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[TheRealBatmanMD]

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[medschoolaspirant]

258 here. If thats the case, I will be screened out. And I am applying competitve field. I think Step 2 needs a screen, but screen at 260 will leave top 20% of applicant in pool (not all applying competitve field). If lets say 10% of them applying competitive field, then spots may go vacant. Thats why if you look at screen for step 2 for most competitive programs, are at 220-240 . still median score for matched applicant for most competitive field is at 256-257 (means people with 235-280 getting matched). This proves it is wholistic selection. Step 2 being one part of equation and not only part of equation.

 

[voxveritatisetlucis]

There’s probably a correlation but much less than SAT, LSAT, GRE

 

[operaman]

Not much of an IQ test - simply not designed that way.

Screens are very program dependent and the number varies. If you’re a top program in a competitive field, then you can probably screen pretty high if you want. If you’re a bottom ranked program in that same field, such a high cutoff may not work out well; you’d either struggle to fill interviews or you’d only interview people who were using you as a safety. And in all cases, you might miss out on someone just under your cutoff that would be a great fit, such as a super productive academically minded person with oodles of research who would be perfect for your very academic program.

But essentially every program screens somehow. Simply not enough FTEs of faculty time for a wholistic review of every application.

 

[Billiam95]

Taking S2 tomorrow - I'll come back and let you know what I think the GS cutoffs should be in a few weeks when I get my score back 😉

 

[bGMx]

Primary authorship is probably a predictor of IQ. All else I am skeptical of.

 

[bGMx]

You mean first authorship on a paper? I highly doubt that unless it's a basic science authorship on a high impact journal (Nature, Science, etc)

Step 2 CK is probably a good measure of resilience and drive with some degree of correlation to IQ. It's an exam that takes 3 years to prepare for and requires a high degree of determination to score 260+. To score in the 90th percentile or higher on the exam says a lot when you realize that the various majority of US MD students performed well on prior standardized tests.

Or you just did nothing else but study for 3 years.
You're right, not first authorship. Being awarded grants is probably a high predictor of IQ.

 

[Morc]

Primary authorship is probably a predictor of IQ. All else I am skeptical of.

my neurosurgeon father put me on 12 papers and i'm first author on 8 of them, so i agree with this

- sent from my iPhone 14 Pro Max

 

[TheRealBatmanMD]

Or you just did nothing else but study for 3 years.
You're right, not first authorship. Being awarded grants is probably a high predictor of IQ.

I have 30 + pubs, so not exactly. The purpose of med school itself is to study for 3 straight years, so your point is invalid.

 

[SweetBurger]

Or you just did nothing else but study for 3 years.
You're right, not first authorship. Being awarded grants is probably a high predictor of IQ.

this is interesting trolling

 

[deleted1139416]

People with high IQs will have avoided the dumpster fire of medicine in the first place....

 

[Goro]

As someone who scored a 270, I therefore personally believe Step 2 CK scores are a good measure of IQ and intelligence. Competitive fields should screen at 260 at minimum. What do you guys think?


(sarcastic about the first part, but serious question, what if any cutoff should there be for screening? 255 sounds about right as it's only 70th percentile)

These exams are far more an assessment of competence, rather than IQ.

I'd throw in MCQ test taking skills and pattern recognition as well.

 

[deleted1139416]

Pattern recognition and MCQ test taking skills are two components of intelligence.

Counter-counter-argument: the guy who actually figured out how to solve a rubik’s cube on his own is smarter than the guy who watched a YouTube video of it and learned to copy it.

Sincerely, A dumb guy who learned to solve a Rubik’s cube by watching a YouTube video of a guy showing how to solve it

 

[Kierkegaard's Bud]

There’s probably a correlation but much less than SAT, LSAT, GRE

SAT has a bigger sample size; I would trust its measure of IQ than Step 2. Plus SAT has a pure math section that tests abstract thinking.

 

[Konigstiger]

Doesn't really make any sense to have an IQ test that you can study for. The more you prepare for a test, the less it says about your IQ and the more it says about your determination and focus.

 

[coffegroundemesis]

I scored a 274. Not interested in anything competitive. I really don’t think the test has anything to do with IQ. Tbh, it’s really about how much you are willing to work for a high score.

 

[Kierkegaard's Bud]

SAT math was just basic algebra. Abstract thinking? lol.

The SAT has been revised since you took it.

 

[Vyzzle]

Counter-argument: Every MD med student is generally a good test taker. The largest remaining factor for scoring very high (260+) is about innate intelligence. Pattern recognition and MCQ test taking skills are two components of intelligence.

You've got a lot of strong opinions for someone who only managed to score a 270 on Step 2

 

[deleted1115000]

Step 2 is by far the least IQ based of the 3 major exams medical students will have taken (SAT, MCAT, Step 2). It's almost pure memorization. Anyone with half a brain can do well if they study thousands of hours. With the MCAT, there's a good portion of people that are unable to achieve a high score despite years of studying/retakes.

For whatever reason you're trying to cope and want to believe a high step 2 makes you intelligent, maybe because it's the first standardized test you've done very well on. If you want to know your IQ go take an official IQ test.

 

[coffegroundemesis]

Step 2 is by far the least IQ based of the 3 major exams medical students will have taken (SAT, MCAT, Step 2). It's almost pure memorization. Anyone with half a brain can do well if they study thousands of hours. With the MCAT, there's a good portion of people that are unable to achieve a high score despite years of studying/retakes.

For whatever reason you're trying to cope and want to believe a high step 2 makes you intelligent, maybe because it's the first standardized test you've done very well on. If you want to know your IQ go take an official IQ test.

kind of interesting conclusion. A quick search shows that OP seems to have gotten a mediocre score on the MCAT. I totally second what you said. I scored a 100%tile on the MCAT and a 274 on step 2. Step 2 takes zero intelligence in comparison to the MCAT, which required a lot more abstract thinking. Step 2 is basically a QUALIFICATION exam, meaning whether you KNOW something. Whereas, the MCAT is an aptitude exam, which requires you to apply abstract concepts in unfamiliar scenarios. So if OP believes that he's really intelligent, first of all, you should not ask the internet whether you are intelligent enough. Also can't help to notice OP's signature. Tbh, that's a real sign of lack of intelligence.

From my experience, most people who want to go into some competitive surgical subspecialties do so for one of the two reasons. First, ego, they just can't stand that they are otherwise ordinary. Second, money, they just want to work their ass off to make a lot of money. Very rarely do I run into people who genuinely find surgery interesting on the intellectual and professional levels. Therefore, I found people in surgical sub-specialties in general are not the brightest people. If you want to do it for ego, that's just dumb to begin with. End of conversation. If you want to do it for the money, you should calculate the hourly rate. There are many many more jobs in which you can make double of the money with half of the hours.

 

[ChordaEpiphany]

I scored a 274. Not interested in anything competitive. I really don’t think the test has anything to do with IQ. Tbh, it’s really about how much you are willing to work for a high score.

I also think this is part of why the steps should remain scored and a major factor for residency selection. It wouldn't matter if it were step 1, step 2, or 12 continuous hours of Liza Minelli trivia, top performers rise to the top when given the opportunity. To make selection even remotely fair, you have to have something everyone works towards and is evaluated on in a controlled environment. Step 1 wasn't the major criteria for residency selection out of pure laziness. PDs objectively noticed that step performance correlated with residency performance and overall competence. I feel this was largely true among my classmates as well. I might not be able to separate a 220 from a 230, but someone with a 260 on step 1 was almost always working with a little more up top.

Clinical grades are theoretically a closer approximation to performance in residency, but in practice they're kinda random BS, and everyone knows it. If you suggested the subjective clinical eval system as a means of studying a new therapy or clinical approach to management of a disease, you'd get laughed out of the room by anyone with a cursory understanding of statistics. It's almost embarrassing that a profession that prides itself on evidence-based practice uses these criteria as the major selection marker for residency. At my school, you are often de facto disqualified for honors just by being assigned an unlucky clinical site. There's also a large element of Dunning-Kruger, where the least knowledgeable students are also the most confident (and thus competent seeming). We all know this dynamic eventually shifts, but as long as you are assessing the very beginning of the learning curve, you're going to get a whole lot of mediocre students riding on a false belief that they are knowledgeable in a specialty.

Step 1, step 2, and even things like SP exams are ultimately better approximations. Of course the devil's in the details. All of these things need more work. The real problem is not the method of evaluation, but the indifference of the evaluators. The NBME has very little incentive to tighten up their statistics and create a more reproducible result, so the exams are notoriously variable and poorly representative of clinical acumen. Clerkship directors have absolutely no pressure to ensure clinical skills exams are within acceptable tolerances. The residents working with students have no incentive to give meaningful feedback, and the attendings have even less still.

Right now, I'd argue that step exams are the best tool we have to identify top students. That doesn't mean it's a good criteria, it just means it's objectively the best we have. It identifies those willing to grind, which I'd argue is immensely valuable in residency.

 

[coffegroundemesis]

I also think this is part of why the steps should remain scored and a major factor for residency selection. It wouldn't matter if it were step 1, step 2, or 12 continuous hours of Liza Minelli trivia, top performers rise to the top when given the opportunity. To make selection even remotely fair, you have to have something everyone works towards and is evaluated on in a controlled environment. Step 1 wasn't the major criteria for residency selection out of pure laziness. PDs objectively noticed that step performance correlated with residency performance and overall competence. I feel this was largely true among my classmates as well. I might not be able to separate a 220 from a 230, but someone with a 260 on step 1 was almost always working with a little more up top.

Clinical grades are theoretically a closer approximation to performance in residency, but in practice they're kinda random BS, and everyone knows it. If you suggested the subjective clinical eval system as a means of studying a new therapy or clinical approach to management of a disease, you'd get laughed out of the room by anyone with a cursory understanding of statistics. It's almost embarrassing that a profession that prides itself on evidence-based practice uses these criteria as the major selection marker for residency. At my school, you are often de facto disqualified for honors just by being assigned an unlucky clinical site. There's also a large element of Dunning-Kruger, where the least knowledgeable students are also the most confident (and thus competent seeming). We all know this dynamic eventually shifts, but as long as you are assessing the very beginning of the learning curve, you're going to get a whole lot of mediocre students riding on a false belief that they are knowledgeable in a specialty.

Step 1, step 2, and even things like SP exams are ultimately better approximations. Of course the devil's in the details. All of these things need more work. The real problem is not the method of evaluation, but the indifference of the evaluators. The NBME has very little incentive to tighten up their statistics and create a more reproducible result, so the exams are notoriously variable and poorly representative of clinical acumen. Clerkship directors have absolutely no pressure to ensure clinical skills exams are within acceptable tolerances. The residents working with students have no incentive to give meaningful feedback, and the attendings have even less still.

Right now, I'd argue that step exams are the best tool we have to identify top students. That doesn't mean it's a good criteria, it just means it's objectively the best we have. It identifies those willing to grind, which I'd argue is immensely valuable in residency.

The reality is that you really have to ask yourself why you want something called a “competitive subspeciality.” I bet most people want it because it is “competitive.” Lmao. It’s another reason why those metrics exist for the sake of reinforcing the fake idea of superiority. I will argue that there’s really no such thing as a mediocre medical student. If you are smart enough to get into med school, everyone of us can be any doctor we want to be, be it neurosurgery or family medicine. The only reason that we can’t randomly pick a specialty is because of supply and demand. It’s not a quality issue but a quantity one. You can teach a family medicine resident how to be a neurosurgeon just as easily as a neurosurgeon how to be a family practitioner. However, somehow neurosurgery appears to be more lucrative, hence it appears that it requires a higher level of dedication and intelligence to be one. But that’s simply not true.

 

[ProReduction]

I scored a 265 on Step 2 CK more than a decade ago when that put you in the 99th percentile. It seems that lands you in the 90th percentile now(?) but who knows. I've never taken an IQ test but I do not consider myself to be brilliant and I am of slightly above average creativity. Why did I score in the 99th percentile on Step 2 CK? Most likely because I studied 8-10 hours a day for a month to compensate for below-average medical school grades in the match.

Step 2 CK has nothing to do with IQ or intelligence. Nothing in medicine does. You know how many geniuses could make it in medicine? Zero. The simple subject matter, emphasis on simple algorithms and memorization, and absence of a need for creativity eliminate all geniuses from any desire to be in the profession. People that are going to win a Fields medal or make a major scientific discovery are not going to medical school. Do you think that Einstein, Benjamin Franklin, Leibniz, Mirzakhani, or Sinead Griffin could have sat through medical school lectures?

 

[ChordaEpiphany]

The reality is that you really have to ask yourself why you want something called a “competitive subspeciality.” I bet most people want it because it is “competitive.” Lmao. It’s another reason why those metrics exist for the sake of reinforcing the fake idea of superiority. I will argue that there’s really no such thing as a mediocre medical student. If you are smart enough to get into med school, everyone of us can be any doctor we want to be, be it neurosurgery or family medicine. The only reason that we can’t randomly pick a specialty is because of supply and demand. It’s not a quality issue but a quantity one. You can teach a family medicine resident how to be a neurosurgeon just as easily as a neurosurgeon how to be a family practitioner. However, somehow neurosurgery appears to be more lucrative, hence it appears that it requires a higher level of dedication and intelligence to be one. But that’s simply not true.

I actually think competitive subspecialties are competitive because they objectively offer a better pathway to high income or good income/work ratio. There's a solid list of reasons why you'd want to be a dermatologist over a pediatrician or an orthopedic surgeon over a hospitalist. If you want to get into people wanting things just because it's competitive, that's prestige. Why shoot for Big Four IM when there are solid academic programs in each of those cities that will get you into any subspecialty you want? Unless you're dead set on academics, probably you'll wind up in a community hospital where no one will care that you went to Harvard (or will think you're snooty because of it). People vie for these "competitive" residencies because their egos are tied up in being the best, not because they offer any competitive advantage for their future careers. Ironically enough, to need a top tier residency you need to want to leave medicine (or make it a very small part of your career).

Otherwise, personally I think you could train any person of above-average intelligence to be a decent physician in nearly all specialties. It's harder than most jobs, but ultimately it's trainable. Most of what makes medical training difficult is stratification, as you mentioned.

You know how many geniuses could make it in medicine? Zero. The simple subject matter, emphasis on simple algorithms and memorization, and absence of a need for creativity eliminate all geniuses from any desire to be in the profession. People that are going to win a Fields medal or make a major scientific discovery are not going to medical school. Do you think that Einstein, Benjamin Franklin, Leibniz, Mirzakhani, or Sinead Griffin could have sat through medical school lectures?

I'm certainly not a genius, but there are definitely geniuses around me. They tolerate medical school because it puts them in a better position to do things that have no ceiling on intellectual contribution, like running a productive research program. Nearly all the physician-scientists I've met regard clinical medicine as hum-drum work a monkey could do with enough experience. One called cardiologists "glorified plumbers."

 

[RangerBob]

I scored in the 105th percentile for CK. I’ve also counted to infinity—twice. I’ve in fact eaten just one Lays potato chip, and after I vacationed in the Virgin Islands they changed their name to “The Islands.”

I saved a fortune on my car insurance by switching to Geico, whilst staying at a Holiday Inn last night.

On a serious note, we all agree the USMLE are stupid but they’re also the least worst standardized assessment we have at this time.

 

[RangerBob]

I actually think competitive subspecialties are competitive because they objectively offer a better pathway to high income or good income/work ratio. There's a solid list of reasons why you'd want to be a dermatologist over a pediatrician or an orthopedic surgeon over a hospitalist. If you want to get into people wanting things just because it's competitive, that's prestige. Why shoot for Big Four IM when there are solid academic programs in each of those cities that will get you into any subspecialty you want? Unless you're dead set on academics, probably you'll wind up in a community hospital where no one will care that you went to Harvard (or will think you're snooty because of it). People vie for these "competitive" residencies because their egos are tied up in being the best, not because they offer any competitive advantage for their future careers. Ironically enough, to need a top tier residency you need to want to leave medicine (or make it a very small part of your career).

Otherwise, personally I think you could train any person of above-average intelligence to be a decent physician in nearly all specialties. It's harder than most jobs, but ultimately it's trainable. Most of what makes medical training difficult is stratification, as you mentioned.

I'm certainly not a genius, but there are definitely geniuses around me. They tolerate medical school because it puts them in a better position to do things that have no ceiling on intellectual contribution, like running a productive research program. Nearly all the physician-scientists I've met regard clinical medicine as hum-drum work a monkey could do with enough experience. One called cardiologists "glorified plumbers."

Someone who calls cardiologists “glorified plumbers” are too full of themselves. For one thing, plumbing actually requires some brains (I’d love to see any PhD try to fix a high pressure leak, not contaminate the freshwater supply, and not destroy the flooring/walls in the process).

 

[coffegroundemesis]

I actually think competitive subspecialties are competitive because they objectively offer a better pathway to high income or good income/work ratio. There's a solid list of reasons why you'd want to be a dermatologist over a pediatrician or an orthopedic surgeon over a hospitalist. If you want to get into people wanting things just because it's competitive, that's prestige. Why shoot for Big Four IM when there are solid academic programs in each of those cities that will get you into any subspecialty you want? Unless you're dead set on academics, probably you'll wind up in a community hospital where no one will care that you went to Harvard (or will think you're snooty because of it). People vie for these "competitive" residencies because their egos are tied up in being the best, not because they offer any competitive advantage for their future careers. Ironically enough, to need a top tier residency you need to want to leave medicine (or make it a very small part of your career).

Otherwise, personally I think you could train any person of above-average intelligence to be a decent physician in nearly all specialties. It's harder than most jobs, but ultimately it's trainable. Most of what makes medical training difficult is stratification, as you mentioned.

I'm certainly not a genius, but there are definitely geniuses around me. They tolerate medical school because it puts them in a better position to do things that have no ceiling on intellectual contribution, like running a productive research program. Nearly all the physician-scientists I've met regard clinical medicine as hum-drum work a monkey could do with enough experience. One called cardiologists "glorified plumbers."

I have been called brilliant by many. I think medicine is really easy as long as you are willing to put in your time. Why do I want to do medicine? It offers a path to financial stability (decent salaries), independence (no real bosses, yeah I get that there are people above you for whatever reason, but overall you have a lot of autonomy), some level of creativity (interested in medical technology and startups) and also respect from others. Can I be an astrophysicist? Yes. Can I be a politician? Yes. Can I be a mathematician? Yes. But none of that offers me the same. Plus I am genuinely interested in the sciences behind medicine.

 

[ProReduction]

I have been called brilliant by many. I think medicine is really easy as long as you are willing to put in your time. Why do I want to do medicine? It offers a path to financial stability (decent salaries), independence (no real bosses, yeah I get that there are people above you for whatever reason, but overall you have a lot of autonomy), some level of creativity (interested in medical technology and startups) and also respect from others. Can I be an astrophysicist? Yes. Can I be a politician? Yes. Can I be a mathematician? Yes. But none of that offers me the same. Plus I am genuinely interested in the sciences behind medicine.

If you could be a successful mathematician then you are in the <0.01% of physicians that could. I switched careers from medicine to engineering (I have a MS in CS and a Phd in Engineering) and I'd estimate that <10% of doctors could pass calculus-based Physics in undergrad.

 

[coffegroundemesis]

If you could be a successful mathematician then you are in the <0.01% of physicians that could. I switched careers from medicine to engineering (I have a MS in CS and a Phd in Engineering) and I'd estimate that <10% of doctors could pass calculus-based Physics in undergrad.

Different strokes for different folks. I think less than 10% of mathematicians can pass the test of comforting a patient. It’s not all black and white. Intelligence doesn’t dictate what you do. Intelligence only dictates how well you can do something.

 

[Goro]

Step 2 CK has nothing to do with IQ or intelligence. Nothing in medicine does. You know how many geniuses could make it in medicine? Zero. The simple subject matter, emphasis on simple algorithms and memorization, and absence of a need for creativity eliminate all geniuses from any desire to be in the profession. People that are going to win a Fields medal or make a major scientific discovery are not going to medical school. Do you think that Einstein, Benjamin Franklin, Leibniz, Mirzakhani, or Sinead Griffin could have sat through medical school lectures?

I don't know, Nobel Laureates Joe Goldstein, Gerry Edelman, Harald zur Hausen, David Baltimore, or Barry J. Marshall all made it through med school. I've met Goldstein and Edelman at scientific conferences, and the brilliance just scintillated off of these guys.

 

[ChordaEpiphany]

Someone who calls cardiologists “glorified plumbers” are too full of themselves. For one thing, plumbing actually requires some brains (I’d love to see any PhD try to fix a high pressure leak, not contaminate the freshwater supply, and not destroy the flooring/walls in the process).

That's not quite the point. I don't share the elitist sentiments of that physician-scientist. I do, however, regard purely clinical physicians as "working class," even if they are objectively more intellectual than a typical blue collar worker, and that's really what he was getting at. At the end of the day, if you sell your time/labor for money to fix one problem at a time, you fit into that bucket regardless of pay, education, or skill. Second, the point is that most people can learn. Having grown up in a rural community where plenty of my friends became mechanics, plumbers, electricians, carpenters, etc... I know that 100% of PhDs could learn to fix a high pressure leak. They'd likely learn way faster than most plumbers did, too. Of course they couldn't walk up to a high pressure leak and perform, but neither can the hungover 19 year old showing up to their first day as an apprentice.

If you could be a successful mathematician then you are in the <0.01% of physicians that could. I switched careers from medicine to engineering (I have a MS in CS and a Phd in Engineering) and I'd estimate that <10% of doctors could pass calculus-based Physics in undergrad.

I have a PhD in engineering and I'd bet that 100% of physicians could be successful in engineering or math. Again, there's nothing magical about this. If you train at something and you have a baseline level of competence/intelligence, you will succeed. It's not until you get to the upper echelons (e.g., becoming a well-funded professor of mathematics) where solidly above-average intelligence and hard work won't get you where you need to go. Yes, I agree that physicians are embarrassingly bad at math. But to say they couldn't pass calculus-based physics is just hyperbole.

Different strokes for different folks. I think less than 10% of mathematicians can pass the test of comforting a patient. It’s not all black and white. Intelligence doesn’t dictate what you do. Intelligence only dictates how well you can do something.

Agreed it's really about what you do. Talent (one example of talent being intelligence) determines your eventual skills plateau. Social skills are harder to learn, but they are still skills. I think most people would have put me mildly on the spectrum in high school. I grew up pretty isolated and didn't get much practice. I decided to work on my social skills and today I have a whole side-hustle that relies on great customer relations. My clinical feedback consistently revolves around how much patients and fellow team members like me. I'm also a trained engineer who majored in math and engineering. It's silly to place people in these buckets based on what skills they've trained or what path they've chosen.

 

[ProReduction]

I have a PhD in engineering and I'd bet that 100% of physicians could be successful in engineering or math.

My fellow PhD in Engineering physician, we both know better. Maybe I should have been more specific in talking about pure math not applied math. We are both Engineers and know that maybe 5% of Engineers could carve out a real career in pure math. I consider myself a pretty solid engineer and I know I'd have no hope to excel in pure math. It is a really tough field that takes both brilliance and creativity in equal measure.

 

[coffegroundemesis]

My fellow PhD in Engineering physician, we both know better. Maybe I should have been more specific in talking about pure math not applied math. We are both Engineers and know that maybe 5% of Engineers could carve out a real career in pure math. I consider myself a pretty solid engineer and I know I'd have no hope to excel in pure math. It is a really tough field that takes both brilliance and creativity in equal measure.

Tbh, I just think pure math requires a different way of thinking. It’s more about aesthetics and creativity. But most of pure math problems have almost no practicality. Such as proving that prime numbers are infinite and etc. I majored in maths and subspecialize in applied math. It’s silly to stratify knowledge into levels. They are just different knowledge. Given our finite life, a human can only acquire so much knowledge before we die. Therefore the limiting factor dictating whether one can be good at physics AND math AND medicine is time but not intelligence.

 

[ProReduction]

Tbh, I just think pure math requires a different way of thinking. It’s more about aesthetics and creativity. But most of pure math problems have almost no practicality. Such as proving that prime numbers are infinite and etc. I majored in maths and subspecialize in applied math. It’s silly to stratify knowledge into levels. They are just different knowledge. Given our finite life, a human can only acquire so much knowledge before we die. Therefore the limiting factor dictating whether one can be good at physics AND math AND medicine is time but not intelligence.

I respectfully disagree. To bring this full circle, I got in the 99th percentile on Step 2 CK, which means little to me and anyone in-the-know; but some might say this is a sign of clinical intelligence / "being good at this medicine thing" / blah blah blah. I did this by staring at First Aid and whatever that blue book was at the time for 8-10 hours a day for a month. I put in the "time" as you say.
Meanwhile, I spent years upon years working on a PhD with the initial goal of doing world-changing work, only to have my work be good not great with nobody excited to write my obituary about it.
My point is that you could give me or any other physician 1000 years and we are not going to reduce the error rate in quantum computing to consumer tolerance levels or solve a Simon's problem.
Engineering was very humbling for me, whereas in Medicine if you just "hang around" long enough you get "good" at it.