Multi-Level Thinking

Here's an example of a question (UWORLD I'M NOT STEALING YOUR INTELLECTUAL PROPERTY, I SWEAR; PLEASE DON'T COME AFTER ME): a patient has X symptoms (ex: low HDL levels), what would you use to treat the side effect of the drug you would give that patient?


You have symptoms, so in your head you come up with the diagnosis (in our example, hypoalphalipoproteinemia).  Once you have that diagnosis, you have to know what drug you use to treat it (niacin).  Once you've figured out (read: remembered; there's clearly no actual reasoning through it) the drug, you have to remember its main side effects (facial flushing).  And finally, once you have the side effects straight, you have to remember what other drug you can use to treat those side effects (aspirin).

You can know 3 out of 4 of those facts, and the world may never know it, because you're still going to get that question wrong.  And that is why these questions are so confidence-depleting and soul-sucking.

To-Do

In case anyone cares, here is my subject schedule (for those 4 hour afternoon review sessions) for the next 9 days.  Pardon the curse word, it makes me feel better.

Crunch Time

Well I'm in the airport in Dulles, waiting for our late aircraft.  They say we're leaving at 7:05, but as it's 6:52 and there's no plane at the gate, I don't really believe that.  At least there's free internet in the airport here, unlike at Newark.  I'm on my way back from an amazing weekend with AMSA (American Medical Student Association).  More about that another time though.  The weekend has been a little overshadowed by traveling woes. 

I'm now 9 days away from Step 1 and I'm definitely starting to enter panic mode.  I was supposed to get home last night, but because (I'm pretty sure) United has a personal vendetta against me, I'm still here outside of DC.  In terms of studying, I've now gotten through First Aid and all the UWorld questions once, so I now have the rest of the study time to cram everything in a second time.

So here's my plan for the rest of the study time.  Every morning, 200 mixed UWorld questions in test-taking atmosphere (meaning timed blocks of 46 questions, not looking at any answers until I finish all of them).  Lunch while I go through the answers.  Followed by 4 hours of review (2-3 chapters of First Aid each day depending on how weak in the subjects I am - I'm looking at you, GI).  Break for a run, shower, and dinner.  Then 100 mixed questions from Kaplan (since I haven't done those yet, and I want to make sure I do some new questions).  Then half hour to an hour of flipping through pharmacology flash cards before bed.

This strict of a schedule is probably something I should have been doing all along for a maximal score, but I don't really think it would have been sustainable for me.  But hopefully I can keep it up for just over a week.  And then vacation!  And then surgery rotation.

Am I Unethical?

It's one thing to get a question wrong that most people get right when the question is simply asking for a fact.  You can always defense-mechanism it away (that's a verb) by telling yourself things like, "Oh I haven't studied that section that well yet" or, "Oops I misread the question."

But last night I got an ethics question wrong that 78% of people got right!!  An ethics question!  And apparently it was obvious enough that a vast majority of people knew the answer.  What does this say about me??

These Are A Few of My Favorite Things

Reading back through my old blog posts (because that's a really good use of my time right now...), I realized I have a bit of an obsession with naming.  Besides all the other names of diseases/procedures/etc. which I have proclaimed to be my favorite name, I have two new favorites:

The first is Rickettsia rickettsii, the bug so nice they named it twice! (It causes Rocky Mountain Spotted Fever, a disease endemic to the East Coast, go figure.)

The second is a finding in syphilis called the Argyll Robertson pupil aka the prostitute's pupil - the pupil constricts with accommodation, but not in response to light.  So it accommodates but does not react, and has syphilis.... just. like. prostitutes.

Practice Questions

When I get a question wrong but I understood the concept, I give myself credit in my head.  "Ok, ok, you forgot that gentamicin was an aminoglycoside, but you totally knew that aminoglycosides cause ototoxicity, and that's what the point of the question was."  So let's assume I got that right.  In fact let's just assume that the 55% I got on the most recent question bank is closer to an 80% (just to be safe).


But in the opposite situation when I have no freaking idea what the question is even asking, and I happen to blindly guess the right answer, I totally still believe I deserved to get that question right, and not only do I certainly not lower my score in my head, but I even give myself an extra pat on the back for my clearly superior random guessing skills.


With the USMLE World questions, they also tell you what percentage of people picked each answer choice.  So if only 30% of people picked the correct answer, and say 40% of people chose the same incorrect answer that I did - well, I get credit for that question too (in my head), because oooobviously the majority can't be wrong (yeah, yeah 40% isn't a majority, you know what I mean though).

Mood Swings

I don't know if it's the constant flow of information into my brain, the amount of hours I spend by myself, the soul-sucking USMLE World practice questions, or what ....but lately the littlest things have been able to set off either a state of euphoria or just as easily reduce me to tears and foot-stomping.




 The other day I thought of the BRILLIANT idea of melting swiss cheese on an english muffin for breakfast (as if it's even an original idea..) and I was so pleased with myself that you would have thought I had just found out I won the lottery and that this guy to the left was going to serve me breakfast in bed followed by a shower of diamonds (because apparently that's my fantasy).





Now fast-forward 4 hours later and it was time for a real study break (as opposed to all the mini-breaks I take constantly).  I sit down to watch some TV and CAN.YOU.BELIEVE.IT, any channel I was interested in watching had a commercial on.  Naturally I took this terrible disappointment as a personal affront, decided God was probably out to get me, and realized I was definitely going to fail Step 1.

And that is how Step 1 studying has turned me into a crazy-pants.

How I constantly feel. Welcome to my life.