The difference between what happened to you and who you are, and what it costs to confuse them
By Dr. Rene Roberts, MD, MS, FAAFP | TEDx & Keynote Speaker | Board-Certified Family Medicine Physician
I said something on the Healing Medicine podcast with Dr. Jesse Mahoney that I've been saying to students for years, and hearing it out loud made me realize it's the whole argument in one sentence.
Failure is data. It is not a verdict.
Those are two completely different things, and medicine trains us to confuse them.
Data is information about an event. It tells you what happened, under what conditions, and sometimes what to adjust. A failed exam is data. It says your preparation and that test, on that day, did not line up. It's specific. It's bounded. It has a date on it. A verdict is a claim about who you are. Permanent. Portable. It follows you into every room.
When I failed the United States Medical Licensing Exam (USMLE) Step 1 exam the second time by three points ( yes, just 3 points) I didn't conclude that my study method had failed. I concluded that I had. I am a person who fails. I walked the halls of Indiana University School of Medicine with my head down for years carrying that as an identity, a scarlet letter of sorts, and that's honestly how it felt. Something stitched on my persona.
Here's the part that took me over a decade to see. The event was survivable. The identity was not.
The event cost me a year of medical school training and a place in my original graduating class. The identity cost me every conversation I didn't have, every time I didn't ask a mentor for help, every colleague who might have said me too if I'd given them the opening. I paid for that exam once. I paid for the story I told myself about that exam for the next fourteen years.
This is not a mindset trick and I want to be careful not to sell it as one. I'm not telling you to feel good about a failure. I'm telling you to be accurate about it.
Ask the accurate questions:
What actually happened?
What conditions contributed?
What would I change if I had to do this all over again?
What does this tell me about the system I'm operating in, not just about me?
Here's what it looks like when I finally ran those questions on my own exam. It took me years to do it.
What actually happened. My studying worked. My score went up. I had a firmer grasp of the material the second time than I'd had the first. And I still fell short, by three points.
What conditions contributed. It was a mental game by then. My head was still under the dark cloud of the first failure and I couldn't get out from under it. On top of that I was carrying the pressure I'd put on myself and the pressure my school had quietly put on me. My school wouldn't allow a fourth attempt. Pass on the third, or be out of medical school entirely. That was more than I could hold.
Thankfully, I did pass on the third attempt. It took everything I had.
What would I change. I'd start studying for Step 1 on day one of medical school. Step 1 is one of the most content-dense exams in a physician's entire career. Some people can cram years of material into six weeks. Some people need to live with it over time. I am definitely the second kind. I needed to accept that instead of trying to keep pace with classmates who didn't need what I needed.
What does this tell me about the system. That the path to becoming a doctor in this country rewards recall and test-taking, and spends far less time on the things patients actually notice.
Not one of those answers is about my worth. Every one of them is usable. It took me fourteen years to run that exercise. It took about four minutes.
My Charge To The Future of Medicine
I want to say one thing to the medical students reading this, because the ground has shifted. Step 1 has been reported as pass/fail since January 26, 2022, and when I tell my story, some of you are doing the math on a scoring system you never lived under. That’s fair. But I'd push back on the idea that this actually fixed anything. The pressure moved to Step 2 CK. In the 2024 NRMP program director survey, 30% of programs required applicants from MD-granting schools to hit a target Step 2 CK score just to be offered an interview. The comparison moved with it. And the reflex to convert a bad day into a verdict about yourself moved right along with both, because that reflex was never really about the number.
I'll go further, because you deserve the accurate version rather than the comforting one. In that same survey, 77% of program directors said they consider failed attempts on either Step exam when deciding whom to interview. So no, a failure is not weightless. It sits in a file and it has consequences.
That is exactly why the distinction matters. The program director's file and your self-concept are two different documents. One of them contains a dated event with a known cost. The other one, if you're not careful, quietly becomes a life sentence you handed down yourself.
That's the thing about a verdict. It doesn't need a score to attach itself to.
What Comes Next
This is post 2 of seven in my series "What Doctors Don't Say Out Loud," drawn from my conversation on the Healing Medicine podcast with Dr. Jessie Mahoney. Listen to the episode here.
The rest of this story, including the part I still find hard to say, is in my TEDx talk "Who Gets to Heal?" Watch it here.
Next in the series: Why the resident physicians who struggle most are often the ones who never failed.
MONDAY MORNING ROUNDS
Real stories, hard-won lessons, and practical insights, every Monday morning. Join readers who refuse to quit when the world says no.
Dr. Rene Roberts, MD, MS, FAAFP is a board-certified Family Medicine physician in practice since 2014, a Fellow of the American Academy of Family Physicians, three-time Castle Connolly Top Doctor (2024, 2025, 2026), and TEDx & keynote speaker. Creator of the L.Y.M.I.T.S. Method™, she is a nationally recognized medical media expert and leading voice in healthcare equity, medical education reform, and resilience. She mentors aspiring physicians through the Urban Bridges Medical Mentoring Program.
Speaking inquiries: www.drrenemd.com/speaking Follow along: @drrenemd | www.drrenemd.com
