I am not much of a writer or intellect when it comes to literary skill but what I do know is what I have experienced in the past and what most medical students and perhaps other students in academia experience every year, failure.
For the most part undergraduate and graduate students don’t begin a semester setting out to fail but rather aim to be successful in their studies as this would confer a personal achievement not to mention a change in lifestyle for them and their immediate family. The pressures in life in the shape of financial or social stressors play an important role as much as knowing what and how to study as any course of study is a different species and must be handled accordingly.
As for myself I began my journey through medical school with the utmost confidence in my intellectual ability. The first year was certainly a challenge but I managed to pass my coursework. I began my second year with a resolve to improve on my grades and study harder. I never thought I would somehow fall into quicksand. That’s how I like to think of my initial interaction with failure. The medical school I attended used a system based approach along with Problem Based Learning, which kicked into high gear second year. I started my cardiopulmonary block and failed it, then figured I just needed to study harder and tried to improve on Gastrointestinal Block and failed again. It seemed that no matter how hard I tried to improve I couldn’t get results, I couldn’t get out of this hole…quicksand.
What started out as an attempt to improve last year’s performance ended up abruptly as I found myself sitting in front of the Dean of Student Affairs trying to explain how I ended up a Bell Curve Outcast. I can’t describe the range of emotions I experienced from anger and frustration to embarrassment eventually culminated in self doubt regarding my career choice. At that time, I was told I needed to take a leave of absence and figure out what I had to do in order to improve the deficiency. I was referred to a newly developed academic support service, given little advice in how to handle or cope with this situation, I felt alone in this matter. More isolating was feeling like a failure and being unable to reach out for help due to my embarrassment. That is when I realized that my study and exam approach was to basically to read and memorize harder and longer and expecting different results. As Albert Einstein once said, “doing the same thing over and over again and expecting different results is the definition of insanity.”
I sought out help from Dr. Melodee Mancuso, a learning specialist and an academic support counselor who was helpful in making sure I had no learning disabilities and also helped me figure out my learning style. In addition to Dr. Mancuso, I met with a psychologist who helped me sort out the root of the problem which by that time was complex. In summary, I feel that my lack of planning and strategy for studying was the beginning of the problem. In addition, I was using extensively detailed reference style books to study from and not using other simpler sources from which to attain general concepts from which to expand on. I treated every piece of information as if it was important and acquired a very detail oriented approach which prevented me from learning major concepts. I was focusing on the individual leaves on the trees and not focusing on “the forest from the trees”. I didn’t realize that a better approach was to establish a sound foundation learning (not memorizing) general concepts which then I could expand on and get detail oriented to a degree.
I was approaching medical school using a linear thinking style similar to when I was in college which got me through my first year but was catastrophic once I was expected to use higher-order thinking to make connections and problem solve and not merely memorize endless facts. Another issue was that I was a poor test taker. I never tested myself on how the concepts I learned where going to be presented on an exam, a process called exam schemata which helps the student figure out what knowledge is important and how this will be tested. Thus I did not prepare myself well to handle the complexity of medical school exams or even the harder board exams. I lacked test strategy and time management skills. In the end all of these issues with my lack of strategy when studying or taking tests translated into performance anxiety which further complicated everything. After my hiatus, I restarted my second year of med school with a new found way of thinking and performed better on those 2 previous courses I had failed. I had experienced a paradigm shift in the way I approached studying and test taking.
In short I became very confident in my abilities and passed the USMLE step 1 with a very good score on my first attempt at the end of my second year. I went unto my clinical clerkships during my third year and had no problems with any of my clerkships. Then time came to take USMLE step 2 CK and CS and based on my new found confidence I scheduled these tests all on the same week. I followed the old outdated adage regarding the USMLE which states that for “Step 1 you need two months to prepare, two weeks to prepare for Step 2, and a #2 pencil to prepare for Step 3”. Step 2 CS was not an issue as I am a great communicator and have great clinical skills. However, I missed the cutoff for passing Step 2 CK by a few points. I was shocked with my score but it did not hinder my performance during my E.R. rotation and received a grade of Honors for that clerkship. I obviously had the intelligence to be in medical school as evidenced by my grade in my ER clerkship.
After my first attempt, I immediately began studying. I was confident that I would be successful since I thought the problem with my first attempt was that I did not give myself enough time to study. However, I felt the urgency to resolve this problem quickly since I was applying for residency and in hindsight that added stress to an already big problem. I failed to stop myself from taking this test prematurely and did not seek professional help. I again failed. By now my confidence was at an all time low and my desperation and anxiety were building up.
I came to realize that I needed professional help and enrolled in a Kaplan Preparation Course. Stress at this time doubled since I had to pass this exam in order to avoid further complicating this scenario. I took the exam and barely missed the cutoff passing grade. At this point I realized that there was something else that was affecting my performance and that anxiety was affecting my ability to think clearly. It was definitely not a reflection of my intelligence or critical thinking abilities because in the clinical setting I could perform as well if not better than many of my peers.
By this point my emotions were a complete mess making it hard for me to even sit down and open a book to study. Every time I sat to study I found myself confronting the same material that had “betrayed” me. Making matters worse was the fact that by then I had managed to lure the attention of the Academic Affairs Progress and Promotions Committee. A meeting was assembled for me to appeal for academic reinstatement in order to obtain a chance at passing Step 2 CK and finishing my coursework. I still remember walking into this room with a long conference table where at least 12 faculty members were sitting to hear my case. I still remember their expressionless faces as I made a case for myself and went into extreme detail on how this had happened and more importantly how I would go about succeeding in my fourth attempt. I had a memorized speech and a detailed schedule of my plan, my strategy to address not only my studying but my emotional, mental and physical needs. Needless to say I was granted the opportunity to continue my course and went into full gear. I sought the help of a psychologist and who helped me with my performance anxiety and underwent behavioral therapy for it. I also attended another preparation course. I excelled during this attempt and continued my career pursuit.
After this I was able to find a residency program through the rematch formerly known as the “scramble” and went unto pass Step 3 during my intern year without any problem and on my first attempt. I also went unto receive a few awards as a Second year resident and became Chief Resident during my last year as well as received 2 awards for leadership, one award bestowed by medical students for teaching and also was named resident board member of the KY Academy of Family Physicians.
This has been one of the most difficult experiences of my life as I was and am not accustomed to failure. However, I have learned many valuable lessons about myself and my abilities and I know that I am a stronger person because of it. I have also learned that courage and determination are rare commodities and that the way a person handles himself in the face of adversity says a lot about his character.
Dr. J. Victor Tovar, Founder and CEO of ProMEDEus
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