Breathing to the Bases Again

For those of you just tuning in, on Monday I wrote the USMLE Step 1 exam.

The USMLE is an 8h mental marathon, designed to ruin free-time around the world and deprive second year medical students of sleep and robust immune systems.

My Summer 'Break' 2011

I will attempt to give an account of test day, though at this point most of it is just a collection of scenes which my stressed-to-the-max brain compiled.

I had my alarm set for 0600h as the testing centre was an hour away from my mothers place but I awoke at 0540h to a newsworthy thunder storm. Peering up from my basement-bedroom vantage point all I could see was a magenta sky--really, it was magenta and I figured either Armageddon or the Rapture had arrived. The thunder and lightening were happening at the exact same time, no pauses between each, just continuous crashes and flashes. I envisioned a darkened testing center, no power, or a flood of water rushing through the place. Didn't happen.

A bald-headed Buddhist Nun in full robes met me at the Prometric doors, told me in heavily accented English to remove my shoes and handed me slippers. I tried to ascertain when said slippers had last been washed as I had bare feet and a wart phobia. She was either perplexed or offended by my inquiry (or both) so I after a few minutes in the unsettling footwear I went to the car and found some socks.

The Buddhist Nun took my ID and information, another guy in line asked me what I was writing, I said, "USMLE Step 1", he coughed softly and replied in a bored tone, "oh yeah, I wrote that last year". I tried to make my smile convey the "please stop talking to me" vibe.

The Nun scoffed at my lunch size. It was ridiculous, I'll admit. I had no idea what I was going to feel like eating so I had everything: a thermos of my sister's borscht, cheese, one bite brownies, strawberries, apples, caffeinated beverages, nuts, fruit leather, turkey wraps, water, and granola bars. Oh and salty chocolate.

I started the exam. Had issues with the mouse and figuring out the 'strikethrough' and 'highlight' option (since I had been practicing on my mac and this was PC delivered). Got in the groove. For the first 60 questions thought, "this isn't so bad".

I took a break after block 2. Not long.

Block three the Nun walked over to me and handed me 2 orange earplugs wrapped in kleenex. I had no idea what was going on but I accepted them and popped them in my ears, under the sound cancelling headphones.

It was so quiet. I was pretty sure I could hear my own heartbeat. I started thinking about The Abyss, got claustrophobic and tore off the headphones and earplugs.

After block 4 my coffee rush and will to go on was starting to wane. I took a break.

The Nun informed me that my mother dropped off the earplugs. Wha??? I remembered saying at breakfast that I'd forgotten to buy earplugs but wasn't too concerned about the oversight. My mother had driven in to drop off some earplugs. I am guessing after the inspection, Nun felt they contained no crib notes, tiny microphones or recorders, and brought them in to me. I told Nun that my mother lived an hour away and it blew her mind. She informed me that she wished she had my mother. I felt Nun and I starting to bond. I think we'd gotten off on the wrong foot (pun intended).

The testing centre was connected to a Sylvan Learning Centre which meant that on my break little Timmy's and Johnny's were coming in and out of the main foyer en route to their reading lessons. The doors were open to the learning centre so naturally I heard the lessons.

Timmy can you draw me a big "D"? Can you draw me a little "d" now? OK, now I want you to tell me which words start with the sound, "duh". 

Oh how I wanted to be Timmy at that moment. I could easily have drawn a little AND big D!! I didn't have much of a handle on the Krebs cycle but I. Know. My. D's. 


Come on TIMMY!! Get your head out of your ass! You GOT this one!!!

Good thing I am not a Sylvan tutor.


Back in I started to really hit the wall. Seems that they put all the easy questions in blocks 1 and 2 and NOW I was getting hit from all directions. Self esteem dropped, dreams of practicing medicine faded, desire for throwing in the towel, peaked.

Break.

I din't feel eating. I felt like building a time machine and going back to study harder and longer.
Decided to have some 2-bite brownies. Chocolate always makes things better.  I parked my butt on the curb outside, in the parking lot, and wrestled with the packaging. The packaging gave, suddenly sending the brownies flying into the air and scattering on the pavement.

Noooooooooooooooo!!!!

I probably would have eaten them if a woman sitting in her parked car hadn't been watching the whole scene unfold. I just couldn't bring myself to pick up the brownies off the oil-stained tarmac. Especially considering how much microbiology I'd learned in the past 3 weeks.

Thankfully I still had a double espresso and taurine drink which kicked in and brought me to the finish line.

Afterwards I walked out into the shimmering heat I noticed a Vietnamese nail shop next door. Yep. Watching Dr. Phil and getting a mani/pedi for cheap was just what I needed.

Then there was catching up with some dear friends, dinner, drinks...some random drunk guys harassing us at the bar flashing their Peace Officer identification cards. One asked me where I'd been all his life and I couldn't resist saying, "University".  Most days that is where I feel I've spent my life.

It all made sense at the time.

And that concludes a romp through the days events. Thanks again for all the support friends and strangers.

Well That Was Surreal...

I need to start by saying a giant THANK YOU to everyone who tweeted, called, emailed, and commented "good luck!" wishes to me for the exam on Monday. I actually walked through the doors of the testing centre with a ridiculous grin on my face because of all the support that had been coming my way. 

On Friday I will give the whole shakedown of the day's events. But in the meantime I will give you a small sneak peak. Exam day involved (in no particular order):

-A thunderstorm of biblical proportions
-A Buddhist nun
-A random mid-test delivery
-A lesson on How to Write Big D's and Little d's.
-A few minutes of self-loathing
-A trip to a liquor store
-A Gypsy reunion
-A martini and a couple gin and tonics
-An encounter with some correctional officers
-A mani/pedi
-A very large bowl of seafood

The bottom line is that one of the bonuses of having a blog is when it feels like I'm in an episode of the twilight zone, I simply smile and think, "blog fodder".

It is over. I hate to guess how I did but I hope I did well...ok passed. I hope I passed because if I have to spend any more time thinking about bacterial pili I may go buy that banjo.

Until Friday.

Please Note

Please note the countdown that is on lower right sidebar.

Accepting all forms of incantations, wishes, prayers, vibes, energy beams, sacrificial offerings, blessings, final thoughts, advice, good-will, and major credit cards. 

That is all.

Feeling Important

Did anyone else get an email from 'North America' today??

Below is part of an email I received this evening, it was quite a long one (since it came from an entire continent so I won't bore you all with the rest of it...)

Yeah. North America is always so formal in our written communications, but I can read between the lines.

The Pit

Of USMLE despair.

Oh God, what have I gotten myself into??

I am getting those urges again to buy a banjo and tour the south-eastern US with a rag-tag bluegrass group.

It's ugly. It's really ugly. I feel nauseated just thinking about it. I spend all day at it, and at the end I feel like I've accomplished nothing, learned nothing, mastered nothing. I think this is what major mental burnout feels like.

I. Need. A. Break. From. Studying.

Like 2 weeks. That is all. Is that so much to ask for?

Don't You Love It?

Don't you love it when you spend all afternoon doing a randomly created practice test and your computer crashes thus making you lose the information, ability to find out the answers, and your mark???

Arrghhhhhhhhh!!!!!!!!!!

[Kicks something, hurts toe, regrets kick.]

Two Clues...

Looking around my study room today I couldn't help but notice two clues that I am back in Alberta.

Oh how I've missed the Old Country. Heheh.

Can't complain, though...my brother-in-law has kindly let me take over the Man Room for the next four weeks--sweet view, fireplace, and couple of bear skins included. Woot!

---

Update! As per OMDG's comment... :)

Can't believe I didn't think of that! hahah

Study Chuckle of the Day

Just going over a few practice questions today while waiting for din din to be ready.

Came across this explanation in my gunner training which made me chuckle, and love gunner just a little bit more...

After reading answer explanations for over an hour I almost missed it. Seriously, it makes me want to write a textbook just so I can surreptitiously add commentary to the content.

The Mug

As a 'congrats on finishing pre-clinical medicine' pressie, I had a personalized mug made for my study-buddy-brotha-from-another-motha, Ryan.

It turned out even better than I had anticipated. He got me a silver ring with BEARS on it (albinoblackbears, naturally) as a little good-luck charm for the USMLE. I am predicting that I will have a borderline allowable amount of jewelery/good-luck charms on during the exam.

I wish I had my lucky t-shirt (somehow sold/lost/stolen in one of my many moves) for the big day. It was Lucy from Peanuts running with a giant syringe in her hand and it said, "Mount Royal Nursing" on it. I didn't go to MRC but the cartoon was killer.

Indeed.

Becoming A Gunner

Apologies in advance for the brief post!

My office is starting to look like a scene from Shaun of the Dead, (actually come to think of it, I am starting to look like a scene from Shaun of the Dead) but I wanted to quickly put the word out to those of you who are deep in the trenches of USMLE hell, like me.

Last week I got an email from a reader about this USMLE prep site that I hadn't heard of, gunnertraining.com.

Anyway, I signed up for the free 1 week trial and LOVE it. It has all the same things that USMLE World and Kaplan but some interesting features that are unique--like these amazing flash cards that distill everything down to the bones and then test you. It's a nice compliment to the multiple choice format as it forces you to recall (because you type the answer in for the quiz parts) rather than just guess or use the answers to prompt.

I'll write a proper post about it when this week is over, but in the meantime go check it out. You can get a free one week trial to nose around the site. I figured many of you are getting close to the finish so I wanted to put the resource out there as fast as I could.

Now that I actually have an account I can give out free 1 month trials so:

http://www.gunnertraining.com/free_trial/1858779

Knock yourself out, kids.

Back to it!!!

60 Days

Until USMLE.

I think I will go and vomit now.

Everything Has to Give? A Little?

I feel like I am doing a half-assed job at everything these days. It seems that there is nothing in my life that I am working really hard at, getting good results, and feeling proud about.

There seem to be two opposing forces: medical education vs everything else. Medical education seems to win most of the time, but not even in a really-impressive-colon-cancer-study-head-of-the-class-and-rocking-exams sort of way. Just in a holding-on-by-the-seat-of-my-pants kind of way.

I am trying to figure out how to juggle reviewing old and current curriculum, as well as maintaining some sort of USMLE study regime,  and keeping up clinical skills review.

My program is pass/fail so do I shoot for the 'just pass' (i.e do the bare minimum of school curriculum to get by) and study-til-my-eyes-bleed for the USMLE? Because ultimately the USMLE has more of a direct impact on my future than what I am doing right now.

[Sorry, I know that the above statement may strike fear in the hearts of the general population: you don't want to think your doctor ever uttered the statement, "so do I shoot for the 'just pass'" but the reality is, there are only so many hours in the day and I can only study so much.]

The thing is, in an ideal world every day, or at least every second day I'd like to:

-run/walk/weights
-do at least a smidge yoga
-play mandolin
-read (something that is not a textbook)
-sit down to eat
-read 10 pages from first-aid book
-watch a Kaplan review video or two
-make some flashcards
-plug away at current information for PBL sessions
-flick through histology slides, anatomy images
-work on presentation for review group
-blog
-read other blogs
-listen to some Goljan
-spend QT with Tobie
-do about 10-40 review questions
-sleep at least 7 hours.

But instead I usually:

-work on PBL but do a skimpy overview of everything
-sleep 7 hours
-make a handful of flashcards
-scramble something together for review group
-feel like I am a horrible student
-have lots of feelings of self-doubt and fear towards USMLE
-blog

This is not good.

Don't get me wrong, after working in the ED for five years I am pretty comfortable with only knowing a tiny bit about a wide range of things.  But at some point during my studies here it'd be nice to feel that I am doing something really well. Even if that thing is playing mandolin or running. Better yet, have it be biochem so I can stop waking up in a cold sweat in the middle of the night.

"Aha!" Moment

I went for a run this afternoon with Prof. Goljan and listened to the part 1 of the cardiac lectures. 
He was talking about aortic aneurysms and aortic dissections and so of course my mind wandered off, recalling the most traumatic ambulance nurse escort I've ever done (outcome aside).

Dr. Goljan mentioned one of the salient features of aortic dissection: the midscapular back pain. This was the complaint which alerted me to the aortic dissection pathology in my 'mild chest pain' patient that day in the emergency department.

In passing Goljan said, "of course the pain is different than cardiac pain because the aorta is retro-peritoneal so it radiates into the back not down the arm".

OF COURSE!

In anatomy we have had to go through cardiac pain, and referred pain a million times, and the dermatomes, the arm, the jaw, blah, blah blah...and then other times we've talked about abdominal structures, retro-peritoneal verses intra-peritoneal, etc. etc. and the aorta being a retro-peritoneal structure.

But I never really thought about the connection with aortic dissection and the pain pattern!

(I know this has probably been dead obvious to all of you nursing/medical people reading this, but it just clicked in for me today).

AHA!

I have known for so long: mid-scapular back pain =  red flag = do bilat leg/arm BP's = ?dissection.

But it wasn't until today that I understood why that was the case.

Ok medical school, we've officially kissed and made up this week. I (heart) you again.

Overwhelmed

I am really not feeling the love right now in school.

I'd like to buy and banjo and do a road trip through the Appalachians.

Is that so wrong?

Below is the reason for my inspiration....

It's a long set, but if you listen to the first song you'll understand.

Decisions, Decisions

So my plan for the summer was to head home after exams (June 12th). Study like crazy for the USMLE for a month, write it mid July, take the last two weeks of July off, return to Ireland to start placements Aug 1st.

Life has offered up a bit of a curve ball and I am unsure as to what I should do.

I have been given the chance to be involved in a very cool clinical trial here in Ireland during the summer break (where I'll actually get to have some hands-on contact with patients). Problem is, the project will be full time for most of my holiday.

Everyone is always droning on about research and how important it is to have some papers on your CV, especially if I want to specialize or study in the US (I'd like to do both). So I am definitely keen on getting started on a project.

Flip-side is, when will I write the USMLE then? Remembering that our curriculum isn't based on preparing us for the exam, we have a MOUNTAIN of extra-learning to do on material that isn't part of my program. Yes, there is a long Christmas break, I could potentially study for it then, and write in January. But if I do my surgery rotation in the fall it'll leave me very little time to do any continous prep: it'll be one giant cram-fest over Christmas. Yeah, the Christmas break that I was planning to do nothing but drink egg nog and skate on the canal (not necessarily in that order).

Scales: USMLE vs. Research

Thoughts?

(Keep in mind that I am no pro-star when it comes to GIANT EVIL EXAMS OF DOOM.)

See the problem is, none of our faculty are Canadians who have studied in Ireland, written the USMLE, done research, organized international electives, or gone through residency applications for returning to North America. This means there is no one here that I can go to and say, "based on your experiences and your understanding of all these processes, what is your advice?"

We are left a little in the dark here in terms of guidance for our future careers.

Flash Cards

My brother Russ gave me an iPad for Christmas (thanks Bro!!) which I have hardly had a chance to use/play with, but this week I finally did a little shopping trip to the app store.

I bought a flash cards app, I know, I know...."why buy an app for something you can do on paper for free?"

See the thing is, I have hundreds of handmade flashcards lying around in these crazy disorganized piles, written in my chicken scratch/shorthand which makes ME the only person that can decipher them.

The beauty of this app is:

-I can put images with the cards, which is the BEST thing about them, because it means I don't have to try and describe the histological differences between an osteoblast and an osteoclast--I can just upload an image from Wheater's on the card
-I can organize them into sets
-it keeps them in one place, not randomly strewn throughout my school bags, gym bag, purse, desk, couch crevasses 
-it keeps stats on which ones I get right, wrong, and sorta-right-but-want-to-go-back-to
-I can select to just go through my 'wrong' piles or my 'review again maybe' piles
-they are typed, not in ABB hieroglyphics, making it easier for another person to quiz me (well, slightly easier).

Anyway, I've only just started making cards but if any of you nerds out there have an iPad/iPhone/iTouch you can download my sets for your learning pleasure. I'll be adding to them every week. I know they are kind of specific to my course, and that making flashcards is a big part of the learning, but hey...you just might LOVE them and become more brilliant for having them (please excuse my occasional mnemonic or loose association technique in the answers).

My page is here. If the link doesn't work let me know and I'll fiddle with it.

Happy studies!

Sample:

Obviously, the images are larger and look way cooler on the iPad.

Experimenting

In an effort to wean myself off music (no earphones allowed during relay race in June) I have decided to try running to the not-so-dulcet tones of Edward Goljan's pathology lectures.

I think it is safe to say that most medical students know about Lord Goljan or G Pac as he is lovingly referred to on his FB fan site. You could say he wrote the book on pathology, because he did. THE BEST book on it IMHO: Rapid Review Pathology.

I usually need some heavy beats to get me up the hill outside campus gates but tonight I had [insert hard American G.I accent here]:

"look at that...what IS that...NUTMEG...does that look anything like a NUTMEG LIVER?? NO!! I don't know who decided that NUTMEG liver looked like NUTMEG. Must have been someone with CATARACTS...someone with corticosteroid use induced CATARACTS...did you know that corticosteroids can cause CATARACTS?? Not glaucoma. Anyway..."

But, it worked! Ok my pace was slower than usual, because he's good but he's no black eyed pea. I was surprised though at how having my brain engaged actually let me forget my usual, "I hate running, ow, ow, ow, remember to smile" mantra. I have been feeling guilty lately about taking time out to exercise what with my study and review for school plus study and review for USMLE schedule. But now--huzzah! I can cram and run at the same time! I do realise that maybe it is a bad thing to combine recreation with studying so I am still keeping up my yoga in a Goljan-free zone.

Path domination here I come!!

Biochem Anyone?

I had been out of university for about 6 years when I decided to go back and take the missing, magical pre-requisites that would be my ticket to passing the MCAT and getting into medical school.

It was a full year and a half of inorganic chem, organic chem, physics, microbiology, and health sciences. It sucked. For a lot of reasons.

Once I was done that I was able to apply to several schools in Canada/abroad and had enough of my bases covered to write the MCAT so I opted to not go back in the fall for another full year of calculus, stats, and biochem--doing that would have given me the pre-reqs to apply to U of Alberta and UBC. But I was getting close to 30 for crying out loud! How many more 1st year courses did I have to endure??

I was living in my friends' parents basement doing o-chem when my 10 year high school reunion rolled around--which I obviously skipped. What was I going to say? Yeah, things are going well...I am in the process of getting dumped, I am doing a second year chem course, unemployed, and keeping my fingers crossed on getting into med? Riiiiiiggghhhhhht.

I just couldn't face it. I'd drained my RRSP's and my relationship. I thought that if I couldn't get in somewhere with what I had then I'd figure out a plan B.

Turns out maybe a little biochem would have come in handy after all.

They barely touch on it in my program, yet the USMLE seems to care if you know what a g-coupled protein receptor is.

I took the kaplan diagnostic test last week and found that my (major) areas of weakness are medical genetics, biochem, and molecular biology. Shocker! I never have taken any classes in those areas!

When we did our little kaplan pep talk a couple weeks back the lecturer said that wherever we have weakness we should spend 30 mins a day from NOW until the exam chipping away at it, "If your weakest area today is your weakest area on exam day then you aren't studying correctly".

Taken at face value it's pretty basic/obvious, but I think it was absolutely sound advice.

I've plowed through the first few chapters in the review book of medical genetics. Tomorrow the autodidact begins biochem.

This is going to be an interesting little educational diversion.

Wish me luck.

Splinters and Successes

I am done (soooo done) studying for the day, but before I crash out for a fitful repose I wanted to quickly post about the USMLE course that I started last night.

Ok so the school didn't pick the best evening to start the class but I figured I'd go anyway, not like I had any other plans from 1900-2300h (ha!) This first session was basically a getting-to-know what we are up against and how to prepare for the exam. It was taught by Dr. Stephen Daugherty via web from Chicago, and moderated by a techie in London. Needless to say we had some technical difficulties and it resulted in him being mic'd through a cell phone for the presentation, but, it worked.

He's actually a very good presenter and I found 90% of his talk interesting and helpful (pretty hilarious in parts as well). His background is in psychology and he appears to have a special interest in watching medical students suffer exam psychology, in relation to medical students.

One thing that really resounded for me though was at the end of the lecture he was talking about successes and failures, mainly around the theme of success on the exam, of course. With that, he made an excellent point, he said that success in medicine (i.e. acing the USMLE) isn't something to be celebrated, it is a splinter that has been removed. It really isn't as pessimistic as it sounds, and I chuckled at the accuracy of the statement. Why didn't someone say that to me TEN YEARS AGO???

For a long long long loooooonnnnnnngggg time I thought that the MCAT was the pinnacle for me. It was like this really big, frightening, monster exam with teeth that dripped blood of recent pre-med wannabes. It seemed like such an obstacle that it took me several years of stalling, starting another career, and studying other things in university before I could muster up the nerve to even attempt the pre-requisites for medical school...then write the MCAT.

Once the denouement of that story was behind me things quickly shifted to the next false summit, getting IN.

Hell. That was a year from hell. The application process and the waiting is horrible. I'd already been rejected once before a few years ago by all the schools that didn't require an MCAT. But, now I felt I'd gotten over what once seemed a nearly impossible event--completing all the pre-requisites and the MCAT. That (massive victory for me) was pretty much lost in the chaos of submitting applications.

Then I got rejected at most schools and got accepted by a few. And I really thought that I'd achieved *the ultimate*. My life-long goal, right? MEDICAL SCHOOL.

Does this sound like I lacked even a shred of self awareness or insight to anyone but me? I honestly shake my head at how absurd it sounds while I write it out. But my profile rant alludes to the discovery that was on the horizon for me. Things don't become PERFECT when you realize a long-term goal. It just means that itch has finally been scratched. That sliver has been pulled out.

And there is another horizon, far far off that my eyes are fixed on now. And things are still frustrating, and upsetting, and annoying sometimes. Things didn't suddenly fall into place for me the day I started medical school. Life is wonderful and challenging and funny and stupid and unpredictable just like it was the entire time I was staring at that false summit of getting in. I'm not saying that I don't appreciate that I have achieved something to be where I am today. What I took a while to discover though is the truth behind the enjoying the journey mentality.

It's good now that I have a different perspective on this, because I catch myself falling back into the "can't wait until" fantasy world. These fantasies about acing the USMLE, or landing the ultimate residency and how things will be so much better then. But they won't be, necessarily. I say that because really, my life was great 5 years ago, my life is great today, and hopefully my life will be great 5 years.

And for now, I just have this sliver in my paw. A big one called "Christmas exams" and another one called "USMLE".

Rant done. Sleep required.

So Unbelievably Lame

So remember how I was all exited about the USMLE course that the school was going to provide?

Well I found out today that now it will likely be cancelled and I am seriously pissed.

The school was offering the course to Canadians who have the obstacle of being International Medical Graduates* upon completion, and it was going to be free for us. If Irish students wanted to take it, it would cost them 1000 Euro.

There was a meeting last night and apparently the Irish complained so bitterly that we were getting it for free while they were having to pay, that now the school is thinking of cancelling it altogether.

(Did I mention that we pay the equivalent to $36 000 per year more than they do?)

I would happily pay the cost of the course if they offered it, I am already in a bottomless pit of debt and if the course brings up my mark by even a handful of points it'll be worth it in the long run.

Classic case of a few people ruining it for everyone. Buhhhhhhhhhhhhhhhhhh.

---

*The deal is, when you leave Canada to study medicine you become an IMG in the eyes of our residency matching system. Not a Canadian-Who-Studied-Abroad-And-Now-Wants-To-Come-Home-And-Provide-Services.

This limits your opportunities for residency, especially in competitive ones because you are part of the IMG pool and IMG's rarely match in the 1st iteration--unless you go into a return of service pool. Fine if you want to spend 7 years in Saskatchewan POST-training (not that there is anything wrong with SK, just that neither Tobie or I have any bonds/family there so having to spend possibly 13 years there if I specialize seems a bit harsh).

The Irish students who study abroad have a sweet deal: they are given priority over foreign grads (like me) for post-grad training when they return home. That means, even if I was the number 1 ranked student in my class then I'd have to wait until the lowest Irish applicant matched before I could get a position in Ireland, if I wanted to stay.

In a nutshell, we get screwed in Ireland and Canada.

So, I planned to write the USMLE as it gives me some more options, and both Tobie and I are keen on living in the States for a few years. The bummer part is that our curriculum is not at all geared toward the exam so we are at a bit of a disadvantage compared to students who studied in places like the Caribbean.