Mar 28, 2009

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.


R said...

Glad to hear you survived it - it gives hope to those of us currently wallowing in Path.

Anonymous said...

Congrats. A rum will be consumed in tribute to your effort.

Ishie said...

Can I have the rum?

Mom said...

Considering the score you got, you can have pretty much anything you want! We are not at all surprised, but your dad and I want you to know how very, VERY proud we are of you.

Well done, Kidlet!


Manuela said...

Hi there, Ishie,
I was googling god-knows-what and found this post, it's HILARIOUS!! I got cramps on my cheeks while reading the part where you describe your studying strategy, I'm exactly the same!!! The Wiki addiction is driving me crazy!! My step 1 is in 25 days and I'm freaking out, and every time I need to "clarify" something on Wiki, 2 hours go by and somehow I end up on youtube watching an animation of how to escape from a teleguided missile... And instead of Scrubs, my problem is House... I tell myself I'm "studying" since they do talk about medicine, but come on, who am I kidding here?
Anyway, thanks, it was fun, I was actually googling some "help-it's-less-than-a-month-to-the-test" and it's great to know someone with similar habits, and equally unable to do 700 questions a day apparently got a good score!
Best of luck!

Ishie said...

Hi Manuela! Thanks for reading and for your kind comments!

I love House too; that show actually netted me ten questions throughout basic sciences. By the end of my study sessions though, honestly I was too emotionally exhausted to deal with a drama, so even House's lovable Vicodin addiction proved too much for my tired brain. Sad, eh?

Massive good luck on the test! Know the First Aid well, especially those tidbits in the back. My mom was reading the keywords to me when my brain hit fried, and that actually helped.

I'm sure you'll do great and before you know it, you'll be jabbing patients and saying "Wait, when do I need to schedule the step 2????"

Destroy it!

Manuela said...

Haha, I know what you mean, the drama is definitely tiring......

Thanks for the support!! Good luck to you too! As a matter of fact, I have actually scheduled Step 2...... But that will be less scary I guess, since I'm an (old!) IMG. I've graduated 12 years ago (I told you, OLD!!), so the basics were the hard part. When I was in school, molecular biology was science fiction! :)

Anyway, the ultimate break for me is Arrested Development, I just can't get enough!


Reynold said...

Good job!

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