Step 1: Post Exam Thoughts (Part 3)

 

Sometimes I feel weird writing this stuff on here. But I pay for the domain so I guess I can write what I feel. I am not some medical school pariah. I am just your medical school classmate. If you’d like to read a post of my morose complaints and reflections, continue. If not, no worries.

While this post is highly personal, I do believe there are lessons that can be extracted by all. This is simply something I’ve needed to get off my chest. My second year of medical school was the most difficult of my life. With deaths, a break-up, and pure social isolation with Step 1 looming around the corner, it was a tough year for me. I can smile now that it’s over, but it’s always important to reflect.

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Step 1: Post-Exam Thoughts (Part 2)

Yesterday I binged the entire first season of Wet Hot American Summer on my couch. My mother cooked ribs on the grill. My brothers were in town. Last night, I sipped beers, laughed very hard with friends, talked to cute girls, and smiled.

I have smiled more the past two weeks than I had in the past 6 months combined.

I hadn’t smiled much at all since starting my second year. With deaths, self-induced isolation, a break up, and Step 1 looming over my head – it was a tough year for me. I’ll write more on all of this is my next post, but for now I want to send a message to anyone currently entering their second year of medical school. You may read this and scoff, but perhaps someone will read this and learn from my mistakes. This is my message in a bottle. I hope someone who will need it in the future finds it.

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Step 1: Post-Exam Thoughts

Took Step 1 yesterday nearly a week ago. I meant to write this the day after, but I have developed a strong aversion to the Internet since walking out of the testing center. The immediate post-test hysteria has worn off and I haven’t yet forgotten the test, so I figured it’s a good time to share my thoughts on the actual exam.

But here’s one thing to keep in mind when reading reports of Step 1: Take every single on of these “just took step 1, here are my thoughts” posts with a grain of salt. Yes, this includes mine. I don’t think that any two people have the same exact test. Everyone has strengths and weaknesses. No one feels “good” after the exam.

When I get my scores back, I’ll give a full breakdown of my preparation. For context, most of my practice test scores throughout dedicated were 250+. I never really felt pressure or anxiety during dedicated. I was well-prepared. That said, after some blocks on the real deal, I felt like a failure. During the test, it’s easy to get flustered, but you have to remember that everyone is in the same boat. There are going to be a few questions that are not found in First Aid or UWorld or any prep resource. Don’t sweat it.

I ended up getting pretty sick the weekend before the test, which wasn’t ideal. Took my final practice test shaking, feverish, with a blanket wrapped around me. Didn’t do so hot on that one, which hurt my confidence going into the exam. Like most, I didn’t sleep well the night before the exam, but that’s to be expected.

On exam day, I woke up around 6 am and did some quick review (I couldn’t help myself). Had a big peanut butter banana smoothie for breakfast. I paced around for an hour. Before leaving, my mother reminded that this day would have been my grandmother’s birthday. This Step 1 nonsense makes us all a little crazy, but sometimes you need to step back and remember that many, many people are proud of you and you have come so far since those pre-med days. So, about the exam…

 

Some general stuff

  • During the first block, I had razor-sharp focus and submitted with 5-10 minutes left. By the final block, I didn’t even have time to review all of my marked questions.
  • I took 5 minute breaks after each section to use the restroom, listen to a song, and take a few bites of a protein bar.
  • The only time I did not take a five minute break after a block was the before my last block. I’m certain that it was my worst. I was reading questions three times over again. Fatigue is real.
  • After my fourth block, I stepped outside for 20 minutes, sat on the curb, munched on a protein bar and listened to some music. I listened to “Push the Sky Away” by Nick Cave & The Bad Seeds and “Since I Left You” by the Avalanches. Those songs gave me a very strange, calm, confidence. The block afterwards was easily my best.
  • I only ate one protein bar and drank one redbull. I wasn’t hungry at all, but in hindsight I probably should’ve forced myself to eat a little more.
  • Definitely do the Free 120 within a week of the exam. I had two identical pictures from the Free 120 on my real exam. I also had a couple repeats from NBME exams.
  • The test felt like a mix of UWSA2 and the last three NBME exams.

 

Questions

  • One thing I did not expect was how easy some questions would be. Seriously. There were quite a few questions that were so incredibly easy that I read them three/four times over to make sure I wasn’t missing something or falling for a trick. Stuff like… “What is E. Coli?”
    • Bacteria
    • Parasite
    • Virus
  • Micro wasn’t super difficult, but it was weird and very situational. I didn’t have any algorithmic bacterial identification. No catalase, oxidase, urease positive/negative. Nothing more than gram(+)/(-) rod/cocci.  A good portion of my micro was questions such like…
    • “Patient is septic and had a catheter. What’s the pathogen?”
    • or “patient has surgical wound infection – what’s the pathogen?”
  • These weren’t actual questions obviously, but I had many questions of this style. The best word I can use to describe the questions was situational. The last few pages of the FA Micro section is golden.
  • My test was extremely heavy on anatomy. I had more anatomy on my exam than biochem and neuro combined. Which was definitely not cool because those were two of my strongest subjects. The anatomy questions weren’t particularly difficult, but spending a solid two days dedicated to re-learning anatomy would’ve been a very good use of time.
  • Legit had a picture of a pathogen. No symptoms. Just a picture.
  • Biochem, neuro, and Endocrine were the three subjects I felt I had truly mastered (on a Step 1 level) by test day. As in I didn’t even need to open them in First Aid. Of course my test was very light on biochem, neuro, and endo. Classic.
  • Like many people have said before me, this test has a weird way of exposing your weaknesses and hitting them over and over again. This happened with me and respiratory. Tons of respiratory stuff. Best way to prepare for this: Don’t have weaknesses. Best of luck.
  • Had a couple MCAT/pre-med level questions. USMLE – you wild!

 

Comments on Resources

  • Got one question right solely because of a weird Goljan story. The vignette described a vague pathology presentation with one very peculiar symptom. I was like bro, I have no idea. I marked it and moved on, but when I came back to it, a light bulb went off in my head as I remembered a story from Goljan audio describing this one peculiar symptom. I smiled at my prometric cubicle. Thank u Goljan.
  • Got several questions right because of Boards and Beyond. I used Boards and Beyond as my primary study resource, so obviously 90% of questions I got right on the test were due to information learned in B&B. But there were specific questions on the test that I wouldn’t have gotten right without B&B.
  • Got one question right because one time a doctor told me that I had lymphoma (I didn’t) which prompted a manic week of research into various lymphomas. Something I had read during that week actually showed up on my exam (not in FA, Uworld, or anywhere else). Nice.
  • First three chapters of Pathoma are filled with easy points on exam day. Know them cold.
  • Sketchy was enough for 80% of my micro. Like I said – situational. I’d make it a point to read through First Aid’s micro section a few times during dedicated.
  • LOTS OF PICTURES.
  • I had a good amount of pharm, but none of the pharm questions were crazy or hard. Pretty straightforward stuff. Didn’t watch Sketchy pharm so I can’t comment on it.
  • I missed one question because as an angsty second year med student with boards on the mind, I decided that class material wasn’t relevant if it didn’t overlap with FA. Jokes on me because I specifically remember thinking, “why would I go through the trouble of learning this, it won’t be on Step 1“. It was on Step 1. Haha!
  • I missed one question because I was too lazy to try to remember a particular card in my Anki deck. Every time it popped up, I just said, “nah”. Smh.

 

Above all, if I had to describe Step 1 (at least my exam) in one word it would this: random. It didn’t feel like a selected group of questions meant to be representative of the studying I had done. It was just flat out random. 99% of what you study isn’t on the test. It’s 280 questions. Then it’s over. You could have ten questions on antifungals. You could have eight questions on brachial plexus lesions. I think I had maybe 5 total biochem questions. and at least 30 respiratory. It’s weird and random. Just have to do your best and laugh when appropriate.

As I previously said, I was confident during dedicated and was scoring > 250 on my practice tests. Still, after the exam I felt pretty terrible. It’s easy to focus on those wacky out-of-left-field questions after the test, but the reality is that 90% of the test was manageable and at times, easy.

When you’re done, forget about it. The gold standard treatment for post-step psychosis is a cold drink with some friends. Go out. Have a beer. Or a mojito. Treat yourself to a steak or sushi or whatever you happen to enjoy. Go for a bike ride. Attend a concert. Kiss someone. Make new friends. Laugh with old friends. Smile and remember that you are more than medicine or some stupid three digit score. Be kind to yourself. You are wildly intelligent, you have already made those who love you very proud, and you deserve to enjoy yourself now.

Next up, a very special message to anyone entering their second year of medical school…

Step 1: Post-Exam Thoughts Part 2

 

The Teacher We Need: An Interview With Dr. Jason Ryan of Boards and Beyond

Hello everyone, and welcome to our interview with Dr. Jason Ryan, creator of Boards and Beyond.

My first year neurology course was frustrating, confusing, and difficult. I passed, forgot everything, and life went on. Early in the fall of my second year, I watched an online video on brainstem lesions. The video was fantastic, but after I watched it, I simply put my face in my palms and let out a deep sigh. If only… If only I had discovered this twenty-six minute video during that neurology course, I could have saved myself hours of frustration, I would have actually understood the material, and I would have retained it.

I can’t think of a better way to describe Boards and Beyond – a comprehensive, clean, concise video series that teaches you just about everything you need to know for the USMLE Step 1 exam. If you know, you know. If not, get with the times and read more here. I am extremely thankful that I discovered Boards and Beyond and I can’t imagine where I’d be without it.

And because of that, we have to thank the creator, the teacher, and the voice of wisdom behind all of those helpful videos – Dr. Jason Ryan, M.D., M.P.H.

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Dr. Ryan is a cardiologist at the University of Connecticut (meaning his cardiology videos are an absolute must-watch). After earning both a bachelor’s and master’s degree in chemical engineering, Dr. Ryan attended medical school at the University of Connecticut. He completed his internal medicine residency, including a year as chief resident, and his cardiology fellowship at Harvard’s Beth Israel Deaconess Medical Center. In addition to his work as a cardiologist, Dr. Ryan gives lectures to medical students at Uconn and perfects the consummate preclinical medical resource in his free time.

Recently, I was fortunate enough to get in touch with Dr. Ryan. We discussed Boards and Beyond, clinical rotations, life in medicine, the New England Patriots, and much more. While we know him as the voice of Boards and Beyond, Dr. Ryan delivers insights, laughs, and gems of advice throughout. Enjoy.

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Anki: Soze’s Step 1 Master Deck (Update 3)

This is the third update of my Step 1 Anki deck. If this is your first time reading or hearing about my deck, I suggest checking out my original post in which I explain the deck – Anki: Soze’s Step 1 Master Deck(It’s different than the Zanki/Bros style).

Also, I feel that it’s important to point out that this deck should be used as a review and companion to your studying. I think I leave out a lot of the basic or foundational stuff. This deck is best used as a supplement to watching Boards and Beyond videos or as a review of the heavy-hitting topics emphasized by Dr. Ryan after you’ve completed his video course. I highly recommend Boards and Beyond to all med students, including first years. You can read my full review on it here – Boards & Beyond: A Review of Medical School’s Best Kept Secret

Here’s the link: Soze’s Step 1 Master Deck (V3)

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Anki: Soze’s Step 1 Master Deck (Update 2)

I’m really glad (and a little surprised) that many have found my Step 1 Anki deck useful. Due to the way I constructed many of the cards, which at times require recollection of long lists of symptoms and side effects, I figured most people would get frustrated with the deck and swiftly kick it to their computer’s trash bin.

The deck is pretty different from Bros/Zanki at times, so before downloading I’d recommend reading my “guide” and explanation of the deck here: Anki: Soze’s Step 1 Master Deck. I find that I understand and retain topics better from quizzing myself with in-depth (harder) questions compared to more cards with one fact per card. Some cards will be difficult (and frustrating) at first, but this helps me compartmentalize disease presentations, side effects, mechanisms, etc. And from the responses I’ve received, it seems that a good amount of people feel the same way, so I’m happy that I have helped in some capacity.

As I stated in that original post, I created the deck without any idea that I’d be sharing it at some point, so I didn’t make cards for every fact or every video I watched. For example, if I watched a video on cardiovascular physiology and understood the principles, I probably didn’t make many cards for that video. Anyone who uses the deck should fill in the gaps and add cards as they see fit. Also, sometimes when I’ve been studying all day, I’m prone to making a messy card here and there, so I have been periodically going through the cards to “clean them up” a bit.

Anyways, here’s what’s new:

  1. Subdecks – Again, the deck was originally created without knowing I’d be sharing it, so as I went through each system, every card and subject was located in one massive deck. (In my first update, I had added subdecks for Hematology and Reproductive systems, so it may have appeared to some users that only Heme and Repro were downloaded).
  2. Musculoskeletal – Musculoskeletal section has been completed. I wanted to add one thing – for many of the anatomy videos, I selectively made cards based on what I presumed would be “high yield”. For example, I wouldn’t ask “list all the muscles innervated by the radial nerve”, but rather “what are the presenting symptoms of radial nerve lesions?” Hope that makes sense.

Next, I’ll be tackling Neuro then Derm. Afterwards I’ll hit the “general” subjects like Genetics, Immunology, etc. So stay tuned and check back for updates if you like the deck.

Also, remember that this deck is not a substitute for learning and topics like physiology do not lend themselves well to Anki cards. I highly recommend purchasing a subscription to Dr. Ryan’s Boards and Beyond (read my review here) and supplementing the videos with the Anki deck of your choice. In my opinion, no Anki deck can replace spoken and visual explanation, so use a pre-made Anki deck (mine, Zanki, Bros) or create your own to use as a companion to your learning; not as your main source.

Here’s the link to my updated deck:

Soze’s Step 1 Master Deck (Update 2)


 

Follow me on Twitter for updates: @JordanSoze

Advice from 10 Students Who Scored 250+ on USMLE Step 1

It’s officially springtime, and you know what that means – it’s board season (for us Vitamin D deprived second year medical students).

First Aid is our bible. UWorld blocks will (or should) take the place of Fortnite. We’ll watch Sketchy in favor of Netflix. And Dr. Sattar will become our new best friend. (This is hyperbole… you should still make time for leisure).

Anyways, as the famous saying goes: “A goal without a plan is just a wish”. I believe that was from Michael Scott. When formulating a plan of any sort, it is always wise to seek the advice of elders – people who have “been there and done that”. Throughout the past year, I have enjoyed reading posts about peoples’ Step 1 experiences in which they share a comprehensive breakdown of how they achieved a certain score on the UMSLE Step 1 exam. I find these posts extremely insightful, and at times, inspiring. I’m sure many of you feel the same way.

So, I thought it might be a cool idea to “interview” a handful of medical students who have conquered and destroyed Step 1, scoring a 250 or above. How did they do it? What resources did they use? How did they use them? And what advice would these students impart to someone currently preparing for the big test?

One last, but very important, comment before reading: a 250 is an awesome score, yeah. But that does not mean you have to hold yourself to the standard of 250. It is an arbitrary number. Each and every person has different goals. Take pride in your work, do the best you can, and don’t compare yourself to others.

Scroll down below to read the experiences, study strategies, and advice of 10 students who have scored over 250 on the USMLE Step 1 exam. I have received more than 10 submissions, but for the sake of brevity, I will post a Part 2 (and perhaps Part 3) with more submissions in the near future.

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Anki: Soze’s Step 1 Master Deck Update 1

In my original post on my Step 1 Anki deck, I claimed that I’d upload a new version of the deck every week or so when I finished a new system. I totally lied because that was over a month ago and this is my first update. I’ve been busy and stuff. My bad.

This updated version of the deck includes cards on the Reproductive and Hematology systems, minus cancer pharmacology. Also importantly – I “cleaned up”, edited and revised many of the cards.

In the original version of the deck, all cards were in one giant deck, which wasn’t stratified by subject. I prefer studying like this (reviewing everything randomly compared to studying system by system), but I understand many others may not. So, I decided I’d begin the laborious process of sorting 2000+ cards into sub-decks by system or subject. Yeah that didn’t happen. BUT, I have begun working on this, and the subjects I’ve recently covered (Heme & Repro) have their own sub-decks.

Link: Soze’s Step 1 Master Deck (Update 1)

Up next will be Musculoskeletal, Neuro, and Dermatology.

For a “guide” to using my deck and my methodology behind my card making (it’s a little different from Bros/Zanki), check out my original post on the deck here.

This stuff gets exhausting, but keep working hard and remember the purpose of all of this. A 4th year friend of mine texted me today saying that he matched into his #1 program, a top tier academic program recognized across the globe. He reached the light at the end of the tunnel and now he’s celebrating with joy and pride. What we’re doing now is preparing us to experience the same euphoria on that day in two years when our fates our decided by a computer algorithm. It’ll all be worth it in the end.

Ok, motivational spiel over. Have a good weekend. Drink green beer. Kiss someone. Do something that makes you happy.

Anki: Soze’s Step 1 Master Deck

It is February of my second year in medical school. Just over four months remain between me and the USMLE Step 1 exam. As such, my Step 1 preparation is well under way. Like many of you, figuring out how and what to study was half the battle. My tentative plan is in place.

To sum it up – I’m using Boards and Beyond as my primary starting resource to build a foundation, before transitioning into my UFAP regimen. And I’m using Anki to solidify and retain the information that Dr. Ryan teaches me. (If you are unfamiliar with Anki, just google it or something. Its great. If you’re unfamiliar with Boards and Beyond, read my review and breakdown here.)

After mentioning this Anki deck in past posts as well as Reddit threads, I’ve received several emails, Twitter DMs, and Reddit messages about sharing the deck. So, due to popular demand, I will share the link to my Step 1 Master Deck in this post for anyone who would like to use it to study.

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Pseudopseudohypoparathyroidism: The Curse of Fuller Albright

Pseudopseudohypoparathyroidism.

During my fledgling medical career, I’ve come across a variety of diseases and drug names that make no damn sense. Half the battle in learning pharmacology is being able to repeat drug names that sound more like the title of a D-movie playing at 3 a.m. on the sci-fi channel than comprehensible english (Seriously, you try to pronounce Levetiracetam or Eculizumab).

However, no drug or disease or anatomical structure with a ridiculous name has truly bothered me like pseudopseudohypoparathyroidism. When I first laid eyes on this asinine collection of letters on page 331 of my 2017 edition of First Aid, I was immediately taken aback. I read it to myself several times over, trying to see if my mind or eyes were playing tricks on me. To my dismay and disappointment, there truly exists a disease named pseudopseudohypoparathyroidism.

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