Medicine From The Trenches

Experiences from undergradute, graduate school, medical school, residency and beyond.

Failure and Work Ethic

At some point in your career, you will “fail” at something. How you recover from that failure speaks volumes about your work ethic. I am going to explore some strategies for preventing and recovering from failures (or just poor performances).
Course Exams

At some point in your education, you will fail (or not perform well) on a course exam. Your first stop is to look at why you failed the exam. Was your preparation not detailed enough for the questions asked? Did you put off studying until the last minute and hope that you did enough to pass the exam? Did you approach the material from a position of “fear” rather than a position of “mastery”? In any of the above instances, you have to go back, correct your study methods and strive to perform better on the next course exam. Correcting your study methods means that you have to shove your ego aside and take an objective look (often best done with a professor), at what you need to add to your study session or how you have to change your approach to the materials. This is not the time to “make excuses” but this is the time to make sure that you hone your approach and add in any strategies that you may have missed the first time around.
If you are having a difficult time understanding your course material, then look at your background (or pre-requisite) preparation for the course. Most undergraduate science courses require a solid grounding in college algebra and trigonometry. If your mathematical preparation is not sound, you are likely going to struggle through much of your physical science courses. Courses such as physical chemistry (if you are a chemistry major) require a solid working and application knowledge of calculus (through multivariate). In short, make sure that you have the math preparation for the coursework that you undertake so that you are struggling to master both the math and the scientific concepts (a task that is formidable for the best students).
You also need to make sure that you reading skills are sound when you begin college-level work. If your reading skills are poor, specifically comprehension, take skills courses and upgrade your reading efficiency (speed and comprehension). If you anticipate the study of medicine, you must be able to read efficiently and understand the concepts as they are presented. Again, struggling with basic skills while attempting to master a large volume of materials is going to cause early burnout and lead to a poor performance in coursework both at the undergraduate and graduate level. Additionally, the Medical College Admissions Test (MCAT) requires strong reading comprehension skills for a solid score. Many medical college admissions committees will focus on the Verbal Reasoning skills portion of the MCAT as a means of deciding whether or not to admit a candidate.
Strong reading comprehension skills can be achieved by taking coursework that forces one to constantly and consistently analyze and critique different types of writing. Good writers without exception are good readers and good readers are usually very strong writers. It is a sound practice at the undergraduate level to challenge yourself with academic, scientific and scholastic writing experiences and courses. It’s also a good idea to read a variety of disciplines as an undergraduate. While it is expected that a physician will be able to read and evaluate medical literature, it is also expected that a physician will be able to incorporate new information and evidence-based medicine into their practice in an efficient and accurate manner.
Standardized Exams
Standardized Exams are well-represented in the career of physicians. Many of these exams have severe consequences when a test takers performance is not strong. Many students will have their first experience with standardized testing with the Scholastic Achieve Test (SAT) or the American College Testing (ACT) Test. Many people were able to take prep courses (expensive) and many people took one or both of these tests more than once. With most standardized tests in medical school, there are no “do-overs” unless you fail one of the steps of USMLE or COMLEX. If you go into one of these licensure board exams with the idea that you are going to fail (or do-over), you have put your career in serious jeopardy.
The key to a strong performance on USMLE (COMLEX) is through mastery of your medical school coursework and a thorough review before taking any of the steps of these exams. A review course does not overcome a poor knowledge base from poor coursework mastery. If you struggled with one or more of your courses (or clinical rotations), then you need to make sure that you review and shore-up that knowledge deficiency. Your test preparation needs to include going to the websites of these standardized tests and learning everything that you can find out about the test. What is the topic base being tested? How are the concepts tested? Are their retired exams available for practice? (Practice questions can be a good addition to your preparation strategy but you can’t memorize these questions because they are “retired” meaning that you won’t see them on the actual test). Don’t get “hung up” on material that is review material if you don’t know the concepts in the first place. This is why a potential test taker need both a knowledge base and a review not one or the other.
Your mindset going into any type of achievement or licensure board exam has to focus on taking the test one time and performing your best. The best way to insure that you have a strong performance is to not have an emotional reaction to the material on the test but to plot a sound review strategy once you have become eligible to take a licensure board exam. Many people focus on what they will do if they fail or what they will do if they don’t get a good score or what how they feel going into the exam (no one ever feels 100% ready but you have to ensure that you have done a thorough and sound prep). If you have been objective about what you need to review and learn and you have not attempted to take “short-cuts”, then you should be able to take your licensure board exams with the confidence that you can handle any concept that is presented on these types of exams. If you have mastered the concept and can recognize how the concept is being tested, then you can answer the question. If you can’t outright answer a question, ruling out possible wrong answers can be in your favor if your knowledge base is sound.
I know I am not ready but I will take the exam for “practice”This manner of thinking is a huge mistake on any standardized achievement exam. These types of exams are not designed to be taken for “practice”, thus consequences come with practicing on actual exam sessions. If you feel that you need practice exams, then spend the money on test prep center practice exams but don’t use an actual MCAT, USMLE or COMLEX exam session as a practice. If you take these exams and score poorly or fail, you have greatly compromised your future career in medicine. A string of mediocre MCAT scores even coupled with a strong undergraduate GPA will not yield success in medical school entry. In terms of USMLE/COMLEX, residency program directors are very wary or people who have multiple attempts at any of the steps in these licensure exams. All specialty residency programs have yearly in-training exam and specialty boards for board certification. If an applicant is struggling with USMLE/COMLEX, they are likely going to struggle with certification exams which will reflect back poorly on the residency program. Don’t take any standardized licensure board exam unless you are ready to pass the exam. There are no exceptions to this rule. In today’s world of residency slots being competitive in specialties that were less competitive even three years ago, you can’t afford to make yourself less-competitive because you took a USMLE/COMLEX step for “practice” and planned on repeating the exam. Get the “repeat” mentality out of your vocabulary and thinking.
Bottom-line Work Ethic
You have to be willing to let go of your ego, change some things that you have become accustomed to and objectively look at yourself if you want to move past an exam failure. If you failed any of the steps of USMLE/COMLEX, you have to let go of your “dream” of a lifestyle or surgical specialty and realistically look at what specialty (likely primary care) for which you are competitive. This means that high-achieving academic university programs in Internal Medicine, Pediatrics or even Family Medicine are going to be out of your reach. This means that community based programs in primary care which often require more self-learning are going to be the basis of your training. If you have a very strong work ethic, a community-based primary care residency program will be a great place to thrive and learn but you have to be willing to put in the work and you may have little choice in the location of your training program. You also have to be prepared for the strong possibility, especially if you have not received invitations for residency interviews which may herald that you may not match into a PGY-1 position, a state that is fraught with stress and pitfalls.
If you find that you have failed a course exam, you have to do the following with speed and purpose:

  • Seek out your exam and your professor so that you can review your exam and correct your preparation mistakes
  • Shore up your deficiencies in your coursework and keep up with your class so that you don’t fail another exam
  • Attend any tutorial sessions and office hours even if you believe you are on track with your exam prep. Checking your learning is a very good idea to make sure you don’t get off track a second time
  • Put any negative thoughts about your previous failures behind you. Every test is an opportunity to change your thinking and upgrade your performance.
  • Remember that you are in competition with yourself to do the best job with your coursework that you can achieve. There are few opportunities for “do-overs” in health care professional learning.
  • Stop comparing yourself to others in your classes or school. You have to do what you need to get the results that you want. What works for others, may not work for you so adapt and apply so that you get what you need for yourself.

By doing the above, this becomes your work ethic and sets the bottom-line for future success. If you can’t adapt and learn for your educational experiences, you will have a tough time moving forward with your training under any circumstances.


29 March, 2014 - Posted by | academics, failure, MCAT, medical boards, standardized tests, USMLE


  1. Hello! Thank you for your insightful post and I have been reading it over the years. I will be starting medical school at a DO program in California and I was wondering what was your take on DO in the field of general surgery. As of right now, I am interested in this field but I am keeping an open mind going into medical school. More specifically, have you experienced academic clinician who are DOs? I mostly shadowed community hospital physicians. I am interested in research, patient-care and teaching so I am looking into academics as an option. Any advice is helpful. Again, Thank you!

    Comment by aspiringDO | 10 June, 2014 | Reply

    • To AspiringDO:
      Yes, I have worked with a couple of osteopathic physicians who are surgeons. One is a vascular surgeon and the other is an ENT surgeon. There is no difference in their practice than mine in terms of surgery and academic work. If you plan on entering academic medicine, you need to have a strong background in research and you want to get an academic degree such as Ph.D or MPH minimally. In today’s world, most academic physicians have dual degree (MD/Ph.D or MD/MPH) so look into getting one of these (or try to enter a dual-degree program at your medical school). If you can’t swing entering the dual degree program, some medical schools allow students to take a year between MS-3 and MS-4 to obtain an MPH. If you can do a DO/Ph.D or DO/MPH, then go for that combination. In any event, having publications is the key in academia these days (publish or perish) thus you need to take advantage of any opportunities to do research (preferably leading to a publication) while you attend medical school. NIH has opportunities for medical students (DO or MD) during summer months where you can immerse yourself in research and make great contacts with principle investigators. Look up the principle investigators (PI) at your medical school and get on board with them during your vacation time. You may even be able to do some research as an elective during your fourth year too. Research also makes you very attractive for university surgery residency programs as long as your academics (medical school grades/board exams) are very good. In 2014, the DO versus MD thing is largely a moot point as long as your grades are excellent. Strive for excellence, make contact with the PIs at your school and get research experience if you can. Depending on where you are located in California, you can look up the PIs at allopathic institutions (UCSF, Stanford, UCLA etc.) and identify someone who may be able to find a slot for you to work with them during your vacations/holidays and fourth year elective time. As a medical student, as long as your academics are sound, the world is your oyster which means that you should find a good mentor at your medical school who can open some doors for you to do some research. Even if you don’t enter surgery, research is great experience. A poster or a publication/presentation at a national meeting (plenty of opportunities for doing these things if you get on board early) is a great thing to have. The best advice I received when I started medical school was get in the habit of reading journals every week. At first you may not understand much but you gain more than you would believe if you keep up the habit. Journal reading helps you to learn to ask the research questions. I read Nature Medicine, JAMA and New England Journal of Medicine (every issue while I was in medical school). I set aside 2 hours each Saturday and Sunday to read my journals, a habit that I kept as I moved through residency and now into practice. I still read 30-40 journals per week (not every word but every abstract and complete articles that are relevant to my practice). Congratulations on your acceptance and make excellence a habit in your academics. The time goes by fast to you want to take advantage of every learning opportunity in school.

      Comment by drnjbmd | 10 June, 2014 | Reply

      • Thanks for the advice. It is, as usual, very helpful. Its good knowing that my merits would determine how well I do and reach in medicine. I identified a faculty at my medical school that may help me in stepping my foot into research. Also, I would look into obtaining the dual degree too. Thanks

        Comment by aspiringDO | 10 June, 2014

  2. I forgot to put the !!!!!!!!

    Comment by Espadaleader | 15 April, 2014 | Reply

  3. Thank you for your outstanding blog. I have been a faithful reader since my freshman year of undergrad and I have waited 5 years to post on this blog as an incoming student at Harvard Medical School

    Comment by Espadaleader | 15 April, 2014 | Reply

    • To Espadaleader:
      Thanks for the kind words and enjoy your journey to becoming a physician.

      Comment by drnjbmd | 16 April, 2014 | Reply

  4. Hi there! If we wanted to contact you directly, how would one go about that? Thank you for the wonderful amounts of information, especially the study skill and work ethic articles. I’ve said those to my study skill notebook and are using them to help me in my studies. =D

    Comment by pallinoia | 6 April, 2014 | Reply

    • To Pallinoia:
      I do not provide personal responses or direct contact information.

      Comment by drnjbmd | 6 April, 2014 | Reply

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