Tuesday, June 10, 2008

E-mail list!

As I have mentioned a fair amount, we're attempting to keep this blog going. In the spirit of this, we'd like to keep any readers updated as to when new posts go out, and of any other goings on. As such, we have set up a new e-mail address, where you may subscribe to our email list - just send an email to mstpla@gmail.com with the subject line reading "subscribe," and we'll keep you up to date. And of course any inquiries, comments, concerns, etc may be sent to this address as well.

Post-Mortem Board Report

Every time I thought I was going to come home from the library and create a blog post on studying for the boards, I found something else to do, such as:

1. Eat canned black beans for the 5th straight evening.
2. Drink my ration of 2 glasses of red wine.
3. Watch a round-up of the best NBA playoffs in years and constantly remind myself I was not watching this because the studying was for a good cause.
4. Try to furiously send text messages to all the non-med-school people I knew and beg them to go out with me on the evenings I ended early and was taking some R&R (I wasn't too successful at this).

In any event, no posts would arrive after the first. Perhaps that is most illustrative of The Experience of studying for the USMLE step 1. I like to think of it as being transported into another dimension for, give or take, six weeks time. Everything else in your life has to take a breather. Well, at least that was my approach; which brings me to my next point. However much you (or I, or anyone else for that matter) hear things from other folks who take the exam, the most important point you can reach is that of personal enlightenment - the point where you have some idea of how your experience will play out, you have a plan for yourself, and you know how to stick to it. With that, I offer the following impressions not as a guide for others (you will probably not need to study immunology as much as I did (I still am hopeless with those Ts/Bs/Natural Killers/Langerhan, etc) nor will you likely be compelled to carry "Grays Anatomy for Students," with you to the library), but as some insight into the growth and discovery that I think makes the studying for step 1 (get ready for this) a worthwhile experience that builds character.

[I should first offer the following disclaimer: I am painfully and painstakingly superstitious about my examination performance - just ask any of my friends - so one should not read into this post as a reflection of success or bitter failure on my part; the exam was reasonable, fair, but I still could have bombed it. So until about July 15th, don't ask me how I did or assume one way or the other. Thank you. You may now diagnose me with one of the personality disorder cluster types (A, B, C, with sub-categories)].

And so, I begin with Charles' first three Ramblings on the USMLE step 1, as (un)commissioned by http://mstpla.blogspot.com:

1. Physical ailments are an inevitability, but not necessarily irreversible. Studying for 15-16 hours a day (which, according to the folks that "primed" us for boards studying at UCLA, is about 7-8 hours too many a day) takes a physical toll. For me, the most significant were lower back pain (a.k.a LBP or Mechanical Back Pain), a bizarre, bilateral fungal infection on my elbows (which Kevin helped me diagnose based on the fact that a short course with topical corticosteroids made the tinea markedly worse), double vision (a.k.a. diplopia) at, consistently, hour 13 each day, near-crippling dominant hand pain secondary to furious annotation of "First Aid 2008," two upper respiratory tract infections (I had not had a single sore throat or cough for two years prior), and of course self-limited gastroenteritis secondary to dining at the hospital cafeteria. Oh I forgot - my derrière was absurdly sore on several occasions; it didn't matter that the chairs in the library rooms we of outstanding comfort (and their height could be easily adjusted). Somehow the human body has trouble sitting for so long. Or I am particularly sensitive or allow undue chafing to get the better of me. Don't worry, friends, there were no short or long-term complications of the pain.

2. On more than one occasion, my friends and colleagues accused me of being two "hard-core," in that I would, at the two-weeks-before-the-exam peak of my studying arrive at the graduate reading room at 6:30 a.m. and study (with food to accompany at appropriate times) until around 10-10:30 p.m. I vehemently disagreed most of the time. If I was happy, not excessively fatigued (during the last couple of weeks, you can probably get away with 6-6.5 hours of sleep and be fine), and able to focus, what was the problem? And furthermore, one becomes inevitably stressed out during the last part of the studying experience (you feel you have to know everything and you know a fraction of it), and so I could imagine a much worse approach would be to slack-off (but feel rested and rejuvinated), and then come to the library with an insurmountable deficit of time and effort. I suppose if one is prone to becoming ignorant and blissful, the latter approach is appropriate. I am not one of those who has either ignorance or bliss during exam preparations. I thought of it like this: How am I going to feel right after the exam? If I put in less than "100%" of the effort I could, such a moment would be neither satisfying or enjoyable (and probably frustrating, filled with "could haves" and "should haves.")

One caveat to all of that: about three days before the exam when I repaired to my folks place in Pasadena for the final stretch (at some point, the toxic environment of medical students studying for step 1 in the same vicinity is too much), I hit a wall. I was unfathomably fatigued, for whatever reason, and it showed: I had just contracted my second upper respiratory tract infection of the six weeks, I had done a set of practice questions where I score ~20-30% below my average at the time, and I was hopelessly behind on my daily schedule for getting through endless amounts of last minute pharmacology and pathology images. I must thank my mother for observing me as I began to eat another fine home-cooked meal, who said, "You know, you really need to get some rest. You're going to be a disaster on exam day. Just go to bed in the next 30 minutes (which would have been 10 pm), and start back at it tomorrow." Going to bed and catching up on some sleep was the best thing I could have done. The next day, I was rejuvinated, was able to return to the 6-6.5 hour sleep schedule, and my mind was sharp (enough) on exam day.

3. I suppose #2 inevitably leads me to my next point. Flexibility is a must-have in the boards studying. Think of it as a healthy exercise in self-regulation (important concept in psychology and psychiatry) - dealing with not getting through that which you have planned for the day, a less-than-ideal score on a practice test, and so forth - that is not just necessary but also vital to keeping sanity in the process. There's enough riding on this whole experience, and stressing out over whether you got through 35 versus 37 pages of renal on a certain day doesn't need to be one of the areas in which that happens. Schedules can be modified. I know that for me, I had to trim down my expectations for final reviewing when all was said and done. It's just not feasible to memorize every word on every page of first aid. Better to take the triage approach to the material at the last minute. On the morning of the exam, I knew that the neurocutaneous disorders (like tuberous sclerosis and neurofibromatosis) were weak in my memory. And so I reviewed them for ten minutes. It turned out that doing that was beneficial - I got a question on tuberous sclerosis on the actual exam. Had I thought reviewing all of First Aid was feasible, I might not have helped myself at all...

More thoughts to come. Fellow Step 1 takers, what are your thoughts? Please comment and let's continue the discussion.