Task failed successfully: How I turned my failed board exams into a triumphant residency

“Failure is another stepping stone to greatness.” This quote, by Oprah Winfrey, was what my best friend put up on our refrigerator after I failed my COMLEX exam the first time. At the time I didn’t know that my medical journey would have so many stepping stones it could be relabeled as a rock garden. After that first fail, I went on to fail every iteration of the COMLEX board exam. I failed Level 1 three times, Level 2 once and Level 3 once.

Before I delve into my journey, I will let you know that this story has a happy ending—currently, I am writing this while I pack up my apartment and get ready for a move to my first attending position as a hospitalist. That being said, let’s begin.

A rough beginning

I went to a state school for college and graduated with an average GPA and an average MCAT score. I didn’t experience many hiccups in undergrad. I didn’t struggle too much in the pre-clinical years of medical school either. I was definitely not at the top of my class, but I did not have to remediate any of my courses either. That’s why when I failed my Level 1, I was shocked. Nothing in my history would have predicted a failure on a test with a relatively high pass rate.

The first time I failed knocked the wind out of me. I figured that I simply didn’t study hard enough for the exam. Luckily, I was not alone in my failure—I was quickly introduced to a colleague who had failed as well and needed support. I could have chosen not to reach out to him, but I knew if he felt anything like me, I did not want him to be alone.

Reflecting on my exam performance, at first, I thought I was burnt out from the constant pursuit of education since I was 5 years old. I thought I might have depression and burnout. However, after I tried being more physically active and was put on an antidepressant, my resulting question sets, and practice tests did not point to this as an answer. But I soldiered on anyway.

After some book-to-nose time for about a month, I retook the test with the first batch of people who also failed. They all passed, while yet again, I did not. They got to move on, and I was stuck wondering what went wrong.

I could not believe it. I had studied. I had put in the work. What was wrong? I thought maybe I had testing anxiety and a stress response from this testing series. I tried an anti-anxiety medication.

I also looked up board preparation programs and found one where you live, eat, breathe and sleep boards. So that was the plan—I did that for a month. I was confident that I could pass … but I didn’t. That was my third fail on Level 1. 

At this point, I was out of breath. I was tired. I was exhausted. I figured I was not right for medicine and needed a contingency plan. My medical school dean sent me an e-mail wanting to have a talk with me. I figured it was the “Sorry you are being let go” conversation. I was packing up all my medical stuff and when I grabbed my white coat … I was in tears. I remembered who I was when I put it on at my white coat ceremony. I couldn’t put it in the box. I was determined to give it one more shot.

Even though I believed Matching would be nearly impossible by this point, I didn’t care. I was going to try anyway. I went to my dean’s office, and before I could let him know my plan, he started the conversation—as he described how I was always a good student, and pondered whether I’m just not a “desk learner” and should be out on rotations learning in the field, I was confused. I was expecting him to dismiss me from the school. He instead suggested that I do rotations for six months and retake the COMLEX exam a final time afterward. I was shocked. I cried and hugged him and probably ruined his suit with my tears. I remember him saying that he still saw the doctor in me that he saw on interview day. It broke my heart in a good way.

Board exam failures are often due to multiple stressors/factors in a student’s life that converge to negatively impact their performance; they typically need to be addressed in order for the student to pass.

In my case, I did learn much better in the field, so the six months of rotations really helped me. And I also finally got the correct medical diagnosis—I was formally diagnosed with attention deficit/hyperactivity disorder (ADHD) and received medication. After rotations and medication, I passed Level 1 on my fourth and final attempt with no problem. 

Figuring it out

After Level 1 came Level 2. I thought I had found the answer with medication and proper therapy. But when I failed Level 2, I remember feeling like I was back at square one again. Was I destined to repeat everything I did with Level 1? My chances to Match were low enough already with three Level 1 fails, but what on earth was I going to do with that and a Level 2 fail? My medical school stayed supportive—they were already committed to me with all the previous fails, so what was one more at this point?

I had my medication adjusted. I put nose to book yet again through TrueLearn, with added frustration, and passed Level 2 on my second attempt. At this point, I met the requirements to get my degree, but how on earth was I going to Match? Was I going to spend years in the Match process just to never have it happen? This is where my previous act of kindness came back into play—remember the colleague I reached out to, to share my struggles? He matched into a residency before me, so I reached out and asked him to vouch for me when I applied for a spot in his program.

Luckily, we had remained in contact and still do to this day. I remember updating him on my life and told him I was casting a wide net and he told me to apply to his program—his mother was part of the administration there, and he said he would vouch for me. It was very sweet of him. I didn’t even know that he had connections until then. He did it without question. And that is how I matched into residency on my first try—a return act of kindness.

A rocky start to residency

While in residency, I thought it was a new game—I was over failing the COMLEX exam. I was practicing medicine, and I knew I was prepared for the Level 3 exam. Unfortunately, I also failed Level 3.

I hope you are as equally frustrated as I was, reader. This really made me think I was not cut out for medicine. I was the poster child for imposter syndrome. My residency gave me a study elective to concentrate on the exam, and at the end of it I passed Level 3—I finally was done with the board exam series. 

However, I was not in the clear yet. I had to take my specialty board exams and apply for a job, which meant I had to apply for state licensure as well. Most states allow up to three fails, which limited my options. Given my familiarity with failure and my rock garden of stepping stones, at this point hearing no or getting rejected was not an issue for me. I applied for state licensure, and was called before the board to explain myself. I told them my tale and the board granted me licensure.

Looking to the future

With all that completed, I looked to my specialty board exam and finding a job. Both, thankfully, were not tales of woe and failure. I applied to be a hospitalist as a family medicine doctor in a field that is predominantly internal medicine, and accepted the job without too much fuss.

As I prepared for my family medicine board certification exam, I was more determined than ever to prove myself and not fail. For months, I would work the grueling hours of residency and spend hours after my shift with my colleague studying and doing questions. It was brutal. It was taxing. I am honestly still exhausted from it a month after finishing. But dear reader, I passed—on the first try.

I am meant to be here. I am no longer an imposter. 

With my rock garden of medical training now behind me, I look back and can realize that it was not just my stubbornness, resilience and will that got me here. My journey was full of administration, colleagues and mentors who saw the doctor in me when I couldn’t. There were many moments when I was weak and had a village of people who picked me up. What I originally saw as a single act of kindness ended up changing the trajectory of my career.

Failure is always an opportunity to learn—there are lessons in defeat. Think of those moments not as an end but as complete. Then you’ll have a new start. If one door closes, and all other doors close, make your own door.

Perpetuating the more toxic areas of medicine and being a hard-working student is not what got me where I am. Acts of kindness and being real and vulnerable with everyone I came across is what has made my medical career. It’s what continues to make my career. It’s why my patients love me.

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