Tag Archives: studying

The New MD

I must have looked at my Match Day appointment letter about six times. Part of me half-believing that my good fortune was some kind of error and if I just read it one more time it won’t actually say that I matched at my number one program. I have never wanted anything this much in my life and to actually get it–well, it leaves me speechless. The years of studying, stress, exams, planning and sacrificing all blur together.

I’m an emergency medicine physician with my first job at my dream program. It doesn’t feel real. 

Match Day was an incredible moment. I went up to the podium with my husband and had him open the envelope. When I looked down at the letter a rush of emotion came flooding in, the culmination of all of my hopes and hard work. I was so choked up I could barely speak. I had no idea I was going to react that way, but the emotion was too overwhelming. I’m not sure I’ve ever felt such joy. Probably because I’ve never worked this hard for anything.

I am so excited to start my career and the next chapter in this journey. Residency will be yet another blur of long hours, stress, sacrifice and emotion. It is terrifying and thrilling at the same time. The thought of the experiences that are to come makes me feel so thankful. I know it is very rare to find a job that you can be this passionate about, and even rarer to have a profession that challenges and pushes you daily–whether you want it or not. I couldn’t have asked for more.

Thank you to all of you guys who have been with me throughout the process and read the blog over the years! It has been a joy sharing it with you. Since I’m not sure just how much time I’ll have for writing I am moving things over to Instagram. Feel free to follow along! MD_Maja

 

 

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I’m Back, Let’s Recap (Step 2 board stuff)

To my amazing readers:

We really need to catch up! My last post left you somewhere near the end of third year. I was grinding out my last two rotations and feeling fairly uninspired. You see, it took all the reserve I had left to keep coming into clinic just as excited as my first day of rotations. I ended the year with ambulatory and family medicine. Two rotations that are classically considered “easy.” Working less than 40 hours a week, having weekends off and getting home by 5 pm was so foreign to me. Paradoxically, I tend to be less productive the more free time I have. A combination of a really long year and a lack of stress propelling me forward left me struggling internally to maintain my tireless enthusiasm. There was no sense of urgency. Even the medical cases were non-emergent. Well, I did have one blood glucose stick of 38 we had to call an ambulance for–and that was the most exciting thing that happened.  Needless to say, those two months dragged. I reconfirmed that my type of medicine is the worrisome kind–at least ruling it out.

I moved from one day being the last day of my rotation to the next day starting 4th year. I began the year with a Step 2 study block.

Board exams are basically the worst thing you ever have to do in medical school. Period. No matter how prepared you are, they are always terrible.  I tried to take away some lessons from my Step 1 experience–mainly that I needed to calm down, so I approached the 4 weeks I had to study much more relaxed this time. I was surprised I didn’t freak out once. Probably because I spent the last two days before the exam dancing around my living room. Doing the Dougie, even terribly, will kill all last minute nerves. Try it.

My study schedule consisted of waking up at 8 am, doing question blocks in Uworld, taking notes, reading my notes, and doing more questions, then going to bed around midnight just to wake up and do it all over again. I kept an excel spreadsheet and ended up doing about 2,900 practice questions. I also took three practice NBME exams. NBME number 4, 6 and 7. My actual score was within 2 points of NBME 4 and 6 and 18 points higher than NBME 7. (Don’t waste your time taking NBME 7 unless you are doing it just for additional practice questions.)

The exam itself was just as terrible as Step 1. 9 hours of answering questions leaves you feeling miserable and delirious. Even though I felt I totally failed, I did not sit and cry in my car this time, instead I took a celebratory selfie and moved on. I purposefully didn’t allow myself to think about the exam at all. If I felt my mind slipping back there I immediately redirected my thinking. This was because I actually thought I failed the exam. Only to find I did incredibly well. So just remember, feeling like you failed is inversely related to your score. The worse you feel, the better you did!

With that monstrosity behind me I FINALLY began what I have been waiting for: my Emergency Medicine rotations!!

Since I will be matching into EM, the beginning of my 4th year is filled with three, 1 month EM rotations: my home institution, a Kaiser hospital and a county program. Because EM deserves its very own blog post I will leave you here. All I will say is Emergency Medicine is awesome and any feeling of lassitude immediately dissipated the second I saw that neon Emergency Room sign. It is perfect for me.

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Photo I took during my away EM rotation. Southern California.

 

 

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Update #2

Time for another update: First, I wanted to thank all my wonderful blog readers for the encouragement and comments. I was in a pretty low place last week and hearing how other people felt similarly during their Step 1 prep helped tremendously. Sometimes all a girl needs is a little commiseration.

It has been 18 days and I am pretty amazed at how much material I have been able to cover. I’ve reviewed Biochem, Biostats, Respiratory, Cardiology, Neurology, Immunology and half of Reproductive. Within those I’ve covered the relevant pharm, physio, micro, anatomy and embryology. I’ve also done 2,080 practice questions (yes, I keep a spreadsheet and I kind of can’t believe that is the total so far). I took my first Step 1 self assessment this weekend…and with 34 days before my exam date….it was actually a reasonable score. That took so much pressure off me. I could have done a cartwheel if I was more flexible.

Taking that practice exam was a real turning point because it allowed the release of a giant amount of anxiety. Mainly from the unknown. Up until then I had no idea if the 12-14 hours I was spending per day studying was doing anything. Having that small cushion of comfort has transformed the whole experience for me. I am working my ass off but now I think it may just work. I found something crucial I was missing last week–confidence. Now that I believe in my own methods, I am actually having fun.

Doing practice questions and getting them right–is fun. So much more fun when you know the material. Reading First Aid and saying, yes, I remember that–is fun. I started by tackling my worst topics: neuro, biochem, cardio. At first, the process was frustrating and exhausting because there was so much I needed to review. But once you get through it and a foundational layer of information forms you can actually begin to enjoy the information. It is medicine after all! And if you know anything about me, you know that I am obsessed with medicine. I was so far in the weeds I forgot that I actually like learning this stuff.

Update #2 is much more upbeat. Hooray, I am no longer despondent! I still have a hell of a lot of work ahead of me, but knowing that if I just keep at it, I can do this, is enough to get me through the day. My very long, long day.

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Ugh, and other things I didn’t expect about Step 1 Studying

Here is a recap: I am exactly 12 days into my dedicated Step 1 Study schedule. The days are long and even lonelier. My mental status oscillates between stressed, tired and panic. I have tremendous anxiety about whether or not any of the studying I am doing is actually “sticking.” I wake up, start studying, and before I know it, it’s 4 or 5pm and I am wondering where has the day gone? Some days I forget about lunch. Other days my brain starts its own mini-revolt and I am forced to walk away from my desk and do something, anything other than what I have been doing for days. That’s when I run. Exercise seems to help.

Before I embarked on this task I thought to myself: hey, you’ve done really well throughout medical school, just relax, put in the work and everything will go fine. It can’t be as bad as everyone says. I would hear stories of 15 lb. weight loss, gray hair, ulcers and serious physical illness all from the process of studying and taking the Step 1 board exam. I never imagined that it actually is that bad. Sitting in a room for 12 hours a day, every day for 6 weeks, with nothing but practice questions and review material is agonizing torture. As positive as you try to remain a certain amount of self-doubt inevitably creeps in. Your mind wanders and begins to reflect on the sheer amount of material you need to know and you start getting a deep sinking feeling. Until you snap out of it and do another block of study questions. Yes, I am teetering on some edge.

I am taking my first full length practice exam (8 hours) on Saturday, so I guess I’ll see how the studying is going. At least if I am terribly on the wrong track with my methods I have time to re-group and adjust with enough time before the exam.

I like to end my blog posts with some wonderful revelation and advice. All I can say about where I am right now is that this process is the first time I have truly felt the sacrifice required of my profession. Maybe because all the other sacrifices were so spread out, a weekend lost here or there, a birthday celebration postponed. But right now as I am chained not just to studying, but the anxiety of it all, the process has made me feel very viscerally how hard it is to become a doctor. I know I’ll look back on this time and think, that was nothing, but being right in the middle of it, it feels–dare I say–like the hardest thing medical school has put before me.

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Everyday I am studying

As I mentioned in my last post, my classes for MS2 year are done! Last week I had my final combined regular exam and all that is left are a series of shelf exams before we disappear to some dark, lonely corner to study for our Step 1 exam. I alluded to the fact that buying a house threw me completely off course in terms of my regular study methods. As a result, because I was packing/unpacking and playing decorator instead of dutifully reviewing new material I had to resort to Emergency Plan B!

What is Emergency Plan B? Well, it is what is colloquially known as the “all nighter” or in med school the “two-or-three nighter.” A marathon of studying and reviewing that eliminates sleep and replaces it with chocolate covered espresso beans, pots of coffee and high carb snacks.  This plan is to be used sparingly and only in extreme circumstances. Yes, staying up for 2-3 nights with minimal sleep gives you the time you need to learn the content –but it comes at a price. The information I just last week knew well enough to score at the top of my class is leaking out of my brain faster than a subarachnoid hemorrhage. Not to mention my mental and physical health took a huge hit. Then there are the mood swings that come with feeling like the living-dead. Unfortunately for him, it was my poor husband who had to deal with my irrational self. So, my dear readers, avoid Emergency Plan B if you can. Do the right thing and study every night.

In other news, I had my first oral presentation at an Innovations in Medical Education conference this weekend. I felt honored to be among the three other presenters who had really inspiring ideas. I am talking REALLY awesome, big ideas. For example, check out this website http://www.2minutemedicine.com. It is an indispensable site for those in the medical field who are pressed for time and need to make sense of the 1,000s of medical studies that come out monthly. A medical student from Harvard (now attending physician) came up with a solution by having doctors write a brief synopsis and rate the validity of the study.

I think that is the best thing about attending conferences- the renewed sense of limitless possibilities you get. Hearing what other people have worked on inspires me to innovate. If medicine in and of itself isn’t awesome enough, there is the added advantage of room for improvement. Medicine changes so much and to have the ability to be part of that is incredible. I feel so lucky to attend a medical school that embraces change and in fact encourages all of us to explore technology and how it can better the field. This weekend I will be presenting at the American Academy of Emergency Medicine (AAEM) conference in Austin, which I am sure will be just as exciting!

My life has been a series of lessons learned and lucky breaks recently, so please learn from my mistakes and don’t procrastinate. You might get lucky and ace that exam, but in the long run it’s a recipe for disaster. Also, don’t accept the status quo, there are so many people out there pushing for change–get inspired!

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OK now that I am studying…

Since I’ve been reasonably productive today, adhering (with only a few small gchat interruptions) to my self-ascribed study schedule, I thought I would give myself a quick break to update my blog. Right now, I am T minus 4.5 days from my next big anatomy exam. As usually happens with big exams, I am starting to feel slightly nervous with some sporadic freak out thoughts of, “omg, am I going to have enough time to go back and learn the embryology and lymph drainage I’ve been putting off?!

Random panicky thoughts aside, things are going fairly smoothly as I tackle learning every word on 463 power point slides. For my non-med school readers, this is not an exaggeration. Anatomy requires precision with very little room for bullshitting an answer (there is only so much you can fudge with bad handwriting– the answer better be pretty damn close). As a result, for this next exam students are expected to know pretty much every word on 463 slides covering gastrointestinal, pelvic and peritoneal anatomy and its embryological origins.

That may seem like a daunting and  impossible task but on most days I find learning this stuff very enjoyable. Eventually, after you read something enough times it starts to stick in your head and you begin to feel pretty good about yourself and your ability to recall the seven branches of the anterior division of the internal iliac artery (sorry to say no one except for you and maybe your future surgery attending is impressed). Anatomy is best learned through repetition. Which is why I’ve read, and re-read every slide, done hundreds of flashcards and re-read the slides again. At first things seem foreign, almost like reading in a language you don’t understand, but after you see the structures in the lab and go back and re-read the material there is this “ah ha moment!” and everything seems to fall into place.

The next 4.5 days will be a race of memorization and hopefully retention. Sadly, my birthday happens to fall on one of the next 4.5 days, which means it will have to be postponed because when it comes to anatomy–even birthdays can wait.

I just hope my fortitude is handsomely rewarded– because even though the class is pass/fail and no one cares what grade I get, there is a little part of me that will never give up loving to get As.

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What now?

As the high and excitement of achieving the improbable wears off, I am left feeling-dare I say it- bored? Over the past four years my life has been manageable only through an impressive routine of time management. Nearly every hour was accounted for: working full time for an international health non-profit, attending science classes at night, studying, MCAT prep, work trips to Africa, clinical exposure at the local underserved hospital. I had a task to fill every moment, warding off boredom and bringing on an inner happiness and fulfillment.

As my schedule now goes from one extreme to the other, I am plagued by ennui. Is it possible to go through study withdrawal? Am I actually craving exams and review problems? Like Pavlov’s dogs, I have become conditioned to learning. Salivating at the mere thought of reading assignments. Most people reading this probably think I am crazy-who dreads free time? Go watch Bravo. There are three seasons of Downton Abbey to catch up on. Read a trashy magazine. All very valid options- yet none of which seem to appease me.

With 4.5 months to go until orientation, I have resorted to embarrassing tactics of re-reading my physiology textbook, watching free biochem lectures on iTunes, listening to emergency medicine residency lectures posted online. I am a sad, sad little nerd.

Most likely, I will look back on this time- my last moments of freedom- and want to kick myself that I didn’t enjoy doing not-much-of anything more. Perhaps I will. Or perhaps something in my brain has been permanently altered. My strange state is not unheard of. I recently came across this article, which may shed some light on my new found propensity for learning.

“Intense prep for law school admission test alters brain structure”

Altered or not. I cannot wait for medical school to start and the endless hours of new knowledge to follow. Only 143 days to go.

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