Locals Only?

Dr. P opened her Zoom app with cautious optimism. Time to check in with Michael, a third-year medical student.

This is their third meeting.

In their first meeting three weeks ago, Dr. P had broken the news: Michael had failed his shelf exam and would need to pass it to move on to his fourth year.

She tried to probe for the reasons behind Michael’s exam failure. He explained that he had planned to complete all of the UWorld practice questions but hadn’t been able to find the time. He doesn’t think that will be a problem this time, though, because he downloaded the app on his phone so he can take practice questions during “downtime.”

Dr. P felt for him. Michael clearly wanted to do well on the rotation, showing interest and initiative in patient care.

But the school’s rule about passing the shelf exam is non-negotiable.

He just needs to pass the exam and move on.

They mapped out a solid study plan. Michael expressed his gratitude to Dr. P for taking the time and promised to follow through.

But at their second meeting, when Dr. P asked how his studying was going, he looked down and said, “Not as well as I’d hoped.”

Instead of following the study plan, Michael had decided to take a full-length practice test—which he failed.

Then he spiraled. He thought he should reread the textbook but soon realized it would take too much time. So, he decided to watch a video series instead. But then his sister got married, he went home, and… you get the idea.

Eventually, Dr. P got him to agree that the original plan was still the best. But with so much time lost, he’d now need to increase his daily study hours.

It’s been a week. “Start meeting.”

......................

Does that story feel familiar?

It does for me.

Recently, I saw Sparky Witte’s excellent LinkedIn post about the “Left Brain Interpreter”. In it, he writes:

I wondered if working with learners like Michael feels challenging because of the Left Brain Interpreter effect. You meet with them and they understand what needs to be done and say they'll do it. But when you check in again, it’s not done. You ask why and there’s a list of reasons, but it’s hard to reconcile the motivated person in front of you with the one who hasn’t followed through.

I wasn’t sure if my interpretation was correct, so I reached out to Sparky directly.

Here’s what he said:

What you’re observing with medical learners struggling to act on what they say they know often involves a combination of psychological dynamics. The Left Brain Interpreter, as you mentioned, is likely at play here, providing these students with self-serving explanations to rationalize past shortcomings. This way, they protect their self-image, attributing failures to external factors instead of internal behaviors.

There’s also an element of optimism bias, which leads them to believe that they’ll naturally perform better next time. This bias can reinforce their explanations for past issues, making them feel assured that they won’t encounter the same struggles again.

Interesting.

But the real question is: what can we do differently?

Again, Sparky came through:

One technique that could be helpful is creating what’s called an implementation intention. This involves turning a vague intention (“I’ll study more”) into a clear, actionable plan (“I’ll study at the library from 6-8 PM on Mondays, Wednesdays, and Fridays”). This approach bypasses the brain’s rationalizing tendencies and channels optimism into concrete actions, giving them a better chance of real progress.

Problem-based learning is now widely used in medical education. It was originated in the 1960s at which medical school?

• McMaster University
• University of Toronto
• Harvard University
• University of Michigan