4 - Shame in Medicine: Pass/Fail
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What is the opening metaphor that sets the tone for the episode?
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You have this dream. Kind of a common dream. Where you're in a nondescript building. Nothing on the walls, no windows or clocks to tell you the time of day. You walk through a maze of hallways toward a security guard. He pats you down. Removes all your belongings. And leads you to a computer terminal. The walls are grey. Your nose burns with the smell of cleaning solution. As you sit down at this computer, you look around and realize. There are other people sitting at computers. Dozens of people. All hunched in front of these screens. They're all clicking their mice, no one speaking. There's a set of headphones on the desk. You put them on.
At the top of your screen you notice a timer. Counting down. And then you remember. Yeah. А на часте ані тест. A test that will determine your future. What you can do and who you can be. Have you been studying for this test? Studying enough? Suddenly you feel an urge to escape, but you can't. You're locked in. And time is passing. If you don't start now. You'll never catch up. So you do the only thing you can do. You start the test.
You're listening to Shame in Medicine, The Lost Forest. I'm Emily Silverman. How do your test scores affect your self image? Who you know yourself to be and what you're capable of in the future. There's been a lot of discussion recently about the utility of these tests. And the cost of placing such an emphasis on sky high test scores. But are we talking enough about the emotional impact of these tests? How does the shame associated with testing carry forward into the profession?
My name's David. I'm a HEMOC fellow in Southern California. During medical school, one of the highest stakes tests that anybody takes is the USMLE step one. It's high stakes because the score you get in some ways determines the kinds of specialties that you can do and sometimes the ones that you won't ever be able to do. Our school, like all the other ones in the country, put a lot of stress on this test. I studied really hard for it, especially the six months before the exam, but I was so stressed out about this test that not only did I delay the test a couple of times but But I had a really hard time sleeping the night before the exam. So much so that when I woke up the next day, I almost thought that I should cancel my test or delay it further because I was so exhausted, but I had simply run out of time to continue to delay my test.
So in tears I drove across town. I was in Houston, Texas at the time. I had worked so hard to study the best I could for this test. I'm not generally a good standardized exam test taker. And so that made me extra stressed about an exam. That for all practical purposes was going to determine my destiny.
How does David describe the emotional impact of the USMLE Step 1 exam on his self‑image?
I called my mom on the way over to the test and and she said no matter what happens, you're gonna get to be a doctor. And so I went in, bit the bullet, took my test. Uh on every break I would go to the bathroom and splash water on my face and try to, you know, do whatever I could to make myself feel more energized and I just made it through the test the best I could. But when I left the test day, I was just worn out. And I had these constant feelings of dread and regret, like I had made a big mistake by taking my test as tired as I was. On the day that test results came, my peers opened up their portal to see their score and you could tell some people had done as well as they had hoped. There was a couple of people that printed up their score reports and called their family and said, Hey, you know, I'm gonna get to be a surgeon or a radiologist or whatever specialty they wanted to do because they had gotten a score high enough to keep that door open.
For me, I was hesitant all day to look at my score.
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Chapters
8 chapters
1
What is the opening metaphor that sets the tone for the episode?
0:00–4:36
2
How does David describe the emotional impact of the USMLE Step 1 exam on his self‑image?
4:36–10:12
3
Why does Will argue that the Step 1 exam should be a pass/fail system?
10:12–14:46
4
What are the main arguments for keeping high‑stakes exams in medical training?
14:46–19:52
5
How does the discussion explore the shame that follows a low or failed board score?
19:52–24:31
6
What coping strategies do trainees share for dealing with test‑related anxiety and shame?
24:31–30:33
7
How do residency program directors view objective test scores when selecting applicants?
30:33–36:30
8
What conclusions does the episode draw about moving beyond scores to a more holistic view of physicians?
36:30–38:06