High School Forever

Some of the unsung joys of undergraduate medical education in the United States are the NBME Step exams I, II and III. In theory these exams are designed to weed out those students who are unfit to practice medicine on patients who have little to no concern for their health. Three seconds spent in a community clinic with family practice residents would disabuse this quaint notion. How do foreign medical graduates pass these exams? God only know, and he’s laughing.

An ancillary benefit of the Step exams and certainly the most salient fact for students attending medical schools in the continental United States is that Step I takes much of the decision making out of choosing what field of medicine the student will pursue. “I always wanted to be a ……….” Bullshit, your Step I score narrowed it down to psychiatry or family practice.

Check out http://www.nrmp.org/data/chartingoutcomes2007.pdf for a more precise correlation of score to successful match.

De facto caste assignment via Step I score brings a whole new dynamic to social interactions by the end of the 3^rd year. Your fellow students pretty much know how well you did by your answer to, “what do you want to do when you grow up?”

Listen up 1^st and 2^nd years this is a trick question! Whoever poses this question wants you to answer with their specialty or, “golly gee everything is just so great, I have no idea what I want to do.” Do not dare tell them what you really want to do if it differs from their chosen specialty and is higher in the caste system. That’s right, even if you have known since you were three years old that you want to follow in the footsteps of Dr. Rey and spend inordinate amounts of money on ostentatious clothing as an outlet for your repressed homosexuality, fake it! Unfortunately these answers do not hold up and you will eventually have to admit that you really want to go to the Brigham and become a world renowned plastic surgeon. You will lose some friends. Unfortunately some of your colleagues will be envious of your standardized test performance so much so that you will become the butt of endless snide comments. Can’t we all just get along?

P.S. I in no way mean to imply that I agree with the specialty caste system in any way, neither is my intent to disparage plastic surgeons, repressed homosexuals, psychiatrists or family practice physicians. Individuals just tend to self segregate themselves, which is a drag. As I have previously stated there are exceptions to EVERYTHING. Here’s to you, Ms./Mr. 274 Step I who always wanted to be a psychiatrist.

It has been a long time, 3rd year is over and there is much to write.