Assumed, Actual, and Average Performance: Preparing for the horrors of Step 2 using the defense mechanism of Intellectualization

In exactly one week (7 days -- 168 hours -- 10,080 minutes -- you get the idea) I will be sitting in a prometric testing center taking, depending on whom you talk to, the most important test I have ever taken capable of determining all of my future career successes, or just something I need to pass to graduate: The United States Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge.

Tensions are running high, but I am actually quite proud of myself. I began studying weeks, no... months ago, and I find that even though I only have a week left, I am doing a lot less cramming than I had to do for Step 1. And I actually might finish reading an entire review book cover to cover. I may actually do well on this exam.

But do you know what's more important than doing well on exams? Knowing, fairly accurately when you leave the testing center, that you have most likely passed the exam with a 95% confidence interval (did I use that term correctly? I still haven't studied biostatistics). Which is why I have begun analyzing my Usmleworld QBank tests. Upon hitting submit, I quietly contemplate how well I think I may have done, remembering how many questions I "knew" verse how many were "good guesses" verse the inevitable "I have narrowed it down to two, equally likely choices" verse "I have not heard of any of these conditions. I will choose the answer choice that seems most viable." Then I write down my assumed score. Then I write down my actual score and the national average for those 44 questions.

Test Results of QBank tests numbers 93 through 101

What conclusions have I come to? First, my actual performance varies widely. Hopefully over my next tests I can become more consistent, although this isn't likely. I believe this is the nature of any test designed to ask many questions on broad topics.

Second, my predictions are much more conservative than my actual performances. Which is nice to know, although a given: more people feel like they failed an exam than actually did, at least in medical school.

Third, my predictions seem to follow my actual scores fairly closely, although doing really well on test 94 improved my confidence so that on test 95, I assumed I did much better -- even though I in fact did much worse.

And now I have to study for at least six more hours before I can go to sleep. I love summer break.

Social Phobia

My step 2 studying attempts are progressing nicely (mostly thanks to habitrpg.com, which allows me to incentivize my daily study habits and my lengthy to-do list). 
My friends and I went out to dinner tonight and we mutually commiserated on how awful studying for huge tests is. But I really think studying for step 1 was worse. I have terrible flashbacks of skin flaking off of my face and my ears bleeding.
Step 2 is better if only because it is more interesting:

Did I know that I meet the criteria for having both social and specific phobias? No!

Although it makes sense. As much as I love talking to patients, I dread actually introducing myself to people. I frequently find that I yell at myself for missing an opportunity to talk to a stranger, or engage with a patient longer. Little things will bother me for the rest of the day, like when I missed an opportunity to say thank you to someone at the park who helped me figure out how to work the water fountain.

The treatment for social phobias is cognitive behavioral therapy (CBT) and SSRIs.

Cognitive behavioral therapy really fascinates me, but I think that's mostly because it's always listed as an efficacious treatment for many psychiatric disorders which I think is pretty counter-intuitive. Psychiatrists (they can prescribe you drugs because they are doctors) are thought of as superior to clinical psychologists (they can talk to you because they are Ph.D's), yet both medicating and therapy are equally effective for a lot of mood and anxiety disorders.

Regardless, I guess I could start trying to enforce CBT on myself. I could assess why I avoid talking to strangers and how that behavior is affecting my life. I could try to change it. I could slowly mold myself to become the person I've always wanted to be--gregarious, friendly, fun--using various tricks I've found on the internet or in self-help books.

On the other hand, I could just ask my psychiatrist to switch me to an SSRI.

UWorld Blues & A Murderous Rage

Studying for boards is driving me into a murderous rage. It is a combination of self-hatred for not studying more earlier and the incredible disbelief that they want us to know so much.

Also I keep getting diabetic questions wrong on UWORLD, which is probably the most depressing thing. You think you understand the process of something fully only to find there are perverted ways of asking questions that make you question what you once knew as true.

This is hell. I also have normal human being things to worry about, but I'm not paying attention to them anymore. I need to cash checks. I need to move. I need to get a new phone. I haven't checked my blood sugar in three days because I lost my glucometer while trying to pack up my apartment. So that should freak me out. But it doesn't. What makes me chuck the First Aid review book across the room as hard as possible is not the fact that my life has deteriorated to this point where I don't care about my own health and safety. No, it is the realization that I don't know how Rifampin works. I haven't been this angry since I studied carbohydrate metabolism in Biochemistry--a class I was desperately failing. I actually flipped a table when I realized memorizing all the intermediates and enzymes that metamorphose glucose was not going to be enough to do well on the exam.

That's how I feel right now. That I know a lot, but that come test day, everything I know either A) won't be tested or B) won't be enough to answer enough questions correctly.

But I have come way too far to fall apart in the next 12 days and fail Step 1 on June 1st.

12 days.

There's no black or white answer to the question: "Are you studying?"

This is what makes studying bearable:

Our second exam of the year is this monday. I have now been in the library, at the same wooden cubicle, for over five hours. My back hurts, I haven't eaten anything in eight hours, my carpal tunnel is flaring up, and I am literally itchy all over (study-induced pruritus, probably).

That being said, the soon-to-be-tested-upon material is, by my estimates, twice as cool as anything we learned last year and an infinite amount of times more useful because last year we didn't learn anything clinical. Last year was just cram, cram, memorize these dumb facts about obscure biochemical pathways.

How helpful has this year already been for me? I'll tell you:

Time "Well" Spent

Today was a relatively difficult day, with me waking up--unwillingly, seriously, my alarm was set for 9:30 and I woke up two hours earlier--in time for my first class. My first class of six. Of course, most of that miscellaneous time was spent making a pie chart for my blog. What is more depressing? The fact that I spent more time in our lecture hall than I spent sleeping? Or the fact that I spent 52% of my day "studying"?

Well regardless I'm proud of myself. I'm not a type A person, so the fact that an entire seven days before my exam I'm already pounding the books... is either a great sign or a desperate call for help. Did no one see me in the library?! Because I was totally there. Totally studying. Totally not an Elora thing to do.

Motherly Advice

My mom (who also attended Chicago Medical School and has now been working there in various roles from Professor to faculty liaison for probably 20 years) told me shortly before I started my M1 year that medical school was easier than college. I proved her wrong.

BRCA1 or BRCA2? Either way, whatever this is, it's definitely new.

Sometimes it's hard to study. I desperately need to study today, and tomorrow, and the next day up until Tuesday. We have a test next Tuesday, and half of its question are from Biochemistry, a class I would love to not be failing right now. But I am. I feel well prepared, but I also feel like this is the first time in a long time that I will not be pleased with anything less than one-hundred-percent. It's possible. But a 92% is also possible, and I would find that devastating.

Has medical school turned me into a type A personality?

Perhaps. While I was studying tonight, I noticed something odd. Mind you, I was ready to go to sleep, lying in bed reading a clinical medical cell biology text book. It's a good book--and by good, I mean it has a serif font. I started reading chapter four. And somehow, I ended up sitting in front of my laptop looking up how often nipple discharge is associated with breast cancer.

Yes. That's right. Somehow I went from studying, which is important, to discovering that my right nipple is capable of discharging fluid. I believe in self-examination, sure, but what this should really tell you is that I'm studying way too much. I don't even like my breasts. To find something wrong with them should only indicate how much I hate reading text books.

I hate it a lot, I guess.

Turns out there are about five illnesses that can cause nipple discharge, and very rarely does a malignant breast tumor indicate itself through fluid production. I just wasted twenty minutes googling that information and then posting the good news to my Facebook.

This is what being a first year medical student is all about. You can know something is wrong, but you have little idea how bad it is, and no idea how to fix it.

And it's probably always cancer.