Category: Medical School

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Best Resources to Destroy USMLE Step 2 CK

*Disclaimer: Below are my favorite resources with associated links. If you like my blog please use the links to buy any books on Amazon or services (Picmonic, OnlineMedEd) as I receive a small referral fee that helps me keep this blog up and running! I only listed products I trust or and/or used*

Question Banks

The purpose of doing practice questions is to find your weaknesses in order to guide your study process and  to get you inside the head of question writers. Hopefully you figured this out already since you most likely already took step 1. However, I found studying for step 2 CK to be more difficult than step 1 because of the other obligations that MS3 requires. Question banks are also great on the go. Long subway to your friend’s apartment on the upper east side? Do a question set on the train. Bored in between lectures? Practice questions. Lost your resident and don’t feel like going back to the floor? Practice questions. Practice questions? Practice questions! Here are the practice questions I used.

USMLE World

Still the gold standard when it comes to practice questions. There is no way around it. You can read the message boards on Student Doctor Network and they all reiterate what I find to be true. That UWorld is the end all and be all when it comes essential resources for Step 2 CK. Some students will argue that UWorld and a review book are the only resources you need for step 2 CK and for the most part that is true. I completed UWorld in its entirety once. Then I completed all of the questions I got wrong (which was nearly half of them). Then I continued to do full question sets until test day so I ended up doing UWorld two and a half times. I highly suggest it.

Kaplan

Kaplan is the other major question bank out there. I used to do Kaplan questions with my friend who preferred not to ‘waste’ UWorld when he studied for his clinical clerkship exams. Just like step 1, a major advantage of Kaplan to UWorld is that they tell you exactly where this topic or subject is located in the most popular review books. I enjoyed using Kaplan but chose not to invest more money in another review book when I could borrow my friends’ PreTest books instead. That being said, I haven’t heard terrible things about Kaplan.

PreTest

I took step 2 during the second week of my first elective rotation in cardiology. So the bulk of my serious step 2 studying was done during my 8 week surgery core and subsequent 4 week surgery elective. I took a practice test and I did terribly. Like embarrassingly bad. And my worst subject was surgery. I had completed all of the UWorld surgery questions and ran through them all a second time. I wasn’t being lazy either. I read through and studied the answers to each question but I just wasn’t making any progress. My friend suggested I try pre-test and I loved it. Pre-test gives you over a thousand questions for each clerkship exam. In some regards they go into far too much detail than you actually need for your step exam and cover a much wider scope of subjects than UWorld alone…but that’s exactly why I used it. You can finish all of the UWorld or Kaplan questions for the smaller subjects like psych and pediatrics quite quickly. These books expose you to a lot more pathology that other qbanks don’t cover. I highly suggest using this resource for in between lectures, after you finish a specific section of UWorld, or if you just want more high quality practice questions. Just beware that they are not NBME format. So I would shy away from them when it comes closer to test day

Practice Tests

The purpose of practice tests are to find your weaknesses and to exploit them in order to maximize your score. Basically, study what you suck at! That’s the point of doing practice questions and that’s the point of doing a practice exam. So you can tell if your study process is working or not. For instance, after I started dedicating more and more time to study my weakest subject, surgery, my score began to creep up. I found that the number of questions I got wrong in other subjects continued to stay relatively stable but I was able to decrease the number of surgery questions I got wrong from 20, then to 12, then to 8, and on my last practice test I literally got zero surgery questions wrong. My point is that you can’t just keep taking practice tests to see what score you would get on step 2. That’s great and you should do that but you have to remember that the purpose of taking a practice test is to evaluate your weaknesses and to strategically focus on them. Okay, now I can get off my soap box.

NBME

NBME is the gold standard because they are written just like the real test. You have to use these wisely because there are only a limited number of them. Additionally, I believe that it is worth the ten extra dollars to purchase the expanded feedback. This option grants you the ability to see which questions you got wrong. Annoyingly, they don’t tell Sure you can screen shot every single question if you really want to (unlike UWorld Self Assessment) but this is so much easier and also doesn’t mess with your ability to recreate test day.

USMLE World- Self Assessment

The only reason this resource isn’t above the NBME practice exams is because there is only one USMLE World Self Assessment (UWSA). Both the NBME’s and the UWSA are only half as long as the real thing but the advantage of the UWSA is that they are like UWorld question sets. You are given full UWorld style explanations of each question, both the questions you get correct and incorrect alike. I chose to make this my last practice test because I was able to utilize these four individual question sets like they were new questions that I was able to review afterwards.

Review Books

I encountered a few problems when I chose which review book to utilize. My ideal review book would have everything in it already. Explanations from UWorld, differential diagnosis categorized by both chief complaint as well as pathophysiology, best initial test, most accurate test, best initial therapy, maintenance therapies, and alternative therapies. I never found that type of book. So go to the book store and check them out for yourself before you buy them.

Master the Boards (MTB)

I liked MTB for the same reason why I disliked it. Its brevity is nice when you just want a quick and dirty answer but it leaves you hanging at times when you want more detailed UWorld style explanations (seriously, why can’t someone just put UWorld in a book format already?!). Between UWorld and MTB you are guaranteed to pass step 2 because they cover all of the high yield stuff but be prepared to annotate the shit out of it. Bonus tip: use MTB for step 3 instead of the step 2 CK version. It’s got a few extra gems in there and it’s really not all that different from it’s step 2 cousin. This way you won’t have to start all over again for your next step.

First Aid for the USMLE Step 2 CK

First Aid was my step 1 bible but I didn’t use it for step 2 CK and I regret that decision. I borrowed this book a few times from my friends and I liked it. It mimics the step 1 version quite well. Again, I did not use this as a primary resource but I would encourage you to check it out.

Step Up to USMLE Step 2 CK

I used Step Up to Medicine (SU2M) for internal medicine only and did not use Step Up To USMLE CK because I disliked SU2M so much. If MTB has too little information then this is the complete opposite side of the spectrum. It has long winded explanations of every subject in bullet format. Some people liked that but it wasn’t for me.

Lecture Material

Lectures were less valuable to me for step 2 than for step 1. I just didn’t have enough time to sit down and watch video lectures. My favorite way to study was to simply review whatever disease my patients had that day. Every once in a while however I just didn’t know something and needed someone to spell it out for me. These are the resources I used for those moments.

Online MedEd

This is by far my new favorite resource that I utilized for step 2. Online MedEd uses a reverse classroom style of teaching with whiteboard based lectures. Lecture videos range in length and subject matter but are amazing resources for both step 2 and for the wards. For instance, one day I was feeling a little lost about fluid management so I went to the library and threw on the fluid management videos. I went back to the floors with a better grasp of what I was doing and didn’t feel like such an idiot. I especially liked the algorithmic way of thinking they employ. I watched every video and would do it again in a heart beat.

Doctors in Training (DIT)

I loved DIT for step 1 but it just didn’t do it for me for step 2. I didn’t have hours and hours to watch videos everyday, nor did I have the energy for it (that’s why I liked OnlineMedEd a little bit more because their videos were short and to the point). What I still loved about DIT was that they remind you of what you may have forgotten. The pre-lecture and post-lecture quizzes are gold. It wasn’t for me but doesn’t mean you shouldn’t at least check them out. Not to mention they’re great guys to follow on Twitter.

Kaplan Lecture Videos

I got my hands on these videos and they were fantastic. Conrad Fischer at his best. If you liked Kaplan for step 1 then you will like them for step 2.

 

Miscellaneous

The other stuff that doesn’t fit into a pretty category like the stuff I already mentioned.

The Successful Match: 200 Rules to Succeed in the Residency Match

This book is pure gold and I highly recommend it to anyone and everyone going through the match process. It provides analytical data on the match. The author provides objective data on a subjective subject like what characteristic traits different program directors like to see in their candidates the most in each respective specialty. This book provides advice on everything from writing your personal statement, the most commonly asked interview questions and the best way to answer them, what type of programs you should be applying to, who you should be asking for letter of recommendations from, and so much more. It was my most valuable resource before and during interview season. You won’t regret this investment. In fact, your friends are going to want to borrow it. Mine did.

 

UpToDate

Most medical schools provide this for you and it was easily my most often used resource during my third and fourth year of medical school. It’s like Wikipedia for medicine when Wikipedia doesn’t do a good enough job at explaining something. Or when someone points out that Wikipedia isn’t ‘a reliable resource’. Anyway, it’s amazing and I love it. Bonus tip: click the ‘summary and recommendations’ tab to get a quick snapshot of the article you’re checking out.

Picmonic

If you used Picmonic for step 1 then you should keep using it for step 2. I talked about Picmonic before and it still rings true. Every time I thought about brain tumors, tumors of the bone, any vasculitis, developmental disorder, and everything from biochemistry my Picmonic note cards would pop into my head. I’ll probably be that one resident who puts a Picmonic mnemonic in the presentation slides for morning report. I don’t ‘like like’ Picmonic. I love them.

*Use my link to get 30% off your Picmonic subscription!

Blueprints

Blueprints is like PreTest because they are good for shelf exams but not so much for dedicated step 2 CK studying. I highly disliked Blueprints because it was so long but others liked it for that exact same reason. Each chapter gives you a few bolded key words, tables and figures and explains the topic in great detail (again, too much detail in my opinion). The book ends with 100 NBME style questions with long explanations. I liked PreTest more because of how succinct it was but I have friends who, again, had the complete opposite opinion. To each his or her own.

Tablet > smart phone

If you don’t have a tablet already I would highly recomend purchasing one. If you are short on cash you do not need to purchase an iPad. There are tablets out there for under $100. Sure they aren’t as pretty but all that you realy need them for is accessing UWorld. Yes, you can simply use your smartphone instead of buying another piece of technology but unfortunately every time you have your phone out people will think you are texting. I remember once when I was on my phone doing a UWorld question set while I waited for the operating room to be cleaned and a nurse called me out for ‘texting instead of taking care of my patient’. Said patient was actually sitting next to me in her bed on her phone playing ‘2048’. She was trying to beat my high score and was failing miserably. Anyway, my patient kindly told the nurse to ‘kindly fuck off’. She was one of my favorite patients ever. Moral of the story: if you are on your phone people will think that you are texting no matter if you are using it to cure cancer or are actually texting.

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Medical Student Sunday Interview with Daily Medicine

The following interview was originally published on Daily Medicine, a blog full of quotes, ideas, lists, and general knowledge. Check it out for your daily dose of medicine!

In the first “Medical Student Sunday” of 2016, Daily Medicine Blog welcomes fourth year medical school student Marc Katz! Many of you have asked me for a look into a Caribbean medical school and now the chance has come to meet a great student from Ross University. Soon he will be matching into a residency spot and I can not wait to congratulate him. Until then, peek into his life through this candid interview:

 

Who are you to the world?

I’m a first generation American born to South African immigrants, a fourth year medical student currently finishing up my last few interviews for residency in internal medicine with plans to pursue a fellowship in cardiology. I also run a blog, MyKatz, where I advice pre-med and medical students about the hidden curriculum of medical school and try and teach others through my mistakes and experiences. My hope is that I can one day I can use my blog as a medium to educate my patients and expand their understanding of disease, health, and wellness. When I’m not in the hospital or library you can find me playing basketball at the gym, playing Call of Duty, finding a new show to watch, or reading a new book in the park. Right now I’m finishing up Scar Tissue by Anthony Kiedis and the next book on my list is The Man in the High Castle. My cousins told me that the show the book is based on is really good so I want to try and read it before I watch it. It’s the same way that I got into Game of Thrones. Except for GoT I binge watched the first two seasons and then didn’t want to wait for the next season to come out next year so I just read the books instead.

 

What has been your journey to medical school? (Were you a traditional or non-traditional student? Did you always want to be a doctor? Etc)

I went straight from undergrad at SUNY- Binghamton to Ross University School of Medicine. I didn’t realize I truly wanted to pursue medicine until my junior year of college so unfortunately my GPA was ever so slightly below average when I was applying. Ross accepted me for the fall semester so I jumped at the opportunity to start my medical career.

Although my grandfather was a well-respected pediatric surgeon in South Africa I was never really pressured into pursuing medicine. It just kind of happened. I blame the years of watching ER growing up. Fun fact, Christiaan Barnard, the man who performed the first successful human-to-human heart transplant in the world, was my grandfather’s resident!

 

What is it like attending a Caribbean medical school? (A lot of students ask me this and I would love a more detailed answer to this particular question)

I loved attending Ross University! It was an amazing experience to study abroad in such a beautiful country. Sure, we had some annoyances. Dominica’s water filtration system was gravity. So when it rained heavily it would trudge up mud and our water would be turned off. I remember walking home from the gym and it started to pour. Lo and behold when I got home I had no running water. Luckily I prepared for this situation and I had a nice shower with bottled water the day before my exam. But it’s not all bad. My strongest memories are those spent with the friends I made on the island. Attending medical school in Dominica is like going to war because only those who experience it can truly understand what it’s like. I spent almost every waking moment with the friends I made on that island for four semesters straight. I seriously wouldn’t have gotten through medical school without my island family and I’ll love them forever for it. Just please don’t tell them I said that. It would be sooo embarrassing if they knew.

 

To you, what is the hardest part of medical school?

Hell, where should I begin? I almost appreciated being on a literal and figurative island during my first two years of med school. We had no distractions and nothing to do besides study…and maybe drink. So focusing on my studies wasn’t difficult but figuring out how to study was. It took me a few weeks to realize how I study best and it was my first major hurdle in medical school. It’s also been the basis of a few blog posts I’ve authored, like How To Study In Medical School, because of how important it is during any graduate education. The next part, actually studying, is even worse.

You have an average of five to six hours of lecture material every day followed by five to six hours of studying every day. It sucks and there is no shortcut. Thankfully I’m a huge nerd and I enjoyed learning about most of the material, but let’s be real…nobody actually enjoys memorizing the enzymatic steps of the Kreb’s cycle.

 

What is a normal day like for a 4th year medical school student?

I actually wrote a blog post about the day to day life of a third year which you can check out here, The Day To Day Schedule of a Third Year, but I’ve never been asked about fourth year before because there really is no ‘normal day’ of a fourth year medical student. The day-to-day life of a fourth year really depends on the rotation and the individual. I’m willing to bet someone who is going into a surgical residency might have a completely different clinical schedule than I do. I wanted to tour everything internal medicine has to offer so my fourth year schedule has been cardiology, nephrology, hematology & oncology, a medicine sub-internship, gastroenterology, pulmonology, and I’ll be finishing up medical school with an HIV/AIDS elective. Some rotations work you hard and keep you long hours while others let you enjoy your last year of freedom before residency starts. So in that regard fourth year is kind of like third year…you’re just slightly less of an idiot.

Fourth year also includes interview season and it leaves you tired and drained during November and December. That being said, my fourth year has been my favorite year of medical school so far. I’m not constantly anxious about having to go study for step one or step two and there aren’t any more tests, just patients. So I finally get to be self-driven about studying and pursue learning about what interests me. I’m just really excited for residency to start. And for my trip to South East Asia with my friends before residency starts.

 

What is the best advice you ever received?

Never yell at the food staff before you get your food and always pay for your date’s meal. Though I have a feeling you meant it with regards to medicine. If that’s the case then I must admit that the best advice I’ve been given isn’t all that original. I distinctly remember two different people telling me the same advice for two different reasons.

As a third year I was growing frustrated in my attempts to impress my attending whom I wanted a strong letter of recommendation from. And as a fourth year on my medicine sub-internship I was growing frustrated by my patient’s family’s indifferent attitude about the medical care of their loved one. In both instances my roommate and senior resident, respectively, gave me the same advice that was applicable to both situations. They told me to provide and coordinate the best possible care for my patient.

Instead of trying to read my attending’s mind I simply focused on taking care of my patient. I did what I could to make someone feel better everyday. I learned that I can sleep at night knowing that at the end of the day I did everything in my power to take the best care of my patient to the best of my abilities.

 

What qualities in a shadowing pre-medical student impresses you? 

The most impressive pre-med students are those that are awake. Seriously, if you’ve got a heartbeat, a smile on your face, and a skip in your step then you’re already better than half the kids I’ve seen. I remember my favorite pre-med student that was shadowing a surgeon I was working with for the month. During surgery she would diligently write down notes about things she wanted to look up later. She would come back with information that she looked up and asked us follow up questions. When we were waiting for rooms to be cleaned she asked to go watch other surgeries. She showed us that she wanted to be there by being engaged. She was visibly excited to be there and it made my day more fun when she was around. They are the same values and characteristics that make for a good medical student. You can read more about what qualities in a shadowing pre-medical student impress me the most in my blog post, Premeds: How To Shadow Like a Boss.

 

What do you like to do for fun?

Does brunch count as a hobby? Well besides drinking coffee, Bloody Mary’s, and mimosas, I also like to visit my brother at Barclay’s Center where he works and try to go to as many Brooklyn Nets and Islander’s games as I can. I’m also currently trying to knock out my New York City bucket list just in case I don’t match here. By the way, turns out the MOMA closes at 5:30pm during the week in case you wanted to go. Made that silly mistake last week. Still trying to find time and someone to go to the top of One World Trade Center with.

 

Do you have a few tips for medical school students & premeds?

I have too many tips for medical students and premeds! I could preach for days about mistakes I’ve made en route to medical school and how to avoid them as well as how to succeed in medical school. But I do have one real piece of advice for premeds and medical students alike and its not going to be very popular with your friends or family. It is to be selfish. Nobody else is going to make your medical education as their number one priority. That is your job. You are going to miss birthdays, anniversaries, weddings, holidays, parties, and average day to day moments that your friends and family will spend together. You on the other hand should be in the library or hospital studying. As I’ve stated before in a post about The Match, you need a strong step score in order to get past residency program filters and the only thing standing in your way is you. So be selfish and go study.

That being said, if anyone reading this has a more specific questions you can always comment on my blog and ask me a question here or tweet at me at @MarcKittyKatz and I’ll do my best to get back to you as soon as I can!

 

If you are in a relationship, how do you handle balancing school and a committed relationship? 

I am probably the worst person to ask about this…because science is my lady. Just kidding! My life isn’t that sad. I am currently single but I can comment that having a relationship during medical school is totally doable. Tons of classmates of mine met their significant others on the island and during rotations. In my humble opinion, you just have to be honest with yourself and your partner about your med school obligations and make your relationship a priority. It’s just like when people say ‘they don’t have time to exercise’. Nobody in medical school has an extra hour or two in their day but you can make time to exercise and you can make time to date and have a relationship. You just have to make it a priority. I mean, it’s not like it’s going to get any easier in residency. And when in doubt, swipe right.

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The Day To Day Schedule of a Third Year

An incoming first year medical student asked me, “what is the day to day schedule like in medical school?” To begin with, I want to differentiate the two halves of your medical school education. The first half is spent in the classroom and the second half is spent in clinical rotations. In this post I will be discussing the day to day schedule during your clinical years, specifically your third year (because fourth year is basically like senior year of college).  Now before you scroll down to see the day to day hourly schedule of a third year medical student I have a few caveats about your third year clinical rotations to reveal.

Everyone’s experience is different. 

During the first two years of medical school, regardless of what school you attend, everyone basically learns the same stuff. The information that you are eventually are tested on during your United States Licensing Exams (USMLE) is standardized regardless if you went to an Ivy League school or a Caribbean one like me. So the first two years of didactic lectures are pretty similar in every medical school. This standardized experience of your first two years of medical school is grossly different compared the second half of your schooling. You can be from the same school and be in the same rotation and have completely different experiences during your rotations, and there’s a number of reasons why. You works with different residents, different fellows, and different attending physicians and each one of them will share with you something unique. Not to mention that you end up seeing entirely different pateints. There is simply no way for everyone to have the same experience. Ultimately, although you might have the same schedule as your colleagues, your experience can be considerably different.

Each respective rotation is different

My third year core rotations consisted of the following: 6 weeks of pediatrics, OB/GYN, psychiatry, and family medicine, and 12 weeks of internal medicine and surgery and each rotation’s schedule was completely unique. Just think about how different the day to day life of a surgeon is compared to a psychiatrist. The same is true when it comes to your schedule. More so, each hospital’s respective rotation experience can vary widely between the hours you work, number of patients you see, balance between autonomy and supervision, and how much the residents and attending physicians are willing to teach. So take the following daily schedule with a grain of salt because it is mainly applicable to my internal medicine rotation that I completed in Brooklyn, New York.

Here’s my daily internal medicine schedule

  • 7:00am. Handoff from the night team. Pick up a new patient.
  • 7:00-9:00. See patient(s). Write note. Talk to the cute nurse. Look up how to treat my patient. Talk to my patient’s actual nurse. Present and discuss my patient with my resident. Prepare presentation for rounds.
  • 9:00-10:30. Round with my team. Present my patient. Discuss assessment and plan with the attending. Make updates to my patient’s treatment plan.
  • 10:30-10:35. Find that piece of paper that you wrote everything down on and then subseqently lost.
  • 10:35-10:40. Find your team that you lost while you were trying to find the piece of paper that you just found.
  • 10:40-11:30. Play it cool. They wouldn’t have noticed if you left altogether. Update my patient’s note. Call consults and check if lab-work results are back and interpret them if you can.
  • 11:15-12:00. Lunch. Attempt to resist drinking second cup of coffee.
  • 12:00-1:00. Lecture of some sort.
  • 1:00-1:15. Go get that second cup of coffee. Remind myself to stop trying to stop drinking coffee.
  • 1:15-4:00. Go say hello to my patient. Make sure labwork, radiology, and procedures were ordered. Call people to make sure it gets done. Eventually ask my resident, ‘if there is anything else I can help with’ and hope that they don’t need something faxed. God I hate fax machines. Seriously, why do they still exist?? I think its punishment for all the years of attitude I gave my parents when I wouldn’t help them find the ‘TV/VIDEO button’. Side note, when are TV/VIDEO buttons going to be a thing of the past?
  • 3:00-3:05. Complain about my research project.
  • 3:05-3:30. Work on my research project.
  • 3:30-4:00. Find someone to procrastinate with. Find someone to annoy if they won’t procrastinate with you.
  • 4:00-6:00. UWorld.
  • 6:00-7:30. Home, relax, gym, shower, eat.
  • 7:30-8:30. Review UWorld or watch Kaplan videos (Thank you Conrad Fischer and Online MedEd)
  • 8:30–midnight. Beer, Netflix, Xbox, read something non-medical, and lament over how little I got done today. Repeat tomorrow.
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How to Study for the Psych Clerkship Exam

Psych is generally regarded as the easiest of all the shelf exams. That doesn’t make studying for it any easier. Here’s how I approached it and what I would have done differently:

Overview: There is always overlap when it comes to clerkship exam content. On the psychiatry shelf you will be tested on neuro, pediatrics, OB/GYN, and some internal medicine along with psychiatry. It’s annoying but it makes sense if you think about it. For instance, if a patient comes in with increasing forgetfulness your differential list can be quite wide. This being your psych shelf you might be anchored to a diagnosis like pseudodementia secondary to depression but you also have to think about Alzheimer’s and hypothyroidism.

Psych Specific Tips: Know the timeline for psychiatric illnesses cold. You need to be able to differentiate brief psychotic disorder from schizophreniform from schizophrenia based on the timeline. And acute stress disorder from post-traumatic stress disorder. And both of those from adjustment disorder. It seems easy and it is. But the diagnostic criteria and various timelines can blend together quite easily when you are taking a two hour hour test and each question has the same differential diagnosis list. Also, psych meds are huge on this test so don’t neglect them.

Resources: First Aid for the Psychiatry Clerkship is gold. It has everything you need for both the clerkship exam and step two. My primary resource when I studied for step two was Master The Boards (MTB) by Conrad Fischer. It provides a good skeleton but leaves you dictating a lot of stuff that isn’t in the book. If you know everything in MTB then you will likely know all the high-yield stuff. But it is entirely comprehensive. That’s why I suggest the First Aid for Psych Clerkship. And as always, UWorld is the gold standard for practice questions.

Practice Questions: As I said, UWorld is the gold standard. Finishing the psych section is doable. I would also attack the neuro section while you’re at it. If you finish all of that then redo all the questions you got wrong. If you finish those questions and want more I would next use PreTest for pysch. PreTest presents a lot of good information that isn’t in any review books (FA, MTB included) or even in UWorld. Granted, some of these questions are beyond low-yield and you should always know the basics inside and out before you delve into the esoteric. That being said, PreTest is a good resource if you’re looking for a couple hundred more new practice questions before test day.

tl; dr: Use First Aid for the Psych Clerkship, annotate Master the Boards, finish the psych and neuro UWorld questions…and basically just know everything.

As always, this isn’t anything groundbreaking but I wish someone told me this when I started psych. Feel free to leave any follow-up questions you may have down below!

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Test Taking Strategies: how to maximize your score

Your USMLE step 1 and step 2 scores are the most important pieces of information in your residency application. However, acing your board exams isn’t just about knowing the science but also about having strong test taking skills. At the end of the day, your score is a combination of how smart you are multiplied by how hard you work divided by your test taking skills. Here are my test taking strategies to maximize your score on test day.

 

Find your weaknesses

It’s hard to improve your test taking skills if you don’t know where to start. So do a question set of UWorld or two and while you are reviewing your answers figure out why you got the question wrong in the first place. In my mind, there are two broad categories of why you get questions wrong. The first is that you straight up didn’t know the answer because you didn’t know the science or medicine behind the question at hand. The second category of incorrect answers is due to poor test taking skills.  So if you get a question wrong because you didn’t remember the auto-antibody that correlates with autoimmune hepatitis then don’t stress out about it. Just go study that subject material. However, did you fluster over this answer choice for five minutes? Did you eat up all of your time trying to remember the answer? That’s a test taking strategy and is something you have to work on.

So first, (1) figure out if you got the answer wrong because of a lack of knowledge versus poor test taking skills. Next, (2) continue to jot down the reasons why you got these questions wrong. Eventually, you might (3) find patterns in why you get questions wrong.

 

Recognize patterns concerning why you are getting questions wrong

So at this point you should have completed a few question sets and collected some data concerning why you are getting questions wrong. Maybe you are a great test taker and you just need to study the science a little more. If that’s you then stop reading this blog post and go study! If you’re like me, you might need to make a plan moving forward concerning how to improve your test taking skills. Some reasons why I got questions wrong in the past were because:

  1. I wasted time on ‘easy’ questions and had to rush through questions near the end
  2. I changed my answer choices
  3. I would be thinking about question number 1 while I was reading question number 2
  4. Test taking anxiety
  5. Stupid mistakes

Next, I will go into how I overcame these test taking weaknesses of mine and hopefully you can mimic what I did and overcome your deficiencies.

 

Overcome minor anxiety by simulating test day

A soccer coach I once knew used to hate when we took practice shots from a stand still. He felt that during a game you rarely had the opportunity to take a shot when the ball wasn’t already moving. It didn’t simulate the game realistically. Likewise, you need to prepare for the exam by answering practice questions against the clock. It will simulate the anxiety of test day and, hopefully, make you more comfortable when answering questions in the hot seat. This helped me get over my minor test taking anxiety. Those butterflies in my stomach.

Power poses are also a great subconscious confidence booster. Long story short, if you have positive, confident posture it will translate into a slight increase in real life confidence. That goes for test day too. Check out this TED talk that goes into more depth on the topic.

As an aside, this post is mainly for test taking strategies. Minor tweaks that can improve your score. Which means that if you have severe anxiety to the point where it is truly inhibiting your ability to take tests then please seek professional help. There is no shame in speaking to a psychiatrist about your test taking anxiety and they are much better equipped to help you flourish come test day. Same thing goes for people whose attention span could use a little artificial endurance.

 

Don’t overthink it and stop changing your answer choices

I recently tried this new ice-cream place in Brooklyn called Ample Hills Creamery (if you live in the area you NEED to go there). Looking at the menu I instantly saw the words ‘Salted Crack Caramel’ and knew what I wanted to try. Except then I saw other delicious looking options like ‘The Munchies’ and ‘Mexican Hot Chocolate’ and I started second-guessing myself even though I knew what I wanted to get. Likewise, when it comes to test day don’t overthink your answer choice. If you think you know the answer then click the bubble and move on to the next one. JUST CLICK THE BUBBLE AND MOVE ONE! Your first inclination is often your best guess…especially if you aren’t sure why you think it’s the correct answer choice (sometimes your gut is smarter than you and not just with regards to ice-cream).

UWorld also has a great tool to see where you are making your mistakes. I found that I had a greater number of answers that I changed from correct to incorrect that the other way round. By making a ‘click and move on’ rule I increased the number of questions I got right. It might only get you one or two questions right in each question set but they add up quickly. Especially when step 1 and step 2 are 7 and 8 question sets long respectively.

The only exception to this rule is if I went back to my question and found that I completely missed something. Oh, the patient had a myocardial infarction because he did cocaine! I’m gonna change my answer from beta-blocker to calcium channel blocker. Boom. Science bitch!

 

Once you eliminate the impossible, whatever remains, no matter how improbable, must be the truth

There were a lot of easy questions on step 2. Things that everyone gets right like ‘give IV fluids’ or ‘compare to old chest x-ray’. Then there are the cluster of questions that make me wonder if I forgot everything or if I just straight up never learned it. For example, on step 1 I remember a question on neurofibromatosis type I but I forgot that it is also often called von Recklinghausen Disease. At the time, I wasn’t sure if von Recklinghausen Disease was the same thing as neurofibromatosis type I or not. Instead of ruling IN the correct answer I simply ruled OUT the incorrect ones. With this approach I was left with only one possible answer choice and ended up picking the right one.

Ultimately, this isn’t anything new or groundbreaking that you haven’t heard before but its worth hearing again. When it comes to these standardized tests every question is worth an equal number of points. I hope that these test taking tips will help you get a few more questions right and help bump up your score because every little bit counts. Happy studying!

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OB/GYN: What To Expect

“I’m starting my third year with OB/GYN. Do you have any tips or tricks for that particular rotation? Anything I should expect working with those attendings? Or anything the attending like or expect from us? Just anything that could help before starting.”

Short answer: Expect vaginas, babies, long hours, and lots of vaginas.

Long answer: During my obstetrics and gynecology rotation I rotated through each aspect of the specialty. Obstetrics, gynecology, gynecological oncology, a week with a preceptor, a week in the outpatient clinic, one week on days, and one week on nights. Days and nights are the worst because they are literally twelve hour shifts. My surgery rotation wasn’t even this bad. In surgery you can at least steal away to the library to study. In OB/GYN, you are constantly doing something. It’s a lot of work and in my opinion the toughest third year rotation. Not to mention all of the vaginas.

For me, one of the most difficult aspects of pediatrics and OB/GYN is the fact that it feels like I’m studying a complete different species. For the most part, in internal medicine, family medicine, emergency medicine, surgery, and psychiatry you study the medicine involved with the adult human being. Pediatrics and OB/GYN are completely different entities. The steep learning curve in OB/GYN is a tough one to tackle. So grab a review book and start reading and, like every rotation, be present! Learn as much hands on medicine as you can. The OB/GYN residents I worked with went above and beyond to teach. They get a bad rap in my hospital for being…high-strung. Yes, let’s say high-strung. All joking aside, they are hard-working, intelligent, and willing to teach but you have to be willing to work. Just don’t get stuck doing SCUT work all day. Yes you are there to help but first and foremost you are there to learn. So be a part of the team, be willing to help out, ask questions, and learn! Of course, pick and choose your time to ask questions. There is a delicate balance between inquisitive med student and OMG STFU med student.

OB/GYN also sends you into the surgical realm. So learn how to scrub in properly and be nice to the scrub nurses. Also be warned- there are certain scrub nurses who will be rude, curt, and straight up nasty to you in surgery. Don’t take it personally and just roll with the punches. Introduce yourself when you enter an operating room and state your purpose. My friend got into the habit of literally walking in and saying “Hi my name is John Smith. I’m a medical student” because when you walk into an OR everyone will look to see who you are and it’s kind of awkward if you just scoot in without saying anything.

As for the attendings, I stopped trying to guess what they are thinking and what will make them happy. Just show up on time, work hard, study your medicine, be professional, be kind to your patients, and you will be fine.

Let me know if you have any follow up questions. And as always, happy studying!

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Now Is The Time To Develop Your Style With Patients

I’m thankful that my first rotation was family medicine out in Youngstown, Ohio. Youngstown is a small town halfway between Cleveland and Pittsburgh. Everything moves a little slower out there compared to what I’m used to in Brooklyn and Manhattan. Similarly, my family medicine rotation as a whole was slower and calmer compared to my other rotations. I didn’t see any emergency conditions or an excessive number of rare pathologies in the doctor’s office I rotated through. I saw routine diseases that affect the majority of Americans- hypertension, diabetes, chronic pain, concerning moles and freckles, so on and so forth.

While I was in the doctor’s office I didn’t necessarily learn about the pathophysiological mechanisms underlying these diseases. That’s not what my physician primarily taught me. I had to dedicate time to study that stuff on my own. Instead, my attending taught me the art of practicing medicine.

What still strikes me today is how well my attending knew his patients. He had entire families coming to see him. We would check grandma’s blood pressure, grandpa’s blood thinners, mom’s thyroid hormone levels, dad’s sugars, and give a vaccine or two to the kids and send them on their way with new scripts and clean bills of health. But he also knew which grocery stores had the cheapest, or sometimes free, medications. With a patriarchal nurturing tone, he would warn his patients not to end up spending too much money at the big chains because they often offered free or bargain-priced medications that a majority of their customers needed as a ploy to get them in the door. He reminded me of my dad telling me to behave before a night out with my friends after an exam.

And the sincerity was a two way street. On many occasions patients would offer my attending help repaving his driveway or moving an old tractor from a ditch with the same nonchalant manner of someone asking to please pass the water from the other side of the dinner table. It was like a tight-knit community out of a corny television commercial. I mean, I had always heard that people are much nicer in the Midwest, or just about anywhere outside of New York for that matter, but are people seriously this nice?

After my six weeks in Ohio came to a close I moved to Brooklyn to complete my third year rotations. I started with psychiatry. My first psych patient came to the office for routine pre-surgical clearance for a gastric sleeve operation. Most patients are required to start a weight loss regimen to help smooth the post-surgical transition and increase the surgery’s success rate. After I finished conducting my portion of the patient’s history, the patient and I joined my attending in his office.

My attending got up from his comfortable reclining padded leather chair that you would expect to find in a psychiatrist’s office and joined us on the other side of his desk. He moved the third empty chair and positioned it to make a small triangle with the patient and me before sitting down. He sat, paused, acknowledged both of us, and asked the patient how she was doing.

Our patient was excited that she was continuing to lose weight and my attending was proud of her too. You could feel that he genuinely cared. It was like they were gym buddies encouraging one another.

The patient was cleared for surgery leaving my attending and I alone for a few fleeting seconds before the next patient was called in. Without looking up from a paper on his desk he remarked, ‘By the way, I liked how you interacted with that patient”. Stunned, I kind of just gazed at him unsure if he was joking in the most extreme of sarcastic ways or if he was actually being serious. Realizing I should probably say something I finally asked him, “What do you mean? I didn’t say anything”. He answered simply, “Yes. But you listened very well”.

His comment made me realize that the warm comradery, earnest candor, and trusting temperament wasn’t unique to Ohio or to family medicine but is intrinsic to all high quality caring physicians. It allowed me to recognize the art of the physician as the exquisite ability to convey trust and compassion not only through what you say but how you say it. By using your eyes, your attitude, and your posture alongside what you actually tell your patient.

That art takes time and practice to perfect. There are physicians who have been practicing medicine for longer than I’ve been alive. Their ability to connect with patients and make them feel comfortable, safe, and heard is engrained in their routines through decades of practice.

As a medical student and future physician, now is the time to develop your personal style of how you interact with your patients. How do you want to be perceived when you walk into your patient’s room? How do you want to make your patients and their families feel when you discuss their health or treatment options? As a physician, how do you want to be remembered? These are questions that only you can answer but you can start figuring that out now. Actively observe how your attendings, residents, and even your peers interact with their patients. Mimic what you like. Avoid what you don’t.

Ultimately, how you interact with your patients is part of your style. It’s a reflection of your attitude and personality. It has the ability to affect the people around you, including your patients, and can be greatly beneficial, or conversely detrimental, to your career. So start developing that style now. And whatever you do, do it with confidence.

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My Three Favorite Study Aids That Every Medical Student Should Have

Besides caffeine, there are three study aids that got me through medical school. These resources speed up the memorization process, enhance your learning for long-term retention, and help you understand the required mountain of material you learn during the first two years of med school. They were my favorite resources to use during the basic science courses and while I studied for step one. The more I found myself using them the more useful they became. As I’ve written about before, don’t half ass anything– and that includes your study aids. So try these out, see if they help you, and then commit to using them. Without further ado, here are my three favorite med school study tools…you know, besides note cards of course:

First Aid for the USMLE Step One

This is every medical student’s bible. If you ask a med student studying for step one, ‘if your house was on fire and you were only allowed to retrieve one item’, their First Aid book would be the answer. If you are about to start med school just go ahead and buy it. This book provides a backbone outline of your medical education and its up to you to fill in the details. You can almost always tell the first semester students apart from the fourth semesters based on how much white space is left on the pages of their First Aid book. Just remember, post-it notes are your friends, don’t use ink that will run, highlight in moderation, write small but legibly, and always double-check to see if the information you are about to scribble in your book isn’t already there.

Picmonic

Imagine that instead of forcing yourself to memorize every bug, drug, syndrome, system, and tumor that you could just watch cartoons and all the information would just magically diffuse into your consciousness. Picmonic is as close at it comes. Instead of just listing information and letting you figure out how to inject the information into your brain, Picmonic provides you with tons of notecard sized cartoon illustrations that tell unique and memorable stories. Each cartoon represents vital information about the subject at hand. With pathognomonic pictures and rhyming raps about almost everything that med students need to memorize and differentiate between, Picmonic makes memorizing the minutia of med school both easy and fun. I seriously would not have made it through med school without it.

*Use my link to get 30% off your Picmonic subscription!*

Pathoma

The only thing worse than not being able to pronounce the diseases you are studying is not being able to understand your professor teaching you. Whether your professor has a thick accent or is just a terrible teacher, Pathoma is the answer to your troubles. It’s the gold standard when it comes to studying pathology. The textbook has clear illustrations and descriptions of every disease process you learn about in the first two years of medical school and the accompanying videos explain the pathophysiology in a clear and concise manner. I honestly don’t know a single med friend of mine who doesn’t use it.

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Reflections After Finishing Second Year of Med School

As I walked home last night I glanced up at the evening sky of Dominica. Twinkling down at me was what seemed like a surprisingly bright star compared to all the rest. It couldn’t be a plane because planes very rarely fly over this Caribbean island. It seemed stationary so it couldn’t be a meteor. Confused, I pulled out my Sky Map on my iPhone and discovered it was not a star at all but instead turned out to be the planet named after the Roman goddess of love and beauty- Venus.

Earlier the same day I sat in my last lecture of my first two years of medical school and it felt strange. There was a buzz in the air. My entire class was about to be done learning new material. From then on out, we were to learn everything we already knew but in more depth and with greater stress on integrating each subject in preparation for the step. Except nothing seemed to change. I went to the same place for lunch that I normally do, went and got coffee like any other day, and procrastinated like a pro as always.

It took me until later that evening, looking up at the night sky, to register the significance of this transition. In that moment, staring up at the night sky alone with my thoughts, a smile snuck onto my face. It’s a smile that my close friends know quite well. It’s the same exuberant smile from the moment I first tried to place an IV port in my friend’s vein. It’s the same smile from the galvanizing moment when I successfully found my other friend’s uterus using an ultrasound. It became a smile from the moment that clarified how utterly happy I was to be on my journey in pursuit of medicine.

As corny and ironic as it sounds, I had to literally stare at the planet named for the Roman goddess of love and beauty to remember how much I love learning about the human body. Ever since I was a little kid I’ve always wanted to know how the silent orchestra of salient biochemical processes worked so well in perfect harmony. For me, its breathtaking to realize that I have learned most of the important processes that were once such a mystery to me and that I will one day be able to expand upon the zeitgeist of medicine.

It’s important to remind ourselves of our goals and our original reasons for why we wanted to pursue medicine- to remind ourselves that the sleep, sanity, and social life that we sacrifice are worth it. To remember why we spend our days in the library instead of on the beach.

I got lucky in that I’ve always wanted to learn about medicine and that I am happy to do so. I got even luckier in that I stumbled upon a strangely bright ‘star’ that reminded me of my passion which has given me willpower to complete my remaining exams with the utmost ferocity and determination. My passion and curiosity to understand the human body was a small part of my original reason for wanting to enter medicine but has become an integral engine that drives me to learn everyday. It is what will power me through the next few months leading up the step exam and beyond it as well.

Ultimately, I could try to answer the age-old interview question of ‘why did I choose medicine?’ except I don’t think it’s the most important question for current medical students anymore. Instead, ask yourself- ‘why do you still choose medicine?’.

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See One, Do One, Teach One

I have completed countless dissections in the anatomy lab and have observed even more through videos provided by Ross University. Like any diligent student I have studied anatomy by creating my own drawings, mnemonics, notecards, and through the ever popular rote memorization. This semester as an anatomy TA I have been given the opportunity to teach first semester students the anatomy of the human body from head to toe. As the phrase ‘see one, do one, teach one’ suggests, my medical learning experience will finally come full circle. I’ve made it this far- how hard can teaching really be?

An experience I had with three first semester students in the gross anatomy lab in the beginning of my second semester made me realize how rewarding teaching is. In no time, I ran through the anatomy of the upper limbs and superficial back with them and quickly quizzed them on the brachial plexus. Not only was I amazed at how much material I had retained but I recognized that I was still learning, compounding new and old information, and making even stronger connections this time around. I loved being able to integrate the 2nd semester anatomy of the pelvis with the 1st semester anatomy of the lower limb. Being able to take the material I memorize and integrate it with the material I actually understand.

My favorite part, however, was how innate my understanding of the arteries of the body felt. It was like driving through a familiar town I hadn’t visited in a while. For instance, last weekend I visited Binghamton. When I drove through the city I lived in during my undergrad years it felt as if I had never left. The map of the city is engrained in my head. Even after major road construction, I could still contemplate the deviations and possible detours I could take to shorten my journey. Likewise, the twisting and often times confusing pathways of arteries of the human body is now engrained in my head. My understanding has become second nature as to how the arteries of the head and upper limbs branch from the arch of the aorta before it becomes the abdominal aorta and continues down to give rise to major branches like the celiac trunk, superior mesenteric and inferior mesenteric arteries. How the splitting of the abdominal aorta gives rise to all the major arteries of the lower limb. These arteries are a roadmap to the human body and I don’t have to stop for directions.

Besides improving my own understanding of the body, it was rewarding to help others improve theirs. It always amazes me when I see the material a student in the semester above me is studying. The work always seems infinitely harder, more complex, and something that I’ll surely never be able to understand…at least until I start chipping away at it. I’ve come to find that the most challenging part of studying is similar to the most challenging part of running- the first step. It’s easy to become overwhelmed with the vast quantity of material I need to cover or how far I plan to run. It’s what makes studying for a final exam that much more daunting. But by simply taking that first step, studying becomes a smoother and less stressful experience. And that’s what the best TAs did for me. They gave me a gentle push in the right direction. A spark to ignite my engines. Momentum to overcome inertia.

However, the best TAs weren’t always the smartest ones. Well, maybe they were. I never really stopped to survey them about their grades. The best TAs would always exhibit the same qualities that my favorite middle and high school teachers and undergraduate and medical school professors have exhibited over the years. They were able to take an innate understanding of a complex concept and simplify it so that someone with a rudimentary understanding could grasp the material at hand. Furthermore, they did so in an entertaining and engaging way utilizing clear and concise language that made the material relevant to me. Don’t just tell me that melanocytes are found in the stratum basale of the dermis. Tell me how the melanin of fair-skinned gingers like myself is both produced in smaller quantities and is also degraded more quickly than dark-skinned individuals.

Using relevant examples and clear language in teaching is a simple enough concept but I recall as an undergraduate physics lab TA when it was far from second nature. I remember how unprepared I was. How I fumbled over my words. How difficult it became to describe velocity and sound equations to my peers who didn’t have the same understanding of the material as I did. I wasn’t the best physics TA to say the least but I learned a lot from that experience like the importance of communication in teaching. This brief but captivating 5 minute TED talk illustrates three key points to good communication between scientists and the public. Whether you are a TA or a tutor or just helping a friend with a concept they have trouble with, these three quick and easy communication tips can help anyone improve his or her teaching skills:

First, as Melissa Marshall from the Department of Communication Arts & Sciences at Penn State explains, “When you’re describing your science, beware of jargon. Jargon is a barrier to our understanding of your ideas. Sure, you can say “spatial and temporal”, but why not just say “space and time,” which is so much more accessible to us?” Likewise, the Latin or Greek name for structures often confuse students. Sure, you can use the term ‘profunda brachii’, but you could rather explain how it translates to ‘deep artery of the arm’, thereby making it more relatable [1].

Second, “tell us why your science is relevant to us. Don’t jus tell me that you study trabeculae, but tell me that you study trabeculae, which is the mesh-like structure of our bones because it’s important to understanding and treating osteoporosis. [1]”

Lastly, “a slide like this, shown below on the left, is not only boring, but it relies too much on the language area of our brain, and causes us to become overwhelmed. Instead, the slide on the right, an example by Genevieve Brown is much more effective. It’s showing that the special structure of trabeculae are so strong that they actually inspired the unique design of the Eiffel Tower. And the trick here is to use a single, readable sentence that…students…can key into if they get a bit lost, and then provide visuals which appeal to our other senses and create a deeper sense of understanding of what’s being described.[1]”

Trabeculae

Ultimately, communication skills are one of the many talents that an individual must master to become an effective teacher. Teaching is an art and quite possibly one of the most difficult arts to master because, as John Steinbeck wrote, “the medium is the human mind and spirit’.

Teaching is similar to other forms of the arts like painting, writing, or playing a musical instrument in that it can be learned. We rely too heavily on ‘the naturals’- people who have innate abilities to teach. Part of the problem is that we rarely teach individuals how to teach. For instance, I have a friend who understands our lecture material far better than anyone I know. He has stellar grades and can easily provide me an answer to almost all the questions I ask him, except he can’t convey his thought process to me. He might understand the material but I can’t understand him. In the end, teachers, tutors, and TAs must work to improve their own teaching skills with assistance from their universities to communicate material more clearly and improve their students’ understanding of lecture material.

1- Melissa Marshall: Talk Nerdy to Me. By Melissa Marshall. Perf. Melissa Marshal. TED: Ideas worth Spreading. N.p., Oct. 2012. Web. 05 May 2013.