A Tale of Two Cities

Taking Your First Step (Part 3)

2009-03-20T02:56:00.000-07:00

8. How about the pathology slides?

The pathology slides on the exam are straightforward. It wont be as detailed as the BOD course. And our pathology course here prepares us very well (but then again I'm biased, I love pathology). I do highly encourage you review at least the slides on FA. And here is an amazing website you can go over..it's helpful for BOD exams as well: http://library.med.utah.edu/WebPath/webpath.html

9. And what about the audio/video questions?

Yes, you'll get a couple of these. They started introducing the audio/video questions only last year to the exam. These include questions where you can listen to different parts of the patients chest and hear a murmur for example. DO NOT waste time trying to develop an "ear" for heart murmurs...the clinical scenario and the location of the heart murmur (whether or not it radiates anywhere) will usually give away the answer.

The video questions (I didn't get any on my exam) are again basic; for example they would show a sixty year old with a resting tremor and instead of asking what is the most likely diagnosis they might ask what part of the CNS is affected in this patient. They know that you know the patient has parkinson's so they take the question a step further.

The upcoming post will be about the schedule and how a typical day of studying is like...I hope you're finding the information helpful so far!

Taking your first Step (Part 2)

2009-03-14T14:09:00.000-07:00

...hopefully this time I wont be interrupted by another endless series of admissions...

6. USMLE WORLD. You should approach this Qbank as a learning tool.

One thing to remember is that you wont face much of a time issue with step I. So use the tutor mode instead of the timed mode. This mode gives you the right answer and explanation immediately after you selected your response.

It's more important to read and understand the responses than to merely check your score. The responses are thorough and help you link and cover topics you wouldn't otherwise by just reading FA. MAKE SURE YOU DO ALL OF UWORLD. Finally, don't be discouraged if your score is around 60-70% or even lower...again it's a learning tool, and the point is to learn from your mistakes; And Uworld does a great job at uncovering them!

7. So what tool can best predict my preformance? The NBME exams.

Those exams are great at predicting your score and evaluating how prepared you are for the exam. They are written by the same people that write the usmle. Unfortunately, they don't allow you to check the questions you got wrong; basically they give you a usmle equivalent score and a breakdown of your preformance in each subject (physio, path, pharm, etc...)

The school does provide for one exam. There are a total of six different exams. They vary in difficulty level. Forms 3, 4, & 6 are known to be the toughest and supposedly most "like" the exam. I suggest you do at least two forms one at the beginning ( after 1 week of studying) and another atleast 10 days preferably two weeks before your scheduled test date. That way you have time to go through any material you have difficulty in.

more later...gotta go

Taking Your First Step...

2009-03-14T05:15:00.000-07:00

I remember being in your shoes at this time last year, worrying about the dreaded usmle Step 1 study "break". Here is my take on the test and how you can better prepare for it, including what I would've done differently to acheive a higher score.

First of all be wary of advice. Student's experiences will vary not just because of the differences in the material tested from on test to another but because of the student's own biases towards their weakness and strenghths. For example a student that swears that the exam was all neurology, most likely found the neuro questions most challenging. So as I give you a taste of my experience and my advice take it with a pinch of salt or two!

I decided to place my FA into a binder, it made it possible to add my own set of notes...it was especially helpful towards the end, when I needed to memorize last minute lists of metabolic diseases, brain tumors, etc...I had those pages set apart in a smaller and easily accesible "for review" binder

So here it goes...

1. KNOW your enemy. You'll be better able to conquer the exam if you know what it's about. I strongly suggest that you start reading and orienting your self about the exam and it's different components. How I would divide the exam, is that it's composed of subjects that require understanding (mechanisms, mechanisms, mechanisms!!) and ones that require memorizing. you will see how this is important when you start forming a study schedule. Subjects like Pathophys, physiology, biostats/ethics, immunology and surprisingly pharmacology require that you trully understand the subject. Microbio/biochem to some level are more about memorization. Another way to divide it is to form a list of the subjects that you feel more comfortable with and ones that you truly dread. Again I will explain how this will help you organize a more effective schedule.

2. KNOW your strength and weaknesses, because it does really take 2 years and 6 weeks to prepare for this exam. Having excelled in your first two years really gives you an edge. But beware, this is NOT enough. Nor is it hopeless for those that didn't do as well. All it means is that for the former group their chances are better and the latter group have to work twice as hard. If you have generally been doing less than average on all subjects, then reassess the way you study and the way you think through problems. Maybe a different approach will help you make better connections and recall information in quicker more organized fashion.

I sometimes used old notes from HSF...this was a drawing of fetal circulation from our all-time favorite course, embryology! :P

3. I'm sure one of the many questions on your mind is: should I start studying now? To be honest, I'm one of the people that did start studying early. Did it make a difference? I can't really tell. But I would highly recommend that you focus on your current courses excell in them and use Firstaid (FA) as a guide for your Triple Jump Examinations. For now just start warming up for the study break, you will have your chance of having NO life in a few months:P
Here are some of the notes I took on Heme/Onc during Basis of Disease course...this were some of the most helpful notes...when it came to studying for heme/onc I only had to do questions and skim through the pages once and it's one of the sections I scored best on! The lesson is focus on doing well in BOD!!

4. Set up a reasonable study schedule for the five weeks. More on this later. It needs a detailed post.

5. What resources should I use?

FA, FA, FA!! (yes try to go through it at least twice!!)
Usmle world (the best Qbank source out there...don't be disappointed if your scoring 60-70% that's how tough it is)
Physiology: BRS physio by costanzo is the best!
Pathology: Rapid Review Pathology by Goljan or BRS path...I prefered Goljan, I'm a big fan :P
Embryology & anatomy: highyield series
Neuroanatomy: Highyield series (I regret not having used this book...I highly recommend you invest in getting a copy)
Biochem: FA is enough. except when it comes to cellular/molecular part
Pharmacology: FA & Uworld should be enough. I did use brs pharm, which I liked, but I felt it was too detailed.
Microbio: clinical Microbio made ridiculously simple it also covers the pharm side of it really well!
behavioral sciences & Biostats: DO NOT blow this subject! It doesn't come naturally...personally over-estimating my psych/behavioral sciences abilities really hurt my score. Invest in highyeild series for each...FA is NOT enough! And these are easy points you should not miss...

That's all for now...I'll post more up soon, inshaAllah

my on-call diary

2009-03-13T22:37:00.000-07:00

My first experience of a 24 hour call was in the Medicine clerckship. We are actually not required to stay beyond 10:00 pm, but that was not my luck on that tuesday. As a medical student I usually get the first admissions. However, that night the specialist on-call had something else in mind; He wanted me to present a case the next morning. And so far none of the admissions were "interesting" enough.

It was nearing 10:00 pm. And I was getting frustrated; If I get a patient now in my current sleep-deprived state it will take me around three hours to fully work him up, check their old file back to back and write a full history and physical. Moreover, this is was the last month so
studying for the shelf was at the back of my mind. But again the specialist insisted I wait...

As I lay in the residents room trying to catch some few moments of sleep, my bleeper goes off...it's 10:35 pm. On the other side I hear the nurse saying it's case of "PUO". Too groggy to care what that meant, I got a quick cup of coffee and headed to the nurse's station. I learn that it's a case of a 16 year old who's been having fever and joint pain the past 8 months. Every labratory work up has been negative;it's a case of pyrexia of unknown origin (PUO). I felt like I was working on a "Dr. House" case. The differential is anything from infection to malignancy. And this boy has been through alot. I knew that taking a thorough history and physical was the most important step. Five minutes into the interview and as the caffeine started to kick in, I realized how lucky I was to be handling such a case.

The hours passed quickly, I had no motivation to go back home. I had to be here early in the morning anyways, so I stayed up. Reviewed the case over and over again, as I skimmed through uptodate resources. I slept a couple of hours woke up again for morning report. I never felt more awake. I was filled with some sense of acomplishment. However, I could never compare this to real on-call situation where you normally cover and round on several patients.

Currently I'm rotating in Ob/Gyn and the calls are even crazier on this side of Hamad. I've just finished rounding with my resident on 40 patients! Not one patient was like the next; 29 weeks coming in labour, patient having triplets with threatened abortion, pre-eclampsia for induction, a misdiagnosed hyperemesis gravidarum...etc. Just when you think there couldn't be anymore patients the pager proves you wrong! And then of course there are always the patients that will need repeated evaluation, possible evacuation or C-section. Really Ob/Gyn doctors deserve great respect for the amount of pressure and work they put up with.

The day after the post-call day is usually the worst for me. On the post-call day I am too damaged to feel the physical "pain". It's like having a third degree burn when you no longer can feel the pain because of all the damaged nerve endings. The day after my body wakes up to tremendous physical & mental exhaustion.

Now third year is coming to a close and in a month's time we will be starting the sub-Is. It will be a true test of how well I handle the calls when given the full responsibility. I hope my experience will be rewarding, with all the pain, exhaustion that is part of the package.

Diving into USMLE World...

2008-04-29T12:41:00.000-07:00

Finally! We have access to the No 1. Q Bank (in my opinion) for the USMLE. It's been frustrating the past 3 days studying endlessly without questions to evaluate my comprehension of the material. Luckily, enough my schedule started with basics;basic pharmacology and pathology which is integrated randomly into the system-based set of questions.

The studying has been going slow but steady. Sometimes I feel myself getting to drawn towards trying to understand every little detail that I end up wasting too much time. I've adopted a technique to prevent that. I study the material in the time I've alloted in my schedule and pace myself accordingly. And if I feel like I need more time I add an extra 15 mins. But then that's it for time! I move on to the next topic. Whatever gaps I have left will hopefully be filled in by doing questions or during the last two week period of rapid review.

I just Hope I can maintain this level of movitation for the next...hmmm...39 days!!

procrastination vulgaris

2008-04-27T11:20:00.000-07:00

I've been wanting to start this blog for more than a month now! The whirlwind of quizes, exams, practicals, however, have successfully barred me from the attempt. And now they have left me lightheaded and very drained and in desperate need of the freeing sensation of spilling and spelling out my thoughts and experiences here.

We have just begun our USMLE (board exams) study break. The irony. How can "study" and "break" lie comfortably in the same sentence. I can almost imagine the two of them restlessly eying one another; "break" is about to jump ahead of "study" pointing out to me that I have been burrowing my head in books for months now and that I ought to "break" the "study" habit. While, study is alluring me to the idea that I should be thrilled by the opportunity to dig deep into the material that we've whizzed through the past two years and indulge myself in an experience that will expand my horizons. Not just by acheiving a desirable grade but by also integrating the knowledge and reliving the two year learning experiences in 6 months.

Study wins. For the next 6 weeks I aim to keep a daily account and update on the things I discover and the past moments I relive. So let the fun begin!