A little over a week ago, I was one of thousands of medical students across the United States who participated in the NRMP’s Match process, wherein 4th year medical students find out where they will be heading to train in the specialty of their choosing. In my case, the specialty is Emergency Medicine, and where I’m headed is San Francisco, CA– I was humbled and ecstatic to have matched to UCSF, which after a lot of deliberation ended up being my first choice. Before the Match happened, I interviewed at sixteen programs across the country and genuinely loved things about all of them– I would have been lucky to end up at any of the programs I interviewed at, and am confident that I would have come out of any of them clinically well-prepared. That said, UCSF as a fairly young emergency medicine program at such a well-established research center, in a city like San Francisco, stood out as a place that would be particularly great to spend the next several years learning to rule out the proverbial badness while also beginning the next chapter of my life with my partner Karen and our black labrador Hal. Suffice to say, I’m excited for this next part of my life– I have one rotation left in medical school (radiology), a wedding, and a cross-country relocation to get through, but I’m sure that it will be here before I know it.

As part of my preparation for residency, I am going to attempt something I’ve done a few times before and been historically not-so-great at: journaling. Only now, I feel like I have a specific thing to write about, and a rationale– and the internet makes this much easier. I plan on using this website as sort of a journal club for myself, inspired by one of my former faculty members, Dr. Ryan Radecki who runs his own very well-written and informative blog EM Literature of Note. I hope that it will be useful to myself, as a place to collate my thoughts and to practice critical appraisal of the literature, and that someday it might even be useful to others or allow me to participate more fully in the #FOAMed movement– I have so far been more of a lurker, as my medical student status made me feel reluctant to contribute, and I look forward to trying to add some content.

For my first post, I’ll share something I found amusing and relevant to the interview season– an article from our neighbors in the frozen tundra region (I think?) of Toronto: Rainy Weather and Medical School Interviews, by Drs. Redelmeier and Baxter, of the University of Toronto. They looked at interviewer ratings of just under 3,000 applicants who participated in consecutive medical school interviews  between 2004 and 2009 and examined the relationship of weather to admission committee members’ perceptions of applicants.

What they found is perhaps not surprising, though I think if you asked most people if the weather on a day you interview “mattered” they would have a difficult time quantifying exactly how much– according to these authors, interviewing on a rainy day (operationalized a priori if  government records reflected precipitation– including freezing rain, snow and hail– occurred in the morning or afternoon) conferred a disadvantage equal to a 10% lower score on the MCAT, or Medical College Admissions Test. The disadvantage was translated from a score disparity that was statistically significant (barely, but still!). The authors remark in the conclusion that “magnitude of the specific influence may be modest, but such small differences can be important in some cases because each year there are about 100 candidates who receive a score within 1% of the admission threshold”, and end by reminding us of something important about cognitive biases that we (especially in EM) would do well to remember regarding all biases: “Calling attention to these issues may diminish their impact on judgment.” (For better or for worse, I mentioned this article during an interview or two when the weather was terrible– luckily, it was a sunny day in San Francisco.)

Anyway, I hope to do a lot of reading and writing about cognitive biases and decision-making in this blog, and how we in the ED can use knowledge of biases and common cognitive stumbling blocks to improve our own practice. I hope that I manage to keep up this endeavor, and I hope that eventually it can be of use to others. If you got this far, thanks, and keep checking in– I promise I’ll work on the brevity part of blogging. 🙂

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