Liz's Medical School Journey

10… 9… 8 more days until my Step 1 exam!  Do I feel ready?  Um… NO!  Do I feel nervous?  Gulp!

Step 1 is so expansive, I’m not sure I could feel ready.  I can quantify the past 3 weeks with about 125 hours of studying, 3 blue highlighters, 200 note-cards, and one afternoon off.  My husband has taken over all domestic duties.  Thank goodness!  I have gone over everything, and now am going back over everything again… and again.  I’m trying to memorize and learn more details about mechanisms, enzyme names, pathways, drugs, etc.  I am afraid that every piece of new information that goes inside my brain will knock something else out.  And my practice “Q-bank” is down to only a few hundred unused questions.

I’m not sure how I hoped to feel before my test.  Mainly I wanted to feel confident that I know a majority of the material really well.  At this point, at least I feel like I will pass the exam.  I’m not sure if I am satisfied because there is still a part of me that wants to do a lot better than that (215-230 to be exact).   After so much studying, I hope this hard work pays off!

Last Friday night, I had sushi with a classmate who had just taken her exam.  She had a glow of happiness, which gave me something to look forward to.  Completing the Boards is a big accomplishment, and there will be satisfaction just from pushing myself to a new limit.  Hopefully in a few more days I can feel the afterglow too.

After all this hard work, everything comes down to whether or not it will be “a good multiple-choice day.”  I know I’ve put as much effort into studying as I can.  So, my performance will be a mixture of knowledge, specific test questions, anxiety, energy level, and comfort at the testing center.  I’m hoping for a combination that helps me do my best.  As I’m counting down, please send “good multiple-choice” vibes my way.

My updated study schedule.

“Step 1,” “Boards,” “USMLE,” “US Medical Licensing Exam Step 1,” or whatever you want to call it… is dominating my life right now.  If you prefer not to hear about it, then skip this post (and probably the next few as well).

I’ve informally polled my resident and young doctor friends about medical school, and it seems most agree that the Step 1 exam was their lowest point in medical school.  Also, most say they would gladly repeat 3rd-4th year, but  NOT 1st-2nd year.  A high school classmate who is now an OBGYN resident wrote, “Good luck! I have some of the worst memories studying for Step 1, it’s truly the worst Step! Remember, it only gets better after this…”  *sigh* I am at this low point, but have lots to look forward to.

I wish I could tell you more about the history of the USMLE Step exams, but I obviously do not have time for that right now.  I do know at some point, it became mandatory that every 2nd year medical student in the USA pass this exam before beginning third year, including me, of course!  Over the course of this year, I have slowly come to terms with the horrific tests that await me, including my current buddy, “Step 1.”  Now that my test date is less than 3 weeks away, I can tell you all the basics.

The exam is an 8-hour, multiple choice test (seven 1-hour blocks with 48 mixed-topic questions plus 1 hour break).  It is administered by our favorite company, Prometric, who brings us great joys, such as the MCAT, SAT, ACT, LSAT, etc.  The Step 1 exam costs $505, but the real cost is more like $1,000-1,500, once you include the study materials and access to online practice questions.  There is no option to retake this exam, unless one fails it.  In which case, one must retake the exam until a passing grade is achieved.  Each exam is recorded on the medical transcript.

Basically, the score is out of 326 (possible points= # exam questions).  The national average is 215, and the average scores of residents in different areas of medicine vary drastically.  As the deans at my medical school said, “some residency programs are more boards oriented,” meaning they consider board scores to be as important, or more important, than character evaluations or clinical performance.  These areas include Dermatology, Anesthesiology, Radiation Oncology, to name a few.  It is rumored that some of these residency programs do not even look at applicants who score less than 240 or 250 on their Boards.  Fortunately, I don’t believe these professions embody my callings in medicine.

Yet, like all my fellow 2nd year students, I still feel tremendous pressure to do well on the exam.  On my future residency application, this exam score will weigh-in more than my entire performance during 1st and 2nd years.  Given that I don’t know which residency programs I want, or where my husband and I hope to live, I want to keep my options open.  And, most of all, I want to avoid any future disappointments and regrets.  I am humbled by the fact that I have never felt that a standardized test score truly represented my gifts.

At the moment, my mood fluctuates between feeling like “this isn’t so bad, I will  do great,” and feeling like a total impostor to medicine.  Since my last exam ended a week ago, I have been studying around the clock, 7-10 hours of study time daily.  For me, this is the most I’ve ever studied in my life, and it requires mental discipline and stamina.  At first, I thought I was going crazy (feeling anxious, tired, upset, hungry, and restless), but thankfully the human body is quick to adapt.  Today I remembered that it is important for me to avoid total isolation (which is tempting), and hence here is a blog update.

My evolving study schedule I made with sticky-notes, so I can move things around (another student's idea). As you can see, next week is mostly empty.

One of my classmates and faithful readers (thank you Ilana!) reminded me that my description of Physical Diagnosis cannot be complete without telling you about one of my funniest days in medical school.  And I’m positive you would rather read an entertaining story than read about my final exams.  Plus I need a mental break from Boards, so here goes…

That Wednesday it was a dark, rainy morning, especially dark considering it was 5:30am.  I got dressed as usual, trying to turn-on as few lights as possible, so my husband could keep sleeping.  I put on brown slacks, and gathered my white coat and medical tools.  Ready!

It was pouring while I walked to the subway, so I was trying to stay dry.  I commuted by subway 45 minutes to get to my bus.  I picked up my usual Chinese milk-tea and almond bun on the way.  We had the spacious bus that day, so I had a seat to myself, where I could relax and put my feet up.  And as I was doing so, I gasped.  I was wearing two different shoes!

Two very different shoes: different shapes, styles and colors.  One was brown and the other was black.  One was pointed, the other was round.  One was Clarks, the other Ecco.  How could I not notice earlier?!  In fact, they suddenly felt different on my feet too!  Apparently I was more exhausted than I thought.  I’m pretty sure I’ve dreamt a similar scenario, but I always woke up thinking, “Thank god that was only a dream!”  That morning there was nothing I could do.  Home was hours away, and nobody packs extra shoes for the hospital.

So, I was stuck with one brown and one black shoe all day.  The first thing I decided to do was tell my classmates because I knew somebody would notice eventually.  Besides, it was pretty hilarious, and an honest mistake anybody could have made in the early morning hours.

Everybody did find it pretty funny.  After a round of “Let me see!” and giggling, one person suggested I could snag a walking boot at the hospital, take off one shoe, and pretend like I injured that foot.  Fortunately my patient was a 6-month old baby.  He didn’t care about my shoes.  In fact, despite being sick, he was cheerfully cooing and grabbing his feet.  Infants and young children can be so refreshing when they don’t have societal qualms that we do.  His mom noticed at one point- at least I saw her look at my feet, then look up, then scan back down quickly.  I wished I could have tuned in to her thoughts, which probably began, “Wait, are those… YES they are…”

In the afternoon, I was assigned to give my oral presentation to the head of the pediatrics department, a tall fellow who takes things very seriously.  As you can imagine, I felt about 2 inches tall while giving my presentation.  I stayed seated, with my legs crossed (hoping to make my feet less noticeable). But, he didn’t seem to care, and if he did, he never said anything.  Therefore, I made it through a whole day with two different shoes, one of the most embarrassing things I could do to myself, and I survived!

In the future l will be checking my shoes very carefully, especially next year during surgery when I have to get up in darkness daily.  Now, however, I feel more prepared for future embarrassments.   At least I know I can make it through a normal day, even if I look weird.  Most people really don’t notice the things that we feel the most self-conscious about, or if they do, they don’t really care as much as we think they will.  So maybe someday I’ll see a medical student with two different shoes, earrings, socks, or a shirt on inside-out, and I’ll understand.