USMLE Step exams are a rite of passage in medical education. They mark the transition from pre-clinical years to clinical years, from medical school to residency and from intern to resident. One of the more difficult aspects of the transition to residency was convincing myself that I really was a doctor. The habits of explaining my role as a student, of hedging every statement with “I’ll need to ask the resident,” proved difficult ones to break. As I studied for my Step 3 exam, the final step, I hoped that this milestone would be the one after which I would believe I was a real doctor. With the exam approaching, I attempted to simultaneously balance my job as a pediatric intern, my responsibilities to my wife and 5-year-old son, and the annoying but persistent need to sleep. I tried to focus on my studies, but I was frequently distracted by these more pressing matters.
On the wards, I could see the progress I’d made as an intern. I was learning more than I ever realized I could, but I answered practice question after practice question incorrectly. I became discouraged and wondered if I would ever be a truly successful doctor. I struggled to balance the pride of my increasing knowledge of medicine and the looming shadow of all the knowledge left out there, waiting to be acquired. I often worried about being the only medical provider in an emergency. The thought was exhilarating but tinged with a distinct fear of failure. Each time I’ve prepared for a USMLE Step exam, studying has exposed this fear and reminded me of the many things I still do not know.
On a cold and dreary day in December, I walked into the testing center for the second day of my 2-day, 17-hour Step 3 exam. I was cautiously optimistic after completing the first day, but the computerized patient vignettes that comprised the second day made me very nervous. These timed, subjective units test a range of management decisions for sample patients. I was hopeful that by getting through this test I could finally get back to the real learning, with real patients.
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