Almost Halfway Finished with Intern Year!

Still smiling!

I thought I was going to put out a lot more content following my last post, but that clearly didn't happen. Honestly, it hasn't been from having a lack of time since I'm currently off service and have had more free time over the past month and a half than I have had since starting residency. I think I've mostly just been experiencing writer's block, which is super weird given that I've had a lot of new experiences that really wouldn't have been too hard to write about. Oh well, I'll use this post to catch everyone up, and then I'll type a couple of new posts today to let everyone know what's currently happening in my world.

Physician Swag!

When I ended my last post, I was just about to begin my emergency medicine rotation. My first day was a complete culture shock! My first shift didn't start until 930am, so coming from the surgery world of 3am wake ups, it was super odd being able to sleep in. The work load was also much less intense. A couple of weeks prior to starting, I was informed that the service would also include internal medicine call which would begin on my first day. What this meant, is when my ER shift ended at 530pm, I would grab the night pager and head upstairs to function as an internal medicine resident until 6am. My first night was not only super busy, but a complete 180 degree turn from surgery life. We were swamped with new admissions, and notes had to include a lot of information that you typically don't see in surgery. For example, if a patient came in with something simple like a fractured hip from a fall, we didn't just workup that one problem, but we focused on what seemed like every co-morbidity the patient had. Whether it was their blood pressure or an episode of asthma that last occurred years ago, we left no issue unaddressed. That first night was a huge adjustment from my typical focus-based notes, and it was even harder considering the first half of my day was spent functioning as an ER resident, and that I had not been on an internal medicine rotation since my third year of medical school. Nevertheless, I quickly learned to adapt after receiving a few calls and texts from attending physicians the next day when I was post-call, LOL.

Relaxation before work

What I will say that I found to be the most shocking about call on a different service was actually leaving at 6am. During my surgery months, call doesn't typically end until after morning rounds, so you can imagine my disbelief at doing sign out at 530am and being out the door by 6am. Even better, during my ER month I had multiple full 24 hour days where I wasn't scheduled to work. That's right, full days where I wasn't groggy from being post-call and could actually sleep in and still have an entire day of productivity mixed with relaxation. I even had shifts that started later during the day, so a few times I ended up sleeping in, waking up to explore the city for an hour or two, and then getting ready for work. It was really nice being out in the sun each day and doing simple things like walking to the park and watching the calming river.

Post-Boards Celebratory Drink

I guess the best thing about having an emergency medicine month, was the extra time I had to study. Last week, I took the final board licensing exam required for me to obtain a full unrestricted medical license (I'm currently under a training license), so I needed all the extra study time I could get. This exam (COMLEX Level 3) differed from the other ones I had to take in order to graduate from medical school because it was a two day exam that took place over 8 hours each day, and instead of only multiple-choice answers, it included fill-in-the blank responses and questions where you had to select multiple answers. It was definitely long and stressful, but since the two days aren't required back-to-back, I was able to sit for the first portion on Monday and have a couple of days to breath before taking the second portion on Thursday. I won't receive my score until February, but I am so glad to be over the board exam hurdle! Plus, whoever it was who decided to place a Prometric testing center in the same building as a whiskey bar is a true MVP, because a drink was very much needed after making it through 16 hours of testing in one week.

On-Call Selfie

Right now, I am in the middle of an internal medicine month, and it hasn't been too bad. The hours are pretty consistent, and there are a lot of daily lectures and other learning opportunities. Oddly, this month has shown me how much I really enjoy and miss surgery, so I am itching to be back on the general surgery service next month. I'm also learning that I don't do well with free time, and I seem to be happier and more productive when my schedule is busier (I'm weird, I know!). The good news is in a little over two weeks, I will finally get my first true break of the year since I will be off New Year's week, prior to going back to general surgery, and I can't wait!!!!

That pretty much sums up the past month and a half. I know I always say I'll be coming out with more posts shortly, and then get too busy to post, but this month will be different. Not only is my five-year blogiversary approaching (stay tuned for a sweet surprise!), but my writer's block has resolved and I have a lot to say right now. Plus, I'm currently in the middle of working a 24 hour call shift, but rounds are over and my patient list is tidy, which means I actually have time to type a few future posts right now :) Stay tuned and I hope everyone has an amazing weekend!

How I Studied for the COMLEX Level 1 and USMLE Step 1 Exams

My approach to studying for boards was slightly different from that of my classmates and probably what most people do. If you’ve been following my blog from the beginning, then you already know my bad history with standardized exams which includes taking the MCAT four times, and this scared me into starting extra early with my board preparation and maybe even going slightly overboard with it. For the record (and in my opinion), the MCAT has absolutely no bearing on how a student will perform in medical school or on their board exams, but I wasn’t about to take any chances. So with that being said, while most students start studying for boards 6 weeks to 3 months out, I started my studying 6 months from my exam date, and I have absolutely no regrets.

I had two major goals before I started studying for boards: I wanted to keep my resources to a minimum to avoid getting overwhelmed and I wanted to have done at least 8000 questions before my exam date. I met both of my goals and even exceeded the minimum number of questions I had planned.

Resources

For both exams, I used First Aid for the USMLE Step 1, Pathoma (both the book and videos), UWORLD, USMLERX QMAX, and Combank. I also took all six NBME exams along with the free NMBE exam, and I completed both UWORLD assessment exams. For my COMLEX exam studies, I added in the Saverese OMT book, but did not take any COMSAE or NBOME exams outside of the one that was administered by my school. I did every single question in each question bank listed, and for UWORLD, after my first pass was complete at the end of February I re-did all my incorrect and marked questions. When I was 6 weeks away from my exam, I reset UWORLD and completed the entire bank again on timed, random mode (I used tutor mode during my first pass). I also completed both the USMLE and COMLEX side of Combank, along with all of USMLERX and when all was said and done I believe this added up to having completed a little over 10,000 questions (not including the assessment exam questions). I also dabbled with the Doctors in Training videos, but I wasn’t a huge fan, and I did read the First Aid book completely through about twice. Additionally, I used Picmonic for any topics that I just couldn’t get drilled into my head, since it was a lifesaver for me during my first two years of medical school. If there was anything I would have done differently, it probably would have been getting in another pass of UWORLD because on my USMLE exam, there were multiple questions that were extremely similar and the exam also had the exact same format as UWORLD. I also would have probably read my First Aid book a few more times.

Maximizing the Question Banks

I know a lot of people tend to get caught up about their scores on the question banks, but I focused on using the question banks as strict learning tools. By this I mean I did not get upset with my super low UWORLD scores when I first started, but instead I used it as an opportunity to explore my weaknesses. Also, outside of my first pass of UWORLD I did all of the questions in each bank without assistance so that I could really see what I needed to work on. This meant lower percentages, but I tend to learn from things I get wrong, so more information stuck with me. What I found extremely helpful was reading over EVERY answer choice explanation on questions I got both wrong and right, and I annotated the information I did not know into my First Aid book.   

Schedule

Studying for boards was hard while classes were in session, so I think when I first started I would just do maybe 20-40 questions per night. I treated the upcoming exams as if I were preparing for a marathon, and eventually (towards the end of my exam preparation) I was doing over 200 questions a day. I waited until I was six weeks from my exams to create a dedicated board study schedule, and I previously gave a snippet of what my daily schedule was like HERE, so I won’t go into too much detail about it right now. Our school does not offer a set dedicated board study time without classes, but I was lucky enough to have tested out of the OMM written exams during my last term, so I only had to be on campus for about 3 hours each week during my final six weeks leading up to my exams. This allowed me to really be able to put in full days where I only studied for my board exams, and that was typically between 10 – 14 hours of study time each day. My days were starting at 430am and not ending until 8 or 9pm, so it was an extremely stressful time. I made sure to schedule in breaks so I didn’t go crazy and I also took one day every week where I did absolutely nothing exam related and just relaxed or spent time with my daughter.   

Summary

So basically, my approach to my board exams was questions, questions, and more questions! It is true that everyone studies differently, but doing questions will not only help you figure out what to expect on the exams, but it will help build your test-taking stamina as well. Most people swear by UWORLD, First Aid, and Pathoma and while I did slightly more than that, I’m pretty sure this would have been sufficient. I don’t think there would have been any way to pass either exam without UWORLD, so if you’re on the fence about buying it, just suck it up and get it! Also, if you’re an osteopathic student who only plans on taking the COMLEX, I would still suggest using UWORLD because it is that good.

In my next post I will compare and contrast the USMLE and COMLEX exams, so stay tuned for that, but hopefully this gave you all an idea of how to go about these exams. Feel free to email me if there is any confusion, but hopefully my next posts will clear any of that up. Just keep it simple, do questions, stay positive and everything else will fall into place :-)