Looking back on the Boards

I don’t have any answers on how to overcome the boards. I don’t even have my scores back yet, and I feel more comfortable looking at my experience through the lens of not-knowing. But I do have a warning for those that come after me for a pitfall that I ran into: I let the other-comparing, over-achieving part of myself take over. While I fought to suppress my creative, communitarian urges to focus like it seemed I should, I found myself wishing to get the top score in the class — or at least to surpass the ridiculously high score that is our class average. I wanted to do this, without thinking about why but simply because, having done so well and jumped through so many hoops to get to that point, I wanted to show the world that I could overcome this hurdle as well. After all, I know how to study. I’ve done well with my last 22 years of schooling, standardized tests included. Why should this be any different?

For those of you who aren’t aware, “the boards” (when you’re talking to a med student) generally refers to the USMLE Step 1 (or if they go to an osteopathic medical school, may refer to the COMLEX Level 1). At 7 hours long, it’s a monster of an exam by any standard, and can feel a bit like an assessment of all of medical knowledge ever. Also, for anyone who has looked at older exams knows, the test also seems to cover more and more material and ask more and more convoluted questions every year. It may be because one just needs to know more to be a doctor these days because of scientific advancements, or because too many medical students figured out what the answers to the old questions were — and so to maintain an evenly distribution of scores, they had to write more and more difficult questions (difficult to say really, since no one really knows what the distribution is “supposed” to be).

It’s also worth noting that it is one of the most anticipated exams ever. Even if our professors were sensible enough to not teach to the test (a trait in teachers that I have been blessed with throughout my schooling), the TAs and other students were always quick to remind us of which facts were “high yield,” which implicitly translates to “this will be on the boards” (and probably the final exam). You’re built up to believe that there are few things that matter more after all that you have done in your life besides that number. Then, in the informational session before the beginning of study period, your teachers try to tell you a different story. So long as you are not thinking to go into one of the competitive specialties (Orthopedic surgery, Plastics, Dermatology, Ophthalmology, etc.), you’ll still be evaluated first on your entire portfolio, then on your board score. But by then, it’s already too late. You’ve already listened to all that everyone has told you about how important it is.  Even as you open the books to realize how much medical trivia is mixed in with the basic pathophysiology.

My mistake was that I let myself get frustrated as I realized that I wasn’t as good at the medical trivia as some of my peers. I forgot (as many of us do) that no matter how high-achieving we’ve been all our lives, if we continue to self-select to spend our time among other high-achievers, we will find ourselves sooner rather than later to be unable to be the best or even among the best of our peers at every aspect of our life. As Danielle LaPorte likes to say, being well-rounded is highly over-rated. You don’t achieve mastery among other high-achievers by being good at everything. You can only revolutionize the world if you focus on doing what you do best.

I need to pass the boards to continue with my medical training. I am also deeply gratified for the opportunity to consolidate my knowledge of basic pathophysiology. But what I need to master, ultimately, is not the boards. It’s the ability to look beyond what’s on the page. It’s to hone my research skills so that I remain trained and able to bring a scientific mindset to what I do (even if that may or may not be academic medicine). It’s to continue looking for ways to make the system around me better, to revolutionize, connect and create. I don’t need to do better than others on the boards to become a great doctor. I need to pass, and then get back to work.