The Next STEP!

Everything I need to know for Step 1... in flashcard form! HOW FUN!

After coasting for the last 5 weeks of 5th semester, you can imagine how hard it was getting back into the full swing of studying. I got home August 21st, took about a week off and started "studying" on the 27th... and when I say "study" I mean doing about two hours of Goljan each day and then going out and doing something not academically-related (i.e. dinner, drinks, run, movies, football). It wasn't really till about two weeks ago that I stepped up my game for my Step 1 preparation. I've been waking up at 8:30 every morning and I start studying by 9. I study for about 5 hours and then stop to go for a run and eat lunch in the early afternoon when my mind needs a break. After my shower, I push on for another 3 hours before my mom gets home and starts cooking dinner and that's right around where I call it quits for the day.

At the moment I'd say I'm putting in around 7 hours of truly productive work each day. Since mid-5th semester, I had been slowly going through Goljan's Rapid Review of Pathology making flashcards for all the diseases by organ system and I'm happy to report that I FINALLY finished the textbook and my cards yesterday. Pathology was the final frontier in my Step studying. I had already finished the notecards for my other subjects weeks ago while preparing for the Comp so now that I've finished Path, I have this very odd and slightly scary gleeful completeness whenever I look over at my little treasures. I was so proud of my work, I even took a picture to show you guys. I would have instagram-ed it (since I now know what that means), but the confining square I was mandated to use would have cut out some of my beautiful stacks and it's just heartbreaking for me to leave any of those little guys out since I put in so much time and love into them (okay... clearly I'm very tired).

Maybe I'm losing my mind or maybe I just have an obsession with flash cards. The way I see it is like this: Textbooks are so big and heavy, with such tiny, boring black print on so many pages that it's just overwhelming and intimidating to even look at from across the room. I have heart palpitations thinking about it. But when I see a nice, friendly stack of cute flashcards with colorful fun-facts on the other side of them, I just feel much happier and relaxed about studying. Flashcards are FUN, people! They are fun-sized for a reason! Haha anyway....
Thanks for indulging me.

Back to the point of this post-- I'm looking to schedule my exam for the end of October. If I'm not feeling great by then, I'll just have to push it back to the first or second week of November and that will be it! Do or die.

New Phone. Check.

First order of business was purchasing a new cell phone. Over these last two years, whenever I came back home between semesters, I had to revert back to the same flip phone I bought as a freshman in college. I had a "free" upgrade available so I decided to splurge on the new Samsung Galaxy S3 despite my mom's emphatic protestations to wait for the iphone 5. I think I made the right choice.

please notice my lovely St. Maarten-themed wallpaper

So Long St. Maarten

American Airlines Flight 2144 started the slow turn at the top of the runway preparing for takeoff. I took my last look of Maho Beach, the brilliant blue-green ocean, and the insane tourists who insisted on standing behind the jet blasts. A few others were lined on the cinder blocks out of harms way all waving goodbye. It wasn't until this moment that it really hit me that I was leaving St. Maarten and I wasn't coming back. As happy as I am to be returning to my family, boyfriend, and friends in New England I still felt an overwhelming sadness. It took everything I had to stop myself from crying and scaring the poor gentleman sitting next to me on the plane. I kept thinking to myself "it's the end of an era! This is the end of an era" since I often reference my existence back to Friends (The One Where Ross Hugs Rachel). There will never be another time in my life where I will be living on an island with all my friends studying medicine.  No more lecture hall everyday with my 120 classmates. We weren't all going to show up at the same club or lounge and just take it over. No more living in a bubble of perfect weather. No more running across to the casino and getting free money. No more Thai dates, no more $2 beers, no more Cuban cigars, no more Carousel, no more parking wherever we felt like, no more jogs to Tahoma/Beacon Hill, no more coffee shop happy hour, no more random conversations with the Sugarcane bartenders. I  could go on and on because there are so many little things that I loved.

When you spend everyday with the same people for nearly 2 years, you can't help but start feeling like they are your family. A few months ago, a friend of mine likened our experience to "going to war together". She added that maybe it was a strange analogy, but I completely understood her. We are tossed in a foreign country in a high stress environment and we have no choice but to lean on each other to get through it. You build a bond, strong bonds with those you study with and celebrate the good times with; carry on the traditions of birthdays, Thanksgiving, 4th of July, St. Patrick's Day; you cheer each other on to get through the grueling study hours and examinations. From my own personal take on things, I never felt like school was a competition here at AUC. I felt people did a lot to help each other out whether it came to group studying, tutoring, giving tips on professors, or trading notes and files. There's nothing I want more than for my classmates to do well, succeed, and kick ass in the Step and clinicals and secure great residency spots. For those who know me well and maybe even the few of you who have read my entire blog, I am an intensely loyal and proud person. You know I love my Patriots and Celtics, Boston, Rhode Island, and now I've come to love St. Maarten,  my AUC family and all my Caribbean med schoolness. Most of us who end up here have experienced rejection, but none have let that get in the way of what we wanted to do with our lives. It's that unwavering drive and determination and then recognizing that same struggle in one another that binds us all together. We are better for it. 

I can't speak for anyone but myself, but all I have to say is I *loved* my 20 months here in St. Maarten and I can't believe this chapter of my life is coming to a close. It seemed like just yesterday that I was a firstie and the 5ths were telling me to enjoy every second I had on the island because time flies and we're only together in one place for such a short period of time. I didn't believe them at the time, but they were right. Time flies when everyday is the same and I'm going to miss everyone and everything here. No matter what I do or where I end up, I will always carry a piece of St. Maarten with me and for that I am thankful.

And now for my anthem of the last 5 days on the island (I averaged roughly 4 hours of sleep)

Rotations at the St. Maarten Medical Center

Borrowed this from Benji's Blog

You finally get your first little taste of clinical medicine during 5th semester. The ICM department requires all fifth semester students to sign up for two rotations of your choosing and they can either be at the St. Maarten Medical Center in Philipsburg or the Mullet Bay Clinic right by school. There are one-hour rotations and four-hour rotations and the specialities available are as follows: Pediatrics, Family Medicine, Surgery, Anesthesiology, Emergency Medicine, Radiology, Dermatology. There may be a few more, but I can't remember them as of now. I ended up doing a one-hour rotation in pediatrics way back in early June and I just had my last rotation, a four-hour emergency medicine stint two weeks ago. Seeing that I am required to write a reflection of each of my experiences, I figured why not just make a new blog post out of it. The alternative would have been writing a poem, singing a song or doing an interpretive dance... And you think I'm kidding.

Pediatrics

I ended up rotating with one of my good friends and two other AUC students for this one. The four of us plus a team of nursing students pretty much ran around with Dr. O for an hour going from room to room learning about each of the patients inside. We started off in the neonatal intensive care unit and saw a some really tiny, tiny babies. They were premature and needed to be put in incubators since they didn't have enough body fat to keep themselves warm. We then looked at another baby and Dr. O asked us what was different about him. After a few minutes we determined that he had Down's Syndrome. It can be tough diagnosing it at such an early age, but there are some tell-tale signs physicians can look for like the "sandal gap deformity" where there is a wide gap between the big toe and the rest of the toes. You can also see excess nuchal skin of the neck (also seen in Turner's Syndrome), Brushfield spots in the eyes (little white deposits of connective tissue in the iris arranged in a concentric ring). Not always, but sometimes the infants can have the "typical" facial features of Down's syndrome like the flat nasal bridge, and upslanting of the palpebral fissures. And usually a lot of these newborns are hypotonic, requiring a lot more support from examiners to hold up their head and shoulders, while the arms just flop back with gravity.   

Nuchal Skin Fold

Sandal Gap deformity

Brushfield Spots

After leaving the neonates we then went and saw some of the older children with their parents. I can't remember much of what we saw during this time, but I do remember two children in particular. One was a little boy who was diagnosed with asthma. I just remember seeing him sitting outside in the tripod position with his labored breathing. Dr. O pointed out the movement of the child's chest while he was breathing. It was just going in and out very rapidly, which is typical to see when someone is having an asthma attack.  The last patient I remember distinctly was a young teenage girl who had Sickle Cell disease. This also happened to be my first real pimping experience and I failed miserably. Dr. O asked me how someone gets Sickle Cell Anemia and I nervously and not-coherently started getting into the genetics about the glutamate to valine mutation and the recessiveness of the disease and all this other stuff when he cut me short and said he was only looking for "it comes from the parents". That was my "oh" moment and I felt a little silly. I'm not sure how I'm going to handle pimping during rotations when I can barely form a cohesive sentence to a simple question like that. Dr. O then asked what kind of medication you give to Sickle patients and the answer was hydroxyurea. It's funny he asked that because literally two hours later during pharm, our professor taught us about hydroxyurea in class. It's used because it increases fetal hemoglobin production in Sickle Cell patients, thereby reducing the dependence on HbS. The same question also appeared on our final exam, and I knew it without thinking thanks to Dr. O. It's funny how much easier learning material is when you can actually see it in a clinical setting. I think that was my main take away point from my peds rotation. Actually seeing patients with certain conditions just stays with you; Reading it from a book.... not so much. Seeing it and then going home to read about it and reinforce it-- even better. I can't help but get excited for clinicals for this very reason.    

Emergency Medicine

I heard that this rotation was hit or miss in terms of how many cases you would see. It was definitely a miss for me, but it was no fault of anyone, just the luck of the draw. Maybe part of the problem is that I went to the emergency department for four hours on a very sleepy Sunday afternoon... I probably shouldn't have expected much. I was the only AUC student for this rotation and basically just followed Dr. B around as she saw a couple cut and dry situations. One guy was brought in by his wife because he fell on his shoulder while playing soccer. Treatment? Sling and a pain killer. Another lady came in because she fell down and sprained her ankle. Treatment? Pain killer. There was an older girl who came in for a terrible migraine. Treatment? Turn the lights off, comfort her, and let her rest. There was an Italian couple that wandered in with a pushy third friend who served as our translator. The woman was on Warfarin but had been having vaginal bleeds for the last week so they were looking for an INR to measure her coagulation. 

The most interesting event of the day ended up being my last case of the rotation and it was when a 6 year old boy was brought in by his grandmother because of a cut on his head. Apparently he had been cut by glass and he required stitches. I had never seen anyone get stitches before and I didn't want to be in the way so I stood a good 10 feet from the table watching in horror as Dr. B sewed the little boy's head up while he squirmed around. The cut was superficial and only needed 4 stitches, but I'm just not used to seeing blood. My recurring thought was what if she sticks him accidentally in the skull? I was standing so far away one of the nurses physically grabbed me by the arm and pulled me right up to the table and was like you need to watch this! And I'm glad he did because after I got over my initial fear of seeing a needle go into someone's head, it was actually pretty cool watching Dr. B at work. After seeing that relatively simple procedure, I think I may actually be able to stitch someone up myself now. Any takers?

Related Articles:
Benji ended up doing Surgery and Emergency Medicine during his 5th semester. To read his experiences click below!
My Day in the O.R. (caribbeanmedstudent.com)
My First Taste of Emergency Medicine (caribbeanmedstudent.com)

Passing the NBME Comp

As you have gathered from my recent posts, 5th semester students must pass the Comp (short for Comprehensive exam) before they can sit for the USMLE Step 1 exam. The exam entails all the material from the first two years of basic sciences and you get a total of four times to pass it before you are dismissed from the school. You need a raw score of at least of 64 to pass. You get your first chance to pass it 2 months into 5th semester. Approximately 60% of the class passes the first Comp and clearly if you pass it the first time, a huge weight is lifted from your shoulders and you can just relax and coast for the rest of the semester (i.e. be like me). If you did not pass the first time, instead of taking the NBME Comp, the school requires you to pass both the Physiology Shelf and Pathology Shelf exams two to three weeks later. This is actually a new policy AUC just implemented last semester and I think it's a lot nicer than having to take another comprehensive exam because it allows for students to just focus on physio and path and to hell with the rest of it. If you pass both shelf exams that is the equivalent to passing the NBME Comp and congrats you are home free.

Should you fail one or both shelf exams then you have to start gearing up for the next NMBE Comp exam and that's usually scheduled for the last or second to last week of the semester.  Blood pressure is going crazy at this point, right? Thoughts of failing out of school, losing two years of your life and being $100,000s in debt start flooding your mind and I don't blame you, that is a pretty scary prospect. However, even if you fail that last Comp, there is still hope! Honestly, this school does as much as it can for you to pass. They don't want to fail anyone out, especially this late in the game and at this point you really just need to help yourself. AUC sends you back to the US for a two week review course somewhere in Texas or Pennsylvania or something like that to cover all the material again. Then the rest of the time is spent preparing for your last and 4th chance to pass something. These students on their last chance then fly back to St. Maarten and sit with the new 5th semester class taking their first NBME Comp, and if you don't pass then that's it... you don't proceed with med school.

The honest truth is, dear readers, the Comp really isn't that hard to pass as long as you put some work into the semester. 98% of you will pass it in one of the first three times and that's fine. Fifth semester is extremely busy and carving out some time for yourself to study can get tricky. It really is a rare instance when a student gets dismissed from the school for failing all 4 attempts, and I can pretty much 100% guarantee you it's for no other reason than they just did not want to put the hours to really know the material. If you fail the fourth Comp even after that review course and the additional two months of having nothing to do but to study... shoot yourself (KIDDING, don't do that). But seriously, re-think this whole being a doctor thing, because clearly it isn't for you if you are so unwilling to give it the attention it so necessarily requires. But again, these are very rare instances. 

Someone commented on one of my posts a couple days ago asking what people did to pass the Comp. Everyone's got a different approach, here are a few of the things people did:

-- Q-Banks!!! Whether it be Kaplan or UWorld, the people who did a block (46 questions) or even 20 questions a day for the first two months did well on the exam. Do a block and then do the explanations of each question whether you got it wrong or right. You are bound to learn a lot from this. Also, Kaplan Qbank does this cute little thing where you can look up the content of the question on the corresponding page of First Aid (it has the right page number for the last 3 editions) and MedEssentials (the Kaplan equivalent of First Aid) and that also allows for more learning.

-- Doctors in Training (DIT) Videos. The 2012 version of DIT is out and I recommend the lower semester students getting the videos from an upperclassmen since we all pretty much have it on our external hard drives. I never did DIT but I think it's about 35 hours and it just goes page to page with the 2012 version of First Aid. Someone said it takes about 2 weeks to get through and if coupled with questions, I think that's more than enough to pass the Comp.

-- Goljan Audio tapes with his Rapid Review Path book. The bootleg audio tapes are out there so definitely get them. He's fantastic. There isn't enough good things I can say about Goljan and his stuff. As for his path book, you must own it. I wish I had done more path in my preparation for my Comp because our exam was almost entirely path. Also, I know of some people who just did all of the Pathoma videos with practice questions and they did well on the Comp. 

-- Kaplan Books. This is what I mainly stuck to. Aside from some of the Goljan audio and a little GI pathoma, I didn't really do much of the above. I didn't do that many practice questions in the Qbanks (but I really wish I had) and I barely used DIT or First Aid (which doesn't really bother me). For the first two month, I was really all about consolidating all the most important information from various sources and putting them into flashcard form (for anyone who sees me in class, you MUST know my obsession with flashcards). I was doing this not for Comp, but just to get my study tools in order for when I go home and start my Step 1 preparation. In my perfect world, I want to have all the information I would ever need for Step on my flashcards and only have First Aid to refer back to if needed.  

I managed to get through all of Anatomy, MCB, Med Micro, Immuno, Pharm, and Behavioral/Med Ethics. Please note when I say "get through" that is completely different from "learned and memorized".  I only did three organ systems for path (GI, heart, RBCs) and did not do any physio by the time I had to take the first Comp. Honestly, the amount of work I put in for Pharm and Behavioral is what saved me for the Comp. Don't feel bad putting all your work in those two subjects during the semester because it really does make a huge difference. 

If I could do the semester over again, I would have made sure I did the entire Goljan Rapid Review book before the first Comp. Path really is the most important subject and what's also nice about Goljan is that he integrates high yield MCB, Micro, and Physio into his book so just learning that would have been huge. Ah well, such is life. I'm doing it now and I know it's going to pay off when it really counts-- Step 1!