I Failed the USMLE Step 1

I failed Step 1 of the United States Medical Licensing Exam. As much as I’d like to begin a detailed account of such an event with a sentence that recalls Dickensian genius, you should know that I am a figment of academic mediocrity. Really, I’ve been waiting for my twenties to provoke me into seeking greatness. My twenties have unfortunately failed me, which I suppose is most of the problem in the first place with “young folk”—the blaming of something else for our misdeeds rather than ourselves. In fact, my generation is bemoaned as one lost to apathy and liberal arts degrees by elderly white republicans. I, personally, have a Bachelor’s degree in history. Could this be where I went wrong? We will explore this together in the future, but for now, I will try to stick to the point. Let me be clear: my failure of this test was almost entirely my own doing, and I own it. However, this does not preclude me from disparaging or making fun of the events that led to it, nor of those that will inevitably follow.

I am brought here by my most recent wanton display of mediocrity, but this time in the form of actual failure. As I said above, I have just failed my USMLE Step 1, which is a test that serves as a formidable rite of passage to the upper levels of medical school education. However, I arrived at this point through a shocking—by medical student standards, anyway—lack of care and feeding for this exam, and it is really no surprise to me that my name is being paraded throughout administrative offices on a list of peers with an identical fate.  As they say in tales of woe, my luck finally ran out, at least when it comes to passing exams.

Yesterday, the Associate Dean and his assistant eyed me warily as I walked into their office for the meeting that would supposedly help me to decide my Next Step. When I had spoken to them on the phone the day before, I had been considerably upset: alternately in tears and robotic. However, after the moment of truth was over, the feeling that most coursed through me was disappointment. Once the shock of having to withdraw from my clinical rotation (ironically the first time since I’ve been in medical school that I’ve felt even a modicum of inspiration) was over, I was mostly disappointed in myself for lurching my way through yet another task the “hard way.” My parents have been telling me for years that I am an unfortunate subject of doing things “the hard way,” and apparently the cycle continues. I always picture myself in an old detective movie, with my dad wearing a trench coat and a yellow Dick Tracy hat, pacing around a room lit only by a naked lightbulb, while my mother (for the sake of imagery, clothed in a red felt dress coat and a shell hat with a large black feather poking out of it) types my answers to his questions on a stenographer’s typewriter in a dark corner of the room. In the image, suddenly my father stops pacing, pounds his fist on the desk at which I am penitently sitting as a bedraggled and mournful sinner, and says, “Do you WANT to do this the EASY way or the HARD way?” And then, no matter how I respond, my mother shrilly chimes in from the corner, “That’s JUST LIKE YOU. We’re not surprised.” The issues, they are plenty, as you can see.

To return to the point, and not deviate into a long-winded metaphor of my parents’ interesting disciplinary methodology, I will tell you that the most surprising part of being one of the whispered names who “failed the step” is the total awkwardness of my classmates. The attitude is similar to what would happen if one of my relatives had died. (In fact, my father is dead, and I can tell you with full confidence that my failure on the step ranks far, FAR below experiencing that. Whoa! Awkward alert! Dead parent mention! But you see my point.) What I mean is, people to whom I speak on a daily basis are averting their eyes when we pass in the hall and then smiling watery smiles when I pointedly say, “Hi, <name>! How you doing?” My message to you is this: the United States Medical Licensing Exam is a test. A multiple choice test. A test summarizing two years of material that, at best, represents 10% of our eventual clinical practice. Having met some stellar physicians who did not perform well in the initial stages of medical school, I refuse to let this silly exam define who I am or how I will practice medicine.

Here’s the thing: I’ve found very little to care about during the first two years of medical school. In fact, I was only really inspired to write about this experience once I failed this (admittedly rather formidable) test.  That should tell you something about the meaningfulness of sitting in poorly-organized lectures for hours at a time, morosely practicing physical exams and role-playing with each other, dreaming up impossible diagnoses for computerized patients, and contending constantly with the overinflated egos of people for whom numbers, class ranking, and a vague pride in wearing a white coat mean more to them than the eventual outcomes of their patients ever will.

I failed the USMLE Step 1. And I’m going to live to tell about it.

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