The Tests that Keep Us Here – USMLE Steps

Yesterday I took the USMLE Step 2 Clinical Knowledge here in Redlands  and I thought, “What better time to write a little information post about my experience with the tests medical school requires?”

I’ve also linked the official websites for each test so you can read more about them.

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When I started medical school, I knew there would be tests.

I had vaguely heard of Step 1. I assumed there were more steps; otherwise why would you number them?

Beyond that, I was lost.

So, because many of you may be planning to go to medical school, or you’re already here but haven’t taken Boards yet, or you’ve done Step 1 but not Step 2, or you just like reading these things because you’re related to me – here’s what little I know from experience about these tests.

Overview

MCAT: Gets you in to medical school.

USMLE Step 1, Step 2 Clinical Skills, Step 2 Clinical Knowledge, Step 3: Let’s you keep going and become a doctor.

MCAT: Medical College Admission Test

Information: AAMC

First things first.

As a pre-medical student, this test felt like the most important thing in the world.

It’s offered multiple times a year, computer based, and has sections on Verbal, Physical Science and Biological Science. When I took it (4 years ago) it also had an essay section, but I heard they’re changing the format with that a bit.

I took it in May after my Junior year of college. I crashed my car into a school bus the week before. Things happen.

I had to go about an hour away from my house to the test center, so I stayed in a hotel right down the street the night before – traffic stress is the last thing I needed.

And I watched the season finale of Grey’s Anatomy the night before. That was a great decision.

The most important thing I can say about the MCAT is that practice counts. It was definitely worth it to have study materials that included computer practice tests.

I spent a summer teaching the Kaplan MCAT course before I came to medical school, and while I have nothing but sorrow for the students who were forced to listen to me all summer [because of my poor lecture ability, not the content], I know they had a good chance of doing well simply because there is SO much practice built into that course. I self-studied out of a Kaplan book and that was right for me, so it depends on your study style of course.

And while it is 100% important to take and do the best you can in terms of going to medical school, there’s so much more ahead it becomes very small in retrospect.

And the best part is that once you’re in, you can forget Organic Chemistry almost completely.

USMLE Step 1

More information from USMLE.

This exam is taken after the second year of medical school. It is generally a requirement to pass both this and Step 2 before you will be allowed to start residency.

Here at Loma Linda, as in most places I expect, you must pass Step 1 before you continue on to Year 3. The school gives us the benefit of the doubt and lets us start rotations while we wait for scores to return, but students then leave rotations to take it again if a passing score isn’t earned.

You register for the test the winter of the year you will take it – so for me I think I registered in January and took it in May. Test sites do fill up – the nearest one for us is the Sylvan Learning Center on Palm in Redlands.

It covers basic information from the first two years and is arguably the most difficult and requires the most focused study time.

How to Prepare: You can get truckloads of differing opinions on this. I would say that the UWorld Question Bank and First Aid are pretty much the ones no one will argue with you about. Everything else is take it or leave it depending on your style. Just study.

The Format:

-Computer based testing. You will have a locker for belongings that you are allowed to access at breaks. Food, drinks, notes, your phone – it’s all fair game at break time. Personally I couldn’t bear to look at notes during the test, but some of my classmates are all about it.

-Blocks: The number of questions in each block may change from year to year. For me it was 7 blocks of 46 questions each.

-Timing: You have a set amount of time for each block, 15 minutes dedicated to a tutorial [which you can skip for extra break time], and 45 minutes of break time.

-Breaks: You choose when to take your breaks and how long they will be. I did this:

Block 1, Block 2

10 minutes

Block 3, Block 4

20 minutes

Block 5

10 minutes

Block 6

10 minutes

Block 7

If you finish a section early, it adds to your break time. I found it hard to take extra break time though. About 10 minutes and I was antsy to get to the next block. Hydration and food are important of course, but it’s a balance. If you hydrate too much your bladder will distract you from the test, and if you eat too much at once you may fall asleep. I sipped a little from thermos of tea at each break and had a small snack to avoid too much volume at once.

There was a guy [from a different school] who had a gallon of milk and a whole loaf of bread with him. I have no idea.

-Managing disaster: I also had a quasi-break during Block 7 because the power went out. The room went completely black, including all our computer screens. That was highly stressful, but the test gets constantly saved to a server, so we were able to start again where we left off and there were no problems with scores later on. The LLU School of Medicine administration really came through for us and made us feel like everything would be okay. Still, I was pretty much a stressed basket-case for like 4 days after.

-Passing scores and average scores vary from year to year. Check the link at the top for the most updated information.

USMLE Step 2 Clinical Knowledge

More information from USMLE. 

This test is typically taken after Year 3 and focuses on the clinical science we’ve covered in the past year. There is more of a focus on diagnostic process and treatment in addition to disease process.

How to prepare: Again, piles of opinions on this. The UWorld Question Bank is #1. First Aid is less ubiquitously used – personally I found that studying sources I was already familiar with was best for me, so I used Step Up to Medicine, because that’s what I used for the Medicine clerkship, and I supplemented other topics from the question bank. You do have a fair amount of knowledge from rotations too – maybe more than you think. I liked USMLE Step 2 Secrets too for the days right before – it’s just a very quick easy read of high yield information. Then again, I don’t have my score yet, so this advice may very well turn into “How you should not prepare,” – I’ll let you know.

Format: Step 2 is similar to Step 1 in terms of computer-based, block format.

It’s a 9 hour test – 8 one-hour 44 question blocks with a 15 min tutorial and 45 minutes of break time.

I broke it up like this:

Block 1, Block 2

10 minutes

Block 3, Block 4

10-15 minutes

Block 5, Block 6

10 minutes

Block 7

10 minutes

Block 8

Sometime in Block 6 was when my eyes started feeling really unfocused. It’s normal. Blink. You can do it.

I would say it didn’t feel as rough as Step 1 – but I can’t really compare because with the power outage in my Step 1, it’s hard to know the real source of my distress. And again, I don’t have my score, so I really don’t know. It certainly got very hard by my last block – maybe it was fatigue, but I genuinely think I had more questions at the end I just had no idea about.

USMLE Step 2 Clinical Skills, USMLE Step 3

More information: Step 2 CS, Step 3

These are still in my future, so they’ll have to be a later post. Step 2 CS is on August 16 for me, so I’ll keep you posted. Step 3 is taken during residency, so I’m going to just not worry about that for a while.

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Questions? The Dean’s Office is a great resource, and of course I or any of the upperclassmen are happy to answer questions. I got a lot of advice from those ahead of me before I went through it.

Time Management

Kari, Third Year Medical StudentHi friends. Guess what? Even though I did my Pediatrics rotation a while ago, I’ve managed to sneak my way onto another Pediatric service as part of the Neurology rotation. I so miss the fifth floor when I have to go other places. But this post is about what I do with my time when I’m not on the fifth floor.

I was whining to my fiance John last night about how it seems like I waste time and don’t get anything done – lamenting my time management skills. It seems like I get home, wind down a second, have some dinner and the next thing I know I’m supposed to go to sleep and I’ve barely had time to study.

This is the USMLE World Question Bank. We should probably hang out more than we do.

I presented a recent night as an example: I was in the hospital from 6 am to 5:30 ish, made it over to the gym for an exercise class, got home, and by the time I cleaned up and made dinner it was literally like 8 pm. And of course Criminal Minds was on and I got a little sucked in and even though I was simultaneously getting worked over by some Neurology questions it didn’t really feel like I accomplished anything.

So I was whining.

John’s response?

“So you’re saying you worked about 12 hours and went to the gym and you’re concerned because you didn’t get anything done?”

Oh. Right. I worked for 12 hours.

I think we forget sometimes that all the things we accomplish as part of the work day count too. I know I’m not alone in that – we really expect a lot of ourselves.

We expect that we should somehow be able to learn ALL the things on top of the long hours. When I don’t know the answer to a question when I’m on service I feel sad. Like it was my responsibility to find time to already have that memorized. It doesn’t matter what it is; it feels like I should know.

My ideally time-managed day from an academic perspective would probably not include anything fun because the hours of studying I would fit in would crowd out everything else. And that just doesn’t make sense.

Bottom line?

Time management = Doing your best. And when you’ve watched some TV,  took your time chopping up vegetables for dinner and gone to bed too late because you were reading something that’s not a textbook, that’s okay.

Because you work hard. And because medical school isn’t just about learning medicine – it’s a trial by fire of how to spend your time, and we’ll all make it. Right?

A new low…

Ingrid, Second Year Medical StudentMy eyes narrow to focus on the words taunting me from the bright screen. My unruly brows furrow deeper, carving a marked crevice into my forehead. A Uworld question directly confronts me.  In the far recesses of my mind, I try to imagine where I saw that rare artifact of knowledge.  Was it in First Aid or my notes or did I hear that from Goljian, King of Pathology? My mind draws a blank. That seems to be happening a lot lately.  As I force myself to march forward against the onslaught of Uworld questions, I realize that my medical school knowledge is buried way too deep or I forgot where I hid it.  Either way, I lose.  Uworld always wins.

This has been my life for the last few months. Every night I do Uworld questions and read my First Aid, practicing for my upcoming duel against the great nemesis of all second year medical students:  STEP 1 (the first of three Boards exams required to complete the United States Medical Licensing Examination, or USMLE)  I will be honest. After all, I agreed to write this blog so all of you who may be interested may catch a glimpse into the highs and lows of medical school.  The months leading up to Step 1 are a definite low.  I will not pretend and say things are going great and that I am ready to slay the dragon.  No. Everyday I study for my classes and then study for Step 1 after that. 15 hours a day. Easily. Do my practice questions or tests reflect that effort?  Not even close.

Signs and Symptoms of Ingrid’s Low Point: 1.  Went to Stater Brothers on Thursday evening to buy ice cream and eat my pain away in pajamas 2.  Went to study at Olive Ave Market on Friday and realized I was wearing a shirt that I apparently already wore since there was a beverage stain right in the front and middle… 3.  Forgot to check Anthropologie’s website on Tuesday (that’s the day that they update all their sale items to their website).  This is perhaps the most troubling sign. 4.  I want to eat all the time: Kettle corn, shortbread windmill cookies and yogurt covered pretzels are my food medications at this time. 5.  My eyebrows are out of control.

In spite of all this, life is not all bad.  God has sprinkled my life with bright spots to keep me going.  First, His presence strengthens me day by day.  When I am discouraged, He keeps me going and I can rely on His promises to get me through.  My husband, Devon, has been very supportive.  He’s even taken up grocery shopping, making salads to ensure I get my 5 servings of vegetables and antioxidants, and cleaning the house for my mental health.  Last Sunday was the last day of spring break, and I took the day off from studying. Sort of. Devon and I drove down to Orange County listening to the sweet sounds of Papa G (Goljian)  playing on the sound system.  As his crooning voice explained the ins and outs of neoplastic diseases, we arrived at Bruxies to eat waffles and shop at Fashion Island. Later that afternoon, we drove to Little Saigon in Westminster and got 1 hour massages.  I felt sorry for the poor Chinese man who had to work out all my knots. All that relaxation worked up our appetites, so as we sat by the window booth watching the rain fall, a bowl of steaming lemongrass pho was placed before us. Great food and scintillating conversation with my best friend.  Thoughts of Step 1 were far away.  Perspective at last…  Ready for the last quarter of second year.

A week later, its time for church. The clock tells me I’m late.  And yet, my wayward eyebrows scream to me from the mirror.  Be on time for church or groom my eyebrows?  I decide to do the public a favor and groom the hedges.  So although I am late, all of you should thank me….You’re welcome.