Everybody in medical school has the same secret. It’s something we never talk about. Something so intensely personal that we can barely even tell our closest friends. It eats at us like a purulent mass—we feel the pressure of it daily and somehow we know that the only way to be free of it is to drain out the pus and corruption, but no one dares. The consequences of release are too disastrous, too close to the core of all that we fear.
The secret is our grades.
This needn’t be a problem and it’s no single person’s fault. It is something innate to the self-selection of medical school applicants. As a whole, we exhibit the traits of perfectionism, competitiveness, and self-criticism to an almost pathologic degree, and in school, we are forced to be artificially compared to each other constantly.
This has long been a reality of medical education and while significant strides have been made in transforming cutthroat campuses into pass/fail curricula that are—in theory—lower pressure, this does little to ease the incessant self-comparisons that we all make. Over the first two years of our education, the main boogieman is test scores; these can partly be rationalized by your level of interest in that particular subject or how you felt on that particular week. In the past, many of my classmates were willing to share their experiences and impressions of their scores in order to receive support from or provide support to their peers. But as second year transitioned into third, this became harder. All US medical students take the USMLE Step 1 and are forced into direct comparison. Suddenly, many students feel like they now have a foolproof way to compare themselves to our peers and it makes us uncomfortable. This is not an question we really want to know the answer to, so we stay silent. We worry that once people know our scores they will realize just how much we don’t belong – how terrible of a doctor we will become.
Suddenly it becomes exponentially more taboo to discuss grades, even to our closest friends. Whether with excitement or disappointment, the number begins to gnaw at us; however, we feel like we cannot share because we worry about the reaction we will get. If our confidant scored lower than us we worry that we will make them feel excluded, and if they scored higher we worry that we will be judged.
Imposter syndrome is the difficult to shake feeling that somehow you have succeeded on accident and at any moment your secret will be discovered and you will be rejected. This is a classic cognitive distortion, but when you actually do have a secret it becomes so much more toxic. Caught between a rock and a hard place, we stay silent and the imposter syndrome grows. Secrets always fester and the only solution is to tell someone and get it off your chest.
I am not at the point where I am ready to post my score on a forum such as this, but as I realized how deeply the secret was affecting me, I reached out to a few of my friends with the truth and they were universally appreciative. Some scored higher and some were lower, but each was thankful to be freed of their burden. In the end, I realized that if someone were to tell me their scores it would not change my opinion of them, and the vast majority of my classmates feel the same. In this arena, I often think back to the old saying, “Those that matter don’t mind, and those that mind don’t matter.”