Tyler Bruinsma (he/him) & Adaobi Okocha, MPH (she/her)
A few short weeks ago, we were pursuing twitter (as we often do at FPR) and happened upon a thread started by Chase Anderson, MD; a child psychiatry fellow at UCSF. He shared his own STEP scores as an opportunity to remind current medical students that they amount to much more than their score. This thread really resonated with us both at the time, midway through STEP studying ourselves and acutely aware that this rite of passage in medical school is harmful to our mental health.
Over the course of STEP studying, we have witnessed as our GAD-7 and PHQ-9 scores, and those of our friends and colleagues have gone up, a major indicator of our deteriorating mental health. We, along with many others have increased our use of counseling services and even started psychotropic medications due to episodes of major depressive disorder and generalized anxiety induced by studying for and taking our STEP exams. We quickly realized however, these effects of STEP studying are seldom discussed among medical students making both of us, and we assume, many others, feel quite isolated.
What saddens and concerns us most is that much of this stress, centered on achieving higher and higher STEP scores is founded in a major flaw: STEP scores are really inaccurate. For those of us who have received a score, we noticed a wide confidence interval, usually 16 points wide for our score. This, in effect, means that a low score that would disqualify you from a program could be eight points higher if you had taken the test on another day. While we won’t break down all this math for you, The Sheriff of Sodium already has and we highly recommend his blog post on it.
Our main aim by sharing these experiences is to normalize the reality that many people experience increased depressive and anxiety symptoms during STEP studying. If you haven’t heard it yet, you are more than a three digit STEP score will ever say about you and the results of this test say nothing about the kind of doctor you will be. All of this said, we would be remiss to only identify the problem without providing some resources to address it. Ultimately, the onus lies with the NBME and USMLE examiners as well as residency programs. These board exams can and should be pass/fail for the sole purpose of improving examinee health. Until this occurs, we did our best to identify some resources and practices that helped us through our exam periods and various other stressful moments.
Find a therapist you are comfortable with. Very Well Mind has a good list of providers that are competent in many intersectional areas of diversity. Many medical schools also have divisions of professional and student mental health who may have free access to therapists, psychologists, and psychiatrists.
When making your STEP study schedule, make sure you take at least one day off per week. Schedule this and stand by it. Save space for unplanned days off too. In this same vein, be open to non-productive days of relaxing, particularly the day before the exam. Rest is essential. Rest is productive.
Finally, while focusing during your study block is important, don’t forget to spend time with your support network. The idea of complete isolation from the world around us and especially our support network is not always the healthiest way. After witnessing the effect that the COVID-19 lockdown period had on the health of so many, it’s no wonder that similar isolation can similarly affect mental health. For both of us, the support people around us made a tremendous difference in our day to day mental health. Whether you need someone to commiserate with or someone to distract you, lean on your support network to help you through STEP studying.