still imaginary.
Try a free simulationNo credit card. Fictional patients only.