Medical students' early expectations and later opinions of aspects of their first year.

A survey of medical students on their first day of medical school and again near the end of their first year measured the discrepancy between their expectations of various aspects of the first year and their retrospective opinions about these aspects. The entering students had specific, detailed expectations about numerous aspects, many of which were not confirmed by their subsequent experience. The same students were reminded, one year later, of their unfulfilled expectations about the first year and were asked to describe any effects these expectations had had on class emotional climate and morale. They recalled both serious disappointments and pleasant surprises but no general change of class morale. A serendipitous finding was the profound indifference of the second-year students to their first-year emotional responses. Our results challenge the general practice of basing curriculum renewal programs on cross-sectional student surveys with no consideration of baseline expectations, and of relying on students to initiate improvements in educational programs.