I survived Step 1.
It still seems surreal to say it. That the seemingly insurmountable task that has been hovering over my head for such a long time is now over and done. In the past.
All that remains is the aftermath. My First Aid binder with pages ripped through their 3 hole punches, hanging out like a dog's tongue after chasing one too many frisbees. Dead highlighters on my desk. Sheets full of self-made diagrams and flowcharts. Sentences underlined in red with "QUESTION!" written next to them. My Goljan book, with its binding cracked down the middle and the second half of the "Hepatobiliary and Pancreatic Disorders" chapter hastily scotch taped back in. 3,400 QBank questions tucked somewhere in my cranium. 2,400 notecards sitting no longer of use on my laptop.
I'll post more about my experiences with my progress doing questions, taking NBMEs, and the like when I get my actual score back and know how accurately it actually projected how I'd do. But I thought I'd talk a bit about the experience of the test. My actual test day went pretty well. My immune system made one last rally and with my prophylactic DayQuil in hand I kept the congestion and runny nose at bay throughout the day. I arrived for the test a half hour early, and found myself starting the exam early at 7:40am. All those hours doing questions paid off and I found my stamina was good enough that I could bang out two hours of question blocks at a time between breaks. Time goes VERY quickly while you're taking the test. You find yourself so focused on each question that blocks can seem to fly by, and hours of the day silently tick away. Before I knew it, block 7 rolled around and I clicked that final "End Block" button and half-assed my way through the survey at the end.
What does it feel like when you step out of the testing center? It's a strange combination of exhaustion, exhilaration, and denial. It didn't sink in for almost two days that I was done. That there was no more studying to do. The day itself almost felt like just a long day of doing USMLEWorld, as the interface, pacing, and question prompts were all so similar.
But it does finally sink in. And its a great feeling when its over. The sheer amount of concentrated will it takes to study endlessly, day after day without reprieve, was honestly something I wasn't sure I had in me. Its a time filled with highs and lows. Lots of lows. Frustrations, and sometimes despair. You realize you have gone days without talking to another human being, and find yourself unable to engage in normal conversation when you do. You become robotic in your routine. Wake up, study. Eat only because you have to. Study. Sleep. Repeat.
I think if I had to sum up the entire experience it would be: I would never want to repeat it. But I'm damn glad I went through it. And now its time to sleep.
So after all this hubbub, after everything of the first two years of medical school inevitably being tied to this day, I take Step 1 tomorrow.
I tried reviewing pharm today. My brain wouldn't cooperate. Took my last diagnostic yesterday, it said I'm right where I want to be.
Still sick, but what can I say? Life sucks, then you die.
Game face.
6:00am - MedZag awakens for another day of relentless Step 1 studying. Man, he feels tired today.
11:00am - MedZag has to blow his nose.
11:15am - MedZag has to blow his nose, again.
11:30am - MedZag is noticing he sure is blowing his nose a lot today, and as he is noticing this, collapses into a fit of sneezing.
4:00pm - MedZag notices an insidious onset of headache, sore throat, and myalgias.
Well, crap. Of all weeks, of all days, my body chose 3 days before the boards to get sick. I know not who the culprit is: adenovirus, coronavirus, rhinovirus, or friends. I do know that this blows. No pun intended.
I've loaded up on the antioxidants and am pushing the fluids. We'll see if my immune system can muster one last Spartan defense before the big day.
And with that, I'm off to bed.
Has it really already been two weeks? That just blows me away. Really, for as exhausting and monotonous all this board studying is, the hours and days fly by. Probably because every day feels the same.
I'm in the final stretch, I take Step 1 a week from Saturday, so I really only have 7 days left of studying. Which is probably a good thing, because my mental stamina is fading faster than your libido after starting an SSRI. I've been doing 100 questions + full explanations every morning, which normally lasts me from 8am-noonish. I then take a lunch break and have grandiose plans for the rest of the afternoon, but generally can only really buckle down and really concentrate another 4 hours before the caffeine-induced diuresis and pressure sores on my ass proceed to tell me I need a change of scenery. I go home, telling myself I'm going to "finish", and proceed to "study" till late. By "study" I mean have something open in front of me and distractedly "look" at it while not retaining anything. This has not bode well on me making any progress on any of the items on my steadily growing "You're Behind On This, Get Your Ass In Gear" List.
I'm starting to notice some holes in my study schedule. For example, I only gave myself 1 day to learn micro for the first time, instead of the 652 days required to memorize all the necessary info as I am quickly realizing. But finding time to plug in additional micro studying when I barely have the mental stamina to slog through 80% of the stuff I'm supposed to study for the day has not proven humanly possible. I'm still trying to figure out how I'm going to remedy this. Without the use of illicit substances.
At least it seems like all the effort has started to pay off, as my QBank blocks have finally started to climb over the last 3-4 days. Of course, each one feels like a fluke to me, and I still expect every next block to come back and give me a big fat 40% in my face, but so far it seems I've been able to stave that off. I think I've hit that quasi steady state where any additional info I learn is desperately trying to offset all the information slowly leaking out of the back of my head. We'll see. A week is hardly any time but a ton of time at the same time.And only during Step 1 time does that seem like a good sentence to end on.
So I had all these "stay balanced" things planned into my study schedule. Gym time, free time in the evenings, all that wonderful stuff. Unfortunately, I think my schedule was a bit too ambitious and as a result those days I was supposed to be done at 6pm are more like 10pm and gym time has been forsaken to make up on lost sleep. But what other choice do I have, really? If I don't get through the material now, I won't ever... and the thought of going into the test having NOT finished a subject scares the crap out of me.
So much for balance.
I was ambitious, I mean, masochistic enough to believe I could get through all of neuro today. I did it... but it took me 10 hours. On a Friday night.
Questions continue to oscillate up and down for me. I'll do a pretty good number on a subject and think I have it hammered down then drop 15% in the same subject a day later. But the fluctuations are getting less dramatic and my scores are slowly trending up, even if it doesn't feel like it. I created an excel spreadsheet with a graph and trendline to prove it to myself. Yes, its gotten to that point. Today was a down day for questions. That coupled with the sadistic enterprise that was neuro and the fact that its Friday but I hardly noticed since it was just like any other day made for a pretty down day for me. I have heard of medical students being reduced to tears during board studying. If I was one of those more sensitive types, today probably would have been one of those days. Instead, I did what any testosterone-fueled male would do... and raged. I have developed a habit of verbally abusing my QBank when reviewing questions. OH! ALL I NEEDED TO KNOW IS THAT tRNA HAS 94 NUCLEOTIDES AND ENDS IN CCAGGG ON THE 3' END! THANKS USMLEWORLD! YOU'RE A GREAT HELP! I've also developed a habit of talking to myself when studying now. That's a new symptom.
14 more days...
The Step 1 gods show no mercy or remorse. This is the forecast for the next week:
This was apparently a holiday weekend. The people I saw out walking and enjoying this wonderful weather sure seemed like they were having a lot of fun. Me, I had fun grinding my ischial tuberosities into my chair slogging through my first couple full days.
I tried to come up with some witty or insightful analogy for what studying for Step 1 is like. But all I could come up with is what everyone will tell you:
It sucks.
Now, this is the type of studying I could really enjoy if I was, say, reclining on a beach with a mojito with a 3 month deadline. It is after all a sort of review, and it's somewhat satisfying when you have those "oh! I remember that!" moments. But the short deadline and the long days add enough displeasure and stress to more than amply offset any enjoyment I may derive out of this process.
Questions are trending up for me. My goal is to get through all the organ systems this week then spend the next two weeks on a meticulous review of each subject/system. Renal and GI are up tomorrow. We'll see how my next NBME looks this coming weekend.
So today I started my Step 1 prep. I purposely scheduled myself a "light" day to ease into things, and even that was pretty exhausting. This is going to be a lot of fun!!!! < /sarcasm >
Anyways, here's my next 3 Weeks of Death™:
So I have my final exam of second year on Thursday. While there is a certain degree of surreality to typing that (part of my brain still feels like its 2008... or 2007 for that matter), I am definitely looking forward to leaving the brain-desiccating monotony of the pre-clinical years behind. If finally hit me as I was sitting down to study today after lecture how close I am to being done with second year. And my brain thought: cool.
A couple posts ago, I talked about my plans for studying for Step 1 up until the end of class and my intensive 3 week period (namely: not studying, but simply "pre"-studying). Well, that was going well, until chatter around the lecture hall started slowly switching to boards, then becoming predominantly about boards, eventually becoming the all encompassing obsessive fixation of the class. The lecture hall soon became riddled with micro note cards, flow charts of the nephron, acid-base tables, and clotting cascades. And frankly, I am not a strong man. I hate feeling like I'm not doing something I should be (one of the many reasons I do not study in the school library). So I've acquiesced and started doing more QBank questions to at least give myself the illusion that I am trying harder. The results have looked something like this:
... I think if you ran a linear regression on that it'd have a negative slope. But the main thing that is so maddening is the up-and-down nature of it all. One night I'm feeling like the work is starting to pay off. The next... certain doom. I took a second NBME and I'm up 15 points from my previous score. Yeah! Still 40 points from my goal. Crap. It's finally starting to sink in what a bear of an exam Step 1 is going to be. Sure, everyone "knows" that but there's a difference between watching Twister on your DVD player and standing in the middle of a field as a F5 tornado descends on you.
So that's is where I am at. Less than 48 hours away from having to regurgitate my last syllabus. Either destined to pass or fail Step 1. Can MedZag make the final push and make up those 40 points to preserve his future career? Or is he just a cocky jackass for thinking he could accomplish so much in such little time, destined to practice primary care in Disappointment, KY? Stay tuned.
So I've been hesitant to really talk about board prep here for a number of reasons. 
Medical students are an odd sort with all sorts of unwritten social rules and idiosyncrasies, and there's a narrow line to be tread between being known as a "nice guy who works hard" and a "gunner." Frankly I think everyone in medical school studies more than they let on, but never honestly discusses it, for fear of being labeled the frightful "g word", except for the select few who are so neurotic that despite their best efforts its simply painfully obvious.
But I know several MS1s at my med school read this, as well as assorted students elsewhere in this wild world (Hi Malaysia! Say hi to Indonesia for me). And I think both board experiences and board advice on the internet tends to be skewed to come from the neurotic minority versus the gross majority of students. I've seen and heard enough through the med student grapevine to know I'm (probably) not in that neurotic minority so I thought I'd give my personal plan.
My Advice For Before You Begin Board Review:
-Do not start studying for the boards before you get into medical school. Do not start studying for the boards during MS1. If you're so distraught over an exam that is over a year away and simply, absolutely, must do something, buy First Aid for the USMLE Step 1 and read through relevant sections as you progress through the subject in your classes. I bought FA last year with the intention of doing something like this, but ended up not even touching it and don't feel like it was any loss.
-Likewise, do not study for the boards the summer after MS1. Anything you DO learn will be long dispersed and displaced by second year classes and its essentially lost work. Besides, the gross majority of Step 1 is based the pathophysiology you learn as a MS2. If you haven't learned it yet, board review books will be pretty much useless to you.
-I'd recommend to "start" doing something the early spring of your second year. For me, this was as simple as getting a study plan together and making sure I had all the relevant materials on hand or ordered. I also 3-hole-punched my First Aid. That was a big accomplishment.
-Everyone studies differently. Everyone learns/reads/memorizes/poops at different speeds. Get a good sense of how you study and how fast you study compared to your peers so when you're creating a plan of attack you know how to tweak your schedule (which will most likely be based on someone else's schedule you run across) to fit you as a person.
-Medical students stress out wayyyyyyyyyyyyy too much about this test. I am as guilty of this as anyone else. Acknowledge you're stressed out, and wrangle your Type A personality down a bit. Stress is useless. And counterproductive.
-If you put in the work like everyone else, you'll pass. Step 1 is not an IQ test, and except for the exceptional few amongst the exceptional few, your success is largely dependent on the time you put in. I say this not to make you exclaim "OMG! THAT MEANS I HAVE TO STUDY FOR 6 MONTHS TO GET A 290 AND MATCH INTO DERMATOLOGIC RADIATION PLASTIC NEUROSURGERY!" but to make you realize that if you study as much as everyone else, you'll pass. If you are really shooting for a killer score, you're going to have to put in more work, but you are not stupid and you don't need 10 weeks to pass.
What I've Done/Am In The Process of Doing:
I've allotted 3 weeks to study for Step 1. Until then, I'm trying to muster up some R&R so my motivation tank is full going into that 3 week period. That being said, I am a medical student. I have a festering Type A personality. So I've assembled a few things to accomplish prior to that period to make me feel like I'm doing something and keep the stress level down. Note that the things I am doing now are not directly studying for the test per-se, but rather making sure I got concepts solidified, sources consolidated, and am becoming familiar with material so that I will have an easier time studying during that 3 week period.
-Read through 
Goljan's Rapid Review of Pathology while listening to his audio lecture (Do not ask me how to get them. Ask Frankie over there. Yeah, the guy sitting at the bar with the mean dragon tattoo on his arm) and annotating things into the book.
-Do the questions in the Robbin's Review of Pathology question book. For questions I miss, I make sure the key concept I was wrong on is in my First Aid. If it isn't, I write it in. 1 sentence max per concept.
-Read through BRS Physiology and do the questions in the book to make sure I gots my key physiology concepts dowwwwnnn. Extrapolate on concepts in First Aid that are vague.
-Review my biochemistry /immunology/cell biology/genetics. You know, all the nitty gritty stuff you're in all-too-much of a hurry to forget when you learn it.
-Skim through Clinical Microbiology Made Ridiculously Simple to jog my memory of some of the more useful mnemonics in it.
-In the couple weeks just before I really have to buck up, plan to start doing some questions on USMLEWorld/QBank to get myself more experience with the question format and system. No more than 48 questions at a time. Missed questions go into First Aid like above.
I started doing these things about 3 months before I take my Step 1 (~2 months before I really buckle down and study). But I must point out that I have done them in order to de-stress, not add stress. So I've been doing a couple, and only a couple, hours a week at maximum.
These are also what I am doing. I know people who have been doing QBank for months. Others have had their First Aid open next to them all year in class. Others have done flash cards for pharm and micro. And still others plan to do nothing until its time for them to really bite the bullet. All of these strategies have worked for others in the past. The key is finding a level of effort anywhere between 0 and 100 that you feel like is helping you.
My final schedule for the 3 weeks+ to come soon.
