Problem Solvers vs Gatekeepers

Something was shared from the podium during our last grand rounds that made me snap out of my dissociative state and sit up straight in that disgusting auditorium seat.

The speaker was my beloved Program Director, and he was sharing an update on the residency match process following the changes of recent years. Having lived through these changes myself as a recent grad, I was mostly looking around the room at all the attendings’ expressions of disgust as Dr. Taylor-Cho described the battlefield that is the residency match today.

While expounding on the origins of the emphasis placed on board exam scores, he said “There are test prep companies who are profiting from medical students’ anxiety.”

Up until this moment I was right there with him. But I must say this statement caught me off-guard.

I spent thou$and$ on test prep materials and I never once felt like I was being taken advantage of by the creators of these products……Had I been duped?

-glances over to corner of office-

Yes.

But not by the test prep companies.

In a time when the Step 1 score was universally understood to be the #1 factor considered by residency program directors, you might have assumed that it was also the #1 priority of medical school curriculum committees as well. Right? Wrong.

I’m not throwing shade, but my med school—along with every other school—wasn’t interested in helping any one individual score a 260 on Step 1. They made it abundantly clear that our neuroticism about Step 1 was a major thorn in their side.

“If you come to class, we can almost guarantee a passing score.” They would repeat this on loop as if they actually believed all we wanted to do was pass.

Their course materials reflected this belief. And thus the gaping chasm between the “official curriculum” and the “boards curriculum”. Needless to say our anxiety was supercharged.

But that’s okay. It’s not like I was paying $35K a year in tuition and fees for them to prepare me and support me in achieving my goals.

I know, Step 1 is p/f now so who cares. Well, if you think the new emphasis on Step 2 will prompt some changes to accommodate you and your annoying needs, think again.

I think that’s why I never felt taken advantage of by the test prep companies. They were solving a problem for me. They cared to do a good job because if they didn’t, they wouldn’t stay in business. Whereas the academic institutions who guard the entrance into medicine, they only need to shoot for the middle.

So yes, I paid additional money to outside sources to supplement (and streamline) my learning. But if I was being “had” by anyone, it was by my medical school.

The amount I spent on prep materials makes up 0.06% of the total cost of my medical education.

What percentage of my success on the licensing exams is attributable to these materials? Hard to say, but it is at least several orders of magnitude more than 0.06%.