Truckin’ on

November 20, 2014

Hello, Readers,

Hope you all are doing well and gearing-up for a fabulous holiday season.  Greetings from outpatient neurology.  Ended up having a great month on inpatient psych, then spent a month doing outpatient pediatrics and absolutely loved it.  Really reaffirmed my decision to do peds-psych.  Now I have moved-on to the neuro folks and admit, I am missing peds, but am surprised to see that there is more psych involved in Neuro than I expected.  A lot of what I have done so-far is shadowing, but it’s helpful.  Definitely different than when dealing with patients on the inpatient service.

Today is Thursday, didactics day and also my day off from neuro.  Trying to get things tidied up around the house and exercise a bit before heading over to meet the rest of my PGY-1 class.  You guys have submitted some excellent questions and thanks for being so patient for me to get responses back.  Keep up the questions and I hope you all stay well!

J

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Packing

August 29, 2012

So I’m supposed to head up to Chicago with my folks this coming Sunday.  We have appointments to go apartment-viewing on Monday and Tuesday so that I can hopefully get moved-in with enough time remaining to unpack and settle before I have to be places.  My biggest apprehension, selfishly, about this whole process is getting internet set up.  Don’t care about TV.  Have cell phone.  But need internet to survive and have had notoriously BAAAAD experiences with ISPs taking a long time to show up/not being on time/not successfully getting internet set up and unlike previous experiences where I could stop what I was doing and go home to finally meet them outside of their scheduled arrival time, that is NOT a possibility now.  ::deep breath::

Otherwise completely excited about moving to the big city.  I think at heart I’m a city girl and hope that I will love urban living, even though I will be in a not-so-desirable area of the city.  Starting to get panicky about my decision to not have a car, but then remind myself of the complications that it would add to my life and stop worrying about that too.  I have a lot on my mind–can you tell?
Let’s see.  Meanwhile I have been doing more shopping.  Organizing.  Packing.  Donating a lot of my old clothes since they’re too big now YIPPEE!  I got a ton of books for my first rotation that are huge and have small print and don’t look that exciting, so instead of lugging those around I have been reading First Aid for the Wards while at the gym and I absolutely love it.  It’s like having a big brother med student to tell you all the right things to say and do during your rotation.  Makes me feel less nervous.  There’s a part of me that’s been bamboozled since I started basic sciences about how (during clinical years) we are graded and how we learn now that we’re not in lecture every day–everyone knows about rounds and stuff but once those are over, the prospect of wandering around a hospital all day/everyday for a few weeks seems eerily unstructured.  Not so.  The book reveals what happens during normal days and what is to be expected.  There IS structured learning.  Yay!

I’ve been trying to balance extra-strenuous trips to the gym with eating local things that I like (and assume I won’t have access to for a while) in the hope that I’ll still keep losing some weight.  It works…sort of.

My other computer, the beloved full-sized laptop from Med 1-2 is in the process of dying.  I caught a virus, the zero access trojan, which McAfee’s platinum-level virus team successfully removed for an economical $89.95 (this is sarcasm) but then in the process of trying to remove another virus I (apparently) had acquired, I started getting the blue screen of death and the McAfee folks starting playing a funeral march for me.  I was given the suggestion (to shut me up) of reinstalling windows and hoping for the best but we both know my sweet little laptop has turned into a brick.  I was still able to de-authorize iTunes and get most of my documents/photos off of it so I’m not that sad, but only going to Chicago with my netbook seems…risky.  I know, I know…millions of people are grateful to have just one computer and survive fine with it, but with all the computer-required responsibilities I have, it seems risky not to have an immediately-accessible back up.  Would LOVE to have a Mac but.they’re.so.expensive. 😦

Hi Ya’ll

July 13, 2012

Well, it’s been almost a month.  I’ve kicked my butt into shape and have been studying on a much more regular basis.  I think getting to the point where you do only practice questions as your main method of study requires a completely different frame of mind.  I came home with the intention of going through Kaplan (since I’m too cheap to go take a $5000 review course) so I gave myself a month and a half to “get into it” and it never really happened.  You sit there passively watching the videos and reading the text but there isn’t really a challenge to it and it gets boring quickly.  Soon domestic chores like cooking, dishes, and car washing become much more interesting and studying takes the back burner.  I did some Kaplan Qbank questions at the same time, but they were really detailed and were on stuff that I knew I’d learned, but was too tired to review.  So other than reading Kaplan books at the gym while working out (and had no other opportunity for distractions), I stopped studying for a good long while.  It wasn’t until I got my test date that I realized I really needed to start studying unless I wanted to end up fighting for a loser clinicals spot in some big city with gang problems, that I probably couldn’t afford to live in.

Since my awakening, I bought a month’s subscription to UWorld–I’m a glutton for punishment–it’s the Qbank everyone said was the most difficult, and I’ve actually been doing ok so far.  I don’t think the questions arethat difficult–not for the amount of whining people did while we were still on the island, particularly when those questions found their way onto our regular exams in class.  There are a few questions every now and then that are obviously trick questions (55% of people choose the wrong answer and like 13% choose the right answer) that you’d expect to see on one of our nitpicky path exams, but you look at the explanation, realize they’re trick questions and comfort yourself with the knowledge that the USMLE people don’t play that way and if they do, questions like that will likely be thrown out. 

The Dean of clinicals recommended that we get to a point where we’re doing 200 questions daily and where we do like…5 or 6 mock exams before the big day.  That seemed like a reasonable penance to me back when I wasn’t really studying that much, but now that I’ve gotten into the habit of doing daily questions, I realize that’s completely unrealistic and find myself completing between 75 and 125 questions daily.  But then again, questions are more of a process for me–I’ll do a block of questions, then take double the time going back through them and reading the explanations for all of the answer choices (even if I got the question right) to make sure that I know the background information, then I keep a notebook of facts that I’ve either never learned before or things that are really important that I’ve forgotten.*  I think it’s easy to get into a state of panic when doing questions, especially if you have a bad block and get many of them wrong, because you think of all these things you’re supposed to remember that you’ve forgotten and it quickly becomes overwhelming, BUT if you’ve got a notebook, where you write those facts down and you know they’re safely tucked away but easily accessible, then if you can’t remember a particular fact at that very moment, who cares?  You just make a mental note to review it in your fact notebook and you’re fine.  Best idea ever.  Really helps to deal with the anxiety.  The key, of course, to this notebook is that you review it so that these new little bits of information you acquire start to stick in your head.  I take it with me to the gym every day instead of my Kaplan books and reread my notes.  My accuracy percentage is increasing. 

*One thing I have noticed as I’m doing questions–and I’m sure this is common across the board for Caribbean medical students–is that I’m often second-guessing my education–rather I’ll come to a question and if I don’t immediately recognize something in the vignette, I’m quick to assume (FALSELY) it’s because it’s something new or cutting-edge that was not covered in my** education on the island.  **I DO NOT THINK MY MED SCHOOL EXPERIENCE AND EDUCATION WAS SUB-PAR!  It’s just that I think many of us have a chip on our shoulder or some doubt in our gut because we went to such well-known undergrad schools, but then ended up down at the “bottom-of-the-barrel” in terms of medical schools [ACCORDING TO THE REST OF THE US] that we often worry that we’ve missed out on learning something from a US med school.  I know this is just a misconception–most US schools have less lecture hours than we do, and really only differ in that they start clinical experiences earlier and many of them now have a research requirement for graduation.  Maybe I’m alone on this misconception, but my point is that I’ll find myself fatigued and about to make a flippant guess on a question when I see something unfamiliar, but that most of the time, if I’ll reread the vignette or definitely when I get to the explanation after the test was over, I’m like ‘oh…crap, yeah I did learn that.’

In a way, I wish I would have started this system earlier, but then at the same time, I know that back in April and May, when I didn’t have a test date even remotely in sight, I wouldn’t have had the motivation to continue studying like I do now.  I took a mock exam from UWorld before I started doing questions so I’d have a baseline and to see how my knowledge has changed since the leaving the island (and regular scholastic activity).  Not surprisingly, my score had decreased since my last mock exam in January (with Kaplan).  (I never checked to see what my comp score equated to in terms of USMLE scores, so I can’t compare it to that.)  That was sad–it was only a 10-point drop, but it was sorta expected and made me feel a bit guilty.  But on the happier side of things, based on my percentage of correct UWorld questions so far, I’m right back where I need to be.  (http://usmle-score-correlation.blogspot.com/)

Paperwork

June 14, 2012

My apologies for the extended absence…not much to share.  Still working on weight loss–up to -22 lbs since I got home, -59 overall.  Lots of gym time, few carbs.  It goes.  Lots of practice questions, scanning through Kaplan and First Aid books while I’m at the gym.  Getting plenty of rest and taking breaks as I should.  One thing I learned today during my “webinar” with the clinicals department, that I should be doing but haven’t so far, is taking self-assessments.  Like the one that comes with Kaplan, or with U-World, or the expensive preferred ones from the NBME.  They’re more realistic than just the question bank questions in terms of difficulty, endurance, etc.  Also, I was informed that ~200 practice questions daily is the ideal number that we should all strive for at this point.  Hmm…

Onto my main soapbox, (I’ve talked about this briefly before) I want to stress to the students still in basic sciences on Nevis the importance of making sure that you get home and get started on your USMLE Step I application ASAP.  I had read, begrudgingly, from upper-Meds that the process took a while, but I am quite frankly FLABBERGASTED at how long the process takes.  As many meetings as you have with the clinical dean and her staff, they never tell you HOW LONG the process takes when you’re an IMG dealing with the ECFMG trying to sign up for the USMLE Step I.

A lot of what I’ve been doing over the past couple months has been hurry up and wait.  I found out, after I rushed all my medical forms, in talking to other students that the school WILL process your paperwork to apply for the Step I if your medical forms are incomplete.  ::Argh::  There are still people waiting on titers to be drawn and to get a second TB test and they already have test dates scheduled.  So, rush that stuff but you need to start dealing with the ECFMG peeps first.  So, the process is actually pretty complicated:

First you have to log on to the ECFMG website and get yourself an identification number with them.  It involves giving them a bunch of personal information and a few days’ time while they verify that you do indeed exist. They’ll send you an email eventually with your identification number.  This takes 3-5 days.

After they email that, you have to log back on to the website and apply to be eligible to take the USMLE step I.  This is much more complicated.  You fill out an extensive online application with much personal information and school information (they give you a guide sheet to fill this out during your last meeting with the clinical dean), then at the end, you have to pay them ::gasp:: something like $800 (because you’re an IMG) to be able to take the Step I, then you’re provided a “Form 186” that you have to print out and sign.  You have to send that form with a recent passport photo to the clinicals office, who will sign it to verify that you did indeed complete basic sciences at the school and are eligible from their perspective to take the USMLE Step I.  They send it on to Philadelphia to the ECFMG people, who THEN review your online application in addition to the completed form 186.  This is the step in the process I’m stuck at right now.  The problem is two-fold:  it seems to take the school an unusually long time to sign your form and send it to Philadelphia (2-4 weeks), and then once ECFMG people receive it, there is a 3-week processing delay while they verify all of the information.  You aren’t told ANY of this during those oh-so-important dean meetings you have to go to when you’re exhausted in 5th semester.

The last couple steps are just from what people who have already completed them have told me.  Apparently after the ECFMG approves your application, you’re cleared to take the Step I so you can choose your test site–Prometric, just like the MCAT–and date.  But then, there is an additional 1-week waiting period while you wait for a “scheduling permit” from the ECFMG.

We got out of class April 15thish.  If you stick to the “3-month deadline” to take the test that the school initially lays out, that means you need to test by July 15thish.  It’s June 15thish, meaning I have a month left, and I still am not even eligible to SCHEDULE my test yet.  So my initial planned test window of late June is obliterated.  I’m going to be pushing it to make it in by July 15th.

So, the point of all this is to say:

1)  Come home and start your application ASAP.

2) Be flexible with your anticipated test date–it’ll more than likely be pushed back.

3) Be prepared to expect delays in processing on both the school’s end of things as well as ECFMG’s.  Just don’t get bent out of shape and do something stupid like call the office and have a temper tantrum with the ladies who control your future for the next 2 years.  (No, not me but people I know…)

That’s all.  Hope you’re all well.  Bed time.  Increased cerebral temperature due to exercise means increased delta sleep. 😀