The halfway point!!

Geeze these exams are long.  By the end you're just skimming questions because you're like "This isn't the Hunger Games!  Why am I here?"

Step 3, as mentioned, is two glorious days of overpriced MCQ (and case scenario) pwnage.  Ostensibly, I could be using this time to review notes and antibiotics and such, so instead, I'm blogging while my powder-pink toenail polish dries, cuz priorities.

The stress level has significantly decreased over the course of the exams, as, weirdly, my distance from the exam center.  This feature is unrelated, but just kind of nifty.

Step 1:  As an IMG (also AMGs, but not half as much), this exam makes or breaks you.  It is stressed again and again how well you need to do, and specifically how well you need to do relative to your AMG cousins.  It was a nightmare to study for.  My hours were long but poorly planned, spent frequently skipping from reading textbook to textbook over the course of about three months during which I was not tasked with doing much else.  I had the all important "unintentional weight loss", the anhedonia, the overwhelming stress, the blood pressures that jumped to about 160/105 regularly toward the end.  I was crashed out in North Carolina, far from fellow sufferers. Dressed in whatever filthy rags I scraped together, drove an hour and a half to Greenville to the exam, and sleepwalked through it while running to my locker at every break, trying to eat something, and cramming Red Bull.  Got my foam earplugs taken away and got distracted by my heartbeat for the whole thing.  Walked out feeling numb and apathetic.  Did well.

Step 2 CS: Not so stressed about this one, since... pathology.  Also, no score other than P/F.  I don't really count it among the classic Steps, since it's not the standard "Prometric" center.  If it didn't cost as much as a 60" LCD TV, it could be fun.  Practiced for a week with hilarious results, flew to Houston, stayed with my lovely family, had my uncle iron my white coat because I'm useless at household anything, wore nice clothes because it's required, saw fake patients, had a nice lunch, saw more fake patients, and hung out in Spring, TX.  Groovy.

Step 2 CK:  Important, yet somewhat less so unless you have to compensate for Step 1.  An hour longer so you really reach the "hit the wall" feeling.  Living up my little hedonistic lifestyle in New York with my similarly hedonistic med student roommate.  Took about seven weeks off rotations to study, which later translated into a long loan-check-less summer.  Studied alternately at home and at the new Brooklyn Bridge park.

Studied a reasonable number of hours a day, did not obsess over tons of textbooks, and pretty much just stuck to UWorld while making sure to rush downstairs to Maria's with regularity to get my evening cocktail.  Finally moved the exam up about a week and a half because I was tired of studying for it.  Took the subway and strolled to the exam at lunch time.  Jeans and a (probably) clean t-shirt with a (maybe clean?) sweater.  Due to the nature of the testing center, had to sneak food into the bathroom and hastily consume sandwiches and Red Bull.  Walked out feeling numb.  Did well.

Step 3:  Seriously.  If you're not trying to get a competitive IM fellowship, just pass the stupid thing.  You have a job.  If you're a pathology resident, try to not be stupid and take it early in your first year.  If you're a path resident and your program doesn't force you to take it your first year, for gods sake man, take it early in your first year.  The stories I've heard.  Took a week off (paid!!!) during which I also worked on presentations that are moderately more stressful since I actually have to impress my colleagues.  On other weeks, did quite a bit of studying in the form of QBank on my iPhone and perusing flashcards by the pool.  Made time last week for this:

And no, that's not me, though I certainly wish it were.  You can't let studying interfere with the *annual* southeastern beard and mustache festival.

Half through so far.  At the testing center, they were super friendly, encouraged me to bring my foam earplugs (WAHOO), and were like "Oh, have a cup of coffee", and referred to me as "Doctor" or "Doc" about fifty kajillion times, which, kinda awesome.  Didn't feel rushed on breaks.  Had lunch at a normal hour, no Red Bull (wha?), and ate it out in the sunshine.  Walked out feeling.. fine?  Staff encouraged me to come back nearly an hour early tomorrow so I'm out sooner.  Can't lie, I don't miss the stress.

Not that this means I'm doing well.  It could mean quite the opposite.  Especially since it's soooo long.  I think it's so long that you don't dedicate as much mental energy to it because you're just "blah blah blah... uhh.. C.  Sure."

But the constant crushing career-rides-on-this, every day you take is money lost feeling is gone and good frigging riddance to it for three more wonderful years until the monster that is the double day dual certification AP/CP path board exams that our glorious leaders are currently suffering through.

But tomorrow... tomorrow.... the end of the USMLE cycle for EVER tomorrow.

Another frigging USMLE, really?

So, in my program, you have to take the USMLE Step 3 by June 30th of your first year because they realize path residents are going to forget all their clinical medicine.  The plus side is we don't technically have to *pass* it until June 30th of your second year.  But since "Step 3: Electric Boogaloo: MCQs in Space" is two days of work-day length misery instead of one, I really don't want to do it twice.

Being a responsible person, I'm taking it June 8-9, which is about three weeks before when normal me would take it, but about nine months past when a reasonable person would take it.

Being a SUPER responsible person, I decided to make use of all resources that would really help me study for this exam.

Yeah, roomie and I got a boat.

How do you study?

Roomie mostly got a boat, particularly since she has a car that can tow it without invalidating the warranty and I don't, but damn.  I'm now officially a disgustingly rich boat owning doctor, except I'm poor and part-owner of a hobie cat we got off craigslist, but the potential is there!  All that's left is to stuff it full of golf clubs and caviar and butlers and such.  Posh people do that, right?

Posh people also go to Kiawah Island.  As part of my program being incredibly awesome, they sent us to attend at least one day of a conference out in rich people land.  This was my first for-real conference, and I was sufficiently blown away.  The lecturers were actually pretty damn amazing; notes came with bling and a preprogramed flash drive with the power points, and then the spread required a lot of extra treadmill/swimming/weights time particularly since it all concluded with an oyster roast/food orgy/open bar out in a beautific location.  I thought when they saw my handbag lacked either a "Coach" or "Louis Vuitton" logo on it, they'd throw me out, but security must have been lax.

So yeah, perhaps I'm in an upswing that will terminate with my telling all you fine people to run screaming from the profession (again), but life is currently making all the Step 3 UWorld pwnage worth it.  Despite the fact that palmetto bug season is starting to bloom, or "Satan Death by Aerial Insect Assault" season as it's known by those who can interpret the screaming.  For you lucky uninitiated, palmetto bugs are roaches that are pumped up on steroids, aggressive, and fly.  You're welcome.  Pleasant dreams.

Back in heme, I was required to do a five minute presentation at conference on something I'd learned that month.  Since I'd had a quasi argument/discussion/I know this topic talk with my attending on thalassemias, we jointly decided I would do that since I'm lazy and he wants to focus on a topic where there aren't a lot of cases here.

For some reason, this five minute topic on a disease my mother is carrying a trait for had me up until 2 AM.  Personally, I blame powerpoint for being a horrendously inefficient way to present information that isn't a picture of something.  So I did the thing this morning to a fading audience, but my attending had left, so I did it again at the beginning of sign out, and he approved, so I may be doing it again to all the heme onc people because I like boring diverse groups of people.

Since I'm pathologically addicted to Game of Thrones, this does allow me to make the most specific geekiest, least funny reference in history by saying "Hemoglobin Constant Spring is a deletion in the alpha gene stop codon which leads to a long alpha globin chain, contrasted to Hemoglobin Winter is Coming which causes the gene to make progressively stupider decisions until someone kills it."  [Crickets chirp, awkward silence ensues]  "Thank you!  You've been a wonderful audience!"

I get nervous about presentations until the time where I actually have to give them and then I don't care.  You'd think this not caring would carry over to the presentation effort so that it doesn't take me 7 hours to hack together a 5 minute presentation, but it doesn't.  I also never do a practice run, usually because it's 2 in the morning.  I attribute this all to being 11 years old, with my precision team, opening the Ice Capades (yes, really) and falling directly on my ass during a simple maneuver in front of at least a couple thousand people.  Given that, scrambling some medical terms to a group of thirty people who know me just doesn't matter.

That being said, if I give a presentation and you ask me to do the same presentation an hour later (today), you will get two entirely different presentations.  And despite all the care and effort I put into making a stupid powerpoint presentation, I rarely reference anything but the pictures.  "Behind me, you'll see a list of bullet points that constitute my midnight stream of consciousness and have nothing to do with what I'm talking about.  Enjoy."

I also over research and under reference.  This has been something I've literally done since high school.

"Oh, I have a paper due on Shakespeare?  Okay!"  [Read all of Shakespeare's works.  Read several biographies on Shakespeare.  Pull up lots of webpages that recount the same information.  Do this for several weeks.  Write entire paper in a single run beginning at 10 PM the night before it's due with no rough draft.  Sprinkle arbitrary references in among facts that may or not be where you got the original information, but by then it's amalgamated into your "common knowledge" and you have no idea where it came from.  Hope like hell they won't fact check you or that you've inadvertently plagiarized someone.  Swear you won't space your time like this next time.  Repeat pattern for next fifteen years.]

What else?  Oh, we did the Residents In Service Exam, which for first years, as I mentioned, has no real significance other than telling you what you need to learn.  What did I learn?  I'm good at microbiology.  I don't really know why I'm good at microbiology since we haven't rotated in it yet.  I'm not good at surgical pathology even though I spent most of my time in it and stresses related to it nearly sent me fleeing to Mexico despite an exquisitely poor command of Spanish for a native Californian.  Baby steps.

I blame the media for my current career path.  I wanted to be a virologist initially because I thought Outbreak was a good movie and I was, like, 12.  I downplayed this during my "Why did you get into pathology" interviews because I wanted to eventually get work.  I'd like to say X-Files hasn't played a role in my current course, but I'm suspicious.  Now I'm weirdly good at microbiology, and the most logical reason I can come up with is that Dustin Hoffman is remotely beaming the information into my mind.  That's reasonable, right?