Step 2 National Licensing Exam on the Horizon

As some of you who have been reading this for a while know, I feel like I shortchanged myself for Step 1 (the first national medical licensing exam). My studying was not that effective during the short time I had, given my master's thesis work. I think I achieved maybe two weeks of good solid studying, and barely squeaked by at the last minute. I later found that most people start studying months, if not years, in advance! It was too little time given how much exam material was not covered in the curriculum of our first two years, and given how little emphasis was placed on the exam by our program. I was probably naive and should have done my own research about the importance of this 8 hour exam, but when someone you trust tells you that you are worrying over nothing, you believe them. Oops.

Scholarship Exam, 1940

Thinking back, I'm not sure why I believed them. My entire life, people have been telling me that I took my academics too seriously. I have often heard that an exam or a grade was unimportant, only to study hard and then realize that it did make a difference later on. Working for a grade only when it 'counted' seemed wrong to me somehow. Shouldn't we be working hard for the sake of doing our best? What frustrated me about this Step 1 episode is that I did work hard the first two years of school, but I felt my energies were often directed toward irrelevant material, such as alternate therapies, politics, and social concerns. Those things are important, but not at the expense of learning the basics of allopathic medicine! I did not make sure that what I was learning correlated to what I needed to learn; I trusted the school to do that and they didn't. I suppose I wish our program had been, for lack of a better word, a stricter one. I also wish I was a little more realistic about the preparation needed.

This brings to mind another myth you hear when applying to medical schools: that all medical schools are pretty much equivalent during the first two years, because it's the clinical years that matter. In my opinion, this is blatantly false. The first two years are your foundation. The quality of teaching and the strength of the syllabus sets you up not only for your board exam studying, but also for the wards. If I were giving someone else advice about choosing a medical school, I would tell them to examine the syllabus for all four years carefully, and look at who is teaching the basic preclinical courses. Are they PhDs without any clinical background? Are they MDs without any teaching background? Are they junior or senior medical student teaching assistants (who are often great)? Do the same professors teach the course year after year? Lectures? Case-based (not necessarily as effective as it is popular)? Both? How well do preclinical grades predict performance on the Step? What sort of board preparation (if any) do they offer? What is their board exam pass rate (can they give you the actual numbers)? In our case, had I looked into this further, I would have seen some serious red flags in terms of the right fit.

Please don't get me wrong -- I am very grateful for all that I have gained and learned during my time in medical school. I understand that no medical school is perfect, and that often, we only get out what we ourselves put in. There are amazing things about my program, which I won't go into here. However, I do not know if I would recommend my program to other pre-medical students. I have no resentment or bitterness about what we didn't learn, but I do feel the need to be truthful about it to others embarking on this journey. For myself, my goal is to move onward with my life and career using everything I did learn.

Anyhow, my experience with Step 1 was a very high-stress way of taking any exam, especially one that turned out to be so much more important than I realized. I do feel that certain doors are now closed to me in terms of both specialty choice and competitiveness of residency programs, which is sad because I know I could have done much better. Looking on the bright side, though -- there is another licensing exam. While a decent Step 2 score may not entirely make up for a low Step 1 score in terms of residency applications, it would theoretically help. Thank goodness there is another exam! Now the pressure is on to prove myself. From every challenging experience or mistake comes a chance to do better, right?

I still have some time before Step 2, so my plan is to go through all the material once through briefly to get a feel for the scope of the material, maybe review some Goljan pathology or internal medicine, and then do as many practice questions as possible from USMLE world. It seems as though everyone uses some variation of review book + online question bank to study for this exam. However, everyone also says that you only need two weeks to study for Step 2, that it's easier than Step 1, etc. That may be true if you felt well prepared for the first Step. Needless to say, I shall not believe it:)

Many of my classmates have taken Step 2, and many are taking it around the same time I am. I hope we all have a better time of it. I will try to continue blogging as I study. Good luck to those taking the exam, and good luck to all those applying for the spring Match! I hope people end up in places and specialties they love. My plan is to smile and keep on keepin' on.