Board to Death: Students Feel Pressure of “Big” Exam

Sierra Green is nervous.  On June 17, the 23-year-old medical student from Kennesaw will take the first of 3 high stakes exams, spread out of the next 7 years, that will determine whether she can practice medicine in the United States or not.

Step 1 of “the boards,” as the U.S. Medical Licensing Examination is universally known, is a grueling eight-hour test that is mandatory immediately following the second year of medical training. It is supposed to assess how capable students  are of applying fundamental scientific concepts to the practice of medicine.

Success is crucial in advancing to the next two years of medical school, when they will spend more hands-on time with patients. In the long run, and exam scores  often determine where they’ll be accepted for internship and residency.

Success rates are very high for first time test-takers. According to the USMLE website, of the 19, 842 people that took the exam in 2010, 90 percent, or 17, 857 students passed. But for repeat test-takers, that is, those who failed the first time, success rates are much lower: 61 percent.

“Historically, I’m not the best standardized test taker, and I feel like they don’t represent how well I can do in a class setting, or in the future in my career,” said Green. “It is frightening to have everything boil down to this one test, especially because we’re going to a new school, and we’re kind of guinea pigs.”

The UGA/GHSU partnership in Athens was established two years ago to alleviate the severe statewide physician shortage (Georgia ranks 40th in the nation for physician to patient ratios), but tensions still run high between the new campus and its sister school in Augusta due to funding allocation. Its financial future heavily depends on whether or not the majority of students pass the exam.

Anna Bunker, a second year med student at the UGA/GHSU medical partnership, shares Green’s sentiments. “I know so many people who are smart and they are going to be good doctors, but they are not the best test takers,” said Bunker. “I think there will be some that don’t do as well on the exam, maybe even myself.”

Green and Bunker are part of the first cohort of partnership students to ever sit for this test, which is a make-or-break moment for each of them individually and perhaps for their school as well.

Their performance will have an enormous effect on the school’s overall reputation, said the school’s dean, Barbara Schuster. “Certainly all eyes are upon us from both [GHSU] institutions, and with a cohort of only forty students, the numbers are very small, and the statistics will be very difficult,” said Schuster.

Nonetheless,Schuster added that pre-test scores from second year students matched the national average, and that she is “feeling very in confident that the students will do very well.”

Like Green and the other students, Schuster knows that anxiety is the enemy where  standardized tests are concerned. She also believes that step 1 and similar exams can’t accurately predict someone’s future performance as a physician, but acknowledge that scores can  influence where students train after graduation and  what specialties they pursue.

A recent shift in career goals has raised the stakes for Justin Brooten Brooten, a former EMT and high school science teacher. He says his newfound interest in opthamology has  “definitely upped the ante”  as he studies for the exam.  He knows that that only top-scoring students secure slots in ophthalmology residency programs that prepare students for a career that generally involves regular hours and high compensation. “Before I wanted to do well, but now, I really, really have to do well,” said Brooten.

Brooten said that balancing schoolwork with  studying for the boards is an extraordinary challenge, especially because he’s  married  and wants to maintain a healthy relationship. But no matter how hectic his schedule, Brooten says he  and his wife set aside quality time and do things together. If he doesn’t, he’ll loss his  battle with anxiety.

“Taking breaks from studying is essential,” he said. “If you let your stress get out of control, you’re not going to retain anything, and that just adds even more stress to the equation.” Nonetheless, he admits that stess levels will always run high, even for the most level-headed med student.

“ It’s definitely overwhelming,” he said. “And if it’s not overwhelming, you’re probably overlooking something.”

Exam jitters are certainly taking a toll on Bree Berry. The 23-year-old student from Marietta said that exam worries are always there, no matter what she’s doing, and that “the boards” dominate  conversations with friends, medical students or not. Also, because she lives with three classmates, Berry says  “there’s hardly a moment [she] can totally forget about something that’s not stressful or school related.”

Above all, Berry says pervasive stress causes  irrational reactions to minor  mishaps.  “I feel like this all time,” she said. “Everything will be going fine, and then one day I’ll drop a bag of groceries, or my car door won’t open and it’s like a miniature breakdown.”

Despite the temptation to buy into the idea that one exam will determine one’s entire future,  Bunker manages to remain optimistic .

“If I don’t pass the test, the world will not end and I’ll take it again,” she said. “I can see looking back that med school is what I was supposed to be doing with my life, so I think it’s going to be fine.”


Robyn Abree

Robyn Abree

Robyn Abree is a second year master’s student interested in covering nutrition, fitness and other forms of prevention. She spent summer 2011 interning at GivingPoint, an Atlanta-based nonprofit that educates youth about health and public service.She created a “Positive Living” lesson plan and quiz that promotes active, healthy lifestyles among teens. Robyn has also written for Georgia Engineer magazine, Georgia Health News, and BLVD magazine.

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