How failing Step 1 helped me pass the boards. Twice.

I remember the day well. The dean of my medical school called me directly. As soon as she announced herself on the other end of the line, I knew it was bad news. Deans don’t tend to make social calls, and I was right. She was calling to tell me that I had failed the USMLE Step 1, the first in a long series of standardized national exams to complete my medical training. I felt my dream of obtaining a medical degree slipping through my fingers. Years of hard work, long hours, and sleepless nights all amounting to nothing. What followed was an ugly cry kind of moment. And by moment, I mean a week or two.

But as I write this, nearly two decades have passed since that day, and I have now successfully became a board-certified physician for the second time in my career. The satisfaction is even sweeter remembering the weeks after my failure and the difficult transformation that followed. As echoed in so many motivational quotes, it’s not the failure that defines you but your response to it. Looking back, my success relied heavily on a few very specific steps I took after that phone call and the ugly cry that followed.

I started talking about it. Silence feeds shame. At first, I was embarrassed and didn’t want anyone to know what had happened. It was a failure after all. But once I decided I wouldn’t keep quiet about my failure, I took control of the situation — and my future — again. In addition, once I started talking, I began to find a community of support, advice, and guidance on what to do next.

I got professional help. Initially, I tried to start studying again right away but each time I opened the books, I was acutely reminded of how badly I had done the first time around. What quickly followed was intense anxiety that I would never pass this test. I couldn’t focus, concentrate, or learn. And what was worse, I couldn’t see a way out. Thankfully, a friend suggested I talk to my doctor about my symptoms, and since I didn’t have any better ideas, I did. She prescribed an anti-depressant, and I slowly began to manage my anxiety and depression about the situation.

I got clarity. With time, I was able to discover what the well-known psychologist, Martin Seligman, termed the 3 Ps that prevent emotional resilience: personalization, permanence, and pervasiveness. Time let me see that this situation was not personal to me (other people failed too), nor was it permanent (I had a second chance to take the test) or pervasive (the rest of my life was still pretty great). With this new vantage point, I was able to start refocusing my efforts on passing the test the second time around.

I got vulnerable. The letter with the failing score posted to my wall forced me to admit I might not have all the answers, and there might be a better way to study. Specifically, someone else might be able to teach me a better way to study. I started visiting with a test-taking expert each week for strategies on what works and what doesn’t and opened myself to new methods. Until then, it had never occurred to me that someone had studied the act of studying! Once I understood that there was scientific literature supporting the changes she was asking me to make, it became much easier to adopt the new strategies she was suggesting.

I got comfortable with going slow. Her first lesson: Slow it down. Previously my focus had been simply moving through the material as quickly as possible. Now the goal wasn’t just to check a box that I had read the material, it was to actually understand what I was reading and why it was important. This meant that if ten pages took ten hours, so be it as long as I walked away really understanding what I’d read.

I applied my new knowledge. I changed gears from the more passive approach of reading and re-reading to more active learning that included a lot more practice questions and problem-solving. I also practiced teaching my new knowledge to anyone who would listen–friends, roommates, even my cat.  The act of teaching quickly revealed any gaps in my understanding and was a very effective (if unforgiving) measure of how well I knew the material and what I needed to go back and review.

I spaced out. My repetition, that is. Another strategy my mentor advised (and which has since been extensively written about in Peter Brown’s Make It Stick) was the concept of spaced repetition. This basically boils down to reviewing recently learned new information with breaks in between. This meant going back to material days and weeks later to review it and, if needed, re-learn it. Time-consuming? Yes. Effective? Absolutely.

Ultimately, implementing these strategies required a big dose of humility, a lot of hard work, and a willingness to try something new. My Step 1 failure could have been the end of my medical career, had I let it. Thankfully, I was willing to adapt and by doing so, I was able to find guidance on a better path forward. We all fail in small (and sometimes big) ways every day. The key is to adapt and adjust course when you do.

Erica Howe is a hospitalist and founder, Women Physicians Wellness Conference, and CEO, The Medical Educator.

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