Hope and the daisy!

By Loren Deutsch

April can feel like a month of transitions. In business it signals the start of Q2, at LAS it indicates the next annual theme (hope), in baseball it marks the end of spring training, for second-year medical students it’s associated with dedicated prep for the United States Medical Licensing Exam (USMLE) Step 1, and for many high school students, it signifies a stressful period before final exams, the end of school, and summer vacation.

As a baseball enthusiast and a Midwesterner, April is an unpredictable patchwork of weather which informs the intrepid of opening day and 162 regular season games away from possibility. After harsh and enduring conditions we welcome intermittent sun and crocuses that push past wintered grounds to celebrate the sight of daffodils and daisies. There’s a fun fact about daisies. They are called composite flowers and are actually two flowers combined into one. The inner flower is called a disc floret and the outer flower (petals) is called a ray floret. The two flowers blend together so well that some people believe they symbolize true love, a hopeful unification of two parts that grow separately and together.

Although spring training promises sunny skies, Midwesterners know that opening day won’t, and so spectator-wear is pragmatically planned. Hopeful fans layer their winter gear over good luck charms and t-shirts, with nostalgia hiding underneath parkas, gloves, and long underwear. Fair-weather fans? Hell no! For Cubs and White Sox fans alike, April games are less about showing up for the winning team and more about enduring harsh temperatures, with doses of reality, and hope. How else to account for the hours sitting on frozen seats in blizzard conditions, welcoming a competitive anomaly of sorts, an annual clean slate before the true celebration of failure begins. Yes, failure. Consider the slash lines for batting, hitting, and slugging. Batting averages of .300 are successes, but in most other professions they would equate to failure rates of 70%.  

Training for the regular season demands strength, speed, stamina, and decision-making. It is demanding and requires perseverance and grit sustained over 162 games, not including the playoffs. Daily practices incorporate iterative practice, strategies, and self-reflection. Sustained over time, this type of practice invokes the testing effect also known as test-enhanced learning or retrieval practice. The testing effect is basically the long term retention that occurs when practicing remembering certain information.

Repeating the process of remembering with spaced repetition and time for self-reflection can inform the muscle memory needed in baseball. Over time that type of practice increases a player’s accuracy, automaticity, and averages (for batting, hitting, and slugging). The same is true with Step 1 preparation. Students become more efficient and accurate at recruiting information (knowledge) stored in their long term memories the more they practice remembering this information using the very questions they will encounter on the test. Practice clarifies the most direct pathway to the information even when questions are answered incorrectly. The testing effect creates a relatively fast and efficient way to remember the correct information, particularly with guidance or coaching at the point of need.  

Like professional baseball, Step 1 is a test of vigilance and stamina. It requires a deep reservoir of factual knowledge and iterative experience developing confidence in decision-making. This knowledge and skillset come from practice. As an example, Step 1 demands a lot from students. They must understand a patient’s narrative and presenting symptoms, identify the differentials and working diagnosis, and know the next steps specific to treatment, interventions, and preventions. It would be insufficient to do this for just one or two question stems. Step 1 demands the capacity to do this more than 280 times, over a 7-hour testing period within a finite period of time, and preparation often feels like micro failures until achievement scores break through a projected three-digit number. The implications are considerable, as they have an impact on where and what is studied in residency.

Keep in mind, batting averages of .300 or more are celebrated in the MLB. They take years to achieve and require sacrifice, practice, study, and even some luck. However, these stats would literally equate to failure on Step 1 and sadly, while they are celebrated in baseball, they are stigmatized in medicine. Keep in mind, toddlers fall down hundreds of times before they learn to walk. We celebrate their falls with clapping and smiling and hugs because we know that making mistakes is essential to learning and getting up is part of learning to walk.

Remember, mistakes that are made during practice are opportunities for the future. They help test-takers remember, course correct, and tolerate moments of ambiguity with a sense of hope. We can accumulate the residue of memory when we pause and reflect on the experiences and feelings associated with perseverance. Stop and think about what it might feel like to take a test, question after question when there are more than 280 questions, not knowing if the answers choices are right or wrong.

Mary Oliver wrote in The poet goes to Fenway, “There are many poets who love baseball, which is, after all, a metaphor for many things that happen when there isn’t a game.”

For those who are preparing for Step 1, consider your incorrect answers (even the ones with low achieving percentages) a little more like baseball, and find the person in your life who’s positioned behind home plate and will help you anticipate the next pitch and the one after that, so you can analyze, course correct, consolidate, and persevere when you run low on hope.