Image of Ryan Orwig against blue background with the words From Struggling with Boards to Success: One Surgeon's Story

From Struggling with Boards to Success: One Surgeon’s Story

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On the STATMed Podcast: Uncommon Pathways Episode 1

Although the shortest distance between two points is a straight line, that’s not always the path that a career in medicine follows. In our new miniseries, host Ryan Orwig speaks with STATMed alumni who share their uncommon pathways to their dream careers.

The Journey from Struggling with Boards to A Dream Career

In this episode, Ryan and JT, an orthopedic surgeon, discuss challenges he faced in his journey to becoming a surgeon. JT recounts the issues he encountered when struggling with boards. He also digs into the hurdles his relatively low scores caused when trying to get into a super competitive orthopedic surgery residency.

“When I found out what my Step 1 score was, I was freaking out. And so, of course, I would ask people, ‘Is this even worth it? Is this even worth doing? Should I just try something different altogether?’ And you know, almost universally, people told me — and this is what I tell people now — your Step score shouldn’t completely define you or dictate what you do. And so if this is something that you really, really want to do, and you know that beyond a shadow of a doubt, you should just go for it, and you should make every effort to make yourself a good applicant.” – Dr. JT

In future episodes, Ryan and JT will dig into how the STATMed Boards Workshop and Doctor’s Study Skills Course helped change his approach to studying and test-taking.

 Are you struggling with boards exams? We can help. Learn more about our Boards Workshop.

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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. In our new mini series, Uncommon Pathways, Ryan talks to JT, a former doctor study skills class participant, and board’s workshop participant about his journey to becoming an orthopedic surgeon.

[JT] Your step score shouldn’t completely define you or dictate entirely what you do. And so if this is something that you really, really want to do, and you know that beyond a shadow of a doubt, you should just go for it…

[Ryan] This is Ryan Orwig with the STATMed learning podcast, where we talk about studying, time maximization, and board-style test-taking for doctors, med students, and those in related fields. Today, I’m here with Dr. JT who’s going to share some insights into the challenges he faced in his uncommon pathway to becoming a surgeon. JT, thanks for coming on here with me. 

[JT] Yeah, Ryan. Thanks a lot. It’s great to be here. 

[Ryan] Can you tell us where you are in your career right now? 

[JT] Yeah so I am, thanks to STATMed, a board eligible orthopedic surgeon. I just completed five years of orthopedic residency and I’m in my fellowship now, a fellowship, just an extra extra year of training for hip and knee surgery. And after I complete that fellowship, I’ll be starting, starting practice. 

[Ryan] Awesome. So to be an orthopedic surgeon, you must be a great test taker. Someone who’s like a TOPGUN pilot when it comes to testing throughout med school, throughout your career, is that, is that you? 

[JT] No, no, not, not, not at all. I, I wouldn’t say I was a horrendous test taker, but I certainly was not, not the guy that you think of whenever you think of, you know, the person that gets into orthopedic surgery. Orthopedics is a very competitive field and it’s only becoming more competitive and you know, the big, the biggest barrier to entry for a lot of people is step one. Obviously that’s, that’s gonna change a lot over the next few years, as they, as step one is no longer pass, is no longer a actual numbered score. But yeah, it was a, it was a huge hurdle for me. And it was a huge source of anxiety just because I knew there was a certain number that I thought that I had to meet. And if, if I didn’t meet that number, then I wouldn’t get to, then I wouldn’t get to be an orthopedic surgeon and I wouldn’t get to do what I wanted to do. So there was a lot of pressure that I put on myself. 

[Ryan] So, you know, you knew you wanted to be an orthopedic surgeon or at least a surgeon of some sort going into medical school, right? And you were putting all this pressure on yourself and what was your step, step one score. 

[JT] Yeah. So step one, my score was, I believe it was like a 223 to 224, something like that. I mean, not a, not a bad score, but not an ortho score. 

[Ryan] Not an ortho score. Right. So you basically felt like when you saw that score, what were you thinking about this, dream you had of becoming an orthopedic surgeon? 

[JT] Yeah. I mean, I, I thought I was, I thought I was toast. I was like, there’s I started a question it’s like, is it even worth applying? Just because of, because of my score. So yeah. I was very, very, very discouraged at that point. 

[Ryan] Yeah, no, so that happens right. And then, you know, obviously the idea is get better through shelves, get better by step two. So you, you’re, you’re doubling down on this and you hit your step two. What was the circuit there for you? 

[JT] Yeah, so, you know, after, well, all through medical school, I had always reached out to people who were a few years ahead of me and had been through the process and I really relied on them for advice and counsel. And, you know, when I found out what my step one score was, I was freaking out. And so of course I would ask people, it’s like, man, you know, is this even worth? Is this even worth doing, you know, should I just try something different altogether? And you know, almost, almost universally people told me, and this is what I tell people now, like your, your step score shouldn’t completely define you or dictate entirely what, what you do. And so if this is something that you really, really want to do, and you know that beyond a shadow of a doubt, you should just go for it and you should make every effort to make yourself a good applicant, despite the fact that you may not have the best test scores. So I, after my step one score, I really set out into the third year, you know, saying yet I’m going to redeem myself on step two. I’m just really going to do well in my clinical rotations. And then just show up as much as I can to, you know, and work with the orthopedic department as much as possible. And just show them that I’m a hard worker and an easy to work with. So. 

[Ryan] And a team player, somebody that they can rely on somebody they want to be with, because you talked about these other things. Now not, you know, not everybody can make it to the, this mountain peak that you made it to. And you, you know, you, and I’ve talked about that, but it seems like what you did was you really did network. You, you, you worked with the people in your, your medical school community, you used mentorship, you found other people, you talk to them, but again, it sounds like you say being present, letting them know that you are someone that they can work with that is can ask the right questions, is teachable is trainable. And you did this throughout your med school career, along with just your, your, your other, your, your classroom basics, your rotation basics. 

[JT] Yeah. Yeah. One-hundred percent. You know, one of the things that people always told me, and I can tell you this from, from experience in, in residency, it’s like, you know, the, the guys that come in that have a, you know, a two, a 270, you know, they may have great scores on paper, but they may really not be cool guys to hang around with not somebody that you want to be putting in, putting in long hours at the hospital with may not be easy to work with, but you know, you get a guy that has a, you know, a 220 or 230 that wants to be there that wants to work that’s as a team player. Like if they see that, like they’re going to take that guy with the, with the two, with the 230, every single time.

 [Ryan] It’s really interesting. It’s a, it’s an amazing, just thinking about where, real world stuff intersects with the paper-based applicant. So, yeah. So you, so you did that, you took your step two and then what happened with step two? You crushed that one?

[JT] No, I did not. So I actually, I went down like two or three points on, on step two. I made like a 2, 221. And that was, I mean, that, that was a gut punch. I, yeah, I was extremely, extremely down after, after that one. I, I got my score on my fourth year rotation on my fourth year ortho rotation. And I was like, the next day I was actually going to ask the chairman for a rec letter so that he could write me the rec letter for residency. And, you know, I went in his office and I told him, I said, look, you know, this is, this is my score on step, step two. Obviously not what I wanted. I studied really hard, and this is just what happened and as I said, I’m just very discouraged by all of this. And then he told me, he said, you know, he said, if every orthopedic surgeon had to be AOA and make a 250 on step, there wouldn’t be many orthopedic surgeons. And so that was a, that was a huge encouragement to me. And that’s something I’ve, I’ve told numerous people before. And it’s, it’s true. You know, the test is just one facet of, of the applicant and of the application process. And there’s other things that, that can make you a good applicant. So you shouldn’t, it’s important, but you shouldn’t, you shouldn’t let that, everything ride on that one or two test scores. 

[Ryan] So, yeah. So this is already painting a picture of this, this guy you are now, you know, at the, at the tail end of all your training and you made it through all this stuff, despite these issues with test taking. And some people think that test taking means, I can, do I pass the test or do I not? Do I pass my step or do I not pass my step? But there can be issues with test-taking that are not reflective purely in the score, or the passing or the failing. Perhaps somebody is testing it at 220, but their knowledge really is 240, 250, but it’s not translating due to too many unforced test-taking errors. It could be that, some people might come to me and say, I study all the time. You know, I do, I do great clinically, but my scores aren’t reflecting. Well yeah, maybe it’s test taking, or maybe it’s more, study-based maybe it’s happening in the way you’re taking and receiving and organizing and encoding and retrieving the information. Maybe it’s a combination of both, but what we’re hearing here is there’s also this other side of interpersonal communication, professionalism, being a team player, being somebody that can receive feedback and build off of all that. So how does, how do you go? What’s the, what’s the short version of, you come out with your step one, your step two, you get through your rotations, they know who you are. You’re sort of doing your training in the south. You, you know, you’re, you’re networking, you know, people, how do you go? How did you land this residency then? 

[JT] Yeah. So I applied just kind of just like every everybody else did. I had all the users, the standard application process. I had a lot of support from my, from my home program. I had a good relationship with the chairman there and specifically the program director and, you know, they, their, their rec letter, their letters of rec went a very, went a long way. I got around nine interviews when I was going through the application process, which was a lot for somebody that had a, that had a 220. And I attribute that to the strength of my, of my rec letters and a lot of the other extracurricular stuff that I had, that I had done to improve my application. I was really involved with a few, one in particular, one pretty large national organization. And it was on a leadership position there that, looks, looked great on my application. And I had a lot of things to talk about with regards to that experience. And I had some research as well with the orthopedic department. So I had a lot of other things to supplement my application in addition to, you know, strong backing from the faculty at my home program that really allowed me to look at a lot of other programs that I would not have had the option to had I not, if I was just going on my own on the score that I had on step one, step two. But yeah, I, I interviewed kind of all over the country. I’m a, I’m a homebody and wasn’t, wasn’t too interested in going way far off and I loved the program there at my home institution. They had a great reputation, just really always had good residents that worked well together. There was a lot of comradery. And so it was a really, it was a really easy sell for me to stay for me to stay at home. So I ranked my home program, number one, and on match day, I ended up staying at month home institution. And I was just, I, I was thrilled. I mean, it was, it was a huge, huge weight off my shoulders. Cause it was kinda like the, the monkey on my back for four years of med school, it’s like, man, am I going to, am I going to be able to do what I want to do? Or am I going to have to be stuck in some, some field that I’m absolutely miserable in? So it was, it was kind of a, a golden ticket as my, as my chairman would, would always say, orthopedics is the golden ticket. So I definitely, I definitely felt like I had, had gotten the golden ticket on match day. 

[Ryan] So you then are in your orthopedic surgery residency, you made it, life was amazing. Life was great. No more stress, no more, no more troubles. Not the case, right? 

[JT] Yeah. Not, not, not the case for, for a number of reasons. Yeah. You know, residency is hard. It doesn’t matter what, what residency you’re doing. It’s, it’s, it’s a huge, huge change of a change of pace going from medical school. Cause all of a sudden you’re, you’re responsible for, for people and your decisions actually, actually matter. Orthopedics is a very, very challenging residency. I mean, orthopedics is up there with, with neurosurgery in terms of the, just the time and the, the difficulty of the, of those, of those five years. So there’s a lot of just challenges from a workload perspective and that’s, that’s a whole other conversation altogether, but yeah. You know, every, once you, once you get into work, their residency, like testing doesn’t, doesn’t stop.

 [Ryan] So what were some of the things that were, so for, personally hard for you and because we’re getting close to where you and I sort of connected finally, because you know, at this point I, you know, we’ve never, we’ve never met, we haven’t talked, but you know, cause this is what we’re, where we’re leading with. This is what led you, someone who’s sort of at the tail end of the, the, your orthopedic residency to reach out to somebody like us. Right. Because so far, even though you haven’t scored as well as you would have liked and stuff like that, there’s no true crisis point here. 

[JT] Yeah.

 [Ryan] So what was that? These things that build up year after year throughout this, this five-year this program that led you to sort of, I don’t know, down the particular internet rabbit hole to find us.

[JT] Like I was saying, once you hit residency testing, doesn’t, doesn’t stop. And there’s a test every year that you take, it’s called the orthopedic in training exam or the OIT for short or Ortie, some programs call it. But I mean, it is just a, it is a terrible test. And every, every resident dreads it, it’s every November. And it, everybody in the country takes the same, takes the same test. And every resident, years one through five takes the same test. And of course, you know they publish the scores and you get your score back and programs use it as a metric to see kind of where they are in the, in the, in the, throughout the country to see how well they’re educating their, their residents. And then also gives you as a resident chance to see, well, how do I stack up against other residents throughout the, throughout the country in terms of my knowledge base. So first year, you know, I took it and I guess I felt going into it. I was like, well, you know, this is just orthopedics. Like, this is one, this is what I’m interested in. And this is only one particular thing that I have to study. It’s not going to happen. It’s not like I’m having to study, you know, urinary tract infections or things like. 

[Ryan] All this stuff throughout med school and through like the stuff that you had zero interest in, right? 

[JT] Exactly. So I was like, well, this is going to be different. Cause I, I’m actually going to be able to study stuff that I like. And I’m probably, I think I’ll probably do better on this. Well, you know, my, my first in training was at the height of intern year when I was just crazy busy. And so I did not, didn’t do well then. And so I kind of just took that as like, well, this is, this is just me getting used to everything, but obviously I would’ve liked to have done, would have liked to have done better. Second year rolled around. It’s kinda the same thing. Like I just didn’t, did not do well on the, on the exam and looking at it from a percentile basis, you always get this, your metric is like, well, what percentile were you in? And you know, if you, if you score like below the 20th percentile, like, you know, you’re in the doghouse with your program director and you get dragged in and it’s like, why didn’t you study harder and all of these things. And so anyway, that was, that was my story, you know, all through residency. Like I just, I never, I was never the guy that knocked the in training exam out of the park, even though I studied, I was consistent with my studying. I was working questions all the time, but it just could never really hit that, hit that number. 

[Ryan] So percentile means comparing, I sure everyone knows this, but that’s comparing you against all your peers across the country taking this as where do you fall with everybody taking this test? And were you always in the doghouse, this proverbial doghouse or where you sometimes out of the doghouse? Sometimes in? 

[JT] I mean, I never, I don’t think I ever really cracked like the 30th percentile. 

[Ryan] But isn’t this sort of, part of it, like it’s this idea they drag in and they yell at you, they brow beat you, basically trying to get either accusing you of not studying enough, not doing enough practice questions, not being serious enough, not taking it the way that it needs to be taken. That’s that’s where a lot of these programs and I, this is from residency all the way down through med school and even below where they just want to almost guilt you into performing better because they quote unquote need you to, but it’s not tactical. It’s not analytical. It’s not, you know, really installing strategies and methodologies. In general, and that’s my experience. And then, and then I think where you, if you, if you are at a really, really like top end institution, they’re not going to think about methodology, and at a top end, highly competitive field, like orthopedic surgery, they’re like, we know you’re good enough there because you’re here and we, and then they’re also thinking like, Hey look how well you perform clinically, but then you’re, you’re, you’re, you’re, you’re not hitting the score. Therefore you’re not working hard enough, which is not helpful for the pressure, for the stress, for the anxiety, for the dread, which I think was part of this, this experience that was growing in you. Right? 

[JT] Yeah, for sure. And I will say, you know, my, my program in particular, my program director is a tremendous educator and he was always the first person to reach out and say, Hey, look, whatever help you need to get better at this. We are more than willing to, to go the distance to do that. So I, you know, I certainly don’t want to throw my program under the bus, but they, in particular, once I found STATMed they went above and beyond to accommodate me and help me succeed. 

[Ryan] Oh yeah. I’ve spoken with the people there and the open-mindedness and the interest, because I think, I think what we’re doing on our end, this idea of installing methodologies and highly intelligent, highly motivated medical professionals is, is fascinating. If somebody is open-minded enough to, to, to, to listen to it, right? And, and you’re, you’re absolutely right. Your program was like totally on board and excited, 

[JT] Absolutely. 

[Ryan] Which is what I want, obviously, as we’re building this thing that we’re building on our end. 

[JT] And I think this is maybe a little rabbit trail, but I think it’s worth saying, I think a lot of this is we’re finding that there’s just different ways, that people learn in different ways. And so, as, as testing, as standardized testing just becomes, just has, has evolved, You just realize that there are people that learn different. And a lot of times, you know, I’m a very, I have to have structure. And this is one of the things that STATMed taught me and residency in general, just as, not as particularly a very, very busy high volume, high clinical volume residency is not conducive to a strong educational structure. And so this is something that I’ve talked with my program director about as I was leaving. It’s like for people like me, that need structure, like you have to identify that very early. Otherwise these problems are just going to keep, they’re just going to keep coming up. And so it’s a, a lot of times, I feel like in the past, when, when, when, when programs would be like, you know, you’re, you’re not working hard enough. I think, I think people are starting to realize it’s like, oh, it’s not like, it’s not that you’re not working hard enough. It’s like, you’re not working in the right way. Like you’re directing your efforts in a way that is just, it’s not, it’s not effective. And so I think what this, what this program has, has shown me, and I think what it’ll show to a lot of people is that it’s all about how you’re learning, not necessarily how much you are, how much you’re doing. It’s a, it, it’s definitely a more focused approach that is in the long run far more effective. 

[Ryan] Yeah, no, absolutely. So, so just a little, so what led you throughout the course of the, of the, of the five years to then sort of at the tail end, as you’re getting ready to take your, your final board exam, what led you to reach out to us or to, or to seek us out? I guess, what were just describe some of the things that led you to say, like I need, other than just the, the in-service exams.

 [JT] So my fourth year, my fourth year of residency, I really, really studied hard for the in-training exam. I mean, I was consistent with how I was doing, how I was working questions, doing stuff every single day. And I got my score back and it was terrible. Like I was in like the, I don’t know, like the 50th percentile or something. I mean, something just, just crazy. And I was just, I was so mad, because I had put in all this time and it’s like, I know this stuff, like, this is not, this is just not reflective of my effort or my knowledge. And, you know, one of the things that they always tell us, like, you know, if you’re scoring below, if you score below, like, I don’t know, maybe the 25th or 20th percentile as a forth, you know, you’re at a significantly higher risk of passing a board. So it’s like, that just scared me to death. I was like, all right, well, I’ve got, I’ve got to do something. And I just, you know, went down this hole online and just trying to figure out, like, why, like, why am I missing questions that I shouldn’t be missing? Like, cause I look at my questions that I would miss and I’d be like, no, like why did I miss that? I know, I know that, why didn’t I see that in the, in the answer choice, or why didn’t I see that particular thing in the question? And I knew that there was something that I was doing incorrectly, like in my process, like, and I didn’t have the words to articulate that yet, but that’s what I was, I was looking for somebody to speak to that. And I just, I just started Google searching and I came across y’all stuff on YouTube. And I think I found y’all within about a week of y’all launching stuff on YouTube.

 [Ryan] We had just, we had just put that stuff out.

 [JT] I mean, it was, it was so early, like y’all’s video, I mean had like a couple hundred views. And I was like, what? Like? 

[Ryan] You were outraged.

[JT] Yeah. Yeah. I was like, what, what is this? And y’all just start talking about this, this stuff that was like, you know, you’re missing, you’re missing these questions. Like, you just you’re, you feel like you’re studying all the time and you’re just not getting anywhere. And I was like, man, like these, like they are speaking my language, like, this is exactly the stuff that I am, that I’m struggling with. So I, I can’t remember. I think I emailed you and was like, hey can I kind of talk with you? And then I ended up having a conversation with you and kind of went through my story and told you what I had been struggling with. And we, we went from there. 

[Ryan] Yeah. Cause then we, and then we had about a six month run to get you sort of, to re-engineer what you were doing. So you could actually get the more bang for your buck. So yeah, we talked for a while. 

[Announcer] Thanks for tuning into this episode of the STATMed podcast. In the next episode, Ryan and JT will dig into study based issues. If you like the show, be sure to rate it on iTunes, Stitcher, Spotify, or wherever you listen to your podcasts. And be sure to subscribe, so you don’t miss future episodes. You can find more test-taking and studying strategies, specifically designed for med students and physicians, over at our blog on Thanks for listening.

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