The Untold Stories Behind Step 1

This episode [Ep. 4 “Pass/Fail”] dug up some old anxieties for me. I vividly remember my dedicated study period leading up to Step 1. I can recall sitting in my apartment trying to spend a scheduled evening to relax and feeling my heart beating out of my chest. I could not bring myself to relax even when I scheduled it in. My anxiety got so bad I actually ended up moving my test date sooner because I would rather not achieve my desired score or fail than continue to live in the anxiety riddled purgatory that is preparing for a high stakes exam where my entire potential as a physician would be boiled down to an arbitrary 3 digit score. I did pass but I also started my first SSRI by the end of my 3rd year as my anxiety continued to snowball from that moment on. I would say it was “generalized”, but honestly it was related to my medical education which just generally consumed most every part of my life at the time. 

Reduction of learners to scores, publications, and institutional pedigrees is common in medical education but the seeds of these fruits are sown much earlier. Growing up in a single-parent working class home in rural Tennessee, most people hoped a lot for me; however, they did not expect much from me. A seminal moment of my life occurred my junior year of high school. A tumultuous year that included  my mother’s second divorce and a devastating house fire gave me the impetus to change something in my life. 

I elected to leave my Title I county school in order to attend the #1 ranked public school in the state (at the time) down the road in the next county over. It wasn’t easy to get in the door. When my mom first called, they said they were absolutely full and could in no way accept students that did not live in the district. My mother was able to work into the conversation that I had taken the ACT the previous spring as part of the Duke TIP program and had received a passing score. Something unlocked when they realized this kid from the sticks could get into college as a high school sophomore. My name was passed along and luckily a family friend just happened to know the principal through the local Rotary Club and was able to advocate on my behalf. After 2 weeks of hopeful waiting, I got the call that I would have a chance to attend Oak Ridge High School. It was a ray of hope in an extremely dark time in my life, but it was also fraught with even more anxieties. I knew no one and was going from the proverbial small pond to big pond. I didn’t know if I could even hack it given these students came from the families of engineers, PhD scientists, doctors, dentists, and lawyers all the while being afforded every possible educational privilege of a large well-funded school system. 

My first day I remember getting to my 5th period class (AP US history) early. It was the first class after lunch and I felt safer sitting in an empty classroom than I did in the milieu of hundreds of kids I didn’t know. The teacher was there, and they looked perplexed when they saw me. He asked if I was the new student from Oliver Springs. I responded in the affirmative. They asked that I speak to him after class. I waited for the other students to filter out, thinking that this was going to be my “O captain my captain” moment where a faculty member saw my previously untapped potential and took me under their wing to help me unlock it. What actually happened was the teacher wanted to express their immense concern to me that I was not academically prepared for their course as it was the most difficult offering in the entire school. They said my coursework at my previous school paled in comparison to what their students had been doing since the time they were in 8th grade. They emphasized that I would be best suited to transfer to the non-advanced placement course. I remember holding back the tears as I simply said that I would still like to try my hand at it. I proceeded to ace the course and got a perfect score on the AP Exam. I made a point to pull the teacher aside at the end of the year and asked them to recount the first time we had met and what they had said. They apologized for thinking so little of me. I thanked them for the sense of spite which fueled my pursuits that year, but I also forgave them and thanked them for such a rigorous course which was the reason I came to the school in the first place. 

Learners should never be reduced to one output or to an aggregate of standardized assessments that fail to capture the intricacies of their lived educational experience. They are nuanced and complex. Learners that have matriculated to UME and GME institutions represent the most talented and hardworking among us, however, their test scores and GPAs don’t tell their stories.