The Five Stages of Step-one Grief

Preparation for Step-one is a process of cyclic success and failure.  Both are pre-requisites if you plan to succeed.  Lets be clear, early in this process multiple failures is commonplace, often occurring daily, over an extended period of time under intense pressure. Clinical depression is more probable than possible.

What is also inevitable is that there is light at the end of the tunnel.  After maneuvering yourself toward the light, there you will find the death of failure.  For the Step-one student the death of failure can be seen in light of the Kübler-Ross model otherwise known as the five stages of grief.

Denial: I don't need any help and i have plenty of time.   There has to be limits on how crazy board examiners can get.  They can't expect us to know anything.  I've been a pretty good student.  After all, i am in medical school.  Millions of people have likely passed this exam.  My school has a pretty good success rate.   My friend told me that most students don't start until the dedicated time anyway.  All i need is this First Aid book.  It is the bible for this exam.  It is well organized.  Every student i know has one.  I can just memorize First Aid, watch a few videos and I'll be fine.  Plus, I heard Joe passed.  If Joe can pass this exam so can I. 

Anger: After memorizing First Aid and purchasing to DIT you can't understand why you still are not finding success.  I keep failing MBNE and getting low USMLE world score. You have now memorized a great deal of facts and can't understand why you are not doing better. When you review USMLE world questions you can't help but to look at the percentage of people who picked the same answer you did....8%. In addition you've scored 40% on this block. You don't even tell anybody your score on MBNE. That would be to embarrassing. The only thing that motivates you to get up to do it again is your arrogance or stupidity. You start to wonder, "why didn't I study_______?". You fill in the blank.

Bargaining:  I don't need a 260.  Those are for the gunners.  I am not a gunner.  I just need to pass.  I wonder what Joe did?  First Aid and DIT were great bu i think i'm not understanding some of these concepts.  I need to get another book and watch other videos.   A different perspective will give me a better shot at passing.  The hottest program right now is _____.   I'll get a subscription and ill get a different question bank.  I heard Jane passed with a high score and she used _____ question bank.   I'll get that one.  No more social media and no more going out for me until i get this thing done.

Depression: My exam is a few weeks away and I'm still not ready.  #$!%^&!!!  Can i push this test back.  If i fail this test i will be a failure.  I'll get a tutor or someone to help. At this point you realize you need a psychiatrist, I mean a tutor. There has to be someone who can help you through this process. Your PhD professor is a nice person but she took Step one last century (literally). And you know your colleague is not as smart as you are, so you befin the hunt. After you are not the first person to attempt to pass step one. As you begin your investigation you learn this 'help' can be pretty expensive.

Acceptance: If you are lucky, you have reached this stage well in time to change your approach.  There is no other choice.  You have to study to the test.  You have to master concepts.  You have to reduce your source material.  You need to learn test-taking strategies.   Most of all you have to understand that you can't do it alone.   Acceptance is the stage where you realize you have no where to go but up.