The Final Countdown

So, I wrote my Step 1.

You know, in retrospect, it sounds like an fitness instructor certification exam.

Step 1

Once my scores come in, my opinion may change drastically to one of the following:
1) Well, at least its average
2) WOOOHOOOO
3) WHAT IN THE &*$&#@$#

That being said, considering I must have set some kind of record for time spent studying in prep for the step 1, the exam wasn't that bad. At least, not until the 7th hour. But I digress.

First: neither Uworld nor Kaplan Qbanks quite match the Step 1 in terms of capturing the essense of the Step 1 questions. More so than I expected, Step 1 questions included many that were either sincerely simple, or were deceptively simple. Several questions were often presented in a way that appeared difficult (ex: having multiple graphs in a single question) while actually asking for a very simple analysis. Compare this to Uworld, where I would diagnose 35 cases of rare cancers in a single block of randomized Uworld.

Second, I was much more calm than I had expected. Over my first two years, trouble sleeping and pre-exam jitters were the norm. Even before my Comp exam, despite spending a generous amount of time studying, I still had trouble sleeping. But I was calm as a cucumber on the day of the step. Even did a tiny block of 10 questions in the morning just to get my brain churning (8/10, baby!). I looked over First Aid in a coffee shop while waiting for the exam room to open up, and while I would have thought that detrimental, I actually had 3 problems come up on things I just reviewed that morning and may have otherwise forgotten. Why so calm? Probably just the vast amount of questions I had done. While I had done some blocks before the Comp, it was still a smaller number than I would have preferred otherwise. However, I left a lot of time in between the two for me to go through question banks.

"Do questions" is advice I have often heard. My first try at it, which was right after the basic sciences, was one of confidence. I felt as if my base knowledge was so full of misconceptions or gaps that doing questions did not aid me. Learning nit-picky details and unexpected drug interactions (EBV + penicillin causing a rash, or the opioid Meperidine contributing to Serotonin Syndrome, etc...) was knowledge, but it seemed like facts heaped upon a larger pile of unsteady facts. I was lacking in confidence in my own knowledge of these pharmaceutical products. After taking a Kaplan course, and doing lots more questions (both Kaplan and Uworld questions) I started seeing archtypes of questions and presentations. Sure, there was the oddball here and there, but just getting used to the common types of questions helped immensely. Additionally, my recall of key facts increased in speed and accuracy, and I ironed most of the misconceptions I had.

 Will simply running through thousands questions help, then? Probably not. Having spoken with IMG colleagues who did into the exam after racing through question banks (4 blocks a day?!?) their performance was average at best. Having a deeper understanding of the answers requires time and patience. Additionally, simply memorizing First Aid or DIT may not help.

The Step 1 was, unexpectedly, a much more conceptual exam than expected. Thinking about the big picture is required, though I have never come across any resources that could reduce the idea of thinking "conceptually" to a few core points. I'm not sure how it can be taught, if that is even possible. I want to expand on this, but my memory has already of those questions has already started fading. Sorry :S

Finally, the last two blocks. Wow. After having a few minutes left over at the end of the first 6 blocks, the seventh was when I started running out on time. I could both see and feel myself slowing down, and my anxiety rising. I normally skip a few questions in each block that are either long or tricky, and return to them and spend more time on these. But by block 7, I started skipping a lot more questions. After reading question 46 on the block, I looked back and noticed that I had flagged many, and left many others blank, with only minutes left to spare.

Typical anxiety reaction.

Why do I think this is typical? Because a study buddy of mine with anxiety issues displays the exact same behavior. It takes a lot of concentration and coordination (which are not exactly plentiful after 6 hours of exam writing) to force yourself to slow down, take your eyes off the screen for a bit, breath, and realign both your body and mind. It was not my recall that was hampered; rather, I lost the ability to hold all the facts in my head and approach the problem from different angles. I forced myself to start reread words three or four times for it to stick and actually click.  ("despite not changing habits, patient has weight loss. weight loss. weight loss. weight loss. oooh maybe its cancer"). However, these two blocks felt significantly more difficult than the rest, and had some presentations that I would be hard pressed to narrow down even on a good day.

I finally walked (more like hobbled) out of there. Never to return.

And at least it is over now.

What do you mean 'Step 2'? What the hell is a Step 2?

No. NO. NOOOOOOOOOOOOOOOOOOOOOOO.

Best of luck on your endeavors .

-Arthur : )