Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The proctor seized during a USMLE Step 3 test. See what this doctor did next.

David Pyle, MD
Physician
May 9, 2016
666 Shares
Share
Tweet
Share

USMLE Step exams are a rite of passage in medical education. They mark the  transition from pre-clinical years to clinical years, from medical school to residency and from intern to resident. One of the more difficult aspects of the transition to residency was convincing myself that I really was a doctor. The habits of explaining my role as a student, of hedging every statement with “I’ll need to ask the resident,” proved difficult ones to break. As I studied for my Step 3 exam, the final step, I hoped that this milestone would be the one after which I would believe I was a real doctor. With the exam approaching,  I attempted to simultaneously balance my job as a pediatric intern, my responsibilities to my wife and 5-year-old son, and the annoying but persistent need to sleep. I tried to focus on my studies, but I was frequently distracted by these more pressing matters.

On the wards, I could see the progress I’d made as an intern.  I was learning more than I ever realized I could, but I answered practice question after practice question incorrectly. I became discouraged and wondered if I would ever be a truly successful doctor.  I struggled to balance the pride of my increasing knowledge of medicine and the looming shadow of all the knowledge left out there, waiting to be acquired. I often worried about being the only medical provider in an emergency. The thought was exhilarating but tinged with a distinct fear of failure. Each time I’ve prepared for a USMLE Step exam, studying has exposed this fear and reminded me of the many things I still do not know.

On a cold and dreary day in December, I walked into the testing center for the second day of my 2-day, 17-hour  Step 3 exam. I was cautiously optimistic after completing the first day, but the computerized patient vignettes that comprised the second day made me very nervous. These timed, subjective units test a range of management decisions for sample patients. I was hopeful that by getting through this test I could finally get back to the real learning, with real patients.

As I took my lunch break, I walked through the entry room where two proctors sat idly watching the test-takers through a large glass window. I remember thinking the young man looked much less interested than his older female coworker. As I was nearing the end, 5 hours into the 8 hour day, I was clicking button after button to save another 65-year-old with COPD exacerbation when I heard a crash and a scream behind me. I turned around. Where there had been two proctors behind the glass, there was now one, looking terrified. The distracted young man from earlier in the day was nowhere to be seen. As her eyes caught mine through the window, I thought to myself “Don’t say it! This is Step 3. I need to focus. I HAVE to pass this.”

When she motioned for me to come over and mouthed the words “Help! Please!” I felt my heart rip in two. There was a part of me that wanted to put my head down and finish my test. What could I really do anyway? I had been a doctor for only six months, and I hadn’t even had my emergency department rotation yet. There was another part of me, the part that chose to invest my life in pursuit of helping those in need; that pulled me out of my compulsion to continue the test. The woman looked terrified. I could only imagine what had just happened to her coworker.

I felt like I was moving in slow motion. I glanced around, thinking “Surely there is at least one other physician here. I won’t be the only one to respond,” but my hope was in vain. Alone, I stepped out of the testing area and saw the male proctor lying face up on the floor, his entire body shaking rhythmically. Blood mixed with saliva was dripping out of his mouth. His leg was repeatedly smacking into a nearby chair, and his head was inches away from a corner of a wall.

In the next few seconds, I left my test-taking brain at the computer. I didn’t wrack my brain to think through the differential of congenital and acquired seizure disorders. I didn’t consider the risks and benefits of each anticonvulsant.  I hardly believe it myself, but my thoughts were “Airway … Breathing … Circulation …”

I knelt down and turned the young man over onto his side, pulling him away from the corner and chair. I watched his chest rise and fall in short rapid breaths and hoped his airway stayed clear. I felt his pulse racing as I tried to stabilize his flailing arms.

“What’s wrong with him?” the other proctor asked from her desk with a phone in her hand.

“He’s having a seizure. Are you calling 911?” I asked, and she broke from her daze to dial the numbers.

I could not tell how long he seized. I imagine it was just a few minutes, but it felt like an eternity. As he regained consciousness, he seemed very disoriented. He asked the same questions repeatedly and attempted to stand up despite my asking him to lie still and rest. I spoke to him calmly, explaining what had happened. I asked about prior seizures, medical problems, and medications. When I finally heard the ambulance siren I couldn’t tell if it had been two minutes or twenty. Two men in dark jumpsuits walked in the front door and opened a box of supplies. As the first turned to me and asked what happened, I reported what I had seen: a crash, a scream, a young man having a generalized tonic-clonic seizure. They took over care of the patient, and I stood up, walked back to my computer, and resumed my test.

My patient with COPD popped back up on the screen as though I had never left. He was still waiting for his bronchodilator orders. Most of my brain fell back into the rhythm of the exam, but part of it stayed behind in the other room with the proctor. As I finished the test, I couldn’t help but think about the irony of the situation. I was taking a formal test to earn the right to practice medicine but the rite of passage I underwent that day had nothing to do with etiologies or treatment modalities. When I found myself the only physician in an emergency situation, the basics kicked in. When I was terrified that I couldn’t help, I sat with my patient and did what I could to help. I do not know what happened to the young man that day after he was rolled out on a stretcher. I will likely never know either what caused the seizure or the patient’s eventual outcome.  I don’t know how much, or even if, my intervention changed anything. But as I sat at my computer clicking buttons to finish the test, I felt for the first time like a doctor.

David Pyle is a pediatric resident.

Image credit: Shutterstock.com

Prev

To make big heath care changes, think small

May 9, 2016 Kevin 4
…
Next

U.S. medical school graduates aren't enough to fill the physician shortage

May 9, 2016 Kevin 20
…

Tagged as: Neurology

Post navigation

< Previous Post
To make big heath care changes, think small
Next Post >
U.S. medical school graduates aren't enough to fill the physician shortage

Related Posts

  • USMLE Step 1 pass/fail winners and losers

    Aamir Hussain, MD
  • There is no place for USMLE Step 2 CS during a pandemic

    Anna Goshua
  • a desk with keyboard and ipad with the kevinmd logo

    The impact of removing numerical scores from USMLE Step 1

    Cory Michael, MD
  • Bracing for change: the escalating importance of USMLE Step 2

    Karolina Woroniecka, MD, PhD
  • USMLE Step 1 tips that may surprise you

    Jason Ryan, MD
  • It’s time to end the USMLE Step 3 exam

    Madeline Wozniak

More in Physician

  • Physician entrepreneurs offer hope for burned out doctors

    Cindy Rubin, MD
  • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

    Elizabeth Cerceo, MD
  • Raw humanity on night float: inspiring patient encounters and overcoming challenges

    Johnathan Yao, MD, MPH
  • Revolutionizing emergency medicine: Overcoming long-term challenges with innovative solutions for physicians and patients

    Anonymous
  • The pediatric health care system tested to the limits: an inside look at the “at capacity” period during the tripledemic

    Jacqueline Bolt, MD
  • How chronic illness and disability are portrayed in media and the importance of daily choices for improved quality of life

    Juliet Morgan and Meghan Jobson
  • Most Popular

  • Past Week

    • A patient’s perspective on the diminishing relationship between doctors and patients

      Michele Luckenbaugh | Conditions
    • Unmasking wage disparity in health care: the truth behind the Elmhurst Hospital physician strike

      Kevin Pho, MD | KevinMD
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • How electronic health records preserve patients’ legacies in the words of oncologists

      Marc Braunstein, MD, PhD | Physician
    • Unmasking the brutal reality of gun violence in America: a call to action for unity and meaningful change

      Osmund Agbo, MD | Policy
  • Past 6 Months

    • The growing threat to transgender health care: implications for patients, providers, and trainees

      Carson Hartlage | Policy
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
  • Recent Posts

    • Physician entrepreneurs offer hope for burned out doctors

      Cindy Rubin, MD | Physician
    • Uncovering the truth about racial health inequities in America: a book review

      John Paul Mikhaiel, MD | Policy
    • Why electronic health records are failing patients: the dark side of copy and paste [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • The surprising medical mystery of a “good” Hitler: How a rescued kitten revealed a rare movement disorder

      Teresella Gondolo, MD | Conditions
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 6 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • 'Medically Relevant to Saving the Life of Your Patient': What We Heard This Week
  • Want to Solve the Nurse Shortage?
  • Why Are Female Doctors Sued Nearly Half as Often as Male Doctors?
  • What Drug Did FDA Just Approve for COVID?
  • PET Scan for Alzheimer's Dx; Predicting Colon Cancer Survival

Meeting Coverage

  • No Access to Routine Healthcare Biggest Barrier to HPV Vaccination
  • Trial Results Spark Talk of Curing More Metastatic Cervical Cancers
  • Cross-Border Collaboration Improves Survival in Pediatric Leukemia Patients
  • Monoclonal Antibody Reduced Need For Transfusions in Low-Risk MDS
  • Less-Invasive Surgery for Pancreatic Cancer Proves Safe, Effective
  • Most Popular

  • Past Week

    • A patient’s perspective on the diminishing relationship between doctors and patients

      Michele Luckenbaugh | Conditions
    • Unmasking wage disparity in health care: the truth behind the Elmhurst Hospital physician strike

      Kevin Pho, MD | KevinMD
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • How electronic health records preserve patients’ legacies in the words of oncologists

      Marc Braunstein, MD, PhD | Physician
    • Unmasking the brutal reality of gun violence in America: a call to action for unity and meaningful change

      Osmund Agbo, MD | Policy
  • Past 6 Months

    • The growing threat to transgender health care: implications for patients, providers, and trainees

      Carson Hartlage | Policy
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
  • Recent Posts

    • Physician entrepreneurs offer hope for burned out doctors

      Cindy Rubin, MD | Physician
    • Uncovering the truth about racial health inequities in America: a book review

      John Paul Mikhaiel, MD | Policy
    • Why electronic health records are failing patients: the dark side of copy and paste [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • The surprising medical mystery of a “good” Hitler: How a rescued kitten revealed a rare movement disorder

      Teresella Gondolo, MD | Conditions
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The proctor seized during a USMLE Step 3 test. See what this doctor did next.
6 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...