Are You Suffering From Premature P.O.E?
The rarely discussed phenomenon affecting medical student performance.
There’s a phenomenon spreading with concerning frequency across the medical student community…
Each week, new students present with the main signs and symptoms…
Passing quietly between students at alarming rates.
It’s called premature P.O.E. (process of elimination)—and is destroying USMLE preparation and scores.
It’s called premature P.O.E. and is destroying USMLE preparation and scores.
As the medical industry’s pioneer in diagnosing and treating USMLE-related maladies, I’d like to paint a brief picture before we get into the frightening details surrounding premature P.O.E.—if you allow me—so we can better understand what it is, why it’s happening, and how we can prevent it.
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Let’s start with a definition…
“It’s never happened before, I swear!”
Premature P.O.E.—as I’ve coined it—is the habit of mindlessly implementing the “process of elimination” while attempting USMLE practice questions. I often refer to P.O.E. as a “strategy of desperation” because it’s helpful when in a bind, but not as an exam-wide strategy.
Whether it’s a straightforward first-order question or a complex fourth-order behemoth… Students are diving into P.O.E. sooner and more often than their ancestors—and it’s destroying their lives… Ok, just their USMLE scores, but it’s still a big deal.
Let’s explore what this looks like in the wild…
~ CUE NATIONAL GEOGRAPHIC BRITISH NARRATOR’S VOICE ~
“The young medical student, eager to feast on the question’s answer choices, navigates the USMLE vignette with speed and precision. Halfway through, his brain lights up as he spots his prey, “I know the answer,” he whispers. Should he so desire, he could move in for the kill and move on to the next question.
The young student, however, oozes inexperience…
His gaze is averted to the answer choices… Marking the onset of confusion, disorientation, and eventual death by distractor…
Option A… It doesn’t look good, but nonetheless, he spends nearly thirty seconds driving himself mad, examining the answer for trickery. Eventually, the student grows bored and decides to forego this option.
Option B… Another tempting choice that doesn’t look quite right… Still, the young student spends an ungodly amount of time examining the answer, looking for hidden meaning in the words—hypnotized. A full minute has been wasted; the test writer’s trickery is working as intended, slowly eroding the medical student’s confidence.
Option C… “This looks right!” the student thinks... Option C matches his original thoughts word for word. “I shall feast on this answer choice,” claimed the student… “But first, I must review the remaining options… just to be safe,” he reasoned absurdly.
Options D and E… The medical student, now five minutes into the vignette, eats away at his limited time. The hunter has now become the hunted… The young, inexperienced medical student is disarmed, fragile, and weak. He’s pulled in every direction, overcome with fear and doubt, second-guessing himself into analysis paralysis.
“Option C seems right,” he reminded himself.
“But it can’t be this easy… There’s no way it’s this easy; it’s a trick!”
As the student guides his cursor to option C, he takes a sharp downturn and instead chooses option E [NARRATOR GASPS!]—believing that trickery must be afoot, he has fallen victim to the USMLE test writer’s trickery.
Prematurely using the process of elimination led this once wise student astray…
Now flustered and unsure of himself, he continues falling for traps… Walking himself straight into a failing score.”
~ END NATIONAL GEOGRAPHIC BRITISH NARRATOR’S VOICE ~
What you’ve just witnessed is a true story. This alarming yet all-too-real phenomenon is known as “Premature P.O.E.”
You could be infected and not even realize it.
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Why this is happening…
"I can’t stop doc… I’m addicted!”
As with so many of the recent USMLE mind viruses… This, too, can be traced back to patient zero—Reddit.
From epically ridiculous advice like “Just memorize all of the old NBMEs” to “Memorizing cartoons is the best way to master microbiology,” premature P.O.E. found its origin in the vile depths of a USMLE subreddit.
It started with one person…
Spread to another…
And eventually, went viral.
While fighting tooth and nail to beat this terrible condition, I continue reminding myself why it’s still floating around after all this time—it offers a veil of simplicity.
As humans, we seek comfort…
This problem feels like a security blanket…
A solution providing a sense of comfort and safety…
The problem?
It’s a false sense of comfort...
And a false sense of security…
Its effects put the victim in harm’s way by wasting precious time, increasing susceptibility to trickery, and amplifying the “second-guessing” gene—the trifecta of symptoms turns premature P.O.E. into a deadly affliction we can’t afford to ignore.
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How we can fix it…
“Just give it to me straight, doc!”
We cannot wait until students grow up and come face-to-face with their USMLE studies to address this issue.
We must… I repeat, MUST teach them early how to handle the pressure of USMLE questions without resorting to irresponsible behaviors.
If we don’t, I fear widespread and irreparable harm.
Education is key! We must start by identifying why students struggle to rid themselves of this crippling behavior.
After years of research, I’ve determined the TOP THREE reasons/causes/excuses. They are, in no particular order:
#1. It’s a default habit
#2. It’s an insurance policy
#3. It’s a crutch
Let’s examine why the underlying reasoning behind each one is flawed and dangerous.
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#1. IT’S A DEFAULT HABIT
Humans seek routine, comfort, and familiarity.
All three are achieved when students use the “process of elimination” as a habit.
The warm, fuzzy sensation brought on by defaulting to P.O.E. may feel good in the moment, but those feelings of comfort are swiftly followed by a cascade of negative side effects.
🕐 Wasted time… When an answer is straightforward but additional time is used to review every possible choice, that time is wasted for zero benefit.
🤔 Increased confusion… By defaulting to the process of elimination, students aim to find a reason why each answer may be correct. Not only is this wasting time, it’s causing them to drift further away from the correct option.
🫨 Second-guessing… More often than not, we know the answer based on the information provided by the vignette. Exploring every answer choice creates doubts that cause second-guessing. This increases the odds of changing the answer from correct to incorrect—another terrible habit.
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#2. IT’S AN INSURANCE POLICY
Sometimes, having an insurance policy is wise… You know, just in case.
However, an insurance policy for the USMLE exams should involve investing in preparation to ensure readiness, not throwing away forty-five to sixty seconds per question.
Imagine…
You’re navigating the question and confident that the answer is “rheumatoid arthritis.” As luck would have it, RA is one of the answer choices… Yes!!
But wait!
The vignette mentioned recent travel to Connecticut, and there’s an option for Lyme disease.
No! It’s got to be RA… All of the tell-tale signs and symptoms are there…
Wait… This has to be a trick… It can’t be so straightforward.
It is a trick! I won’t be fooled!
I’m going with Lyme disease.
Sure, there’s a ton of support for RA, but the patient’s fatigue and recent travel cannot be overlooked—Lyme it is.
And just like that…
A correct answer is overturned at the hands of a distractor…
All because you decided to “play it safe” and review all the answer choices, even though your initial diagnosis of the scenario was correct.
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#3. IT’S A CRUTCH
Last but not least, the process of elimination is used as a crutch.
This often stems from a lack of confidence or a bad habit that now feels like the only way to tackle a question.
Using P.O.E. as a crutch is a bad idea, but not for the reasons you might think.
A “crutch” is used when an injury or deficiency is present. It is not a tool someone would use without a specific purpose.
We’d never consider using crutches to ambulate when our legs are in fine health. Why, then, would we rely on a crutch for USMLE questions? Unless, of course, the plan is to slack off during the preparation phase and make up for it by using the process of elimination.
Still, if that’s your plan, it’s riddled with faults.
For one, the process of elimination isn’t a substitute for knowledge…
Nor is it an efficient way to navigate the exam…
P.O.E. is a USMLE “crutch” reserved for when you’re lost, unsure, or confused and don’t know what’s happening.
If P.O.E. is used for every question, it will slow you down (you could run out of time), increase your confusion (more susceptible to the distractors), and cause second-guessing (easily luring you into choosing a tempting distractor).
Avoid, at all costs, the use of P.O.E. for every question… It’s not worth it and, more importantly, unnecessary if you’re properly prepared for the exam.
WHEN TO USE P.O.E.
“Just give it to me straight, doc!”
As I mentioned, the process of elimination is a great tool, but there’s a time and place to whip it out and put it to use.
When, exactly, is the right time?
P.O.E. is appropriate in any of the following scenarios:
• You’re completely lost and unsure what’s happening (rarely should this happen if you’re properly prepared).
• You can’t connect the information from the vignette to the question being asked (another indicator of being unprepared).
• You can’t figure out what the vignette is trying to tell you (i.e., You can’t make a diagnosis).
Those reasons—or some variation—are ideal times to pull out the P.O.E.
As with any test-taking strategy, tactic, or tool, there is always a suitable time and place for its use.
Overusing—or underusing—the “strategies of desperation” on the USMLE exams will slow you down and prevent you from reaching your peak potential on exam day.
If the goal is walking into the exam with peak efficiency, confidence, and accuracy, avoid overusing the process of elimination throughout your exam preparation.
It’s a great tool that will undoubtedly help you score a few extra points on those extra-challenging questions, but as with anything else, too much of a good thing can backfire.
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