Competition in Medical Training and Practice: Too Much?

Anthony Rudine -- My studying for USMLE Step 1 has begun. The reality has finally sunk in that the big test to determine the course for the rest of my life has arrived. But has it?

I have historically not put too much emphasis on test taking, and not given much credence to the tests themselves, but this one feels somewhat different. I have been told, as I am sure all of you have been told or soon will be told, that your score on this test, taken in one day over eight hours, will determine what quality and specialty of residency you are competitive for.

It seems as though there are so many more aspects to a residency candidate than just a simple score on a test. For example, how far does a well-placed letter of recommendation go to alleviate a possibly low score on Step 1?

Although I do not plan on doing poorly, the thought has crossed my mind: What if I fail? What if I do not fail but barely pass? Are my healing days over before they even begin?

It may seem like I am already planning for the worst case scenario. Not so. I believe that your performance on a particular test is quite predictable, but the anxiety leading up to the test is certainly not. And it is this anxiety that can cause one to question their career choices.

For physicians and other healthcare workers, does it seem like the competition never ends? That your guard can never be let down? Is this a good thing?

In my opinion, competition is important, so long as it is not so intertwined with medical practice that the patient loses in the end. I hope this is not the case.