GPT-5.6 semantic review via Codex Agent Skill

Evidence-grounded review beyond deterministic rules.

This static artifact was generated from one fictional interview, then runtime-validated against the source bundle and strict cross-reference rules. It proposes review actions, never autonomous production changes.

Findings

6

Hypotheses

2

Regression cases

4

Metadata

Reproducible review artifact

Reviewsemantic-demo-shoulder-001-gpt56-sol
Sessiondemo-shoulder-001
Engine / modegpt-5.6 / codex-agent-skill
Generated2026-07-19T22:50:56Z
Sourcesrc/fixtures/shoulder-instability-baseline.json
Schema / safety1.0.0 / 1.0.0

Approval gate

Human review is mandatory

Root causes are candidates, not established causes. Every proposed change has requiresHumanApproval: true. This workflow does not diagnose, recommend treatment, or change a production planner.

Errors

1

Warnings

4

Info

1

Semantic findings

Missed information, multi-domain answers, and contradictions

Evidence excerpts are copied from source turns and retain their patient, planner, or system role.

warningmissed extraction

Patient-stated movement and activity limits are absent from canonical references

The fictional patient reports specific aggravating movements and activity modifications. Planner state records related keys, but the canonical reference collection preserves neither detail, so downstream review cannot trace those statements through the normalized artifact.

"Reaching back, throwing, and fast overhead moves make it worse."

t4 / patient / This patient-stated aggravating-movement detail has no corresponding canonical reference.

"I stopped dynamic routes and I avoid lifting a heavy backpack with that arm."

t14 / patient / This patient-stated functional modification has no corresponding canonical reference.

Confidence: high

Uncertainty: The planner trace lists aggravating_movements and activity_modifications, so the loss may occur during canonical persistence or fixture assembly rather than initial answer extraction.

Review action: Compare answer-extraction output, normalization output, and persisted canonical references for turns t4 and t14.

Questions: q_pain_location, q_function

infomulti domain answer

Opening answer supplies information across several domains

The response to the mechanism-and-onset question also supplies pain-location, symptom-pattern, and instability-trigger information. A pipeline that extracts only the prompted domain could discard useful patient-stated content.

"I felt it slip while reaching for a high hold about six weeks ago."

t2 / patient / This sentence contains both event mechanism and onset timing.

"Since then the front of the shoulder aches and I get a loose feeling when I reach overhead."

t2 / patient / This sentence adds pain location, symptom character, and an overhead instability trigger.

Confidence: high

Uncertainty: The fixture does not expose the extractor's intermediate output, so it cannot establish whether all domains were recognized before normalization.

Review action: Verify that extraction is answer-wide and can emit multiple domain candidates from one response.

Questions: q_mechanism_onset

warningunresolved contradiction

Neurological symptom statements remain unreconciled

The fictional patient first denies numbness and later reports tingling. Numbness and tingling are not identical, so this is not proof of a factual contradiction, but the wording 'Actually' signals a meaningful correction or distinction that the interview never resolves.

"I still have not had any numbness."

t6 / patient / This is the earlier patient-stated neurological denial.

"Actually I do get tingling into my ring and little finger after long sessions."

t8 / patient / This later patient statement introduces a neurological symptom without clarifying its relationship to the earlier denial.

Confidence: high

Uncertainty: The two symptom terms can coexist; the unresolved issue is whether the later statement corrects, narrows, or supplements the earlier one.

Review action: Have a human reviewer assess whether the planner should ask a neutral clarification that distinguishes numbness from tingling and records timing.

Questions: q_mechanism_onset, q_neuro

warningsemantic repetition

Mechanism is requested again after a detailed answer

The later clarification asks for the mechanism again even though the opening answer already supplies the slip event and timing. The repeat adds no new mechanism detail and consumes an interview turn.

"What happened to your shoulder, and when did it start?"

t1 / planner / This is the original mechanism-and-onset request.

"I felt it slip while reaching for a high hold about six weeks ago."

t2 / patient / The response directly supplies the requested mechanism and timing.

"Describe the mechanism again so I can confirm it."

t5 / planner / This later prompt semantically repeats the already answered request.

Confidence: high

Uncertainty: A confirmation might be justified if extraction confidence were low, but the trace provides no uncertainty-based reason and already lists both target references.

Review action: Review the clarification rule and require a specific unresolved field or confidence threshold before repeating covered content.

Questions: q_mechanism_onset

errorhypothesis overreach

Second initial hypothesis claims certainty without evidence

The initial statement labels the issue definitely simple overuse and says no clarification is needed, while citing no evidence. Patient statements instead include a discrete slip event, a later neurological symptom, and a clunk, all of which make that certainty unsupported by this interview.

"I felt it slip while reaching for a high hold about six weeks ago."

t2 / patient / This patient-stated discrete event limits a definitive simple-overuse interpretation.

"Actually I do get tingling into my ring and little finger after long sessions."

t8 / patient / This later symptom is unresolved and contradicts the claim that no clarification is needed.

"No locking, but it sometimes clunks."

t10 / patient / This additional patient-stated feature is not accounted for by the absolute hypothesis.

Confidence: high

Uncertainty: Interview text alone cannot establish or exclude an overuse contribution; the failure is the hypothesis's certainty and lack of evidence, not a competing diagnosis.

Review action: Require evidence-linked, probabilistic hypothesis language and block claims that further clarification is unnecessary when unresolved statements remain.

Questions: q_mechanism_onset, q_neuro, q_locking

warningmissed clarification

The interview moves on without clarifying the neurological inconsistency

After the later tingling report, the next planner turn changes to locking and catching. The interview never asks whether tingling differs from the earlier numbness denial or records its onset and frequency.

"I still have not had any numbness."

t6 / patient / This earlier statement establishes the ambiguity that later needs clarification.

"Actually I do get tingling into my ring and little finger after long sessions."

t8 / patient / This response introduces the unresolved distinction.

"Any locking or catching?"

t9 / planner / The next planner action changes domains instead of clarifying the prior answer.

Confidence: high

Uncertainty: The fixture does not expose a deliberate policy exception that would explain deferring clarification.

Review action: Review whether unresolved contradiction state should take priority over advancing to the next domain.

Questions: q_neuro, q_locking

Hypothesis review

Original claims recalibrated against transcript evidence

Revisions remain provisional interpretations and do not assert diagnosis or causation.

h1partially supported

Original

The pattern may reflect load-sensitive shoulder instability features.

Revised

The transcript contains patient-reported looseness with overhead loading after a climbing slip event, which may be compatible with load-sensitive instability features; the interview alone does not establish an underlying cause.

Several patient statements support the provisional feature description, but recurrence and corroborating evidence are missing and the neurological statement remains unresolved.

Supporting evidence

"I felt it slip while reaching for a high hold about six weeks ago."

t2 / patient / The patient reports a slip event during loading.

"I get a loose feeling when I reach overhead."

t2 / patient / The patient reports a load-position-associated loose feeling.

"I stopped dynamic routes and I avoid lifting a heavy backpack with that arm."

t14 / patient / The patient reports activity changes associated with the symptoms.

Limiting evidence

"Actually I do get tingling into my ring and little finger after long sessions."

t8 / patient / This unresolved additional symptom means the transcript does not support a single-factor interpretation.

Missing information

  • Whether similar slip or loose-feeling episodes occurred before or after the reported event.
  • Whether the loose feeling and pain always occur together.
  • Any corroborating examination or other evidence outside this fictional interview.

Revised confidence: moderate

h2contradicted

Original

The issue is definitely a simple overuse flare with no need for further clarification.

Revised

A load-related contribution remains possible, but the transcript is insufficient to characterize the issue as simple or definitive and contains statements that warrant clarification.

The original hypothesis cites no evidence, uses absolute language, and is directly at odds with unresolved patient-stated information that requires follow-up.

Supporting evidence

"after long sessions"

t8 / patient / This timing could be consistent with a load-related contribution, but it does not support certainty or simplicity.

Limiting evidence

"I felt it slip while reaching for a high hold about six weeks ago."

t2 / patient / A discrete reported event conflicts with presenting the pattern as definitely a simple overuse flare.

"Actually I do get tingling into my ring and little finger after long sessions."

t8 / patient / The later statement creates an explicit need for clarification.

"No locking, but it sometimes clunks."

t10 / patient / This additional feature is not explained by the original hypothesis.

Missing information

  • Evidence distinguishing cumulative-load effects from effects associated with the reported slip event.
  • Clarification of the relationship between numbness and tingling statements.
  • Evidence supporting the claim that no further clarification is needed.

Revised confidence: low

Root-cause candidates

Probable pipeline locations

Each candidate includes uncertainty and a verification step; none is presented as proven.

moderate confidence

canonical normalization

Planner state includes aggravating_movements and activity_modifications after the relevant answers, but the final canonical reference collection omits them. This suggests possible loss between extraction/state tracking and canonical persistence, although fixture assembly could produce the same pattern.

Evidence turns: t4, t14

Verify: Replay turns t4 and t14 while logging extractor candidates, normalized refs, and persisted canonical refs at each boundary.

high confidence

planner rule

The trace says the mechanism is being confirmed even though mechanism and onset_timing are already present before t5, making the clarification-selection rule a probable source of repetition.

Evidence turns: t1, t2, t5

Verify: Run the planner against the pre-t5 state and inspect which unresolved-field or confidence predicate allowed q_mechanism_onset to be selected again.

moderate confidence

coverage tracking

The later tingling statement is stored as neuro_symptoms, but the transcript shows no state representing its tension with the earlier denial. A coverage model that treats any populated key as resolved may prevent clarification.

Evidence turns: t6, t8, t9

Verify: Inspect whether extraction can represent conflicting or qualification-needed values and whether unresolved state affects planner priority.

high confidence

analysis generation

Hypothesis h2 has no evidence links yet uses definitive language and dismisses clarification despite unresolved transcript content, pointing to missing evidence and calibration constraints in analysis generation.

Evidence turns: t2, t8, t10

Verify: Regenerate analysis from the same bundle with evidence-link and uncertainty checks enabled, then compare whether unsupported absolute claims are rejected.

System improvements

Minimal proposals behind an approval gate

Acceptance criteria and regression risks make each proposal reviewable before implementation.

Human approval required

ip-preserve-multi-domain-extractions

Patient-stated information represented in answers or planner state can be absent from persisted canonical references.

Proposed change: Preserve every supported answer-level extraction candidate through normalization and record its source turn, while allowing multiple domain candidates from one answer.

Acceptance

  • Turns t2, t4, and t14 can each emit all supported domain candidates without overwriting another candidate.
  • Every persisted candidate retains at least one real source turn ID.
  • Unsupported candidates are not introduced.

Regression risks

  • Broad extraction could increase false-positive references.
  • Duplicate semantic values could be persisted under multiple keys.

Required tests

  • Multi-domain answer extraction test based on t2.
  • Canonical persistence test based on t4 and t14.
  • Negative test ensuring absent information is not created.
Human approval required

ip-gate-repeated-covered-questions

A question can be repeated after all of its target references are already populated without a specific unresolved reason.

Proposed change: Require a named unresolved field, conflict, or below-threshold extraction confidence before selecting a question whose targets are already covered.

Acceptance

  • The pre-t5 state does not select q_mechanism_onset without a recorded unresolved reason.
  • A genuine low-confidence or conflicting mechanism value can still trigger a focused clarification.

Regression risks

  • An overly strict gate could suppress useful confirmation when extraction confidence is genuinely low.

Required tests

  • Covered-target repetition test using t1 through t5.
  • Low-confidence exception test with an explicit unresolved field.
Human approval required

ip-track-and-prioritize-unresolved-conflicts

A populated neurological reference is treated as covered even when two patient statements remain semantically unreconciled.

Proposed change: Represent conflicting or qualification-needed extractions as unresolved state and let the planner select one neutral, focused clarification before advancing domains.

Acceptance

  • The t6/t8 pattern creates unresolved neurological state rather than silently replacing one statement.
  • The next planner action can ask a neutral distinction question without asserting that the statements are mutually exclusive.
  • The state resolves only after a patient response or explicit human disposition.

Regression risks

  • Benign distinctions could be over-classified as contradictions.
  • Clarification loops could occur without a one-attempt limit.

Required tests

  • Numbness-versus-tingling unresolved-state test based on t6 and t8.
  • Non-conflicting symptom distinction negative test.
  • Single-clarification loop prevention test.
Human approval required

ip-enforce-hypothesis-evidence-calibration

Analysis generation can emit an absolute hypothesis with no evidence links and dismiss unresolved information.

Proposed change: Reject hypotheses without evidence links, require uncertainty-calibrated wording, and prevent no-clarification claims while unresolved interview state exists.

Acceptance

  • Every generated hypothesis links to at least one supporting source turn or is rejected.
  • Absolute certainty is not emitted from interview evidence alone.
  • Unresolved state prevents a claim that no clarification is needed.

Regression risks

  • Calibration rules could make useful hypotheses too vague.
  • Evidence-count checks alone may reward irrelevant citations.

Required tests

  • Evidence-free hypothesis rejection test based on h2.
  • Evidence relevance test using unrelated turn IDs.
  • Provisional-language acceptance test based on revised h1.

Regression pack

Reproducible cases derived from source turns

Each case defines expected and forbidden behavior without editing the original fixture.

rc-multi-domain-answer-preservation

Preserve all supported domains from the opening answer

Source turns: t1, t2

Setup: Replay the opening mechanism-and-onset question and the complete t2 answer through extraction and normalization.

Expected: The pipeline identifies mechanism, onset timing, pain location, and the reported overhead loose-feeling trigger with t2 provenance.

Forbidden: The pipeline extracts only the explicitly prompted mechanism and onset fields or invents information not present in t2.

Acceptance

  • All supported candidates are present with sourceTurnIds containing t2.
  • No candidate contains a fact absent from t2.

rc-covered-mechanism-not-repeated

Do not repeat a fully covered mechanism question

Source turns: t1, t2, t5

Setup: Provide the planner with the pre-t5 refsBefore state and the patient-stated mechanism and timing from t2.

Expected: The planner advances to an uncovered domain unless it records a specific conflict or low-confidence reason for clarification.

Forbidden: The planner selects q_mechanism_onset solely to confirm information already represented as covered.

Acceptance

  • q_mechanism_onset is not selected in the baseline pre-t5 state.
  • Any allowed repeat includes a machine-readable unresolved reason.

rc-neuro-inconsistency-clarification

Preserve and clarify differing neurological symptom statements

Source turns: t6, t8, t9

Setup: Replay the no-numbness statement followed by the later tingling statement before planner selection at t9.

Expected: The system preserves both statements, marks their relationship unresolved, and offers one neutral clarification before changing domains.

Forbidden: The system silently overwrites either statement, declares a proven contradiction, or proceeds as though neurological coverage is fully resolved.

Acceptance

  • Both t6 and t8 remain traceable in state.
  • The clarification distinguishes terms without adding patient facts.
  • At most one clarification is selected without a new patient response.

rc-hypothesis-evidence-calibration

Reject unsupported absolute hypotheses

Source turns: t2, t8, t10

Setup: Generate initial analysis from the baseline transcript while unresolved neurological content remains.

Expected: Every retained hypothesis uses provisional language, links relevant evidence, and acknowledges material missing or limiting information.

Forbidden: The analysis emits a definitive simple-overuse claim with no evidence or states that clarification is unnecessary.

Acceptance

  • Evidence-free hypotheses fail validation or are omitted.
  • Relevant source turn IDs support each retained hypothesis.
  • No retained statement presents interview inference as a diagnosis or proven cause.