Wednesday, November 28, 2007

Post-Step 1 Catharsis

*Caveat: As the title says, this is a catharsis piece. This is more for me than for those reading it (at least the first half). However, some of my friends who will later take the same exam have asked me to describe how my experience went so this might be useful for them. Now, I don’t know how I did. It’s very possible that I might have done terribly. If I end up failing this test, then everything I write here would be trash, wouldn’t it? So take the tips I give with a grain of salt. A lot of salt, really.

It was surreal and it was difficult. That’s how I’d describe the USMLE Step 1 examination. Let me start this by telling you the events leading up to the exam.

I did some last minute reviewing the whole day yesterday and last night. I made sure to buy some biscuits to bring to the testing center, and a diphenhydramine tablet, which I took at about 8:30 pm. I thought I’d help myself to get to sleep earlier than usual by taking the most harmless sleeping pill I know. By 10:30 pm, I was feeling a bit groggy and sometime then, I finally fell asleep. I found myself wide awake by 4:45 am, a full hour before I was supposed to wake up, and I had a little bit of a headache. Great. Tip #1: Don’t take a sedative the night before the exam.

I was in Makati by 7:30 am so I had some time to buy a cup of Peppermint Mocha. My dad and I walked to a Starbucks store a couple of blocks away. I was in the testing center by 8:30 am. I placed my things in the locker (I was given a key after signing in), went to the restroom, and was finally called into this pre-testing area where they took my picture and made me sign in to a logbook. I was told I could start immediately and that I didn’t have to wait for 9:00 am.

Because I used the practice software that came with the USMLE CD, I skipped the whole tutorial part and before I knew it, I was answering the exam proper. I had a momentary feeling of depersonalization (for those studying for Step 1, you should know what this means) but had soon settled on a routine. My technique was to answer the question by knee jerk (the first thing that came to my mind). If I didn’t know it, I guessed. If I wasn’t sure about my answer but knew I could work out the question, I still picked an answer then and there. All guesses and all questions that I planned to work on later were marked (the check mark on FRED) and I tried not to leave any item unanswered before I moved on to the next question. I kept an eye on the clock and made sure I was past item 25 when the remaining time struck 30 minutes and that I was going through all my marked items with 15 minutes remaining. I was usually done with an entire block with about 5-10 minutes to go and I made sure I never ran out of time. I was that OC about time.

I took 2 breaks. I answered 3 blocks straight through then took a short lunch break. I didn’t have a watch with me so I hurriedly ate my food, went to the restroom, then returned to the computer. At this time, I noticed that I had about an hour of break time left. So I planned to go on break again after 2 blocks, and I planned to relax the next time. I answered what I thought were 2 blocks. By the time I was halfway through what I thought was the 2nd block, I felt tired and restless and wondered why the block took so long to finish. Finally, I finished with what I thought was the 2nd block. I took a break, ate a pandesal, and went to the restroom again. I took my time knowing I had an hour of break time to squander (I didn’t consume the whole hour of course). On returning to the computer, I started what I thought was my 6th block (or 2nd to the last block). However, as I finished that block and clicked to start on a new block, I was shown this screen that told me the examination was finished and that I was requested to answer a short survey. I was of course very confused by this time and I had to think back whether I had missed an entire block by mistake. I fumbled through the survey then finally clicked on the exit button. I had finished an hour and a half ahead of schedule. I was stunned and perplexed that the test had ended so prematurely. It was only later when I realized that I had actually finished 3 blocks during the post-lunch break set, instead of the 2 I’d originally planned to answer.

How did I find the actual test? It was difficult. Most questions were workable and familiar, which is comforting, but the time pressure really made everything much more complicated. I had to rely on my knee-jerk answers, quick associations that I’d made from answering Qbooks or from mnemonics I had memorized. But don’t get me wrong. There were also the occasional questions that were out of this world. I didn’t bother to work those questions out and I just gave it my best guess.

I considered the review for the local boards as my first reading so the videos reinforced that and also refocused my attention on the things that I needed to know the most. I officially began studying for this test sometime in late August. I went through the entire Kaplan video series, together with the Kaplan notes (outline form, not the 4-volume home-study edition). After that, I spent the last 2.5 weeks going through First Aid. Everything came together when I read First Aid and it was the book I used to memorize stuff. I spent the last 2 days before my exam as “Cram Days.” This was the time to memorize formulae and tables and flowcharts which have brain half-lives of less than 3 days. I also bought a subscription to USMLEWorld for a month ($90; this was in late October). Regrettably, I only got to answer about 30% of their banked questions as I chose to prioritize First Aid rather than answering their questions.

Having said all that, I have several observations-slash-tips:
  1. I learned loads from the Kaplan videos. There were many physiologic and pharmacologic concepts that I’d never understood until I saw the videos. However, I don’t think the videos will be effective without the notes in front of you. I also don’t think the notes are effective without watching the video. But that’s just my opinion. My favorite parts were Physiology, Biochemistry, and Behavioral Science.
  2. First Aid is really, REALLY HIGH YIELD. All the websites I’ve read that posted tips on Step 1 said so. Now I can attest to it. Those knee-jerk answers and quick associations I made? They were from First Aid. The tables are helpful. The figures are helpful. If you can memorize the book from cover to cover, you’d probably get a very high score (don’t try it, you’ll just frustrate yourself). BUT, and this is a big BUT, I wouldn’t have appreciated the tables and figures in First Aid had I not gone through the Kaplan videos or even the local board review books first (BRS, etc.). What First Aid does is integrate everything you know into bite sized pieces that can serve as short term memory boosters. Without really knowing, say, the biochemical pathway of Urea, the First Aid figure wouldn’t be of much help.
  3. It would really help to review pathology slides, radiographs, and CT scans. They don’t just ask about normal anatomy. I got a question about a type of pneumoconiosis and was asked to identify which radiograph best fits the description. There were a lot of questions with patho slides (gross and microscopic). I got no questions with videos though.
  4. PRACTICE. Use the Kaplan Qbooks, get a USMLEWorld account if you can, and use the software that came with the USMLE CD. I noticed that the Kaplan Qbook questions were structured very similarly to the way the USMLE questions were made. The content was also similar but more than that, it was how the questions were delivered that was more important. The USMLEWorld questions were very difficult and although it’s nice to have that as practice material, you can do without it if you really couldn’t get a subscription (I still highly recommend getting one). It gives you a graphical feedback on the areas you need to improve and it trains you to think through difficult problems.
  5. More on Practice: It is important to practice answering questions with no time limit. This trains your brain how to think through the question stem and make analyses the way the USMLE wants you to. I used the Kaplan Qbook for this. After that, practice with a 1 hour time limit on blocks with 50 questions each. This will train you to think the way you need to think but quickly. It will allow you to practice making rapid associations and formulating your knee-jerk responses. This is where the USMLEWorld questions will help because it simulates FRED. If you have more time (I didn’t), you can even practice taking 7 timed blocks one after another so you can simulate the actual test day.
I think that’s it. My score comes out in 3-6 weeks. I really don’t know how I did. I made a lot of guesses and who knows whether those knee-jerk answers were even correct. I can only trust God’s leading on this and there’s really no use ruminating on what could have been. Hehe. For those who have yet to take the exam, I wish you all the best and God bless! For the many people who prayed for me, my deepest thanks. I now wait on God to reveal His will through this exam.

1 comment:

The Fish said...

now why can't i come up with something this brilliant? :)