The Step 1 Shuffle

Sometimes it’s hard to tell whether med school is the source of my problems or if it’s just the vehicle that perpetuates already existing ones. Look no further than USMLE Step 1, the pinnacle of pre-clerkship, often considered a defining medical school experience. It is the first of many board examinations taken to become a licensed physician in the United States. The weeks of dedicated study leading up to my exam tested my limits (literally and figuratively) sending me on the medical student pilgrimage I never asked for. My experience isn’t representative of everyone, but the emotions evoked throughout are sure to sound familiar to others who have gone through or are going through the process.

A passing exam score is 192.

Insecure. I didn’t think it would happen as quickly as it did, but the waterworks kicked in on day two. It had been 6 hours and I was still on the same chapter as when I had begun. If I couldn’t make it through a single chapter, how was I expected to comb through 18 months’ worth of material in a matter of few short weeks? I was overwhelmed. I was frustrated. I started to play the blame game. In an attempt to justify knowledge gaps, I pointed the finger at everyone or anything but myself. Cue quarter life crisis.

My first practice exam score was 182.

Progress. At first, my dedicated study period was a mess, with more trial and error than one’s psyche can handle in such a short interval. I was so consumed by the three digit score I envisioned for myself, I forgot that learning is a process, requiring a certain delay in gratification and patience (something I’ve been known to occasionally lack). My well researched and meticulously crafted study plan ultimately proved incompatible with my style of learning, which was detrimental to any performance growth. Resource overload prevented the appropriate time investment each one deserved. I was setting unrealistic goals of what I thought I could accomplish in a day, which resulted in memorization, but not understanding. Online forums I read were inundated with Step success stories, so it was hard for me to find any solace in my predicament. I stopped browsing and gradually became more comfortable with where I was. Step 1 is a national board exam and as much as I thought and wanted my experience to be unique, it wasn’t. Thousands of medical students sit for this exam. For every person posting about their triumphs, there was at least one person out there like me trying to navigate their own struggles. A change in perspective made all the difference.

My second practice exam score was 230.

Setbacks. I went through a constant cycle of apathy, panic and enlightenment. The repetitive nature of studying began to take its toll on me. My library study room unofficially became a second residence, even registering as “home” on my phone. Although I was ecstatic coming off the last practice test, my enthusiasm soon faded. I found myself absently flipping through pages, disinterested and burnt out. While getting Vitamin A toxicity from eating animal livers is a fun bit of trivia, I didn’t care or see its relevance. I was dragging my feet through the details and question bank. I needed some peace of mind. I needed to recharge.

My third practice exam score was 223.

Hustle. Practice exams don’t account for the clutch gene, right? At least that’s what I told myself. Despite what my pale complexion may have conveyed or the self-loathing tinged inflections of my voice, I was motivated by my practice score dip and the fear triggered by my impending test. I was relieved to find that everything was finally making sense and coming together when I needed it most, including biostats! By making the necessary adjustments early on and sticking to them, I was writing my own success story. I channeled my inner Sattar, hitting both high and low yield topics with accuracy and precision. I thought it was too good to be true.

My final practice exam score was 240.

Game Day. We had an anatomy professor who would always refer to each exam as a Celebration of Knowledge. I have never been too keen on euphemisms, but for whatever reason, this one stuck. It was a reminder that there was purpose behind all the hours in the library. It made me reflect on my attitude and approach to learning. Through the spells of annoyance and, at times, anger, there was no denying I came out on the other side of my dedicated studying a different student than when I began, and for the better. Don’t get me wrong, I was still the same anxious and nervous train wreck as before, but a train wreck that could sound off coagulation cascade pathophysiology on command. I trusted my prep and was ready to “celebrate” on my own terms. The exam itself was difficult, as expected. I flagged, marked and questioned myself more than ever before. The minutest of things I thought would never be asked were on the exam. There were also moments when I surprised myself, pulling answers seemingly out of thin air. After 8 hours of testing, I had no idea how to feel. Nevertheless, I didn’t walk out crying, so I considered that a win.

My USMLE Step 1 score was 222.

I bet y’all were anticipating a different outcome. So was I. Based off practice exams, I had high hopes. In the aftermath of its release, I was unnecessarily hard on myself, embarrassed and left with a lingering disappointment. I had prepared for everything but this. However, I made the conscious decision to not let a numerical score dictate how I felt or change my outlook. There was little benefit trying to determine where things went wrong. I put my best foot forward and gave it my all. I’m keeping my chin up because with the exam behind me, I am a Step closer to where I want to be.