My blog has been silent for a while...mainly because things have been pretty darned crazy in our house for the past nine months or so. But I wanted to take some time today to hopefully make some of you aware, at least to some degree, of a small part what your physician has been through.
I'm currently watching my dear wife study for her first round of board exams.
Now, most of us have taken tests - and many of us (myself included) are good test-takers. I've always fared well with standardized testing - the ACT, the GRE, etc. And I've done a lot of graduate-level test taking in advanced masters- and doctoral-level music courses. But nothing I have ever done compares to the kind of things doctors have to do for their board exams.
You see, when you read a physician's bio and see that they are "board certified", this means that they have passed a very difficult, very complex test (actually a series of tests for practicing physicians) with a high enough score to earn the label "certified".
Bekah is currently preparing to take what they call Step 1. Your family physician, or surgeon, or whatever specialist you go to see, has actually taken at least three rounds of board exams (Step 2 is taken during residency, and Step 3 is the test that must be taken prior to being allowed to practice medicine unsupervised - it's what means you are a "licensed" doctor). Then there are board exams for each specialization as well...it never ends!
But back to Bekah's current challenge...think of Step 1 as a cumulative exam, covering EVERYTHING a medical student has learned over the course of two years.
I look at the past two years, everything Bekah has studied, the many thousands of pages (not kidding at all here, folks) of content she has read, learned, memorized, and had to apply. And she has to take an exam over ALL of it. At once.
It wouldn't be so bad if it were like the tests most of us take - where you simply have to remember facts or formulas, or maybe know how to apply data to a situation to come up with the correct answer. However, the kind of questions that are asked on these exams are multi-level questions, meaning that you not only have to be able to recall facts, data, formulas, and other details, but often you have to be able to recall multiple facts from different disciplines. THEN you have to apply them to a specific setting or context, and THEN you have to be able to synthesize all of that information to determine the BEST possible choice (out of several options) based on what you know.
Questions look something like this:
A patient comes to the ER presenting with symptom A, symptom B, and symptom C. His medical history involves asthma, a heart defect, and certain lifestyle-related health-risk factors. He is currently taking medications X and Y. His blood pressure is 130/85, his pulse is 140bpm, and his temperature is 101.2. He was seen in the same ER for symptom A two weeks ago, and seemed to respond well to treatment with medication X, but now his symptoms have worsened. In the two weeks since he was last seen, he has traveled to Mexico and back. What is the most likely reason for the downturn in the patient's condition?
(this is NOT a real question - it is simply a theoretical sample intended to demonstrate the complexity and multi-leveled thinking required for your physician to pass his or her board exams).
Looking at the question, the first thing you see is that the patient has three symptoms. The physician must be able to recall possible causes of all three symptoms, along with any specific illnesses, bacteria, viruses, or disorders that could present with all three symptoms. The physician must also be able to look at the history elements - asthma, heart defect, and lifestyle-related health-risk factors - to determine if any of those could be contributing to the symptoms. Vital signs are next - again, recall of which illness, etc. might fit with the given vitals. Medications - the physician must be able to identify what those medications are used to treat, what their side effects are, and whether they might have any interactions. Then they are given some additional information (like the trip to Mexico) and finally asked to identify a possible diagnosis, treatment, process, or interaction.
Most testing that typical students think of involves simple recall of one or two facts with minimal at best "second level" thinking. (i.e. what composer from the Romantic period of music was best known for his incorporation of Scandinavian folk music elements into his solo piano pieces). That's what most of us are used to, and when we think of tests, that's what comes to mind.
We think it is a lot of work to prepare for a final exam in history (or in my case, my dreaded graduate course, Renaissance Music History). So we put in hours (the most time I ever prepared for a single exam in grad school was about 16 hours of focused studying) preparing. But med students put in WEEKS preparing for the Step 1 exam. And I am not talking about the months of classes in the 2nd year of med school that are supposed to be starting to prepare a med student for Step 1. I am talking about WEEKS of FOCUSED, INTENSE study. 8 to 12 hours daily. For ONE TEST.
You see, it is eight hours of questions like the one above. And if they don't pass, they are not allowed to continue study into the clinical portion of their education. Additionally, the scores from Step 1 are often used as filters for residency programs - if a student wants to get into certain specialized fields of medicine, they are expected to achieve higher scores in their Step 1 exam. And they only get one shot at it...
So there's a lot of pressure to succeed and do well. Pressure from the med school itself (they want their students to have the best pass rate and average score possible, because it makes them look good). Pressure to perform well to have the best chance to get into a desirable residency program. Pressure, for some, to simply pass the test to avoid extending the medical program another year.
I've watched Bekah preparing for this and have been amazed at the amount of time and effort involved - and at the incredible complexity of the questions, and the difficulty of the material. I've always been blown away by the sheer volume of material she has been required to know, but this takes the cake, because it is a cumulative exam like no other, because it goes so far beyond simple recall of facts it isn't even funny.
She has ten days to go before her test date. She's planning to spend literally most of her waking hours preparing, studying, reviewing, taking sample tests, watching lectures, listening to recordings, and doing everything she possibly can to make sure that her score is the best it can possibly be. She was able to take some time off the past two weekends to do something fun with our family, but for the next ten days, that probably isn't going to happen. It is a sacrifice she has to make, and one that her family is supporting her in 100%. As her husband, I've seen how hard this stuff is, and have some idea of exactly what it takes for her to do well. Most people do not have a clue how hard med school really is...
So the next time you visit your doctor, or have to go to the ER, or have a surgical procedure done, or consult with a specialist, THANK THEM for what they had to go through to be able to serve you...they spent countless, thankless hours (days...weeks...) studying and preparing and working to take their board exams so that eventually they could be in the position they are in today. They have given up time with family / spouses / loved ones. They have given up personal free time. They have had to sacrifice above and beyond anything most of us can think of - just so that they can continue to learn and eventually be licensed and able to practice medicine.
And if you read this and think about it, please pray for Bekah. She is working VERY hard, and desires to do extremely well. Let her know that you are supporting her in her efforts. It makes a difference, because studying for boards is a very lonely, frustrating, difficult process.
This has been an amazing journey to walk through with her...a difficult one...but the end of the first major component is in sight. Her third year begins July 1 with clinical rotations, which will be a whole different kind of adventure! I'm going to try to do a better job cataloging my experience as the husband of a medical student during the next couple years...in the meantime, until my next post...remember this:
THANK YOUR DOCTOR for what they've had to go through to get where they are. And never take for granted what has gone into enabling them to be able to serve you, help heal you, and help make your life better.
