“Strong Opinions, Loosely Held”: A Renewed Call for Error-driven Learning in Medical Education

Improving clinical reasoning is a national priority to reduce medical error. This commentary advocates for “strong opinions, loosely held” as a cognitive aid to improve reasoning and retention in medical education. Learners should commit confidently to decisions while remaining open to revision as new evidence emerges. Grounded in prediction error theory, which emphasizes memory retention when expectations are upset, this approach mirrors expert clinician strategies. Case-based curricula can operationalize this by prompting early hypotheses and reassessment. Despite concerns about overconfidence, we view discomfort as natural when transitioning from passive to active learning, ultimately promoting autonomy, improved retention, and deeper engagement.