We learn from outcomes, yet outcomes are unreliable teachers. In critical care, decisions are made with incomplete information, under time pressure, within systems that normalize workarounds, and where causality is opaque [1]. The feedback we receive later, whether a patient survives or dies or the extent of their recovery, reflects more than the decision itself. Physiology, system redundancies, timely intervention by a colleague, stochastic variance: all shape outcomes independently of our reasoning [2]. If we treat outcomes as verdicts on decision quality, we will systematically mislearn. [More]