Imprinted Experiences

Coming into medical school I think many of us have an image in our head of all the great things we’ll get to do. In general most of them probably include a collage of things like saving lives, using defibrillators, performing surgery…you know, TV medical drama-esque stuff.

In reality, medical students very rarely save anyone’s life and generally the extent of our surgical experience stops at holding bladder blades and retractors.

That’s not to say that we are not sometimes a very integral and important part of the healthcare team, only that it’s often in the patient’s best interest if we learn slowly. Fortunately for you all, that typically means starting with small things like sutures and staples, not being in charge of stopping a bleeding great artery or removing an infected appendix.

However, one relatively universal opportunity we get before giving up our “MS” designation is the chance to deliver a baby.

And by chance I mean, if you don’t deliver a baby you will not pass your Ob/Gyn clerkship.

So, last semester I got to deliver babies…with the help of some well-versed doctors, of course.

During my Ob/Gyn clerkship it was me, on several occasions, who handed a tiny little body to it’s exhausted mother as she took in the image of her child’s face for the first time. I was given the privilege to be the one who wiped a precious little face and whispered, “Look momma! A tiny baby boy…he is absolutely perfect!” while tears of happiness mixed with droplets of sweat and settled on her relieved cheeks.

Last semester I got to deliver babies. As it turns out that experience, one I never expected to be so supremely moved by, will soon become a part of my career. However, everyone doesn’t end up going into Obstetrics and Gynecology, but even so most remember their first experience with birth. Some will recall it as shocking or scary, others as bloody and jarring, but almost all will tell you it’s nothing short of amazing…even if they hate obstetrics.

 

There are few things we will distinctly remember from these years, but here’s a few experiences (some wonderful, others painfully heart-wrenching) that I will never forget:

  • My very first patient.
  • My first patient who died (who also happened to be my very first patient).
  • Witnessing the preterm delivery of a baby at just 24 weeks gestation.
  • My first day in the OR and how lost I was scrubbing in.
  • Suturing something other than a pig’s foot for the first time.
  • Finding fetal heart tones for the first time.
  • The deafening silence of not finding fetal heart tones when they should be there.
  • How quickly blood can fill an abdomen.
  • Seeing a patient’s blood pressure drop to 45/?? on the monitor during surgery.
  • My first patient who miscarried.
  • My first experience with serious, life-threatening trauma.
  • Holding a patient’s hand as they were told they had cancer.
  • Watching major abdominal surgery on a preterm baby <6 lbs.
  • Holding the hand of a woman who had experienced a horrifying tragedy.
  • Talking with a truly manic patient for the first time.
  • Watching an infertility couple cry at the site of their baby’s heartbeat on ultrasound.

There are probably so many more, but these are some of the things that have imprinted themselves on my brain forever. These are experiences I carry with me – some I hope to experience many more times, others the opposite – all I hope have made me a more caring, compassionate future doctor.

What are some things that are imprinted on your mind from many years ago in your career? If you’re a medical student, what experiences will you never forget?

Image 1: FreeDigitalPhotos | Apple’s Eyes Studios
Image 2: FreeDigitalPhotos | arztsamui

Reflections on Third Year

The past year has been one of unexpected and broad personal discovery, involving aspects of heartbreaking disappointment and sheer, unsurpassable joy.

Since July of last year, when I started third year, I’ve met amazing people, learned incredible things (including learning how much I don’t know) and been afforded unique opportunities.

I can confidently say that the third year of medical school was one of the most life-changing years of my life. Not only did I (finally) figure out what I want to be when I grow up, but I experienced breathtaking highs, gut-wrenching lows, unexpected humor, and a back door glimpse into a mysterious side of life…and death…that many never see.

Overall, I feel like this year, both personally and professionally, I’ve truly experienced an overwhelming breadth of humanity…and honestly, I never saw it coming.

I just wanted to thank y’all for making this journey with me. I have received so much advice, support, encouragement, and love from Mind On Med readers and through Twitter. I am continually thankful that I choose to share my experiences here – not only to give others a glimpse into this life, but so I can look back someday and remember how pivotal these years were in helping me become the physician I will eventually be.

I’m expecting that the next year will be an adventure in itself – two new babies (!!) who will hopefully keep cooking until December (oh, did you miss that – yah we aren’t getting another dog – no my friend, we met our four-legged & furry quota long ago), residency applications and interviews, Match Day in March, and all kinds of fourth year fun (hopefully involving significantly more DIY projects than third year). Thanks for sticking with me through the craziness!

Ok, I do believe that is enough mushiness for one year.

Here’s a few of the most viewed posts on Mind On Med from the past year:

Image: FreeDigitalPhotos.net | Ambro

Oh Hello, Fourth Year…

I’ve finally buckled down and started studying for Step 2 CS, the third of four USMLE “Step” exams we have to take to be a fully licensed physician. So far I’d say it’s going as well as can be expected…

I plan on taking the test at the end of June and having a week off before fourth year starts.

On that note, holy wow – when did fourth year become weeks away? Our fourth years have been doctors for 2 weeks now, which makes my class the next in line for graduation.

While we’re on the subject of graduation, let’s talk about something I saw while doing a little perusing on Pinterest today (you know…while I was…studying…):

Medical School Graduate Gifts 

Now, I’m sure this is a great blog (actually, I’m not sure seeing as I can’t read a lick of Turkish, but we’ll give them the benefit of the doubt), but they have totally missed the mark on this one.

Let’s put it this way, do not buy any of that crap for your med school graduate. Just don’t. 

Actually, there are some adorably decorated cookies or something on there as well. I’m pretty sure anyone who isn’t diabetic or lactose intolerant can appreciate some delicious iced sugar cookies, so that one I’ll make an exception for…you can buy them cookies.

But please forego the X-Ray iPhone cover, Caduceus tie and super creepy doctor trophy.

Along the same lines, I’d probably stay away from stethoscopes, speculums and pen lights.

If you feel so compelled as to buy your medical school graduate something, take advice from this more appropriate Yahoo article and go with a something useful – like a Hep B vaccinated house keeper to clean their house (which likely still has dirty anatomy scrubs and scalpels laying in the back of a closet somewhere) or money to put towards the outrageous debt they’ve become blissfully married to over the past four years.

Or a car, that’d be a nice gift, too.

But seriously, a Starbucks gift card is probably your best bet for winning over your future intern.

Medical School in Indonesia

Today I’m excited to introduce to you Anna, a 22 year old medical student from Bogor, West Java province in India. She is in her last year of clinical clerkships at Universitas Pelita Harapan medical school, a bilingual (Indonesian and English) open to both local and foreign students.

Currently, Anna is undecided on a specialty, but is interested in both Neurology and Emergency Medicine. She has five more rotations before she finishes, so it will be interesting to see what she decides on! She blogs at Surreal Hours and you can catch her on Twitter @a_elissa.

She contacted me a few weeks ago asking if I was still open to having more posts in the Medical Education Monday series. I’m so thrilled that y’all find medical education in various countries as interesting as I do…it’s certainly been great to hear about all the different systems.

If you are (or someone you know is) a medical student or physician in a country not yet covered, please have them contact me! Here’s what Anna had to say about Medical School in Indonesia:

Getting In:

How old is one when they begin medical school?

We begin medical school directly after high school. However, some schools are open for students who already have an undergraduate degree, this is usually the case for foreign graduates.

What exams does one have to take to get in?

  • Public Schools: National exam called SPMB that is designed for a specific major, but is valid for any universities. This exam is not the actual entrance exam, it’s only for filtering out students who are academically eligible for a certain major, in this case for medical school. A prospective student sitting the medical school SPMB also needs to fill out a list of schools of their choice. The result of the exam is then sent out to those schools, and he will receive a notification about his acceptance. There is then another exam and an interview from each school that he has to complete and pass before being formally enrolled.
  • Private Schools: Each school has its own entrance exam, usually consisting of basic science focusing on human biology and chemistry, and an interview. Students applying for scholarship may be required to sit an additional exam.

Is there any required pre-requisite coursework?

The national high school system divides the curriculum into two major programs: Ilmu Pengetahuan Alam or IPA (Natural Sciences), and Ilmu Pengetahuan Sosial or IPS (Social Sciences). One has to do the IPA / Natural Sciences program to be eligible for medical school. If a student graduates from a foreign curriculum, like Cambridge or the International Baccalaureate (as in my case), then he must have taken at least biology, chemistry, and maths.

Is it a competitive occupation?

Very.

What are you called at this stage of training?

A high school graduate.

Being In:

How long is it?

5 years.

How are the years broken down?

  • The first 3 – 3.5 years are pre-clinical years. Using the new block system, we learn basic anatomy, physiology, biochemistry, and immunology for the first year, then system-based approach for the remaining pre-clinical years. The actual division of the organ systems depends on each school. In my school, it is musculoskeletal, cardiology, pulmonology, gastroenterology, genitourinary, endocrinology, neurology, obstetrics and gynecology, dermatology and venereology, tropical medicine, hemato-oncology, and emergency medicine.
  • Students who have completed the first 3.5 years are considered graduates already, and are granted the title “Sarjana Kedokteran” (Bachelor of Medicine). They can quit at this time and start working non-clinical jobs.
  • The last 1 to 1.5 years are clinical/clerkship years. We do 9 minor rotations and 5 major ones. They differ by duration: minors last 4-5 weeks, majors last for 10-12 weeks. Minor Rotations: Neurology, radiology, psychiatry, ophthalmology, ENT, oral medicine, dermato-venereology, anesthesiology (including critical care), and forensic medicine. Major Rotations: Surgery (including emergency medicine), internal medicine, obs/gyn, pediatrics, and public health. Upon completing the clerkship, we then graduate as Medical Doctors.

Describe your typical day.

  • Pre-clinical: Class starts at 7:30 AM. Some days start with lectures, some with PBL discussions. Labs are usually in the midday. On the last period every Friday, there is a plenary session where the PBL case study that week is discussed with an expert. The day usually ends at 3:00 PM.
  • Clinical: In my hospital, office hours start at 7:00 AM and end at 2:00 PM, while outpatient clinic starts at 9:00 AM. The first thing we do in the morning is write SOAP notes of ward patients, then wait for the attending physicians to come for the morning round. After rounds, activities vary according to department. We may have academic activities, like tutorials or case study presentations, or we may go to outpatient clinic and have academic stuff later in the day. For surgical specialties, most operations commence at around 10:00 AM, depending on the number and difficulty of the cases that day.

If you choose a specialty, when do you have to decide by?

There’s no requirement for that. Age-wise, residency programs only require applicants to be less than 30 years old by the time of entrance.

What are you called at this stage of training?

  • Pre-Clinicals Years: Medical Students.
  • Clerkship Years: Our formal name is “dokter muda” or junior physicians, but we are more often called with our colloquial names, “co-ass”, from the Dutch word co-assistant. We still use a lot of Dutch medical terms in spoken conversations.

Getting Out:

What exams do you have to take?

The law is changing as I’m typing this. There used to be no exam getting out, as each rotation in clerkship already has its own exam. However, the new bill proposes for a national board exam. It is still undecided whether the exam will be a test for theory or clinical skills, or both.

Do most people graduate?

Yes.

When are you finally considered a “doctor?”

When we have taken our Hippocratic Oath at the end of clerkship (and after the board exam, if the new bill passes).

Do you have additional training after MS or do you start working immediately?

Again, the law is under some changes. The new law requires an unpaid 1-year internship in a hospital chosen by the government. After that year, doctors can work independently.

What’s the average debt for attendance?

There is no debt, except for scholarship students. Regular students pay the full fee. Scholarship students will pay back by working for their universities or teaching hospitals immediately upon graduation for a certain period of time, usually 2n + 1.

What are you called at this stage of training?

A doctor. More formally, a general physician.

Being Out:

What’s the average salary?

Depends on where you work. The general rule is the same everywhere: it’s higher in private institutions than public ones, and is also higher in bigger cities than in rural communities.

Is the job security good?

Yes. There is a high demand for doctors throughout the country, especially outside the main islands of Java and Bali.

Can you switch specialties?

Yes, but people rarely do this.

Can you go back and choose a different specialty?

Technically, yes, as long as one has not reached the age of 30 by the time of entrance. However, I have never heard of anybody doing that.

What are you called at this stage of training?

A specialist.

Breaking The Rules

A recent article called “To Tweet, or Not To Tweet: Physicians Misusing the Internet” discussed a new JAMA study which apparently found that…

“92 percent of state medical boards in the United States have received reports of [online] violations ranging from inappropriate contact with patients to misrepresentation of credentials.”

I guess this is supposed to be shocking, but I was really somewhat underwhelmed with the information (I was actually more shocked it wasn’t 100% – which state has had none…because that’s awesome). It’s exceedingly easy to report a violation that occurs online, since it’s permanently etched in the history of the internet, so of course there’s a large number of state boards receiving reports on violations that occur online.

The discussion is relevant and interesting, but clearly written with a negative attitude and watch-your-mouth, paternalistic tone (like many of the recent articles and research publications on social media in medicine, unfortunately). A quick search finds that the doctor on the answering end of this Q&A session has a rarely used Twitter account (@RyanGreysen) and no blog (that I could find, anyway)…clearly making him one of the least effective people to be discussing these issues unless his only advice is going to be to avoid a presence in social media all together.

However, that’s not exactly the point. What irks me so much about the recent onslaught of negative-nancy articles on physicians in social media is that they pretend that the internet is some delinquent hangout for the physicians who can’t seem to conduct themselves professionally. The tone of these articles comes across like Twitter is where we gather to join in HIPAA-violating hippie parties and have inappropriate contact with patients.

The tone implies that these things don’t happen on the elevator, at the football game or in the corner bar. The article (and many others like it) repeatedly discusses the need for educating physicians on the “rules” of online behavior and “how to conduct yourself online.”

That is not the problem.

The fact that the online world documents breaches is the problem.

Venture into any hospital hallway and you will be bombarded with far more private information in a circle around one ward than you will in a full days Twitter stream.

The issue is not that we’re gathering online and violating HIPAA because we don’t know how to conduct ourselves online, the issue is that it’s recorded here.

By saying we should educate physicians on how to act online we imply that either:

A) Unprofessional conduct is not occurring off-line.         OR

B) It’s more important to watch what you say here because it’s documented.

 

Is it important to watch what you say here because it’s documented?

Absolutely. Unequivocally. Yes.

Is it more important than it would be in your local Chili’s?

I sure hope not.

 

Sure, you’re less likely to get caught if you’re talking about private patient details in Chili’s, since it’s not being recorded and all, but that doesn’t make it ok. As a kid my mama would tell me,

“Doing something bad when you know you won’t get caught doesn’t make it any less bad.”

Doesn’t that rule still hold true?

What I’m saying is that these are not separate entities. Just because reports aren’t getting filed about physicians discussing private patient details in elevators as often as they are about physicians discussing private patient details online does not mean it’s happening less. It means it’s recorded less. That is not to say that there is no room for guidelines or advice about conduct in social media, just that online behavior is not inherently different than offline behavior. @SeattleMamaDoc really said it best,

“We are worse in the elevator than we are online.”

We don’t need to educate physicians on behavior online, because this problem is not unique to the internet. We need to educate physicians on keeping private patient information to themselves. On using some common sense and respecting co-workers and patients alike. Not just on the internet…everywhere…including on the internet. The physicians who are violating privacy and acting unprofessionally in the elevator are the ones who will talk about their patients online. This is not a problem inherent to an information medium, it’s a problem inherent to a person. And I’m not sure it’s one that can just be “educated” out of someone.

Thus, this is not about our online conduct, it’s about our conduct…and as soon as we make it about online conduct we imply that it’s only important to follow the rules if there’s a really good chance you’ll be caught if you break them.

 

Image 1: Pixomar | FreeDigitalPhotos.net

Find Your Voice, Listen To Theirs

Rain drops trickle down the double-paned, ovoid window as my eyes jump from plane to plane watching for movement on the runway. The rainy weather in my connecting city has brought me back to the familiarity of muggy, hot Spring days that were so common place in my college years and I’m reminded of the excitement I felt of being in a new place, doing new things. As we taxi the runway for what seems like hours I reflect on the whirlwind weekend I’m making my way home from…

New city.

New people.

New ideas.

New Inspiration. 

I spent the weekend surrounded by what I can only describe as the most innovative and creative group of people I have ever encountered. The thirst for knowledge, aptitude for leadership, drive for entrepreneurship and innovation in the room was almost palpable. I found myself repeatedly standing just outside of conversations and listening – not wanting to join in too quickly because I was learning so much as an observer.

Amazed by everyone from medical students to physicians to marketers and computer programmers, I began wondering what I had missed…how I had become so complacent with doing the same things every day rather than innovating and advancing.

Being surrounded by people who harbor a thirst for knowledge and desire for advancement is contagious. The viral enthusiasm was quick to seep into my brain and I now find myself wondering how I spent so long in the dark about all the opportunities available for me…for my husband…for anyone who wants to seek them out.

I feel so blessed to have been a part of the Doximity Leadership Summit and I am so impressed with the ideas and information coming out of the group of physicians, students, supporters, developers and crew. My eyes have  been opened to an entirely different world of medicine that I never knew I was missing.

 

Doctor Vartabedian of 33 Charts wrote today on the future of Key Opinion Leaders – what does a physician influencer in the age of social media look like?

In my eyes they look like the people I was with this weekend – innovative, intelligent, well-spoken and … most importantly … just plain excited about all the things we will be accomplishing in the next 10, 15, 25 years.

 

As medical students and young doctors this is exceedingly important – we have this opportunity to use our voices and ideas to further not only our careers, but the entire field of medicine and how it’s practiced. I no longer feel like we have an option to be involved – this is an obligation…to ourselves, to our patients, to our educational experience. If you aren’t interacting with your tech-forward peers and mentors you are robbing yourself of an opportunity for personal advancement and missing out on inspiration and innovation coming from the mouths (and finger-tips) of people just like you.

Life is short, take this opportunity to find your voice and listen to the voices of others.

The digital age cannot be viewed as threatening for medical professionals any more – the longer we shy away due to scare tactics and unfounded concerns, the longer we lag behind in innovation. We can use this platform to change the world.

 

To be inspired…to create…to have a voice…this is a privilege. 

 

Five Reasons Mind On Med (and @daniellenjones) Won’t Disappear For Interviews

As Match Day for the Class of 2012 quickly fades into the background and residency applications for my class begin to appear on the (horrendously terrifying, Wizard of Oz tornado-esque) horizon, I find my classmates starting to disappear (or discuss disappearing) from Facebook and other socially-oriented websites.

“Are you taking your blog down for application and interview season?” someone innocently asked, “I mean, some program directors just may not appreciate the ‘social media’ involvement as much as you do.”

The question, while valid by many accounts, irked me a bit – of course I’m not taking down Mind On Medicine for residency applications. 

Why? Let me give you a few reasons.

1. I have nothing to hide.

If I were to take down my blog for residency applications and interviews it would imply I have written something here that I need to hide from my “higher-ups.” I don’t write about patient specifics, in fact I can think of only one time I’ve even written vaguely of a patient interaction, and I don’t write negatively about classmates or residents or attendings. I just write. About medical school, about my life, about funny stuff, about serious stuff…I just write. This is my hobby and I enjoy it, why would I hide that from anyone?

2. It seems a bit dishonest.

If I did take it down what would happen when I started residency? I’d put Mind On Medicine back up and eventually someone would ask why it conspicuously disappeared for the period of time I was applying and interviewing? Awkward turtle. 

3. It’s sort of on my CV.

Not explicitly, but in a round-a-bout kind of way. I was recently published in one of my school’s magazines and the article mentioned this blog. So, if someone were to read my lone “publication” and attempt to visit Mind On Med from that reference only to find I had deleted it…well, that’d be a little weird. I’ve also received some opportunities from this blog that are included on my CV – being a founding medical student of Health Tap University, working with Doximity, a job writing reviews for iMedicalApps, attending and participating as a panel member at an upcoming Doximity Leadership Summit – and I’m sure at some point in my interviews it will come up how I stumbled upon at least one of these awesome, non-traditional opportunities. These are seriously amazing things I’ve had the chance to be a part of all from being involved in social media…I really just want to paste it everywhere so people can see the benefit, not hide it like a red-headed step-child*.

4. I’m proud of my writing & involvement.

I consider my involvement in social media more than just a haphazard manner of sharing what I had for breakfast (although, I do occasionally share what I have for breakfast…especially when it’s cookies…or vending machine crap…), it’s a way for me to learn. I have gained so much from being involved in social media, more than just cool opportunities. Not only do the people I’ve met teach me as much as the people I interact with “in real life,” they’re helping me network, expand my career and, maybe most importantly, open my mind to ideas, lifestyles, & beliefs I wasn’t previously familiar with. There are so many people on Twitter who have taught me how to be a better physician in the future and I am so grateful – these opportunities have been overwhelmingly valuable to me.

5. What a freakin’ hassle!

Umm…I’m not entirely sure what all would go into making this blog disappear for a certain amount of time, but I am confident I do not want to deal with that! I worked too hard creating a blog, moving it to WordPress, designing a Header, organizing, changing, adding, subtracting and editing to make this thing disappear. It’s a work of art (notably included in the “my-3-year-old-could’ve-finger-painted-that-what’s-it-doing-in-the-Smithsonian” genre).

 

A while back my internet friend (oh, – reason #6 – if I hide my internet existence it knocks me down to 2 friends total…and one is married to me…so I really can’t afford delete myself at this point) and Mind On Med guest blogger, Allison from MD2B, wrote a post called “My Social Media Manifesto” in which she, much more gracefully and intelligently than I, described some fabulous reasons for keeping her internet presence around during application and interview season. Hop on over and give it looksy…good stuff.

So, there you have it – the 5 reasons I am not using the Abracadabra dust to make me internet-invisible come September.

Agree? Disagree? What are your reasons for keeping (or Control-Alt-Deleting) your online presence for application season?

 

Image: graur codrin | FreeDigitalPhotos.net

*No offense meant to red headed step-children. I myself am a step-child…and am currently sporting hair in a shade of red. I did not take offense to that statement, so neither should you. If you did I need you to evaluate your life and discover what your evil step-mother did with your sense of humor. It’s likely locked in the cold, dark basement she kept you in when you weren’t mopping floors.

 

Mind On Med Ultimate Guide to Studying for USMLE Step 1 and COMLEX

A couple of months ago I asked a few of my favorite online medical students to answer a few questions about their experiences preparing for Step 1 and COMLEX. They gave me some very insightful answers, so I wanted to share them with you. This post is simply to create a comprehensive answer to the question we all have as second year med students, holymaterialexcessiveness how do I even begin to prepare for this? Believe me when I tell you that these 4 students have amazing advice & guidance. I’ll answer the same questions from my point of view in another post. For today, though, let me introduce you to my guests:

            

Step 1: June 14            Step 1: June 24             Step 1: Early June         COMLEX 1: May 27

Blog: APM                   Blog: MD2B                  Blog: Lancet                 Tw: @endlessrant

Tw: @astupple             Tw: @grecoa3               Tw: @michaelbmoore

 

I’m ecstatic with my score.

 

I am very happy with my score. I originally set my goal around average – which is 220 or so. After taking a few practice tests, I realized I could aim a little higher and ended up surpassing the new goal as well. I used this score calculator online. It factors in UWorld, NBME, and practice questions to give a score estimate and I found it very helpful for setting my goals.

In general, I am very happy with my score. It wasn’t perfect, but it wasn’t ugly either and really, unless you are shooting for something super-competitive, that should be your goal. The test is a reflection of how serious you are and the effort you are willing to put into a task, but it is also a measure of your ability to answer arbitrary arcane of standardized multiple choice questions on a specific day in May, June or July. For me, it’s like running a marathon in under 4 hours – not going to get you into the Olympics. It’s my best. In retrospect, that sounds like a total rationalization, but hey…it’s my rationalization.

Yes & No. Going into the exam I had determined a score range that I would be happy with. My actual score ended up being the literal bottom of that range. When I got my score, I started laughing. One point less & I would have been in tears. So yes – I’m happy, but (as always) I would have liked to done better.

 

No formal prep classes. My school had a week of formal review in late May provided by one of the prep companies with a wonderful live lecturer. I was happy with it and the videos provided with it were good, but if you hadn’t done a lot of prior prep-work it wouldn’t have saved you.

Doctors in Training. I highly recommend it. I was reluctant to use it, because it’s essentially a guided tour through First Aid, but it really keeps you going at a fast pace for 15 days (the length of the program).

 

I used two books: Goljan Pathology and First Aid, and supplemented with the classic textbooks from each supporting discipline. Goljan Pathology is not for everyone, but it is worth taking a serious look to see if it suits you. I found it ideal because it was clinically applied pathology, written with STEP 1 in mind. I did all of USMLE World, taking time to read through the explanations. Also, I listened to the Goljan audio recordings of his STEP 1 review several times through during the year to learn pathology in general.

I predominantly used First Aid for Step 1 and UWorld question bank. I also used specific books for weak areas – Rapid Review Biochemistry, BRS physio (super high-yield) and Microbiology Made Ridiculously Simple.

Book: First Aid for USMLE Step 1 Resource: Kaplan Q-Bank (on PC/Android/iPad). A note on Qbanks, your choice of Qbank is not as important as your discipline in using them. If you are a MSII you should be deep into a Qbank – start as soon as you can and use it often. A month with the best Qbank is not going to make up for lost prep time.

First Aid for Step 1 + Saverese OMT Review = The complete COMLEX study package. Practice Questions – COMBank & COMSAE

 

I studied non-stop for five straight weeks after second year was over. Prior to that I thoroughly read through Goljan and First Aid once with friends as a study group before the end of second year classes. We started this before Christmas break, meeting roughly once a week. The group wasn’t a huge time investment and it paid off tremendously because, when full-time studying came, I knew where to look to sharpen areas that I’d become rusty on.

I ended up studying for 4 weeks and a few days. After formal lectures ended the school gave us a maximum of 6 weeks to study for the test. I tend to get distracted very easily when I’m studying, so I knew that a schedule would be important to keep me on track. I would wake up around 7 and get to the library by 8. I would study until lunchtime, when I would walk back to my apartment and grab some food and take care of other errands. I’d get back to the library around 1 and study until 5 or so, when I usually took a class at the gym. At night I’d eat dinner and do a set of practice questions out of UWorld, and get to bed around 11 or so. I used a systems-based approach to studying. Our curriculum was systems-based, so it made sense to me to review the material the same way I learned it in the first place. I didn’t even start studying for the USMLE until our last class ended in May. Instead, I focused on the coursework and doing well on my tests, since these covered each topic more in depth than Step 1. You only have a few weeks to study before the exam, which isn’t nearly enough time to re-learn everything from the start of 1st year, so learning the material well the first time through is key.

 My school did not give me time to prep – our classes ended a week before our mandatory live prep course. I tried to get 2-3 hours of prep a day regardless of my class schedule. I would use the review materials/Qbank pertinent to the organ system/specialty we were studying at that point. It’s not as hard as it sounds.

I started studying concurrently with classes in January 2011. This might seem early, but I consider myself a slow reader & my weakest subjects were biochem & micro (2 BIG subjects & sections of FA). I used the Taus Method where you annotate each section of FA using a review book. Study time varied by week & topic I needed to cover, but I aimed to put in 4 hours/week of board prep on weekdays & at least 4 on the weekends. I then studied for 2 weeks after classes ended. During that time I’m guessing I studied 10-12 hours/day.

 

The day before the test, I broke the rules and did some reading. Personally, I feel more relaxed just reading stuff. That way, I don’t have to convince myself that it’s okay not to do any preparation. I’m not a hyper-focused person who’s too neurotic to relax, it’s just that I prefer to read over material rather than not.

I still had some questions left to do in UWorld, so I finished them early in the day. I spent the day packing to go home for a few days, cleaned my apartment, hit the gym, and went to bed early.

I reviewed my ultra-high-yield/most commonly asked questions…Brachial Plexus, Dermatomes, Cranial Nerve Exams, Characteristic Drug Side Effects/Reactions. Mainly for nerves and to give me something to do.

I got a massage, ate a great lunch, watched Inglorious Basterds & reviewed FA. Everyone says “Don’t study!” I disagree. Don’t try to learn anything new, but do set a cut off time – mine was 6pm. I went to bed at 11pm.

 

Take some time preparing a lunch that will be tasty, you’ll actually want to eat, and that’s easy to store in a 1 cubic foot nonrefigerated locker. Figure your lunch out the day before and don’t forget napkins and all that. Also, pay attention to what foods make you tired an hour after eating and avoid those.

I took the exam early in the morning (it’s an 8 hour exam). I recommend taking lots of sugary snack and caffeinated drinks, because it’s a marathon of a day. The exam has a tutorial section and a lunch break built in, but you can skip both. I wouldn’t skip the tutorial, because there are a few ways that the test software differs from the practice tests. Also, the lunch break can be split up. I took breaks in between each of my exam blocks to stay fresh.

Bring snacks, one for each break and your own water. Sounds dumb, but make sure you do it. Make it tasty, but not too tasty, with a good mix of complex and simple carbs (Power Bar). If you need caffeine, re-caffeinate at lunch. A day long test is as much a physical challenge as a mental one.

Make sure to have a snack during your breaks. You won’t be hungry during your break, but you will be 15 minutes after it ends.

 

The one thing that I regret is not taking more full-length practice tests. I don’t think I ever sat for 8 hours straight during my preparation and the fatigue definitely got to me on tst day. I consider myself kind of tough, used to working 8 hour days and longer, but I was surprised at how my focus was off. If I were to do it again, I would have done two or three 8-hour practice sessions, just like the regular test day; get up at 6AM, make a quick breakfast, and then go to a room and do nothing but questions for 8 hours. It sounds awful just writing it, but considering all the work invested, this time developing test stamina might have had a big impact. Last comment: I would seriously consider not taking ANY notes or doing ANY highlighting. Just read and do questions. Your brain is amazing, and trying to force it to remember stuff with notes and highlighting just gets in the way.

Most of my classmates took about 5 weeks to study, and began Monday after our last final exam; this gave them a week or so afterward to travel and relax before third year began. Hands down, the best decision I made was taking a week off to go on a trip BEFORE I started studying. Most of my classmates thought I was crazy, but when I came back I was fresh and relaxed. My other biggest strength when it came to studying was that from the beginning I wouldn’t let myself get freaked out by what everyone else was doing – some friends would literally do nothing but eat, sleep, and study. I didn’t get bent out of shape about it, because I just can’t study that way. I made sure to take time for the gym, and my favorite TV shows. I took weekends off from studying and did fun things. I think it helped keep my mind clear and stress level down.

Great question. I waited until January before my test to make a freaked out OCD schedule for my prep. I wish I had done that sooner.

QBanks – if you are only taking the COMLEX, a 3 month subscription to COMBank is all you need. The questions are indicative of what’s on the actual test. If you think you want to take the USMLE as well, then stick with UWorld & get a 1 month subscription to COMBank. Take a practice test. There are several available on the NBME website for $50 each and they are definitely worth it. They are made of retired questions and it is exactly how the actual test will be (but only 200 questions instead of 400). My suggestion is to take one about 2 months before your exam so you have a baseline & then another 1 month before so you can see how you would do on a real exam. The downside to the COMSAE is that you don’t get an answer key. They score it for you & give you a breakdown, but not explanations so they aren’t really helpful for learning – just assessment. I took 2 & my actual COMLEX score was 60 points more than what COMSAE predicted.

365 Days of (Mobile) Photos – Week 18

October 27 – November 2

Cute Puppy
Day 120: In the hospital for 15 hours today...Wrigley was all I managed to get a picture of...mostly cuz I just needed a picture.

 
Pumpkin Carving - Jack O Lanterns
Day 121: Halloween party at the neighbors house - some pretty sweet pumpkin-carving skills going on over there.

 
Bleeker & Juno for Halloween
Day 122: Juno & Bleeker for Halloween. 🙂 I got told twice to put my drink down because they seriously thought I was pregnant. Best pillow pregnancy ever.

 
Delivering Baby Mannequin
Day 123: Last week I learned to deliver a plastic baby in the Sim Lab...today I delivered a real one.

 
Starbucks - Why We Go Together So Well
Day 124: Donnie is so awesome - brought us coffee for Night Float. The saying on the cup is pretty accurate too. 🙂 Love him.

 
Hats With Bows
Day 125: Love these little bows they make for the hats they put on the baby girls.

 
New Simple Shoes
Day 126: New kicks.