Yesterday I binged the entire first season of Wet Hot American Summer on my couch. My mother cooked ribs on the grill. My brothers were in town. Last night, I sipped beers, laughed very hard with friends, talked to cute girls, and smiled.
I have smiled more the past two weeks than I had in the past 6 months combined.
I hadn’t smiled much at all since starting my second year. With deaths, self-induced isolation, a break up, and Step 1 looming over my head – it was a tough year for me. I’ll write more on all of this is my next post, but for now I want to send a message to anyone currently entering their second year of medical school. You may read this and scoff, but perhaps someone will read this and learn from my mistakes. This is my message in a bottle. I hope someone who will need it in the future finds it.
This is my grand confession: I have been absolutely miserable for the past year. I think I did pretty well on Step 1. My goal was 250. Pretty much all of my practice test scores during dedicated were greater than 250.
But it made me miserable.
All is well now. I am revitalized and the world suddenly feels like a playground again. Life after Step 1 has been nothing short of glorious. I meant to write this post immediately after my exam, but I’ve been having too much fun to sit down at my computer and type these words. I am more excited for life itself than I have been in years.
However, just two months ago, I came to the realization that I was slowly but surely destroying myself.
My muscles had atrophied. My energy had plummeted. My weight had dropped. My phone’s inbox had become empty. My friends had dwindled. My passions had taken the backseat to Step 1. My guitar collected dust. My happiness had faded. My only joy in life was a good score on my daily UWorld block. I was not me at all.
Do I regret working hard and making sacrifices to put myself in position to do well on Step 1? Absolutely not. This test is my (our) future, and I’d be ashamed if I let this opportunity slide by without giving it everything I have.
But I messed up. I let it consume me. And by the end, I was burned out. Not in the sense that I grew tired of studying – I deeply enjoyed studying. Yes, I loved studying for Step 1. I embrace the stress. A goal. A journey. A challenge. I thrive on pressure, as I’m sure many of you do as well. I felt like Rocky Balboa training in the Siberian tundra to fight Ivan Drago. I welcomed isolation.
A couple months ago, I saw a post on the medical school Reddit page. The post was written by a student who had just completed first year. It read:
During orientation week… everyone was saying how you should make time for hobbies, you should find a good balance between school/life, you should make sure you prioritize loved ones above school, etc. This advice makes a lot of sense. But you have to take into account WHO the advice is coming from.
Almost every student who was telling me these things was going into a primary care specialty. They were mostly average students… It wasn’t until I met an M4 who was applying to derm programs and another M4 who was applying urology. It was insane how different their advice was. They said if I wanted to do something competitive, I had to bite the bullet on the next 3 years of school and make it my top priority. They said to spend every waking moment doing your absolute best and working your ass off NOW, so you can enjoy your dream specialty LATER.
I cringed. I wanted to shake this person and scream, NO. Please god – just no.
I know they meant well and I don’t blame them for thinking like this. I was the same way. It’s easy to become engulfed by this mindset but it’s simply not true. It’s a lie.
Yes, you have to work harder than you’ve ever worked in your life. Yes, you have become militant at times. But you also need to know when to turn it off.
My friends, you don’t need to sell your soul to succeed on Step 1.
As I said previously, most of my practice test scores in dedicated were above 250. On Wednesday, I’ll get my score. I felt that I did pretty well on the real deal too. Not sure though. I don’t really care. I know what I put in. I know where I stood. The three digit number that they churn out isn’t “me”. If I get a 260, sweet. If I get a 240, it’s the same damn thing.
I started studying consistently in November, roughly seven months prior to my test. By dedicated, I had covered every subject in depth. I had completed UWorld. I didn’t know what to do with myself.
Before dedicated, I spent months building a wall around myself, brick by brick, closing off all connection to the outside world. I ignored texts and calls until I stopped receiving them. I went out once during the span of March to May. And during that day, which was supposed to be devoted to relaxation and laughter, I was doing Anki cards while out with friends. Is that normal? No. Absolutely not. During the three months before the test, the only reasons I left my apartment were to go to class or get food. Nothing else could pull me away from my cave, away from my kitchen table and my Macbook. By the end, no classmates ever called or texted me to go out and get a drink. They knew I wouldn’t show up.
I thought I had the be this way. That monasticism was the only route to success. I was flat out wrong. Not only did it destroy my mental (and physical) well-being, but it was completely unnecessary.
I could’ve gone out. I could’ve gone to the bar, drank beers, and layed on my couch hungover the next day. I could’ve taken a night off to watch a movie. I could’ve blown off studying and visited a friend for a weekend. It would not have changed ANYTHING.
I didn’t make much progress during dedicated. If anything, I regressed by the end. I had six weeks of dedicated. My practice test scores were the highest in weeks 2-4. By the end, I was so sick and tired of reading questions that I was making stupid mistakes on every practice test. The more I knew, the more I started to confuse myself on simple questions. The knowledge was there. But my soul was desperate to leave this chapter of life behind.
I don’t think there was a single question on Step 1, inside of the UFAP sphere of information, that I didn’t know. No extra Anki cards would’ve awarded me a single point on the test. You know what would have? Sleep. Rest. Happiness. Peace of mind. These things are wildly underrated. They’re more important than you can ever imagine.
And people actually think it’s a good idea to study for Step 1 during the summer between M1 and M2? We are given one last period of bliss to get away from medicine for a brief period of time and people want to throw that in the trash? It’s not a horrible idea, but it is completely unnecessary. It may not hurt you. You may not burn out. You may enjoy studying as I do. But you will miss out on memories. And you won’t be in a much better position for it.
If you are considering studying for Step 1 during the summer between first and second year, I have the perfect study plan for you. Get USMLE Rx, Kaplan, or another question bank. Do blocks on tutor mode. Every time you get a question wrong, have a drink. After a few, you won’t have the focus to study anymore, which is actually the goal. Now you will go hang out with your friends, smile, laugh, enjoy yourself and take a break from medicine.
Aside from perhaps your dedicated studying period for Step 1, medicine should never be on your mind 24/7.
You don’t need to abandon your hobbies. My guitar didn’t need to sit untouched for months. I should’ve sat down and played and learned new songs. I should’ve blown off studying occasionally to watch some weird horror movies. I should’ve taken some nights off to write more. I should’ve explored new music. These are my hobbies. These are the simple treasures of life that fill me with joy. But I told myself I didn’t have time for these things. I was wrong and I payed the price. You certainly have your own hobbies and passions. Make time for them and nurture the you that existed before this mess.
Make time to exercise. Last year at this time my shoulders were wider, my chest was fuller, and my abs were more defined. I was strong and I felt amazing. During the months leading up to dedicated, I convinced myself that an hour of working out meant an hour away from studying, and that simply wasn’t acceptable. I atrophied and felt awful about myself.
Make time for the people you care about. Kurt Vonnegut is one of my favorite authors. He is wiser than most and has the gift of being able to deliver profound messages with simplicity. He once said, “A purpose of human life, no matter who is controlling it, is to love whoever is around to be loved“. I convinced myself that I didn’t have time for the people I love. I told my (now ex) girlfriend that she wasn’t allowed to come visit me some weekends because she was a distraction. I ignored texts from my friends. I failed to keep in touch. I hardly ever talked to my parents. I made zero effort to reach out to anybody. And this destroyed me.
So with this knowledge, you must understand that it is painful to read posts from others claiming that finding balance in life is a bad thing. That a life outside of medicine cannot coexist with success on Step 1.
I promise you, friends, there is so much time during second year to study for Step 1. You can and will learn everything if you want to. But when you sit down at that prometric center to take Step 1, you’ll never remember it all. That’s ok.
When I read posts about people geeking out over the latest Anki deck, I cringe. We’ve become so weird. This is not normal. These things shouldn’t actually excite you. Having a patio happy-hour beer on a sunny day with friends should excite you. Going on a date should excite you. Not an Anki deck.
I am not jealous of the person who spent the summer between M1 and M2 studying for boards who got 260. I pity them. The real winners of this game are those who were able to find balance in life, maintain happiness, health and personal relationships, while knowing when to turn it on and kill the test.
Because that’s all Step 1 is – it’s a game. It’s an extremely important game, but it’s a game. It’s Fortnite. It’s Call of Duty. It’s Madden. It’s Runescape. You start playing. You are terrible at first. You slowly progress and get better at it. Then you finally sit down at a computer to play one last time. To face the final boss – Step 1. Afterwards, you get a three digit score. Then life goes on. It is not something that should ever ruin your life. It should never make you question your intelligence. It should never determine your happiness or sense of well-being.
It’s a game. You have to know when to laugh when you get a UWorld score below your average. You have to know that there are others out there who will be better than you. You have to give it your all, but you also have to know when to turn it off. You need to go outside. Exercise. Laugh with friends. You cannot let it consume your life. You cannot let it determine your daily happiness. And once it’s over, you need to smile and realize that you are a wildly talented, intelligent individual, and many people are extremely proud of you no matter what that score is.
I will say this one last time to drive the point home – most of my practice test scores were above 250. But I didn’t have to give up everything I love to get there. I truly believe that if I had spent a little less time studying, and a little more time doing the things I love, that I would have done the exact same, if not better, on Step 1.
So please, reader, if there is one thing you must take from this post, it is this: be kind to yourself.
Study hard. Work harder than you ever have in your life. I mean that.
Imagine two students. Both study the exact same amount throughout the week, but student #1 takes off Tuesday night to cook dinner and watch a movie to decompress. Student #1 also goes on a date on Friday night because going on a date is exciting and a nice break from the routine. Student #2 doesn’t watch a movie Tuesday or go on a date Friday night. Student #2 thinks that those activities would be wasted time from studying. Student #2 is not more dedicated. Student #2 is a masochist and a fool.
Wake up and hit the gym. Go out and have a few drinks on that random Friday night when you were supposed to be studying. Go on a date. Spend one Saturday binge watching an entire season of your favorite show. Go outside and go on a hike in the park. Laugh when you get a bad score on a UWorld block. Put your fists in the air like a heavyweight boxer who just won the title when you get a good score. Be a human being. You are not a robot. You are more than this test. Recognize when you’re overworked or burning out a little bit. Know when you need a break. And don’t punish yourself when you don’t hit your goal for a particular day. Please.
You can make yourself miserable, miss out on the beauty of life, ignore those you love, and score a 250 on the USMLE. You can also study throughout the year or months leading up the dedicated, enjoying yourself along the way, savoring the journey, and score a 250 on the USMLE as well. In my opinion, that’s bad ass.
It’s up to you.
As for me… I don’t like to think about it much, which is why it has taken me three weeks since my test to write this post. My second year of medical school was a very dark time in my life. One of my closest friends tragically died. Others died. My significant other of nearly three years abandoned me just before dedicated. I spent 99% of my time alone in my apartment.
Life is glorious now. I have a few weeks before I really start rotations. I have no reason to think about medicine. So I won’t.
I’ll open my score on Wednesday. Win or lose, I’ll celebrate. In fact, I’ll be in Chicago from Wednesday to Saturday. If you’re in town and would like to meet up for a drink, shoot me a message on twitter (@JordanSoze) or send me an email (firstname.lastname@example.org).
In my next post, I will reflect on the past year and expand on what really happened. If you’d like to read an entire post of my melancholy whining, click the link. If not, I completely understand.