How to Honor Your Tests in Med School

Someone posted the following on SDN.  I thought I would catalog it here for future reference.  It comes from a thread where people are arguing about how people manage to get 100s on tests in med school.  Suddenly this guy pops in really late to the discussion and drops a bomb.  It was the only good advice given, and I intend to follow suit.

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I had a horrible go of it in first year and failed four courses despite working long hours studying. I looked around and was in disbelief that anyone was getting or could get 100% or near that on these tests. 

When i was blessed with another chance at the year, i went to each member of the top 10% of my former class and took them to lunch to pick their brain.

They told me consistently the same thing...and it worked for me the next year to get near 100% all the time...you should plan to review the testable content a minimum of five times before the exam. This seems very daunting but each subsequent trip through is much faster because you have seen and understand the interrelationships of the content sections. I struggled to do this at first, and had to set a time limit per page and set a timer. When the timer went off, regardless of how far down the page I was, I turned and started on the next page. I also had to limit the number of sources I used to study from to a dictionary, anatomy atlas, and the recommended syllabus (it was a bound set of provided pages back then). At the top of each page I made a hash mark each time I had reviewed the page. By the fourth, fifth, and sixth time through, I could flip the page at about a ten second clip and recite the core material per page. As others have said on SDN before, its not hard to know how to achieve success in these classes, it is hard to do it though. In my experience repetition is key. 

This was my experience…yours may be different:
Barely one time through the content = barely pass
two times through = pass to slightly above average
three times through = above average to high pass
four times through = high pass to honors
five times through = honors to top three scorers
six plus times through = top three scorer

Over Joy

As I sat in the Library reviewing my Physics notes, I heard that distinctive note from my phone informing me that a new email had arrived to my inbox.  I quickly flipped over to take a look and felt my blood run cold when I saw who it was from.

MedAdmissions

The dreaded moment had finally arrived.  I was about to find out if my dream would finally come true, or if I would be forced to spend yet another year of my life trying to prove that I am worthy of the medical vocation.

I called my wife over to share the moment with me.  Initially she looked at me with a confused look.  Why was I interrupting her study?  Finally she acceded to my wishes and walked over.  I pointed to the screen, and then clicked to open the email.

On behalf of the Executive Dean, I am very pleased to offer you an acceptance...

I literally felt my body start to shake.  I was in disbelief, so I started to read the email again to make sure.

On behalf of the Executive Dean, I am very pleased to offer you an acceptance...

The words had not changed, yet my mind still could not comprehend.  My body continued to shake uncontrollably, and my wife embraced me from behind.  She was already crying, which caused me to cry too.  These were tears of joy, tears of disbelief, tears of pent up emotion that craved release!  I can't imagine what the other people, who beheld such an odd spectacle, were thinking at that moment.

My wife rushed off to call everyone and relate the good news.  I sat there in a daze, still trembling as emotion and adrenaline coursed through my body.  I realized at that moment that over the past seven years I had convinced myself that it would probably never happen, yet I was stubborn enough to keep trying in the face of the impossible.  Now I was confronted with reality, that it was possible, and the door to my dream had finally opened.

In retrospect, as I think about this now, I have never been so excited, happy, and relieved to have been given permission to start something.  Something that will take more effort, time, and dedication than anything I have ever tried in my life.  It is ironic, because many people would think it is over, but no...that was just the beginning, the first step on a road of training that will last at least 8 years.

This moment will forever be engraved in my mind.  I payed a high price to reach this starting point, but looking back on my credentials they are only average at best.  I can't help but believe that a miracle was enacted on my behalf.  I would love to take credit for this, but the truth is I must defer to the athlete who has just scored a touchdown and raises his hands to point heavenward.  I personally know several applicants with way better stats than me that were rejected.  Somehow God saw fit to turn the hearts of the Admissions Committee in my favor.  In turn I would also like to raise my hands heavenward and point to Him, because I can really see no reason why I am better than anyone else.

The blessing of God, have given me reason to be overjoyed and grateful at the same time.  At least once a day a surreal moment overwhelms me, sending me back to that email once again just to make sure;

On behalf of the Executive Dean, I am very pleased to offer you an acceptance...

Step by Step

All Rights to Mcraw-Hill and junk

The first two years of Medical School exist to prepare you for one seminal moment in your medical career.  That moment is when you take your first Board exam called "USMLE Step 1".  The last four years I have been so focused on sitting for the MCAT and getting into Medical School that nothing else has occupied my mind.  Although I have not been accepted into Medical School, I  recently started focusing on it and making plans for how I will approach it.

Although there may be some debate about this, I believe that the one key component which will allow you to apply to any residency unimpeded will be your Step 1 score.  I always thought that as long as you score a 99 on the Step 1 you could write your ticket, but this is not the whole story.  There are actually two scores and even if you are in the "99" range the second score can vary anywhere from 240-270+.  From my research I have been able to determine that scoring a 250 is very good, the top people are in the 260 range, and the godly freaks are in the 270 range.

Getting into Medical School will make me supremely happy, however that isn't my ultimate goal.  I will probably be accused of "gunnerism" for my approach to medical school, but I prefer to think that I am going into my future studies fully informed about the process.  As a non-traditional student, I am lucky to have already lived and done many of the things I wanted.  I have traveled the world extensively, lived abroad, married a wonderful woman, and enjoyed many reunions with friends.  As an undergrad I only wanted "to get my degree".

This time around, I want to see what I am really capable of, to fully embrace the process, and actually push myself to excel.  Most importantly, when it comes time to choose my residency I don't want my academic performance to have closed any doors.  I want the freedom to choose from any residency.  Even if I ultimately choose Family Medicine, which does not require a super high Step 1 score, I still want to have had the option to choose Neurosurgery or Dermatology.

Traditionally most Medical Students will use their 6 week break after the second year of Medical School to study for and take the Step 1 exam.  I plan on starting much much earlier.  From my first day I am going in with one thing in mind, to crush that test.  I will use every resource available to me to ensure that I am more than prepared on test day.

I have been formulating a plan to achieve just that, but it is still not complete.  What I have learned from the MCAT, is that I am not a super-freak that will be able to collate 2 years of study in just 6 weeks.  Taking the long term approach and making sure I continually maintain and refine my medical knowledge as I learn it, is really the only way I can expect to come out with a top score on that test.

Of course all this planning is still dependent on getting accepted into Medical School, so here is to hoping my interviews go well.

Why Can't I Get Off the Couch?

I always wondered why, when I wanted to get something done, I couldn't find the strength to get off the couch to do it.  Today I discovered the culprit and you will be surprised as to who is responsible.  The answer is gravity my friends.  The equation for gravity is as follows

It is important to understand that gravity can be exerted between any two objects, and using that equation we can find what the force is between two distinct object.  So bear with me as I quickly describe what each variable stands for, so that we will all be on the same page. 

F is the total Force of Gravity, m1 is the mass of one object, and m2 is the mass of a second object.  For our discussion I am m1, and the couch is m2;  r corresponds to the radius between both objects, which we can basically say that it is the distance they are away from each other.  Finally G is the universal constant of Gravity.

What I want you to pay attention to are two things.  First the radius variable.  As the radius decreases the Force of gravity becomes much greater.  As radius approaches zero the Force approaches a value close to infinity which means, my ass is going to be glued to that couch and there is nothing I can do to escape.  It is just too strong!  

Oh, but gravity hasn't finished with me yet, because that brings me to our second observation.  Pay attention to the m1 and m2 variables.  Well, if I increase the mass of one or both of the objects in this system, yes you guessed it, the Force of gravity once again INCREASES!  This is where I really have a problem with gravity because the amount by which my own mass increases is directly proportional to the amount of time my ass is glued to the couch, which by now we have determined to be nearly all the time since the radius is close to zero and the Force is near infinity.

It is a vicious cycle my friends, and Gravity has me in her cold hard grip.  She is a fickle lover, jealous of all distractions.  Will I escape?  My mathematical calculations lead me to believe that there may be little hope, but that is not why I am writing this.  I want this message to reach you, dear reader, so that when you see a couch you will know that you should run and run far.  Save yourself, it is already too late for me!

The Vagaries of Change

A Beatiful Sign Close to My New Home

Things have changed since I last posted.  I quit my job and moved 850 miles away from my home.  The day I took the MCAT my wife shared a surprise with me when I got home.  She told me that she had been accepted into a Graduate program at Tulane University.  I was absolutely shocked by this, because it was something I never expected.  Somehow, in less than two months I was able to find a new place to live, a new job, and relocate to an entirely new city.

I am now settled in and we have established our new rythm of life, however things are different.  For one, living arrangements are vastly different from before.  I went from a three bedroom house with a nice yard, to a tiny 1 bedroom apartment.  When my neighbors have friends over, I can hear it.  They often wake me up in the middle of the night, which is something that never used to happen before.  The hallway often carries suspicious odors that whisper to me their nighttime activities.  I never realized that living in an apartment would mean being more intimate with your neighbors...you literally share everything with them, whether  you want to or not.

The smallness of our apartment and the need to walk everywhere has also drawn my wife and I closer together as well.  We have been spending much more time together, and I am now thinking that bigger is not necessarily better.  Most people dream of having a big house, but I am not so sure I want one now.  I don't like that family members can hide from each other by going to other rooms in the house.  I especially don't like the maintenance duties of a large house.  Cleaning, upkeep, and yardwork take up so much time.  Now these are things I don't have to worry about, and I love it!

A View From my Morning Commute

My work routine has changed as well.  After moving here, I decided that I would bike to work everyday instead of driving the car.  Many things contributed to making this decision, such as traffic, expensive parking rates, and my lack of knowledge of the city, however, the main reason is because I was really craving a way to lose weight.  As an aspiring Physician I think that it would be hypocritical to meet patients as an overweight person.  If I am going to preach the high principles of healthy living, then I must also follow those principles as well.  My problem is that I hate going to the gym, especially when I have to do it by myself.  Forcing myself to bike to work accomplishes several things at once.  It allows me to learn the city, it provides me with a means of transportation, and it ensures that I get a healthy dose of exercise every single day.  With a 22 mile round trip I have already managed to lose 10 pounds in two weeks.

All of this upheaval has been difficult, yet instructive as well.  I have learned that sometimes we need a drastic change that will take us out of our comfort zone.  In the short month I have been here I have totally revolutionized my lifestyle.  I look back on who I was before and I am amazed at the change that has happened in only one month.  Most people battle to keep things from changing, because that way they never have to face a scary or uncertain situation.  It is those situations, that makes us grow the most.  The more of them I experience, the more I look forward to it.

All of this has caused me to evaluate my personal goals as well.  Last year I was so sure I would get accepted into Medical School that I was rocked when the rejection came.  This year, I decided I have to prepare for it.  I must have a contingency plan in place so that I can smoothly transition into plan-B instead of being caught unprepared.  I was scared to quit my current profession before, because the stability that an Engineering income provides is very comforting, however I have realized I am reaching a point where I need to go the extra mile if I am really serious about Medicine.  If I am not accepted this cycle I will be going to Graduate school starting in January to study Neuroscience.  I have finished all the pre-med courses that I can take at a community college.  The only thing left ot me now is some GPA redemption by going through a Graduate program.  GPA redemption isn't my only goal, because I also want to study something that I find interesting while also continuing to prepare me for Medical School.

Change can be scary, but change is necessary.  The saddest thing to me is to see someone who has done the same thing, in the same place, for thirty years or more.  I know there are probably many reasons for this, but to me it looks like they were scared to go further, so they decided that where they were at was "good enough".  The possible risk to go further was too much for them so they settled.  I hope that I never settle in my life.  I hope that when I reach my goal of becoming a Physician that I will go even further from there.  I never want to be satisfied with where I am at, because the alternative is scarier than any nightmare I could ever dream up.

Being Successful

Sort of cliche, but sports are an appropriate metaphor for success

I often think about success, and say to myself "Wouldn't it be great?"  I don't think I have the traditional definition of success where the end result is tons of money, a hot car, trophy wife, and a white picket fence with a two story house.  No I am always impressed by true success.  Success that people reach where they look back after a long journey and say to themselves "I made it!"

One thing I have noticed about success is that I hear other people speak of those who have achieved it in hushed tones of envy.  "Oh if I was only as LUCKY as them."  or "I could never do that, he's a GENIUS." or "It's just not FAIR" or "I just don't have the TALENT they have".  These people always look at a fully realized successful person and assume that they have always been that way.  They totally ignore the journey  that person had to take in order to become successful.  They completely ignore the hard work, the agonizing moments, the long tear-filled nights, the times of self-doubt, the times when they believed they couldn't go on...yet they did.

I find my favorite success stories by reading through blogs.  I love reading about the journeys people take to become better athletes, to learn a new hobby, or to reclaim their lives from obesity.  Every day "average" people decide that they are going to do something great.  They are going to go from a sedentary life to running the Ironman in Hawaii.  Maybe it is someone who is going to get on a bike and ride from Alaska all the way down to the tip of Argentina.  How about a person who decides that their life has been ruined by complacency and that they are going to lose a tremendous amount of weight one day at a time?

For me, I always have to start at the first post when I read those blogs.  I want to know about the days when it was impossible.  I want to read about the times when they felt weak, unable, and inadequate.  It is because I feel like this all too often, and I hope that one day someone is going to read my blog and realize that they can do it too.  I want to say now, that I FEEL like I will never become a doctor.  The cards are stacked against me.  I have an average MCAT, and substandard GPA, and I have been out of college for more than 8 years.

It is impossible for me, but I have something that all the lazy apathetic people don't have.  I just can't find it within myself to give up.  For some reason, after I was laid out flat by rejection after five years of preparation I got back up and said, "Lets try again."  Even after everyone online said, "No, it is impossible for you, you just don't have the right stats."  I closed my ears and decided to keep going.

When I start my residency, I want to look back at this post and remember what it was like when it was impossible.  Because I know what will happen when I get into medical school.  People will start saying those things about me.  "Oh it is because he is so SMART." or "I wish I was as LUCKY as him."  But it isn't true.

None of them who say that noticed the tears streaming down my face.  None of them were with me when I was defeated.  None of them sat with me during the long study sessions I had to do AFTER I had already worked a full day at the office.  None of them were there when I had to turn my wife down for date night so that I could do well on a test.  None of them used their vacation time to study those final two weeks for the MCAT instead of going to Peru for some fun.  The only thing they see is the end result, the fruits of my labor, what happens AFTER all the sacrifices.  So they simply dismiss it with a casual statement, because it makes them feel better for giving up on their own dreams.  That is the real truth, and that is why when I am successful I want to look back and remember how high the price was.

I also hope I can inspire someone, somehow.  I want them to read about my journey and realize that Doctors, Lawyers, Engineers, Businessmen, or whatever you choose to be has no bearing on your intellect.  It has to do with how much time you spend practicing, improving, sacrificing and moving towards your goal.  An elite athlete practices for years so that one day he can stand on the big stage and compete in front of thousands.  It is no different for the highest levels of success in any arena.

I did not improve on my MCAT score this year.  Conventional wisdom says, that after 2 tries you should quit.  That a 29 is "good enough".  You know what?  It isn't good enough for me.  After three tries, guess what?  I am going to start studying again.  Because it is all stuff I NEED to know.  Because I know I can do better, and because I want to do better....for me.

I think that the key component to success is the ability to maintain discipline.  By managing to put for a solid effort every single day over a long period of time someone inches ever closer to the success that they have in mind.  Writing a novel does not happen in a one week flurry if intense activity.  It consists of research, writing, revising, and often times throwing away large portions of script that have to be redone.  Losing weight does not happen in a week, even if commercials tell you it does.  It happens over a long period of time after someone has changed their lifestyle and committed themselves to a new discipline of diet and exercise.  My own success, hinges on daily efforts of reviewing material I have learned in the past, keeping up with current advances in medicine, and constantly striving to involve myself in the opportunities that exist to participate in volunteering or research.

Today my goals seem impossible, but I can see that every day I am inching ever closer to what I truly want.  Once I reach the starting line of Medical School I am looking forward to raising the bar even higher and making a new set of goals that will further define my new success story.

Coming Clean

I have been avoiding this post for some time, because I honestly just didn't want to come clean.  I didn't want to own up to the disappointing results of my MCAT.  I studied hard for that test, like I have never studied before in my life (and if you are familiar with this blog, this is now the third time I have taken the MCAT.)

So how did I do?  Exactly the same.  Yes, that is correct, I got the same exact score as last year.  To me it was a disaster, because the whole point was to improve, not to stay static.  The numbers tell me I haven't learned a thing, and yet I am positive I know VOLUMES more than I ever did last year.  Last year after the test I felt horrible, I was in a fog, I couldn't even remember the content of the test.  This year was different.   I remembered almost every single aspect of the test, I spent weeks beating myself up over the questions I missed, constantly going over things I was unsure of in my mind.  It was significantly more traumatizing this time around, all because I knew what I did and didn't miss.

Upon receiving my score, the feeling was horrible.  It was almost as bad as realizing I wasn't going to be able to start Medical School this year.  That every single school I had applied to did not find me worthy.  That somehow intellectually I do not measure up to anybodies standards.  I just turned 34 this year, and the thought of spending another year in exile from the path that I am convinced I should be walking, sounds like a death sentence.  I am reminded of Moses and the nation of Israel who wandered in the wilderness for 40 years  How many years will I wander before I reach my promised land?  I have already wandered these last 5 years gathering pre-requisites one class at a time.  One of those years of exile was a year of rejection.

So now we come upon this year, and a new application cycle.  I decided to apply early decision this year.  It represents a huge risk to me, because early decision means I am selecting only one University and declaring my intention to them to ONLY go to their school.  I cannot send applications to any other school until I receive a rejection letter from my early decision application.  This would happen by October 1, which means my applications would be going out late, putting me behind the curve for the rest of those schools.

Why did I take such a risk?  I did the math.  For some reason it comforts me.  There are some aspects of my life in Engineering that I will never get away from.  I only received an interview invite from one University last year, so that is the one I chose to investigate.  I discovered that if I apply early decision I have a 37% chance of getting accepted versus only a 4% chance of doing a regular application.  If I get an interview invitation my chances of getting accepted suddenly jump to 60% in early decision, versus 37% for a regular application.

So come August I will find out if I will have an interview or not.  Until then I continue to second guess myself.  Why did I work fulltime during my undergrad?  I could have had a better GPA if I didn't.  Why did I major in Engineering, instead of Theater?  I could have had a better GPA if I did.  Why didn't I sign up for a Master's program as a contingency plan?  If I get rejected, yet again, it will be another wasted year.  I find that I learn all too many things in retrospect, after it is too late.  I wish I wasn't like this.

In other news I will be uprooting my entire life to move halfway across the country.  My wife has been accepted to a Master's program for Clinical Research, and I decided it would be better to give up my career to keep our family unified than try to maintain a "long distance" marriage.  Some of this hasn't been easy, but the process of relocating, of having to solve a myriad of life problems on a tight deadline has drawn my wife and I closer together than before.  Sometimes I feel like things need to be shook up, that we need to be broken out of our routine so that we have an opportunity to rely on each other more, and build our trust in each other even more.

Some days I find it exhausting to be the one who has to carry the load, both financially and emotionally.  Often I want to quit and say I have had enough, but how can I when this empty gnawing feeling of unfulfillment will just remain and grow even greater?  I cannot allow my current misery spill over and ruin the hope I have for the future, for that is really the only thing that pushes me to move forward.  Then there are the expectations of my family.  How could I fail them, when I have already put forth so much effort?  I don't think I could bear to look my wife in the face, to see the pain in her eyes.

I am very grateful for my wife, I don't deserve her.  Even though from the outside it looks like I am the one "bringing home the bacon", the great Software Engineer making big money, while she merely studies; the truth is I see the effort she puts forth, I see the tears of frustration she cries, the resolve she has, the passion she fights with, the organizational skills she possesses, the brilliant mind she puts to use, her patience to see things through, the strong character that allows her to stand up after several crushing defeats, and secretly think to myself that I am way out of my league.  Nobody is as lucky as I am.

I feel like we have been successful because she puts forth effort every day so she can please me, and I get stuck every day doing my best to please her.  I think that as long as we both keep putting each other ahead of our own personal desires we are always going to have a wonderful marriage.  The worst times I can remember have been when I got stuck on myself, instead of following that intrinsic Universal paradigm, that law of nature more reliable than Gravity, where I should love others more than my self.  How much moreso should I love my wife then?