I have actually taken the USLME Step 1 Examination twice, having failed it the first time, so I have a slightly unique viewpoint regarding this exam. There is a multifactorial explanation/excuse/reason as to why I did not pass, but it did give me a lot of experience preparing for the exam. I do not believe that this an examination that tests basic medical science but rather tests your ability to take a huge multiple choice test. Yes there is a significant amount of information you must know, but rote memorization will not get you through, to quote Goljan (http://usmlestep.com/goljan.htm) you must understand mechanism, not only of the underlying physiology and pathophysiology, on both micro and macro scales, but of the mechanism of the test questions themselves. The resources I found useful for information review were:
Gold Standard Board Review System (http://www.boardprep.net/)
Kaplan On-line lecture series (http://www.kaptest.com/Medical_Licensing/Step-1/View-Kaplan-Programs/Online-and-Supplemental/webprep.html)
USMLE Step 1 Made Ridiculously Simple (http://www.amazon.com/USMLE-Step-Made-Ridiculously-Simple/dp/0940780712/ref=sr_1_1?ie=UTF8&s=books&qid=1241648745&sr=8-1)
The oft touted Step Up (http://www.amazon.com/Step-Up-USMLE-Step-1/dp/078178090X/ref=sr_1_1?ie=UTF8&s=books&qid=1241651240&sr=1-1) and First Aid (http://www.amazon.com/First-Aid-USMLE-Step-2009/dp/0071548963/ref=sr_1_3?ie=UTF8&s=books&qid=1241651203&sr=8-3) were not of great help to me, but if your mind wraps well around such outlines then it may be of benefit.
I split my days into a morning of questions (minimum 100) and an afternoon of lectures. I took at least one weekend day off per week. Approximately every two weeks I would do 8 hours of questions to simulate the exam, out of a book of written examination questions. Make sure that you reverse engineer the questions, I noticed that there were certain types of questions that I missed. I just kept doing the questions until I had done them all right. In all I did over 3700 different questions between all my resources, which included Q-bank, Q-Book, and other test question repositories.
Since then I have been introduced to the Goljan lecture series, while I didn't use them I believe they would be of benefit.
Do not let the cost of a prep course discourage think of it as a $1000 to $3000 investment in your future. You will carry a failure or a low score on USMLE Step 1 for a long time, it is not the end of the world but it will make you work harder for residency and it may keep you from getting your foot in the door.
Thursday, June 04, 2009
Wednesday, May 20, 2009
Tuesday, May 05, 2009
Marley and Me
I watched "Marley and Me" (Twentieth Century Fox) last night. The movie started out with John Grogan trying to find himself as a journalist and in doing so got an insanely disobedient labrador that he and his wife called Marley. My family has had numerous pets both dogs and cats, and the young Grogans let Marley run roughshod over them. Granted labradors are high energy pets but without someone to tell them what is and is not appropriate they will do whatever they damn please. After years of Marley's endearing antics the Grogan's start having children and this loyal blacksheep adopts the Grogan chidren as his own. The movie progresses to the emotionally wrenching twilight years of Marley's life. The lovable hellion begins to slow down, eventually having a foreshadowing bout of Gastric-Dilatation Volvulus (GDV) from which the plucky canine recovers after a touch and go night at the vet.From here I started weeping as the ending scenes of Marley played out like the passing of the Doberman Pinscher I had from high school through graduate school. Agrippina ("Pina"), was a powerful canine in her elder years who after a run on a cold winter night had massive abdominal distention due to GDV. Dobermans are bred not to feel pain and she looked more confused than pained as the shock of ischemic bowel set in. My mother and I scooped her up and took the weakening dog to the veterinarian who had rushed in from her home. The doctor shook her head as she said that our only option was surgical correction, which as with Marley would have limited benefit and only prolong suffering due to her other chronic medical conditons. Pina was a fatigued ghost of herself and as the veterinarian administered the euthanasia she passed away quietly. Never had I experienced an emotion so purely as the grief I felt at that moment, the tears, sobs, and bellows poured out of me uncontrolled and it was minutes before I had any semblance of control. Later that morning I looked at pictures of my baby in her prime and I knew that although painful for me, this was the best way for Pina to go, chasing rabbits on a cold night. Watching the end of Marley should bring tears to everyone's eyes but the exact timing and helpless grief of Marley's family was a spot on recreation of my experiences on Pina's last night. I wept unabashedly as emotional memories I thought I had marshaled assailed me anew.
Monday, May 04, 2009
Saturday, April 25, 2009
Salmon on Cedar
Despite appearances I'm a pretty good cook.
My girlfriend is a great cook.
However when we combine our powers we are well nigh unstoppable. This evening we prepared salmon with olive oil, red pepper, dill, and bay leaves grilled on cedar planks soaked in white wine and whiskey. We also had some jumbo scallops marinated in A-1 steak sauce. The side dishes were foil wrapped peppered corn as well as foil wrapped miniature red potatoes with onions and garlic. We served this with Barefoot Cellars Sauvignon Blanc. For dessert we had ice cream from Marble Slab Creamery.
Despite a small misestimation of the coal preparation and heating time followed by some first degree burns and smoke inhalation injuries after aforementioned coals had reached a suitable temperature, the meal was awesome. The subtle cedar smokiness greatly added to the salmon's flavor as it dissolved in our mouths. The grilled garlic potatoes were addictive and the corn a fresh savory adjunct to our evening's repast.
My girlfriend is a great cook.
However when we combine our powers we are well nigh unstoppable. This evening we prepared salmon with olive oil, red pepper, dill, and bay leaves grilled on cedar planks soaked in white wine and whiskey. We also had some jumbo scallops marinated in A-1 steak sauce. The side dishes were foil wrapped peppered corn as well as foil wrapped miniature red potatoes with onions and garlic. We served this with Barefoot Cellars Sauvignon Blanc. For dessert we had ice cream from Marble Slab Creamery.
Despite a small misestimation of the coal preparation and heating time followed by some first degree burns and smoke inhalation injuries after aforementioned coals had reached a suitable temperature, the meal was awesome. The subtle cedar smokiness greatly added to the salmon's flavor as it dissolved in our mouths. The grilled garlic potatoes were addictive and the corn a fresh savory adjunct to our evening's repast.
Thursday, April 23, 2009
White Coat Ceremony Talk 2008
I gave this brief talk to the medical students in 2008, I thought it was pretty good:
This is not a white coat.
This is a superhero’s cape; a knight’s tabard; a wizard’s robes. Not convinced? Where else but in comic books and medicine can grown-ups wear the equivalent of pajamas and be taken absolutely seriously. Who else but a paladin or a physician would be on a quest to help people. What else but the magister’s raiment or the white coat symbolizes knowledge and the hope of miracles.
Despite its mystic origins, the white coat is a poor insulator against the freezer they call the cath lab and attracts tomato sauce. It will snag every exposed door handle and makes a barely tolerable pillow. Its carrying capacity is significantly less than the mass and volume of assorted pocket references, peripheral brains, pagers, and diagnostic gadgets required of medical students.
The mark of a physician, however, is not in their sartorial splendor but in their desire to help people through their compassion, intellect, and work ethic. The white coat symbolizes the best qualities of a physician. They are the vestments of medical knowledge and the license to alleviate suffering. They command both power and respect while demanding duty and service. Today these medical students begin their clinical apprenticeship, they become squires to Sir Osler and side kicks to Hippocrates.
These student doctors will find that as soon as they don their crisp white coats that they will be looked to for answers regarding simple analytical diagnosis to the difficult decision of whether to allow a fellow human being a glass of water. From a simple piece of cloth they will be privy to a person’s most intimate secrets and exposed to a patient’s greatest moment of weakness. They will find that no matter how much they load the straining pockets of their uniform they will never carry enough resources to have all the answers.
This coat will be your introduction to clinical medicine, sometimes frightening but always rewarding, it is by interacting with patients as a student doctor that you will learn to be a physician. This white coat is your passport to that experience. Welcome to the most fun part of medical school.
This is not a white coat.
This is a superhero’s cape; a knight’s tabard; a wizard’s robes. Not convinced? Where else but in comic books and medicine can grown-ups wear the equivalent of pajamas and be taken absolutely seriously. Who else but a paladin or a physician would be on a quest to help people. What else but the magister’s raiment or the white coat symbolizes knowledge and the hope of miracles.
Despite its mystic origins, the white coat is a poor insulator against the freezer they call the cath lab and attracts tomato sauce. It will snag every exposed door handle and makes a barely tolerable pillow. Its carrying capacity is significantly less than the mass and volume of assorted pocket references, peripheral brains, pagers, and diagnostic gadgets required of medical students.
The mark of a physician, however, is not in their sartorial splendor but in their desire to help people through their compassion, intellect, and work ethic. The white coat symbolizes the best qualities of a physician. They are the vestments of medical knowledge and the license to alleviate suffering. They command both power and respect while demanding duty and service. Today these medical students begin their clinical apprenticeship, they become squires to Sir Osler and side kicks to Hippocrates.
These student doctors will find that as soon as they don their crisp white coats that they will be looked to for answers regarding simple analytical diagnosis to the difficult decision of whether to allow a fellow human being a glass of water. From a simple piece of cloth they will be privy to a person’s most intimate secrets and exposed to a patient’s greatest moment of weakness. They will find that no matter how much they load the straining pockets of their uniform they will never carry enough resources to have all the answers.
This coat will be your introduction to clinical medicine, sometimes frightening but always rewarding, it is by interacting with patients as a student doctor that you will learn to be a physician. This white coat is your passport to that experience. Welcome to the most fun part of medical school.
Thursday, April 16, 2009
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