The big day…

When I set out to share my journey through medical school, I knew I’d have to share the highs as well as the lows; that was the only way that I could ever feel good about what I was doing. And so when I embarked on this USMLE journey, I knew that I would be sharing everything – which meant that if I were to get a Step score that I was dissatisfied with, it would be really difficult.

As fate would have it, that is how things turned out. I received my score not this week, actually, but last, and I’ve been coming to terms with it until now. I am not one to talk about my emotions until I’ve had time to process them, and I don’t respond well to motivational speeches and such.

Some of you have been here since the beginning of the account; many of you have been following since I started preparing for Step 1 in the summer, joining me during livestreams, chatting on Discord, sharing the joys and pains of studying for this exam. I appreciate the companionship more than I can say, but in a way, it’s extra hard to share this with you guys.

Moment of Truth

For starters, let me just say this: the reason I’m disappointed is not because it’s a bad score. I don’t think it is, and many people have said that I should be glad I passed. I am glad, of course. But the disappointment stems from the fact that in the weeks leading up to my test day, I was doing quite well on practice exams. And so I truly believed that I would be able to do well on the real deal when the time came.

My test was on January 19th, 2020, and below I’ve shared my assessment scores leading up to the exam.

On the day of the exam, I didn’t feel abnormally or overly stressed. I was nervous, yes, but it wasn’t debilitating. Nothing felt out of the ordinary, and with the exception of feeling like the exam had too many embryo questions, I walked out of there feeling like I had no idea how it went. So there was hope: I genuinely thought that I would at least hit my target.

I’d like to go into emergency medicine; the average Step 1 score last year, if I remember well, was 234. I aimed for a 235 with the hopes that it was a nice, achievable goal that would set me on the right path for EM. After my UWSA2, I felt like that goal, that target, was definitely within reach.

the real deal

230

I was pretty upset. I’m still pretty sad, mostly because I don’t know what I messed up, where I went wrong. I really felt like I was on the right path – my scores were gradually increasing and holding steady above my target, and I felt like I was learning from my mistakes.

And yet, here we are. 28 point drop from my UWSA2. 12 point drop from my NBME 18. These things happen. I don’t know why, I can’t explain how, but it’s over and done with. It’s not something I can change, and I’m not sure what I could have done differently.

So what’s next?

Life moves on, right? Each day is a bit easier, but I still get sad sometimes. I’ve spent the last week or so moping around and talking to people in all stages of their prep; those studying for Step 2CK/CS, some who are applying and currently waiting for their Match results, and some that are already residents in the US. Everyone’s been incredibly patient and helpful, and I’m so grateful. My friends, family and boyfriend have all been really sweet.

For those wondering, I won’t be applying to Match this year; not necessarily because of the Step score – in general, it would have been too rushed, because I haven’t done any US clinical experiences yet and thus have no letters of recommendation. This means I’ll have to take a gap year after my medical school, but I don’t think that’s the worst thing in the world. A bit of time to travel, research, volunteer never hurt anyone.

Going forward, my current projects are on hold. I had a lot of fun meeting some of you on Zoom and giving insight into my study plans/sharing tips, and I thank you for your confidence. I had also started working on additional episodes of the podcast, but right now I don’t feel like I should be giving advice – I feel like the ground has become unsteady under my feet and I’m not sure which parts of my study techniques actually worked. So until further notice, I probably won’t be answering Step 1 prep questions, not while I’m having trouble gauging what of my advice is useful and what might not be.

Step 2 CK Plans

My biggest concern now is Step 2 CK. As many of you know, that’s the clinical knowledge (CK) part of the USMLE, and in light of my weaker Step 1 score, I’ll need an extra good CK score.

The problem is… I don’t know where I went wrong. Because they’ve changed the score reporting, I can’t exactly troubleshoot my Step 1 experience. And now I don’t feel like I’ll ever be able to trust a practice exam score again. I went into Step 1 feeling calm – I’d done what I could, my self-assessment scores were good, surely I would be fine. My mantra has always been, “Trust your process,” and until now, I’ve had full confidence in my process.

That’s the most frustrating part about this. That confidence? It’s gone. I need CK to go really well to have a shot at Emergency Medicine (for them, the clinical exam is definitely very important), and most programs expect to see a 10 point rise from Step 1 to Step 2. So I guess what I have to do now is to find the self-confidence to attack this new challenge with renewed vigor.

One issue is something that I’ve always struggled with: self-sabotage. Growing up, I didn’t often put my heart and soul into anything. I had this fear that if I gave something my all, and ended up underachieving, that would be devastating. So I would put in less effort, less soul, and if/when I underachieved, I could safely justify it to myself. After all, I hadn’t even ‘tried my best,’ right? This is the reason why I didn’t apply to any ‘reach’ universities in high school – no expectations, no disappointments. Well, for Step 1 I really did feel like I gave it my all. So it was really upsetting to feel like even when I put in all my strength, energy, focus, etc. … I still didn’t reach the outcome I wanted. It makes you (or maybe just me) question your abilities and it truly sucks.

So going back to CK: I don’t quite know how to study for this differently than I did for Step 1. Any tips in that regard would be great! How was Step 2 prep different for you? Is there anyone in a similar boat who has some insight into succeeding with CK?

The Match

After the Step exams comes the next phase: applying to residency. It is a really complicated process that I am just now getting more knowledgeable about. I know that things other than Step scores are important, so my focus is now to get rotations (USCEs) in the States. However, with my medical school rotations being as they are (in our 6th year we have to do x weeks of y specialties), it’s becoming incredibly difficult to actually schedule any rotations, much less find people to host me. But hopefully I’ll be able to pull it off.

Final Words

Thank you for reading.

Studying for Step was actually a really difficult point in my life; it was very demotivating at times, and definitely mentally and emotionally exhausting. One of the things that kept me going was the consistently increasing self-assessment scores. Although now I don’t know the significance of that, I guess I am grateful that they were increasing gradually because it encouraged me to keep studying when I became worn out.

It’s not all doom and gloom. Step has been pretty incredible in giving me broad knowledge about a ton of crucial medical topics. Yes, we’ve had to memorize some seemingly unimportant facts – those I’ve already forgotten, trust me. But there’s a lot that I haven’t. After the exam, I felt like I knew so much. That feeling has gradually diminished since test day, to the point where I was frustrated that I’d already forgotten everything (how is that possible?!). But now I feel like it’s plateaued – I knew a lot, and some of that I’ve forgotten (whoops), but the rest has become this steady knowledge ingrained in my brain, hopefully for the remainder of my studies. And there’s still Step 2 CK to fill in whatever gaps remain (because they do remain, trust me!). As one of my favorite desk quotes states, “Study for the knowledge.” And that I did.

[A nice Step score wouldn’t’ve hurt though.]

I don’t mean to discourage you during your exam prep with this post, or instill fear that the same thing will happen to you. I have read so many Step 1 experiences where UWSA2 was truly predictive, and NBME 18 was only 1-2 points away from their real score. It seems that for the majority of people, these exam scores are indeed excellent predictors of the outcome. I just wasn’t one of those people – I’ve spoken to 1 other person like me, and it sucks, but it really isn’t the majority of cases. In fact, there are some people who consistently score lower than their self-assessments and get a better Step score on test day! So do not be discouraged, keep studying hard.

Also, thank you in advance for any words of encouragement you send my way. If I don’t reply, I apologize. I just don’t feel ready to dissect my studies just yet – as I said, I usually process things internally first.