Step 1 Study Period: My Approach

If you are not studying for step 1, I’d just skip this post altogether. This is for the Googlers out there who magically find their way to my blog. I don’t feel comfortable publicly posting my score, but I will tell you it was good by any specialty’s standard.

Before I started studying, USUHS had us do an NBME pretest that I beyond failed and had zero correlation to my score. Quite demoralizing to hear people say “oh you typically improve 10-30 points from your first NBME test” when that would range from “still failing” to “oh good I hit 200.” I think 228-230 is average for the exam, so I was originally shooting for above 230 (which is probably a typical goal). I don’t suggest doing a diagnostic test prior to studying because it will likely only freak you out. If you’ve been actively studying for step 1 prior to your dedicated study period, a diagnostic might be a good idea to see where you are at.

As an FYI, USUHS does Step 1 after a year of core hospital rotations. Although it makes us further from the basic science stuff (killer when it came to relearning microbiology and neuroscience in particular), it made the clinical vignettes much simpler to understand. Pharmacology, a sore subject in pre-clerkship, became pretty straightforward after working in the hospital. I personally found it to be an advantage.

For studying, I cut out ALL social engagements. They tend to stress me out when I need to focus, and I am a happy camper doing solo activities. I would typically wake up around 9am. Sometimes I worked out in the morning and had a late start to studying (as late as noonish). I went systematically through organ systems and covered an organ system a day. I would read a chapter in First Aid, do the corresponding questions in UWorld (tutor mode), and watch the Pathoma lecture while taking notes in my book. Most organ systems could be done in a day. Cardiology and Heme/Onc needed ~2-3 days and Neurology needed ~3-4 (for me). I personally bought a fresh copy of First Aid 2017. My First Aid 2014 had notes all over it that I found either too detailed for step 1 or too basic for the level of comprehension I had reached. I tagged pages that I wanted to make sure to review again. I did one full round of UWorld and completed a chunk of the questions I got incorrect (it’s easier seeing them a second time but super frustrating to get them wrong again!).

I cooked and cleaned pretty frequently. Andrew and I would have dinner when he’d come home from work, and we’d usually watch a TV show or movie before I would get some last bit of studying done before bed. I slept a TON… like 9-12 hours a night. I can function really well if I sleep a lot, though it was probably secondary to pathologic sleep deprivation I had throughout the previous year of rotations. My study period was 5 weeks long with really 4 weeks of truly focused study time. The first week I maintained some social semblance and realized it was impossible for me to be productive. I only had a few days in the first week where I did practice problems casually and perused First Aid a little.

I did the two UWorld assessments one and two weeks before my test day and thought they were really helpful (though I panicked because people kept telling me that I would likely do 10-15 points worse on my real exam based on the uworld scaling compared to NBME). I got the same score on both assessments and ended up with 13 points higher on my real step 1 score. I personally didn’t want to pay extra for the official NBME practice exams online, especially without getting answer keys, but I have heard from many that they found it useful to get comparative test scores. Keep in mind though, I tend to test well – I am pretty calm during exams. On test day itself, I took a minute break between sections just to close my eyes and breath. I forced myself to take 25 minutes for lunch. The exam day felt shorter than I anticipated because I thought it would last forever. The nice thing is most test locations let you start early.

My grand advice is:
– Make a study plan. I felt like 5 weeks was perfect timing to include my first week of figuring the system out.
– Figure out your resources (mine were UWorld, First Aid, and Pathoma). Don’t use too many.
– Don’t be too hard on yourself if you are behind schedule. It’s inevitable. Plan your schedule like you have one less week than you really do.
– Give yourself frequent breaks!
– Don’t let yourself burn out. Schedule entire days off!

Studying for Step 1 is uber stressful but it can also be really nice to make your own schedule for once, wear pajamas all day, and be your own boss. Enjoy the perks!

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The Life of an MS3: Good Times and Good Riddance

USUHS fourth-years are officially done with classes/hospital rotations and have graduated this past weekend. So concludes the third year of my medical school career. Cheers to that!

My existential crisis [see last post], though ongoing, has abated in intensity. I have accepted my fate as a physician despite the occasional fantasies of retiring to a small town by the water, becoming a fiction novelist, and traveling countryside in an RV with Andrew. I signed up as the newsletter writer in Alpha Omega Alpha (AOA), so I will consider that my attempt to bridge between the worlds of medicine and humanities. It’s the little things, my friends, that keep you going.

I have lots of updates for the past year, and I will try to keep them brief. Last post, I talked about how pediatrics restored my faith in my career in medicine. That was a wonderful rotation (shout-out to Walter Reed’s pediatrics department and their fantastic program!). The entirety of the rotation, I reevaluated my life and thought, “Man, I should be a pediatrician.” Then followed Family Medicine in Offutt Air Force Base. Yes, folks. That is in Omaha, Nebraska. I have finally ventured to the real Midwest. I was lucky to go during the summertime with a lovely classmate and had the best rotation of medical school – a much-needed escape from life’s obligations at home. I learned that I love primary care and appreciate the family medicine physician mentality. For the first time on rotations, I truly felt like I fit in.

As the five weeks in Omaha continued, I saw the perks of family medicine – especially in the military. The options are endless. I can do primary care in adults AND children. My experience in pediatrics helped facilitate more positive experiences with children. Fun fact: I had never picked up a baby prior to my pediatrics rotation at Walter Reed. Now I am a diaper-changing professional. Anywho, the physicians I worked with in Omaha were fantastic. I fell in love with the field. I felt at home. Considering I always intended to be a psychiatrist, I also became very confused.

Next up, my elective! I chose addiction/substance abuse at Fort Belvoir, VA working in both inpatient rehabilitation of active duty members and in outpatient psychiatry with a methadone clinic. What a great experience where I felt involved in understanding the epidemic of addition in our nation. I worked with fantastic psychiatrists that made me feel at home in their field, despite the fact I hadn’t even rotated in my core psychiatry clerkship yet. One resident made it his mission to reaffirm my decision to pursue psychiatry considering my recent interest in family medicine. During the rotation, I definitely felt like I wanted to be a psychiatrist again (ie positive experience).

The theme of wanting to do the field I was rotating in continued (which I hear is common for those interested in family medicine). I really enjoyed my internal medicine rotation, especially the inpatient experience where I had the opportunity to work with residents and attendings who were dedicated to my betterment as a student. So much knowledge to be had. I was nerding out. Internists are definitely the Ravenclaws of medicine [Side tangent: that would make Surgery the Slytherins, Family Medicine the Gryffindors, and Pediatricians the Hufflepuffs… I need to figure out how to fit in the other specialties].

My last rotation of 2016 was psychiatry. Naturally, I was doing exactly what I wanted to be doing for my life but at a medical student level. I felt challenged and never experienced the “psych-ation” hours some students enjoy on their core clerkship. I had hoped that it would help clarify psychiatry vs. family medicine for me, but it actually made me more confused. I love psychiatry, but maybe I also love family medicine. How can I do both? I have been looking into joint residencies – there used to be an Air Force option to do family medicine/psychiatry at Andrews AFB way back. There is currently an internal medicine/psychiatry residency (5 years as opposed to the 3 years in medicine and 4 years in psychiatry) offered to Army, Navy, and Public Health Service. Unfortunately, a double-boarded position is not currently in the needs of the Air Force right now, but I am trying to sell it [wish me luck, folks]. 

So that is how I concluded my 2016 year of core clerkships (typically done during third-year for other medical schools). I am still unsure about what I want to do for my specialty, and I approached my schedule so that both psychiatry and family medicine remain on the table. 

Over winter break, I got engaged (hollaaaa) to the love of my life while on vacation in Dominican Republic. It was a beautiful trip with us and a childhood friend of mine (the one who I credit with our relationship because Andrew was originally her friend from college). We met some great people while we were there and are developing an international friend pool, which is a good deal for future travels. 

Winter break went straight into Step 1 study time. We take it later than other medical schools to make up for the fact we start in the hospital 6 months earlier. Not much to say there because not much happened. My score was pretty awesome, and I think it is because I chose to CHILL OUT for once, minus the occasional panics about how I was behind schedule and felt like I was going to fail. In case there are pre-step 1ers reading this, I’ll lay out my study plan in another post.

After Step 1, it was back to the classroom after over a year. We had 6 weeks of trainings and additional education on certain clinical topics. We got certified in BLS (basic life support), ACLS (advanced cardiac life support), and ATLS (advanced trauma life support), when only BLS is required for medical students. We had a fun military event called Gunpowder that’s a prelude to Bushmaster in September where we do military medicine scenarios like making a rope bridge to get a patient across the river, running codes, and climbing walls (or in my case, having someone help push you over a wall). My team consisted of a group of classmates I had never spoken with before, and we worked great together – made it in third place among 16 teams!

Despite the training, I felt rusty on my hospital skills and was anxious to go back. Day 1 back in the hospital was on my birthday at Madigan Army Medical Center at Fort Lewis-McChord in Washington state. Neurology was a great transition rotation because we acted as the inpatient consultation service, so I felt like I was relearning all of medicine despite our focus on neurology. I also felt like so many things were finally clicking from basic science neuroscience to clinical practice. Neurologists are definitely friendly, love what they do, and have a good lifestyle. The brain is cool, friends. I don’t understand how neurology isn’t a more competitive field!

Washington was good to me. The lodging was comfortable. My residents were awesome. My USUHS classmates were fantastic, and I met some friendly HPSPers. A couple USU folks and I traveled on weekends – to Seattle, Portland, Crystal Mountain, and Tacoma. What a beautiful state! Despite all the rain, the sun managed to shine bright on weekends.

Although I had a great time on neurology, it was nice to come home, reunite with friends and family, and NOT have homework anymore. FYI to non-USUHS folks, neurology entails 10 papers, 1 take-home quiz, and a final exam. Fun stuff.

I am currently on ophthalmology where the surgeons are happy, and I am trying to get used to a new routine. I became re-engaged in group organizations after being welcomed into Alphi Omega Alpha and the Gold Humanism Honor Societies. I am working on a curriculum project with school and have two research projects going at the same time. I am also trying to get in shape for the wedding. So it has been pretty busy since I’ve come back home. Andrew and I had an epic engagement party with local friends/family this past weekend where his family was exposed to the beautiful wonders of Persian dining. With those wonderful memories and my social quota reached, it’s time to get busy. I have a book chapter due on June 1 and my step 2 CK on June 7. Cannot say I have been studying too much for this one…so I’ll let you know what my study plan is after I figure it out myself!

Surprised you’re still reading. It’s been quite the year, so I appreciate your time as I share my experiences 🙂