The USMLE Step 1 is an 8 hour exam with 280 questions designed to test the knowledge gained by medical students over the two didactic years. If you’ve ever wanted what feels like your entire life accomplishments reduced down to a 3 digit number that could determine your whole future – this is the exam for you!
I remember the first day of orientation when I first heard about Step 1. We spent several hours having the fear of God struck into us by a certain Dean of the Education about the rigors of medical school and especially about the importance of Step 1. We then spent two weeks on the wards (i.e. In the hospital) during which I began to hear the words “high yield for boards”. This was the first time I was introduced to “First Aid” the review book used by almost every medical student for step 1.
During that first year I never really believed that I would actually get to take Step 1. I guess I figured that I wouldn’t make it that far. As someone who definitely didn’t graduate college with a 4.0 GPA, the “Imposter Syndrome” was strong. I never imagined I would make it past the first test cycle much less to the half way point of the program. Once second year started, Step 1 became more of a reality. It was a cloud of anxiety that loomed over every page of notes and every hour of lecture.
Why is it that this exam imposes such terror in medical students around the country? Sure 8 hours is long, and 280 questions sound exhausting, but is it really such a big deal?
In the world of medical school for many people their Step 1 score is one of the greatest determinants of what specialty they get to go into. This 3 digit number can slam a door shut as easily as it can swing one open. And if you’re considering a career in one of the more competitive specialties (radiology, ENT, plastics, ophthalmology), you have a higher chance of these doors being slammed than opened by this exam.
So by January of this year our lives were consumed with First Aid, UWORLD questions and Pathoma (all common study aids with some of us throwing in Gojian for fun), desperately trying to relearn every fact from first year as well as learn things that we were never taught or that we neglected the first time around. Every moment that we weren’t studying for in house exams we were studying for Step 1. We started taking practice exams, getting predicted scores and creating study plans. No one needed to scare us into taking Step 1 seriously anymore. We were all balancing the line between fear that motivates us, and the fear that paralyzes us.
By the time classes ended in the middle of April, no one was coming to class anymore anyways. We took a month of subject exams and mock boards. We stood at the feet of the giant whose shadow was so dark we could barely see the next exam in front of us.
People started changing their exam dates, pushing them back or moving them up depending on their practice exam scores.
Then after everything else was done, we finally got uninterrupted study time. I chose to take 2 weeks. Some took less, others took more. And at the end of those 2 weeks, I walked into a small testing center in Rancho Cucamonga and finally took the exam.
I don’t remember much about the exam, except for the overwhelming feeling that it didn’t feel BIG enough. It didn’t feel like what the USMLE Step 1 should feel like. It should feel like a huge accomplishment right? I should walk out of the testing center feeling like I had conquered the world!
But that’s not what it felt like. Instead, I walked out of the testing center feeling like it was any other day. I didn’t feel accomplished, I just felt tired and maybe a little hungry.
Everyone asked me “don’t you feel so awesome?!” and I smiled wide and said “yea it feels great!” But in reality I felt exactly the same as I had always felt, only that because I was expecting to feel so different, I was left in the end, completely empty. This feeling of incompleteness grew exponentially when I started contemplating all of the things I had given up in the past 2 years. All of the friends I had ignored, the dates I didn’t go on (ok let’s be real, it was like one date), the adventures I didn’t take.
So what did I do after Step 1? I went home and cried. I mourned the years of my life I had lost to this monster, and I think I’m still mourning them now. I am like that stereotypical cheerleader in every teenage movie. When she finally loses her virginity to the quarterback and then comes home and cries because she “feels empty”.
Well, Step 1 was the sexy quarterback I spent 2 years pining for and when I finally got him, he definitely did not live up to my expectations. Then I had to go home and wait for two months for this sexy quarterback to rate my performance (ok, now this analogy is getting weird, lets abandon it).
Then on July 13, 2016 at 8 am I went to the NBME website and checked my score. Checking your score is a two part process – first, you look to see if you passed. This is a tricky thing emotionally, because no one really cares if you pass but they REALLY care if you don’t. The only thing people care about when you pass is by HOW MUCH you pass by.
So I take a look – and I PASSED!
First hurdle down, so I keep scrolling and see my actual score. It wasn’t a surprise, which was partly exhilarating and partly disappointing. I think there is a little piece of all of us medical students that are like “what if I’m actually like the smartest person I know and I scored like a 295?” That didn’t turn out to be me, but that’s ok! The good news is that I didn’t face plant – it’s not a great enough score to make me the single most desirable candidate ever (although there are a lot more to that than just the Step 1 score), but it also isn’t so bad that it closes the doors I want to go through.
I probably won’t be a dermatologist – but rashes gross me out anyways, so that’s not the end of the world.
Now that I have the score, it does give me a little more fulfillment. I worked hard, and that hard work did show in how I performed. Does the entire experience feel “worth it” yet? No, but I’m nowhere close to the end of the road. There are still plenty more exams for me to study for and possibly mess up.
However, I have the foresight to know that in March of 2018 when I get that email telling me that I Matched – it will all be worth it.