Dismissed from Med School: One Student’s Rebound from Failure to Super Success

Dismissed from Med School: One Student’s Rebound from Failure to Super Success

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How One ER Doc Built a Dream Career After Initially Failing Out of Med School 

In this series, we‘re talking about something people rarely discuss: failing in med school. During these interviews, former STATMed students share some of their most vulnerable and scary moments. They talk about their “crisis points” — or their darkest hour in med school when they realized they were about to fail or lose sight of their dreams. We look at what led up to these critical turning points and how these med students and doctors overcame them to achieve ultimate success.

As a society, we love a success story. The protagonist has a dream; they work hard and achieve it. If it’s a movie, there’s usually a montage of struggle, perseverance, and, ultimately, success. It’s heartwarming and uplifting. But in real life, when you’re in the struggle part of the montage, it can be an incredibly isolating and scary place. This is especially true for aspiring doctors who find themselves drowning in the depths of medical school. Crisis points like failing out of medical school or not passing board exams happen. They happen pretty frequently. But it’s rarely discussed. 

Navigating A Med School Crisis Point

In this podcast episode, host Ryan Orwig sits down with Mike, a former STATMed Learning Class participant. Mike shares his crisis point, when he was dismissed from med school, and outlines his path to ultimately achieving his dream of becoming an emergency room physician. 

“Basically, you’ve been working through high school, through college. You’ve spent six or eight years of your life going to this point and getting through to be a doctor, and in two weeks, it all gets stopped dead in its tracks.” – Mike, ER Doctor, and STATMed Alumni

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Announcer: Welcome to the STATMed podcast, where we teach you how to study in med school and how to pass board-style exams. Your host is Ryan Orwig, a learning specialist who has over a decade of experience working with med students and physicians. Today, Ryan will be talking with Mike, a former STATMed class participant. Mike is sharing his crisis point for the moment in med school when he first realized he was seriously struggling and needed to take action.

Mike: So you’re basically, you’ve been working through high school, through college. You spend six or eight years of your life going to this point, and getting through to be a doctor, and then in two weeks, it all gets stopped. It stops dead in its tracks.

Ryan Orwig: I’m Ryan Orwig with STATMed Learning, where we talk about learning and test taking in med school and on medical boards. This is episode one of our Crisis Point Series, where I’m going to talk to physicians and med students who’ve experienced various crises on their personal paths toward becoming a doctor. Today, I’m with my old one of my oldest students, Dr. Mike, who has volunteered graciously to share his multiple crisis points with us. I think it’s safe to say I’ve spent more instructional hours with Mike than any other student in my very long career of working with med students and doctors. That’s quite the claim to fame, Mike. So Mike, go ahead and introduce yourself.

Mike: Hey, Ryan. So I am a ER physician in Florida. I’m family med boarded. I did an ER fellowship. And I’ve been out approximately three years out of fellowship. I’m currently living in Central Florida with my wife and two daughters. And by most people’s standards, we have a very successful life. We have a boat, a new truck, and we even have a vacation house. So everything should be great, right?

Ryan: I mean, it sounds great, you know? I think, and I obviously know a lot about your story, and that’s what we’re gonna get into here. And I think your story on your journey to become a physician starts like most med students. Smart kid, did well through high school and college. Somewhere along the way, you decide you wanna be a doctor. You take the MCAT. You hate it, but you get through it. And you get into your DO program of choice. And then, I guess you’re just off to the races, right? Congratulations, you’re in med school. You made it. You’re on the fast track to working in an ER in Florida, with a vacation home, and a happy wife, happy kids, blah, blah, blah, right? So a pretty fast track for you once you got into med school to becoming an emergency medicine doc, right?

Mike: Well, not really .

Ryan:  So, okay. So a few bumps in the road, I guess you’re saying?

Mike: Yeah, I’ve definitely had a few bumps, for sure.

Ryan: When was your first bump in the road in med school?

Mike: The first one was about two weeks in to med school when I failed my first test

Ryan:  Oh, god.

Mike:  of many.

Ryan: All right. That happens. So then I guess, what? You passed your second test?

Mike:  Nope. Failed that one too.

Ryan: Oh, my! All right, all right, wow. So, when did you realize that you were at this inflection point in your life and your career, that you were actually having this sort of crisis, that you were at a crisis point?

Mike: Well, after about six months of med school, and failing more than just the first two tests, I was dismissed from med school for failing too many tests.

Ryan: Oh, right, right, okay. So, there’s a lot to unpack here. So, I assume, this is one of these classic crisis points. Look, I hear these stories every week, and I’ve been doing this for over 15 years, where I meet people, and they’re at this particular crisis point, that at some point, maybe in the first year, maybe in the second year. People aren’t posting this on Facebook. People aren’t wearing t-shirts. People don’t have plaques on their office wall, in their hospital, or in their doctor’s office, like, hey, yeah, I failed my first year of med school, where I got kicked out of med school, but that’s certainly where you are. And again, I really appreciate you deciding to share this, because this is a story. This is the kinda story that I just think that, again, I hear this all the time, but I feel like, when people are in it, and I know that that’s where you were, nobody is sharing this. Nobody’s talking it. So let’s talk about this first year, Mike. So you take that first test, and belly flop, right? So what can you tell me about that first test? This first year of med school, first test?

Mike:  First test, you’ve been successful through college. No real problems. And so you come in, you’re around a bunch of other people that have all done the exact same thing as you have, been successful in college, and everybody comes in, and takes this first test. And you study the same way you did in college. You go through. You take this test, thinking it’s gonna be the same as every other test you’ve taken. And instead of getting your normal 85 to 95, you know, miss a couple of questions, go on to the next one, and end up with a 55. And-

Ryan:  Isn’t that- Mike, is that a real number?

Mike: That was a real number.

Ryan:  Is that the real number?

Mike:  Yeah, yeah, that was a real number. And 10 years later, I still remember that number.

Ryan: Yeah, oh, I’m sure that leaves a mark. So you get this 55, which is just a, I mean, it’s probably a trauma, right? Like no exaggeration to call that a trauma, right?

Mike:  Yeah, absolutely. It’s the first time you’ve ever gotten a score that low after being in school for 20 years.

Ryan: Yeah. And then everybody’s talking about it, right? Everybody’s like, hey. What’s some of the chatter going on in this very new group that you’re just now forming with? Your life depends on your performance. What can you just say briefly about that?

Mike: Yeah, so you’re starting to make all these new friends. Everybody’s new. Everybody’s in a new situation, and trying to figure it out. So you’ll have people complaining, because they didn’t do as well as they thought they were going to. And so you’re like, oh, you did somewhere close to what I did, and then they tell you the score, and they got a 94, or an 85, or a 92, and you realize, you’re in a completely different league, and don’t really know even how to get out of it.

Ryan: It’s gotta be isolating, lonely, terrifying, all that stuff, right? And this isn’t even the true crisis point that we’re talking about. This is building up to the crisis point. So at your med school, what was the policy on failure? How did that work, as far as like a little bit of trouble to a lot of trouble?

Mike:  Well, you could start, and then classes were kinda blocked differently on a rotating basis. So basically, you could have three failures within any time in the first year. And at that point, you had to repeat, and go in front of the Student Promotions Committee, and then they would decide to bring you back, or if they thought it was better that you moved on and did something else.

Ryan: Right. So you failed the first test, and you’re freaked out, and I’m sure that means you… And I know, you studied more. Some people might not realize the speed volume density equation of med school, and maybe they’re not studying enough, but that wasn’t your situation. You were studying like more than your peers, right?

– Yeah, they were all going out to dinner, having a good time. They would go work out at the gym. And I was sittin’ in a room by myself studying trying to catch up, because you start behind off the first test, and so you’re like, all right, the next one, I’m gonna go, I’m gonna work harder. I know what to do now, and go harder. But that’s still, it still didn’t work.

Ryan: Right, ’cause then you-

Mike:  So you’re just tryin’ to-

Ryan:  You got the second test, and you failed the second test as well?

Mike: Yeah, I think I went up like 3%, something ridiculous. But you’re studying twice as much, you know? All these friends that you made in the first week, and that you see are doing well, then they’re continuing to do well, and you have no idea why you’re not, and what you need to do, and how to fix it. And you’re already behind, and then is still trying to keep up with something that’s as rigorous as anything we’ve ever done.

Ryan: Yeah, you can’t compare it, like just the speed volume density, like I said, of med school. So basically, you end up failing multiple classes. And how long did it take you to rack up those three failures?

Mike: It was about four months

Ryan:  Yeah.

Mike: before I was completely done and out.

Ryan:  So walk us through what this is like. So in med school, and you’re flying blind. You’re just – you’re head down. You’re either head down churning, or you’re being called in, or sort of being updated on your status as, your standing as a med student. So walk us through what happened. After you get these three fails, you then, what? What happens to somebody at that point?

Mike:  Yeah, so even before that, we have a test every three to four weeks, and so you’re trying, after the first test, you’re trying to talk to everybody you can. You’re talkin’ to biochem professors, and anatomy professors, and you’re trying to talk to other students, and figuring out what they’re doing, and you’re trying to talk to the learning specialist that the school had on staff. You’re trying to do anything you can to catch up, and figure out what the thing that everybody else has that you don’t have to be able to keep up with the information, and to be able to do all these tests. You go, and you try that new thing for two weeks, and then you do a little bit better, but you’re still behind, so you’re not able to catch up. And you’re trying to study, and trying to learn how to study. And so with our situation, they gave you three fails. Once you failed, then you had to go before the Student Promotions Committee.

Ryan: Now, this… I’ve heard a lot of these stories, and I mean, it sounds awful. So you’re going in front of this committee, this sort of like anonymous… They don’t know you. You don’t know them, necessarily. You’re just like on their docket. And I don’t mean to sound harsh about it, but it sounds… Like somebody, like as a learning specialist who works with med students and doctors, I’ve been hearing these stories for years. And I heard your story when I met you. But it just sounds awful, right? ‘Cause these people are going to… You know going in, they’re gonna decide, is Mike gonna be allowed to continue, which probably means come back and repeat the first year, or is he out? Is that about the size of it? And am I right about that?

Mike:  Yeah, that’s exactly it. You dress up in your suit. You try and look professional. You go and sit in a room with a biochem professor that’s been at the school for 20 years, and an anatomy professor, and people that know of you, but don’t know, don’t know what’s going on, don’t know what you’re trying to do. They see your numbers in a file, and that’s what they’re basing their decision off of, a 20, 30 minute conversation, and the numbers in your file, and the scores that you’ve gotten on your test. Meanwhile, they don’t know that you’ve been trying everything you can to get out of this hole, and trying to learn how to study, and trying to catch up. But they just, they don’t know. There’s 20 or 30 people there

Ryan: Yeah, it’s not-

Mike: having the same meeting.

Ryan: Right. So you go there, you present, and then what was the verdict?

Mike:  So after I had the meeting, I then had to meet with the president, who… You basically walk in-

Ryan:  The president, wait. The president of the med school?

Mike: Yeah, the president of the college, the med school. And so I go in. There are multiple other people had failed before me. They had gone through the meetings. They had gotten their letters that they were allowed to repeat. So that was the assumption that was what was gonna happen going through my meeting, and going through the process, that it would all, it would happen,

Ryan: Yeah.

Mike:  and go through,

Ryan: It’s like a hoop.

Mike:  It’s a hoop- Yeah, like a hoop you jump through. You go before the committee. They rake you over the coals a little bit, and then they send you the notarized letter or whatever, and then, hey, you’re back in. Get your act together. Fix what you gotta fix, and come back. So a lot of people go into this thing just sort of waiting for that. But for you, instead of getting the letter, you were notified, hey, go to the president’s office. Yeah, so I walk in-

Ryan: Sounds ominous.

Mike:  Yeah. So I walk in, all dressed up again, sit down with the president, and what turns out to be the school’s lawyer, which is never a good sign. Sit down. The first question the president asks is, oh, how do you think the meeting went?

Ryan: How did it go? The promotions? You mean like the presentation to the Promotions Committee?

Mike: Correct, yeah.

Ryan: Yeah-

Mike:  And so-

Ryan: Let’s rehash it, right?

Mike:  You go through this whole spiel about how you think it went well. You’re confident that you’re gonna be able to come back and do well. And this whole thing, you kinda sell yourself to this person, that, again, that you’ve never met. Doesn’t know you from the next person, but has your file, and can see that you have not done well, which is already embarrassing in the first place, ’cause you’re with someone that has already gone through, has already been successful. And so you sell yourself to this person expecting them to be like, okay, well, make sure it doesn’t happen again, try harder, blah, blah, blah. And instead, you get the conversation that you are dismissed from school. You’re not to come back. Everything you’ve worked for up to this point is over. You’re now $50,000 in debt, ’cause you just paid tuition for a year of med school. You paid rent on your house that you’re sitting in by yourself, ’cause you don’t have any friends, ’cause they’re all in school still. And so you’re in this situation with… The president of the college is basically telling you your whole life path has changed. Your mom’s told everybody that their son’s a doctor. That everybody knows you went to med school. You’ve told all your friends. And so now six months in, $50,000 in debt, you’re now kicked out of med school.

Ryan: You are kicked out, right? I mean, it’s brutal. And yeah, I think like the idea of like, yeah, all your friends from college, they know where you are. Your mom, and extended family, yeah, they’re already like, yeah, he’s gonna be our physician or whatever. I mean, you know how people… People not in the field don’t understand. Yeah, It’s awful. And then you’re still living in this town. So what happens then? So you’re kicked out. There must’ve been step of recourse you could have taken or something, right?

Mike:  Yeah, so at that point, they gave you three weeks to appeal the decision, because it’s just, it’s five professor’s decision off of a committee. You know, they volunteered to be on a committee

Ryan:  Yeah.

Mike: that sees these cases. So at that point, you have three weeks to appeal, but also, you’re kicked out of school. You know, you have to figure out what’s going on. You have student loans. You have to figure out what you’re gonna do with the rest of your life.

Ryan:  Because it’s looking like, most likely, even with the appeal, you’re most likely not gonna get back in. That’s at least a fair point of view in that point in time for you, right?

Mike:  Correct. And so you’re basically… You’ve been working through high school, through college. You know, you spent six or eight years of your life going to this point, and getting through to be a doctor, and then in two weeks, it all gets stopped. It stops dead in those tracks. And so then you’re trying to scramble, and figure out, one, I have to pay rent. My student loans are up in two months. All the money’s gone. You know, you’re trying to figure out what to even do. Do you get a job? Do you go to grad school? Do you go to PA school? You’re trying to just try any avenue to get out of this situation that you’re in.

Ryan: But you’re also, it’s like you’re in a limbo. You’re stuck in this like sorta stasis, this limbo-ish spot, this in-between world. Because you’re living in town where your med school is. You are dismissed, but there’s a three week window where you’ve gotta figure out how to write that silver bullet of a letter, the miracle Hail Mary letter, to convince them to let you back in, correct?

Mike: Yeah, so you have three weeks to even decide. Because we’re six months in, it has not gone well. Even though you’ve worked the past six or eight years to get to this point, do you decide, hey, maybe they’re right, and maybe this isn’t for me? Hey, do you do something easy? Do you completely switch paths? Right- Because yeah. ‘Cause even if the miracle… Even if the miracle is granted, it’s like, wait a second. Again, it’s like the whole, the idea of like, I got into med school, I made it, right? Just like that’s like this sort of misperception I think a lot of people make, ’cause, yeah, you still gotta do the work, still gotta make it through, gotta get through your steps gotta get through residency, all that jazz, right? Likewise, the idea of even if they grant you permission to come back, what’s to say it’s gonna be different this time?

Ryan: They say, hope is not a strategy. It’s an old military statement, right? It’s not a strategy. And if you’re like, well, I was already working harder than everybody else, and I got fileted by, during that run, it certainly makes sense that… ‘Cause I guess maybe even for me, it’s like, oh, yeah, that is a factor. Like you then have to decide like, am I gonna stick in this, correct?

Mike: Yeah, because you’ve just gone through the most miserable six months of my life.

Ryan:  Miserable.

Mike: It’s hard-

Ryan:  Miserable.

Mike: You know, other people, it’s definitely in the top five worst times in anyone’s life that they can go through,

Ryan: Yeah.

Mike:  especially as a 23-year-old, you really don’t have that much life experience. You now have no job. You have no future. All your friends from college are moving on. They have jobs. They have kids. They have families. All your friends from med school, it just keeps turning. They’re in school. They’re in class. They’re studying. They’re still 80 hours a week, and you’re sitting in a rental house hours away from any family by yourself trying to figure out how to dig your life out of this tailspin.

Ryan: So that’s the big picture, but even day-to-day living during these three weeks, I mean, do you even wanna go to the gym, or go out for dinner or drinks with these people? You know, do you even wanna see ’em? Because it’s just more, I presume, humiliation and embarrassment, certainly for the people you only peripherally know or generically know. Is that a part of it?

Mike:  Yeah, because our class was 200. So you have a couple of three or four close friends that know actually what’s going on, but the majority of people you see in class or you see in passing. And so then, all of a sudden, they just don’t see you around. The same thing happened. I was still in class, and people would just, their chair would be empty one day, and then nobody knows what’s happening, nobody knows where they are, nobody knows if they’re still around, and so people just disappear-

Ryan: Well, this is- And this is a different era, too. Yeah, this is back, what are we talkin’ here, like 12, 13 years ago? Somethin’ like that?

Mike:  Yeah.

Ryan: So back then… You know, now, there’s so much more like on demand learning, remote learning. People could be, not go to class, and only watch on… But that wasn’t really the culture at your school at that time, right? It was more or less people went to class and we’re sitting in class. You had assigned seats too, right? And like it was like, you could tell when somebody was gone, and it really stood out, correct?

Mike: Yeah, you had your little name tag, and you had your little basket of pencils, and all those things, and those things just stayed almost like a memorial to the people that were gone. But that stuff all stayed, cause you’re not gonna come back, and clean out your Post-it notes and pencils. And your little name tag stays, so nobody else is gonna sit in your seat ’cause you’re gone, so.

Ryan: Yeah. I think a lot of our med students and physicians, at whatever point the crisis point comes along, by and large, not equipped to deal with failure. ‘Cause , like I failed all these times in my life. I mean, sure, I mean, some people are like that. But by and large, this is the not only the first failure, it is such a staggering, I mean, I guess the size and scope of the failure, and it’s not like you’re equipped with that, right? Not equipped for failure, not equipped for how to ask for help, how to seek help, how to to articulate what kind of help you need. You don’t even know how to formulate those questions. It’s like, is it a knowledge-based issue? Is it a study skills-based issue? Is it a test taking issue? You don’t even really have that kinda sensitive vocabulary. You just go into like the biochem professor, saying, I need help, and they’re like, well, maybe you need to study more. or you’re asking your peers, and they’re like, well, you know, I like to mix it up. I studied biochem for a while, then I switch over to anatomy. Just stuff that’s not really tangibly gonna make a difference. And I think that’s… It’s all part of the conundrum that you guys find yourselves in, right?

Mike: Yeah, and you’re just trying to find whatever straw that can make you survive until the next test, but eventually, it just isn’t enough. And nobody- You can’t talk to your family. Like, your mom tells you to just do more flashcards, and study more, and work harder, and get more sleep. Even your friends in med school that are doing well, they can’t give you advice, because they’re doing well, so.

Ryan: Yeah. No, absolutely. So you’re in this three week limbo period, three to six week limbo period. You’re trying to decide what you’re gonna do. Maybe you’re gonna make that, write that letter, or try to make it the silver bullet. But then you’re also, I think, exploring other options in your life, right? You’re like looking at other grad programs and stuff like that. Am I on the right track here?

Mike:  Yeah. During this time, you just assume you’re out of med school. You assume the decision’s made. They’re not gonna change your mind, so you have to figure out, you have about three months to figure out what’s gonna happen in the next year of school, ’cause all you know is being in school, so that’s what you’re trying to go right back into. So I start applying to physiology master’s and medical science masters, and trying to just find a plan to get in somewhere. And, you know-

Ryan:  Yeah, ’cause you can’t just like show up somewhere. When school starts on September 1st, you can’t just show up on the 29th of August, and say, let me into your program. I mean, you’ve gotta plan these things out. So this is getting close to where you and I met. What year? What year is this, 2009?

Mike:  It was 2009 when we met, yeah.

Ryan:  Okay, so we’re getting close to that. So you ended up coming to town where I live in Huntington, West, Virginia. You’re poking around Marshall University looking for… I think you go… Maybe you went to the Post-Bac? they have a Post-Bac Biomed program, which you’ve been, you’ve sorta been admitted to prior, but then you didn’t need to go there, ’cause you got into med school. And so I think you poked around there a little bit. Like maybe you were thinking like, I’m gonna go do this Post-Bac program, but they were like, sorry, you’re damaged goods. Is that right? I mean, they didn’t say, they didn’t call you damaged goods, but they might’ve treated

Mike:  No, but that-

Ryan: you as such.

Mike: That was a feeder program to get into med school. That was a program to

Ryan:  give you your shot

Mike: Yeah, support.

Ryan:  to prove yourself to be able to get into a med school somewhere. And so by the time I’d already failed out of med school, that’s not the program for me.

Mike:  That’s not it. It’s not.

Ryan: They made that very clear.

Mike: Yeah.

Ryan:  And they, you know… That wasn’t an option. So there were other cardiology, electrophysiology masters. And so you’re just trying to be somewhere close to medicine, ’cause that’s what you’d like to do, that’s what interests you, science, the human body, that kinda thing. So you’re trying to find something. But Mike, but for you, it wasn’t just be a doctor. You wanted to only be an emergency medicine doctor, right?

Mike: That was it, yeah.

Ryan: That was it. You’d shadowed. You’d explored this, like the lifestyle, the mentalities, how your brain’s wired. You didn’t just like say, I wanna be a doctor and figure it out. You’re like, I wanna be an emergency medicine doctor. And then-

Mike:  Yeah, I mean, I was at- I did night school when I was in college, and got my EMT. So I was an EMT in college. I did research in first year with the ER residents at the local program.

Ryan: Yeah.

Mike: Everything I was doing was building up to after you graduate, ER residency, movin’ through there.

Ryan:  Yeah, that what that was. And again, I think that’s an important point to underscore. Like you said, at that age of 23, you’ve never been outside of academia. Yeah, you just think, I’m gonna go back into this. So you’re pokin’ around different programs, and I think somebody, while you were on campus, somebody must have directed you toward me, right?

Mike: Yeah, so one of the deans, I was speaking with, and we talked about still wanting to be in med school, still wanting to go to med school, and so he was like, well, if you’re having all these issues, then you were running a Study Skills Program at Marshall at that time.

Ryan: Yeah. Yep.

Mike:  It was a three minute walk from his office where I just happened to be meeting with him on a random Tuesday, because I was out of school. I didn’t have anything to do. So I went up and met with him

Ryan: Right.

Mike: on a Tuesday. And luckily, you happen to be in your office that day.

Ryan: And then our kind of-

Mike: Yeah.

Ryan:  Our lives have intertwined for the past 10 years.

Mike: Yeah, so I mean, I remember this, and I have a very… So I was running this little program at Marshall for med students who might’ve had like some learning issues, or study issues. That’s sorta where I got, one of the aspects of how I started with this whole, in this whole field. So I’m sitting in my office, and I’m, like I said, I’m running this small little program there, these five week Study Skills courses. Now I cover the same amount of… A lot of different stuff going on in that. But now, like our 10 day STATMed class sorta covers the things that I found to be important during that. But anyway, I’m sittin’ in my office, and then you stick your head in. I’ve never seen you before. I don’t know. You’re like, hey. I was like, hey, and you sort of invite yourself in. I was like, yeah, come on, have a seat. Let’s talk. And you explain your situation, describing to me the walloping you just took in you’re in your first year. And I’d already met a lot of people, and I understood the crux of that problem. I guess I remember how raw it was. And you were in that limbo space. We don’t know if you’re gettin’ back into med school or not, or what you’re gonna do, but I think you knew at the core, at the very least, it was a study-based issue. I mean, now, we might say, it was study-based and test taking-based. But even back then, I didn’t have the fidelity in my own models to really parse that, right? And so you sit down, and I’m like, yeah, you… I think I sized you up. I have a pretty good radar for these things. It’s like, this guy’s got his head screwed on straight. He’s passionate. He’s hungry. He’s workin’ hard. He just does not have the skills. He does not have the tools. He doesn’t have the methodology. I figure this is a guy I can probably help. I can help him unlock his aptitude and really navigate med school and boards. And I think I said to you something like, I’d love to help. We have a class coming up. Unfortunately for you, it’s full, and there’s already a wait list. Sorry . Good luck, young man. Yeah. And I was in kind of a- And I was kind of in a time period where my future is still we didn’t know what was goin’ on.

Ryan: Right. Right.

Mike: I was still waiting for my appeal meeting to go through. And so-

Ryan: And it didn’t sound good. It didn’t sound good. It was like, this sounds like he’s probably not gonna get back into med school.

Mike:  No, and I was gonna do your program just for whatever was next. Like that wasn’t gonna be

Ryan: Yeah.

Mike: my key back into med school where I failed out. That was for whatever is next. And yeah.

Ryan: Yeah, I think you knew you wanted to be in med school. We knew that you wanted to be in medicine. Maybe that meant… I mean, the advice, like PA school, maybe you would go into physical therapy, maybe you’d go… We didn’t know. You didn’t know. I didn’t know, of course. But I think we were both like, let’s add some study skills that tie directly into the study of medicine, and give this guy agency, and give this guy control, so that he’s in the driver’s seat, not just being abused in the, like, passenger seat, which is how I think things had been going for you. So I felt bad. And you made like a very, like, serious appeal to me. Like we’d been talking for 15 minutes, I never met you before, but you’re like, why is it capped at 10? ‘Cause it was 10 students in the class. And I was like, I don’t know. It’s a small classroom. It’s hard to put a lot of bodies in there.

Mike: That was it.

Ryan: – What’s that?

Mike: It’s 10 chairs. You had 10 chairs.

Ryan:  Yeah, 10 chairs. Like, yeah, there’s 10 places, room for 10 seats. And I think you’re like, could you maybe put 12? And to which, in the back of my mind, I’m like, probably, but I was just like… You know, it was just that weird, like that was what I inherited with the program. That was how things were done. I already had people on the wait list. I was like, huh, could I do 12? And I think I was like, well, if I were to overload the class, you might not have some of the fringe benefits, ’cause it was just a lot of logistics I had to work out. I wasn’t being lazy. I was just being like, that’s not how things are done. But you left an impression, and you laughed. I was like, I’ll think about it. I’ll see what can happen. But you were like number 12. I think there was somebody in front of you?

Mike: Yeah.

Ryan: And- What happened was, I thought about it. I think I poked around. I think I went in the classroom, and was like, yeah, you can do this. It’s just tight. And then I guess I called you later, right? What do you remember about that?

Mike: Yeah, I remember we laughed, and it was, you were gonna to see what happened. You basically told me, if somebody dropped, I could be the 10th if somebody dropped, and the person on the wait list decided not to come.

Ryan:  Yeah.

Mike:  You said it was kinda flexible. People sometimes dropped.

Ryan:  Yeah.

Mike:  We left it up in the air. If somebody dropped, there was room, if not, then I could take the class in six months the next time, which was in-

Ryan:  But that would be- But that would only work if you were not back in med school. It would’ve been in the fall.

Mike:  Correct.

Ryan:  Right.

Mike: And so I went home. I continued to look for grad schools. My meeting for my appeal kinda came through. You had to put in a letter, and go through a formal appeal process, and go back through a different Student Promotions Committee. And so at that time, right in that area, you decided that you could make room in the class. I had to go back through the committee. And so right in that area was when you decided that I could take the class, whether I got back into school or not. And fortunately, the appeal was successful. I went through the meeting, and I had a plan. I used your program-

Ryan: Yeah, we talked about… Hold on, Mike. Let me just interject. Yeah, so you wrote your silver bullet let me try to get back into school letter, right?

Mike:  Right.

Ryan: They granted you, and then… So then you had like… You had to go before them and make your case, and you used part of, and again, the sequence I’m not exactly sure, but you did use the fact that you were gonna do my class as part of your argument to, hey, let me back in. ‘Cause I think people, and I’m not an expert in dealing with promotion committees, but I’ve obviously talked to hundreds of people about this. I think you have to show them, make it a believable argument, if they grant you permission to come back, it’s going to be different. Like that’s the whole like… The definition of insanity is doing the same thing and expecting different results. I think part of what you did, was you convinced them that if they let you back it is not gonna be the same thing, in part, because you were gonna go do this class, and this class was gonna directly impact the negative outcomes you had. It was gonna teach you ways to manage the information, ways to organize it, ways to encode it, ways to be active, ways to move away from passive studying. Part of the problem, I think, is med students don’t have this vocabulary. They don’t have the vocabulary to even talk about where things went right and wrong with studies. You might say, I don’t know how to study, but it’s not as more, as nuanced. But I think you were able to use whatever stuff I had at the time to make that argument. We can speculate that that was part of why they let you back. Is that fair?

Mike: Yeah, and during that first meeting, you basically say, you’re gonna study harder, you’re gonna get better, you’re gonna work harder, and so that kinda goes both ways. Do they think that you haven’t studied hard enough the first time?

Ryan: Right, yeah.

Mike:  But you know you have. You know you’ve put the time in. You know you’ve studied hard, but it just wasn’t efficient studying. And so then when you have a separate plan that isn’t just work harder, that isn’t just study more, that isn’t just try harder, that then they look, and say, well, maybe you give this person another chance, because they’re gonna go do this extra outside thing. I had to… It was three hours away from my house. I had to go live someplace else to do this class, so it was a financial investment. It was a time investment.

Ryan: Yeah.

Mike:  And so I think they recognized that that, that you’re gonna put the effort in, and so I think that definitely helped with the second meeting.

Ryan: Yeah. And then what? You got the certified letter saying, congratulations, you’re back in?

Mike:  Yeah, so you go through this meeting again. You sell yourself. You do sell the new plan. And then two weeks later of this three month process of failing, to getting kicked out of med school, to finding a plan to change what’s gonna happen next time, to then meeting again, to meeting with the president, to then finally getting a re-acceptance letter, which was much more emotional than getting the first initial acceptance letter even to get in, because you had to fight so hard, and you’ve kinda been told no so many times to even get back in just to be able to start over.

Ryan: Well, yeah, ’cause you know now, you know the odds are definitely stacked against you. And once you’re dismissed, I mean, the odds are against you, I think. It certainly seems like that, right?

Mike: Well, and your name’s always on a list. So your name’s on a list. Your margin of error is so much smaller even coming back, which is even more stressful, because you’re trying to go back in. You’re trying to do well. You’re trying to be successful. It’s already more stressful than it was the first time, because you’ve already done it, and you’ve already done it poorly, and now, your name’s on a list. Your chances are much fewer. And so-

Ryan: Oh, yeah. I mean, yeah, now your margin… And the criteria for what constitutes being in trouble . But let’s first talk about… Okay, so… ‘Cause we’ve sorta talked about the crisis point of getting kicked out, and then the fight to get back in. And then just real briefly, so you did the class, which is sort of a proto, I mean, sort of a different version of the STATMed class that we do now, Study Skills class. So you sorta came in, and I think like based on what I recall… Like I said, you are a hardworking guy, a smart guy, but you really did a lot of stuff that I think led to what we call the trap of familiarity and the illusion of productivity. Very common issues. Lots of reading and rereading. Lots of copying recopying. Maybe some inefficient word-based concept mapping, which I’m sure I was like, Mike, here’s why I don’t like this and that. You were spending the time… You would put the time in, and more time than others. So you were overcompensating with more time, but again, lacking at being efficient and effective. So I think we added a variety of skills. I think the main ones that you really profited from were like a version of what has evolved to what we call frame working, where you find the hidden structure of the lecture before watching lecture. And I think you did some visual mapping, where you’re creating your own visual links to encode information, tapping into your creative, funny, inappropriate, nonmedical imagery. Visual memory is more powerful than textual memory. And then I think you were really seizing on the power of retrieval practice. Really activating that. Really, like, bringing those. So those are the three skills that I think you really brought on board to carry into the next year. And it’s funny, I was thinking about the way we teach this concept of frame working, and we wanna really… It’s all about like the hierarchical structure of information, finding that hidden structure and power points. But I remember the day you showed me one of your frameworks, and it was all text. I was like this webby, bubbly thing, and it was a mess. And you were like… You were just like, how do I see the layers? I was like, I don’t know. And you were like, what if I made each layer a color? And I was like… I was probably like, I don’t know. Go try it out. And you did, and you brought it to me the next day, and you were like, look at this. And I was like, wow, that looks interesting. You sorta explained the layers. ‘Cause you were saying, like five layers, or something like that. You identified like most stuff that’s not universal, but you would find these like five layers of information, hierarchical information embedded in, say, like a PowerPoint lecture, and you were using the colors to delineate the hierarchy. Now, look, I’ve evolved that, and I’ve built that into the fabric of this frame working skill that I’ve taught for the last 10 years. And that 100% came from you. So that has paid forward over the years. But the reason I… One of the reasons I point this out is, I’ll never be a med student. I’ll never, like, know what it’s like to study as a med student for a month, or a week, but I understand the design of med school. I understand where things break down for people, and I understand the skills that need to intervene. But it comes from, and this is why you and I have had such a long relationship, is like, I will listen to you guys explain to me what works and what doesn’t. And then you’ll say, well, this works because of this and that. And then we sort of adapt that, and build that into the systems. And you definitely helped formulate that. Do you remember that? This is relevant for you, right? Like these colors and these layers.

Mike: Yeah, because that’s how I did it all the way through. Once it was set, I had the same four or five pins, the same colors, and so that would tell you where the information was when you went back on a test, and would try to figure out the difference between one or two different little details, and so those little details were always in the same level, and so you could see where they were. The colors helped you see the levels down of information. And so that was-

Ryan: Well, it made you- It made you purposefully identify and encode them that way, that then facilitate a retrieval. This is really getting into building that closet, which I think with you, your brain doesn’t do it. You’re like one of, what I call, a single tracker. You’re one of these classic single track brains. You can either build structure, or build details, or jam details. And what you learned to do with this frame working skill was, since you didn’t do it automatically, you purposely did it. So when you went back to school, I think that was definitely… We touched base and whatnot over that time. That was a key part for you. And to me, it’s like, that’s what he’s doing before lecture, finding structure with his multi-layer, multicolor frame working process, really emphasizing structure. And I feel like that unlocks things. I mean, if you come out of every lecture behind, which I’m sure is what you were doing the first time through. You’re sitting there trying to suck up information, and it was probably just, at best, being jammed into the closet in a disorganized fashion. One thing I say is, I think learning at the medical school level has to start with organization. I think the majority of med students innately, like innately, and maybe even subconsciously, organize the information. And I think you were on the opposite end of that spectrum.

Mike: Yeah.

Ryan: So by adding that,

Mike: Yeah.

Ryan:  it changed things.

Mike: And also, going back, once you have the terminology and the strategies, you then see people doing different strategies, and you’re like, that’s what they’re doing. So they were doing memory palaces, or they were doing frame working to then be able to make the time that they spent, the eight hours in lecture, more efficient, instead of having to sit in lecture, getting lost halfway through, then trying to

Ryan: Yeah.

Mike: waste the next half an hour of a lecture until the next one started. And so then not having to go back at night having to re-listen to lectures, getting lost in the middle of it again, and then have to redo it. So that’s what people were doing, was they had a way to organize the lecture so that they got the framework the first time, so that then once five o’clock came around, they were done sitting in class all day. They could then go, and actually remember, and encode the information that then was important for the test. But if you don’t-

Ryan: Yeah, using something, some kinda retrieval practice, using some sort of retrieval practice or something, right? And yeah, I think part of what we do anytime we teach, is like we’re teaching smart, motivated people learning theory, but learning theory grounded in the very nature of studying in med school and studying for boards, how that might work, and having the names of the skills, and the rationale with the skills. ‘Cause yeah, you and I would talk, and then we had a common vocabulary. And once we have a common vocabulary, ’cause you went through the class, and you got all my specific vocabulary and rationales, we could troubleshoot it easier. We could say, well, yeah, do this, don’t do that. Do this, don’t do that. More often than not, I’d say, “Why”, and then you would give me a rationale. Well, I’m doing this because, and then we could see if it was gonna work or not. So yeah. So you go back into school. I don’t know that we would… Would you say it was smooth sailing the whole way, part of the way, once you… So you’re going back, repeating first year, which, again, totally annihilated you the first time. You’ve got the class under your belt. You’ve got the skills. You’ve sorta got me as a resource. You go back. What can you say about that experience?

Mike:  Yeah, so initially, you go back in with way more confidence, ’cause you spent a year just getting beat down, and not able to keep up. So then you have the skills. You have the confidence to go back in. That’s the biggest thing I remember after leaving the summer with you and going back, seeing all these people again, was that you have the confidence and the tools that you need to be able to take care of the information that’s gonna come at you.

Ryan: And that’s because you did something proactive, ’cause it is pro. Mean, you’re reacting to the experience, but you’re like, I’m gonna go acquire new things I did not have. And you knew… I mean, ’cause you knew… And I like it ’cause it turned a negative experience, one of the worst years of your life, right? Like since you experienced that, and we gave you the skills, it then made it more like, oh, like I now, I can take this bad experience, and learn from it, and build off of it. And then you go back in, right?

Mike: Right, because you know what’s coming. You know the same information’s coming. You know how fast it’s coming. You know what’s coming at you. It doesn’t get easier. You don’t automatically know all the information because you’ve done it before.

Ryan: No.

Mike ‘Cause I really didn’t know that much information the first time. I didn’t get that much of it,

Ryan: Right.

Mike:  because I couldn’t study. And so you’re basically starting over, but this time, you have ways to, I’ve got these 17 nerves I need to remember, and now you have tools to be able to put those together, and separate ’em, and make your way through them to be able, on test day, identify it, and go through it.

Ryan:  Right. So now, we’re sorta on the down side of the crisis point, and you’re in that first year. You’re repeating first year. Doing pretty well month after month, after month, right? There is like a little mini crisis point, even on this return, that you told me about.

Mike:  Yeah, I went back-

Ryan: Margins of error, stuff like that, let’s talk about that.

Mike: You go back, you do well in the first seven or eight tests. They’re every couple of weeks. And so you have small, little tests thrown in there, 100 questions total for the entire class. With that, your margin of error is very low. One, two questions either way, and that is a huge percentage of your entire class. And so about-

Ryan: So Mike, let me interject here, right? So since it’s like high stakes testing, pretty much, it’s not like you’re getting all these participation points, and give me points, like in undergrad. It’s a few tests. So number one, in general, if you’re a med student, the margins are narrow. Like three fails, you fail three blocks, and you’re in big trouble. Is it the same or different as a repeating first year?

Ryan:  As a repeating student, it’s even worse. You have basically one failure before you start the whole process again. So you’re already behind-

Mike: Wait, which process? What do you mean process?

Ryan:  The whole- The whole Promotions Committee process, where you meet with them-

Ryan: So if you fail one block, you fail one block, and it’s back to the guillotine, back to the tribunals, back to the committee, where it’s like evaluate and determine your fate right then, right?

Mike: Back to the selling yourself for the rest of your life

Ryan: Oh.

Mike: Immediately. So-

Ryan: Wow.

Mike:  Seven months in, you fail a class that has 110 questions by one question, you missed it by-

Ryan: Is this a hypothetical?

Mike:  No, no, this is exact.

Ryan: So this is the , or second. This is a mini crisis point. This isn’t like a full blown crisis. But I mean, I don’t know, maybe it is. So we’re not calling it as such. So now you’re back. You’ve done well, done well, done well. You’re near the end of the semester, the end of the year, I take it, right?

Mike: End of the year. Yeah, you’re eight months in. Everything’s gone well. You’re high 80s, low 90s. You’re able to breathe a little bit, but still working hard, still going through, still doing the work.

Ryan: Okay, Mike, okay. Let me ask you this. Does the stress stay the same? As you’re working through month, by month, by month proving yourself to yourself and to the school that you’re not an imposter, that you deserve to be there, ’cause you can’t fake… I think anybody can fall down the steps, and score lower than maybe their aptitude indicates, but you don’t fall up the steps. If you’re hitting 80s, 80s, you’re good. You know, you belong. Does it get less stressful as you’re like, say, in month, five, six? How does it feel stress-wise? How are you managing that?

Mike: It does get less, because you’re further away from failing. So you’re like, okay,

Ryan: Yeah.

Mike: this is going well. You’re getting more comfortable taking tests. You’re getting in… You have a study group. You know where you’re studying. You know what the schedule is. So the stress gradually decreases. It’s never going away. It’s never less, in college, less than when you started, but it is gradually decreasing

Ryan: Improving.

Mike: as you’re working through.

Ryan: You’re proving yourself.

Mike: But- Right, you show you can do it. Things are going well. You’re working hard, and the hard work is paying off. But that stress is two questions away from skyrocketing again,

Ryan: Right.

Mike: and it comes right back as soon as you have any type of trouble again.

Ryan: Well, I guess that brings you… It brings us to like, was this like one of the last blocks of the first year?

Mike: Yeah, so I probably had a month left to first year, and it was a small class in addition to some of the other ones, but I think it was 100 to 110 questions, passing 70. You miss two or three questions too many, and you’re at a 69.4, and you just failed your one class for the year.

Ryan: And that’s what happened? That’s what happened?

Mike:  That’s exactly what happened.

Ryan:  So this is a crisis. I mean, to me, I mean, I don’t know. We talked about this before, but this sounds like a potential crisis, I guess. So what is the outcome? So then you’re back to the Promotions Committee?

Mike:  Yeah, so the whole process starts again. They have to evaluate what has happened through the year. Your year before, they still have all that information. And so you’re going through, and you’re having to show that you’ve done well for seven, eight months, and that you belong again. And so-

Ryan: This is concurrent with while you’re still in classes for the next block, right?

Mike: Yeah, because just because you fail one, you can’t let the next one slide,

Ryan: There’s no pause.

Mike:  And then you’re absolutely-

Ryan: There’s no pause-

Mike:  You’re absolutely kicked out.

Ryan:  Yeah.

Mike: And so you’re, you know,

Ryan: Yeah.

Mike: you’re studying all morning. And then a one o’clock on a Thursday, you go and meet this same group of people that kicked you out 10 months before to sell that you actually belong, and that you can do this. And you missed two questions extra. You just didn’t perform on one test. But the margins of error are so small on small tests, and then even smaller after you’ve already had trouble.

Ryan: Right. If you fail another one, first of all, you’re done. If you fail like- Done. And then this one, they could have kicked you out, but I guess, obviously, they said, okay, let’s… And maybe your track record, the fact that this didn’t happen on the first block, but it happened eight months in, certainly to your benefit. But man, the wind blows a different way. Who knows? There’s a lot of like what if, sliding door-type stuff happening here whenever you start… I’m sure this is uncomfortable to reflect on, and I appreciate you sharing these like just horrible wounds to your psyche, and your soul, and all that stuff. So they let you… They said, okay. So you finish out the year, but you still have to take the test. Now, we were talking about this on the phone before the interview, and I said, “I guess you passed the test?” And what you literally said to me was, “Yeah, I re-took that one fail in the summer”. “No big deal, I passed it.” I was like, oh, cool, no big deal. But then I was like, wait a second, “No big deal”, but wasn’t it a big deal?

Mike: Well, your question was-

Ryan: Unpack this.

Mike: Your question was, what happened if you didn’t pass it? So then you stop and you think, well, it’s game over again. You-

Ryan: ‘Cause that-

Mike: They let you repeat, you failed a class, they let you take the class again, and if you don’t pass that class again, there’s no path forward. They’re not gonna let you move on to second year. They’re not gonna let you repeat the first year for a third time. And that test was still 100 questions. So you-

Ryan: Right.

Mike: You had one question, and mid-summer, you had one test, 100 questions for the rest of your life again. And so again-

Ryan: Right. Yeah, I was sorta shocked at first, ’cause I was like, oh, “No big deal”, cool. Wait, was it no big deal? And I think we can both conclude it was indeed a big deal.

Mike: And that’s what we’re talking about. It was a big deal. It was no big deal because it went well, but it was a huge deal at the time, and a huge deal if it doesn’t go well. And so that… And every test going forward becomes a bigger deal

Ryan: Yeah.

Mike: if you don’t do well.

Ryan: Yeah, ’cause there’s- Right, there’s no wiggle room. So yeah, big… So all that. And then you go to second year. Can we say if there were any crises in the second year? Fingers crossed.

Mike: Second year went well. I passed all my classes

Ryan: No-

Mike:  through the year.

Mike:  Everything

Ryan:  Excellent

Mike:  pushed through second year.

Ryan:  Second year was great. You talk about some of the like, you know, you start pivoting away from classroom stuff, start focusing on your Step 1, Level 1, so the stress points change. And I’m always worried for you guys. Like, are you gonna take your eye off the ball back half of second year, and like fail a class ’cause you’re studying for Level 1, Step 1 too much? But that wasn’t the case for you. But that is a pivot. That’s something you’ve gotta keep your eye on, right? The balance, the balance between the two.

Mike: It definitely happens to people, that you get so focused trying to study boards, and it’s as big of a pressure of a test as ever, because it’s the test that keeps you from being in the classroom to actually going out on rotations, and actually getting to do what you go to med school for. And it-

Ryan: And nobody’s going to med school to be a med student, right? Nobody’s says, I can’t wait to go to med school to be a med student.

Mike: Right.

Ryan: It’s- These are just the painful hoops you have to jump through. So you did that. You take COMLEX Level 1, like the equivalent of your Step 1, and how’d that go?

Mike: So I passed. I think I was- Yeah, so passing was 400. I barely passed. I was at 415, 420 with-

Ryan: That’s the skin or your teeth, right?

Mike: Yeah, that’s probably about… We figured it out. It was probably between 5 and 10 questions on a 400 question test. You take 20 minutes of that test off, and it goes a very different way.

Ryan:  Yeah, when I work with COMLEX students, I mean, we’re like, we want nothing less than 450 on like your NBOME’s, maybe closer to 500, because of just variants and fluctuation. We weren’t really talking. So now, I look at everything through like two different pillars. Like pillar one’s like study side, where you take the information, you organize it, and code it, make it retrievable, applicable. But the other column is the test taking. And back then, when we were meeting, they sort of were linked together. I didn’t have like a full on separation of those things, right? So you probably compensated… Spoiler, you’re a really bad test taker naturally. Like the way your brain is wired, is that safe to say?

Mike: Yeah.

Ryan: I’m not like trouncing on any sacred, sacred ground? Like, you’re a terrible test-taker. And so much of the STATMed Boards Workshop has come from me and you talking, either me helping you, or running some like beta plans through it, or you helping me create sample questions. I remember, I threw you a question, and you were like, oh, I’ll butcher this for you. ‘Cause I needed to know how somebody might miss it. And you were like, oh, I’ll miss it for you. Like, thanks. Because that’s just your default wiring, right? And you offset it using proper STATMed methods. You’re a naturally a bad test-taker, and that might be even worse than the study side stuff. I mean, it doesn’t really matter at this point, but I think you definitely needed help on both ends. But the bad test taker compensates by overstudying, by overknowledge. And I think that’s certainly what you did. And that’s what accounts for that rampant swing in your scores. Maybe you’re testing around 500, and you hit 412, 415, or whatever on test day.

Mike: Right, yeah, ’cause all my practice tests, did well. Sitting around at my house doing questions, you sit down and do a block, you do well. Confident going in. Spent the time, again, using the proper study techniques to be able to do well on it.

Ryan:  Yeah.

MikeL Studying with other people that were doing well, people that… And then they took it as well, and did way better than I did. And so-

Ryan:  You had like people you were studying with hitting like 560- plus, like stuff that would get ’em into like anesthesia residencies.

Mike: Yes.

Ryan: And you’re testing right there with them, but then you’re testing, just scraping over the finish line. Now, what I tell people, like Step 1 is switching to pass/fail, and all that stuff. But I still… Obviously, you don’t have… You take the test, and you’re stuck with the score you get, you know? And it’s like, did I… At least you passed it, you know? But that’s sorta where you were with it. But you also talked about some of the… You passed it, but what did you say about that passing score when you found out what the score was?

Mike: Well, it was easily the unhappiest I’ve been about passing a test, because you know how much work you put in, you know where you are in comparison to what other people are doing, and putting in the work. You have all these study skills that you’re using to be able to know the information, and you’re putting all this time in so that you can do well, so that you can get the residency you want, and everything goes smoothly, and then you you pass it, but it’s not the score anybody wants. Nobody’s putting up on Facebook that they barely passed their boards. And you have the doctors you’re working with asking, oh, you got above average, and you have to tell ’em no, and they’re like asking your score, and you have to tell ’em. And so it’s just not like… It’s not a thing that you’re proud of, even though you pass, and that’s good, and you’re moving on, but it’s just not what you want from the amount of work you put in, and it’s not what you

Ryan: Well-

Mike: needed to do for the future.

Ryan: Right, ’cause you’re thinking about emergency medicine residency, but you’re also thinking about the time and energy you put in, and the fact that you were seeing these scores in a much, they were trending much higher. And then to get something with such a huge gap from those scores down to the test, and again, I think once we got into the test taking down the line, we really figured out where that breakdown was, because you were just missing way too many questions you shouldn’t have missed based on like our definition of bad test-taking.

Mike: Well, because at that point, you really didn’t have the test-taking program separate.

Ryan: No.

Mike: That wasn’t a thing that we were working on together,

Ryan: No.

Ryan: and it wasn’t even an option at that point. I didn’t even understand- I didn’t understand at that point where the behavior came in, and how the training had to work. I mean, this has all evolved, and we’ll talk about this later. And then you got into rotations, your third year and a fourth year, building up to the Step 2, Level 2. But one of the quirks about your school at the time, is you guys didn’t have shelf exams, not real shelf exams the way that we do now, that we see everywhere now. So you didn’t really… Because I think had you had shelf exams, the bad test taking would have been exposed. But you were… I mean, you did extremely well clinically. Just personality-wise, team-wise, knowledge-wise clinically, and that’s really what you’re judged on. Fair? Is that fair to say?

Mike: Right, and so then the actual testing, the sit-down multiple choice testing, was more just practice for then Level 2. So you kinda would go every month, but it didn’t have any implication on your grade. It didn’t really matter. And so it was more just practice tests to move on.

Ryan: But no stakes, right? I mean, a lot of med students who, they come to me because they’re in trouble with their shelf scores. So you sort of were just excelling, because it was much more about the clinical skills, and showing your knowledge clinically, and that’s sorta where you were, you know? We would talk every now and then. But it seemed like you were well on your way. And then that led to your first attempt at COMLEX Level 2. How’d that go?

Mike: I failed that the first attempt. And I failed it

Ryan: And that-

Mike: by about the same margin as I passed Step 1. So your 5, 10 questions on the other side.

Ryan: Right, the flip of the coin. It’s the flip of the coin for you. And that definitely drew a very stark line in the sand in your life in your career. So that will be… We’re gonna come back and talk about that in Episode Two with Dr. Mike, sharing how crisis plague two manifested with his issues on Level 2 of his is a board exam, and we’re gonna dig into how that happened, and then how he got out of it, and see how all roads lead to where he is now, happy, successful, and content. So thanks for listening. Be sure to listen to our next part to see how he got himself out of this particular pickle on Level 2. Thanks for listening.

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