Training Towards Boards and/or Practice? Or a Little of Both?

So when I was in medical school, we all had our medical licensing boards (aka “the Steps”), at least two of them, to worry about passing in order to matriculate into residencies and to start the process for obtaining our medical licenses. It was a rite of passage. And even though many of us stressed and spent many a sleepless night in worry and study to pass them, they were not seen as insurmountable by most. The Steps were perceived as an important exam we had to take while going about the actual practice of medicine. During my second year, we only got two weeks off at the end for Step 1 study time. During my clinical years, we didn’t get any specifically designated time off to study for Step 2 unless we used our two week vacation.

And yet, when it comes to our specialty boards, the stakes feel immeasurably higher and most training programs do not set aside an uninterrupted study time period for these exams. After all, we are employees, where our absence means someone else is doing our work. While I was rotating as a medical student on elective pathology rotations and from what I’ve seen and heard since becoming a resident, many PGY-4 everywhere spend their senior year using their saved up vacation time and/or lighter CP rotations to study mainly for boards. Some are even barely seen on the rotation service and are more often seen glued to their cubicles studying or listening to boards review lectures. But what does this say for how we train our pathology residents?

Full disclosure…I am a concentrated crammer, always have been – a habit that I am still working to break but since I generally so well on standardized tests, I haven’t had the selective pressure to change as quickly as I probably should. So, I can’t imagine consistently studying for a year or two for these exams. Although I can imagine stressing over them for that long, I don’t have the attention span, memory abilities, or discipline to learn in this way. There is nothing wrong with the slow and steady study personality. But for me, I learn more by doing than by just reading or listening to lectures. And hopefully, this translates to needing to study less and not needing to feel as if I have to learn everything I should have in 3 years of residency crammed into 1 when my time comes.

But the specialty boards really seem to push our buttons, even to the point where there have been headlines of residents and fellows punished for their use of remembrances with some cases resulting in cancellation of scores. For many of those providing such remembrances to others, suspension of medical licenses have even occurred. Are we conditioned to feel that we need protected study time in order to feel confident that we will pass? Because as residents, who are no longer medical students, no such time is allotted because we need to carry out patient care.

So why do we seem to freak out so much more about our boards exams as a resident/fellow, then we did as a medical student? As a medical student, we learned most of the material for Step 1 during our basic science years. If we studied for our clinical rotations and attended clinical lectures, then we also were exposed to much of the material we would see on Steps 2 and 3. But do we learn enough while on pathology rotations to recognize most of the material we will see on our AP and CP boards? Or is it just the perception that we aren’t exposed to everything we need to be during our rotations that makes many residents spend a year or more studying for these exams?

From my experience, residency training programs are more variable than medical schools are in terms of their curriculum and exposures. So, how can we transform our training within the confines of our specific program’s idiosyncrasies to provide what we need?



Betty Chung, DO, MPH, MA is a second year resident physician at the University of Illinois Hospital and Health Sciences System in Chicago, IL.