Friday, August 23, 2013

Depths, Darkness, and Doom: The Fight to Survive the United States Medical Licensing Exam (aka Boards)

From the end of the school year and White Coat Ceremony, to the looming Boards exam, we had roughly six weeks to prepare.  Six weeks to re-learn, cram, study, and come to understand all there is to know about the human body and what ails it (or at the very least, everything we had been taught over the last two years of medical school).

The logistics of the United States Medical Licensing Exam (USMLE, aka "Boards", aka "Step 1"):  Registration for the exam occurs about six months in advance, and costs roughly $600.   The exam is taken in a private testing facility off-campus (where finger printing, metal detectors, pat downs, and constant video monitoring can be done), and is composed of seven 1-hour testing blocks....with breaks, totaling 8 hours.  Each 1 hour testing block contains 46 questions, and the results of the exam are released 3-4 weeks after the exam is completed.  The consequences of failing the USMLE exam are immense!  One is not allowed to simply "retake" the exam, but must drop out of medical school a minimum of one year, and if a re-examination is permitted after a year, a person's record will always show that they failed that first attempt.  And that score, whether passing or not, determines much of what specialty (and general residency) one can get into.  And if the exam is passed, a student is never allowed to retake it...no matter how much one dislikes their score!!

In essence, this test tells the world whether or not you are prepared to provide basic patient care.  According to the National Boards Medical Examination website, the exam "is intended to ensure mastery of not only the sciences underlying the safe and competent practice of medicine in the present, but also the scientific principles required for maintenance of competence through lifelong learning."

While the period of Boards preparation is stressful for all medical students that go through it, for me, it redefined isolation and inadequacy; I had no problem graduating at the top of my undergraduate university or passing my classes throughout the two years of medical school, but when it came to this, as I took and retook practice questions and mock exams, I was falling far short of expectations!!  I studied nearly every waking hour of every day; I turned off my cell phone, shut down my Facebook, and denied my e-mail, friends, family, and health...and yet I could not retain the information the way I needed, or mount to the practice scores required of me.  (It is a long story, which I have spent much time and energy analyzing, as to why I suspect I was not able to succeed as easily as others.  This will not be reflected on here, but has much to do with my background private life.)  

As my testing date neared, my grief and panic mounted...and of course, anxiety and productivity have an inverse relationship....so, my ability to succeed became less and less as that fateful day neared.

A few of the many scenes of intense Boards preparation!
There came a point in my preparation, in the days before my scheduled exam, that I realized there was a very good chance that I would not pass my exam.  With a sober understanding of the consequences, and with great humility, I requested from the top administrators of the medical school, permission to cancel my first 3 week clerkship rotation, in preference to the possibility of being forced to delay by a minimum of a year secondary to failing the exam.   In recognition of my unique circumstances (personal background not reflected here), I was given incredible grace by way of a three week extension.  THANK YOU, LORD!!  And thank you to an administration who truly wants their students to succeed!

A new lease on life, so to speak, I plugged away once again, hard core, and this time with the full force of every resource the medical school had to offer backing me!  Three weeks later, I knew I was much better prepared, but still doubted my abilities and felt crippling anxiety.  Emotionally, mentally, and physically exhausted, I sent a text message to my closest prayer warriors, asking for prayer backing.  And backing I did receive!  Prayers poured in from all over the country, and the world!  I felt the love, and so appreciate those who believe in what the Lord is capable of doing through my brokenness!  Truly, if you were a part of this, thank you!

I was overwhelmed by the sheer selflessness of a few select individuals.  I shall always remember the kindness and love of these loved ones, whether it was by way of prayers, texts of encouragement, patience through my absence and frustrations, or baked goods.

No matter how hard I tried, I was not able to sleep the two nights before that fateful day.  Insomnia is a beast!!!  But even so, I knew it was that test date or never.  As I readied myself the morning of, I spent a long while in prayer as I thanked God for the opportunity to celebrate many years of accumulated knowledge, and prayed that he would reign over the exhaustion felt in every inch of my being.

The exam itself was torture.  It was scheduled from 2pm until 10 pm, and as 8 pm rounded, my brain began to shut down.  No matter how hard I tried to focus on each question at hand, my mind could no longer comprehend what it was reading, and I felt as though I had never before seen or heard of much of the material staring at me.  I did my best to power through, approaching each question as though a new challenge.  But even so, my brain and pace continued to slow, and I watched as the timer counted down faster than the number of test questions remaining.  I was running out of time!  And my brain and body couldn't keep up!

With 30 seconds remaining, I still had three questions unanswered, so raced to each, and selected a random one of the multiple choices, and then read through as quickly as I could, to try and better answer at least one of the three.  I quickly raced to change my answer on one, and barely just made it as the screen suddenly turned WHITE.  I had run out of time.

In that moment, I completely broke.  So much energy, anticipation, emotion, and general life, had been poured into that moment....so much of life sacrificed....and as the screen flashed white....I realized that for better or worse, it was all over.  Still at the computer station, the only student left in the building at 10 pm, and with video monitors on me and chaperones watching from the other side of the glass, I laid my head onto my arms.

After a few moments, I pulled myself together and quickly scurried out of the room, put up with once again being fingerprinted, having my id checked, and being pat down, and then made a break for my car.  Once safely in my car, the tears I had denied for months broke free.  It was done.

Only once during Boards preparation had I emerged from my apartment with hair and makeup done, and that was for a single night, in order to support one of my dearest friends at the Miss Washington pageant.  I had gone for several months with minimal contact with friends, and with out seeing my family - and OH, how I missed my siblings and nephews!!  But, in the three day weekend between my Boards exam and starting my first clerkship, I reclaimed much of the life I had denied myself for so long. I traveled from Seattle, WA to Portland, OR to Moses Lake, WA to Spokane, WA, back to Moses Lake, and finally back to Seattle....and LIVED.  I reclaimed my life as my own!  And caught up on mass amounts of love and hugs that had been tragically denied for so long.

On the left: my typical day of Boards studying (no makeup, bun, glasses, complete emotional and physical exhaustion)  On the right: my one night out, for Miss Washington



 Catching up with my baby boy!!!  (my nephew)


The next three weeks, I lived in trepidation.  I went through my first clerkship rotation, not knowing if I was starting my clinical career "for real", or if I would receive my results 3-4 weeks after the fact, and be forced to drop out of my clerkship and re-enter the darkness of Boards studying once again.

Exactly three weeks after I had taken my exam, I received an e-mail alerting me that my results would be released at exactly 11 am Eastern Time that day (8 am my time), and I raced to find a computer at which I would be able to open my results.  At exactly 8:01 my time....I logged into the National Boards Medical Examination (NBME) website, and saw that magical word....."PASS".

My score report, showing a "PASS".
 I stared for a second, not blinking, and again, the emotions came over.  I fell back on the floor from my seated position, and just stared up at the ceiling as tears rolled down my cheeks.  It was really over.

My dear friends, I REALLY AM GOING TO BE A DOCTOR!!!!

And goodness, the grace of the Lord Most High, is beyond all comparison!  Continue to use my life as you will, dear faithful Father!


1 Chronicles 29:11   Yours, O LORD, is the greatness and the power and the glory and the majesty and the splendor, for everything in heaven and earth is yours. 

 

Romans 8:18 (NIV) “I consider that our present sufferings are not worth comparing with the glory that will be revealed in us.” - See more at: http://succeedasyourownboss.com/01/2013/13-bible-verses-every-small-business-owner-needs-for-2013/#sthash.UfnWkdmD.dpuf

James 1:2-4    Consider it pure joy, my brothers, whenever you face trials of many kinds, because you know that the testing of your faith develops perseverance. Perseverance must finish its work so that you may be mature and complete, not lacking anything.

 

Jeremiah 29:11  "For I know the plans I have for you,” declares the Lord, “plans to prosper you and not to harm you, plans to give you hope and a future."

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