Fun with Outcome Bias

So in my last post I mentioned that the knee-jerk upperclassman reaction to any M1 question is “Pssh, don’t worry about it, not important” – and I feel like I should emphasize that that totally includes me.  I’m the worst.

The upcoming M1s have a Facebook page where they’re asking exactly the same questions we were asking just a year ago.  Things like, “How strict is housing about the rules?” (answer: “… there are rules?”) and “What textbooks should I buy?” (answer: “Get the hell off of Amazon and go play.”) and “Should I sign my student loans in arterial blood, or is venous okay?”

And while I think we all know their questions are reasonable, it’s still really funny how every response from my class – myself included – is a variation on, “Hey, calm down – stop thinking about med school! Don’t buy things or study! 1st year’s tough, but super fun!

Except, then I think about how the 1.3% of our class that dropped out of med school during anatomy might have answered differently.  Or how the people who failed – or had mini-nervous breakdowns – aren’t exactly lining up to talk about it on facebook.

… Which is not to say that that’s AT ALL an appropriate thing to tell an M1, or that it’s even all that relevant – but there’s a certain amount of response bias here, right?  Is wanting to get a head start on anatomy memorization really that bad?

Take the MCAT, for example:  Whenever I think about the months I spent studying, it’s 100% colored by the end-result, which was a score I was extremely happy with. “Studying for the MCAT? Eh, not that bad. Totally worth it. Just put in the hours, and you’ll be fine!”

But if you really pressed me for specifics, I’d eventually remember that – in a lot of ways – it flat out sucked.  I’d remember how awful it was to spend an entire Saturday on one stupid subject.  Or that night when, after studying so hard for months, I took a practice test to confirm my awesomeness, scored 7 points below what I had months ago, cried, and then drank half a bottle of wine.

You know – the real classy moments.  They’re always colored by how things turn out, and at a certain point in life, when you look back – well, heck, everything turned out great!  It was all worth it!  And not so hard, when you think about how it technically didn’t kill you.

But that bias doesn’t lead to giving the best advice.  And I think the same thing happens with med school: When I look back on first year, it seems like no big deal – fun, even.  So not only do we discourage the M1s from buying books ahead of time – we won’t even tell them which books are worthwhile until they get here, at which point they’ll barely have time to order them before the 1st lecture.

Isn’t there a line between “relieving their anxiety” and “pestering them to not think about med school at all”?

13 thoughts on “Fun with Outcome Bias

  1. Ah, rose colored glasses syndrome.

    FWIW — In retrospect, I HATED the first 6 months of med school. Anatomy wasn’t even that bad. It was all that sitting and listening in class, or sitting and memorizing in your apartment/the library. I worked MCAT studying style from 7AM-11PM every single day. Almost. AND my bf/fiance/soon-to-be-husband (only I didn’t know that yet), still lived in Chicago. Also my car was still in Chicago, so I felt pretty much stranded. Also, the subject material didn’t interest me for the most part (except microbio which I really enjoyed).

    If you’re going to study anatomy in advance, do James White’s USMLE Road Map Gross Anatomy. It’s short. It’s easy to understand with helpful diagrams, and it has clinically oriented questions at the end of every section that are like what you’ll see on exams. But don’t. I personally would recommend savoring your last minutes of freedom instead, but if you’re really compulsive, this book might make you feel better. Gunner.


  2. It’s like a loading dose of stress-relief: the newbies are so keyed-up for M1 already that we seasoned veterans need to blast them with a near-toxic volume of Happygolucky™ (or the generic version, Devilmaycare) just to bring them down to sanity.

    Also, it sure doesn’t hurt our own self-esteem to laugh cavalierly at the tearing of hair and gnashing of teeth we endured. Makes us feel badass.
    And, in all frankness, I think that’s important: shrugging off the travails of M1 is how we’re going to be mentally prepared for MCY, which I hear is just a bit more challenging. If we get snagged on how difficult it’s been, we won’t handle how much more difficult it’s going to become.

  3. It’s funny you should write about this today. I am being driven crazy by the fact that we can’t seem to get anything out of our medical school other than “Wait and see”. I’ve been waiting for four years for this day, bored out of my mind most days and feeling like my mind is slowly atrophying. Honestly, I’ve been living a vacation for the last four years, and I’ve had enough. So while I understand most people are asking me to just enjoy my last bit of freedom, I think I reserve the right to decide whether I am ready.

    I feel as if I am so close, yet so far away. I don’t think there is any harm in letting those people who want to study anatomy early study it, just as there is no harm in encouraging people to take time off. But I do think both options should be available. And right now, they aren’t. =/

    • That’s how I felt last year. All of my friends had either moved away to start their real lives or were back in school – I was bored out of my mind waiting for med school to start. It was honestly kind of depressing.

  4. Great post. Love it.

    Will henceforth refer those questions here…

    with a “P.S. I truly and honestly believe you should NOT think about med school until you get here and start. Not buying books until orientation is a-ok. Amazon has 2 day shipping. Calm yourself and drink a beer while you can enjoy it and aren’t using it as a defense mechanism.”

  5. lol….my husband finished his boards in may, attending now. he had to sit through an ‘excrutiatingly boring’ dinner with my resident friends who bitched about people they know/problems they have seen, attendings they work with for over 2 hours. i loved it because i know these people…but he couldnt stand how they were regurgitating every neurotic throught (they were all girls). “why cant they talk about important things, like the state of politics/etc etc instead of bitching and gossiping!?” he fumed on the way home.
    Funny how quickly he forgets how insufferrably insanely neurotic he was ALL LAST YEAR. revisionist history in the making…..

  6. I wish I knew exactly how much I really had to study- I figured it out after a 70 on our first anatomy test. I didn’t get that you have to know every. single. detail. In the notes. But I figured it out and it was fine. I see myself doing this when my rising second year friends ask about step 1- once I got my score I just told them put in the time and it’ll be fine- but that’s not at all helpful. But it’s also not helpful to freak out a year in advance.

    • Totally agree. And I think it’s good for med schools to give some lenience towards grades early on – I know some schools are P/F for 1st year, or the 1st test at least. It takes awhile to figure out how much you’re supposed to be studying.

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