Next 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 a fourth-year Harvard medical student. E-mail her at shortwhitecoat@gmail.com.

I just took step two of the national board exams, yet another hurdle en route to earning that medical degree. Each subsequent step becomes easier as pre-clinical material cedes ground to more practical, patient-based knowledge. Case in point: the only nod to the organic chemistry we once had to slog through was a question about the difference between DNA and RNA (the stuff of middle school biology).

Still, these exams are inevitably artificial in their answer choices and in the time allotted to picking them. The test demands that we push aside the nuanced thought processes that should inform clinical decisions in favor of the knee-jerk responses that, after doing hundreds of practice questions, we’ve learned test-makers want to see.

Young African-American woman has a cough and bumps on her shins? Sarcoidosis. Salmon-colored rash on a kid? Juvenile rheumatoid arthritis. That pearl we learned from taking care of patients becomes a distraction, and knowing too much about a subject becomes a handicap. Arguably, the exam provides a useful quantification of knowledge we’ve accrued over the years, but how well does it really correlate with our future effectiveness in practicing medicine?

Numb from nine hours of motionless concentration on that day, I rose from my swivel chair and trudged out of the testing site. Once home, I ceremoniously piled my test prep materials in the back corner of my room and mentally re-set my focus to patient care. My next task at hand in this fourth year of electives is a sub-internship in medicine at the Massachusetts General Hospital (a brief taste of life as an intern) and then, eventually, step three. What was that about being a life-long learner?