At the end of second year, I had about a month to study for Step 1 of the United States Medical Licensing Exam. All medical students must pass it in order to continue on to clinical rotations. In 7 hours and 322 computer-based multiple-choice questions, it tests the basic science knowledge gained in the first two years of medical school: anatomy, physiology, pathology, pharmacology, biochemistry, etc. If you fail, you cannot continue on to your next rotation until you retake and pass the exam. If you pass, you do not have the option to retake it in the hopes of earning a higher score. (In some ways I feared passing with a low score more than I feared failing.) Step 1 is a serious source of stress for second-year medical school students starting around March. While still covering new coursework in our classes, we began pre-studying, or getting ready to study (e.g., making flashcards, revisiting old notes, buying far more review books than one could ever hope to read). And freaking out.
I entered the boards studying period with a carefully-crafted plan. I made a schedule on an Excel spreadsheet outlining which topic would be covered on which day, and how I would spend the hours of each day. I emailed this plan to my parents so they would know what I was doing and also know what times of day would be appropriate to call. My plan made me feel safe and equipped to tackle the beast that is Step 1.
The first day went very well. I started with immunology, a topic that I had especially enjoyed learning and was eager to revisit. I covered the appropriate section of my review book and completed the planned number of questions. I reviewed my flashcards for immunologic drugs in the evening and went to bed at my set bedtime feeling quite good.
After a day or two, I started to stall out a bit. Sometimes I misjudged how much time I should spend on a certain study task and realized later that I had left too many things to accomplish in the afternoon. Sometimes I took a long lunch break, like when one of my sorority sisters was in town. Sometimes I just didn't feel like studying and my brain rebelled, spitting out poetry instead of medical facts.
Over Memorial Day weekend, Tay and I moved up to Vermont, where we would spend the entire month of June. I had high hopes that the change in scenery and decrease in distractions would allow me to really buckle down and stick to my rigid schedule. On the first night, we unpacked everything and I set up my study station, with everything organized just so.
It was a good decision to study in Vermont. I followed my schedule reasonably well, with breaks on most days to go for runs through beautiful scenery. Tay was fantastic about taking care of all of the grocery shopping, food preparation, cleaning, and quizzing me nightly on my drug flashcards corresponding to the organ system I had studied that day. Given the isolation, putting on nice clothes and going out to lunch became ridiculously exciting. And every now and then, with much encouragement and reassurance from Tay, I put down the books and took a night off from studying to go out for a burger and a beer, do some last-minute wedding prep, or just watch a movie.
Of course, there were darker times, too. It's exquisitely difficult to quit for the day when you have not accomplished what you hoped to, and know that tomorrow will likely yield too few hours in which to accomplish its assigned tasks, let alone to catch up from today. And that each time you are seeing each topic is the last time you will see it before the exam because there is too much to even cover fully once, let alone repetitively. These were the forces that kept me slogging along past my bedtime and - a rarity in my life - unable to achieve restful sleep. I reached a new stage of being worn out: the bags under my eyes grew such that there were actually two levels of bags. Tay and I referred to this as "double-bagging." My goal became not to be fully rested - that would take weeks - but to be down to single bags leading up to the exam... and our wedding.
I wish that I had blogged about this experience earlier, so as to actually capture the mix of tension, fear, frustration, and exhilaration as they coursed through me. It's hard to fully revisit and describe the apprehension, the feeling of Oh God I'm not studying hard enough... if only I could concentrate better and for longer... why didn't I study harder over the past two years... this is ridiculous, how can they expect anyone to know all of this stuff... what if I actually can't do this? when I know my score and have progressed through months of clinical training so that the boards are a distant memory.
One of the things I do remember is this: that sometimes, even while in the depths of worry and frustration, I would stumble across a connection so great that it made me want to cry. Often the knowledge imparted during the first two years of medical school feels like thousands of facts, each existing in its own little space with no relation any other, each to be memorized individually. And then somehow, either through a practice question or an explanation in a different review book or even just seeing the information again and seeing it in a new light, I would suddenly understand that these bits were not individual entities but part of a broad mural exhibiting and explaining one disease. Sort of: Oh, that causes that... and then they lead to that. Ohh-ohhhh! It felt like all of the facts were tiny dewdrops sprayed out separately in space, but with closer inspection I began to see the fine threads of the spider's web to which they were all stuck, that actually formed numerous links between them.
I took the exam outside of Burlington on June 21. Tay and I had planned go out in the city afterwards, but I was too exhausted; he picked me up, drove me to get my pre-wedding spray-tan, and then we went back to the condo to see Mom, Dad, and Bijou, who had arrived that day. I am rarely super-confident when I leave a test, so I refused to even speculate that I had likely passed. However, I felt that I had prepared well and that during the test I was focused and really "on."
Scores were released on July 14, but I refused to check mine for a few days. Finally, on Friday of that week, I came home from the hospital and Tay insisted that I check. I cried. He cuddled me, then pointed out that I was being a two-year-old and was no longer actually producing tears, just whimpering. (True.) Finally he logged onto the website for me. He stared at my score for a moment and my heart dropped; then he turned the screen toward me. I shrieked, we embraced, I called my parents, and then we went out for dinner.
And I reached the halfway point. From there I could begin to count down to the end of med school.
Posts
.JPG)