The first step

Short White Coat is a blog about learning to be a doctor. Posts appear here as part of White Coat Notes. Ishani Ganguli is about to start her third year as a Harvard medical student. E-mail her at shortwhitecoat@gmail.com.

In the very-linear path to doctorhood, the Step I Board Exams mark the end of the classroom learning that has defined 20 years of our lives. This national licensing exam covers All of Medicine (as we know it) and is known to be the worst of the bunch (Step II, at the end of medical school, requires about two weeks of preparation, and Step III no more than the proverbial number 2 pencil, the saying goes). It also represents the first time we’re graded (Harvard Medical School is pass/fail). We need to pass the exam to graduate, but the score is a component of our residency bid in two years.

Preparing for this exam was the singular focus of our precious free time in the past few months, and the soon-weary excuse for skipping out on social events and neglecting the Important Things in Life. In our attempts to learn or relearn the vast amount of material covered by the exam, we clung to the tried-and-true review books, memorized inane mnemonics that often stuck longer than the content they represented, and clicked through endless cycles of online practice questions.

Among fellow sufferers, we’d unapologetically judge every interaction on its relevance to The Boards (yield was paramount -- low yield was a stinging indictment, high yield the ultimate praise). As long as classes were in session, we’d work ourselves into dizzy spells over our classmates’ preparation, each convinced at the drop of a lysosomal storage disease that the others knew more (of course, this was sometimes true).

This particular brand of neurosis took a toll on our wallets, as we amassed review books and school supplies to soothe our tired brains. A new book was a novelty, the freshly printed pages inviting their study. And maybe, just maybe, the water- and flame-resistant index-card holder and that perfectly tinted highlighter would make the information stick just a little faster. Once the retail therapy wore off, we hoped to be left with the rapid recall of the drug interactions and often obscure disease associations that make up the bulk of the test questions (neurofibromatosis and café au lait spots, squamous cell lung cancer and hypercalcemia).

On Wednesday, I was scheduled to release all the factoids that were swimming in my head like so many Naegleria fowleri (brain-infecting amoeba that invades the noses of freshwater divers.) And in the flash of an eight-hour, 350-question multiple-choice-a-thon, it was all over.

It’s unclear how much our scores really matter (we’re assured by our professors that they are less critical than we convince ourselves). But the experience at least consolidates what we’ve been learning for the past two years and prepares us somewhat for our imminent descent into the hospital wards -- the "classroom" of our third and fourth years. If only real patients came with multiple choice answers.