sanguinemare

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.

Advice

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. 🙂

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