Residency Interview Advice

Interview offers are like new pleural effusions. 

You should never let the sun set on one.

Greatest. Quote. Ever.

Moral of the story: schedule your freakin interview the day you hear back!

How highlighters made me bitter for a second

For a second I wanted to be this girl, who I stood behind on an elevator in one of the clinic buildings near the hospital. I saw this girl in baby blue scrubs, and four perfectly-aligned highlighters.

If you know anything about me, you'd know that writing instruments are one of the few things in life I'm picky about. I am extremely particular about the experience of writing (if it isn't a nice pen, you won't write neatly). I once read that neat handwriting is a courtesy to the reader. (Of course, I am in NO way implying an opinion about physicians...)

Anyway, it had been a long day, and I was on my way out when I became fixated on these highlighters. All I could think was, "what does this girl do, that she only needs four pretty highlighters in her pocket?" And then, "since they're so neatly arranged, does that mean she doesn't actually use them?" (Ie, does she actually do anything.)

Clearly med school has warped my thought processes, seeing pretty highlighters and having such a visceral response. Overwhelmingly I was reminded of my own (short) white coat..a few shades off from the bright white when it was new (ok, a lot), jammed with pens (one of each color, a highlighter, permanent marker and penlight!), lip gloss, a few dollars, a radiation badge, a bunch of old patient lists covered in notes that I eventually want to organize and copy into my "little black book," reference charts, my phone and pager, a small bottle of ibuprofen, and probably a bunch of other random stuff.

I know that that moment was one of my "why am I doing this again" thoughts, which seem more frequent but fleeting, the closer I get to graduation.

I had this instantaneous yearning to have a normal, predictable job where all you need in your pockets are four highlighters. As quickly as that feeling came and went, the next brief thought was, "that seems like a horrible job; how boring and unrewarding would that be?"

Then I just felt guilty for having such a cruel thought, and then I remembered how really, really tired I was, and if I hadn't taken the picture I probably wouldn't have remembered it for this blog anyway.

Dominate Step 2 CK

As promised, I will include a few thoughts in reflection of my Step 2 CK (clinical knowledge) exam prep.  First of all, I scored very low on Step 1 (but passed), and that has cast a shadow over my career since.  Knowing that top tier residency programs were now out of reach, I realized I had to dominate Step 2 in order to have a fighting chance at a decent residency program.  My major concern was that I have always wanted to go into cardiology, and in order to get a cardiology fellowship, you need a great residency position (and therefore, great step scores).  So a low Step 2 score would have pretty much been the kiss of death on my cardiology dreams.

This story has a happy ending: I scored a 251 on Step 2!  (My fiance is so sick of me shouting this number out, even a month after the score came back.)  My dean's office adviser told me it was the biggest jump he'd ever seen between 1 and 2 (I'd rather have the honor of scoring the highest on both, but this will suffice).

I feel like I was not prepared for Step 1, and I'll have to explain that to residency programs.  But I keep telling myself: it's a lot easier explaining one bad test score than TWO bad test scores.  I can truly say that I had a bad day.  While I'm still out of the running for a lot of top tier schools (that I may have had a decent shot at, had I done as well on the first one), I still have high hopes for some fairly good programs.

So what happened?

What I did wrong while preparing for Step 1:

• The WAY I studied: the "test taking prep" center at my school singled me out for "help" before my first exam and did a one-on-one session; they concluded that I just didn't know how to do multiple choice questions and gave me a strategy (this method took about 3x as long).  Assuming that my weakness was rooted in the questions, not content, I essentially just did a massive amount of practice questions.
• WHAT I studied: I figured if I did 2000 practice questions (or all of UWorld) I'd hit every topic, so when I got a question wrong, I'd go through all the wrong answers to make sure I knew that content as well. 
• HOW LONG I studied: I took the test shortly after finishing 2nd year (less than a month) and didn't get many full days of studying in

What I did right while preparing for Step 2:

• Taking it seriously: this unfortunately translates into a financial issue; I researched test prep for about a day before hesitantly deciding to purchase Kaplan's online lecture series (yeah, over $2000 for 3 months).  Best. Decision. Ever.   
• WHAT I studied: I realized that the question banks test you on a microscopic fraction of the material, spot-checking your knowledge for massive gaps, and you have to know how to use your performance to study: don't study with the qbanks.  I'll go ahead and do a free endorsement for Kaplan: they concisely presented a massive amount of material making it a finite amount of material (I felt overwhelmed on Step 1, wondering how you could study everything; well, YOU CAN'T, but no one tells you what to study or what not to study- until Kaplan!).  The lectures were cumbersome but memorable (at times I was falling out of my chair laughing).  Best of all, I remembered it when doing questions.  
• The WAY I studied: after doing lectures, I used UW for its intended purpose: spot checks. I literally only did about 500 questions over the 4 weeks I intensively studied, because I was sure I knew the material.  The best part was seeing the questions in a whole different light: with Step 1 I felt overwhelmed with the question (I often didn't even know exactly what the question was asking), and narrowing down to 2-3 choices and guessing randomly. With Step 2, within the first few sentences of the stem I'd know the topic, what 3 questions they'd predictably ask, and often, the answer (yes, before even finishing the stem).  

Step 2 (and maybe Step 1...can't speak on that obviously) is an extremely predictable test.  The problem is no one tells you that, so you prepare for an unpredictable test (studying a little bit of everything, just in case). They really only ask a few types of questions, so you only need to understand those concepts from each topic (for example: what's the diagnosis/what's the best way to diagnose/what's the best treatment are really the only questions asked).  

But again, Kaplan broke things down to the basics and built up from there. They really focused on looking at things that were similar (ex: lung infections: bronchitis vs abscess vs pneumonia vs TB) and looked at the similarities and then the unique characteristics that the test would focus on:

Pt presents with fever and cough: think lung infection (any of the 4 diagnoses)

Keywords for diagnosis: "normal chest x-ray" (bronchitis); "bad teeth" and aspiration risk like seizure history (lung abscess). If they're going to ask a specific question about a specific diagnosis they have to "tell" you what the diagnosis is!

Diagnostic tests: universally a CXR initially; but based on diagnosis know that there are exceptions for definitive diagnosis, like a lung biopsy is most accurate for abscess 

Treatment: know which antibiotics treat which organisms (ie penicillin family for staph/strep) and then know which organisms are commonly causative (ie abscess=anaerobes so therefore clindamycin)

I didn't touch First Aid, but I hear it's a good resource (wouldn't rely on it solely though, unless you just want to pass).

Crush Step 2 (Brochert): excellent summary of high-yield topics. Not very thorough (you'd definitely pass just reading this, but would use it as a review during the last few days to make sure you got all of the important information down)

Step Up to Medicine: love this as a textbook, to look up pathophysiology you don't completely understand; wouldn't use as the primary study aid though (saw some people do that)

Kaplan's notecards: I got these last minute (Diagnostic tests, physical exam findings and a general one) to have something to carry around. I also do better with short, concise points; plus they have great pictures. I think it's a great supplement (although a bit expensive; I will probably try to sell mine later, but they're good for step 2 and 3).  Like Crush Step 2, makes sure you didn't miss any important high-yield topics.

NBME Practice Tests: again, pricey ($50 each I think). I did 2 of them "officially." Great for estimating your progress and score; I took one about a 2 weeks before the exam, and scored in the 220s, then did one a few days before the exam and scored 241. There are always rumors that some of the questions overlap with the actual exam (I didn't notice that, although some questions just have to be asked on every exam and those may be the ones referenced), but I think more than that it confirms whether you're ready for the exam.  They all seem to correlate fairly well with your actual score (look on message boards on the net for how each correlates- some overestimate/some underestimate, but by a predictable amount).

Anyway, hope this helps someone out there.  I really think that if you approach studying (even for step 1) by seeing it as a predictable test with a finite amount of information you'll dominate it.  You just have to be willing to go find a resource that will teach you what is important.