So that's the USMLE

Uhhh... geeze... What to say... there's so much and so little, and I want to make sure to break the silence of "just having taken the examism".

I was looking for USMLE experiences online, but a lot of times, it's like take the exam... and drop off earth. For good reason. Everything's been pointed to that day and then it's not. And then you have to realize you need your health forms in and your stuff finalized and there's all of that. And there are some experiences, but still, it's this big unknown looming beast, and there's so much hype on it, and so many pro tips on it (Kaplan, Falcon, etc) that it's almost like the hype becomes not real and you start wondering what it's *really* like because they're not going to use these buzzwords or test you on that disease you've seen fifty billion times in med school so it's become something *everyone* knows.

Oh, study it, by the way. If Goljan says it five times, then freaking know it. If it's common knowledge among medical students, then know it in obnoxious detail.

The other problem is the exam has an, on paper, incredibly rigid "do not tell people what's on the test" policy... and since this exam determines the whole future thing, and since there's frequently a blackout on information for the final run, I know for me that creates an intense paranoia. What does "don't share info" mean? Obviously it means don't mentally recreate the question and its 20 potential answers the second you get out of the exam and post them on the internet.

Though it doesn't say anything about trying to wikipedia the answers to 336 questions immediately after, because as we all know, that is awesome for your mental health.

But don't discuss the exam during the exam with other examinees, though I've heard you're actually allowed to have the First Aid in your locker and study it during breaks (I didn't confirm that since I had no intention of doing something that was that absolutely likely to give me a panic attack so it was irrelevant anyway), so I'm not sure what discussing it with other examinees (most of whom, I believe, are taking the SAT) would accomplish. Particularly since I think even the USMLE forms are completely different.

Does this mean you can't focus on any topic? What *types* of questions were hard? Is saying "the part of the exam where there was stuff from medical school" taboo? Honestly don't know. So I'll start classically, with what I did, and then talk about what the exam was like.

I also have no idea on where I stand versus where other people stand on study:test. The standard schedule seems to be 8 hours a day and 10 in the final crunch, which made me feel like an utter failure if I didn't spend 8 hours of every day painstakingly copying out the First Aid (this is just the horrendously inefficient way I study, and no, I don't read the notes later, nor are they legible. I just fill notebooks and throw them away!)

It seems like everyone's schedule is "Day 1: Read 600 page book of high yield physiology equations Ishie didn't make it through in 3 months of physio. Lunch. Afternoon: do 700 USMLE World questions. Average 90% Copy all explanations from all 700 questions into arranged notes that have been cross referenced and typed out by subject headines. Read 50 pages of First Aid. Work out for an hour. Attend to my personal hygiene. Get to bed by 10 PM and wake up at 6 AM.

Which *was* my planned schedule, which evolved into

"Week 5. Contemplate the fact you haven't made it all the way through First Aid because while pharm only seems to take most people 1-2 days, it's been 6 days and you still can't keep adrenergic antagonists straight. Wikipedia a disease condition you found in First Aid and were unsure of and plagiarize a three page dissertation on it into your notebook before realizing FA had summarized the highlights in two sentences. Get distracted by an adjunct wikipedia page and follow the Wikicrastination chain until you end up on the mating habits of bonobos. Google "effective USMLE study strategies". Watch old episode of Scrubs. Consider the fact that the residents get pimped in rounds during the first season to be "studying" because you know what C-peptides are. Realize three hours of your life has gone by without doing anything. Check facebook. Realize how much others are doing. Panic. Write out First Aid adding notes in a desperate frenzy until 5 in the morning. Realize you haven't done any questions. Do questions until 6 in the morning. Pull up score. Contemplate career change. Read explanations. Write in the first 10 in detail before hitting a question where 9% of respondents got it correct. "Say 'no one could ever freaking know that!!!' " and skim the rest of the explanations Realize the sun's up, and the chances of getting going by 8 AM are slim. Listen to Goljan as you're going to sleep... realize you're still up. Watch Red Dwarf. Contemplate whether you should try to take a shower before going to bed at 8 am, and decide it can wait. Swear to yourself you're going to get up earlier the next day to keep to your "plan". Wake up at 3 PM. Repeat.

And so forth.

Will it prove fruitful? Who knows. I certainly wouldn't *recommend* it as a study strategy because no matter what score it nets, it should be subtitled "how to live at such a high level of stress and self loathing that you forget how to experience happiness. Or panic anymore. So I suppose that last thing is good.

But the exam... ah, thought I wouldn't get there, eh?

Dibasic's tips are pretty spot on and reflect what other people have said. Oh, especially that 5 minute break after each section. You only get 45 minutes for the whole day so plan ahead. I took one after every section, avoided looking at any notes at all, and pretty much used the opportunity to get up, sign out, use the restroom, get water, possibly calories, at one point a Red Bull, sign back in, and log back in. Even though the testing facility was over an hour away, I drove it in advance and told you about that.

Got there about an hour early and went over microbio flowcharts I'd made and scanned a last minute antimicrobials in the First Aid since the ones without mnemonics really trip me up. They came in around 7:30 and I wandered in. They were quite friendly, and though it was clear it was a whole closely monitored environment, I didn't get the whole grim reaper vibe some proctors give off.

There are lockers you put your stuff in. ALL of it. No water bottles, watches, jackets, etc. Turns out no earplugs either. Whoops. I saw a "USMLE allows earplugs!" thing and thought it was current, but it isn't, so I got mine taken after my first break, but the lady was really nice about and didn't come in and nail me during the exam portion or any of that, so it didn't add to the stress levels.

There are noise canceling headphones, which turned out to be all right though at first they seemed like they were going to be tight and give me a headache. The room itself was pretty quiet, but I am the tightly wound type. One drawback is that noise cancelling headphones are WAY better than earplugs at amplifying your own heartbeat, so I got to do the test to the tune of "Lub dub lub dub lub dub... hmmm... this question sucks LUBDUBLUBDUBLUBDUB".

See how unstable I am?

Uhhhhhh, without going into "put marks on my record so I can't be a doctor ever no matter what I get", the exam is somewhat destabilizing, because some of the questions are ridiculously hard, but here's the kicker, some are RIDICULOUSLY easy. Oh, not many, don't get me wrong, but you do hard and medium questions and BECAUSE of that hit the easy questions and spend an eternity on them because you're going "No... there's a twist here." Once they hit a pattern, I'm also wondering if the easy questions are part of the "HOLY CRAP I FAILED MISERABLY" post-test reaction, because as I first walked out, it was like gut-punch, but I think a lot of the easier questions fly by and then you hit a hard one and you slam your self esteem into it like a car hitting a deer. Either that or I failed it so badly it's completely beyond me.

Oh, speaking of eternity on questions, be careful of the automatic log out feature that calls an "UNAUTHORIZED BREAK!" and flashes a red screen.

How did I know that? Uhhh... somehow spent 5 minutes on a question (bad time management, bad!) and was looking down intently at the laminated sheet I was scribbling on and then suddenly something flashed and it said "Unauthorized break". Which I figured meant "And now even though you've done six sections, we will cancel your exam and send your profile to the feds", but so far it seems to just mean that you have to log in again. And I actually knew about the unauthorized break thing, and still hadn't realized I'd spent 5 minutes on a question. Nothing feels like enough time, and then I found myself feeling like for some questions I was 'half assing', because it was a sacrifice of one question for five. And I did finish all questions though pushed the buzzer on all sections and one, I cut 8 seconds from end of block. Whew.

I ended up finishing fairly short of my scheduled time, I think due to starting early since my "time for the day" clock was running really low. I ended with five minutes of break time left, largely due to there being no clock in the lobby and being intensely paranoid because if your break time cuts into your exam time (the computer tells you at every stopping point how much total break time you have left, how much time left you have for the day, and how long the next block is (an hour) ), it just starts shaving minutes off the exam. Fun. But I did break after EVERY block.

The main study hints I can give now are the ones everyone gives, though I can't authorize any of those since I have no score yet. I put the First Aid into a binder and used it as a central source, as Topher suggested, and tended to expand on it when I didn't know what they were talking about (ie, all of pharm) and then supplemented it. I'm not sure if there's magical high yield books for these subjects. Most pretty much got the job done and covered areas that needed expansion. Wikipedia, though much maligned, DID fill in a lot of gaps, especially in the end game when I needed to clarify stuff.

Uhhh, USMLE World, holy crap. Same thing everyone else says. computer interface is pretty much identical. A lot of people talk about whether USMLE World or the USMLE is harder. I think USMLE World has a higher *proportion* of really hard questions, which I found helpful. I also like their explanations, though it's a humbling program. I started off more in tutor mode and subject oriented since I couldn't see any reason to waste pharm questions when I didn't know any pharm yet and was mid embryo. Toward the end was just trying to do timed unused. I felt like that was a huge bonus, because as stated, time is an issue, and USMLE World has the same issue. I think if I'd stayed in tutor mode for the whole thing, I'd have ended up completing like 10 questions out of 48 for each block.

Right NOW, if I had to do something differently having seen the test, I probably would have spent a bit less time READING two textbooks for embryo and micro (good, and probably would have benefited doing it during class, but used up those huge chunks of time mentioned earlier since I can*not* read a textbook in a day), and done all the USMLEWorld questions twice over, as many suggest. I did well over half on it, but I felt like especially toward the end, that was really good practice, plus my brain was tending to gloss over the review of the First Aid when I was rereading it, so it had to be directly challenged.

I took 2 NBMEs to try to evaluate where I was. Whether they will resemble my actual score, I have no clue. Just really glad it's over. Hopefully until the Step 2.

My silly song for the USMLE

I'm gonna try to get this one in my head even though I don't speak French. But I can sympathize

Almost over!!!

Exam... 7 hours... all is well... all is well. Back to sleep. This is the first time I've gone to bed before midnight since I was 8!

Broad spectrum WTF

Okay, so it's been a mood swingy sort of day for me for no increasing reason other than the whole taking the step 1 in a week thing.

So I get my mood leveled off to "could be mistaken for catatonic schizophrenia instead of paranoid schizophrenia and I can only differentiate between the two now because I'm anal retentive and went on a snipe hunt on Wikipedia after seeing it in the book" and so in a full state of passive anhedonia, decided to take the NBME 2, which alleviated my stress by having my frigging internet flip out in the middle of it several times, including having it do "loading next question" for like 10 minutes, and then bringing it to a "can not be viewed" page. That helps the stress out, like hugely. Because nothing calms your nerves like trying to take a mock practical and having the computer bug out.

The Suddenlink people advertise that they have the "most improved" customer service. They never say "best".

So come out post exam having finally gotten the internet to cooperate after 4 hours of chewing cinnamon gum until it dissolves and that cat starts yowling at me because she thinks it'd be awesome to pick now to go into heat.

I had a little breakdown on that because my moods weren't unstable enough, so I get on a whole "I hate my life; I miss the Rock; I need a paying job, dammit" thing for a while, and that improves, so I'm back. For now.

So then on the broad spectrum WTF and speaking of animals in heat (and a tie in to my other WTF article on the weird upswing in bestiality spam mails), I see this article attached to my Yahoo mail, because since I'm studying, it only likes to tell me about the really important news stories.

Now, instead of trying to figure out which of 17 billion cephalosporins I would use for a self-limited infection, I'm stuck trying to figure out what the most fucked up part of this story is, because it's a toss up; it is.

TV Update

I pretty much have two strategies for USMLE relaxation since I can't be trusted out of the house, out in daylight, or anything else that would remove me from the list of impending symptoms of a psychotic breakdown, and they are: Watching Red Dwarf and Watching Scrubs.

Ooh, the excitement. My other "break" consists of the constant rollercoaster of emotion that is USMLE World, which is a high yield question bank that has an extremely steady pimp hand.

What I'm learning from my tv habits (other than that I'm a loser) is that I really really love Red Dwarf... I know I've mentioned this, but I've watched it enough that it's actually comforting. Like in 2nd term (when I was also crazy), I'm freaking using it to go to sleep, like children would use a 1980s British sci fi themed blankie. I think it's the accents, and the wish fulfillment that is Lister, since he's an unwashed curry-stuffed space bum, which is kind of what I want to do with my life right now.

Other thing I'm learning... I know she's like the "smart sexy doctor type", but the more Scrubs I watch, the more I'm really really hating Elliot Reid. Like more than 13 from House, because unlike 13 she's often likable (and hasn't killed anyone's dog), and then mixes that up with being a female-stereotyped man-chewing bitch for no reason while remaining a 'heroine'. Gods. I don't try to be a self-hating female-doctor-archetype uh.. hater, but Scrubs and House make it very very difficult. I like *actual* female doctors just fine.

So that's my life. Oh, and Happy Saint Patrick's Day. Join me in a little over a week when I deliberately and systematically destroy every brain cell I've hypertrophied since January. Yeeeeahhh!

Oh yeah, doom date on March 27th. I'm so happy it's going to be over with, I'm forgetting to panic. Oh wait, I'm not... but I have a doctor bear Dave sent me as moral support, so it sits on my keyboard when I do USMLEWorld.

The dragon looks smaller from here

So on excellent advice, I did a run to the test center, since it's a little over an hour away, though I didn't time it on traffic yet, since my sleep schedule's been completely jacked up...

Basically, after two years of being told this is the most important test ever, and trying to memorize books and tests full of pages, I was picturing my prometric center as being a large, probably marble elevated Parthenon style temple up on a hill, no doubt guarded by various beasts, and before you got in the door, a huge sphinx with the face of the path director at SGU would force you to read a CBC in 15 seconds, and if you got a single value wrong, it would deny you entrance and then kick you in the stomach (or if you're male, the crotch) until you vomited blood.

This would then be followed by going into the facility, which would probably sport some type of thick vapor, where I'd be strip searched, rinsed off with a fire hose, and tossed into a room naked with 50 students, all of whom were straight A students at Harvard, but despite that, half of them would be huddled up in the fetal position crying, and the other half would have smuggled in ipods blasting audible soca music while flicking through the questions in an hour before sauntering out shouting "nailed it!"

I would log onto a system that would stream values matrix style, and then crash windows style, putting up a blue screen of death for 8 hours that no one would fix, and then at the end, it would bring up a giant flashing "you failed, ha ha, loser" sign.

Ya know, or something like that. If I made it past the sphinx.

What I was not expecting was a tiny unassuming little office space that looks exactly like the office of Kelly Services where I took my typing test so I could qualify as a secretary. Well, not a real secretary. A temp secretary. And a single janitor that just gave me a half nod and a smile while I peered in the windows looking for the Rottweilers. And it looks like there's very little space in there, so conceivably I won't be taking the exam with a bunch of people. At the very least, I'd assumed I'd be crammed into a high school desk with a ton of shuffling people like I did for the MCAT. Now my main concern (besides the whole failing and having to flee the country thing) is that someone will have their car alarm go off in the parking lot.

And then I got curry. Because facing fears with curry is a good way to overcome them. Next stop, the cockroach farm! Then the circus!

On the way home, a little path lecture on the ipod through the speakers (otherwise known as the most expensive part of my car, which has a Kelly bluebook of like, five dollars now, which caused me to scream *one* of the dorkiest things I've said, which is "A pox on the damned A-a gradient and all its manifestations".

Seriously, pulmonary phys? Hate you SO MUCH. SO much.

But now, I'm headed to bed so I can get a long day of reupping my blood pressure tomorrow. And for a change, before 9 am! Woohoo!

USMLE hypertensive crisis time...

Though probably not as much as in a couple of weeks.

Because I firmly believe that procrastination will cause all problems to eventually resolve themselves, I waited until now to schedule my appointment for the USMLE, which will commence on March 27th. As I discovered that my testing site is available at the right time AND that there's a site only an hour and a half from me rather than the three hours I was initially expecting, this all seems like good stuff, but somehow hitting the "Confirm" button made it all seem very very real.

So I'm torn between the relief that it's all going to be over with along with a more acute version of the stress I felt when I was about to take off for Grenada the first time, only that time, my entire future wasn't determined by how well I can perform for 8 hours.

Ulp.

Weird accomplishments

A lot of people measure accomplishment in terms of, like, saving kids, annual salary, number of prostitutes killed in Grand Theft Auto (okay, that was me when I was unemployed; don't judge me), etc, but my whole self worth lately has been tied up in A) How many USMLE World questions I can do without inciting a panic attack and B) How many pages of First Aid I can clear in a day.

So this leaves me feeling even dorkier than usual (and I've been to a science fiction convention, so I'm an expert) because at the end of the day, I will either say things like "No, I cannot possibly afford to take a shower tonight/tomorrow; I have to catch up. I only did 4 pages today" or "YEAH! 14 PAGES!!! Rock out!! I've earned myself a 15 minute break to grab some frigging Taco Bell!"

Yeah... but I'm also learning stuff... stuff I should have known a long time ago. Primary sclerosing cholangitis can cause secondary biliary cirrhosis. Everything that gives you cirrhosis can give you cancer. All the time in the world you lovingly spend memorizing tumors anywhere along the bile pathways is useless because they all kill you within 6 months and have obnoxiously long names terminal patients probably aren't going to be all that interested in. Cancer drugs, speaking of which, are still completely forgettable, even though I know I went over the Vincristine flashcard fifty billion times in pharm, I still don't remember that it stops cell division in uh... (checks notes) the M phase. Oh, and I REALLY should have cracked my First Aid in basic sciences rather than just occasionally during pathophys. That thing's actually useful.

Besides the whole "self worth as determined by numbers in First Aid" thing, I also am relearning that my mental state is based completely on how much sleep I do or don't get. I've also bypassed the phase of diagnosing myself and others with psych conditions (as is common third term and the psych part of pathophys) and have concluded that it doesn't matter so long as the voices aren't actively telling you to kill someone whose death would attract immediate police attention.

And so forth.

Oh, 50,000 hits! Rock on! And thank you!

What else?

Oh, I'm trying to figure out what song I want stuck in my head for the USMLE. I've figured out that second guessing myself and panic are my main foes on tests and that my subconscious, unlike my conscious, knows what it's doing, so my best scores in med school, looking back, were those for which I had songs stuck in my head, so was highly distracted. The tests I did the worst on (except nutrition) were those for which I'd built myself into such a panic that I just melted down at the first sign of Alpha Fetoprotein.

Highest score in path was accompanied by these songs (really profane language warning).

Best in pathophys accompanied by some help from the Amateur Transplants, though none of that medical stuff, since that would be way too relevant (really profane language warning; seriously, "C" word and everything). Weirdly, since I've only been to London once, I don't even have a reason to be mad at the tube, but there ya go.

Seriously, during those tests, I was literally "la la la ing" in my head even though the tests were extremely freaking difficult, to a point where my main focus had to be on NOT singing the stuff out loud. For so many reasons.

I'd been suspecting, based on a few of these experiences, that my active mind shares a few characteristics while my subconscious does all the real work. I've been confirming this on USMLE World, which is a question database whose 'easy' questions read like "Unified Field Theory will rely on _____". When I'm distracted and hit first guess, it usually goes well. However, if a question is stressful and I feel like I SHOULD know it, rather than going with the option that my subconscious picked after 10 seconds, my active mind will attack it with the violence of a sci fi geek nitpicking the physics of the Death Star, go over the entire lexicon of medical knowledge I've ever been exposed to in all permutations and, without fail, spend 6 minutes picking the wrong answer.

Then, harried by all the fuss of subconsciously knowing I chose the wrong answer, that active mind will hang out and panic for the rest of whatever test I'm taking, count seconds, and gradually mess everything up for the rest including stuff I've known since the 7th grade, leaving me in a shame spiral.

There's an upside. This focused supposedly "smart" mind is REALLY REALLY easily distracted by goofy music and profanity. Cartoons optional but bonus. So if I sing to it, it'll leave my subconscious alone to do what it does.

So now I need to find something basic, profane, hopefully animated, and capable of occupying me for 7 hours. Search is on.

More specialty choices

This pains me to say, but the more I study it, the more I like pathology. Like a lot. Like view the slide review sessions like I'm playing frigging jeopardy and get inappropriately excited over getting stuff right. Because there are few things dorkier than pumping my fist in the air yelling "Reed Steinberg cells!! Who is your f'ing daddy?" And no, it doesn't make sense. I've mentioned I'm cooped up, right? And wasn't really stable to begin with? Cool.

On the study update, since I've moved onto systems, I finished off cardio and finally have a half-assed grasp of the drugs, even the classes of antiarrhythmics, which for some reason I need to differentiate despite most of them sharing the feature of "causes the problem they're supposed to treat along with some hideous bonus side effects". But I'm finally getting comfortable with the physiology of the heart, which I was really bad at a year and a half ago, and got so paranoid about it that I beat it to death in physio, path, and pathophys, and now again. I'm getting to where I can draw out Wiggers diagrams and length-tension curves and understand them fully, which is one of those cool skills that has very little practical application. Which is sort of a theme in my life. Seriously, ask me about Red Dwarf.

I reviewed endocrine because it's high yield, and I was in an eye chart kind of mood. Tacked reproduction onto the end of it, which despite focusing on nearly the same mechanisms, makes me want to claw my eyes out, and also features the one area of pathology I don't especially like due to the tendency of the ovary to get seventeen billion tumors that all present exactly the same way but derive from different cells that I need to know about, including what they look like when they're normal, which digs back into a deep and inexplicable dislike of the female reproductive system. Oh, and I finally know breast anatomy (thanks Netter!), which made breast pathology a whole hell of a lot easier, since by the time I got to that part of path, I was like "ductolobular..., screw it, I'm studying renal again". Which turned out to be a wise move for the exam. 1 breast question. 40 kidney questions. Booyah.

In re-review, I also finally learned that during kidney transplants, they leave the old defunct ones in and just shove the new one in the front because it's easier to get to. This falls under my description of awesome, right up there with one of the few things I do find interesting in female reproductive systems, which is that you can get ovarian tissue to still ovulate even if you stick it in someone's arm (a female someone). Something about putting organs where organs don't normally go steps up my interest. And it's pronounced "Franken-STEEN".

Oh, reviewing reproduction also reminded me of the fifteen thousand reasons not to have a kid unless you get it off Ebay. Pregnancy is frightening. The only things that make it more frightening are med school or reading "What to Expect when you're Expecting", which for some reason, they recommend to pregnant women, because being in abject terror for 9 months is good for you when your body is already maxed out.

And now... uh, since I'm the only one on the east coast not getting snow, here's a picture of Grenada.