So I've been hesitant to really talk about board prep here for a number of reasons. Medical students are an odd sort with all sorts of unwritten social rules and idiosyncrasies, and there's a narrow line to be tread between being known as a "nice guy who works hard" and a "gunner." Frankly I think everyone in medical school studies more than they let on, but never honestly discusses it, for fear of being labeled the frightful "g word", except for the select few who are so neurotic that despite their best efforts its simply painfully obvious.
But I know several MS1s at my med school read this, as well as assorted students elsewhere in this wild world (Hi Malaysia! Say hi to Indonesia for me). And I think both board experiences and board advice on the internet tends to be skewed to come from the neurotic minority versus the gross majority of students. I've seen and heard enough through the med student grapevine to know I'm (probably) not in that neurotic minority so I thought I'd give my personal plan.
My Advice For Before You Begin Board Review:
-Do not start studying for the boards before you get into medical school. Do not start studying for the boards during MS1. If you're so distraught over an exam that is over a year away and simply, absolutely, must do something, buy First Aid for the USMLE Step 1 and read through relevant sections as you progress through the subject in your classes. I bought FA last year with the intention of doing something like this, but ended up not even touching it and don't feel like it was any loss.
-Likewise, do not study for the boards the summer after MS1. Anything you DO learn will be long dispersed and displaced by second year classes and its essentially lost work. Besides, the gross majority of Step 1 is based the pathophysiology you learn as a MS2. If you haven't learned it yet, board review books will be pretty much useless to you.
-I'd recommend to "start" doing something the early spring of your second year. For me, this was as simple as getting a study plan together and making sure I had all the relevant materials on hand or ordered. I also 3-hole-punched my First Aid. That was a big accomplishment.
-Everyone studies differently. Everyone learns/reads/memorizes/poops at different speeds. Get a good sense of how you study and how fast you study compared to your peers so when you're creating a plan of attack you know how to tweak your schedule (which will most likely be based on someone else's schedule you run across) to fit you as a person.
-Medical students stress out wayyyyyyyyyyyyy too much about this test. I am as guilty of this as anyone else. Acknowledge you're stressed out, and wrangle your Type A personality down a bit. Stress is useless. And counterproductive.
-If you put in the work like everyone else, you'll pass. Step 1 is not an IQ test, and except for the exceptional few amongst the exceptional few, your success is largely dependent on the time you put in. I say this not to make you exclaim "OMG! THAT MEANS I HAVE TO STUDY FOR 6 MONTHS TO GET A 290 AND MATCH INTO DERMATOLOGIC RADIATION PLASTIC NEUROSURGERY!" but to make you realize that if you study as much as everyone else, you'll pass. If you are really shooting for a killer score, you're going to have to put in more work, but you are not stupid and you don't need 10 weeks to pass.
What I've Done/Am In The Process of Doing:
I've allotted 3 weeks to study for Step 1. Until then, I'm trying to muster up some R&R so my motivation tank is full going into that 3 week period. That being said, I am a medical student. I have a festering Type A personality. So I've assembled a few things to accomplish prior to that period to make me feel like I'm doing something and keep the stress level down. Note that the things I am doing now are not directly studying for the test per-se, but rather making sure I got concepts solidified, sources consolidated, and am becoming familiar with material so that I will have an easier time studying during that 3 week period.
-Read through Goljan's Rapid Review of Pathology while listening to his audio lecture (Do not ask me how to get them. Ask Frankie over there. Yeah, the guy sitting at the bar with the mean dragon tattoo on his arm) and annotating things into the book.
-Do the questions in the Robbin's Review of Pathology question book. For questions I miss, I make sure the key concept I was wrong on is in my First Aid. If it isn't, I write it in. 1 sentence max per concept.
-Read through BRS Physiology and do the questions in the book to make sure I gots my key physiology concepts dowwwwnnn. Extrapolate on concepts in First Aid that are vague.
-Review my biochemistry /immunology/cell biology/genetics. You know, all the nitty gritty stuff you're in all-too-much of a hurry to forget when you learn it.
-Skim through Clinical Microbiology Made Ridiculously Simple to jog my memory of some of the more useful mnemonics in it.
-In the couple weeks just before I really have to buck up, plan to start doing some questions on USMLEWorld/QBank to get myself more experience with the question format and system. No more than 48 questions at a time. Missed questions go into First Aid like above.
I started doing these things about 3 months before I take my Step 1 (~2 months before I really buckle down and study). But I must point out that I have done them in order to de-stress, not add stress. So I've been doing a couple, and only a couple, hours a week at maximum.
These are also what I am doing. I know people who have been doing QBank for months. Others have had their First Aid open next to them all year in class. Others have done flash cards for pharm and micro. And still others plan to do nothing until its time for them to really bite the bullet. All of these strategies have worked for others in the past. The key is finding a level of effort anywhere between 0 and 100 that you feel like is helping you.
My final schedule for the 3 weeks+ to come soon.
MedZag: Socially Isolated, Unloved Medical Student
So we recently had a series of sessions on "breaking bad news." The scenario we focused on was trying to tell a woman that she had leukemia - the crux of the series being that from the moment you break the bad news, Joanne goes from simply being "Joanne" to "Joannne: Leukemia Patient," until the point she becomes "Joanne: Leukemia Survivor" or "Joanne: Leukemia Victim." She will never be able to remove herself from that moment when the word "leukemia" comes out of your sorry mouth. It will forever come to define who she is and who she will be, and be a part of her from that moment on. Truly thought-provoking stuff. With all the reverence given to such a serious subject, I began to think of other correlary conversations that are equally life changing:
"Mom and dad, I'm gay."
Jenny goes from being "Jenny" to "Jenny: The Black Sheep"
"I'm sorry we didn't tell you sooner Betsy, but, you're adopted."
Betsy goes from being "Betsy" to "Betsy: Unloved Child"
"Joe, I love you." "WTF Brock?!?"
Joe goes from being "Joe" to "Joe: Object Of Man Crush"
"Suzie, I have something to tell you. Your mother, she is also your sister."
Suzie goes from being "Suzie" to "Suzie: At Risk Of A Plethora Of Consanguinous-Related Genetic Disorders"
I could offer some real and meaningful insights now about the difficulty and anxiety associated with difficult bad-news conversations, but for now I think I'll just ride the funny wave.
MedZag fails at the internets.
I've come to find that blogging (wow, its hurts me to type that) about medical school during the first two years eventually loses its momentum and eventually reaches this steady state. In the beginning, everything is cool and interesting "WOW! MED SCHOOL TESTS! WOW! ANATOMY! WOW! DONE WITH FIRST YEAR! Hahaha I'm a quarter of a doctor! If you have 4 of us stand together we make a whole doctor! Hahaha!" But really, the life of a medical student during the pre-clinical years is about as interesting as stale bread. After the excitement wears off, you realize that even though the subjects change, your life stays pretty much the same, and after a while you run out of things to say about it, because at its core its a perverse form of Groundhog day (minus anything nearly as humorous as a young Bill Murray). And frankly, that's definitely had an impact in my absence from posting these past 54 (wow) days. Neuroscience was a bear of a class, spring break was an opportunity to recover, and I finally decided since I have this "little" test called Step 1 coming up in 7 weeks that I should probably start doing some review for, so facetious things like blogging have unfortunately fallen by the wayside, especially when I don't feel like I have anything interesting to say. Do interesting things still happen? Probably. But you tend to notice them less because you have an exam coming up on Wednesday or you've had a swamped week and have been ignoring your significant other or the weather is nice outside and you just want to go catch some rays.
A couple of highlights of the past 2 months:
-I learned some stuff.
-I did my first pelvic exam, and successfully found the cervix on the first try. It's the little victories that get you through the day.
-The "Prostate exams performed" ticker has quietly climbed up to 1.
-I have amassed 1472.8 miles driving to and from my preceptorship this year, and have only 56 miles to go until I never return to that far away land.
Currently I am suffering from a bad case of what has affectionately been termed "2nd yearitis" (inflammation of the 2nd year?), otherwise known as a completely and utter apathy towards everything involving the pre-clinical years of medical school. We're currently slogging through our "Human Growth and Development" class which is roughly the equivalent of "Gynecology Gynecology and Gynecology," and 4 more exams, a book report (yes, a book report), and an OSCE separate me from being blissfully done with the monotony of the first two years of medical school. And frankly, I cannot wait for it to be over.
At the beginning of medical school, the clinical aspect of things can often be trepidating. And the lecture hall is a refuge of sorts, where you engage in an activity you've been doing for pretty much all of your life... that your long-term memory tells you anyways. Namely: class, note-taking, studying, ad nauseum. Regurgitate, rinse, and repeat. Sure the material is at an enormous volume, but studying is studying and its not really any different in med school, so its a comforting activity compared to trying to do a history and physical on another human being when you can barely tell a uvula from a vuvla. But along the way of the first two years, it's been my experience that something switches. You start to gain a certain level of competency in the clinical setting and start to find the intellectual engagement from patient problems instead of focusing on not f*cking up enough to let the patient and your superiors know what an idiot you are. And once that happens, its all over, because the lecture hall becomes a place where you're forced to sit, absorb, and later upchuck banal facts and minutiae that have often have no context or application to your actual fund of medical knowledge. And the clinical side becomes the place where the really interesting things happen.
It's in a way analogous to the "senioritis" of high school, when you feel like the trivial things that high school involves are behind you, and you can't wait to get to college and start the next stage of your life, but you're forced to gut out another few months or weeks of the same old crap just to graduate. Likewise, I've been slogging through the staging of prostatic cancer and whether a mature Graffian follicle has a single or multilaminar layer to its antral chamber. I could care less about this stuff, but am forced to go through it for the sake of crossing the finish line. Even though all the while my eyes are set on June, when I'm out of the classroom and into the real action. Sure, third year and beyond involves its own set of aggravations and monotonous activities, but they're different aggravations and monotonous activities.
And there's sure to be more interesting stories for a medical student blog than "woke up, went to class, ate lunch, studied, ran, studied some more, made dinner, watched True Life: My Life Is Boring, went to bed."
The Macula Densa and Hollywood Socialites
They say in medicine everyone has their favorite organ. I think that's true (mine's the heart). Even my preceptor, who as an oncologist deals every day with a multi-system approach in her practice, didn't even have to think about hers and rattled off the thymus right after I asked. The human body is a beautiful and awe inspiring thing, and everyone eventually finds some particular facet especially elegant and thought provoking. Personally, I love the heart for its power and its simplicity - the way it utilizes electrical and fluid dynamic principles to amazingly fine tune such a critical and demanding aspect of our daily functioning as circulation. The dramatic way disease manifests itself when things go wrong. The way, in a congenitally deformed heart, things can go from horribly awry to just fine within minutes by simply moving some pipes (vessels) around and taping (suturing) everything in place.
But I'd like to counter that point with another point. Everyone also finds an organ they hate.
Mine's the kidney.
Now I am a very fun loving and agreeable guy. I have a great sense of humor and make an easy friend. So I don't throw around the word "hate" very often. I have only used the word hate in a few sorts of circumstances in my life. I hate Paris Hilton. I hate steamed squash. I hate the Santa Clara Broncos men's basketball team (sorry guys). I hate people who try to merge onto I-5 at 35mph.
And I hate the kidney. I have since the very first day I attempted to learn about it, back in high school. I hated studying it for the MCAT. I hated questions about it on said MCAT. I hated it in anatomy. In histology. In biochemistry. In physiology.
Needless to say, we're studying the kidney right now, which puts my effective motivation to study at about... 0%. My dreams are haunted by podocytes, GFR, aquaporins, and that douchebag Henle.
Why do I hate the kidney, you ask? Well, like anything involving hate in this world, I don't really have a good reason. It's a completely irrational and unfounded hate. Maybe because it makes pee. Maybe because its involved in the renin/angiotensin system (does anyone actually enjoy learning about that?). I can appreciate how important the kidney is. I can appreciate what it does is impressive. But its not fun or exciting.
One day, I may have it in my heart to forgive the kidney. Make up with it. We can be friends. But not today. Today, and for the next two weeks, you will officially be number one of my hate list, Kidney. Lock your doors.
You know you're in med school when... (V)
Your notes sometimes look like this:
And other times look like this:
Scrambled Eggs.
I have come to realize medical school is like juggling a bunch of eggs.
In the beginning you start with a couple eggs. Like any beginning juggler, you kind of fumble around a bit. Maybe you break some eggs, but eventually you start to get the hang of it. Before you know it, you're juggling those couple of eggs and thinking "This is NIIIICCCEEE!!!"
But med school doesn't applaud your newfound juggling skillz. Med school gives you a snarky face and adds another egg. You get the hang of 4 eggs? Try 5. 5 becoming a breeze? Try 6. As you progress through your training, the eggs may change. The "biochem exam" egg becomes the "OB/Gyn shelf" egg. The "research for residency" egg may become a "giving a talk to colleagues at regional conference" egg. The "I just failed that test" egg becomes a "I just lost that patient" egg. But the more skilled you become, the more eggs there are, until you become a proficient and masterful physician/juggler. Then you retire.
Why juggling? Because it requires constant attention. Why eggs? Eggs are fragile. One of the all too familiar feelings as a medical student are those moments when your concentration lapses and you break an egg. Could be not getting enough sleep. Stress getting to you. Failing an exam. Getting out of shape. The analogy applies to many if not all walks of life. But man, med school sometimes sure feels like a lot of eggs sometime.
Of course, its not all doom and gloom. When you're on a roll juggling those eggs, then hell, it can be damn fun. Makes you kinda feel like this guy:
I guess that's why I haven't been posting as much lately. Second year threw a bunch of new eggs at me and I had to ditch one to make things more manageable. But things are back on the up and up and I'm back to cruisin' down the highway with the top down and the wind in my hair. So I'm adding another egg back in.
And hey, if I break one, I can always make scrambled eggs.
MedZag gets beatdown by Old Man Winter.
oh hai. Apologies for going on hiatus for two weeks. Haven't had much to post for the last while, but we've currently been slammed with a nice winter storm the past two days which has effectively put me on house arrest. For those of you who have no idea where I go to med school... that pinpoints my location down to pretty much 30 of the 50 states. For those of you who know where I go to med school... you know what I'm talking about. We actually got a snow day yesterday, which I never thought I'd see in med school.
You know, in med school we like to talk about all the things we gain in our training. Experience, knowledge, insight, competency, warm fuzzies, giant egos, all that shmooze. But I also have been reflecting lately on the things I've lost in med school. No, not my virginity, or my sense of humor (completely). But I have lost a great deal of patience (thankfully no patients yet). Not to toot my own flute, but I used to be a pretty darn patient person in my younger life. But one of the constants in medicine is the feeling that there is never enough hours in a day. And I've been deluged with that feeling every day for a while now. Between trying to keep up on studying, trying to maintain my sanity, trying to make it to meetings and talks I find interesting, and trying to maintain a semblance of a six pack, I find it amazing I have found time to even poop or sleep. Lately I've noticed myself become exasperated by activities, PBL sessions, and lectures which I feel like are a waste of time. I haven't developed overt road rage yet, but have formed a habit of yelling expletives at slow drivers (which breed like rabbits in this state) in front of me regularly when driving alone.
But it all came to a head this week. Now normally I have quite the active routine. I go to the gym, go study at different coffee shops, basically get away from my apartment, which is too close to campus and frankly claustrophobic.
Damn you freezing temperatures. I've been stuck at home for only 2 days now, and have already resorted to cleaning my apartment (!), organizing my DVDs, and even studying at home, a near impossibility for me normally. I am going insane.
Speaking of studying, we're currently mucking through endocrinology, which I have come to disdain nearly as much as the kidney. I do not state that lightly. But unlike the kidney, I actually somewhat enjoy the pathophysiology of the subject, I have just come to disdain the manner in which it is conveyed to us. For example, some of the bullshit lectures we have been fed in the past 3 weeks:
12/02 - Nutrition in Diabetes
12/05 - Nutrition Assesment
12/08 - Weight Loss
12/05 - Nutrition and Disease
12/06 - Women Nutrition
12/06 - Pediatric Nutrition
There are three main thoughts I have come to from our course direction. (1) Endocrinologists are glorified nutritionists. (2) Why am I spending $180,000 for this degree when I could get a bachelor's degree in nutrition for $60,000 (and its online!!!) (3) Why the **** are 20% of our endocrine lectures on nutrition?
Look, I know eating healthy is all puppy dogs and ice cream for your body. And the health care burden would be reduced substantially if people learned to eat better. But last I checked, med school was supposed to teach me what I needed to know to practice medicine. And there's only one thing you need to know about nutrition as a practicing physician. And that may or not begin with a "c" and end with an "-onsult nutritionist."
For comparison, we have spent 8% of our time on thyroid disorders. Ah, med school.
A long December.
Man, time flies when you're having fun. And by having fun I mean really busy. But with four days off for turkey day I got to fit a little bit of fun in for good measure. Ok a lot of fun.
But as they say, all good things must come to an end and so this week we jump headfirst into our endocrinology block. It still feels like September to me, so the fact that we are barreling headfirst towards 2009 is equal parts disconcerting and exciting. Cardiovascular, renal, pulmonary, gastroenterology, the march through the body and everything that goes wrong in is continues. But a brief break also allowed for a bit of that "reflection" crap that I hear about all the time in our Principles of Clinical Medicine class.
MS2 is has turned out to be quite a comfortable year. You establish your system of studying during your first year, after a certain degree of flailing, and I've found I've been able to stick to that system with only some minor tweaks through my second year. I'm a tactile learner so I like to write a lot of information down, which has proven to be a larger pain in the ass this year with the larger volume of info that gets thrown our way, but it hasn't been enough of an annoyance to force me to change things up yet. The next step will come after the new year when I have to teach myself how to do worthwhile board prep in conjunction to my classes, but I'm sure I'll figure it out. Or I won't, and I'll fail Step 1 and end up in family practice. Either way, I'm sure it will be interesting. I was one of those douchebags that was able to skate through the majority of my academic career without too much effort, and that included the MCAT, so I'm curious to see how this next major standardized test will go when for all intents and purposes your score is an almost direct reflection on the effort you make into preparing.
But so far, MS2 has been a comfortable year. If MS1 is a futon, MS2 is a nice padded fabric couch (and MS3 is sleeping on a wood board over a ravine). Medical school is as much about learning the language of medicine as it is the facts that you cram down your throat, and its definitely the year when things begin to come into a more complete picture. The days tend to blend together the more comfortable you become, but I don't necessarily think that's a bad thing. In fact it may be a sign that I'm continuing to enjoy myself in this masochistic path to a career that I've chosen. I don't know if there's much more to say about it. After a while, the first two years of medical school become a certain form of Groundhog Day. Wake up, go to lecture, fit in some fitness, study. Wake up, go to lecture, fit in some fitness, study. It's like watching the proverbial lawn grow on your brain. It may be nice to host a block party on in the end, but no one is going to make any movies about how it got there. So I feel there isn't much to say about the second year of med school in regards to the academic side of it all. It's just more of the same. More learning. More growth. Of grass. On your frontal lobe.
Oh, and since this is MedZag's blog... go Zags. 5-0, with 3 impressive victories over Okie State, Maryland, and Tennessee over the break. #5 in the nation. Good time to be a Gonzaga fan. I'll be in Seattle for the UConn game the day after my next exam doing my best PremedZag impression. Which may or may not involve copious amounts of a liquid that affects your... endocrine system.