From our anonymous insider…
We are finished with classroom education and now begin our Step 1 study period. Eight weeks from now we begin clinical rotations, also known as clerkships. Students may take the Step 1 exam, which determines the rest of our careers, at any time within this period. Mine is scheduled for six weeks in.
Unlike after most block exams, there is no mass exodus to exotic travel destinations or to visit family. The library is packed with M2 classmates as the M1s go on break.
Study resources are standardized across medical schools and were made available to use at the beginning of our M2 year. The most future minded among us began cramming for Step 1 back in August when our school’s one-year group subscription to the Step 1 UWorld question bank began (the individual rate, with two practice tests, would have been $479). First Aid is the foundation and we also use Pathoma ($85) and SketchyMicro and SketchyPharm ($160 each). Several students have also been using Anki, a flashcard manager, to test themselves on First Aid information. We are told to focus on the four “High-Yield” subjects: neurology, cardiology, pulmonary, and gastrointestinal.
Mischievous Mary, driven by her desire to be a heart surgeon to extreme studying habits, gets up every morning at 5:30 am for a Orange Fitness class. “It’s my guilty pleasure. I know we have gym membership through our tuition, but paying $100 a month gives me motivation to actually work out. When I wake up I think, I can’t go back to sleep. I have to go, or I am wasting $100.”. People respect her corner table in the library, where she leaves her books, and she arrives there by 8:00 am for a 12-hour shift. I’ve asked her several times to get lunch with me. She explains, “I don’t really eat meals. I just snack.” She showed me her bag from the local health food store: kombucha, fruits, and nuts. The only chink in her discipline is Netflix on her Macbook’s screen, visible through a window from outside the library.
Sarcastic Samantha drafted a Step 1 studying schedule for Lanky Luke. Samantha had taken her PA boards in January. “She killed her boards,” said Luke. “She is smarter and frankly should be the doctor.” Samantha responds: “I am so thankful that I didn’t go to medical school.” She now makes $115,000 a year as an inpatient hospitalist at a competitor’s hospital. Luke took his exam three weeks in and has been relaxing all day while Samantha works 12-hour shifts, 7 days on/7 days off.
Gigolo Giorgio complains, “The stuff we’re learning now is not useful in practice. For me to get those extra ten points, I have to study so many trivial details.” He cited the different types of immune mediators (IL-6 versus IL-5), different RNA polymerases (Pol II synthesizes messenger RNA, whereas Pol I synthesizes ribosomal RNA), and preferred growth agar (media) for various bacteria (Chocolate agar versus Thayer Martin agar).
Jane scheduled her exam for four weeks into the period. Our typical day starts with the gym or a run, which should help Jane prepare for summer military boot camp, and we’re ready to study by 10:00 am. Jane purchased a paper calendar and color-coded days for each subject. She watches Pathoma videos in the morning, then does 80 UWorld questions before lunch. She watches Sketchymicro videos when she is burnt out from questions or from First Aid. We’re a little out of sync because I made the decision, later regretted, to spend two weeks shadowing a third-year Emergency Medicine (EM) resident and a ENT physician (see the next chapter).
Not everyone is as faithful to the library as Mischievous Mary. Gigolo Giorgio studies at Starbucks in the morning and expressed fear and anger regarding the company’s plans to shut down for a day of diversity training. I saw six classmates working individually at a nearby county library. Through the school library’s plate glass windows one can usually see two or three students taking a break on the patio. During my own breaks, the patio crowd would tend to gossip about study habits and travel plans after “Step”: “How many UWorld questions have you done?” or “Are you finished with Pathoma yet?” Mischievous Mary: “Why do we put ourselves through this again?” My response: “Don’t forget that we are paying three percent more tuition than last year, even though we are in school for twenty-five percent less time.”
After two weeks, classmates lose some of their intensity. Pinterest Penelope sighs deeply and mutters “God Dammit” when she misses a UWorld question. Although the entire library can hear her, people no longer lift their heads in surprise. I can’t resist checking Facebook or WSJ after finishing a Pathoma video or 10-question UWorld test.
Our school gives us vouchers for two practice tests and more can be purchased at $60 each. I take one about two weeks into studying and score 221: primary care. I take another 3 weeks before my exam and score 247: near-dermatology. Two days later, the Dean of Student Affairs stops me in the halls and says, “Good job on the practice test.” I didn’t realize that he had access to our our practice test scores.
Averaged over six weeks, I probably managed less than 8 hours per day of real study. I get to spend time with Jane. I’ve picked up some hobbies, such as gardening, woodwork, and biking. Lanky Luke, Sarcastic Samantha, Jane and I get together twice a week for our favorite burger-and-beers spot or for grilling at their new house. They just signed a two-year lease on a house as the apartment was not big enough for their adorable Great Pyrenees runt.
Jane’s best friend from childhood comes to stay with us. She works nights as a certified nurse assistant (CNA) at a large academic health system specializing in neurological disorders. One of her recent patients, a 60-year-old veteran suffers from cauda equina syndrome (“horse’s tail” syndrome, describing how the nerves of the lumbar and sacral region get pinched in the spine). The veteran had been going to the VA for several months complaining about leg numbness. “They just gave him lots of anti-inflammatories. When he came to our hospital, he was not able to walk. If he had been treated early on, he might still be able to walk.”
Jane’s friend described how her 25-year-old stepbrother has schizophrenia. “He needs to be committed. He is is starting to resist haloperidol injections. My father is concerned that if he is committed he will lose any future job opportunities when he gets better. My father and stepmother need to accept that he is not going to get better. Job opportunities should be the last thing on their mind. He could never hold a job in his present state. You should see some of the things he does. He goes off and buys hundreds of dollars of clothing, he moves around to new cities and lives homeless for several weeks at a time.”
We start talking about marijuana. Jane’s friend mentions that she noticed a lot of their high school friends who smoked pot early have mental illnesses. Jane, in full study mode, exclaims, “It’s in our First Aid! Smoking pot early on is associated with schizophrenia.” I add, “I do not understand why so little research funding is allocated to marijuana. States are legalizing. An entire generation is going to impacted with unknown complications.” I leave Jane and her friend to reminisce while I walk her beagle-mix dog, a joint shelter adoption with a boyfriend. The boyfriend is gone, but the dog and his neurological disorder, which had discouraged anyone else from adopting him, remains. The animal freaks out whenever there is an unexpected noise.
I attend a Planned Parenthood event hosted by the women in medicine student group. A 27-year-old led the discussion. She graduated college and began as volunteer medical assistant and was then hired as an educator. She runs workshops at local high schools and middle schools “advocating for women’s health and reproductive rights”. The Our OB/Gyn clerkship director arrived late for questions.
Why would someone go to Planned Parenthood, instead of a typical gynecologist? Our OB/Gyn director: “The main reason is animonity. For example, a 30-year-old mother of four who wants birth control, but is uncomfortable telling her husband she does not want more children. The husband would see this visit and prescription bill from the insurance company. Planned parenthood can guarantee a greater level of anonymity. This is a common situation in my experience for my Muslim or immigrant patients.”
A fourth-year student, interested in OB/Gyn: “How do residents get trained on performing abortions?” Clerkship director: “Great question. The ACGME requires that every Ob/Gyn residency program train their graduates to perform abortions. Most large health systems, such as training hospitals, will perform only medically-necessary abortions. For residents to get enough practice to meet the procedure requirements, each health system will have a connection with an abortion provider in the area for elective procedures.” (Why won’t big hospitals perform elective abortions? Our director attributed this to the complexity of ensuring that Federal funds weren’t used to pay for the procedures, but did not explain why this was more challenging that the rest of the administrative and bureaucratic operations of a big hospital.)
Catholic-run hospitals generally do not perform abortions, except in emergencies. What about Catholic would-be Ob/Gyns? There may be an opt-out policy during residency. Thus not every Ob/Gyn will have training or experience in performing abortions.
Classmates have been more active lately on Facebook, perhaps because students are on their computers most of the day. Type-A Anita enjoys sharing “Sassy Socialist Memes” on Facebook.
“When America regularly overthrows democratically elected governments but suddenly needs someone to overthrow its own government like come on CIA where u hiding all of a sudden isn’t this ur “thing”
“Someone should probably tell the rich that workers banding together to present formal address of grievances is the alternative we worked out a long time ago to breaking down the factory owner’s front door and beating him to death in front of his family? I fell [sic] like they forgot.”
Anita is hoping that her Step 1 scores will be sufficient to get her into an Ob/Gyn residency. If she completes her training she will be able to bash “the rich” on Facebook while earning a salary over $200,000 per year and closer to $1 million per year if she decides to specialize in fertility.
Anita is also passionate about immigrants:
Keeping families together is reproductive justice.
Where all my PRO-LIFE and ALL LIVES MATTER people at? I can’t hear y’all over the cries of immigrant children at the border…
These assholes who call parents “irresponsible” for trying to immigrate to America with their children to escape violence and create a better life for their families ARE THE SAME people who exult their own ancestors who “risked it all” to come to America on the Mayflower or some other shit … FUCK that racist bullshit
Pinterest Penelope:
If you had time to wish your dad a happy Father’s Day you had time to (depending on how tech savvy you are) google what’s happening at our border, email your state representatives about refusing to cooperate with ICE, email your federal representatives to demand they work to end this barbaric practice, and/or consider if you are able /willing to attend a protest against this injustice near you.
“This week has brought another wave of tragic news that has left me beyond repulsed and outraged. Thank you, Facebook, for reminding me 100x that my birthday is coming up and I should start a *birthday fundraiser*. I’m no Chrissy Teigen/John Legend, but I’d like to raise at least $280 to support RAICES (The Refugee and Immigrant Center for Education and Legal Services), the largest immigration legal services provider in Texas. After researching how I can help the humanitarian crisis, I found that RAICES is helping reunite immigrant parents with their children. Over $6 MILLION has been raised this week which is incredible and gives me some hope in Trump’s America. … Oh, and 2 hours ago Trump announced he will be signing ‘something’ to keep families together… Still no plan of action on wtf will be done to reunite these families and fix this horrible, inhumane shitshow
[Editor: Penelope is from Massachusetts, whose winner-take-all family court system permanently separates more children from at least one parent in a typical week than ICE temporarily does in a typical year.]
Perhaps 10 percent of students delayed the exam by paying a $50 fee within one week of their original test date. Pinterest Penelope moved it back twice. Mischievous Mary before her exam: “I’ve become so frustrated, so numb from studying, that I am not even nervous. I am anxious to get it over with.” Roughly as many students moved the exam up. Sometimes this was from study exhaustion. Jane moved it up four days to earn more free time before boot camp.
Statistics for a typical week Study: 50 hours. Sleep: 8 hours/night; Fun: 2 nights. Example fun: class winery tour and tasting set up by Pinterest Penelope attended by 15 students.