Medicine From The Trenches

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

Medicine From The Trenches

toolsofmytrade.jpgThoughts and ramblings from a physician who remembers her thoughts & ramblings from medical school too well…



  1. To piggy back on a question that was recently ask, is the possibility of fellowship lost if you have terrible board scores? Exams are not my friend. I’ve had to retake most of my boards, but I’ve always passed them with a solid score. I don’t believe my interest are terribly competitive – Adolescence medicine or preventive med. I would like to think that my board scores will not haunt my career forever — I’ve managed to match with my abilities thus far — however I have no idea how what fellowship selection is like. Is it enough that I’ve completed residency? And potentially board certified?

    Comment by Kane | 30 November, 2014 | Reply

    • To Kane:
      Your in-training exam scores are more relevant to fellowship application than your USMLE/COMLEX scores. You need to make sure that your in-training exam scores are as high as possible along with solid clinical evaluations. Preventive medicine and adolescent medicine are not hugely competitive but you can’t have a series of very poor in-training exam scores. At some point, you have to overcome your issues with licensure/specialty board exams. Residency is usually when folks work these things out and in-training exams are a good tune-up for specialty boards.

      Comment by drnjbmd | 30 November, 2014 | Reply

  2. I am so confused right now about which approach to use. I am a IM 3rd year resident, failed step 3, have been interviewing for jobs, close to signing a contract with one place. Not sure what to tell the potential interviewer. I am not sure what to use to study for my second attempt. I used Kaplan videos and UW. I also did 7 hrs of archer videos. Any advise would be appreciated.

    Comment by vaidehi | 2 April, 2014 | Reply

    • To Vaidehi:
      Crush Step 3 is more than enough for this exam + being thoroughly familiar with the software (and the critiques) that came with your Step 3 registration. You likely over-studied for this exam. The videos are not working for you so go to printed materials. Many people are just not visual learners. Good luck.

      Comment by drnjbmd | 2 April, 2014 | Reply

  3. Hi,
    I have a little problem. I am a 2nd year medical student and I am preparing for the Step 1. I have been preparing for it for about a year now and I have not been improving. I have tried doing many questions and prep books, etc. and my score is still not passing. I do not know what I should do. I do not want to fail or to be removed just because I can’t pass a stupid standardized exam. I have come too far. I am beginning to get very anxious. What can I do to calm down and improve my performance?
    This really means a lot to me and I don’t know what I would do if I am unable to pass.
    Please respond back when you can.
    Thank you for your time.

    Comment by Stephen | 1 April, 2013 | Reply

    • To Stephen:
      Your first and best preparation for Step I is thoroughly mastering your coursework. Without complete mastery of your coursework, any review items are practically useless. You can’t “review” what you haven’t learned in the first place. The next thing you have do is not “talk yourself out” of passing this exam. If you persist in labeling the exam as “stupid” or something that you “can’t pass” you won’t be able to pass that exam even if you took 5 years and memorized every book out there. Preparation for Step I takes first, thorough mastery of coursework, a review of said coursework and systematic preparation in terms of question analysis and structure so that no matter how a concept is tested, you can figure out the answer. If you are doing question after question without regard to structural analysis of the questions, you will only know the material in the questions that you cover which is likely not going to be enough to get past that exam. The final thing is not to focus on “what you would do if” you don’t pass but how you will maximize your chances of passing. What makes it so easy for you to focus on the negative, as this exam is concerned rather than the positive situation which is you will know your coursework and you will do a thorough review?

      Comment by drnjbmd | 1 April, 2013 | Reply

  4. I took my USMLE step 3 exam second time and I failed it with 71(175) score.. During my CCS exam, computer had froze thrice and had to ask prometric person for help who restarted it each time….Now with my score report I also got an email from FSMB administrator that we didn’t get a data for your 1 ccs case but even if wee give u full credit for that, ur score report from fail to pass won’t happen. And also said u can waive ur fees for next attempt…….I replied back them by explaining situation tht It happened thrice and I also got a minute less for each other 2 cases and I got panic which affected my other CCS cases performance……But she didnt want to listen and said its not our fault. It was technical difficulty so we cant do anything (Rudely) ….when I asked again to give me better solution by removing an attempt from my transcript, she said she will forward my letter to upper level as an appeal.

    I am not seeing any hope for removing attempt……I want to raise this problem to the most upper level and want to remove my failure attempt from my transcript…..

    Anybody plz can help me with this situation>? what should I do?

    Comment by bhadres | 25 October, 2012 | Reply

    • To bhadres:
      You need to keep all of your e-mail correspondence from the company about this situation. It looks like the last person is sending your case to an upper level person for investigation. Once all of your appeals are exhausted, you can seek legal action but at this point, you have to go through their process. Keep all records and look for legal advice (consult an attorney who is well versed in these types of matters).

      Comment by drnjbmd | 25 October, 2012 | Reply

  5. Hi,I am new here, I am looking for advice.
    I failed step 3 twice:( . I don’t know what should I do? I have done UW+CCS+Kaplan Q book 3 times. I am willing to do anything to pass this test.
    Would you please help me.

    Comment by maida | 4 July, 2012 | Reply

    • To Maida:
      Did you look at your score reports carefully? These reports generally give an idea of what you missed. In reviewing for this exam, did you make sure that you covered all of your weak areas? You can’t sit and try to memorize any set of review materials if you have broad knowledge gaps. Make sure you have closed your basic knowledge gaps and take your time with a thorough review. No review course will offset a poor knowledge foundation.

      Comment by drnjbmd | 5 July, 2012 | Reply

  6. I really enjoy your blog. Awhile back, you responded to a post of mine after I failed Step 3. I retook the exam, and did exactly as I had on prior USMLE Steps scoring in the range of 210-214, which is right about average. Now, I am facing having to apply to fellowship with the failed Step 3 attempt on my USMLE transcript despite passing the exam the second time I took it. And although I had some significant personal challenges around the time I took Step 3 for the first time, I also really feel that I must have done something horribly wrong with the cases. For example, I do no think I knew how the clock worked and accidentally delayed treating a patient. Anyway, I am not sure how to approach this issue in my application for fellowship. Do I address it in my personal statement? Or would it be best not to highlight the issue and let it come up during the interview process. Alternatively, would it be reasonable for one of my letter writers to discuss it? I really don’t want to advertise the issue, but I am wondering what the best way to handle it would be! Thanks for your time and advice.

    Comment by pathmd | 3 July, 2012 | Reply

    • To Pathmd,
      Don’t use your personal statement in a fellowship application to explain failing Step 3. You should use the PS to explain why you are applying for fellowship and your career plans etc. Don’t even have one of your letter writers address this because at this level (you should have an unrestricted medical license), your Step 3 score doesn’t matter. What matters is that you are licensed and that’s all. Good luck.

      Comment by drnjbmd | 4 July, 2012 | Reply

      • Thanks! I guess I should just be prepared to discuss it if it comes up during interviews. I do worry about it hindering my chances for interviews since some programs require an official USMLE transcript, and it will show up there. Since not all programs require the official transcript, do I even need to share with them the failing score or would it be ok to just give them a copy of the passing score? I want to be honest but I don’t want to share it if it isn’t necessary!

        Comment by pathmd | 4 July, 2012

      • To Pathmd:
        Have a good (non-excuse) answer for why you failed Step 3 if the subject comes up. Beyond that, submit transcripts where needed and don’t apologize for failing Step 3 again. Would it have been better if you hadn’t failed that test? Yes, less expensive for one thing but it’s done and you move on. Step 3 only counts for licensure; once done, it’s a non-issue.

        Comment by drnjbmd | 5 July, 2012

  7. Hello,

    I am a reapplicant this year getting ready to submit my application. My previous mcat was a 29M and UGPA of 3.71 with ec’s etc. However, I retook the mcat hoping to do better but did worse! got a 27Q so I am kind of rattled though I know there is nothing I can do about it now. Just curious about what this means for my chances this time around, i.e. whether it is worth it to apply this round or try and take it again (though I think the stats indicate I won’t do much better than I have done considering I thought I was much more well prepared the 2nd time around and did worse.)

    Thanks for any feedback

    Comment by ALex | 21 June, 2011 | Reply

    • To ALex:
      That 27 Q is a huge liability because your first score is under average. Both of those scores would tend to make an admissions committee question how much grade inflation played into your uGPA. If you took it again and scored lower than 29, you would just about tank your chances of acceptance. If you reapply, be sure to completely rework every part of your application that is under your control. This means rewriting the PS, getting updated LORs and definitely doing more extracurriculars (the more unusual the better). With a totally upgraded and revised application, you also need to apply very broadly (allopathic and osteopathic) especially since you did worse on your second MCAT attempt. Again, a third attempt would need to be out of the park, which is quite unlikely. You might be able to explain (only in an interview if asked), that your second score was due to not feeling well or something like that but a second retake with a score less than 32 would just about knock you out of the game. Is that worth the risk?

      Comment by drnjbmd | 21 June, 2011 | Reply

  8. Hello there Dr. NJB,
    I’m a first year medical student and I wanted to get your opinion on the issue of grades disclosure in medical schools. I go to a small medical school, the prof’s post our grades on the bulletin boards without our student#’s only. This semester I managed to make a 100 in one of my courses (histology) and the prof kept talking about how i was the first to break a record. He didn’t really mention names or anything but I was cornered by one of my study buddies and I ended up telling him what I go on the test. Little did I know, this study buddy of mine spread the news around the class and now I feel like I’m looked at in a very different way. I really feel like its effecting my academic performance too (in a bad way). I don’t know what it is, I can’t explain it but everytime I try to ask someone for help they tell me that I shouldn’t need anyone to explain anything to me since I make 100%’s in all courses (not true, it was only one course). I don’t know how to deal with people’s expectations. I don’t knwo if I am making a big deal out of it but its really hurting me a lot. I know that I’m not as smart as people think I am…I just simply studied very hard. How would you deal with it?
    Any thoughts are much appreciated.


    Comment by Sara | 23 March, 2011 | Reply

    • To Sara:
      Let this go. It’s done and you can’t change anyone’s thoughts except your own. Make your own thoughts about doing your best and living up to “your” expectations of yourself. Words like “smart” don’t actually mean very much in medical school. Everyone in medical school is “smart”. You are either prepared for an exam or you are not. Sometimes one may prepare better than at other times but make no mistake, everyone is smart enough to be there or they would not be there in the first place. This is why it is pretty useless to compare yourself to anyone else. Run your own race and let things roll off. Part of the process of becoming a physician is realizing that you do the best you can on any given day with the tools that you have. In the end, you give your best to your patients and make sure that you haven’t cut any corners where their health is concerned. In the end, one test or even one class for that matter, isn’t going to make much of a difference in your day to day career in the long run. Move on and congratulations on the excellent performance.

      Comment by drnjbmd | 23 March, 2011 | Reply

  9. I really enjoy your site. I just linked you on my website – thought you might enjoy it, too!

    Comment by Mary | 14 July, 2010 | Reply

  10. Hi

    Great site!
    Just out of curiosity…
    Did you pursue research during your Medical School Career? What were the “extra curricular” activities that you were involved with?


    Comment by Anar | 3 November, 2008 | Reply

  11. can you write little bit about why you chose surgery? some of the current trends and where the profession is headed?

    I will be a 27y.o. first year medical student and concern about how do I fit possibly starting family (currently single) to long rigors of surgery residency.

    Couple of my friends ended up doing residencies in rad and anes even though they liked surgery the best.


    I love the site, I find myself re-reading the same blogs :)and coming here on weekly basis to see what’s going on.

    Comment by chris s | 17 July, 2008 | Reply

  12. I really miss having your articles organized by topic in the right nav portion of your blog. Often, I will find myself working on a specific topic and will visit your site for advice. Since removing it, it has become more difficult to find pertinent information. Just my opinion – thanks so much!

    Comment by Dan | 19 February, 2008 | Reply

  13. Wow. I somehow managed to come across this website while searching out some backyard ballistics to entertain my nephews – don’t ask my how its the joy of the search engine.

    I am actually starting PA school in June and your documented journey has been extremely helpful for me to plan my plan. I am also a visual learner and plan on implementing your study habits as it relates to color. Is it possible for me to view how you layout some of your notes? Perhaps even scanning them in and posting them would be just great.

    Thanks so much!

    Comment by Dan | 13 January, 2008 | Reply

  14. Great site. I’m a potential “non-traditional” applicant. Just surfed on to your site and really found it helpful.

    Comment by Harry | 11 August, 2007 | Reply


    Comment by MONICA | 7 July, 2007 | Reply

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