So, Third Year.

So tomorrow marks the end of our "Transition to Clerkship" week, which means at this point I'm supposed to be pretty much transitioned to whatever this "clerkship" thing is supposed to be.

In the past I had (arguably) witty food analogies for the first two years of medical school. First year is like a hot dog eating contest. Second year is like trying to polish off that 72oz steak at Billy Joe's Steak Emporium. If I had to come up with an analogy for what transitioning to MS3 would be like... it'd probably be analogous to that NBA commercial involving Yao Ming (still one of my faves):



Yes, third year is like trying to eat a live crustacean. It's new, it's exciting, it's exotic, and you have no idea what the f*ck you're supposed to be doing. You can google how to eat a live crustacean, people can tell you how to eat a live crustacean, but until you've actually gotten out there and done it, you really have no sense of what its like. And when you try for the first time, its awkward, you fumble around, and you generally look like an idiot.

Our week started off with a morning full of "talks" from the big wigs in the School of Medicine who never appear unless something "important" is going on, which basically consisted of them reminiscing to us about their own days at the beginning of their clinical days. Luckily things picked up at that, and the rest of the week has been very fun. Finally had my first quasi-patient which I had to do a full H&P on and present the next morning. The rest of our time has been filled with workshops filled with how to scrub for the OR, knot tying and suturing, intubation, accessing/reading/interpreting path reports, how to place an IV, managing acute patients, etc, etc. The material has varied from interesting to repetitive, but the best thing is that is have all been HANDS ON. It's all been simulated, but actually getting your hands dirty and having things be interactive beats the hell out of sitting in lecture all morning and then hurrying up to sit in front of your syllabus the rest of the day.

Start peds on Monday. 2 weeks on the general wards then 3 weeks in the PICU. Hoorah.

The Aftermath

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.

Step Prep: 503 hourzzzzzzzzzzz

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.

Step Prep: Day 19

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.

Step Prep: Day XIVa (The Clotting Cascade Tribute Post)

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.

Step Prep: Day 7... or is it 8? I don't know anymore.

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...

Step Prep: Day 4

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.