The USMLE is more than an exam. It is a test – a test of your ability, a test of your confidence, and test of your will. The exam is long. The knowledge to be mastered is vast. The chances for error are profound.

By sitting for the UMSLE, you confront reality. You may tell yourself how good you are, but without come external validation, how do you really know? In your dreams, you may see yourself as a great physician, but how real are those dreams? People you know may tell you that you have what it takes, but are they telling you the truth or just being kind?

Hope, dreams and confirmation from others all fade in the face of the cold, hard reality of your USMLE score. Your score is a fact, a clear detail that can not be changed or avoided.

The USMLE offers the promise of validation. If all works out well, your score is a credential you will carry with you all of your life. Once you get the score you are seeking, no one can take it away from you. When you doubt yourself, your USMLE score will remind you that in the face of a difficult challenge, you were able to face it and succeed. When you question your ability, your score gives you a firm fact on which to stand.

But, how do you know you are good enough before you take your exam? How do you know you have what it takes? How do you know you are smart enough for the task ahead? How do you know what is true?

The short answer is that before you face your exam, you do not know. Before events unfold, you simply do not know how they will turn out. The desire for assurance may be strong, but reality has a way of surprising us. Reality will emerge only within the exam itself.

This truth is hard for many students to accept. The wish to know your result before you take the exam is strong. Some students spend as much time assessing how they are doing as they do in actual study and preparation. Many become obsessed with their scores on practice questions. Increasing numbers of students take the full series of NBME exams. All of these efforts are attempts to glimpse the future, to seek certainty, to answer the question am I really good enough?

The danger here is that all of your efforts will be dissipated trying to find out how you are doing, and not enough will be left for the actual task of preparing for the exam. The obsession with your score on practice questions, endless comparisons of how you are doing compared with peers, the overwhelming desire for reassurance, all of these distract you from the main job at hand. Exam preparation is a process. Too much focus on the outcome and you fail to learn the fundamental concepts and techniques that are required for success.

Self-assessment if fine, but the hard work and struggle of study are what really move you toward your goal. Exam preparation is not about helping you feel good, but about facing up to what you do not know and taking concrete steps to fix those deficits. Acknowledging personal deficits can be hard. But, that hard reality offers a wonderful foundation on which to build real world success.

Are you good enough? The exam preparation process does not answer that question for you. You must know before you begin. Preparation for the USMLE exam will not, in general, help you feel better. If you are like most students, you will be shaken. You will look doubt squarely in the face. Preparation will chip away at your confidence, not bolster it. Every practice question you get wrong, every fact you can not recall makes you feel less confident and less secure. Getting ready for your exam will not tell you if you are good enough. You have to have sufficient confidence to begin the process in the first place.

Are you good enough? You must begin your exam preparation process with a resounding, “Yes!” Look at the facts. If you have made it this far, if you have completed all of the hurdles to just get to the place where you are allowed to take the USMLE, then of course you are good enough! Reflect for a moment how many people wish they could make it to the level you have already achieved. The medical education system does not let you get to the place where you are even able to register for the exam unless the evidence is overwhelming that you will succeed.

Start with the assumption of confidence. That confidence will give you the grit and endurance to do the preparation you need to do. Then, spend your preparation time doing the things that will get you your higher score.

As you prepare for the USMLE, you have a simple choice. You can act to bolster your confidence, or act to boost your score. Begin with confidence and focus on the learning that will move you to success.

  1. Study subjects where you are the weakest to make them better. Resist the temptation to read over what you like but already know.
  2. Questions you get right help you feel great, but do not help you improve. Forget your practice score and focus on going back and learning the content that the questions you miss tell you that you still need to master.
  3. Talk about what you are studying with others even if you do not know it well and are afraid that they will think you are stupid. Discovering those deficits by talking with others will motivate you to go back to your study material and be sure they are deficits no more.
  4. Organize the material you study in a way that makes sense to you. Rote memorization of what is in your review books may seem the obvious method of preparation, but it will not give you the sort of in-depth understanding to handle the problem-solving required on USMLE questions. The exam rewards thinking, not memorization.

The USMLE exists for you to show the world that you have what it takes. This is where you stand up to be counted. This is where you struggle with your doubts and win. This is where you show all the critics that they are wrong. This is where you silence the whispers in your head with an assertion of simple, quiet resolve. Are you good enough? Are you smart enough? Of course you are. This is your chance to show it. The USMLE is the moment when you convert your confidence into the reality of achievement. Because doing that, converting confidence into finding solutions, is what Doctors do.

Steven R. Daugherty, Ph.D.

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