Conciseness

The bulk is dense operational content that earns its tokens — a tool parameter table, exact thresholds ('REVEL >= 0.7', 'mis_z > 3.09', 'pLI >= 0.9 or LOEUF < 0.35'), and the full classification combination rules. However, the InterVar section carries two long anecdotal prose paragraphs ('Cross-validation example, verified live', 'Known data-quality issue, verified live, not a guess') and the ESM 'Mechanism complement' paragraph is narrative-heavy — minor instances of over-explanation that could be trimmed, matching the 4 anchor rather than 5's 'every token earns its place'.

Actionability

Fully executable guidance throughout: concrete tool calls with named parameters in every phase, precise numeric thresholds for each criterion, a copy-paste output-format template, and four worked patterns showing phase order and expected verdicts. This matches the 5 anchor (copy-paste ready commands, specific examples covering the common cases); the few '...' placeholders are input-dependent values, not pseudocode, so it is not 3 or 4.

Workflow Clarity

Phases 0–6 are clearly sequenced with validation checkpoints and feedback loops: Phase 0 validates HGVS/transcript explicitly ('Wrong HGVS or wrong transcript cascades errors through every downstream criterion. Validate first.'), Phase 1 handles missing data ('note the gap and continue'), Phase 2 defines discordance handling, and the InterVar cross-check section prescribes what to do on disagreement ('treat it as a reason to re-examine your manual criteria'). This matches the 5 anchor's explicit validation plus error-recovery loops.

Progressive Disclosure

No bundle files exist (no references/, scripts/, or assets/), so the entire skill is one ~230-line monolith: the tool parameter reference, full 28-criteria guidance, classification algorithm, and output template are all inlined. Section headers give it reasonable structure, but content that clearly belongs in one-level-deep reference files is inline and there are no references at all — matching the 3 anchor ('content that should be separate is inline') rather than 4, since 4 assumes references exist and are mostly clear.

Specificity

The description lists multiple concrete actions — 'Systematic ACMG/AMP germline variant classification with all 28 criteria', 'Produces 5-tier verdict (Pathogenic / Likely Pathogenic / VUS / Likely Benign / Benign) with cited evidence per criterion', 'Combines ClinVar, gnomAD, computational predictors, and gene-mechanism context' — with no meaningful gaps in coverage. It matches the 5 anchor (multiple specific concrete actions, comprehensive) rather than 4, which would require minor coverage gaps that are not present.

Completeness

It explicitly answers both questions: the 'what' (systematic classification producing a 5-tier verdict with per-criterion cited evidence, naming the data sources) and an explicit 'Use for variant interpretation, VUS resolution, and pathogenicity assessment' trigger clause. This is a direct match for the 5 anchor's example structure, so it cannot be 4 ('when' could be more explicit) — the when-clause names three concrete use scenarios.

Trigger Term Quality

Natural trigger phrases are comprehensively covered: 'variant interpretation', 'VUS resolution', 'pathogenicity assessment', 'germline variant classification', plus the vocabulary users actually invoke (ACMG/AMP, ClinVar, gnomAD, criteria codes). This matches the 5 anchor's synonym-level coverage; a 4 would require missing natural terms, and none of the common phrasings are absent.

Distinctiveness Conflict Risk

The ACMG/AMP 28-criteria framing, 5-tier verdict, and criteria codes form a clear niche with distinct triggers, but 'variant interpretation' and 'pathogenicity assessment' are broad enough that a general variant-analysis sibling skill (the body itself references 'tooluniverse-variant-analysis') would also match them — minor overlap risk with a closely related skill, matching the 4 anchor rather than 5's 'minimal conflict risk'.