Brainwash 'n Vent

There it was. The truth. Stretched out in front of me like the end of days. And loudness. So much strife and bustle. Everywhere. Cars and the people with their voices and the humming of buildings with their AC units pumping in cold to isolated rooms separated from the world and the streets within the city of Chicago. And the El up ahead a block, three or four stories high with always the same voice alerting passengers and future passengers alike: "Doors opening." Then two bells. Then: "Doors closing." This was my present but less than an hour ago I was in a completely different world. Oppressive silence. The distant sounds of mouses being clicked at other terminals was the only thing to distract the dull buzz that came with inactive listening from taking hold on my ears. Distant, fluorescent lights. Everything controlled. And cold. So cold. That was the world of the United States Medical Licensing Examination Step 2, the second of three licensing exams. And I realized on the streets of Chicago, I could not remember a single question. 355 questions. 9 hours. And I couldn't remember a single thing.

What could possibly be more horrifying?

Step 2 is a serious exam, of course, otherwise, why would we have to pay $580 to take it? If cost equals quality, then Step 2 is a lot more important than the scantrons and blue notebooks I used to use in high school to take advanced placement (AP) exams--which actually helped me take less courses in college, saving me thousands of dollars. I think those cost $25. USMLE tests cost me money to prove that I can be a doctor. I guess if failed enough times, I would have to take a year of medical school again: $50,000. Okay.

AP scores can be dolled out in a simple 1, 2, 3, 4, or 5. Step scores are much much much more complicated. Not always was this so, of course. In the old days, you passed or you failed. Quite simple really. Because we all must be evaluated and found worthy of the MD that will follow our names for the rest of our lives, but do 355 randomly selected and sometimes silly questions mean that we deserve or do not deserve to put our hands on a patient, to share in their suffering, to help and to heal and to comfort and advise? No. They really, honestly shouldn't.

This year the passing score on Step 2 jumped up from 200 to 209. Was this arbitrary? How was this determined? And isn't nine points.... a lot of points? More importantly, if the passing grade was just determined based on how many people passed Step 2--which is the way some courses are run-- wouldn't this imply some kind of insidious ploy to make sure that enough people fail so that the administrators of USMLE can charge some poor soul another $580 and increase revenue? Or does the increased score make everyone feel better that residents are intelligent enough to be able to control and manage possibly dying patients, and the additional money made is just an extra benefit?

How many times have I heard a discouraged patient say something along the lines of, "I know you just see me as money to be made at my expense." Should I also feel the same way, as a medical student, stuck in a world of constant cost with no monetary profit?

Let's assume however, that a lot of thought was made into making it so that 209 was meant to really pick out who would do well as a resident in terms of knowledge. Isn't it possible that there are people who score below 209 who would make good residents because they know how to look up answers on uptodate or even google? And who work hard to make sure that they overcome their deficits? Conversely, couldn't someone with above a 209 simply make the worst resident ever and incur a lot of lawsuits because of they have the worst bedside manner? Or couldn't someone with a +209 score completely slack off for the rest of their career and be unable to provide the standards of care for anyone besides the hypothetical patients he saw before him in paragraphs on a computer screen on test day? I mean statistically, some people who score below 209 will ultimately practice great medicine while people who score above 209 will do absolutely terrible things.

So did I really need to be locked in a room for 9 hours--an amnesia-inducing, cubicle-filled room with no music, no food, no human contact for 9 hours--so that I could answer 355 questions that I would instantly forget and then spend the next three weeks until receiving my score panicking and scratching at my skin, picking at my scabs, and eating antacids like candy because how can you feel like you did well on a test if you can't remember any part of it? Only to find out that I did pass and that I did do well.

All that nervousness and I have to pay $580. Infuriating.