Thursday, September 5, 2013

USMLE Step 1: The Journey

The thought of studying for step 1 is something med students try to avoid their first couple of years and are happy to forget once it is over. It is a time where you brush up on all of your basic sciences and prepare to prove what you know on a standardized test. The stress that comes with the test is unimaginable. If there is a single most important thing you put on your application for residency it is your step 1 score. It is this magic score that determines where you can apply and in what speciality. No pressure!
I started with the best of intentions and was going to study for 7 months. I ordered my books and that first 2 weeks of that 7 months I did some reading, but then I got lost in my other responsibilities and step 1 studying took the back burner. I worked, finished some of my undergrad courses, and did some crafting. It was a joyous time, but eventually step 1 got closer and after a stern talk from the council on curriculum, I settled into a studying routine. I cut down the amount I was working and studied from the time I got up to the time I went to bed. I saw basically no one and sit in the same place everyday for about 8 weeks.
My normal day consisted of a morning routine(aerobics, tea, shower), First Aid, Qbank, and then a night routine(tea, sitcom, stretching.) I actually got very comfortable just doing that every morning and I really enjoyed it(I know I was surprised too!).
Well I enjoyed it when that routine thing actually worked out. Nothing in my life has been all that simple and some of the things that make me the happiest also have the ability to make my life very difficult. That first week was ideal, I made tons of progress. The second week, my grandma had a TIA. I am incredibly close to my family and when I got the call, I went straight home. We initially thought she had, had a stroke, but after a couple of difficult days she regained all function and was able to go home. First obstacle, check. A couple of weeks later, car problems. With boards just a few weeks out I was very worried about making it to the test which I would have to take a short road trip to get to. So back home for a little help from my dad. Second obstacle, check. Then the first sign of good news was my successful NBME on the 4th of July and to celebrate I headed home for a night with the family. You know that feeling you get when you can tell something is wrong or that look written across someone's face when there is bad news? Well with a combination of those things, I could tell sometime wasn't quite right at home. My grandpa was diagnosed with Stage 4 Lung Cancer which had metastasized to his brain the day before(sometimes knowledge is a burden). Third obstacle, check. After spending an evening with my grandpa, I had to put that at the back of my mind and move forward. I was feeling pretty good about all the progress I had made and with a week left before my board exam I got very sick. A combination of an ear infection, walking pneumonia, and costochondritis. I spent my last week studying on the couch, sleeping, and taking antibiotics, but luckily I was feeling 100% a couple of days before my exam.
The day before my exam I didn't study. I had a 2 hour drive to make and a hotel room booked close to my testing center. I got my hair cut in the early afternoon and headed out. After checking into my hotel, I ate at a local restaurant, took a bath, had my tea, and went to bed early.
The morning of my test, I surprisingly didn't feel nervous. I had actually felt much more on edge the week before. My biggest regret was not getting up earlier so I was more awake for my first block of questions. The test is 8 hours long with about 45 minutes of that being a break you can take in-between blocks of questions. Each block is 46 questions and you have 1 hour to complete them for a total of 322 questions.
Entering the testing center felt like entering a police station. It was a long hallway with chairs and a fridge at the end of the hall. I settled into a chair and waited. Shortly a lady came out of a door and gave me instructions on where to put my food and drinks, that I couldn't have a backpack, they would be taking all electronics which needed to be turned off, and all other things would be put into a locker. The final direction was to keep my drivers license with me at all times. After listening to all the directions, I followed her into the check in room. I was photographed, fingerprinted, patted down, and my things locked up. It is a very controlled environment. After sitting down you are provided ear plugs from the testing center, a small fan, and are watched my 3 different cameras. Good thing I'm not camera shy.
 The first block of questions was a little rough, but after a quick break which included jumping around and doing jumping jacks in the parking lot, I was ready to go and the last 6 blocks were successful.
After I finished the exam, I didn't have the initial wave of relief I thought I would have. Overtime I quit thinking about it, except on Tuesdays. Test results are always posted on Wednesday mornings, so I rarely slept well on Tuesdays. On the 4th Wednesday after my test, I finally got the email saying my test results had been posted. I was on my Psychiatry Clerkship and checked them after we got done rounding in the attending's office. When the results finally loaded up, I felt the urge to jump up and down, but contained myself in front of the rest of the team. I am incredibly satisfied with the results I got, though I can still remember 3 questions I should have gotten right, but didn't. Maybe one days I will forget those. Since the results have come in, I don't really think about it. Life has of course moved on and the next challenges of med school have already taken over.

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