How One ER Doc Went on to a Dream Career After Failing A Board Exam
In this series, we‘re talking about something people rarely discuss: failing in med school and on boards. 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 their medical careers 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.
Navigating a Med School Crisis Point: Failing the Boards
In this episode, host Ryan Orwig is back with Mike, a former STATMed Learning Class participant. Mike shares his second crisis point when he failed his COMLEX Step 2 exam. He outlines the bumps in the road and the steps he took to achieve his dream of becoming an emergency room physician after failing a board exam.
“You take it (board exam). Then you go off on rotations and auditions and to all these different programs. You’re trying to look good and work hard and get into one of these residency spots. And you’re doing well, they like you, and they think you’re a good fit. But then they pull your scores and see your Step 1 and your failed Step 2, and then you’re back to the embarrassment of not doing well on testing because that’s what everybody looks at.” – Mike, ER Doctor, and STATMed Alumni
Don’t miss the first part of Mike’s story in Part 1.
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Announcer: Today Ryan continues his conversation with Mike, a former STATMed class participant. This is part two of a conversation in which Mike shares his crisis point or the moment in med school when he first realized he was seriously struggling and needed to take action.
Mike: Yeah, it’s the line in the sand. You have eight hours, whatever number that computer spits out is whether your future is done and you’re not a doctor or you can continue on and graduate. That is the line you have to cross to be able to graduate.
Ryan Orwig: So what did you do?
Mike: I called you, panicked.
Ryan: I’m Ryan Orwig with STATMed Learning where we talk about learning and test taking in med school and on medical boards. Welcome back to our conversation with my former student and my friend, Dr. Mike, who has been sharing with us, his crisis points on his journey to becoming an emergency medicine doctor. If you haven’t listened to part one go back and do that one first, it’s a doozy. So Mike, a quick refresher, tell us who you are.
Mike: So just a quick recap. I’m a ER physician in Florida. I’m the assistant director of a mid-sized ER, here in Florida. I’m here with my wife and kids and we have a happy family, happy life here. Ryan and I had our intertwined life for approximately past 10 years. And sitting, talking we’ve talked and touched base multiple times. And you just kinda think about how different your life could have been. Any of these crisis points had gone differently and how different it was because of the crisis points in the first place, so.
Ryan: Absolutely. So let’s pick up on your story where we sort of talked about how you fought your way through med school and dismissal and some mini crises along the way, squeezed by your level one board exam, did well getting through your rotations and then hit your second crisis point which is what we’re gonna talk about right now when you failed COMLEX Level 2 by a handful of points. So that’s kind of where we are right now. Well, can you tell me about the buildup to that test? And of course, the fallout from not that passing that test.
Mike: It’s a very similar story to a lot of people that don’t pass. At that point, I knew I had just barely passed step one. So I was on rotations, doing well on rotations through the year. I decided I was gonna do ER and was applying to residencies and had auditions set up to travel all over the country to go to different ER residencies. And you know, this is a important test and you’ve got to do well. And so for the months leading up to it, I would go into the hospital early. I would study before rotations, I would study at lunch. I would carry flashcards in my pocket just to squeeze every little bit of studying time in. After rotations, I would go back. I would study more until nine, 10 o’clock at night. I basically lived at the hospital. We were there all the time. I studied more than I did for step one because I knew this was the one that this is this level two that everybody looks at. And this is what determines which residency you get, where you go. And so that was my mindset going in was I’m gonna use the study skills that I learned when I repeated first year combine that with working harder than I’d ever done before. And so went in confident to that boards practice tests. I think I did about 5,000 practice questions before I even got to the test. So I did every question bank there was, did some of them multiple times. And so, obviously
Ryan: But Mike, let me intervene. Let me intervene. So yes, 5,000 something questions, studying all the time. And again, I said this in the last episode but this is what somebody who is an inconsistent test-taker, a poor test-taker does, they overcompensate, they overtrain, they overstudy, they do more questions than the person sitting next to them. That’s just how you compensate. Unless we can intervene through methodology. And at this point, what year is this?
Mike: This is 2012 at this point.
Ryan: Yes, so you’re doing this, the buildup through 2012. And this is also when I left Marshall and I created what would become STATMed Learning during the same exact year. So it was big year for you. I was sort of leaving and trying to figure out the next step for me. So you’re doing all this. You’re doing all this prep. And then you take the test, right?
Mike: Yeah, so as most people first couple weeks in July you take it, you’re six weeks out and so. But at that point you go off on rotations and auditions and you’re going to all these different programs and you’re trying to look good and you’re trying to work hard and you’re trying to get in to one of these residency spots. And so you have, you’re doing well. They like you. They think you’re a good fit, but then they pull your scores and they see your Step 1 and they see you failed 2. And so then you’re back to honestly the embarrassment of not doing well on testing, because that’s what everybody looks at in all places-
Ryan: This is a major crisis, right. This is like, you are, there are people like lining you up and earmarking you, like we like this guy. We want this guy on our team. And then the shoe drops and you fail this test, right? This isn’t just like, they wanted you to get above average and you scored below average. That’s a different scenario, right?
Mike: There’s a lot of places they use because they have three or 400 applicants for four spots. That was 10 years ago. Then their first line of defense is board scores.
Ryan: It’s easy.
Mike: And if you don’t pass the boards you automatically are off their list. And so going there and kind of can get you closer. But a lot of places were like, we’re sorry you didn’t pass boards. That’s the first step to even getting an interview. And so that-
Ryan: All right, so number one, so that is right there, bang that’s a massive blow. And then you’ve got the school and what the school is gonna do to somebody who’s now failed their boards, correct?
Mike: Yeah, so then they’re reaching out and they’re doing the best they can, again, they don’t, they think that the answer is to study more and to do more questions and to practice harder. And you go back to the story of just work harder is really the advice to be able to get through it, and-
Ryan: Mike, is there also an accusation that maybe you didn’t work hard enough the first time?
Mike: Yeah, that’s, ’cause I mean, they see that all the time that people didn’t put the effort in, they didn’t put the time in, they didn’t do what they were supposed to. And so that’s the people they see. And so they think that if you put the time in you do what you’re supposed to do, you do practice questions, you prep, then you’re gonna pass.
Ryan: Because I think there’s a presumption that all med students are built the same. Why are the same, same cognitive wiring? And it’s just the simpler solutions. I mean, everything’s easier if that’s the case, right. But we have to embrace it, not everybody has the same strengths and weaknesses, that not all people read and process test questions the same, not all people learn and encode information the same but it is the easier answer. Oh, you fail. And I say, it’s an easy recommendation. Like go do 1,000 more questions, go do 5,000 more questions. Use this bank instead of that bank. Those are easier recommendations than, we got to retrain this brain. We got to like intervene with an appropriate intervention. That’s tough, that’s a harder set. It’s a harder solution. And I don’t think that’s just our cultural setup. It’s just like, well, go do this. So after the first failure of step two did you have to go back to the promotions committee? Or was that just like, just get ready to take it again?
Mike: No, that was just a, you have a couple of months to retake it, start over, keep going. ‘Cause you’re already doing, you already have all the information. You already have all this stuff prepped out. You already have been studying this for five months at this point. Every day, this is what you’re doing. This is your life was studying for this test because you’re trying to do well. And so now I’m traveling you’re every two weeks or moving to the next program. You’re still trying to study and look good to these places because in a year you’re hopefully graduated from med school and you want a residency spot and you want one of these spots that you’re going to. And so you’re trying to, again, balance the studying for boards ’cause you still have to pass it. And none of this happens without passing it.
Ryan: Right, so you pretty much turned around and took this test pretty quickly after that, right?
Mike: Yeah, so, I mean, you have matched it, you have a deadline and they have to have all their stuff back by match day or you miss the whole cycle. And so I think I took two and a half maybe three months, had it rescheduled ’cause you’re off the normal cycling. So scheduling is a little more difficult. You’re off traveling. So where are you gonna take is a little more difficult. And so getting everything lined up, so two, three months turnaround but you’ve already done all the work. So you think, it’s a bad test day, like I, and so you can just turn around. I’ll get through it, pass it quick. And then, you’ll be able to move forward, continue the interview process, get the residency by match day.
Ryan: Yeah, I mean, I think it’s a logical. I don’t know that, I don’t think we talked between these two tests. So you did what I think is a fairly logical thing. How many more questions? So you think you did a lot more practice questions again?
Mike: Yeah, I probably did a whole another question bank, one or two times. I was probably at another 2,000 questions by the next three months. But it was really just going through reviewing and like trying to find the stuff that you were weaken, hitting it hard and then, finding your weaknesses and moving through it.
Ryan: Yeah, and so you did that and then you took it again and I’m assuming, what I don’t wanna assume what happened then when you took Step Level 2 the second time?
Mike: Yeah, so now we’re November, our fourth year, six months from graduation. And I failed again two months from match day. So I failed step two twice now and I’m really in trouble.
Ryan: Yeah, this looks like maybe game over, right?
Mike: Yeah, again, back to margin of error. If anybody else had sailed through first and second year, sailed through step one, you fail boards twice and it’s not as big of a deal, but you already have history. You’re already on the list. You’re already going through the promotions committee. And so then everything starts over and so then you have to be alive.
Ryan: Now, Mike is the committee now back on your case?
Mike: Yeah, so now you have to get approved to be able to take it for the third time. And then your-
Ryan: Now, remind me, could the promotions committee decide, sorry, you don’t even get a chance or is it like, you’re gonna definitely get a chance to take it the third time?
Mike: No same, they can decide if you don’t have a plan, if you don’t have an explanation, then they very easily can say you’ve taken it twice that was your shot. We’re not gonna let you take it again. You’re out again.
Ryan: Wow, terrifying. So what did they say to you?
Mike: So they, you get dressed up, you go to the meeting again, you try and talk to these people about it. And so they, luckily you said, one more shot. You get the third chance, you take it, this is it. There’s no more, there’s no fourth time. You don’t take it again. There’s a third and again, that’s your line in the sand. You pass it or fail it. You’re in med school or not. And so-
Ryan: This is the ultimate test for you, after all the stuff you’ve been through. It’s like, this is truly, it’s like, I don’t know. Like every move is like, this is the biggest battle. This is the biggest challenge for whoever’s like, this is Ironman’s biggest challenge, this is Jason’s Bourne’s biggest challenge. But this really is like, this was Mike’s biggest challenge, right?
Mike: Yeah, it’s the line in the sand. You have eight hours, whatever number that computer spits out is whether your future is done and you’re not a doctor or you can continue on and graduate. Like, that’s the line, that is the line you have to cross to be able to graduate.
Ryan: So what did you do?
Mike: I called you, panicked. So we have these intertwining episodes of the five years of med school. And I call and you panicked ’cause I thought it was still a study thing. I was studying what we did and it wasn’t working. It wasn’t coming through on the test.
Ryan: I had just left my spot at Marshall. I just like packed up and I said, I’m going on my own. I’m gonna figure this thing out. Didn’t really have a business plan. Hadn’t really figured out what it all look like. But I knew at that point, I had decided at that point that like the models were different and the demographics were different. And I wasn’t really looking to work with the same demographic. I was working with a Marshall. I was like, I think that I can help anybody who identifies as being, I don’t know how to study in med school. And that was gonna be the STATMed class. And then I was building this thing called the STATMed boards workshop, which is I’m smart, I know my stuff. I just can’t show it on test day. That’s the STATMed boards workshop. Take a bad test taker and turn them into a good test taker on medical board exams. Let’s go to step one, level one, all the way through step two level twos, step three level threes, shelf exams, specialty boards, subspecialty boards, anything under the umbrella of medicine from anesthesia to emergency medicine, to cardio to just different surgeries, whatever. But I was just building it. I was just now trying to figure out, like what’s the through line? What’s the mechanism? What’s the system? And I think, we talked about it. You were panicked. I was sitting in this little office I’d set up in the back of my house. And I was like, I wish he was calling me six months later when I had this thing built. But I think what we did was, I think it was like, I was like, “All right, Mike, I hear you. And I know your brain as well as I know anybody’s and I know your personality, I know your temperament and all that stuff.” And I was like, “And all the study stuff,” I was like, “Sounds fine, sounds right. I don’t hear,” I’m not seeing a lot of times you can see it’s like a matrix. It’s like, there’s a breakdown here or this is fuzzy. Maybe there’s a problem here, maybe not. It also, I mean, I think we had your study stuff up and running pretty well but we didn’t have this other side, this test taking performance showing consistently what you know on medical board exams over this eight-hour test. Because I’ll say like, I’ll say this elsewhere. I say it all the time like test taking is a weak link system. Some things are strong link systems, some things are weak link systems. This isn’t about you at your best when you crush a question, don’t care about that. What I care about is you at your worst, when you are abusing the question. When you’re distorting the specific question being asked. When you’re rounding down key clues. When you’re doing single points of contact. When you’re using a binary test taking mentality. When you’re ruling, instead of ruling out and you know you, are truly the poster child. So I think what we said, I was like, “Look, Mike, why don’t we just have you be the Guinea pig? As I develop this.” That’s what we did, right. I was like, let’s just-
Mike: I think I was the third person that take the class, like, you tried it once. And then I think I was the second or third person to go through it. And you were still putting stuff together and you had notebooks, you were mailing out, and so crazy.
Ryan: It was crazy, very crazy. Yeah, very early in, and I was like, “Well, we’re just gonna spin this thing out.” And yeah, like I said, I believed in you, I knew you. And I was upset for you. I mean, I was like, oh my gosh, no, not at this point. And you were just crestfallen and scared and traumatized. And we get into it and I’m looking at your test taking. So this means like, using like Google Hangouts or whatever weird portal we were using at that time. And you were, that means you’re reading questions out loud and then articulating all your thoughts as you go. And it’s just, it’s a train wreck, it’s a mess. So one of my skills, I think my special skill and I think this is similar for you as an emergency medicine doc is I’m really good at pattern recognition. And my background with like the way the ADHD brain works, the way reading and learning works, where gifted learning works and like learning disabilities work. Most of my docs, they might have a little bit of this, a little bit of that, but it’s just patterns. It’s like, look, this is a bad pattern. He’s exhibiting this bad pattern, these same bad patterns repeated over and over. Now, and maybe there’s like 12 to 15 bad test taking patterns. Somebody might only be doing two or three of them. And it’s enough to really wreck their test taking. But you, you were like checking so many of the boxes. It was a great early like avatar to build through. ‘Cause like you could just say, look, let’s plug Mike into this. He does that. He does this. And again, it’s not, they’re just invisible behaviors to you. So we get in there and we start installing the system. Now that system’s evolved a lot since then and blah, blah, blah. But we’re installing this very rigid process for reading the questions. It’s kind of like an elaborate apparatus, right? You go from prompt to passage, to triangulate what we now call status checked and taking each option one by one not weighing them together, giving them one of these codes. It’s like sort of weighing in a vacuum. How accurate, how honest are those? And then if you go to a tie break, how do you break that tie? This is all stuff that you can see some videos on our website about this. This is our statement boards workshop. But on the one hand we have to install the system. I don’t think it’s like rocket science to install the system. It’s a process and we’re good at it. I mean, probably wasn’t as fast, but you had about two months, I think, right? When you got ahold of me, till I turn the ship around. And so we start installing the system, like hammering it into place. So we had to teach you to play the game the way we want you to play it. And then ultimately you guys are smart people. Mike you’re smart person. My med students physicians are smart. They have to be their own coach. Like every time you do questions, you have to use the system. And this is what we’re getting up. And I’m figuring this out like, this is really important. This is less important and all that. And really getting it up and flying from untimed to like tutor mode, to time mode, to what’s our success rate with high breaks and all this stuff, right. So we get this thing up and going and I think we did it for free, right. Wasn’t it like, “Mike, you’re gonna do this. I’m not gonna charge you because I’m still making it up. And then you’re just gonna help me in the future.” And then you’ve been indebted to me ever since.
Ryan: And that’s really why you’re doing this blog. Like I owe him forever. I’m just kidding.
Mike: I think I’m.
Ryan: You did the work, I didn’t. And there’s a lot of work. It’s a lot of work because bad test taking is bad behavior. That’s like one of my mantras. Do you think that’s true? Like it’s just like you’re default wiring. How you operate in these questions, right.
Mike: And nobody knows because you’ve been taking tests since I was four years old and you’ve been taking them the same way and you go back and you think when you’re in third grade you miss questions ’cause you didn’t, you went too fast or you jumped too fast and you know, your mom was like, “I studied all this stuff with you and you still got this question wrong. Like what’s going on? You know this stuff. And then you go to the test and you didn’t get it right.” But, and so that just carries on until you get to boards. And so it’s the same deal just on a bigger scale and-
Ryan: On a bigger scale. But what I tell people.
Mike: Then these are more amplified.
Ryan: Well, they’re more amplified but it’s like, why didn’t it get caught before? And I say, it didn’t get caught before because it wasn’t a problem. It’s not a problem until it’s a problem. And so you’re able to, yeah, maybe you’re missing some of these nuanced questions due to impulsivity or you’re sort of coloring outside the lines or what have you, but you’re able to then cover it up with your intellect and your ability to explain to a teacher and to get points elsewhere. But when you get to the construct of these medical board exams, they’re very unforgiving. They’re all of equal cumbersome build. And if you have weaker executive functioning, weak or working memory, which I think applies to you, it just all gets exposed and it all gets amplified. Part of having a good test taking solution at this level is finding out where the weaknesses are, and then having a system that limits the burden on those weaknesses. That’s bad decisions, bad behavior, working memory weaknesses, executive functioning weaknesses. And you really wanna build that system out to sort of buffer that. What might. So we did this, we’re working for like two weeks. What can you remember maybe one or two of, I’m putting you on the spot, of the kinds of mistakes you might make, either the name of the mistake or a contextualize example of the kind of mistake you might make on a question where, ’cause I think what happens, let me just say this first, the idea is like in your training, ’cause it doesn’t matter on testing, you don’t know. You just have to execute like you train on test day. You miss a question, you read the answer explanation, you then sort it into one of two categories. Was it a knowledge miss or a test taking miss? A knowledge miss is like, yeah, I just didn’t know that, fine, fair miss. You’re gonna miss it. I don’t care about those. But like the true legit knowledge miss you were making were not, while you were scoring the scores you were scoring below 400. The reason you were scoring below 400 is because of the other side of the test taking misses. This is when you read the answer explanation and you realize, hey, I should’ve gotten that right. And then just the staggering number of these things you have to in training identify the test-taking misses. Then you always have to do like a post-mortem autopsy where you track out what did you do, right, and what did you do specifically wrong? And that’s where like the boards workshop is very mechanized, a streamlined for all this. But I mean, anybody can do that to a degree. Do you remember, like an can example of one or two of the kinds of misses you were particularly susceptible to?
Mike: There are a bunch, but I would twist to twist the vignette into fitting an answer that was wrong. I would do that a lot.
Ryan: Square pegs will fit in round holes, if you hit them hard enough, right. Yeah, so this is where the like the you and I think it’s funny, ’cause like twisting is like a weird way to abuse your knowledge, right. ‘Cause you’re not like twisting it from nothing. You’re seeing an answer option. Then you’re reading the clues in the vignette and you are manipulating them based on your knowledge, right. To make them fit to shape the square peg into a round peg. So it’ll fit through the round holes. It’s not even hitting it hard. You’re distorting the object to fit. So you’re like a really bad twister, right?
Mike: Yeah, and then also I would be answering the wrong questions because my working memory was so bad. I would forget what question I was answering by the time I was trying to work through all the choices. And so I was losing details in the question,
Ryan: You mean like the specific question being asked like the last sentence, what we call the prompt,
Ryan: Right? So if it’s asking for best initial treatment you lose sight of initial treatment. You’re thinking best overall broad spectrum treatment. Most appropriate, next step in management, you’re choosing something farther up the staircase, not immediately next. And then you miss it and I’d say, well, would you do that next? No, you wouldn’t do it next, you do it later. And that’s the answer you chose and you would know, right? So and your brain isn’t gonna just leave a giant hole in like, what is the question being asked. Your brain is going to lose the question and then auto-correct and fill in the void. And then that’s, I think what you end up plugging in because it’s all swirling around, it’s a mess, it’s chaos. And you’re saying, yeah, this is something you could do for this patient in this situation with compartment syndrome. But it’s not what you would do next. And you know that as an emergency medicine physician, you’re like, no, it wouldn’t be. Or you would pick something to stop the most appropriate. Like I would see you do this all the time. Like you’ll pick an answer and you’ll explain to me why it’s right. And it sounds really good and medical and knowledgeable and I’m like, would it be the most appropriate next step in management? Like just breaking down the simplest yet complex question that you might see in a medical board exam, right question. And you’d be like, well, you could do it. I’m on the right track, right.
Ryan: Yeah, you can do that. But I’m like, but is it most appropriate? And this isn’t even like most appropriate compared to other options. You’re just like, no, it wouldn’t be like the textbook thing, and that’s fair, right?
Mike: Yeah, and after you do so many questions, you see that all the answers are right for a different question. They’re right if the question vignette has changed just a little bit, and that’s the point of the test is to see where the details are. And so if you are missing it from the beginning and you’re going down, looking for the right answer to the wrong question, you’re in trouble. It’s impossible.
Ryan: It’s the equivalent of you trying to tell me what 10 plus 10 is. But like you’re, if I say what’s 10 plus 10, you tell me it’s 20. I’m like, “No, Mike it’s 22.” And you’re like, “What?” And I’m like, “10 plus 10 plus two.” You’re like, “I didn’t have the plus two.” You have the wrong coordinates. Well, it’s Raiders of the Lost Ark. It’s like, so Raiders of the Lost Ark. Like the bad guy Nazi. He like, Indiana Jones has this head piece to the Staff of Ra and Marion has it. And there’s writing on both sides, spoiler for a movie that came out in 1982. And so the bad guy grabs it when it’s in the fire, and he screams like hilariously in agony when it burns into his hand, but it only burns one side. So the bad guys are digging based on the coordinates of only the front side of the head piece of the Staff of Ra, the good guys have the actual medallion and they can see on both sides, they have the right coordinates. So what you were describing and what you would often engage in is you would take the wrong coordinates, either not even from the clues, the medical clues in the vignette but simply the last the sentence, the question being asked. I think is a pretty popular advice. Read the lessons first. I think it’s well-known at this point much better than it was 10, 15 years ago, but I still see so many of my bad test takers they read that last sentence, but they don’t profit from it. 30 seconds later, 65, 70 seconds later when they’re choosing their answer, they’ve become unmoored from it. And they’re answering a different question. And that’s what you’re describing, right?
Ryan: I mean, I don’t know if people can appreciate the how bad this is, right. Because I guess it’s just a matter of how prevalent and consistent it is, right? If you do it once every block, every two blocks it’s not a big deal, but you were at risk of doing it at such a high rate. Almost any question you were at risk and you didn’t know when you were doing, right?
Mike: Once we went back through and analyzed, when we started, I was probably at 60 to 80% of my misses were test-taking misses. You could figure out a way that it was a test-taking miss.
Ryan: So people might. Six out of 10, call it 70% of your misses. You miss 10 questions, only three of them were fair misses. And if that’s true that means your knowledge was so far above 400, the bear passing. 500 was the average back then, I don’t know if it still is. So ideally if you clean up your test taking you should be scoring much higher. So we really hammered away at this stuff. And I think you really understood all the steps because we’re like, I even use like specific vocabulary. Like the last sentence I called the prompt, we use steps called triangulation. The tie breaks have very specific names like reverse the flow, like for and against. We talk about like different miss phenomenons. We give them names. I think it’s really important to give them names and rationales to go with them because that’s giving the test taker like you ownership. And it gives us a common vocabulary to talk about as we’re troubleshooting. So I remember you really struggling like you really brought the system on board but we weren’t seeing the results. We weren’t seeing the score. ‘Cause what happens, I think is if test taking is a true problem, like it was for you, the system has to be all the way dialed in. Like you can’t just do like the system 60 of the way there, so I’ll see a 60% increase, doesn’t work like that unfortunately. It’s like, it’s gotta be all the way dialed in like 95% fidelity. And if it’s not, then you see 0% increase. So I was driving to Baltimore to teach a class. Like January, it was New Year’s Day, I’m driving up there. And I remember stopping in Morgantown which is like three hours from my house like halfway between here and in Baltimore as I was drive and talking to you about we’re like going over, like just trying to get unstuck from it. It was like, I think we were just dissecting one question. But you were trying to figure out the difference between where the inference ended and where the twisting began and really weighing the options neutrally. But you just weren’t seeing the scores flipping. This was right around that time. And I think what had happened for you was, you get to a point of frustration, like you were recognizing it in what’s called self-reflection. So you were able to see the mistakes consistently after the fact. You would self-reflect and say I’m still making that same mistake. I’m twisting here. I’m twisting there. I’m talking, I’m narrowing down to two and picking the one I know least about, least about. I’m moving away from the specific prompt, the question being asked. And so that’s called self-reflection. You have to get really good at self-reflection seeing the problems after the fact, and that grows what’s called self-monitoring being able to regulate yourself in the run of play. Some people I think are gonna just really, the self-reflection and just live the self-monitoring. But for you, you’re one of the ones where it’s like you have a breaking point and like ideally the self monitoring, like the kicks in before you’re ready to throw your computer through the wall. But I think yours was well past that. Like you were dude, is this right? Like you were really frustrated, like why is it not, like you could see it. You can see the mistake types after the fact, but it just took that 10 clicks past frustration, which is pretty far to then really start to see the scores flip around. Does that sound right?
Mike: When we had slow it down and I was writing long form out, explanations on the whole question. And so we slowed it down. You’d give me a question that I missed and I would write it out, long form paragraph form into explanations and send it to you. And then we would go through it. And then, and really being tight with the analysis was what was important as well, because if you-
Ryan: Well, so that’s what we call Mike. That’s what we call those day was deep analysis write-ups and that’s been really productive for people. So there’s a form of that, that sort of evolved out of there. Because when we make people write them out nobody wants to do it. There’s nowhere to hide. And then you could eat more easily see where somebody is going off track. And I think we had you write those up. So the better you got at the write up the better the self-reflecting guide and the better the self-reflecting guide, the better yourself monitoring became. But eventually it clicked in, right. But yeah, we would go through these write-ups correct.
Mike: Right, and so it was just, you’d do 10 questions at a time, you’d stop. You’d go through in and out, analyze them, figure out what you did, figure out which ones were testing and which ones were knowledge. And then the test taking ones you really went back through and then we’d figure out which mistake you were making. So that when you saw a question of the same pattern, 200 questions later, you don’t make that same mistake coming through.
Ryan: Well, and it also it’s like you could also then feel yourself starting to make the mistake, and then you could switch. It’s like you steering your car off the road then you’re building the rumble strips to bring you back on that’s the self-monitoring. So you would be able to catch yourself and prevent the catastrophe from happening, right.
Mike: And there was one question that really stuck out in this time that we did a write-up on and then two days later, 200 questions later, it was a different question, same pattern, same vignette but different answers and I got it right. And I sent to you, I was like, “That was it.” That was the same question. Two days ago, I was missing it. And then today, like I could see it coming. You could see the pattern of the question going through. And so you don’t miss it then.
Ryan: Yeah, because it all came from the training. And again, I think we know this, like this is how it works in sports. You practice patterns of play over and over and over again, you analyze, you reflect. And eventually you’re able to do it in the round of play. And that’s exactly what we had to do with you. So you turn around on this thing, you didn’t do anything else. You didn’t study anything else. You only did questions using the STATMed process in that two month window, right. In December into January, is that accurate?
Mike: Yeah we just started, you do one question at a time, analyze it, one question at a time, analyze it. Then you’d go to 10 questions at time, analyze those 10.
Ryan: Could be adding time, adding time, adding. And then we, in every time we added a variable for you, your scores would drop down.
Mike: Back of 10% anytime we change something. Going from like going from like, on time to time, going from 20 questions at a run, 25 up to 50 questions at a run like the COMLEX is 72 seconds per question, 60 minutes for 50 questions. Then even going from the paper-based trainers that we used to the computer simulation trainer like we’re using the dry erase marker and the stupid grid sheet they gave you, every time we added a variable your scores would drop 20%, right, so-
Ryan And we had to figure out how to make it work because the training sheets were different than what you had on the day of the test. And so then we had to adapt the coding and changing and analysis to do a real time during the day of the test on the, you get one marker and one flimsy sheet of paper, it has a grid on it. And so you had to figure out how to do that. So that the day off, you had it set. And so we spent all that-
Ryan: So now, right now, like that’s built into the words workshop. Like we call it the, I call. I just, yeah, it’d be these different simulation trainers. So now weeks before the test, depending on people’s window of time, people are training with a sheet that emulates what they give you with the marker they give you. And that’s like if you’re gonna play the Superbowl you play all season on grass. And the Superbowl is gonna be on turf. You know those last two weeks are only training on turf because it’s like, that’s how you train for a competitive event. You understand the arena and you train for it. But again, a lot of this stuff came from me and you just raging against the stupid logistics and then saying, all right, it is what it is. Let’s train for it. So you did all that, you only did the STATMed stuff. You failed with like a 385, 400’s passing, 500’s national average. What score did you get?
Mike: So after two months of the program or working through everything, step two I pass with a 580, which was in the 80th percentile range.
Ryan: So you went from what percentile to what percentile?
Mike: Probably the first or second to the, between 80 and 85th percentile in two months.
Ryan: I mean, this should be like a infomercial. Maybe it sounds like when I don’t know. I mean, it’s amazing, right? Like that’s crazy.
Mike: And that’s, the unfortunate part was that it took two years of barely passing boards or barely passing tests to figure out that that’s what the problem was and to go through it and to be able to figure out what the problem was and to be able to fix it.
Ryan: Well, that falls on me a little bit. ‘Cause that’s just where I was on my evolutionary curve of building the board’s workshop. I mean, I didn’t know. And you know it really came together with me and you working together. Like, if I didn’t have you as this, like, I mean who knows how many hours we spend on that, just like I needed the feedback. I needed somebody who was living organically. And I needed to see what happens when we took it all the way through to its logical conclusion. And I mean, sit hitting a 580 such a, I mean, that’s like what kind of residencies, if that’s what somebody gets? What kind of realm are we talking about? We’re talking high-end residency.
Mike: Yeah, that could have gotten you most things like that was where people were getting what residency they wanted.
Ryan: Right, back at that time. So anyway, so that is sort of the resolution of your second major crisis point, very happy ending. And I’m glad that I could be of help for that. But then you did have one last crisis point, the third of three crisis points in your career to get to where you are now in Florida working as an emergency medicine doctor. And we’re not gonna spend as much time on this, but what can you tell me about this?
Mike: Yeah, so it’s all timing. So by the time you pass boards you miss match day and you don’t get the residency you want, no place was really even looking at you ’cause you don’t you’re haven’t passed boards by the time they pick their group of people they want every year. And so at that time, I passed just in time. I graduated two weeks late because they pulled me off rotations to study for the boards the third time. And so luckily, like I could start residency on time but I ended up scrambling into a family medicine residency that, so I could go forward because there wasn’t really any other options to. At that point, all the ER residencies were filled. Everybody had their spots and a lot of the family medicine residencies in the country were filled because everything was billing pretty significantly quickly then, it’s even worse now, really. And so, that I ended up in a family medicine residency which was obviously never the plan. That’s not why I went to med school. And we had talked about this.
Ryan: I know that because I came through town where you were in residency, I was just driving from wherever in the Carolinas or whatever. And I came through town and we lined up and we went and had lunch. And I remember the restaurant. I remember where we were sitting. I remember we’re stretching, we’re facing, we’re catching up. And you say to me, “If I knew I was going to have to do this to do family medicine,” nothing against family medicine you need family medicine docs. It’s just not what you got in the game for. It’s not why you sacrificed and struggled, all through all this to do. You were like, if I knew I was going to have to do this to be a family medicine doctor, I never would have done it. It was such a kick in my stomach. I was just like, man, Mike, I felt so bad for you ’cause I was like, this guy, this is not what he wants. I knew what you’d sacrifice. I knew the long-term suffering you’ve gone through. I knew the work you had done to overcome these challenges. And I was like, man. So I remember driving home in those hours. I think I just drove for like an hour in dead silence, which I never do. I don’t know, just like thinking about your plight is awful. Great lunch, Mike, great lunch. But it left a mark and, you know, I don’t know, I was upset for you. And I felt like I was a part of your career. I mean, again, you’re the one that did all the work and you helped me in a lot of ways as much as I helped you, but to think about, ’cause I mean I knew what you wanted to do. And I was, I’m part of like an emergency medicine, like review program, I know all these guys and I know how much they love their job. And again, it’s not for everybody, but I think that’s what you wanted, what you were trained for. So that’s kind of where you were. And then how did you just real quick, like, how did you get out of that? ‘Cause you are an emergency medicine doctor. Like I knew in the old days there was like a weird relationship with family medicine and emergency medicine. That was before they had enough emergency medicine doctors ’cause it was relatively new and like that portal would close, right?
Mike: Yeah, and so, especially when I was going through and this is 2012, 2013, ER got really competitive and has continued over the past eight to 10 years of getting more and more competitive. So I was doing family med. It was fine, but personality wise that just that wasn’t my deal.
Ryan: No, it’s not you.
Mike: And so I had to figure out a way. And so there were options. You could go straight out of family med and work in a small ER somewhere out in the middle of nowhere and kind of do it that way. But I knew I needed more than what more ER experience than what I got doing family med clinic and rounding in the hospital and that. And so I’ve found a ER fellowship that was a year that I could go do. And it was basically a mini residency that I went and moved, picked up my family again. And we moved and went and did another year just as ER, just what I wanted to be doing. And that prepared me great for coming out. And so there are other ways to get around and to get to where you wanna be.
Ryan: And I think that’s just an important message, right? ‘Cause like you don’t, you can’t sit down. Like if you sat there, when you and I are sitting there in that restaurant we couldn’t see the way out. You couldn’t see the way out. I couldn’t see the way out. All you can do is like put your foot forward and finish up, do what you can do and then pivot and look for other options. I think that’s part of the, I don’t know the message I took from it. And I got, I didn’t know how my business was gonna evolve or how it was gonna shape. And I just try to connect with my people and help people and how I can, when I can. Can you just hope that that opens doors for you? And I think both of us have ended up on the other side of things with that, right?
Mike: That’s why you have to realize there’s stepping stones at each place. And so you have to get through whatever you’re doing at that point. You have to put the time in to study for step one so that you can move on to the next thing and you have to get things through and you have to do everything that you need to do to be able to graduate. And then you need to be able to get into a residency and get through a residency. And so each of those things are different stepping stones but each time you get through the next thing more and more options open up and then you can kind of find where your place is and where you need to be and what you want to do and what makes you happy.
Ryan: But, and even if, and again, I think the key was like even if you can’t see that end, ’cause I think a lot of us like sort of, personality types, it’s like I wanna be able to see what that plan is. Sometimes you can’t see it. Like you couldn’t see it the day I was talking to you.
Mike: And so I definitely couldn’t see it when I didn’t get an ER residency and I was calling places all over the country, trying to find a family medicine. You definitely don’t see the future. And you don’t see that 10 years from now where it’s gonna go and that your life can be good and it’s gonna be good, and everything’s really great. But you can’t see it when you’re in the middle of it. And because all you can see is tomorrow what’s gonna have to happen and what you’re doing tomorrow and the next day. And so, and you kind of start getting out of it and then something else that might pull you back in and you’re in the forest again and this dark again and then you can push back through it. And, but as long as you’re moving forward it’ll eventually kind of move through.
Ryan: Yeah, well certainly there are, I mean, in in different places there are these different inflection points, but yeah, I think that your, again, like the way you found your way through this and where you’ve ended up and what you’re doing is really wonderful stuff and it’s inspiring. And I certainly, remember these crisis points that you went through, and then again as we, like you and I were talking about before we started recording, like you start looking back at it and it’s like, you know, I don’t know. It’s like looking at like, we could’ve gotten run over here. It got run over there. Dodged that bullet didn’t know I was dodging, like where I knew it was, but you’re seeing the fight trying to keep your head above water or however you wanna mix the metaphor. It’s pretty gratifying to see the other side. And I certainly appreciate you for getting to where you got and then, and sharing all of this. So all that said, thanks for listening to this first episode or these first two episodes of our Crisis Point podcast series. Thanks to Mike for sharing this awesome story. If you relate to Mike’s experience, feel free to reach out so I can hear your story and answer any questions you might have and see if we can help you on your path to success in medicine. Thanks for listening.
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