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!

 

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.

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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!

My First Scientific Conference

February 11, 2017 § 8 Comments

It’s almost 3 in the afternoon and I’ve only been awake for 2.5 hours. Even still, as I lay here in bed writing this, I’m considering taking a nap (Edit: it’s now 19:00 as I continue writing this… I fell asleep for another 3 hours).

This week was scary, amazing and all-consuming. Almost everything I did was outside my comfort zone. There were some really high high’s and some very low low’s. Everything is changing now. We are nearing the end of this giant, life-altering chapter of our lives and that fact sinks in deeper and deeper with each passing day. I feel like I’m standing in a giant room with every door and window open; time is running out and I need to escape this room, but I don’t know which door or window to go through.

Now, let’s take you through the past week:

MONDAY

  • 8:00-12:00Hematology practice on the Buda side
    • Leave an hour early to make it to anatomy on time
  • 12:00-13:30 – Teach anatomy
    • Colleague is sick, so take on his class as well. Come up with a plan for making the practice useful for your now 25 students.
    • Teach cardiac embryology and hope that they at least understood half of what you were saying.
  • 13:30-14:00 – Try to help your students with a scheduling problem they have with PE and anatomy.
  • 14:00-15:00 – Last minute preparation for public health (PH) research presentation
  • 15:30-17:30 PH research presentation
    • Mock presentation of your research for the entire department
    • Note down critiques and tips and answer any questions
    • Sit in on the presentations and critiques of two other Hungarian students – all in Hungarian
  • 17:30-18:30 – Get home and eat dinner – you’ve only had two protein shakes so far today
  • 18:30-22:30 – Work on changes to your PH presentation

TUESDAY

  • 8:00-13:00 –  Hematology practice
    • Try to pay attention and learn something, but you are 18 people crammed into a small room and you can’t think about anything other than your research projects.
    • Leave early with Amir to work on surgery research project. Note to self: make-up missed session later (just another thing to deal with).
  • 11:00 – Find out you’ve been rejected from the 6th year program in Stavanger, then immediately after, get a call from your boyfriend that he was accepted. Feel extreme happiness and sadness simultaneously.
    • Ignore your emotions so that you can focus on your research project
    • Best friend pushes you to talk about it. Feelings and fears about your future as a doctor rush forward. Freak out about the future for 30 or so minutes.
  • 12:00-22:30 – Surgery research project
    • Literally 10.5 hours of constant work on your presentation. Remember all that statistical analysis you did in December when you wrote your abstract? That doesn’t make sense anymore. Re-learn it and do it again.
  • 22:30-02:00 – Home to finish up project while talking about Stavanger with boyfriend
  • 02:00 – Submit presentation to advisor
    • This still counts as Tuesday night, right??

WEDNESDAY

  • 8:00-13:00 – Work on presentations
    • Make final changes
    • Look up any articles/data needed for any potential questions about your research
  • 13:00: Find out that you need to attend the laparoscopy competition on Friday and need to find someone to cover your classes 
    • Luckily, one of your TAs is a close friend and amazing human being! (Thank you, Marianne!)
  • 14:00-15:00Surgery research presentation for your advisors (one of which is the head of the department)
  • 15:00-16:00 – Watch 4 sessions of the Hungarian student conference while waiting for your public health advisor
    • Get smacked in the face with the reality of what is going to happen to you tomorrow.
  • 16:00-16:30Meet with public health advisor to go over finishing touches on presentation
  • 16:30-17:00 – Rush into a store to find a suit jacket for tomorrow
  • 17:00-18:45 – Amir’s place to work on changes to surgery presentation
  • 19:30-02:00 – Work!
    • Finalize both presentations
    • Practice presenting
    • Make quizzes for anatomy class – and start grading quizzes from Monday!

THURSDAY

  • 07:00 – Get ready and practice presentations
    • Realise you’ve made a mistake in your presentation and go through the data again. Make the change in your presentation.
  • 10:00-11:00 – Attend presentation by Thieme at the anatomy department.
  • 11:00-12:45 – Practice presentations at conference location
  • 13:00 – Session starts!!

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  • 13:35 – Surgery research presentation
    • Maximum 10 minutes
    • 5 minute question section, where jurors can ask any questions regarding your work. Some of your questions:
      • How did you account for the potential bias of those that volunteered for the experimental group (i.e. that they were already interested in surgery as a profession and therefore likely more skilled)?
      • Do you plan to redo the study and if so, what measures will you take to increase the statistical significance of your results?
      • What role do you think gaming systems play in the development of laparoscopic skill and technique?

sabstract

  • 13:45 – Rush out of room with Marcus (a fellow 5th year student presenting with you in the next block)
    • The block for your other presentation is already halfway done and you have to sneak in and upload your presentation during the break
  • 13:50-14:50 – Observe presentations of all other students of your block.
    • Marcus does an amazing job and gets more questions than you’ve seen anyone get (he worked on a study comparing different EKG readers).
  • 14:55Public Health research presentation
    • Maximum 10 minutes
      • Get a little thrown off when one of your animations messes up and shows Dresden and Munich as being in the middle of the North Sea. Marcus tells you later that you made a nice save.
    • 5 minute question section, where jurors can ask any questions regarding your work. Some of your questions:
      • What explains the age difference between the analysed subgroups?
      • How did students specify their desired specialty?
      • Do you have similar statistics showing predictive factors of other specialities?

phabstract

  • 15:15-19:00 – Pictures, celebrate and nap before the closing ceremony.

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  • You didn’t finish grading the quizzes from Monday, so you have to do it while celebrating with your friends at Spiler.
  • Luckily, your friends are awesome and split the grading with you. Cocktails and grading for the win!

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  • 19:30Closing ceremony
    • On the way here, Skjalg brings up how he thinks you could win. You tell him to stop bringing it up because you don’t expect it and don’t want to start thinking about it. You’re just happy with having presented.
    • The ceremony starts and people keep asking you what section you were in. You honestly don’t know. Getting through the day was literally the only thing on your mind.
    • You recognize a name in 3rd place of one of the sections. Skjalg, Amir and András (your advisor) get antsy. Second place is announced and you see your name flash across the screen as it is read out loud by the conference director.

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    • You walk up, get your prize – in complete shock – and then return to your friends.
    • The next section results are read. You’re busy looking at your prize and diploma – still in complete shock. Suddenly, your and Amir’s names are read out loud for 1st place.

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  • Back to the front you go – is it possible to be more in shock than to be in complete shock? You and Amir are both so surprised that it makes for one of the most endearing and genuine moments.

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  • 22:00 – Bed
    • Have you ever been this tired before? Probably, but it doesn’t feel like it.

FRIDAY

  • 06:00 – Suturing practice
    • Laparoscopic competition is at 8:00 and you haven’t practiced suturing in a long time
    • No chicken breasts or bananas present….this kitchen glove will have to do!

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  • 8:00Laparoscopy Competition
    • 1st round – Peg transfer: you do great during warm-up, but when the comp starts, you drop your rubber tube twice! This adds 40 sec onto your best time and puts you in 12th place.

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    • 2nd round – string 5 pieces of straw onto suturing thread: you drop one of your straw pieces (again!)

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    • You (somehow) manage to snag 4th place. Your amazing boyfriend rocks it with 3rd place!

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  • 13:00-17:00 – Last day of haematology practice on the Buda side
  • 17:00-18:00 – Psycho-cleaning of the apartment
  • 18:00-midnightIndian night with your friends!! And a perfect way to close a hectic week.

indiannight

Click here for all of the abstracts by presenters at the conference.

In summary:

  • I was rejected, and Skjalg accepted, from Stavanger. This means that I will be here in Budapest for 6th year and have to find a new place to live (for myself). Skjalg will be in Stavanger for the entire year and will come back to Budapest every few weeks for exams.
  • I won 1st place together with Amir for our surgery research project and 2nd place for my public health research project.
  • Skjalg won 3rd place in the laparoscopy competition.
  • I have amazing friends from all over the world.

I’ve slept for about 16 of the last 24 hours, which is a pretty good indication of how I am feeling right now. This week was a heavy one. A really, really heavy one. But in the end, I am so happy for it. It felt so good (afterwards) to have pushed myself through something I never thought I could do. I’m happy that I have the strength to throw myself in new directions and the support system to care for me when I don’t quite make it.

 

4th Year: CHECK! MD without the .

July 3, 2016 § 8 Comments

Skjalg told me that he’d heard that you get the “M” after the first two years, the “D” after the second two, and the “.” when you graduate. So, we’re officially MDs!

It’s been way too long since my last post. After Moscow I only had a week and a half before my next pharmacology midterm. It was a big deal for me because we needed over 80% on both midterms in order to qualify for the competition at the end of the semester. I put so much time into my pharma studies that this was probably the most important thing to me. I wanted to know it in and out and prove my knowledge to myself by passing the competition. The studying for the midterm paid off and suddenly there were only 2.5 weeks left in the semester. In true Semmelweis style, we were overloaded with mini-exams/competitions/papers, etc. at the end of the semester. It’s worse in the first two years – mainly due to the lab exams and the third round of midterms – but it can still be quite heavy depending on the amount of electives you have. I spent so much of this semester trying to master the new topics that I didn’t really get to review too much of last semester’s topics. As I write about it now, I feel as though I should have had enough time….but I promise that I did the best that I could with the time I had. So, I had less than three weeks to prepare for the competition. Weeks peppered with various exams, classes and other extracurriculars, like helping out with the anatomy competition and tutoring.

The competition took place on the last day of the semester. I had been through the topics twice and had a strong general knowledge of the subject. In the hours before the exam, I went through questions in BRS and Katzung and got around 75-85% of the questions right. I was at a point where I actually felt excited for the competition.

We were only ten English students, maybe four German and up to maybe 80-90 Hungarian students there that day. I sat in the front – as I usually do during exams, so as not to be distracted – and felt my throat cramp into a knot. When I opened the exam and started reading through the first questions, I felt like the blood had been drained from my body and replaced with adrenaline. Everything looked foreign. It was like I’d never studied before.

We had 60 minutes for (if I remember correctly) 60 questions. Normally, I go through and answer all the questions I can really quickly, go through a second time and answer the ones I marked for later, and finally a third time to check my answers and answer any stragglers. This exam was not like that at all. As I moved onto each new question, without having been able to answer the one before it, I completely lost all my confidence. I tried starting from the back, returning to the front again, jumping to the middle – nothing worked! I found a chunk of five or so questions that I felt I could answer correctly and gained back a little of my self-esteem. I looked at the clock. Thirty-five minutes had passed. I’d answered five questions in 35 minutes. I began to panic and started looking through the questions again. The answer choices were mixed with drug names/features from different drug groups/topics so they took a while to process. For example, it’s easier to pick out the drug with “anti-hypertensive effect” from a list of drugs acting on the cardiovascular system than a list of drugs from entirely different systems. There were also some questions that were, I thought, ridiculous. For example, “Which of the following drugs has the highest molecular weight?” followed by a list of just names of drugs. Molecular weight was not something we were expected to learn. It’s enough of a mind melter to remember the group, the physiology, the names, the mechanisms of action, pharmacokinetics, effects, side effects, drug interactions and contraindications. As a doctor, molecular weight is not something that trumps the knowledge of how the drug works, how it will help my patient, any side effects it may cause, how it may interact with other drugs, etc.

When I looked at the clock the second time, I only had twelve minutes left. Twelve minutes to answer maybe 25 or 30 questions. In those last minutes before the end of the exam, I was at a point where I was just selecting answers at random. It’s something I hate to do and something I can’t remember having done since first year. It hurt more knowing how much time and effort I’d put into it and how easily that confidence was taking away from me.

I had my exam six days later. They never posted the results of the competition, so I never found out my score. I had to ask my Hungarian friend Cintia if she knew anyone who had taken it and if they had any information. She told me that one of the guys in her dorm passed the competition. The winners had been notified by email. All were Hungarian and all were from medicine. No English, German or dentistry students made the top 10. (Edit, April 15, 2017: There was at least one English student who passed).

The days before the exam were not what I wanted them to be. I’d lost the excitement that I had before the competition. Instead, I felt defeated. I tried to motivate myself, but I was just too tired and was dreading the four weeks of exams that lay ahead. During the semester, I’d put absolutely all of my focus on pharma. Once that exam was done, I knew that I would pretty much have to start from scratch for the rest of my exams. Only my friend Amir and I took the exam that day. It was the same day at the one-time-only written exam for Bioethics, so the rest of the class was there. All 180-190 of them.

Our examiner was an older woman. She was kind but stern, a perfect mix of both. She and I did not communicate well at all. I tried my best to speak slowly and clearly, but she still misunderstood me and there were points where she would ask me questions that I had already answered. Those are the worst because it takes you forever to figure out what they want. You know you’ve said it already and don’t realize that they didn’t hear it, sometimes until it’s too late. The same thing happened to me in my pathology exam.

The topics I got were also quite…weak. All three of them were from the first semester and they were kind of “leftover” topics. The ones that don’t really have a place and are kind of thrown in at the end. They lack a system and are therefore just annoying. I’d gone through them, of course, so it wasn’t a problem recalling the information. But they weren’t the kind of topics that you could impress with. They weren’t topics that I could use to really show my knowledge – especially when an entire semester of material wasn’t even relevant! Together they represented maybe 0.5% of what we needed to know for the exam.

I was exhausted, defeated and stuck in my own head. I feel locked inside myself. Unable to show what I really knew. To convey the effort that I had put in. To prove my knowledge. On my third topic, I made a huge mistake. I said that clindamycin was a beta-lactam antibiotic rather than a protein synthesis inhibitor. This was an example of an answer where I used no logic whatsoever and was simply going off of visual memory. In my notes, there are 6 drug groups for both beta-lactams and protein synthesis inhibitors. I rushed and went with the first list in my mind, rather than giving myself time to think it through. Amir would later tell me (when I asked him to give me constructive feedback on my performance) that I need to become more comfortable with silence and let myself think. He told me that I answered immediately almost every time, rather than giving myself the opportunity to find the right answer in my mind. When I made this big mistake, the examiner flew back in her chair with an almost offended look on her face. At that moment, I thought she was going to fail me. It would have been the first time I’ve ever failed an oral exam in my entire time here at Semmelweis. “What mechanisms of actions do you know for antibiotics?” she asked me. I then proceeded to list out every group and every mechanism of action. At the end she told me that I was lucky that she was able to find the right answer in my head.

I ended up with a 3 on what was probably my worst oral exam ever. Rather than feel happy that pharma was over, I felt totally empty. I made up my mind that I was going to retake the exam. I was going to subject myself to the stress all over again. I waited almost 45 minutes for Amir to finish his exam and was beating myself up the entire time. The amount of work and effort I’d put in to pharma…all of that time and energy…and to walk away with the 3? It felt horrible. Countless hours, study group sessions and 538 pages of notes (I know because I took pics of them so I can have them in my iPad) – all felt worthless in that moment.

Here’s a taste of some of the pharma madness:

After talking it over with Amir and Skjalg and getting this perfect message (below) from my friend Andrea, I decided to accept my 3 and move on. I still love pharma and taking the exam over again may make me hate it – and I don’t want to risk that!

“Bianca WHY would you retake it?? A 3 is absolutely acceptable, and the most important point is that you know this so well! Had you gotten a 3 but were actually lucky because you should have failed, then I would understand..But putting yourself through so much stress again only for improving the grade seems unnecessary. I’m so sorry that you had a bad experience! Student X also had (the same examiner) and said she was difficult…she also got a 3. I don’t mean to tell you what to do. But please reconsider if you need to do it. It will make no difference to your future patients. I know you know this so well and I am so confident in your capabilities in pharma and on any other professional area.”

The following week I had my written public health and orthopedics exams. Studying after pharma was like trying to push through a marathon without having trained properly. Public health and I have a strange relationship. My teacher last semester was…let’s just say not motivated and after getting a 2 on the semi-final – my first two since first year! – I knew I had to make a change. I switched teachers and put in more personal effort this semester. It’s unfortunate because it is such an important class and yet most of us won’t realize its importance until we are practicing physicians. So, how did it go this time? Another 2!! Then, a 3 in orthopedics the next day. At that point, this was shaping up to be one of my worst exam periods. That Thursday, I hit an ultimate low point. I felt miserable in literally every aspect of my life and felt like the thing I was putting all of my effort into – school – was pointless. How could I work so hard and do so poorly?

After that, I had my ENT exam. Despite my weak start to the exam period, I pushed through and came out with a 5. I got the head of the department, who was a bit tough and demanding, but also easy to please. To start the exam, we drew two cards with so-called “minimal criteria” topics. These must be answered immediately – no time to think or process. After that, we drew two more cards with topics. We had over an hour to prepare these, which was more than enough!

The “minimal criteria” is a list of 32 or so items that we need to be able to repeat verbatim. They are the minimal points in the field of ENT that we should know as medical doctors. I’d come up with some memory tools for them and they proved to be extremely helpful. I even ended up sharing them with the rest of my class and got a lot of positive feedback. One of my friends told me that when she took the exam later that week, that everyone had a copy of the memory tools. Memory tricks go a long way!! Here’s an example of some of them:

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After ENT, I had two full days to prepare for my oral exam in bioethics. Since Amir and I had taken our pharma exams on the day of the written exam, we were the only English medical students who had to take the exam orally. I have to say that I absolutely loved studying for this exam. It answered a lot of questions I’ve had through medical school and it was really interesting to view medicine from a different perspective.

Once in my exam, I did something I’ve never done before: I started talking about my topics without writing anything down. I like writing everything down for two reasons: (1) It gives me time to really think about my topic, to remember the small details and make plenty of drawings/graphs, etc., to really turn it into a presentation, and (2) It gives them something to look at, read and process if for some reason they don’t understand what I am saying. The language barrier is not usually a problem, but I like to have the support just in case. I have a tendency to speak very quickly and even though I slow it down to a totally unnatural level (for myself, of course) during exams, sometimes it’s still not enough. This time, however, I felt it was an exam that should be done as a pure conversation rather than a presentation. After five or ten minutes it was over and I was out with another 5. Things were finally starting to look up again.

The following week, I started my surgical practice at the same hospital where I’d taken my surgery course this past year. I still had my surgery exam left, but my teacher said it was ok to start the practice early. We have to do a 4-week practice each summer and since we have to work, we wanted to get it done as soon as possible. The more we can work, the better!

I ended up taking my surgery exam a week into the practice. My topics were inguinal hernias and rectal carcinoma, which I’d seen plenty of times in the OR by this point, and I really got to showcase my knowledge about them. My examiner was the same doctor I’ve had as my teacher this past year. At the end of my exam, he told me some things that really warmed my heart. It felt like I was getting back to the student I want to be rather than the version I was at the beginning of the exam period. He told me that he was proud of me, that our group was a pleasure to teach and that I would make an amazing physician no matter what specialty I choose. Those words meant so, so much to me. I’ve always admired him, both as a surgeon and a teacher, and it feels good to know that I made him proud.

Even though my exam period was officially over at that point, I decided to go through with a little project I’d been working on: retaking my public health exam in order to improve my grade. During the semester, my teacher (who is the head of the English program of public health) offered me a research position with them and offered to be my thesis advisor. Thus, getting yet another 2 in Public Health did not sit quite right with me. I’ve never retaken an exam to improve my grade before, so I didn’t really know what to expect. The public health exam is written for the first attempt and oral for each subsequent attempt. The topic list was intimidating! There were 69 topics and I honestly had no idea how far to go with some of them. I ended up writing a book – pretty much – for half of the topics and then had to copy-paste from WHO, CDC, etc., for the remaining ones.

On the day I took it, I had to wait for all of the Hungarians to be examined first (their public health exams are only oral, never written. I got there at 9:00 and didn’t have my exam until around 13:00/13:30. Thankfully, I brought some protein pancakes, water and some caffeine to keep me functioning while I paced around like an insane person and powered through my notes Rain Man style.

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My teacher picked my topics out of the envelopes for me. When I saw the third one, my heart jumped. I didn’t recognize it! I realized then that I had been using the wrong topic list while studying! I told him this and he told me that I should just do the best I could. The first topic was perfect. Why? Because I had done a presentation on it this semester. It was on poliovirus and rotavirus. The second was “Occupational disorders related to air compression. Vibration and noise.”. The first part had not been on the topic list that I had studied from, but vibration and noise I knew well (thankfully!). The third and last topic was “Secondary prevention. Sensitivity and specificity. Lead time bias.”. I had the first part of the topic down, was rough on the second (despite the fact that sensitivity and specificity are brought up constantly in diagnostics *bow head in shame*), and had no clue how to start with the third. I started preparing the topics and then asked if he wanted to switch to a conversation-style so that he could save time (he had been examining people all day without a break and I didn’t want him to be irritated with me for writing for too long). It’s funny how things can click when you talk about them outloud. It’s like when you ask someone a question and your brain comes up with the answer in the same moment that you ask it. That was how this exam played out for the third topic – thankfully! After all that effort, I finally proved myself in public health. It felt so good to redeem myself.

At the end of it all, I ended up with one of the best GPAs I’ve had. It would have been the best – maybe even perfect – had I done better in pharma and maybe retaken ortho. But I’m happy with the result. It represents the hard work and the room for improvement.

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Now for a random picture section with pictures from the past two months. Lots of studying, healthy meals, walks in the sun and studying, did I mention that part?

Enough of a update for today I think :D. For those of you that have managed to stay with me, here is a little treat: Skjalg’s first Vlog! He’s decided to do one Vlog a week. I love it! It’s such a great way of summing up the week. Here you can see what our last week in Budapest was like:

July Snapshots

July 19, 2015 § 7 Comments

This month (so far) in pictures.

July 4th – Our first day in Bodø and our first hike of the summer
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July 5th – S and I enjoyed coffee in the sun and then mowed the lawn. A total of 5 hours in the sun left us a nice golden/burnt.
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Our first round of student-budget grocery goodies! We’re on super-saver mode this summer since the dollar is so high (and we pay our tuition in dollars, unfortunately).
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Grandma’s homemade whole grain bread!

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It is light here all day long…this was taken around 23:00. Makes it so hard to sleep!
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July 6th – Signed up at the new StaminaHot gym. They are remodeling the whole area and the gym is now up on the 4th floor. It has stunning views!

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Post-workout sushi made by Skjalg’s stepbrother Pai – such a treat!

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Super excited to find tuna for even cheaper than the one we bought 😀 Only 4,90 kroner per can (about 60 cents)!
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July 7th – First day at work and after lunch, I was all alone. Decided to keep myself busy…20150707_145443

In one of the older wings of the hospital, there is a large office area designated for medical students with lockers, computers and books for us to use. 20150709_134900 20150709_134913

This random photo represents one of my “I love Norway” moments. The receptionist at the gym is only there for a few hours a day during the summer, so the rest of the time, the gym is unmanned. There is a little kitchen area with coffee mugs and a coffee pot. I watched one guy walk over, wash some dishes and put on a fresh pot of coffee. Then he poured himself a cup and walked back to the training room to continue training. This is something I feel could never happen in the US because of the liability. Here it just seemed so natural…and homey.
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July 11th
– Skjalg and I started the day with a hike up to the top of Keiservarden
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That night, Skjalg had his shift at the restaurant (we’ve been working a couple shifts at Skjalg’s dad’s restaurant; I have mine on Fridays). He ordered some chicken satay to go, picked me up and we headed up to turisthytta (a sort of lookout point) to eat dinner and enjoy the midnight sun.
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After last weekend, this has been the weather pretty much every day 😦 Trying to make the best of it and appreciate the coziness… but it’s hard!

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