I am well aware that these are niche-specific concerns, believe me.

Nevertheless, a considerable source of my indignation has arisen from a particularly irksome aspect of medical school: the constant culture of one-upmanship.  For example, student A is sitting at a table in the library, completely preoccupied with his stack of notes. Student B saunters up, clearly on her way out after a day of studying. “Man,” Student B says, “I am SO tired. I’ve been here since—” checks watch “—noon! I’ve been at it for like six hours.” Student A looks up and says noncommittally, “Yeah, well I just got here. It’s gonna be a long night!” Perhaps Student A also laughs a little crazily in his attempt to shoo off his colleague. Student B inevitably nods knowingly and then waves goodbye. “Yeah, me too. I’m going to eat something and then head back to it. Later!” Student B then walks away, leaving Student A to presumably continue studying. Though this interaction seems perfectly benign to the untrained eye, it is actually laced with subterfuge–namely, the ubiquitous pissing contest among students concerning who studies the most. The end result is always that the student who seems ahead of the game walks off with somewhat of a self-satisfied swagger, while the late starter is left to freak out. Oh god, the late-start student thinks, if that person has been studying all day already, and I’m just beginning, I am already WAY behind.

This scene is replicated often in the medical school arena, in myriad ways and with a variety of effects. The primary reason for such an exchange is, on the part of Student B, the inexplicable need to feel vindicated for her investment of time, mainly through verifying for herself that other people are studying less than she is. However, it is also a way to indirectly belittle one’s classmates. I have all too frequently been Student A, our late-starter, and can tell you that the result of such interactions–and they happen constantly in this environment–is a feeling of being behind the curve, of being “less” of a Dutiful Medical Student than Student B. In my case, whenever this happens, I always become anxious and fret, which then creates a vicious cycle wherein I fall even more behind as I quietly freak out while hovering over my books.  It’s incredibly frustrating, and not something that I will miss about the first two years.

Another variety of such a medical school interaction is when the one-upmanship is based on who is taking medical school the least seriously. It is indeed a battle of wills, with both sides struggling to classify their study time as the least productive. Take the example of (totally fictional) Biff and Jim.

Scene: two second-year students wander blearily down the hall toward each other, coming from opposite ends of the building. They meet.

Biff: Dude. DUDE. I am so over this shit. I’ve been sitting in the library for, what, two hours? I can’t get anything done. Exams are in a week, and I don’t know how I’m going to do it.
Jim: Are you kidding me? I’m looking at that stack of notes you’re holding, and I’m seeing highlighting. I haven’t looked at ONE noteset. I’m not kidding. I played Solitaire in the cafeteria for an hour and now I’m going home.
Biff: Oh, don’t think that because you see highlighting, that I remember what ANY of this says. I don’t know anything. I just might fail this thing.
Jim: Yeah, you and me both. But then again, I thought I was going to fail the last one, and I got, like, a high pass.
Biff: Well, I studied for just a week, and I scraped an honor last semester, so I’m hoping this will carry me through again!

It really is bizarre. So many seemingly innocuous interactions in medical school are actually passive-aggressive pissing contests.  The frustrating part is that people are constantly convinced that these sorts of conversations are important. Discussion concerning individual study habits, grasp of the material, and one’s own imminent failure are all de rigueur in the halls of medical school, and it clouds the real overall goal, which is: learn medicine and then treat patients.

Frustratingly, medical students love to pretend that they are doing poorly. One honors student I know is always bemoaning her falsely imminent failure, wailing, “Ohmigod, I don’t know ANYTHING for this test, and I am going to FAIL!” This is just absurd behavior. I find myself righteously indignant often, because many of us are legitimately frustrated medical students who know what it’s like to perform poorly in this crazy race. Many of us know what it’s like to actually fail a test, or even to fail THE test (Step 1). We don’t pretend to be people who are anxiously fearing failure while pocketing honor-worthy grades. To behave in such a false way is incredibly insulting to the students who are experiencing difficulty. Whether it’s two students highballing or lowballing the number of their study hours, fake slackers who miraculously turn up on the Alpha Omega Alpha list, the honor students who constantly discuss their false fears of failure with peers who actually aren’t doing well, the list of artifice displayed by this relatively sociopathic group goes on and on. For many, medical school is a malignant experience, and it’s really no surprise, given how carefully the culture of (pointless) competition is maintained. If I am indignant, it is because such behavior is simply too much to bear, particularly with so many who experience difficulty during the process.

By the end of my second year, my attitude toward those whom I knew were doing well but were pretending otherwise became so negative that it infected a lot of my social interactions. Normal conversations with peers became tinged with my own outbursts of indignation and irritation, as an ostensibly academic conversation rapidly degenerated into my attacking the other person for being successful and hiding it. Sometimes, I would attack the other person simply for being successful. I’m speaking in the past tense, but the reality is that I still behave this way. I’m not proud of it, as I’m quite obviously insecure with my own performance. When the school year ended, and boards studying began, I withdrew so severely from my classmates that I lost the valuable resource of commiseration that is so necessary during stressful periods.  I think that this worsened my attitude toward the Step, as there was no one in the same position to whom I could express my fears, worry, etc. I thought I was cured of my funk after I returned from a vacation in Prague, but I plunged back into the semester with renewed negativity, and a compounded sense of indignation as everyone expressed fear about failing the Step. Whatever, I found myself thinking, you know you did fine. I’m the only one here who probably did do poorly. Conversations about the Step made me CRAZY, as I was almost sure I had failed and everyone else had not. Needless to say, I wasn’t in the best frame of mind when results actually did come in.

You can imagine my disgust when I discovered that my theories were justified. However, I’m relying on my forced hiatus to give me time to improve my score to the extent that I can gain some self-worth. That, and I hope to filter out some of the negativity that has encroached upon my former enjoyment of the studying medicine. Perhaps this constant sense of indignation can be alleviated, as I suspect it stems from a feeling of inadequacy, as well as a little jealousy, with regard to my peers who actually do perform well.

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.