10 days to go

November 14, 2017 § 4 Comments

The time has finally arrived where I can answer “next week” when asked when my exam is. Do I have time to be writing this? Not really. But I don’t have time for anything. Not sleeping. Not eating. Not washing my hair. Accepting that was crucial. This is not an exam for which you can be “done” studying. It is not an exam for which you can perfectly prepare. It is not an exam that will allow you to feel confident with every question. So, I’m simply doing the best I can. And that is going to have to be enough.

I’ve had dips of panic in the past few weeks when examining the discrepancy between the days I have left and the things I want to get done. There are so many different recipes, techniques, methods of attack for this exam that it’s possible to lose your mind trying to figure out what you should do, how you should handle your last days. I’m lucky enough to have people in my life who have been through this and who knew exactly what to say when I needed to hear it.

Preparing for this exam has been unlike any challenge I’ve experienced before. I look forward to being able to fully reflect on this experience and to finally entertain and indulge those fleeting moments of reflection I experience throughout the day. There are so many thoughts I want to express now, but if I’m being honest with myself, now is not the time for reflection.

At present, I’m a perfect blend of anxiety and calm. The anxiety is self-explanatory. The calm comes from taking a moment to step back and appreciate how lucky (yes, lucky) I am to be where I am now. Seeing how I’ve progressed since I first started, to experience how quickly my brain works to diagnose a case, to witness how I recall and store information has been such an amazing and humbling experience. Sometimes I will actually laugh when a question comes up because I can so vividly recall the first time I dealt with that same topic in a different question, how much guilt and shame I felt then for not knowing the answer. I’m so proud of my knowledge now. I feel confident in areas I felt so weak in before. My knowledge is so much more accessible and my differentials so succinct. I have to appreciate where all of that came from, from all those moments of weakness, of feeling worthless and stupid, from all of those incorrect questions… I’m stressed, but I’m also really happy and genuinely enjoying myself. I’m giving it everything I can, I’m learning from my mistakes, I’m evolving and most importantly, I’m growing, personally and knowledge-wise.

My brain has noticed that this is not USMLE-related, so I have to go back to UWORLD, but I’ll leave you with this picture and amazingly accurate description of what these questions are like (discovered by my reddit pirate younger brother):

Original Post

Hey guys, I just took the beast a week ago. I’ve been using this forum as a resource for a while now, and I just wanted contribute those who have yet to take it.

I also posted it on SDN. This is for those want to have a “feel” for gauging the test.

One thing very difficult to grasp and that I’ve wanted to know prior to my exam was: What is the STYLE of questions compared to the practice tests. Here is personal interpretation from my exam:

Type 1. Straightforward knowledge-based question. Seen in typical NBMEs, and a good deal of questions on the Step.

What’s the state capital of California?

a) Kathmandu

b) New York City

c) Sacramento

d) San Francisco <– The only other “PLAUSIBLE” answer

e) Beijing

For these questions, if you read that paragraph on FA or heard Sittar’s beautiful voice on Pathoma, you’ll get it. Pretty straightforward.

Type 2. The verbose stem but straightforward type. Good deal of questions UWorld, some on the real Step 1.

State capitals are really nice. Some are big, some are small. The patient comes from some the state capital, and he really likes them. He also likes dogs and cats, but not skunks. Why not skunks? Because they smell. Here’s a map of Nevada:

By the way, what’s the capital of California?

Same answer choices.

For these questions, it’s simply a matter of skipping to the end (if you’re confident) or skimming it (if you’re a fast reader) and ignoring irrelevant BS. The trouble is not getting bogged down. I distinctly remember a handful of questions on my test that had the key facts in the middle of the literary novel.

Type 3a The straightforward question with HARD answer choices. Some Uworld, a large minority Step questions.

What’s the state capital of California? “OOO I KNOW THIS”

a) a large commune sitting at the base of the Himayalas. <– “OH **** can’t be Himalayas”

b) New York City <– easy elimination

c) a population center which has a subpar NBA team windward of the Sierra Nevadas. “WTF…this..maybe?”

d) a metropolitan area closely associated with the MUNI transportation system. <– you gotta know MUNI is SF and NOT Sacramento

e) a city in a province <–Classic vague answer choice.

As you can see, the QUESTION itself isn’t hard. But the answers PARAPHRASED with additional facts that you must know to answer that question. You might know that the Sacramento Kings are a bad NBA team which would help. You may have never heard the word “windward”, but you can sort of guess what that means. This is when good ELIMINATION and INTUITION come in.

Type 3b. Straightforward ANSWERS but vague QUESTIONS. A large minority of Step.

There’s areas that may determine the legislative future of its surrounding area. That large region around the Pacific that’s part of the US, what’s that legislative-area?

a) California. “What? no?”

b) Oahu. “Well, it is around the Pacific…but legislative?”

c) Sacramento

d) the White House. “It IS politically-related…but it’s not an AREA?”

e) Dolphins <–easy elimination

I would say 3a/3b are why people come out of tests so unsure. Notice how it’s awkwardly phrased with non-specific words. It’s not terribly long, or terribly anal in its wording, yet it’s hard. I suspect there’s only so many ways you can test one fact, so they gotta soup it like this.

Type 4. “WTF?!” Only seen in real Step 1.

Who’s that one construction worker who worked on that capital building of the capital of California? <–super specific

or…

Where do you get sandwiches around the capitol building? <– easy if you KNOW the answer but WHY WOULD YOU?

I would argue there’s NO DELIBERATE WAY to study for these questions, other than having incidentally heard it OR having closely listened to professors during your first two years. It helps to have good long term memory too.

On MY TEST (YMMV), I would say the approximate break down would be:

40% Type 1 questions.

15% Type 2 questions.

40% Type 3a/3b questions.

5% Type 4 WTF.

These are obviously arbitrary classifications (just as in a lot of medicine). There’s overlap and some questions can be a combination. But I hope you get the idea.

So in summary, MOST Step questions (Type 1/2/3a/b) can be answered with UFAP studying, but a good amount require ADDITIONAL processing of the question or the answers. And obviously some questions are next to impossible (type 4) but I wouldn’t worry about those.

Hope this will help someone with a similar mind to me 🙂

Still here? Let’s take a look at some snapshots from Biancasfantasticsuperamazingexcitinglife.

25 days out

October 30, 2017 § 2 Comments

I’ve told myself almost 100 times now that I can treat myself to writing a blog post when I reach my goals (for that day). Clearly, that hasn’t happened yet! So here I am, sneaking time away from studying even though I’m nowhere close to finishing today’s task list.

Studying for this exam is unlike anything I’ve ever experienced. I’m literally being tested on everything that I’ve learned, every single subject simultaneously, and there is absolutely no end to it all. I could probably study for this exam for years and years. Luckily, that isn’t what is required to pass this exam.

I am 25 days out from my exam and I am officially freaking out (while still being mildly functional). For at least the past month, I’ve lost my ability to communicate like a normal person. I can tell when I am having conversations with my friends that I’m just not making sense anymore. How do I know? Because even I don’t know what I am saying! I’ve also lost my ability to come up with metaphors that DON’T have something to do with medicine (e.g. “Haha, he’s just like a retinoic acid receptor!” or “You’re just like Class IB antiarrhythmics, both of you have a predilection for damaged tissue”). I wish I was kidding about that.  This sort of mania is something that I think only people who have studied for this exam before can understand. My friend Stephanie is the best example: she NEVER gets stressed or anxious for exams (or honestly about anything) and yet, even she had panic attacks while studying for this exam.

Luckily, teaching has been really helpful and I’ve enjoyed the break away from the books to spend time with my students. We are covering neuroanatomy this semester and preparing for the lessons has made me ace almost all my neuro questions. They’ve been amazing and are always so engaged. I share some of my Step 1 questions (the ones relevant to their material) in our facebook group and I love seeing how they process and discuss the possible answers. I’ve been so, so impressed with their knowledge and efforts!

So, what exactly is my life like right now? I wake up at 5:00 (sometimes 6:00 if I’ve had a rough night sleeping, which happens more often than not), throw random grains and nuts in the rice cooker (if I don’t have some leftover), do cardio while doing questions/watching Pathoma or Sketchy videos, shower, settle in for rounds of questions (UWORLD: I do a full block (40 questions), random (all subject and disciplines) and on timed mode every time. This is the best way to simulate the exam experience. The exam is as much about knowledge as it is about endurance.). Doing the rounds and their subsequent review can take the whole day (and it usually does). I study as late as I can and then I do flashcards in bed until I fall asleep. If I’m lucky, I’m asleep by 22:00. Obviously, there are various dips in energy and focus throughout the day. I haven’t been able to nap longer than 15 minutes for the past two months and now I’m even down to only 5-10 minutes before my brain starts going through uncontrollable UWORLD withdrawal. Now that I’m starting to get even more anxious, I’m going to start studying out of the apartment more. I need to dissociate my exam from my home if I am going to stay sane these next few weeks.

Everything in my life right now is 100%, absolutely full-force USMLE. I’ve tried to minimize all other obligations so that I can (a) have more time to study and (b) prevent spreading myself too thin and doing horribly in all areas of my life. I’ve pushed A LOT until after my exam. This includes my thesis and my gynecology final, as well as a huge chunk of my internal rotation (which I am doing now). My friends Marianne and Dushyant have offered to take some of my anatomy classes, which is extremely helpful. It is really important to me that my students have a good teacher and I’m so lucky to have strong, competent friends who are willing to step in when I can’t be that for them. Marianne is doing most of her rotations in Norway, but she is here for two months to do her pediatrics rotation and she’s been at my place studying almost every day.

Ok, the books are calling, so I’m going to leave you with some pictures that I’ve taken the past two months. Clearly, my life is little more than studying, cooking (I’ve been making literally all my meals in a rice cooker – those things are amazing!!), and going out for groceries or to walk Baloo. Luckily, I live in a really beautiful part of Budapest, so leaving my apartment is always a treat.

Music has been my saving grace through all of this. I listen to music from when I get up until I go to bed – and the selection is all over the place!

 

Berlin

September 7, 2017 § 4 Comments

The date is set! There’s no turning back now.

Registering for Step 1 is a pretty long process (really a lot of waiting). First, you have to register with ECFMG. Once that is assessed, you are sent an ID number and eligible to apply for a three-month exam window (I chose September to November). Then you need to submit a form to your university, who then has to send it to the US for further processing. That’s where the waiting comes in; I completed my application in mid-June and didn’t receive my scheduling permit until the end of August!

(Studying for USMLE: You know you’re in deep when you get really, really, genuinely excited about seeing “cerebral amyloid angiopathy”!)Screen Shot 2017-09-07 at 19.30.03

I already knew that I would be taking my exam at the end of November, but I didn’t know the exact date or location. Amir took his Step 2 exam in Berlin and really loved the city and the testing center, so I decided to follow suit. I’ve been putting off setting the date because….well, there is really isn’t a good reason. Once you set the date, things suddenly become very, very real, and I was probably trying to put that off for a little longer.

I’m extremely nervous for the exam. I want to do well and I have so much going on in my life right now that I’m worried I won’t have enough time to prepare myself. But there is nothing I can do about that. I can only push forward, maximize my time and hope that my best is good enough.

My final exam in surgery is on Tuesday, so I’ve switched over to exam cramming for now. I am so, so thankful that studying for exams doesn’t mean covering an entirely different subject! The surgery exam consists of three topics (out of a possible 168) and we are examined orally by one general surgeon and one trauma surgeon.

That’s all for now! Be nice to me, Berlin…

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Berlin

 

Starting over

September 2, 2017 § 8 Comments

I’m struggling to find the words to describe where I am at this point in my life. These past two and a half months have changed me. They’ve forced me to face parts of myself that I either never wanted to face or didn’t know even existed. I’ve had to evolve and grow all while embarking on some of the greatest challenges I have yet to encounter.

I’m in my final year of medical school and the idea that I will be a doctor this time next year is… paralyzing. It’s exciting, yes, but paralyzing at the same time. I’ve spent more than half of my life trying to get to this point and now that it’s finally here, I feel like I don’t know what to do with myself. Knowing that I am about to achieve THE goal leaves me feeling almost empty. Checking that box will mark the end of almost 20 years of doing everything I possibly could to make this happen. It makes me wonder, will anything ever even come close to that?

Since I last wrote, I’ve been re-familiarizing myself with… myself. All while studying for one of the biggest exams I’ll ever take. There have probably been more bad days than good days, but the bad days are becoming fewer and fewer as time passes.

We started sixth-year rotations in the middle of July. My first rotation is surgery, which lasts for about 8-9 weeks. I only have one week left now and will take my final exam on September 12th. I’ve really been struggling with how to balance everything on my plate. I’m planning on taking Step 1 at the end of November and that exam requires EVERYTHING from me. But I can’t give it everything. I have my final exams in surgery and obstetrics and gynecology (not to mention the rotations themselves). I have my thesis. I have teaching. I have applications for next year. It’s…suffocating.

So where am I now? What am I doing? What am I going to do? These are all questions I’ve asked myself almost daily since the beginning of June. If I’m going to be completely honest, this has not been an easy summer for me. Everything I thought I knew about myself, my life and my future changed. My foundation fell out from under me right when I needed it the most. I needed to be the best version of myself and I didn’t know how anymore. So, I slowly started picking up the pieces, forced myself to accept whatever I was able to produce – regardless of how small – and pushed forward.

I turned 30 almost two weeks ago. I really wish I could describe the feeling I had that day. I know that birthday means different things to different people, depending on where they are in their respective lives. For me, it meant everything. It meant saying goodbye to myself. It felt like starting over. Like stripping myself of everything I knew. Complete and absolute vulnerability and, oddly enough, strength. What made the experience even more “life-altering” was the fact that I celebrated it in the historic city of Acre, Israel with my best friend and his family.

7c5dd14a-2472-4d72-a70c-dfbe681fb97c.jpeg

In the days leading up to my birthday, I was in a constant state of reflection. With the way my life has developed, the multiple life paths I’ve entertained, the struggles I’ve endured to get here…it’s not uncommon for me to take a moment and think about where I am versus where I would have been. Whether sitting on the banks of the Danube with a bottle of wine, wandering through the crumbling barracks of Auschwitz, looking out over the fjords from Tåkeheimen, reading the names on the stone plaque beside a Sarajevo rose, or feeling the jasmine scented footprints of Muhammad at the Al-Aqsa mosque in Jerusalem, I always have the same thought: I wasn’t supposed to be here. In that moment, I think about all the points where the course of my life changed, all the decisions and challenges that brought me there and how rich and special my life is as a result. On the eve of my birthday, I stood alone on Amir’s parent’s balcony and watched the sun dip into the sea. As I sipped a glass of wine, I said goodbye to myself as I knew me in my 20’s and reflected on who I will become in my 30’s.

 

 

That trip changed everything. I had a moment in the car on the way to Jerusalem where everything clicked. Suddenly, I could see my future. I saw exactly where I want to be and what I need to do to get there. Every time my future has crossed my mind in the past two years, it’s been followed by absolute nothingness. It’s been a source of anxiety and fear and prevented me from enjoying the present. So when everything clicked, the feeling was indescribable.

Once I’ve worked out some details and made some progress with my plans, I will share them here – I promise.

Otherwise, things aren’t very exciting here. I pretty much only sleep and do practice questions. I’ve been sick since last week and my cough has been pretty extreme. Since I’ve been holed in my apartment studying, I didn’t even notice that I’d lost my voice until I went to the pharmacy to pick up an expectorant. When I opened my mouth to utter the first words I’d spoken aloud in three days, nothing came out. There were a few strange squeaks, followed by a long, intense cough. The pharmacist began to laugh. I laughed and coughed. Exciting stuff.

It’s off to bed for this one! To be continued 😉

 

A picture is worth a thousand words

June 20, 2017 § 4 Comments

So much has happened in the past two months that I hardly even know how to write this post. It makes me sad to think that there are memories that are lost or that will fade because I didn’t have the time to write them down here. This blog has documented almost every step of this journey – from applying to medical school to now. Though this year has a bit less documented than the others, I plan to continue it until the end.

The weeks after we returned from our trip to Ukraine were a complete whirlwind. I honestly can’t even organize my mind enough to put those weeks into words, so I think my only option is to describe these past months in photos.

Ukraine Trip
April 26th

Helping out at the anatomy competition

April 30th

Even Baloo finds studying for exams exhausting

May 1st

Baloo brings everyone to the yard

May 3rd

Notes everywhere! I was trying to gather together all the hematology notes I’ve taken since 3rd year, since we were tested on it again in internal medicine this semester.

May 4th

Going through cranial CT scans in neurology

May 5th

Jannie’s 30th Birthday!

A quote I wrote in her birthday card

May 6th
May 7th

May 8th

That feeling when your puppy sleeps in the same room as you so that you’re not alone during your all-nighter

May 10th

Marianne signing her contract as a student doctor!

May 11th

Cram time!! 4 days out from Internal and Gyno

May 12th

Huge day – LAST LECTURE EVER!!

Last dinner with the gang

May 13th

Weekend of hell! I had 6 exams the following week and had already been cramming for weeks up until this point.

May 14th

An idea of what I was up to during the month of May

May 15th

May 16th

May 19th

Sword and Scale is my ultimate guilty pleasure podcast!

May 20th

It’s nice that some of us get to sleep in

May 21st

When your notes randomly pop up somewhere on the internet..

May 24th

Studying for my last exam with Marianne!

May 25th

DONE WITH MY LAST EXAM PERIOD EVER! Still can’t believe I survived 10 exams in 2 weeks.

May 26th
May 30th

Dedicated Step 1 studying time – here we go!

June 1st

Charlotte’s Birthday!!

I love this city!

June 2nd
June 3rd

Wandering the city and running errands while listening to a new favorite podcast

June 5th

Goodbye dinner with this one 😀

June 7th

Re-discovered my old, little notebook of quotes

What happened after all this? Well, a lot. After 8 years together, Skjalg and I split up. We love each other very, very much and will continue to be good friends. As he is off to Stavanger to complete his 6th year (and I am staying here), I’ve moved into a new studio apartment. The past two weeks have been a bit heavy, but now that the moving is complete and I am finally in my own space, I’m really happy. I whittled down all my belongings to the essentials, donated 3/4 of my clothes, gave away tons of my notes to one of my students. I tried to take only what I really needed. It is so utterly liberating to not be tied down by tons of things. With the recent changes in my life, my future is now a blank slate. I have no idea where I will end up after medical school, but I’m really excited for the year that lies ahead, for the challenges that await.

Here is my new place before I moved in:

And here it is “Biancified”:

Alright, back to studying I go!

Ukraine, here we come!

April 20, 2017 § 1 Comment

After my last post, my streak started to suffer a bit (I either jinxed it, or I started getting a bit tired. Probably the latter!). I didn’t feel well this weekend, so I left the library early on Saturday and spent the rest of the weekend studying at home. I returned at 6:30 on Monday morning (in order to get in a full study day before picking up Baloo, who came home that day). I’m still so shocked at how many people are at the library. I’ve spent so much time studying at home, random cafés or hidden libraries that it’s like I have no concept of just how many people I go to school with. We’re probably a couple thousand across all the years and all the faculties Hungarian, English, and German). It’s been really motivating to study in the same building as so many similar students.

In the end, I ended up with 83 hours and 5 minutes towards obstetrics and gynecology studying over break. I honestly wish I had gotten through more topics, but I’ve come to accept that most of my goals are unrealistic and that I should be happy with any progress I am making. Considering how poor my studying was at the beginning of the break, I’m pretty satisfied with the turn-around!

This week we are in our trauma rotation. We started the day with four back to back lectures, then spent an hour in the emergency room and finally an hour practicing suture techniques.

On Tuesday, six of us stayed for our extra shift in the emergency room. Previously this consisted of returning to the hospital from 15:00-22:00, but today we were expected to just remain at the hospital until 19:00.

There was a huge queue in the emergency room when we got down there. In the main entry there were three stretchers with their corresponding two paramedics waiting to enter the exam room along with at least a dozen other patients. The next few hours were a bit of a whirlwind. Trauma doctors see an unbelievable amount of patients in a short amount of time. Each of the patients has about two minutes with the doctor asking them questions and examining them. Then wounds are bandaged, blood taken, etc., by the nurses. Then the patients are sent off to imaging or surgery. I really loved the dynamic, high-energy environment. Next week we have our actual emergency medicine block and I’m excited to learn more about it as a specialty.

In other news, Skjalg and I are leaving for Ukraine today! We are going on a medical screening trip organized by our university. We will be visiting various rural areas for a total of four days. Each of the English students is paired with a Hungarian student and we will work at different stations: history taking, physical exam, EKG, blood sugar monitoring, etc. I’m a little nervous, but I’m really, really looking forward to it. The weather is going to be horrible and some of the locations don’t have any heating, so we’re definitely in for an experience!

Library wormhole

April 13, 2017 § Leave a comment

I’ve fallen down the rabbit hole. I met up with my friends Stephanie and Amir for a drink on Sunday evening (after a weekend of study-fighting against myself). They are both only a week or two out from their Step 2 exams (for the USMLE) and the weight of that was almost palpable. When Stephanie told me that she had been studying at the school library, I made up my mind to join her the next day. I love the comfort of studying at home, but lately, that comfort is just slowing me down.

Fast forward to now. Every day, I get up at 6:00 to have breakfast, shower and prepare my food for the entire day.  I hop on my bike and then before I know it, I’m seated at my favorite spot in the library. I’ve gone every day this week and it’s already starting to feel routine. In fact, I hardly even know what day it is. I feel like I could continue on this way forever. On top of that, my focus has been almost robotic. After 4.5 years in medical school, I’ve learned to take breaks for the sake of increasing my overall productivity. But this week? Totally not needed. I’ve been sitting – with lazer focus – for over 10 hours – almost everyday. The only time I’ve gotten up is to go to the bathroom. I’m not on my phone, I’m not napping or talking to friends – I’m not even leaving to eat my lunch and dinner (I eat them while I’m reading). Healthy? Not so much. My body hurts from all that sitting, no matter how many different positions I can come up with. Productive? Absolutely. And it’s honestly just what I needed. It’s only the end of Thursday and I’ve already put in 48 hours and 14 minutes of high quality studying. I find this so strange – and almost shocking – but I’m going to milk it for as long as I can. Like I said, this is just what I needed. Pure, productive and uninterrupted study time.


After Easter, we only have 4 weeks of school until exam period starts. We have 8 (or 9?) exams that I need to power through as fast as humanly possible in order to reach my holy grail: dedicated Step 1 study time. I need it so badly – and I’m so close – I just need to attack these hurdles head on. My plan of attack is to study for my exams as much as possible now so that I can finish all of my exams within the first two weeks. If I can do that, I will have 6 or so weeks of pure USMLE prep goodness until rotations start in the middle of July.

Enough of an update for now! The wormhole is calling…

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