Mid-December brought us first- and second-year med students a much-needed winter break. Mine was lovely, punctuated by only a few moments of panic as I contemplated studying for this summer’s upcoming board exam or attempted explaining this grueling test to my family.

The boards, which I have affectionately started calling That Which Shall Not be Named, will be haunting the mind and soul of every second-year medical student ever you meet, for the rest of your life. To be precise, what chills my soul is Step 1, the first test in a series of three exams that compose the U.S. Medical Licensing Examination, or USMLE, tests which anyone hoping to practice medicine in the United States must pass. These tests exist to ensure that every U.S. doctor has a good grounding in basic science, patient skills, caffeine abuse and anxiety disorders.

Step 1, which we must pass this summer before we are allowed to resume school, is an eight-hour multiple-choice exam that encompasses the entire first two years of our medical school science education, plus a bunch of things like dermatology which we have to figure out on our own. Well, not entirely on our own. A large industry makes millions of dollars peddling test-prep classes, books, flashcards, online quiz programs and more to nervous students. They make enough money on this that the two big companies, Doctors In Training and The Washington Post Co., gladly give free lunches, pens, T-shirts and other paraphernalia to students willing to come hear their pitch for Step 1 preparatory courses that range from $800 to $9,000. (No one worries about steps 2 and 3, which are comparatively easy – hence a medical student saying that you should study  two months for Step 1, two weeks for step 2 and bring two pencils to step 3.)

Fortunately, our faculty assure us that these pricey courses are optional. All we really need to do to pass is do well in our classes, answer about 2,000 online questions, read a 680-page book three times over and memorize it. And to not panic about the test, of course. They’ve been telling us not to panic at monthly meetings which serve primarily to remind the class that there’s a big test coming on which our whole lives depend and throw us all back into a big panic. They even gave us a helpful diagram comparing how past students’ med school grades compared to their Step 1 scores. My attention quickly fell on one outlying student who had run around 90 percent in his classes but still failed Step 1, reassuring me that, no matter how smart you are, you can still screw up your life with just one bad day.

If it seems I’m being overly dramatic, well – yes and no. This is truly how I feel in the moments when I’m most worried about the exam which, outside of our test-reassurance sessions, were rare prior to the new year. But now I’m starting to study for the test, in between hours spent on our new neuroscience course. I spent part of my break reading “Pharmacokinetics Made Easy” (which I assume sold better than “Pharmacokinetics Made Incredibly Difficult”) and trying to answer questions in a handy test-prep book I got on sale at a now-defunct major bookstore chain. (Sample question: What is the inheritance of lipoid proteinosis? Sample answer: What the hell is lipoid proteinosis?) All this means I’m slowly growing more prepared, and more panicked. At this rate, by my mid-June test date, I will be very well prepared for the exam, assuming I can use the keyboard while wearing a straitjacket.

One response to “Unspeakable

  1. Oh Andy, I am right there with you. I particularly like one of the last lines “I am slowly more prepared, and more panicked.” That will be our process, and we can lean on each other for hugs, chocolates, and screams along the way.

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