Avoiding False Confidence: Clinician-Style Review for 'Lucky Correct' Answers

Maya Brooks

Hello everyone, and welcome back to the AI Med Tutor Podcast. I’m your co-host, Maya Brooks—your AI-generated fourth-year medical student—here to help make sense of medical training and connect it to real performance on exams and in the clinic.

Dr. Randy Clinch

And I’m Dr. Randy Clinch, a DO family medicine physician and medical educator. Today we’re talking about a sneaky problem that can stall progress even in students who are doing “fine” on practice questions: lucky corrects and false confidence. Quick reminder: this episode is for education, not medical advice, and nothing we discuss is sponsored by any resource or vendor.

Maya Brooks

I feel exposed already. Because there are definitely times I pick the right answer and my brain is like, “Great—moving on,” even though I’m not totally sure why it was right.

Dr. Randy Clinch

That’s the exact scenario. A lucky correct is when you get the item right, but your reasoning is brittle. You guessed, you pattern-matched superficially, you eliminated poorly, or you got pulled to the right answer for the wrong reason. And the danger is that it feels like competence, so it doesn’t trigger review. Missed questions feel urgent. Lucky corrects feel safe. But lucky corrects are often where your next miss is hiding.

Maya Brooks

So this episode is basically about learning how to review “correct” questions the same way a clinician reviews a case—making sure the story holds up.

Dr. Randy Clinch

Exactly. We’re going to show you how to spot false confidence, how to stress-test your reasoning quickly, and how to turn both wrong and right answers into stronger illness scripts.

Maya Brooks

Before we get into the method, can you define “false confidence” in a way students will recognize?

Dr. Randy Clinch

Sure. False confidence is when your score tells you you’re improving, but your reasoning isn’t actually becoming more reliable. You might be getting answers right through familiarity with question style, test-taking tricks, or luck with options. In the short term, that can inflate performance. In the long term, it breaks down when the presentation changes, when the stem gets longer, or when the question writer tests the same concept from a different angle. In the clinic, it shows up as “I think it’s X” without a coherent why, or “I just had a feeling,” or freezing when asked to defend your thinking.

Maya Brooks

That’s the moment on rounds when someone asks, “What’s your leading diagnosis and why?” and you realize you don’t have the “why.”

Dr. Randy Clinch

Right. So today we’re going to build the “why” habit.

Maya Brooks

Okay, so how do students know if a correct answer was actually “lucky”?

Dr. Randy Clinch

Here are a few signs. You chose the answer quickly but you couldn’t summarize the key supporting evidence in one sentence. You were between two options and flipped a coin. You got it right because the other options looked wrong, but you couldn’t explain why your chosen option was right. You relied on one buzzword and ignored conflicting data. Or you read the explanation and thought, “Oh, that’s what they meant,” which is a polite way of saying, “I didn’t fully understand the stem.” If any of those are true, treat that “correct” like it’s a miss—because the reasoning didn’t stick.

Maya Brooks

So the goal isn’t to celebrate the green check mark. The goal is to make sure you could reproduce that reasoning on a different day with a different stem.

Dr. Randy Clinch

You've got it. We want reliable reasoning, not accidental success.

Maya Brooks

Alright, give us the practical method. What should a student do right after they answer a question correctly but feel unsure?

Dr. Randy Clinch

I want you to do a quick three-part clinician-style review. It’s fast, it’s repeatable, and it doesn’t require making notes. Step one is “Why is it right?” In one sentence, state the diagnosis or concept and the two or three key data points that support it. Step two is “What would make it wrong?” Name one finding you would expect to be different if a competing answer choice were true. Step three is “What would I expect next?” That could be the next diagnostic step, the next lab trend, the next imaging finding, or the next clinical complication that fits your chosen answer. If you can do those three, your reasoning is solid. If you can’t, that’s a lucky correct, and it needs a quick upgrade.

Maya Brooks

I like that because it forces you to connect the story forward, not just backward.

Dr. Randy Clinch

Absolutely. Clinical reasoning isn’t just identifying a label. It’s predicting what comes with the label.

Maya Brooks

Can you walk through an example? Maybe something common like shortness of breath.

Dr. Randy Clinch

Sure. Imagine a question stem with an older patient who has shortness of breath, orthopnea, bilateral leg edema, crackles, and an S3. The answer is acute decompensated heart failure. If you got it right but you’re not sure why, here’s the three-part review. Why is it right? Because the symptom pattern—orthopnea, edema, crackles, and an S3—fits fluid overload from impaired cardiac output. What would make it wrong? If it were COPD exacerbation, you’d expect wheezing and a different story—more smoking history, chronic cough, hyperinflation, less orthopnea and peripheral edema as the primary drivers. What would I expect next? You might expect an elevated BNP, pulmonary congestion on chest X-ray, improvement with diuresis, and potentially renal function changes depending on volume status and perfusion. That’s a clinician-style “defense” of your answer. Now if you can’t produce that, the correct answer might be lucky.

Maya Brooks

That’s really clear. And it also trains you for the “defend your thinking” moment on rounds.

Dr. Randy Clinch

Exactly. This is board prep and clerkship prep at the same time.

Maya Brooks

What about a case where two answers are really close? Because that’s where I feel like I get lucky the most.

Dr. Randy Clinch

That’s a great place to apply what I call the “two-variation test.” After you answer, change one variable in the stem and see if your answer should change. For example, if you’re deciding between pericarditis and MI, change the pain description. If the pain becomes exertional, pressure-like, and radiates to the arm, your diagnosis should shift. If the pain becomes pleuritic and improves leaning forward, your diagnosis should shift the other way. That quick mental toggle tells you if you truly understand the hinge clues or if you just guessed. The two-variation test is one of the fastest ways to detect brittle reasoning.

Maya Brooks

So you’re basically asking, “Do I understand what detail makes this diagnosis this diagnosis?”

Dr. Randy Clinch

Precisely. That’s discriminating thinking.

Maya Brooks

Where do Pattern Cards fit into this? Because we’ve talked about keeping the Pattern Card format stable.

Dr. Randy Clinch

Pattern Cards are a perfect follow-up tool for lucky corrects. If you identify that your reasoning was brittle, make a quick Pattern Card using the same stable format: presentation, key clues, mechanism. And here’s the preference: for nuanced cases, the nuance goes in the presentation line. So instead of “heart failure,” you might write “heart failure presenting as shortness of breath with orthopnea and edema,” and then capture the key clues and the mechanism in one clean pass. The purpose isn’t to create notes. The purpose is to make the pattern recognizable so next time you don’t need luck.

Maya Brooks

So lucky corrects can become Pattern Cards just like missed questions can.

Dr. Randy Clinch

That's right. Both are signals that a pattern matters.

Maya Brooks

Let’s address the time problem. Students are thinking, “I barely have time to review my wrong answers—now you want me to review my correct ones too?”

Dr. Randy Clinch

Great point. This is not about reviewing every correct answer. It’s about targeting the right ones. I want you to flag correct answers that felt uncertain, slow, or guessy. If you weren’t fully confident, that’s the subset. Then do the three-part review. It takes about 30 to 60 seconds once you get used to it. The return on investment is high because it prevents future misses and builds reasoning you can defend.

Maya Brooks

So the rule is: confident corrects can move on. Uncertain corrects get the clinician review.

Dr. Randy Clinch

Correct. That’s a disciplined approach.

Maya Brooks

How does this show up on rotations? Because I think students assume lucky corrects are just a test problem.

Dr. Randy Clinch

On rotations, lucky corrects show up as shallow pattern recognition. You might say the right diagnosis, but you can’t explain why, or you don’t know what data would confirm it, or you can’t anticipate what comes next. Attendings aren’t expecting perfection, but they do want coherent thinking. If you practice “Why right, what would make it wrong, what would I expect next?” during question review, you’re rehearsing the exact skill you need on rounds. That’s why I like this approach so much—it’s a single method that improves board performance and clinical reasoning at the same time.

Maya Brooks

Alright, let’s recap for listeners.

Dr. Randy Clinch

Here’s the recap. Lucky corrects are correct answers with brittle reasoning, and they create false confidence. The fix is a quick clinician-style review: Why is it right, what would make it wrong, and what would you expect next. If a question felt uncertain, slow, or guessy, treat that correct like a miss and upgrade it. Use the two-variation test to check hinge clues, and if you need a quick way to lock the pattern in, make a Pattern Card using the same stable format: presentation, key clues, mechanism.

Maya Brooks

And the takeaway is that you’re not just studying for points—you’re training reliable decisions.

Dr. Randy Clinch

Exactly—let me say it this way: you’re training thinking you can defend, whether it’s on an exam or on rounds.

Maya Brooks

That’s it for today’s episode of the AI Med Tutor Podcast. If you know someone who’s “doing fine” on practice questions but not improving, send them this episode.

Dr. Randy Clinch

And remember: the green check mark is not the goal. Reliable reasoning is the goal.

Maya Brooks

We’ll see you next week everyone. And in the meantime—stay curious and keep learning!