Actually, SO, I would argue that the fact you did well enough in your school's courses, both clinical and pre-clinical, but had repeated trouble with the Steps implies that the problem *is* with your school. To me, it means either the grading was lax or that the material was simply not adequate/sufficient to prepare you for the national boards.
While having a good board prep program at your school helps some, I am more inclined to agree with superoxide. In the end, the residents (and students) who did/do self-directed learning do very well on the wards and on the boards in general IMHO. If you see a patient with meningitis then you read up a lot about it, and do this for every patient. You can't afford to wait and be spoon fed.
I did very well on the boards (near the top of my class in step scores) and got eye popping comments when I interviewed, not because of any school preparation, but because I realized that there were huge holes in what I was being taught in medical school and on the wards. I made use of huge amounts of review materials and basically read everything in the Lange series, cardiology, pediatrics etc . . . Also, on the wards if you read journals regularly you really stand out. I began reading a popular medicine journal 3-4 years ago weekly, i.e. about 10 articles a week and it pays off when you feel more confident about patient care and when you can say, "I read in x that pharmacologic treatment for Marfan's syndrome is being questioned in that . . . "
I would agree that your school can give you a bad start, in agreeing with Blonde Docteur, in that some schools give the impression that what you learn in years 1 and 2 is sufficient for board prep. Maybe to just pass or barely pass, but if you want to excel you need to do more. Never say "Well I am passing all my basic science classes I just need to study for a couple weeks for Step 1." A lot of the material for step 1 and 2 is not taught in some medical schools and they don't realize that some of their material is out of date. Reading Kaplan microbiology and a good microbiology book will save your bacon on Step 1, while just reviewing your micro notes may not if your school did a bad job in the course as mine did.
Remember as a physician you will have to keep up with your reading, especially in private practice, but also in academia. A lot of physicians don't and this is why there is more focus on re-certification for some boards I believe.
It is true that you WILL learn a lot during third year. When I took Step 2 there many questions where I thought back to what happened on the wards with such and such a patient. However, I had read up on sepsis or acute lung injury so I remembered my patient. And I reviewed pharmacology some in third year by knowing all the meds my patients were on, i.e. mechanism, side effects.
I would advise all med students studying for the steps to run their own personal board review program, i.e. find the books they like in addition to what their school provides and to be proactive learners during third year. If you read up on ALL your patients in third year, and know selected books like Blue Prints Ob/Gyn, First Aid Medicine, Kaplan Medicine, i.e. know what is good, it is almost impossible not to break average. I absolutely love Case Files as well, put it in the bathroom and chug through a case a day.
Blonde Docteur can disagree, but I have street cred in this department as I did >99 250+ on Step 2 CK. But I never rest on my laurels and will read two more journal articles tonight before calling it a day. I would expand the quote from DB above by saying that
no school has adequate preparation for the boards as you have to do some heavy lifting yourself. Even more so in residency you have to read about your patients when you have the chance and don't think that just by doing you are learning enough as you have to do a little bit of reading as well.
