May 25, 2013

Hypochondriasis? Or heart/lung problem…

Hah – one thing that studying for med school/Step 1 really does is turn us all into hypochondriacs (people who worry about/think they have a disease despite medical assurance that they don’t).  Well, I was feeling my heart yesterday and noticed that I definitely felt some heartbeats/flutters in the left sternal border (slightly left of midline in between the ribs).  Normally, you’re only supposed to feel a heartbeat at the point of maximal impulse on the left side of your chest, not near the midline.  In addition, I had been having some chest pains (for years mind you), and a semi-recent bout of a weird feeling of coldness in my lungs for a while, and recently also noticed that I either have an S3 heart sound or a very clear splitting of the second heart sound that is not affected by inspiration.

So of course I talked with my med school friend about it, and after looking up a bunch of stuff, we determined the heartbeat I felt was probably a right ventricular heave, which can have all kinds of bad stuff be the cause, or (hopefully) just subconscious high anxiety that manifests physiologically.  The other thing it could be however, given my other symptoms, and also the fact that I’ve always had some sort of exercise intolerance, is idiopathic pulmonary arterial hypertension (iPAH), which is not very good.  :\  Also most other things that cause a RV heave are also not very great… so I may end up getting that chest X-ray after all… bah.

It was also kind of funny because yesterday, my friend was saying, well, this iPAH this is pretty rare in real life – like 1/1 million.  But if you see this on a test with those symptoms, you should probably pick that.  So today, as I’m going over old test blocks (since my UWorld subscription for the test I took 2 Sundays ago expires tomorrow morning), what happens to be the first question (that I got wrong at the time)?  A question about iPAH.  Haha, oh life.  You’re funny.

May 21, 2013

The decision (and advice for future Step-1 takers)

Filed under: "Me" updates,Med School and the MSTP,Step 1 — sanguinemare @ 2:42 pm
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The Decision

Well, it has finally happened.  I have decided to delay Step 1.  $100 in schedule change fees and plane ticket changes later, as well as giving up on my family medicine rotation and multiple long e-mails and conversations with faculty and a few med school friends, the decision is now final. (Skip to the Advice section if you just want to know my advice on Step 1 studying, and how I would do it again if I could redo it after going through all this)

The decision was not an easy one to make.  There were a lot of things I was concerned about. One major thing was my family medicine rotation, which I either had to do in June or would not be able to do it until I returned to medical school in my 7th-8th year, because of the way the MSTP pays for our tuition.  What that means is that 1) I would not be able to get the experience of medical practice before starting my grad school years.  From what I’ve heard from upperclassmen and staff, this opportunity (which our school only instituted a few years ago) is very helpful in both understanding how to put our basic science knowledge to practice, especially coming off of Step 1, as well as helps ease the transition later 4 years from now.

It also means that 2) I will have one less elective/Acting Internship (AI) to explore in my clinical years, since we are required to do family medicine (in order to apply to states like CA for residency, a family medicine rotation is required).  Why is that a bad thing?  Well, I tend to be one of those people who can’t make up their minds about what they really want to do in life, so having more options to explore is always a good thing.  I worry that I will end up being one of those people who finish 3rd year clerkships but was not able to rule enough things out, and still has no idea what they want to do, thus making the electives all the more important.  What I should also add to this is that apparently as MSTP’s, at least at our school, we don’t get the full 2 years that other MD students do to do clerkships and AI’s.  We only get 1.5 years.  Hence even more why “losing” one elective slot is kind of a bummer.

So what ultimately decided me?  Well, yesterday I took a full-length Kaplan practice test (all 7 hours of it) and my brain was fried.  And while I was going through it, almost every single question was a guess.  For those who don’t know, Step 1 is 7 sections long, 46 questions for 1 hour each.  Each question is usually a small paragraph in length that gives you a clinical scenario, and you have to figure out not just what the problem is, but some additional fact about it.  They call it a “2-step” question – basically after you figure the first thing out (like what the problem is), the actual question asks something associated with the disease, like what other problems that disease could present (show up) with, or what genetic markers puts people at risk for the disease, or what you treat the disease with, or what would not be used to treat it.  Stuff like that.  So it’s  pretty much a long day of your brain trying to run a marathon.

Anyway, so I took that test and… got pretty much the same score as I did last week.  Slightly disheartening of course, but I didn’t work nearly as hard as I should have so it was only to be expected.  Plus, last week I only took the 4 hour long one… this 7 hour long one was pretty brutal.  And I hear Kaplan’s harder than UWorld, so it makes me feel at little better.  The question styles are certainly much different, and have a much different focus.  After talking with some of my CA med school friends, I think I’ve decided not to extend my Kaplan date (it expires next week) as it sounds like UWorld is pretty representative of the actual test.

So I talked with my two friends about the test and their advice (they are 3rd and 4th years now), and after discussing it with them, I feel much better about my decision to delay the test.  Step 1 IS important after all, and it sounds like especially so in CA (which is where I would eventually like to end up), so ultimately, I have come to the conclusion that my test score is more important than having the experience of being able to do family medicine prior to my graduate school studies.


All that being said, I do not necessarily suggest medical students to go this route (and in fact it does throw off a lot of scheduling and such, so should be avoided if possible).  If I were to do this again, this is what I would suggest.  Plan ahead and work hard.  Get a head start if you feel like it.  I don’t know if I would recommend starting over winter break because most people seem to feel that it’s too far out to help much, but if you’re someone who needs multiple passes through material to get it, then go ahead and start then.  In general though, I would say start looking through material maybe 2 months ahead of time (for outside resources besides First Aid.  For example, Pathoma is excellent to go through early in your studies, and BRS phys was great as well.  And you may as well listen to Goljan if your spare time if you want to just solidify stuff.  Micro made ridic simple was also good).  During this time, if you want, you can buy Kaplan’s Qbank or Robbin’s Path Review to drill questions on what you’re learning to make sure you’re getting the right stuff out of your studies. Then, 1 month prior, read through First Aid, which will maybe take a week or so, and start drilling question blocks.  Take a UWorld practice test maybe after reading through First Aid the first time, then again maybe 2 weeks out. I have been told conflicting things about the NBME practice tests, and I personally have/am not planning to try them, so not sure about their usefulness.  But most seem to feel UWorld is pretty solid.

That’s just what I would do.  I’ll try to post at the end of my Step 1 journey about different ways I’ve heard of people studying (and roughly how well they did using that strategy).

In terms of whether or not to delay a test if you’re at a point in your studies where you feel completely lost and disheartened, I would say this.  How far away from the test are you?  How confident do you feel about your performance?  Of course, as far as I know, no one ever feels completely prepared going into this test, or even close.  But how familiar are you with the style of questions and being able to at least somewhat figure out what’s going on?  If you are hitting 60-70% on UWorld and have done at least 75% or more of it, I would say don’t delay and just go for it.  If however, you’re like me and barely hitting 50%’s and most of those are luck, and you’re also only 1 week away, I would say it’s probably a good idea to at least consider delaying (unless you are either one of those people who know for sure for sure what they want to do in your career and the field doesn’t require a high Step 1 score, or you don’t care at all what location and/or specialty you go into).

If you do decide to delay, (and every individual med school has their own policies on this), I would just like to say not to feel really bad about it, like you are somehow a failure by doing so.  I know quite a few people who have delayed their test this year, so don’t be afraid to do so if it’s necessary.  I spent a long time wrestling with the embarrassment and feeling like if I delayed my test, it would mean I was somehow cheating because hey, most of the other students can take it on time and plan their days out so it works, why can’t I?  And to a large extent I still do feel that way.  But after talking with my friends, I have recognized that well, this is perhaps one of the most important tests that we will be taking in our career, and like my friend said yesterday, confidence can significantly affect test day performance.  So if you don’t have the confidence, whatever the reason, it might be something to consider. (Caveat: if you’re one of those people who’ve already done UWorld 2-3 times and/or Kaplan Q-bank and many practice tests and still don’t feel ready though… just take the darn thing already!  😛  You’re already as prepared as you’re ever going to be.)

For me personally, with so much of the Qbank not yet done and my abysmal practice test grades, even if I had known more of the material, I probably still would have done poorly simply due to lack of confidence, if this practice test was any indication.  As I kept marking almost every single question as a guess, I could feel myself almost giving up halfway.  Probably, if I had done all the Qbank questions at least once and was just hitting say even 15 points lower than my target score, I would have gone ahead and taken it.  But at this point, I think this is the right decision for me. 🙂

May 12, 2013

Countdown to Step 1 – 16 days left…?

Filed under: Med School and the MSTP,Step 1 — sanguinemare @ 9:13 pm

So…… just took my first practice test on UWorld – self assessment #1.  It’s only 4 blocks, whereas the real test is 7 blocks, but it gave me a big indication that I was in trouble, since my mind started losing focus the 2nd block already, then almost completely wandered in the 3rd block (and I was hungry), so that I would have to read questions like 3 times to figure out what I was reading.  People weren’t kidding when they said this test was like training for a marathon!  Need to do more pumping iron for my brain.

Sooo yeah… pretty bad results.  At 2 weeks out, I’m only scoring about a 201 on UWorld… that’s about 50% right, but I actually had probably only 10 questions (out of 46) per block that were not marked with a flag, indicating that I was unsure of the answer.  Pretty scary stuff.  Looking at my score report that has bars showing how consistent we were in answers and areas we need to work on, the bars are HUGE (indicating very poor consistency) and if there were any that were consistent, they were consistently low/below average.

So… am seriously considering delaying my test (a big no no in my book usually, and something kind of frowned upon at our school unless you really need it/are failing).  Ah, I feel like med school has made me into someone I don’t like being – starting to argue with grades, asking for exceptions, asking for extensions… I never did that before until this year.  So embarrassing.  Unfortunately, without delaying this test, I am almost positive that I won’t score above around 215 or so, assuming I get myself consistent in scores before then.  There’s just too much I haven’t done.  Sigh. I wonder if everyone feels this way 2 weeks before their test.  Probably not. Most of my friends had already done UWorld at least 1x and finished FA at least 1-2x by now.  Bleh

I e-mailed our program director earlier and she helped me feel a little better by letting me know other people in our program have scored low 200’s and still got into their residency of choice.  Of course, not knowing what residencies they wanted to be in and all the factors, that’s not saying much, but at least maybe I can do ok even with a lower score.  … hopefully.  Also e-mailed the school of medicine to see what their experiences were and if I can actually realistically hope to improve my score well enough in 2 weeks.

Sorry for all the downer posts lately – I’ll try to be a little more positive next time.

Status: bummed at waiting for advice from the administrators.  Also, happy Mother’s Day!

Countdown to Step 1 – 17 days left

Filed under: Med School and the MSTP,Step 1 — sanguinemare @ 12:27 am
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FINALLY!  Just finished with all of Pathoma whoot whoot!  Yeah, I got a little off schedule (no surprise at this point haha) so only just finished with Pathoma and haven’t reviewed the rest of FA yet.  Mainly there was a lot of stuff that happened yesterday that derailed me, and I’m barely recovering from it.

Basically, I got pretty distracted all morning after finding out I did terribly on the final paper/project for one of my graduate school classes this semester, and we were told to contact the professor if we had any questions before she posted the final grades today.  Since that final paper (which I worked pretty long hours on at the expense of Step 1 studying) was basically most of the class grade, and I felt the feedback docked me very heavily in multiple areas for the same issue which I felt was not applicable to my paper, I, for the first time in my life, “argued” with a teacher about a grade.   It was pretty stressful… I have never received such a low grade in my life for a paper, especially not one I actually spent hours/days trying to write.  After multiple e-mail exchanges in the morning that were less than assuring, we finally arranged for a time to do an online video chat in the afternoon since I am out of town for Step 1 studying.  Thankfully, once she was able to communicate her perspective, she was very understanding, and eventually accepted my explanations.  I get the feeling she had had high expectations for me, so when it wasn’t done as she’d expected, I perhaps got marked off a bit more heavily than I would have otherwise. She may have also thought I didn’t put in as much effort as I should have.  However, after I explained my reasoning behind why I wrote it the way I did, she understood that I did try hard on the paper and was willing to accept my explanations and change the grade.  Praise the Lord! (I checked it today and she even changed it higher than I’d hoped!  Thank you!)

So that was pretty emotional, and then there was someone who got very upset at an article I had posted up on another social media site (for very different reasons than why I posted it… in fact I am still unsure why that person read so much into certain specifics when it was mostly an opinion article on a different subject… oh well).  Anyway, after trying to write responses for that back and forth for the afternoon, I was quite out of sorts and had pretty much lost all motivation to study.  So studying-wise, yesterday I think I did a neuro block in the morning but only went through about 1/4 of the answers, and tried to get finished on Pathoma for Repro but didn’t even finish the first chapter.

Clearly, the moral of the story is, when you are studying for Step 1, don’t go on e-mail or facebook or blogs or news, etc… anything that can distract you is a BAD IDEA.  Because it can quickly wipe out a day before you know it.  Hah.

Today was better – I finished the rest of that Female Repro chapter in Pathoma, as well as all the rest of Repro and Endo, which ended the rest of Pathoma.  You don’t know how proud/happy I was to finally close that tab on my windows haha.  Dr. Sattar’s seriously a great resource though – I’ve definitely done question blocks where things he said were “high yield” or that he taught conceptually showed up in the exact same way he said it would.  So props to you, Dr. Sattar!

Tomorrow I hope to do a practice test still as planned… obviously with me not having gone through all of FA, I will be missing significant parts of the test, but I think it’ll be good to get some idea of where I am now that it’s about 2 weeks out and I need to start ramping things up.  Will try to speed-read some FA tonight until I get too tired, and will update tomorrow about how the practice test goes.


May 9, 2013

Step 1 Countdown – 19 days left

Filed under: Med School and the MSTP,Step 1 — sanguinemare @ 7:42 pm
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Did Pathoma for Neuro this morning, working my way through FA of Neuro and Psych and will do a question set for neuro tonight.  Here are the short-term goals I’ve come up with today… hopefully I’ll be able to keep to it, and I’ll be able to just barely make it in time. T__T  Wish me luck!

Goal tomorrow: Finish Pathoma (4.03 hrs worth of material x 1.5 (the extra time I’ll need to write down notes/repeat parts of it, if I’m lucky) = 6.05 hrs. Ugh!) That includes both Repro and Endo, with most of that being female repro/breast pathology phew.  Then if I still have strength after that, will try to finish all of repro and endo in BRS phys and FA, and if time permits, do 1 question block tomorrow.

Goal Saturday: will go over answers for all the test blocks that I haven’t finished going through answers for yet, try to finish any remaining stuff in FA, and start random question blocks. Hopefully get 2 in, but we’ll see.

Goal Sunday: Practice Test starting at 7:30am (my actual test time).  And going through answers.

Calculating including today and minus 2 days for practice tests, I have to do an average of 115 questions a day to finish the Qbank before test day. T___T  That’s almost 3 question blocks per day (which my friend had said was probably the max I’d be able to do)!  And of course I won’t be starting randoms until Saturday, so I’ll be needing to make up even more.  Oh I am so screwed… prayers for focus and getting through this over the next 19 days would be extremely appreciated!  Heh. T__T

By the way, if anyone has any questions about the resources I’ve used so far and things like how well the info correlates to what I’m seeing on Q-banks, or the usefulness of each resource, feel free to ask!

[edit: hah! I learned a new word today: blepharospasm (sustained eyelid twitch).  I’d love to be able to say that in context someday.]

Step 1 Countdown – 20 days left

Filed under: Med School and the MSTP,Step 1 — sanguinemare @ 1:26 am
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Finished Skin on Pathoma and did a MSK + skin problem set.  Barely went through the answers, but not all of them in detail.  Will probably need to do more tomorrow.  Exhausted.  I think I’m burning out.  No good.  And I still don’t think I’ve gotten more than 8 hrs of actual studying in a day yet.

May 8, 2013

Step 1 Countdown – 1 month away

Filed under: Med School and the MSTP,Step 1 — sanguinemare @ 12:34 am
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Sigh, didn’t get nearly as much done these last two days as I’d hoped, with some personal issues that came up yesterday and distractions looking up news and following up on stories people had to suffer through today blah.  But I said I’d update so here ya go:

Yesterday: Finished going through answers on the hepatobiliary question set and read some renal physio.

Today: Finished reading renal physio and renal FA in the morning and did a problem set on Renal (67% whoo, if I can keep that percentage on random blocks, I’ll be good to go! They say 70% is a good score on the real test).  Went quickly through the answers just checking why I missed what I did instead of going through all the answer choices like I did before – saving that for tomorrow to review Renal somewhat.  Did some Pathoma on Musculoskeletal before I got distracted by news stories found on facebook during one of my breaks and there went the rest of the day researching on old/similar stories.  I think I’m going to at least finish MSK on Pathoma before I go to sleep tonight.  1 more section to do.  Wish me luck!

May 6, 2013

Studying for Step 1

Getting into the full swing of studying – I’m at T-3 weeks + 1 day right now, and need to really ramp up the studying.  I think after today, I’m going to try to update daily with a brief entry on what I’ve done every day so there will be a record somewhere in case anyone wants to know the step-by-step process of studying for this humongo test that basically determines your medical career (or what you can apply for with reasonable hopes of matching into at any rate haha).  Before I start my records, here are the things I have bought/otherwise acquired for Step 1 for your reference:


Pathoma (book and lectures), USMLEWorld Q-bank,  South Biochem, Clinical Microbiology Made Ridiculously Simple, BRS Physiology (5th edition, Linda Costanzo), Robbins and Cotran Review of Pathology, First Aid 2013, Netter’s Atlas of Human Anatomy, Kaplan’s Q-bank, Goljan audio, NBME exams, Kaplan Q-book.

I first bought Pathoma during the school year since we got a good deal on it as students.  Same with a USMLEWorld Q-bank that I didn’t touch until last week.

In April, I bought: Clinical Microbiology Made Ridiculously Simple, BRS Phys and studied from those, borrowing a Kaplan Q-book and Robbins and Cotran Review of Pathology from a friend to do micro questions.  Was thinking about buying Lange/other pharmacology flashcards, but decided not to after reading reviews.
Later, I of course bought First Aid 2013 (new and improved from the 2012 version and much less errata), and also Netter’s Atlas of Human Anatomy (for reference) and my own copy of Robbin’s Path (see above).  I also bought Kaplan’s Q-bank last-minute last week just in case, but I’m not sure whether I’ll have time to do it yet.

Other resources include: Goljan audio (a classmate at school also downloaded short-audio versions, which is great to put on an mp3-player/ipod), South Biochem (audio and handouts) and NBME practice exams.  Hopefully no one sues me for putting this up or takes away resources because of this post T__T.


So here’s what the rough timeline of what I’ve done so far (with first a word on how studying was with grad school on top of it…so skip the first long paragraph if you don’t want to read about that):

Medical school ended around March 22, which was about 9 weeks ago or so.  Most of my MD classmates start clinical clerkships this week, so they all had to finish before May 2.  However, us MSTP’s have an extra month because we still had grad school throughout April.  From what I’ve heard from upperclassmen/current MSTP classmates is that people in the grad school “themes” all finished 2 weeks ago, and that they either have tests or had a presentation or two on journal articles related to their classes.  Each class is also usually only about a month long.  I, on the other hand, actually had it pretty tough this time since I’ve decided to do a Nutritional Science PhD, which is off the beaten track, so I have to pioneer the way so to speak.  I only had 2 classes this semester, but both were whole-semester long classes that only ended last week, with writing assignments every week (this is all on top of taking all the regular med school classes mind you), and one of them was a grant writing class that also had a couple quizzes and required a grant proposal written throughout.  The final grant proposal was due last Monday, which was the same day my final review paper was due for my other class (along with other projects)  Basically, April for me was spent working on grad school – Class 1: writing/editing the grant proposal and peer-reviewing other people’s grant proposals for hours, and preparing a powerpoint scientific presentation on a paper (which takes hours for me, even for a 15 minute presentation), then Class 2: Researching/preparing for a mock, taped interview session (on acupuncture), researching and presenting another powerpoint scientific review on green tea, then preparing for a consumer presentation on the topic with a handout that also took hours T__T, and finally, writing a review paper (on different studies!) on green tea.  I should say that the grant proposal was on the Paleo diet.  So no overlap between classes unfortunately, which many of the other students were lucky enough to be able to do.  (My topic for the Paleo diet was already chosen by someone else so I was told to choose something else for the other class).  I think the mindset of studying for tests and med school is drastically different than the mindset of a writer/presenter.  I never really realized that so clearly even in undergrad with my double major in the humanities and the sciences.  But here, while trying to flip the way I organize my thoughts so much in such a short space of time, I have recognized that they really are like two sides of the brain.  Needless to say, studying was very difficult in that context.

So, not much studying was done during April, and I am currently left with basically the same amount of time as a regular med student (or maybe less since I didn’t study for Step 1 at all during med school except for chapters 4-5 of Pathoma during Heme-onc, which I re-did anyway for Step 1).  There are two major things that I did accomplish in April though, and that is to go through all of South’s biochem review (audio along with the handouts) and read through all of Clinical Micro MRS (minus the last 2 chapters on antibiotics in the future and a recap of diseases for bioterrorism, both of which I just skimmed), and did a few micro questions in the Kaplan Q-book and Robbins Path.  I may have also gotten in a few chapters of Pathoma and BRS phys in.  Hah, so I did do a little more than I thought, phew.

Since last week, which was my first week of full day studying (which I was not nearly as productive at as I should have been…), I did Pathoma, BRS Phys, and First Aid (FA) for pulmonary and 1 question block on UWorld for it.   Man, going through answers for the test block took literally 4 hours, I kid you not (and I thought my friend who just took it was exaggerating when she said that… she was spot on.)  I also did manage to go through the same 3 resources for GI and finish a question block, but that was all for the week (including yesterday).  I suppose I did lose a couple days because of clinical orientation on Thursday and I flew home Saturday (listening to Goljan and annotating FA on the way as best as I could with a passenger that kept trying to talk to me on the 4-hr leg of the flight >.<), but still, it’s been hard to focus.

So yes, need to really ramp it up.  Did Renal on Pathoma yesterday, and a question block for hepatobiliary on UWorld that I am currently going through right now before I decided to type this up hehe.  I am way behind my schedule (I thought I’d be done w/ MSK and onto neuro by now HAH as if) so my goal today is just to catch up as fast as I can – hopefully after going over questions, I can finish Renal on FA and BRS phys and do a question block… won’t be too expectant that I can do much more than that.

Oh a comment on studying schedule – I’ve only been doing like <8 hrs previously, but starting yesterday I’m doing around at least 10 hrs, waking up at ~6:30am (thank goodness for jet lag in my favor here) and working until 10pm, with breaks for meals.  I have heard that an avg of 12-14 hrs a day is normal at this point (and really should have been true starting at least 4 weeks out from the test).

Ok, I think I’ve spent enough time here… I hope it was somewhat helpful on understanding the life of a med student while studying for boards and what the timeline should be like for your own studying if you decide to go to med school.  I would eventually like to also post some of the crazy/weird mnemonics/ways of remembers stuff I’ve come up with on a separate post to keep track of all of them, but we’ll see if I have time haha.


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