Ramblings on healthcare, medical education, and life with a spinal cord injury
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Just One Teensy Step

Two days ago, I took a huge step forward. No, not that kind of step this time. A metaphorical one. One of the major rites of passage in medical school is taking the first part of the US Medical Licensing Exam, or USMLE, as it’s cleverly known. The test is administered over the course of several years in three sittings, known sequentially as Step 1, Step 2 and Step 3, and taken after second year of medical school, during fourth year, and during the first year of residency, respectively. Medical students tend to refer to this first part as “Step 1,” or “boards” or “that $*#^% test.” I’ll just stick with “Step 1″ for now, this being a family kind of place and all.

One must pass all three in order to apply for a medical license in most states, I believe. Step 1 is an eight-hour marathon of questions. There are seven sections, each containing 46 multiple-choice questions and lasting one hour. You get 45 minutes of break time, plus a 15 minute tutorial that you can skip and add to your day, thus providing 60 minutes of break time to allot as one sees fit. And any time you have remaining when finishing each one-hour question block is also added to your break time. Take three sections back-to-back, then a full hour off, then four sections back-to-back if you like. Or take all seven straight through and be done in seven hours if it’s your preference. Based on solid advice from a good friend, I brought plenty of caffeinated beverages, fruit, snacks and a small lunch. Way too much, but better safe than sorry. Rather than one huge break, I took 5-10 minutes between every section with a bit longer for lunch and just tried to maintain a steady pace all day long.

It’s hard to overestimate the stress that this singular exam can put on students, and it’s important to keep one’s mental state in check. Yes, residency program directors do look at Step 1 scores as an initial guideline for who to invite for interviews. And it’s one of the biggest single components of a residency application. But of course, it’s not the only part. We were given eight weeks of time to prepare ourselves and even at the end, there’s always something more you could have studied. One more time to have gone over the microbio notes. One more time to review pharm. Just once more, I need to look at Wegener’s granulomatosis.

But it’s ok, because no matter how hard you study for this beast, there’s always just a little more that could be done. And what’s interesting is, I’m okay with that now. This is drastically different from when I took the MCAT five years ago. I left that test freaked out, thinking I should have cancelled my test right then and there because I was in such a daze that I was sure I’d bombed it. Well it turns out I didn’t bomb it, so I’m glad I didn’t cancel my score.

This time I didn’t even feel that urge to cancel it or feel overcome with concern. It was a test I’d known about as being a gargantuan stepping stone since long before I applied to medical school, and one which I’d been concerned I’d approach with great trepidation. But none of that was present. I just felt…relieved. Relieved to know I was done. Relieved to know that I’d spent as much time as my sanity would allow preparing. Relieved to know that I’d worked hard to get to that point. Relieved to know it was time to get my life back.


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