When I was in high school, about a decade or so ago, everybody talked about junior year. The dreaded junior year of high school; it was supposed to be the hardest year, or so they said. Indeed, if it was your desire to go to a great university and lead a great life and do great things, you had to take a shit ton of AP and Honors classes, if for no other reason than to boost your GPA.
Letters and numbers. It is how students are measured. GPA, SAT, MCAT, USMLE, MD. Does it ever fucking end? The answer is yes and no. The exams become less frequent and how well we do on them becomes increasingly less important once they add those two little letters to the end of our names. In the meantime, in medical school, they think so little of us, they might as well just refer to us by our initials and our Step 1 Scores. But I digress.
I took one AP course in high school. Just one. And I would like to think I turned out just fine. Rather than doing AP classes, I took night classes at the local junior colleges. When I went to college, the grades transferred over seamlessly, and I was able to graduate a few semesters early as a result of it. It wasn’t a bad deal, because AP classes did not count towards fulfilling medical school requirements the way the night classes I took in high school did, and saved money on those semesters of college I didn’t have to pay for.
The third year of medical school is basically the equivalent of the junior year of high school. It’s the most stressful. In the preclinical years, we had only one responsibility: do well on our exams, and prep for the USMLE at the same time. Unless you were like me and decided not to start UWorld until two months before your Step 1 exam. In any case, those were our responsibilities: an exam every so many weeks and the big exam at the end of the year. As third years, we have the same responsibilities: an exam every so many weeks and the big exam at the end of the year. Except, on top of those responsibilities we also have to apply to away rotations, which are ostensibly auditions for residencies, buff up our CVs with extracurriculars like research and public health projects, and do a million other little things that crop up along the way, like getting the fifteenth fucking PPD to prove that you don’t have TB, or getting quantitative titers on vaccinations you had over 2o years ago.
On top of that, we also have to go rock our rotations which could be anywhere from 8 to 12 hours a day. I won’t pretend it’s the equivalent of work; we don’t have the responsibilities that physicians do and that suits me just fine at this point in my medical training. But it is work. It’s not enough to just show up, to just be there, we have to be on the ball all the time, ready to answer any question thrown at us by a preceptor, see patient after patient after patient back to back to back. Seeing patients is the best part, after all. Interacting with actual human beings instead of clinical vignettes in a textbook or question bank is simply a better way to learn medicine. But alas, if only it were that simple. That we could go to our rotations, go home, read up on the things we saw that day, and go back the next day and make ourselves better, take better histories, ask better questions, do better physical exams, write up better H&Ps. The strive to always be better is what keeps us moving forward, it is what makes good doctors. The need to take meaningless exams which equate to scores upon which we place far too much importance is what stunts our growth as future physicians. And that’s a damn shame.