02 February 2007

Difficulties In General...

No matter where you are in your medical career, difficulties are bound to show themselves. In my experience, they make you stronger and make you appreciate that this career is a journey much like your family vacations. Some folks struggle to gain that medical school acceptance; praying through every organic chemistry exam or physics exam. Other folks struggle through coursework during the first and second year of medical school and some folks manage to do fine until residency when the demands and responsibilities become overwhelming.

One of my best friends has struggled with passing her first board exam in medical school. She did well in her coursework but has not been able to get past Step I even at the time that I am writing this blog. She has missed a pass by less than five points on every attempt. Needless to say, she is struggling and even questioning whether medicine is in her future. (In order to become a licensed physician in the United States, three steps licensure boards must be passed).

Many may ask, "How can she do so well in her coursework and yet not be able to pass Step I?" "How good a physician would she make if she couldn't pass boards on the first try?" The answer to both of these questions is, "an excellent physician" because passing board exams, while necessary for licensure, does not measure one's ability to treat patients. There are many excellent physicians in practice today who struggled with Step I, Step II or Step III of liscensure boards.

On the other hand, there are far more poor physicians in the United States that sailed through board exams. The bottom line: You have to pass three steps of licensure boards in order to obtain an license to practice medicine. Passing all three of these steps may be a struggle but they must be passed. Whether it takes two or three tries on each step, once all three are passed, your license is issued and it's up to the individual to practice excellent medicine or not. The practice of excellent medicine has more to do with work ethic than board scores.

Another class mate of mine struggled with several courses in medical school. She is dyslexic and had difficulty with physiology and pathology. She too struggled with one step of her licensure board exams but prevailed. She has been discouraged at times but she is one of the best physicians that I have ever observed. She is certainly a far better physician that I who didn't struggle with passing board exams. Her patients love her care and flock to her office. It is very evident that she has a high level of medical knowledge and is gifted in her application of that knowledge. She just struggled with boards.

We had members of my class who repeated a year of medical school (first or second year). In every case, they excelled with they started their clinical years and are establishing practices at this point. It was in the struggle that most of them truly learned to appreciate the journey. They also learned that sometimes "things" happen in your life that are totally beyond your control. These "things" must be taken care of before you can move on with your studies. It's not the way you planned for your career to work out but it's the career that you have been handed and you make the best of it.

Often I listen to folks who anticipate attending medical school who just KNOW that they will be a neurosurgeon. Just the mention of neurosurgery causes them to sit up more straighter in their seat or breathe a bit deeper. These budding neurosurgeons discover a wonderful course called Neuroscience and their plans for neurosurgery take a hike. Sometimes they get past the neuroscience but hit surgery clerkship in their third year and discover that there is nothing about surgery or being in the operating room that interestes them. The whole mystique of the OR or the "prestige" of the specialty that drove their interest in medicine will leave and often leave them depressed or unhappy about their choice to study medicine in the first place.

On the other hand, my classmate who sat behind me first and second year, always knew that he wanted to be a neurosurgeon. I had the pleasure of doing a case with him when I was on my pediatric surgery rotation. He was the neurosurgery resident and I was the pediatric surgery resident. It was great. We have since worked together on Trauma service too. It's neat to see how our careers have developed respectively.

If you find that you are struggling with undergraduate or medical school, figure out a way to get some help. Your performance is not diminished by the fact that you ask for help or attend tutorials. I remember an MD-Ph.D candidate who was a pharmacist before he started medical school. He spent hours helping all of us with our pharmacology during medical school. He was awesome and a very gifted physician scientist. There are loads of us, myself included, that owe him a debt of gratitude for taking the time to point out the finer lines of pharmacology.

If you fail something or repeat a year of medical school, remember, that no patient is ever going to ask you how many years it took for you to get through medical school. If it takes you five years instead of four and you are a good physician, then every second of those five years was worth it. In the end, the job is all about taking the best care of your patients that you can. Sure, you are not on the schedule that you set for yourself but it's the endpoint that is really your goal. Pat yourself on the back for hanging in there and know that the experience with struggle and strife only makes you more resiliant.


Jacqueline said...

Your advice couldn't have come at a better time, really.

Thank you Drnjbmd.

Fredrick Schwartz said...

Cavalor has sent me on this mission of mercy. He would like to offer you full posting privileges at the Digital Press Club but we can appreciate you not wishing to share your e-mail address. Feel free to pass along anything you have to submit in comments or create a google e-mail solely for posting at the DPC.

Once again,

Qu'ul cuda praedex nihil!


Anonymous said...

This is the first post I read of yours and I'll have to come back to read the others. Excellent.


David P said...

Thanks for this encouraging post.

However, I still feel really bummed that I might have to repeat a year. I just can't shake this feeling so easily. Maybe next year I'll feel better. But now I'm filled with anger/ depression and shame.

Drnjbmd said...

To David P,
No patient is ever going to ask you if you repeated a year or if you skipped a year so it really doesn't matter as long as you finish medical school. You will feel "angry, depressed, bummed, frustrated" right up until you start your repeat year. When you take USMLE Step I (or COMLEX 1) you are going to feel pretty happy too because you are going to know your stuff that much better.

If you have a strong Year 3 and garner some good clinical comments/LORs from the attendings who work with you, you can find that repeating that year will become a very distant memory and will not affect your future very much. Residency directors look at your Board Scores and clerkship grades more closely than your pre-clinical stuff and you can have a strong third year.

People repeat years for all sorts of reasons (more than you think) and you have nothing to be ashamed of. Focus on starting the year off strong and total mastery. You will have more insight into the material than your classmates. Good luck and ease up on yourself.

David P said...

Thanks again. I'm trying to keep my chin up. I really enjoy your blog.