MD [Vent] How to move forward (feeling like a failure)

[riseup2019]

As the title suggests, I am very much at a loss with what has been a rollercoaster of anxiety, depression and overall feeling like a failure. I failed my STEP 1 exam (184) and found out earlier this week that I failed by OB shelf exam. Really scared that this will continue to be a pattern and I've been hit with a tsunami of bad thoughts hence writing this.

I have always been a hard worker, and typically excelled prior to medical school. Received a full ride scholarship to a well-ranked university and managed to get into a few schools. Although my MCAT was not stellar, I was able to pass all of my school's exams (NBME's) -- never failed an exam, although I was average to below average for most. I didn't think I was at risk of failing STEP because I spent a lot of time studying throughout my first two years and started studying for it months in advance. I failed my school's NBME exam prior to taking the exam that gives us the green light to take the exam, but passed it on the retake. Studied and was doing ok on practice exams (not great, but at least passed the last one).

I also feel pretty much alone right now. I am studying for STEP again, and I don't know how to go on from here. I am taking a course, but right now I feel like they are pretty much dumbing the material down. Also, I already did UWorld twice during my last study period. So I have moved onto Kaplan and getting in the (50%-60%). So lost. Please help. Any words of encouragement would be really needed at this time.

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[VacheronConstantin]

As the title suggests, I am very much at a loss with what has been a rollercoaster of anxiety, depression and overall feeling like a failure. I failed my STEP 1 exam (184) and found out earlier this week that I failed by OB shelf exam. Really scared that this will continue to be a pattern and I've been hit with a tsunami of bad thoughts hence writing this.

I have always been a hard worker, and typically excelled prior to medical school. Received a full ride scholarship to a well-ranked university and managed to get into a few schools. Although my MCAT was not stellar, I was able to pass all of my school's exams (NBME's) -- never failed an exam, although I was average to below average for most. I didn't think I was at risk of failing STEP because I spent a lot of time studying throughout my first two years and started studying for it months in advance. I failed my school's NBME exam prior to taking the exam that gives us the green light to take the exam, but passed it on the retake. Studied and was doing ok on practice exams (not great, but at least passed the last one).

I also feel pretty much alone right now. I am studying for STEP again, and I don't know how to go on from here. I am taking a course, but right now I feel like they are pretty much dumbing the material down. Also, I already did UWorld twice during my last study period. So I have moved onto Kaplan and getting in the (50%-60%). So lost. Please help. Any words of encouragement would be really needed at this time.

The good news is that now you know what specialty you will apply to (FM). If you are a US MD at a reputable school, you should match. Your shelf and Step 1 failure are closely linked timeline wise, so its feasible to give one all-compassing explanation.

 

[riseup2019]

The good news is that now you know what specialty you will apply to (FM). If you are a US MD at a reputable school, you should match. Your shelf and Step 1 failure are closely linked timeline wise, so its feasible to give one all-compassing explanation.

I am interested in internal medicine (still in the field of primary care) so I was going to apply to any and every program I can in that. I do think that finding out about my STEP 1 failure during clerkship affected my confidence for the following shelf exam. I will be pulled out of my next rotation and have to study again, but how can I make sure I crush the exam and that I'm not just doomed to keep failing? (sigh)

 

[carrots28]

Change your study strategy completely. It could be that your approach was not the best for this type of exam. Best of luck

 

[riseup2019]

Change your study strategy completely. It could be that your approach was not the best for this type of exam. Best of luck

I approached it the way most do: UFAP (UWorld twice, and worked through pathoma and first aid the entire time). I am unsure what approach to take at this point. Do you have any suggestions/advice?

 

[togaedere]

I would add more questions. USMLE Rx questions are decent for determining how well you’re absorbing the knowledge from first aid, and I’m sure there are more question banks out there. Basically do all practice questions you can get your hands on, and go through them all in blocks every day.

My step 1 study strategy was this - I did a block of questions in the morning, went through all the answers. Then when I was done with that I spent the rest of the day on a dedicated body system (I think I had 10 distinct systems). Reading the first aid chapter, doing the pathoma, doing pharmacology, using whatever resources I had (I took step 1 in 2013). Then on the weekend I did a practice test in the morning (have you done all the NBME’s?) and took the rest of the day off. The following day I went through the nbme and went over what I got wrong.

What do you mean that you passed the last nbme? Does this mean you failed the others? If you fail a practice test you gotta go through that thing hard to see what you’re getting wrong. The answers aren’t immediately available but they are out there if you search for them.

I would definitely beef up how you are performing on practice tests - and not take the exam again unless you are clearing the practice tests by 20-30 points.

I approached it the way most do: UFAP (UWorld twice, and worked through pathoma and first aid the entire time). I am unsure what approach to take at this point. Do you have any suggestions/advice?

 

[MerYangBey]

I’m not sure what resources you’ve used. What’s a typical study day for you?

But I recommend using Boards and beyond to supplement your learning.
I’m not one of those people that like learning from question banks. I feel like they help cement the information but not necessarily a good way to learn if you have weaknesses in the subject matter tested.

Best of luck!

 

[riseup2019]

I would add more questions. USMLE Rx questions are decent for determining how well you’re absorbing the knowledge from first aid, and I’m sure there are more question banks out there. Basically do all practice questions you can get your hands on, and go through them all in blocks every day.

My step 1 study strategy was this - I did a block of questions in the morning, went through all the answers. Then when I was done with that I spent the rest of the day on a dedicated body system (I think I had 10 distinct systems). Reading the first aid chapter, doing the pathoma, doing pharmacology, using whatever resources I had (I took step 1 in 2013). Then on the weekend I did a practice test in the morning (have you done all the NBME’s?) and took the rest of the day off. The following day I went through the nbme and went over what I got wrong.

What do you mean that you passed the last nbme? Does this mean you failed the others? If you fail a practice test you gotta go through that thing hard to see what you’re getting wrong. The answers aren’t immediately available but they are out there if you search for them.

I would definitely beef up how you are performing on practice tests - and not take the exam again unless you are clearing the practice tests by 20-30 points.

I took an NBME early on in my studying and then 1 a few weeks later. I unfortunately tried your method last time around (did around 2 blocks a day and reviewed organ systems). I do not think doing a million questions helped me because a lot of times I was just getting isolated facts.

 

[riseup2019]

I’m not sure what resources you’ve used. What’s a typical study day for you?

But I recommend using Boards and beyond to supplement your learning.
I’m not one of those people that like learning from question banks. I feel like they help cement the information but not necessarily a good way to learn if you have weaknesses in the subject matter tested.

Best of luck!

I am trying to spend a lot of time balancing both this time instead of heavily focusing on practice questions. I also deal with serious depression which has made it hard to focus

 

[MerYangBey]

I am trying to spend a lot of time balancing both this time instead of heavily focusing on practice questions. I also deal with serious depression which has made it hard to focus

I hope you’re prioritizing your health and well-being. And getting any help you might need. At the end of the day that’s what’s most important.

 

[riseup2019]

I hope you’re prioritizing your health and well-being. And getting any help you might need. At the end of the day that’s what’s most important.

I do not think I have tbh. I signed up to take the exam, but don't know if I'll be ready in a month.

 

[togaedere]

Sorry it didn’t work for you

Sounds like the depression is a big barrier. Hopefully you have access to treatment and are focusing your energies there. People can and do rebound from step failures!

I am trying to spend a lot of time balancing both this time instead of heavily focusing on practice questions. I also deal with serious depression which has made it hard to focus

 

[riseup2019]

Sorry it didn’t work for you

Sounds like the depression is a big barrier. Hopefully you have access to treatment and are focusing your energies there. People can and do rebound from step failures!

This has been something I've probably started brewing in me since before I got into medical school. Throughout med school I've tried taking anti depressants, exercising, seeing counselors but I'm at a loss

 

[darknecrosforte]

You need a coach.

A coach is someone who knows what "success" patterns look like and will be able to watch you in action, overlaying your pattern with the ideal. Wherever your behavior/mindset isn't ideal, it will be identified and corrected. This should feel like therapy + someone watching over you while studying/doing questions/simulating exams. You should expect to feel "grilled" as your coach asks about your thought process regarding a LOT of choices or your understanding regarding a Pathoma video you just watched, etc.

It will not help for you to have an ego or to lie about understanding something since it will be verified when going over questions. This should not be cheap unless you're doing it through school, but most schools fall short in providing what I just described, usually due to time/commitment constraints in either the school or the student.

 

[riseup2019]

You need a coach.

A coach is someone who knows what "success" patterns look like and will be able to watch you in action, overlaying your pattern with the ideal. Wherever your behavior/mindset isn't ideal, it will be identified and corrected. This should feel like therapy + someone watching over you while studying/doing questions/simulating exams. You should expect to feel "grilled" as your coach asks about your thought process regarding a LOT of choices or your understanding regarding a Pathoma video you just watched, etc.

It will not help for you to have an ego or to lie about understanding something since it will be verified when going over questions. This should not be cheap unless you're doing it through school, but most schools fall short in providing what I just described, usually due to time/commitment constraints in either the school or the student.

thank you for this! where do you suggest I find such a person?

 

[darknecrosforte]

thank you for this! where do you suggest I find such a person?

Ideally, you can reach out to your school's "tutoring" department (they're all called something different depending where you go) as a starting place. They may have these specific services or only some of them. From there, they may be able to refer you to reliable coaches they have used for some students or at least tell you which ones are probably scams. Whoever is coaching must have taken Step 1 within the last 5 years to be effective imo.

You will have to self-assess how well you used each specific resource. Maybe you watched Pathoma, but wrote nothing down or never followed videos with USMLE-Rx Q's on the topic you just watched. If video, followed by questions immediately is your style, Lecturio is pretty good. Every video will have several questions that keep you honest about if you paid attention or not.

I'm not paid to recommend any specific tutoring service, but the only one I'm aware of that seems legit is medschooltutors.com, but they are pretty expensive. (30 hours of tutoring is ~$7000-8000). This is why you should try to get as much as you can from your school and if you lack the part where someone watches you study for a couple of hours and goes through questions with you, you can probably pay a classmate who scored super high but didn't rely mostly on super high IQ - to do it for much cheaper. To find the right kind of person in your class, you'd need to ask several high scorers who THEY'D say fits the description and go with whoever got the most votes.

 

[precisiongraphic]

I do not think I have tbh. I signed up to take the exam, but don't know if I'll be ready in a month.

DO NOT TAKE it again until you're ready. Delay the test. In fact, I'd talk to your school admin and discuss your depression and perhaps take a leave of absence or take Step I after third year with a research year in between.

Failing Step 1 again could be disastrous. Going through third year depressed could be disastrous and could even lead to being dismissed from medical school. What does your school say?

There is a Step 1 thread here on SDN where people post their practice scores and study tips. Here's an example of the study progression - you need to review that forum, post your scores on practice exams and get some help.

Step one goal: > 230

CBSE (before studying): 182.5
UWorld SA 1 (1 week of studying): 205
NBME 18 (3 weeks of studying): 203 (I was really rethinking my goal at this point and was absolutely demoralized)
NBME 16 (4 weeks of studying): 215
NBME 17 (5 weeks of studying): 230
NBME 19 (6 weeks of studying): 230
UWorld SA 2 (6 weeks of studying): 243
UWorld Questions: Timed random from day 1, originally scored around 40-50% with some even in the 30's, by the end averaging >70%, 66.7% was my overall average

Actual Step One Score: 241

As someone said above, you need a coach. There may be people posting here on the Classified section who offer Step tutoring and/or coaching. Take a look.

I wish you success - craft a plan and you'll get there.

 

[Tabiyou]

Can you talk to your guidance counselor? Maybe you need a LOA?

 

[riseup2019]

I am starting a course and will take a practice on Monday to gauge where I'm at. I know well over a few month has passed since I took the exam, but I guess it'll be my starting point to see where I'm at. From there, I will gauge if I need some extra time.

I've talked to my school's advisers multiple times over the summer about this problem, and I didn't get much help to be honest. Thank you all for your input, advice and encouragement. I really do appreciate it.

You all are right. I'm only going to take the exam when I see significant improvements on the NBME.