The Brain Is a Sieve.

If you haven't yet been to Michelle Au's blog, you should check it out. She's a anesthesia resident in NYC who also happens to have a great sense of humor that really comes across in her blog. The following was lifted from Dr. Au's blog:

"And half the time even when I do try to read something for academic's sake, I can't really seem to retain it once I turn the page. This is problematic. I am turning stupid."

Oh, how this resonates with all residents.

The 1st and 2nd year of medical school are pure studying, where one tries to figure out what medicine is all about and how to possibly learn all the things you're expected to know. At the end of 2nd year is the first part of the medical licensing exam. The formal name is United States Medical Licensing Exam: Step I, but it's usually referred to as "step I" for short.

Now, there's three parts to the licensing exam, and if you pass all three parts, you can officially apply for a U.S. medical license. But Step I is usually considered the most important part of the licensing exam, because the score that one gets on it is used as part of the residency application process. Much like SATs are used for college. (Yes, my friends, it never ends...)

Different medical specialties view the Step I score in different ways. These are gross generalizations, but usually the specialties that have many positions to fill every year care less about the exact score, and just want to know that you passed Step I. For the more competitive specialties, you usually need to score as high as possible, because some programs have automatic Step I cutoffs that are used to try to narrow down the number of qualified applicants.

A "passing" score on Step I is around 180. I've heard that some programs used 230 as their screening score, which means that if you score below that, your application is never reviewed. Some people say that creating a "cutoff" is unfair, but when you are a program with one or two positions a year, and more than four hundred people apply each year, there's just no way to flip through four hundred applications and do them justice. Hence the cutoff.

So Step I scores are important. Step II is taken during the 4th year of medical school, and Step III is taken during/after the internship year. There is a saying that you need to study "two months" for Step I, "two days" for step II, and "bring a #2 pencil" to pass step III. Not because the tests get dramatically easier, but because by the time you take step II and step III, you've already matched in your residency of choice, and the scores no longer matter. You just have to pass.

Because of all the studying done for Step I, your medical test-taking, trivia-winning brain is really at its apex. From there, all those little tidbits you so painfully crammed in for the test disappear from memory, so it's not uncommon to run across a term, know that you once studied it for Step I, and actually once knew it, but now have no idea what it means. A lot of the material memorized for Step I is really test-taking fodder; much of it has little clincial application, so is pretty useless on a day to day basis. So while you gain more clincial experience, all that clinically-less-useful book knowledge falls by the wayside, and you always have the uneasy feeling that you're getting dumber by the day. Because, after all, you once knew more factoids than you do now, right? And clinical acumen isn't easily assessed, so it's easy to forget that this has replaced all the less useful book knowledge.

The end result is the feeling that the brain has become one big sieve. The rate of information loss its just a matter of how big or how little your sieve holes are, and how fast (or slow) you're pouring the water (new material) in. Water in, water out.

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