Every moment is the paradox of now or never

December 2, 2017 § 6 Comments

It’s been one week since my exam and it has not been an easy one for me. I started writing a post on Wednesday but had to stop because it was just too soon for me to write about everything. I’m extremely, extremely hard on myself. I always have been. Over the years, I’ve learned to direct my focus to the constructive self-critique and ignore everything else. Well, at least I try to. It’s a constant battle. I’ve learned to appreciate this quality. I think its one of the reasons that I push myself so hard, that I am constantly striving to be a better version of myself. But every great strength can also be a great weakness and this week has been a heavy one for that.

I’m going to post what I wrote here. I don’t mind sharing my low moments with people. There are only a select few that I turn to when I am actually deep in the thick of it, but afterward, it’s a learning experience. We all encounter periods like this at one point or another and pretending that we don’t doesn’t make us stronger. I’ve always believed that acknowledging and embracing my weaknesses takes away their power. If I own them no one person or one situation can use them against me. Then I am free to work on them at my own pace.

At this point in time, this is as much as I am going to share about the exam. I still have another two weeks until I get my results and I have plenty of other things to focus on now. Now is not the time to relive the experience, to criticize myself or even to reflect on these past few months. In two and a half weeks, I will have the result, I will have finished with my final exam in internal medicine, and I will be on the way to the US to spend three weeks with my mom and brother. I’ll be traveling with Amir and Baloo and am looking so, so forward to spending so much stress-free, quality time with some of the people I love most in the world.

Unpublished post: 124 hours

I’d been told what to expect when I finished the exam. I’d been primed for the feelings of inadequacy, the sheer disbelief, the relief of it being over and the anguish at the thought of having to wait three weeks for the result. I’d been warned of the flashbacks that would hit me in the days that followed and that the wait would be heavy and torturous. If you’re expecting this to continue into a more melancholic post, you’re correct. If you were expecting it to take a positive spin, this won’t be the post you thought it would be. Unless you count pushing through hell as being positive.

I’ve been in a bit of a daze since Friday. I’m finding it hard to put my feelings into words. Coherent is the last word I would use to describe my thoughts these days. I just feel very, very…sad. Maybe a bit shell-shocked. Empty. Low. Defeated.

The exam was…I can’t even think of a word to describe it. I thought I was ready to write about it. I thought sitting here now would be cathartic…

That exam coupled with my intense self-critique broke me. I was stripped of all my armor and skill and thrown repeatedly back into battle with every block. Dragging myself through those 9 hours was one of the hardest things I’ve ever had to do. It was so different than what I expected or what I’d prepared for that it honestly felt like they’d given me the wrong exam. It felt like I’d studied Spanish and was getting tested on French. After the first block, I locked away my pride and told myself it would get better, that I just had to stay positive and keep pushing through. But then the second block was the same. And then the third. And the fourth. It wasn’t until the 7th and final block that I finally got questions that I felt confident on. Questions where I knew what they were asking. Questions where the answers made sense. Questions that finally made me feel like I could show what I knew. But by then, there was honestly hardly any of me left.

Everyone keeps saying that they think I did well, that it’s a good sign that I felt it was so difficult. Right now, I don’t agree with any of them. I feel so, so strongly that it didn’t go well. There are weeks and weeks worth of learned material that I didn’t get tested on. It wasn’t like any of the question banks or practice exams I did. The questions were such that there wasn’t even any point of quickly browsing through my quick-review notes or looking in First Aid during my breaks. Those couldn’t help me. I did the best I could. I really mean it when I say that I dragged myself through it. I took several short breaks rather than one long one and used those to inhale water and a rice cake, rub my temples, take a deep breath and jump back in.

I do want to end this post on a more positive spin, so I am going to share something else I wrote: a letter to myself. In the days before the exam, I found my thoughts getting more and more negative and a special sort of panic begin to set in. One night, after two hours of not being able to sleep, I asked myself what I would say to someone I cared about if were him or her going through this and not me. Then, I wrote those things down. It felt silly at the time, but it worked wonders. I read it to myself several times a day after that.

Letter to myself

This is not something you get lucky on. This is a fully comprehensive exam with 280 questions that span almost every subject you’ve learned in your entire medical education. This is not a “pick two topics and hope you get the ones you studied” exam. This is unlike anything you’ve done before. So you need to have a different mentality about it. You have been preparing for this for months now. You’ve done thousands of questions – and done them well! You’ve learned so much from when you first started and your brain has adapted so amazingly well. Of course there are going to be things you wish you could improve upon, things you wish you could do differently. But that is not an indication that you HAVE done something wrong. In fact, it’s just a testament to your growth, to your ability to evolve. You can look back on any situation in life and see how things could have been done differently, at what you could have done better, at how things could have been more streamlined. And you can do that because it’s in the past. Now, you know what happened. It’s easy to criticize after the fact, to see exactly what went wrong, but only because you already know the outcome. What you can’t do is let that criticism stop you from progressing. There is literally nothing that comes out of allowing it to debilitate you. So why would you let that happen? Why would you let yourself be weakened now?

Now is not the time for critical reflection. You’re not done yet. Stop trying to rush things. Look ahead. Look at the time you have left and what you can and WANT to do with that time. Literally anything you decide to do is good. You could get tested on anything, so it doesn’t matter what you do. I promise you, when you are done with the exam, you will have time to analyze how you prepared. Even better would be to wait until you get your result. Why? Because you can’t trust yourself when it comes to evaluating your knowledge. And B, there is no possible way you can manipulate this exam in your favor. This exam is way, way bigger than you. It’s sole purpose is to evaluate and quantify the knowledge of medical students. So trust it. Let it do what it is supposed to do. Do what you can now. Take care of your mind and your body, remember that this exam is as much about endurance as it is knowledge. Your mind will not work in a hostile environment, so remember that you need to create a safe space for it. No fight or flight response. When you’re there in the exam, that is literally the only place in the world you are supposed to be. Nothing else exists. It’s just you and the question you’re working on.

All the anxiety you are feeling now is the result of you thinking that you have control, that you can somehow determine what is going to happen in the future. You are taking responsibility for something that has not happened yet and for something that you are not even supposed to be taking responsibility for. Who do you think you are that you think you control the future? Let it go. This is not what the battle is. The battle is preparing yourself to the best of your abilities at that point in time, challenging yourself, and then evaluating the outcome. You have done exactly what you should have done when you needed to do it.

If there is a lesson to be learned, let it present itself in due time. Let the lessons of this world appear when they are supposed to appear and stop trying to predict and control them. There is no shame in saying you were wrong, in admitting you could have done something differently, in apologizing. We are dynamic, forever evolving and adapting creatures. You are not perfect now, nor will you ever be. You will never be done learning. You will never be “done” or “complete”. There is always going to be a better version of you down the road. So stop looking back. Stop looking at where you are now and obsessing over if it is the right place or the wrong place or if you made a mistake somewhere that you need to fix. Leave all that noise and move forward. Embrace the self-development, embrace the humility and the strength that comes from enduring these challenges. You live for this. You know you do. So let yourself breath it in!! Right now, you are the most perfect version of yourself that you could be in this moment. And tomorrow, there will be a new, stronger version that is perfect for then. Leave things to grow and develop at their own time – yourself included. You are not in control and you never will be.

Tomorrow is a Wednesday. Wednesday is the third day of the work week (depending on what country you live in). Some people call it “hump day” because it’s seen as the hump of the week. There will be another Wednesday next week, another one after that, and another one after that. Tomorrow will have different meanings for everyone in the world. Some people may remember it forever while others will never think of it again. For you, it happens to be the second to last day before your exam. You’re going to do some practice questions, go to the gym, take a hot shower and maybe take a short power nap, pack for your trip and review some notes. Then it’s going to be over. You’ll never live that day again and it will never hold more meaning to you than it did while you lived it. It’s as simple as that. Find peace in relinquishing your perceived control of the uncontrollable.

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.

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…

The Transition

March 23, 2017 § 3 Comments

During a break on Tuesday, I mentioned to an Erasmus student from Germany how brilliant Budapest is when Spring really hits. I told her, “There will be one day where the temperature jumps and the parks fill with people – that is the day where everything starts.”. Wednesday was exactly that day. After class, I came home, opened up the doors to our small balcony and laid out a yoga mat. For two hours, I soaked up the first real taste of spring while listening to a samba mix. It’s amazing how much a difference the sun makes!

I took the rest of that afternoon to work on my study schedule (the one I was supposed to do Monday). I’m always searching for ways to improve my studying and I stumbled across a USMLE blog presenting a technique that I am going to try. It’s really common when studying to designate “days” for a subject. Whether it’s a certain day of the week, a certain number of days a month or a chunk of days for cramming before the exam, using “days” as the base study-time unit is extremely common. This new technique involves breaking up each day into sessions and studying different topics during those sessions. What I liked most about it is that it gives several opportunities to “restart” during the day rather than waiting until the next day to start fresh. If the 1st session doesn’t start on time or isn’t successful, the rest of the day can continue without that guilt and negativity trickling in to the rest of the day’s tasks. I’m definitely one of those people who gets thrown off if things don’t work out like I planned, so something like this is perfect for me.

I’m going to put a little more emphasis on preparing for my finals (which will take place during the middle to end of May). I want to get those out of the way as soon as possible so that I have more *pure* USMLE time. We have 8/9 exams, 4 of which are oral. During oral exams, we usually have to draw a certain number of topics from an assigned topic list and present each of these topics to the examiner. Thus, the best way to prepare for oral exams is to write out a plan for each topic that includes major points/info you should mention. For forensics, obstetrics and gynecology, pediatrics and internal medicine, I’ve divided up the topics over 6 weeks. If all goes to plan, I will be done preparing a week before exam period, which means that I won’t need as much time between exams during exam period.

My tentative plan for next week

Today was my first attempt at this plan and it went really well – in spite of not actually going to plan! I slept an hour longer and took a 2-hour walk with Baloo, but still managed to get a chunk of topics done within different subjects. It felt really good to be able to look at my schedule for the start of the next session rather than waiting until the next day. No more entire-day sabotaging for me! It was also really nice to mix the subjects (5 years of medical school and I still haven’t figured out how to successfully study multiple subjects at once). I was tempted to repeat gyno for a session because I was really enjoying it, but now I’m happy I moved on because I really look forward my next session with it (and it feels good to have made progress in other subjects).


I’ve been a bit more reflective this week than usual. Fifth year is not what I thought it would be. It feels so much more final than I ever could have imagined. We still have one year left, but most people go back to their home countries to do their final rotations there. As such, most people are treating this as the last semester. I notice so many different ways of coping with this transition, of cutting ties with Budapest, of closing out this chapter. We’re going to be doctors soon. An overwhelming fact that weighs heavier with each passing day. And with such an immense transition ahead, it’s hard to focus on the present. Every effort is placed on cushioning the inevitable blow that follows graduation.

In autopsy on Wednesday (our current block is forensics), we had two young men, only 21 and 22 years old, who had been killed in a car accident. One of them had just gotten a new haircut. The day before that, we had a 18-year old male that had died from complications associated with his almost decade-long history of drug use. The fact that I am almost 10 years older than them was not lost on me. It’s so important to savor the present, to soak it all in. The sights, the smells, the sounds. To just marinate in the moment. Life is too short to rush through a transition, even one as big as this.

Here I am, maximizing this moment 😉

 

World, stop.

March 19, 2017 § 4 Comments

This weekend, I finally took some time to breathe. Since I last wrote, I’ve been busy studying for Step 1 of the USMLE (which I’ve been planning to take in June), studying for my classes and enjoying some time with friends and family. Step 1 requires many, many months of dedicated studying and trying to manage that in addition to my normal “life” load has been really difficult – and exhausting! I’ve been waking up every morning at 5:00 am to complete a block in UWorld (the quintessential question bank). After that I work out from 6:00-7:00, go to class and then come home to review my questions from that morning ands study. Each block is 40 questions and reviewing an entire block can take a really, really long time. Sometimes, I’ve even used up to 8 hours reviewing a single block! Each question comes with detailed theory pertaining to the correct answer, as well as information behind each wrong answer. In addition to doing my blocks each morning, I should be reviewing the various subjects. I had planned to cover at least one subject each week. Have I been able to do that? Nope!

In the beginning of March, we visited Krakow with a group of friends. I kept my studying up during that time, but it was not easy! Waking up at 5:00 while everyone was still asleep for a least a couple more hours was…lonely and frustrating.

Outside of that, the trip was amazing! The city has so much history and it was such a unique experience to visit Auschwitz. It’s really something I will never forget.

After we arrived back in Budapest on Sunday evening, I only had a couple of days before my mom and brother arrived (from the US and Oslo, respectively). We haven’t been together – the three of us – in 4 years, so this was an extremely special trip for me. In the beginning of their visit, I tried to balance studying with family time. By that Friday, I gave in. This past month has shown me that I’m not going to be ready for the exam in June. I’m not planning on going back to the states in the immediate future and you can only take the exam one time, so I would rather push the date and take it when I am more prepared. It felt good to check out of my study world for a little bit and fully enjoy time with my family. They mean the world to me.

Their visit was perfection. We tried out new restaurants in Budapest, including an AMAZING new one called Makery where you make your own dinner. You are supplied with prepared ingredients and a fully stocked workstation. Each person chooses their dishes (just like in a normal restaurant) and then follows step-by-step video instructions to make it. Such a cool concept! We also did some escape rooms, had a cocktail night with all of our friends and took a day and a half trip to Vienna.

We even got to celebrate Christian’s 27th birthday on the day! Our friend Amir brought over a bunch of fresh goods from his favorite bakery, which we served alongside a collection of cakes we’d brought back with us from Aida in Vienna. Then we watched Chef (one of my favorite movies, which Christian had never seen before). After that it was shopping on Vaci utca, two escape rooms, drinks at a roof top bar close to the basilica and dinner at Iguana with Dushyant and Amir (including the dogs! My mom’s dog Romeo and our dog Baloo).

My mom and Christian left on Thursday and I spent the rest of the day reviewing for Friday’s anatomy exams. Since I have my own group, I’m a main examiner during midterms. This means that I may be in charge of examining an entire group (other than my own). I like to vary my questions as much as possible, so I try to do a thorough review of all the topics before the exams.

In addition to exam day, Friday was the day of Baloo’s surgeries – yes, surgeries! Technically, there was only one surgery with three parts, but when your dog weighs less than 1.5 kg (3.3 pounds) you worry a bit more! On top of being neutered, he had two baby teeth taken out (some of them have been a bit stubborn) and a suspicious lump on his head removed. Luckily, the lump turned out to be nothing more than a hair follicle that had grown inward! If any of you follow Dr. Pimple Popper, then you’ve seen these before. If you’re curious, check out this compilation video.

I was so thankful for the distraction of examining students for the anatomy midterm during Baloo’s surgery. I was so nervous that something would go wrong! When Skjalg picked him up at 14:00, the vet told him him that everything went smoothy and there were no complications at all! Afterwards, he was a bit loopy, but by Saturday he was almost back to normal and even playing fetch!

​The only problem now is dealing with his cone. Because he is so small, the cone they had that fits him is really hard and narrow. He absolutely hates it. While it’s on he will stand in place for 10 minutes then get tired and try to lay down somewhere (but never really get comfortable). I slept on the floor with him the first night, since he can’t navigate the stairs leading up to the bed in the dark. Last night, we tried putting his jacket/harness thing on instead. He was able to sleep through the night, so hopefully that is enough of a “blocker” for any licking or scratching he might try.

Otherwise, week 8 (already!!) of the semester starts tomorrow. I’m starting with new material for my students, which I will prepare tomorrow morning before my class at 12:00. We are in the middle of our forensics block, so I might start with preparing my notes for our final at the end of the semester. I’m considering October for Step 1, so I will start studying more for my current course load (I’ve ONLY been studying USMLE so far this semester). I’m going to have to sit down tomorrow and make a study plan for the rest of the semester.

 

 

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:

A perfect start

February 7, 2016 § 4 Comments

We’re only one week in and I already feel like this is going to be my favorite semester so far. I’ve not had this much time to study since 4th semester, which was a whole 2 years ago! Plus, I’m enjoying all of my classes – which is such a huge help.

On Monday, I only have orthopedics in the afternoon so I start the day at a café/library to get in a good study session before. This week, I headed over to Costa Coffee and started working on my pharma topics. We have our final at the end of this semester and as it is our “big class”, I’ve planned to go through all the topics early. We have a study group planned on the weekend where we will go through the topics as a group, giving us a chance to actively memorize the material we reviewed during the week.

We’ve organized the topics we are going to cover each week – new ones covered this semester plus reviewing some from last semester. My goal is to go through everything on my own during the week and memorize them if I have time/energy on Saturday night. That way the group is more of a verbal test. This first session will probably be a little bumpy, but we’ll get the hang of it!Screen Shot 2016-02-07 at 09.46.29

I’ve been pushing the idea of “topics, topics, topics” on the students I TA anatomy for. (For those of you who aren’t familiar with the term “topics”: most of our exams are oral and based on topic lists. These are made available to us during the semester (ideally before). At the exam, we randomly select topics, usually one from each list (depending on how the topic list is divided up). Sometimes the topics are already divided into cards and we draw a card with 3 or 4 topics on it already. Then we have about 20 minutes (sometimes more) to prepare notes before our oral presentation of them.)

So, the students I TA for are in their 4th semester and therefore have their finals in anatomy, physiology and biochemistry at the end of this semester. I can tell that they are a bit overwhelmed by it all. Some of them stopped by the café I was studying at last night to talk about how to study this semester. It’s always really helpful to talk to someone who has been through it before – I definitely have a couple of people I “harass” at the beginning of every semester. It still feels weird to be the person giving advice, but after so many exam periods and this last one with so many exams, I feel like I finally see the pattern. I advised them to do the same thing I’ll be doing this semester: dividing up the topics from the final topic list into the different weeks of the semester, while paying attention to midterms (i.e. cover the internal organs topics before the regional anatomy midterm covering the thorax and abdomen). Then, review them on your own during the week and meet on the weekend to go through all the topics together.

This may seem really obvious to some. For me, it has always been so clear and simple in theory and never manifested successfully in practice. I remember Charlotte, Rina and I were going to do something similar for biochem one semester and it only lasted for about three or four weeks before we were thrown off by midterms. What we did then was to write out notes and send them to each other to sort of “turn in” our assignments for the week. I’ve also tried to do it on my own, but once you fall behind and have 20 topics to cover in a week for each class, it feels almost impossible to continue. Getting an early start for me is key. When I have a slow start to the semester, I constantly feel like I am making up for lost time rather than staying ahead. And motivation is hard to come by when feeling that way!

Orthopedics started off a bit slow but ended on a high note. My teacher is an orthopedic oncology surgeon and in the beginning his English was… lacking. Once he started talking about orthopedics however, things improved immensely. You can tell he is really passionate about what he does and he presents information in a very systematic way. He also seems to remember how we think as students and keeps that in mind when asking us questions or refreshing our minds (like muscles acting on the hip joint, including their origins and insertions – which we learned in anatomy during the first semester!).

On Tuesday, I start the day with surgery lecture (which was really, really interesting this week, probably because we are going into more detail now) and then head off to TA anatomy before my ENT (otorhinolaryngology) lecture and practice. I’ve been a TA for the same group since the beginning (going on our 4th semester now) and I really enjoy them. The problem is that the professor I TA for is a very, very busy man – head of more than one department, has his own clinic, etc. – and misses a lot of classes. This really kills the moral of the group. As a TA I can pick up some of the slack, but I’m nowhere near the level of an employee of the anatomy department who has worked there for 20-30+ years. On top of that, I have to leave the class 40 minutes early to make it to my lecture. I’m hoping a solution is found soon…

I only have one class on Wednesday: surgery! In this class we do presentations, go on rounds and then have an option of staying in the O.R. for as long as we’d like to watch any of the procedures they have that day. I love my teacher. He is clear, sharp and demanding. If we show interest, he’ll teach us everything he can. If we don’t, he won’t waste his time. I find this so motivating! He told us that in Hungary, if you want to be a surgeon, you need to start getting involved as soon as you know. They don’t accept applications for specialization from doctors who have not already had 5+ years experience in the O.R. The reason for this is that they don’t want to spend the time and money training someone who doesn’t really, truly want it. So, according to him, we should start now – or should have started 2 years ago!

Thursday is another short day: public health from 8:00-9:55. Last semester I took the advice of some previous students and chose a teacher who “does not give a shit” for lack of a better term. We have definitely had some classes where… efforts are best placed elsewhere. Public health is definitely not the most exciting class, but having a teacher who doesn’t care makes it even worse. So, I made sure to go the opposite direction this semester – and I am so happy I did! My teacher is the tutor of the department and is extremely outgoing. He calls us out by name during class and makes tons of silly jokes. It keeps the mood light and keeps your focus – something I desperately need!

On Friday I start with pharma practice. My teacher is amazing – Dr. Riba – and I am so happy I was able to get him (he’s the hardest one to get during registration). He has two classes during the week and allows us to go to either of the two. Since most people want to have the whole Friday off, this meant that we were only 5 for class this Friday. It was such a nice change from the 25 of us that were packed in the room for his class last semester! I heard that on Wednesday’s class there were even three people who had to sit on the floor.

The reason I chose to attend his Friday class over his Wednesday class was so that I would be more motivated to attend the bioethics and laboratory medicine lectures that follow. For those subjects we only have lectures – no practicals – and it’s tempting to forgo those for a full day of studying. Most people attend the first week’s lectures and drop off once they decide they can go without it. While the lectures are not the most exciting, they definitely bring up some important topics. Bioethics brings up many difficult situations we’ll have to face as doctors and laboratory medicine provides us with knowledge we know we are lacking and will need in the future. I know it will be hard to fight the desire to get an early study start that day, but I think forcing myself to go to those lectures will pay off down the line. At least that it what I am going to tell myself! It’s better to regret the things you’ve done than the things you’ve haven’t, right? Screen Shot 2016-02-07 at 11.11.19

On Friday night we went ice-skating and then out to karaoke with some friends. The girls with the bad knees – me included – sat on the side and sipped mulled wine while watching the Scandinavians take to the ice. Karaoke at Blue Bird starting at 21:00, so we grabbed some spiked hot chocolate on their heated patio before then. They have two venues: upstairs for more calm songs sung by really talented individuals and downstairs for pure insanity. We were downstairs together with about 20 drunk Brits and some traumatized Vietnamese tourists. IMG_3407 IMG_3411 IMG_3417 IMG_3414 IMG_3426 IMG_3427 IMG_3429

We were home around midnight and headed straight to bed. Skjalg and I have both been so exhausted this week! We let ourselves sleep in Saturday morning and after a slow, calm start to the day, we were out the door to studying at a café. Then it was home to watch Ocean’s 12 before bed. Not a bad first week if I do say so myself!

 

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