Tachy Med Student: Step 1 Scores Released

As I mentioned yesterday, my USMLE Step 1 scores were released. I'm just going to talk through my experience and thoughts on this in a Q&A format:

For more official USMLE Q&A, check out these questions from their website. 

1. What's the USMLE Step 1?
It's the first (and arguably the most difficult) part of the three-step licensing exam to become a doctor. It stands for United States Medical Licensing Examination. It's taken after the first two (of four) years of medical school and it's currently seven blocks of 46 questions taken over 8 hours all in one day.

2. Why is it important?
At most medical schools, you can't continue in third and fourth year clinical rotations until you pass it. It's also a crucial part of your applicant profile when you interview for residency - the part of training after medical school that can last anywhere from 3-7 years, depending on specialty. A poor score will decrease your chances of matching into competitive programs, or sometimes any program at all. It may be more important than any other test, but a mediocre score with room for improvement on Step 2 isn't going to ruin your life.

3. How is the exam scored? 
It's scaled based on other students, but the actual process is intentionally rather veiled. The highest possible score is theoretically 300, though there are rumors that it isn't really so set in stone. Perhaps given that the test is 322 questions, it's actually 322? There's also a 2-digit score - you can read more about that on the website linked at the top.

The point is, it's kind of a mystery, but it's apparently all very technical and statistical.

4. What's a passing score? Average?
A passing score is 188. Average on my and recent administrations of the test was reportedly 222 with a standard deviation of 24. In general, most people fall between 140-260.

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5. When did you get your scores?
My scores were released some time between 8 am and 10:30 am on the reported score release day, July 13 2011. I'm not sure of the exact time because I was trapped in an operating room with no internet. I know it was in this window because I received my e-mail that my scores were available at 10:30 am. I actually successfully checked them around 5 pm.

6. Did you do anything special to "set the tone" to see your scores?
I settled into my desk and made sure I was by myself in case I ended up having an embarrassing reaction. (This was pretty negotiable though - I originally tried to look them up at lunch with my friends but couldn't get them to load.)

I set some happy music, an old mix from John, to play on my laptop.

In order to see it, I had to download a PDF, so those few moments it took to save it, open it and wait for it to load were some of the longest of my life.

6. How did you do?
I'm going to be intentionally vague about this, because I hate to deal in numbers with people. I don't want anyone to know my score, and I don't want to know anyone else's. It's impossible to avoid even subconscious comparisons, and a number like that will never tell the whole story of what kind of doctors we'll be.

Suffice it to say I passed. I'll say that I am within one standard deviation of average.

7. How do you feel about how you did?
Very mixed feelings.

My first reaction was a wave of relief. I'm ECSTATIC that I passed and don't have to take it ever again.

At the same time, I'm not happy with my score, but who knows what score would've made me really happy. I mean, obviously a 250 would have, but I was never that kind of student.

I do think my score reflects the kind of studying I did and the way classes went for me. I worked very hard, but I also struggled sometimes. I also had a lot of fun in the past two years that I wouldn't want to give back. I haven't lived a lifestyle of studying that led me to think an outrageously high score was in my future.

I'm thrilled about the amount of improvement from my practice tests.

I can't really sum it up in one sentence yet. Maybe in a few days.

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The point is, I get to continue.

I will be a doctor. In just 2 years myself and my wonderful classmates get an M.D. after our names. I swear I'm not old enough for this.

And no matter what happens next, I promised myself I would go back to this post: When the Scores Say You're Not Enough.

It's strange to read it again knowing that it's all worked out. I feel really blessed for that.

If you have any Step 1 questions (or questions about tests in general, or anything) feel free to ask. 

Tachy Med Student: Step 1 Scores Tomorrow.

Some rumors say USMLE Step 1 scores will be available tonight at midnight Eastern Time. Does that mean 9 pm Pacific (AKA in an hour and 30 minutes?) 

Other rumors say 6 am tomorrow. 

Either way I'll be able to confirm or deny these shortly. 

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I also heard that sometimes people have panic attacks and their airways close up and they swell and get hives and have to go to the emergency room when they see their scores.

Or sometimes they just disappear and then show up in their hometown 25 years later disheveled and rambling, having been living in the jungle.

And also sometimes the Boards monsters crawl through the screen and punch you in the kidney. 

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If we pretend these are real rumors, whatever craziness I throw down seems tame in comparison. 

I've been keeping busy and trying not to think about it, but you see my face up there - that's the face my soul is making. 

And to all of you in my position, good luck!

USMLE Step 1-pocalypse.

Or: The day medical Boards took 10 years off my life. 

I had a bad dream about this once. That the power shut down in the middle of my big exam.

YES. IT HAPPENED. FOR REAL. 

I was 12 questions (twelve! of 322!) away from being completely done, that's 7.5 hours in, and the power went out. The room just went dark. We all looked around. Someone swore. I won't say it wasn't me. I mean, what do you do? We came out and just waited hoping it would come back on and we'd figure out what to do. The proctors were scrambling, but not really talking to us about what would happen. 

Questions were asked like, 

"What if we have to take it over again?" 

"What if our scores don't count?" 

"What am I going to do? I have to leave town tomorrow." 

"Does this mean we have to delay our third year?"

And statements made like,

"I'm not doing this again."

"I'll sue." 

"I'll drop out of med school."

"I haven't seen my son in days. I cannot study anymore."

And from me, "I think I'm going to be sick."

When it came back everything was saved and we were able to finish from where we started, but I'm running so high on norepinephrine and other various panic signals right now - I'm beyond drained. 

We're reasonably certain our scores will still count, though I think it does register with the National Board of Medical Examiners (NBME) as an "aberration." I feel sick thinking about the possibility of not really being done, but it should work out. Our administration and the NBME have both been notified, and I'm sure they'll work it out the best they can. 

Suffice it to say I'm a major stress case right now. 

Add to the technical problems, I also felt just not that good about it. 

It's a hard test. It's supposed to be, and I made some smart guesses I'm sure, but it felt hard. Very. 

So yes. I ate well at least. Unfortunately with all the nervousness this breakfast didn't exactly stay with me, if you know what I mean. 

Banana Almond Butter Oats

Here's what I had for snack-meals on breaks. It's definitely a good idea to eat a little bit more often as opposed to a big meal during a full-day test. And it was 2 of those thermoses of coffee. Got to titrate that caffeine and keep it at a steady level. 

English muffin PBJ, 2 apples, 2 carrots, Odwalla protein bar, Coke Vanilla Zero. 

And now, although I don't exactly feel relieved, I'm going to take a little time to let it all go, be with some friends, and celebrate the end of this saga. 

No matter what, I'm on vacation for the next 2 weeks. Pretty soon I'll start to enjoy that fact. 

The Day Before the USMLE Step 1

Or: How I spent the day before Boards.

Edit: If Googling "The Day Before the USMLE Step 1" brought you here, welcome. Maybe you're wondering what other people do the day before Boards. Or maybe wondering what you should do the day before Boards. I studied a bit - but lots of people don't. I think I got a couple questions from my day-before review, and it was calming to just review things I already knew. Definitely NOT a time to learn something you've never understood. I sincerely recommend avoiding anything that isn't already familiar - you want to cultivate some confidence for your test day.


To see how it turned out (plus what I ate to keep my brain fueled) see here. 


And thoughts about scores once I got them are here.


And GOOD LUCK!

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Yes, tomorrow is "P-D-E-M-M-D-T-A Day." 
(That's "Please Don't Ever Make Me Do This Again Day.")

I started medical school 2 years ago. I've studied hard. I've studied really hard. I've passed all my classes. I've dealt with a lot of self-doubt and not a couple failures.

However, I'm still here and although these have been the most depressing 6 weeks of my life, between finals and the constant studying, I made it to this, test day, and I will go on afterwards no matter what.

So tomorrow we'll see if I learned anything.

8 hours. 322 questions.

I studied for a good chunk of the day, and around 6 I quit because I found lots of topics I didn't feel I knew well, and I started getting anxious, and that is exactly the opposite of what I need the day before my exam.

So, what does one eat the day before a big test? Just some deliciousness:

Breakfast: Strawberry Colada Oatmeal

Lunch: I went on a great lunch date to Ranu Thai with classmates Eric and Andrew (who took their tests on Monday and have become rays of sunshine and freedom). Ranu has a $6.50 lunch special. Tofu hot and sour soup, salad, yellow curry and a piece of tempura. 

Snacktime: A lovely fuji. Side of studying with Molly and Gennaya, my quizzing angels full of encouragement and also lots of knowledge. They take it on Monday, and they will rock.

Oh hey Molly!

Dinner: It's just about corn season, and this was so delicious. Side of balsamic/oil salad with raisins. And what's in the cup? Mineral water of course, but in a champagne glass, because we're celebrating making it to test day. 

Dessert: Hot Chocolate soymilk.

The carton looks a little speckled from some aggressive pouring when I first opened it. 

And now?

Well, the night before my MCAT, (the big test you take to apply to medical school - almost exactly 3 years ago) I watched the season finale of Grey's Anatomy, and it went pretty well. 

So now before I get a hopefully great night's rest, I'm watching some House and turning this into a tradition. The USMLE Step 1 is a completely different beast to the MCAT, but I feel relaxed, sort of. A little. As much as can be.  

I'm well-organized for tomorrow, I've worked hard, there's nothing to do now but go kill it. 

Do you have any night-before-a-test traditions?

When the Scores Say You're Not Enough.

This post is a little text-heavier than usual, but it's about something important to me. Still, I know none of us have unlimited time, so if you're not my Mom, who's obligated to read every word, you can get the highlights with the bold and colored sentences.

What do you do when the results don't match your efforts?

This is the analysis of my first practice Boards, taken April 12, about 5 weeks ago. To make it simple, good scores have blue lines on the RIGHT side.

Mine, clearly, are on the left:

This was a demoralizing thing to see 5 weeks ago, and I don't want my Boards breakdown to look like this. 

In fact, it can't look like this, I would have to take it again. Good thing I'm studying just as hard as I possibly can. 

Thank you SO much for all the supportive comments on my whining about Boards studying. It's wonderful to know I have so many people pulling for me that I can't even see. 

I've been getting through and working really hard this week, but right around 7 this evening I hit quite a wall and I'm glad it's Sabbath. Time for a day of rest.

The Boards countdown is now 7 days, or actually 6, not counting the day of.

I feel like it needs a name, like B-day, but that just makes me think birthday. U-Day for USMLE? S-Day for Step 1?

What about P-D-E-M-M-D-T-A Day? For "Please-Don't-Ever-Make-Me-Do-This-Again Day"?

I know my life will be full of other Boards and tests and evaluations and recertifications etc. for a very long time, but something about this just feels like such a big deal. Not so much for my career. I know that even if I don't do that well, as long as I pass I'll get where I'm going eventually, even if it means an interlude for residency in rural Montana instead of my dreams of Oregon Health Sciences.

It's more about how I'll be able to see myself, my brain, my ability to learn and all the work I've put into the past two years. I was never the kid who was good at finding things to like about my talents that were unmeasured by grades. I was great at feeling proud because I worked hard and got exactly the grades I wanted. I wasn't particularly artistic, athletic or musical, and I was very result-focused. These past two years have really challenged me to find other strengths, other sources of self-worth, because at the medical school level, I can no longer think of myself as excellent.

In fact academically, I feel I've become  rather completely mediocre, despite working as hard as I can.  


And I will freely admit, sometimes no matter how much I know there's more to my life, these failures feel like the whole world. 


What else is there when my life's been primarily defined by academic achievement?

The question becomes, Who are you if you take away what you thought you were good at?

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Pass or fail, medical school is helping me form an identity that relies on traits, passions and joy that isn't meant to be quantified by acheivement.

I'm a fiercely protective and proud sister.

I am completely unashamed of my rather loud and squeaky laugh.

I love people fearlessly. My friends, my family. Sometimes that means my heart hurts because I miss someone, but it's the way it should be.

I love making health fun, and I care enormously about the health of those around me. Medicine's where I feel at home, but I know I can find a way to feel helpful with or without an M.D.

God made me perfectly, and that includes my brain.

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And I just couldn't resist (although it may be categorized as achievement) 

I make an awesome bowl of oatmeal:

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No matter what the result, I plan to come back to this post in 7 weeks when I get my scores, to remind myself how little influence they truly ought to have.

Whether the scores say we're smart or not, they will never define any of us. Not them, or our jobs, or our degrees, or the number of successful parties we've hosted, or loaves of bread that have risen, or races we've run, days with clear skin, pounds lost or notes played in tune on our musical instruments.

We're worth more than the sum of achievements, 

So tell the scores to shove it.

I Chose This Right?

The last couple weeks (10 days!) before Boards kind of feel like living in an H E Double Hockeysticks of my own creation.

It feels like I'm studying all the time, though I know I'm not, and when I'm not for a second it's just nothing but guilt. (Like now, or earlier today when I racked up 20 wins on Facebook's Tetris Battle - don't start. It'll suck you in.)

I started getting headaches. I don't get headaches.

Sometimes the video on my review lectures goes out of focus. At first I thought it was the video; now I think it's probably my eyes. Not to worry, I'm eating plenty of carrots.

I get sad when I realize I've already showered on a given day because that's the one time I'm not trying to take studying with me.

I'm drinking coffee like it's falling from the sky.

I no longer listen to music while I run - I listen to audio reviews of pathology. Also while I cook. And play Tetris Battle.

And Nora got a flat tire yesterday, so that chops my built-in daily activity to none. It also made me realize I hadn't driven my car in over a week, which is actually kind of awesome. I need to get that fixed.

Endorphins = functional person. No endorphins = this depressing study dungeon takes over my psyche.

And the worst part? It feels like every piece of information I cram into my brain means something else falls out. I don't actually theoretically believe my brain has a limited capacity, yet I am somehow experiencing it.

Are we sick of my whining? I kind of am. I mean, I chose this right? 


Alternatively, I could say to myself, "What an awesome opportunity. You get to take an enormous test that allows you to go onto the wards and work with the team and treat patients. You're becoming a doctor, and all of this is important." 


That said, people say this is the hardest I'll study in my life, and no matter how positively I try to spin it, I really really hope that's true. 


At least I'm not alone. I don't know what I would do without my roomies, friends and classmates with whom to study, and lament. And my wonderful family and Boyfriend (and now you - thanks) to listen to me whine. They're the only reason I haven't just smashed that coffee cup over my head yet.

So, this much-needed brain break is just about up, but here's a little montage of recent brain fuel.

Breakfasts: Yogurt bowls. 

Lunch: Mexican Salad, Almond Butter and Raspberry Jam on Oatmeal Bread

Dinner: Black Bean and Sweet Potato Chili (recipe to come), Roasted Root Veggie Chili Mac

Quick, tell me something awesome you're doing! Or mediocre. Anything really. Tell me anything. 

April Goals: Week 1

We're 1 week into April, safely past April Fool's Day, and just 2 and a bit weeks from Easter!

So how are those goals going? Original April Goals.

1. Family: Talk to them every week. 

  I believe this week I talked to: 

Emma (2nd sister, 18-on-Monday!, high school senior)

Shannon (1st sister, 21, Air Force Academy) 

and Mom. 

We're missing Dad and baby sister - well, she's 15, very grown-up, but baby of the family. 

I hope to catch up with everyone this next week.

2. Fitness

  a. Enjoy half-marathon. It's in 2 days!! This isn't so much a goal, as one of those things I put on the list so I can check it off, because obviously I'm going to enjoy it. I hope - provided nothing goes awry. Weather says sunny and 69 degrees. A little warmer than I prefer for 13 miles, but better than rain I suppose. 

  b. Strength train 3x a week. I set this with the intention of starting next week, because I don't want to be sore for the race, so we'll have to see how this goes. Even after the race, I could probably do arms and core early next week and give my legs a break. 

3. Boards

  a. Doctors in Training Review Questions 5/day: On track.

  b. Qbank questions 150/wk: I'm not sure the exact number I did this week, but it was at least 150. 

  c. First Aid Review 90 pg/wk: Not so much. I've actually done 75, but it's hard to say what counts. I mean, if I read it, does that count? Or only if I have it all memorized? I guess the point is spending some time on it, retaining as much as possible. 

  d. Pathology or Physiology Review 30 pg/wk: I didn't actually sit down to this one until last night. I got out my enormous pathology textbook and had some lovely bedtime reading. The first 7 chapters in Robbins are supposed to be particularly high yield, so I'm trying to get through them, at least with a good understanding of the images and diagrams. My current goal of 30 pg/wk won't make that happen in time for the test though, so I may up it to 60/wk, or 10 a night. This past week I did...6 pages. Oh dear. 

  e. 1 USMLE Practice Test - 200 questions. This is in my study plan for the afternoon, so it WILL get done. And likely the result will be more than a little depressing, but it'll help me focus the areas that need work a little bit better. 

4. Food Expense Tracking. 

  a. Groceries: $30.55 this week. 

I haven't yet tabulated coffee shops and restaurants...but it was a lot. All well-enjoyed and worth it, but I had an indulgent weekend. I'll update that next week. 

Do you have goals this month? How are they going?

Ducks-in-a-Row Daily Schedule...and April Goals

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Today I'm getting my ducks in a row. I hope that by writing out these details, I'll be increasingly motivated to actually stick to it. 

Last night I had a dream that I had a beard. I was relieved to find when I woke up that I do not have hair growing from my chin, and I thought, "Well Subconscious, Happy April Fool's Day to you too."

So it's the first of April and 57 days until Boards. It was a great day to write a schedule and some goals. 

Ducks-in-a-Row Daily Schedule

Morning

5-6:30 (or earlier) Exercise/Get Ready/Devotion

6:30-7 Boards Study (DIT, Qbank or First Aid)

7-7:30 Breakfast, Pack lunch

Late Morning

7:30-12 Class or Class-related Studying

Afternoon

12-12:30 Lunch

12:30-1 Boards Study

1-6:45 Study (or go to required labs/lectures)

      (2-4 hrs) Class: Review lectures, Make Flashcards

      (2-3 hrs) Boards: First Aid, Qbank

Evening

7-8 Dinner and a break

8-9 Boards Study

9-9:30 Relaxing activities: Reading etc.

9:30-5 am Sleep

Total Study/Learning Hours:

   Class: 6-8 (including lecture)

   Boards: 4-5

   Overall: 10-13

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Boards Weekly Goals

Working 6 days a week

150 USMLEWorld Qbank Practice Questions with review (separate from practice test)

90 pages First Aid USMLE Step 1

30 Doctors in Training Review Q's

30 pages Pathology or Physiology Review

1 Practice Test with 150 Questions

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April Goals

1. Family: Talk to them every week (continue)

   I want to keep doing this like last month; I feel it was pretty beneficial.

2. Fitness

   a. Enjoy the half-marathon in just a little over a week. 

   b. Maintain some kind of exercise schedule after the half-marathon, but give my ankles/feet some time off to rest. I'd like to increase my strength training to 3x a week, because I'm kind of a slacker when it comes to strength training, but I really like the results. 

3. Boards

   (see above) I'm not setting goals in terms of scores for school or Boards, because the only thing I can control is how much time I put in, and that will hopefully reflect in my score, but I'm going to have to be proud of myself if I put in the time I want, whether it leaves me feeling completely prepared or not.

4. Expense Tracking

   This is a new one for the month - I want to track all my food expenses to see specifically what I'm spending to most on and whether I want to cut back or increase certain areas. I'm going to do it by category: groceries, eating out, coffee shops and we'll see how it turns out. 

Besides writing a schedule and studying, it was also a gorgeous day with some great food.

Lunch: Salad and an apple in my undergrad cafeteria. I was visiting a professor, but it was strange being back. It made me feel old. 

Some campus, beach and bluff-walking:

And for dinner, we went to California Pizza Kitchen. It was surprisingly vegan-friendly: the thin crust is vegan, all their soups are vegetarian, and the spaghettini is vegan. I got the Vegetarian with Japanese Eggplant (no cheese) on Thin Crust, and our server, who was also vegan, suggested I add the balsamic on top and it was a great touch. I ate 2/3 of it, so I'll have some for a snack tomorrow. Another vegan in our group got the Pear Gorgonzola with No Cheese, add Balsamic, on Thin Crust as well. 

On other cheeseless pizzas, I've felt the flavor's been lacking, but this was everything it should have been. 

Are There Dragons in the Soul-Crushing Study Dungeon?

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I'm going to go ahead and be straight with you for a bit here. It's not going well.

I severely underestimated how much I would despise going into the school and studying on this spring break Monday. I got in about 10:30 am, and by 2 pm I couldn't take it anymore, so I left. It felt like the oppressive forces of the USMLE Step 1 were physically trying to crush me. It doesn't help that my scores for the finals went up and let's just say all those hours I spent didn't really show up in my performance on a couple subjects. At the moment I'm still passing all my classes, but it's March - of my second year - shouldn't I know how to study for these by now?

The post-test depression leads me now to have this conundrum: no matter what else I do with my day, it isn't the studying I was supposed to be doing, so it doesn't make me happy. At the same time when I sit and try to study, my mind just drifts to what it will be like talking to the academic review board or getting pulled out of my rotation if I fail boards and have to take them over, because I couldn't study, because I was too busy feeling depressed. I've cried multiple times today. It's been two years of feeling like I'm barely making it and I really miss feeling like I'm good at something.

Things that would normally make me happy just didn't sound fun today at all. For dinner I heated up some pre-cooked rice, steamed a couple carrots, and gave it a dollop of teriyaki sauce. Don't get me wrong, it was fine, but usually a semi-vacation Monday night would call for a new recipe or something. The idea of getting off my bed and going to the grocery store was entirely overwhelming. I watched a few too many TV shows, though it wasn't particularly fun, and I found myself watching the clock and willing it to be bedtime.

It's now 8:20 pm and I might go to bed.

I leave you with pictures of breakfast (a bowl much like yesterday's but with a different cereal) and dinner, the culinary creation of an energy-less girl.

No idea what makes this "slim" but it's crunchy and good with yogurt.

Maybe it's me projecting, but I feel like this dinner looks sad too?