The Guinea Pig Complex: Uncertainty in the Age of Virtual & Pass/Fail Medical School

“We are the guinea pig class.” My classmates and I often joke about this. We started medical school in the summer of 2020—in the height of the COVID-19 pandemic. Except for our cadaver lab and physical diagnosis course, our entire first year was virtual. The magic of medical school was mere lore to us; we had to take the upperclassmen’s word for it.

Virtual medical school led to my class’s uniquely conspicuous burnout. Personally, I felt like I allocated most of my energy into simply trying to stay afloat; there was very little energy left over to excel. I would do my homework, study for my tests, and pass everything. Yet, I always heard a voice in my head asking me, “Is this enough?” I was uncertain—in my own abilities and how I was spending my time. This feeling is common in medical school, but the unprecedented setting of virtual medical school during an international pandemic amplified this sensation for me.

During my first year of medical school, USMLE® (the United States Medical Licensing Examination® is a three part medical licensing in the United States) announced the Step 1 exam change from a numerical score to pass/fail. Yes, this change offered some solace, as it simplified my Step 1 goal to “pass” rather than to score above a certain percentile. However, this change also made my class guinea pigs again. Uncertainty loomed as my classmates and I were unsure how to best prepare for this new format. Because residency programs historically used Step 1 scores as the primary screener for interviews, we were also unsure how this change will impact our competitiveness for residency down the road, especially with the pandemic limiting shadowing opportunities and slowing down many people’s research projects.

In the beginning of my second year, I had a knee surgery that extended my virtual tenure to be even longer than my peers’. Then, after attending two weeks of in-person classes, a COVID flare resulted in classes going virtual again. It was not until my last block of medical school when I finally had the opportunity to experience a sense of normalcy. I finally could engage in the typically uncelebrated routine and socialization that define the pre-clinical years. For the first time, I could organically catch up with my friends between classes or at lunch, instead of coordinating our schedules to meet up. In class, I could participate without having to unmute my microphone or fear talking over a peer. I felt empowered to crack jokes, engage more deeply in the material, and better connect with my peers. My classmates and I could explain ideas to each other, quickly, and could more easily pull up references from textbooks or draw out concepts. With my newfound sense of revitalization and confidence, I was going out of my way to study the material in greater detail than I knew I would be tested on. For the first time since I started medical school, learning was not a chore but a thrill. Maybe the magic of medical school wasn’t mere lore…

My final block exam ended up being (by far) my best exam in all of medical school. I had been in medical school for nearly two years, but I had only truly felt like a medical student for a few months. I ended my pre-clinical years on a high note, only to be confronted by the behemoth of Step 1 preparation. Understandably, I entered my dedicated study period (many medical schools provide protected time for students to prepare for the Step exams) feeling overwhelmed. I initially planned to take Step 1 after a month of dedicated studying (all I had to do was pass, right?), but I ended up pushing back my test date by two weeks to be fully prepared.

During my dedicated study time, I felt the most stressed I had ever been in my life. I often would call my parents or sister and cry, frustrated at myself for not doing more earlier. Fortunately, it all worked out, and I ended up passing. I now have the hindsight to forgive myself for not preparing more during my preclinical years. A medical education is not meant to be learned behind a screen and removed from people. No wonder a socially distant learning environment caused me to burn out.

Having spent my gap years teaching math, I witnessed my students experiencing many healthcare disparities; my desire to address these is my greatest motivator to pursue medicine. Pre-clinical learning is already removed from the humanistic components of medicine, and the pandemic limited opportunities to apply my newly learned knowledge to directly help people. The result was that I lost touch with my inspiration and grappled with my motivation to pursue medicine, despite logically knowing this career would be fulfilling on a personal level and impactful on a community level.

Fortunately, the rest of my medical education will be face-to-face. I soon will begin my clinical rotations, during which I will spend my days collaborating with other students, residents, and physicians to help care for patients. With this privilege comes a heightened sense of pressure that, with a pass/fail Step 1, clinical evaluations, and the Step 2 Clinical Knowledge score will now serve bigger roles in residency applications than ever before. For now, I am focusing on my enthusiasm rather than my uncertainty, but the two coexist.

I feel immense privilege to be a medical student, especially as someone not accepted to medical school the first time I applied. I am learning that I can feel frustration and fear simultaneously with gratitude and hope. The more I talk to my peers, the more I realize I am not the only one who feels this way. In fact, I probably would be feeling this same emotional dichotomy even if my preclinical years panned out exactly how I had once envisioned them. At times, I can feel emotionally overwhelmed, but, when I do, I remind myself that part of my medical education is to learn adaptability and resilience, two attributes I continually strengthen as a member of the guinea pig class.