Preparation for the USMLE requires persistent effort over time. Success depends on your ability to sustain that effort. So, as you prepare for your exam: What motivates you? What keeps you going when thing seem hard? What sustains your effort over weeks and months?
The answer, in all likelihood, is that you are motivated by more than one thing. Some simply want to move through the process as quickly as possible. Others want the bragging rights which come from getting the highest possible score. Others want to show family and friends that they have the “right stuff”. Still others just want to avoid the embarrassment of failure.
Motives are what move us. What get us out of bed in the morning and keep us going through the long day. Motives are the driving forces that make it possible for us to put in the day, weeks, and months of efforts required for USMLE preparation.
Stripped of all jargon, there are two basic types of motives: Motives to get something and motives to avoid something. Both can be powerful forces that get us started and keep us going. But, while both can be useful, each carries with it a hidden danger.
Common USMLE Preparation Motives
Motive #1 Getting the Score
For some people, the USMLE score is everything. Getting a top score is the brass ring, the key and ultimate reward at the end of all the effort. Getting a top USMLE score is a solid, empirical measure of achievement that certainly makes getting a coveted residency position easier.
The danger here, however, is that a focus on the score will blind you to what you need to do to get there. Like someone single-mindedly concentrating on a destination, you are in danger of missing the twists and turns that make up the journey. Too obsessive a focus on the ends may lead you to not complete the process which gets you there. At the end of the day, it is the score which matters most, but having the right preparation process is what carries you to that ultimate success.
Getting a top score is a good dream. Just make sure you make the right moves to get you there. Wishing alone does not make it so.
Motive #2 Getting the Knowledge
Knowledge is the foundation of medical practice. Without the proper insight and understanding about the human body, disease processes, and the body’s responses to those diseases, a physician confronted with illness is simply guessing. Knowledge is what separates the physician from the non-physician, and the expert physician from the neophyte.
One of the great benefits of USMLE preparation is the chance to go back over previously learned material and come to a fresh understanding. Done correctly, you emerge from the process with an understanding beyond simple memorization. Done correctly, you walk into your exam with a clear sense, not only of what makes a good answer, but why it must be so. The flash of insight, the rush of comprehension, the thrill of understanding what was unclear before, can be a powerful motivator to keep pushing onward with exam preparation.
However, students driven by their own quest for knowledge and their own excitement at emerging insights is in danger of losing sight of the specific requirements of the USMLE. At the end of the day you will take and exam. You will not be judged by your knowledge and insights alone, but by your capacity to offer correct answers to the presented exam questions. Knowledge and insights give you the raw materials for this task, but to not carry you directly to the essential goal of getting that exam score.
In short, focusing on getting the knowledge, while it gives you the means to succeed, may cause you to lose sight of the essential endpoint of the process: getting that higher exam score. The danger is that you will become enamored with the journey itself and become lost on a journey without end, never to arrive at the final goal you must be seeking.
Motive #3 Avoiding Failure
Nobody wants to fail. The experience of failure is singularly unpleasant and calls in to question all of our past successes. Maybe failure is the reality and all of our past successes are the illusion. Maybe, as we have always feared, we are indeed, not ready for the tasks we face.
The fear of failure can be a powerful motive. When we are tired, it causes us to reach inward and give that extra effort. When we get distracted, it serves like a rudder to guide our attention back to the task at hand.
Fear is, however, a force that tells us what to avoid, not what to do. Fear, without direction quickly devolves into anxiety. Fear of failure grabs our attention, but risks paralyzing us at the same time. At its worst, the fear of failure becomes so great that we give up and do not even try. Better to fail because we did not try than to give it all we have and still fail!
In my experience, trying simply to avoid failure is a recipe for disaster on the USMLE. Fear is a good way to get started in your process. But if you are to succeed, you have to know what you are seeking, not just what you are hopping to avoid. To get to success, you have to face you fear and leave it behind.
Motive #4 Avoiding looking or feeling stupid
Who wants to looks stupid in front of friends or colleagues? Don’t we want our teachers and our parents to regard us as intelligent? What if, the spotlight of the USMLE shows this to not be true? What if we just are not smart enough and do not have what it takes?
And it is not only others. We want to see ourselves as smart. We want the face in the mirror that looks back at us each day to be intelligent, savvy, and successful.
So, we work hard to show that we have what it takes. We spend long hours with our books so that we will have the answers when our professors ask. We stay up late into the night so we will never have to face our parents and tell them we just did not know. Wanting to avoid looking and feeling, stupid and inadequate can be a strong, driving motive in our lives.
It can also encourage us to lie, to others and to ourselves. To avoid the appearance of being stupid, we do not talk in class. We avoid discussions with colleague who we think know more than we do. We repeatedly re-read what we already know and avoid what confuses us so we can feel the sense of, “I have this.” We avoid practice exams that may result in scores below our and others expectations. We do practice questions we have looked at before to get that better practice score.
Seeking to avoid looking stupid encourages us to focus on how we look, not on what is real. Our study becomes driven by managing impressions, not by getting results. We hide from the light of reality as long as possible.
But we can not hide forever. Sooner or later, we have to face the harsh spotlight offered by the USMLE. In that light, the shadows of perception disappear, and we are left with the reality of a clear empirical result. Playing for image is no more than playing for time. Sooner or later reality always catches up with us.
To get to success, you have to accept the reality that you do not know things and then take action to change that. Image management is easy, but short term and fleeting. Let yourself look stupid. It is the first step to making a new reality where that is no longer true. You do not know everything. Your time and effort preparing for the USMLE are your commitment to changing that.
Seek to Win, Don’t Just Avoid.
The bottom line is that no one motive gets you where you want to be. In general, positive motives, seeking something (a score or knowledge) are better than negative motives (avoiding shame or failure). Positive motives tell you where you are going while negative motives merely tell you where you do not want to go. Avoiding pitfalls is critical, but having a goal and a vision that will sustain you throughout the preparation process is the more likely road to success.
Steven R. Daugherty, Ph.D.