Step 2 CK experience (Ethiopian IMG experience) – By Dr Tinsae Tsegaye

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Step 2 CK experience (Ethiopian IMG experience) – By Dr Tinsae Tsegaye

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Introduction

Hey everyone…sharing my experiences in the hopes it will help and inspire someone in this journey. But I will have to say this first. I am not an expert. I repeat, I am NOT an expert. I am simply a medical student just like yourself who has gone through the grind of medical training and who over the years has developed effective, self-tailored study habits. I apologize, but I cannot make comments tailored to everyone’s specific scenarios (for example: “if you don’t have a dedicated period, do this” or “if you have 5 weeks to study, do that”).

 

“I will make some generalized recommendations based on my own experiences.”

 

What I mean to say by this is that my experience prepping for Step2 is unique to me alone, and my advice should be taken in context of reality. Reality is, what worked for me may not work for you. That is OKAY. I highly encourage you to reach out to other students at your school, friends, Reddit Step2 write ups to gather many different perspectives. Utilizing a variety of people for advice is a double-edged sword as sometimes it can be overwhelming; however, at the end of the day I enjoyed talking to others because I eventually used bits and pieces of what worked for them.

So, I do not have all the answers, and you actually may not glean anything new from this document that you don’t already know. The best I can do is be completely transparent about my approach and inspire you to think critically about your own journey.

 

Common Questions and Dr Tinsae’s personal Opinion

You might ask me what’s the most important thing with regards to scoring higher in CK…well my answer is a solid step 1 base. This is absolutely crucial. I took my step 1 in December and then took a 3 month break. I took CK only with 4 months of study. The reason I did well is because of my step 1 foundation. I know the temptation there is now to take step 1 lightly with step 1 being pass or fail .But trust me when I say this 70-80% of step 2 is basically step 1.So the best thing you can do for your preparation for CK is to go at a 100% during your preparation for step 1 and give it your all. If you read my Step 1 experience, you know that I don’t believe in using 15 different resources when the same can be achieved using one or two. Unlike Step 1, there isn’t a single sized shoe which fits everyone. There is no First Aid to save your ass this time. I have nothing against Master the board or First Aid for Ck, but I don’t think they are high-yield enough or detailed enough to help you gather basic info. The method for scoring high on Step 2 is far less well defined than doing so on Step 1.

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Resources Used

Anki, FA, Pathoma, and Sketchy are all well-validated materials for Step 1, but when I started step 2 ck prep, I found that there was no gold standard set of “best” materials to guarantee you’ve covered all the appropriate material for Step 2CK. Faced with this, I decided to take a minimalist approach to my Step 2 studying — use only the materials I knew were absolutely essential, while staying almost completely away from less well proven materials.

1. UWorld

Essential. Every single question needs to be done; every single description needs to be read over. Understanding why the right answer is right and the wrong answers are wrong in every single passage is the key to scoring well on Step 2.

UWorld is more than enough, as long as you take the time to treat wrong answer choices similarly to right! Do not overwhelm yourself with resources, the 4000 or whatever questions (all with many wrong options) is a ton of info! So essentially I did 2 passes of uworld. Some people will recommend against seeing questions twice, but personally I found the repetition to be advantageous. For one, I did not remember the questions (lol) so I did not remember what the correct answer was. Essentially, the questions felt brand new. Where the repetition did become apparent was in how comfortable I was getting with the THEMES of each question. Later in this document when I talk about how I reviewed my incorrects, I will mention how important it is to pinpoint the exact learning objective of each question, what distractors are thrown at you, and what key words could clue you in to the correct answer. Step2 is difficult in that the concepts are very broad, yes, but for every one concept there are a few key things that these people (test writers) ask OVER and OVER. Repeating some of the UW questions during dedicated was a way for me to see these important concepts yet again, and I developed a strong sense of what the test writers would want me to know/what the “themes” were for each clinical disease. Overall, I would say I don’t think it matters if you “redo” questions, in fact I think it is actually a super smart move.

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TIPS WITH REGARDS TO UWORLD.

TIP #1: Use UWorld in tutor mode, or at least at the beginning of your studying use tutor mode.

– How I approached the UW Question bank blocks:

o Each block has 40Q, you are allowed to do them in tutor mode or timed mode. Tutor mode means you have instant access to the correct answer after submitting your response to a Q. Early on in my study period,I utilized tutor mode. I would make sure I was spending ~1:30min or less on questions by just watching the clock. Tutor mode was helpful to me because WHY I chose a certain answer/the thought process and the gaps in my knowledge were fresh in my mind as I read the explanation. This is really important, because often times students (myself included) may not be entirely sure of an answer but on review of the exam they notice the question is marked “correct” and therefore subconsciously do not spend as much time on reviewing the explanation. Essentially, in waiting to review your corrects you may overestimate your confidence in actually knowing the material vs making a solid educated guess. Does it really matter if you get the answer correct, regardless? Honestly, yes. Because for that one specific question you may have been able to make an educated guess, but something about another answer choice was tempting to you. In a future question, this temptation may be stronger due to a different vignette or different wording and suddenly you get the question wrong. In tutor mode, we have accessible access to our exact thought process and the gaps in our knowledge that allowed us to be “at risk.” It is SO important that these gaps are brought into our awareness and that we reflect on them and perhaps even engage in some repetition. One downside of tutor mode is that it becomes really reassuring to instantly get feedback on a question. On the real test day, I think I grossly underestimated my performance as I was not allowed the reassurance of knowing whether or not I got a question right. Amidst the high anxiety of test day, this lack of instant feedback made me doubt even the “easy” questions. I left the Prometric center thinking I had undershot my goal score by at least 30 points. This did not make for a fun 2 weeks while I waited for my score. Be aware of this downside when choosing whether or not to practice questions in tutor mode. For me, the benefits of tutor mode outweighed the cost. Choose what works best for you – another idea is alternating between tutor and test mode.

TIP #2: Remember UWorld is a learning tool, use it to LEARN. Review your missed questions with a fine-tooth comb.
– Excuse me, what? WHY??? I have 4000 questions to get through in 2-4 weeks and you want me to spend like 10 minutes on a single question? Not possible.
– Yes, yes I do. Lol, It might not be possible to get through all the questions during dedicated. But I firmly believe if you at least get through ~50-60% of the UWorld and all the practice exams while learning from your mistakes, you will be FAR better off than if you try to crank out as many practice questions as possible without proper reflection of the explanation. This is a simple concept and one I am sure you have heard before (like I said, it is likely that nothing in this document is new to you). However, students often avoid this approach because it is tiring and can be stressful. They get tired since it takes such a long time to do this approach, and then they get anxious because suddenly there’s 1.5 weeks left of dedicated and only 50% of the Qbank is done while their pals are 80% through. Do not compare and do not get discouraged.

o So, what does it mean to be effectively learning from the questions? It is easiest to explain how I reviewed questions by giving an example:

o Example: One thing I consistently struggled with in OBGYN was recognizing uterine rupture vs abruptio placentae vs vasa previa vs placenta previa (i.e. causes of third trimester/and postpartum hemorrhage). When I started doing practice questions, it was almost guaranteed that I would get the question incorrect if the topic came up. I originally tried making my own notes related to the “buzz words” of each cause of bleeding: for instance, the presentation of uterine rupture is often described as “sudden-onset abdominal pain” with “a palpable irregular abdominal mass.” I would make a note to practice memorizing the buzzword, but this was NOT effective. What ended up happening is I would be able to recite all the different buzz phrases for the respective pathologies, but I was still unable to identify the diagnoses by clinical vignette. That is, I continued to miss questions. I specifically remember this issue because it was at the beginning of dedicated, and I was reluctant to sit down with the material and take the time to actually learn from my mistakes, as I am preaching that ya’ll do. This reluctancy was due to underlying fear that spending too much time on any one topic would set me back and disadvantage me in the long run . When I surrendered and let my anxiety go, I was able to fully engage with the material and BOOM – no more missed questions.

o The first thing I did with nearly every question I wasn’t comfortable with was noting the disease/disorder and what subject (specialty) it was from. I created working documents according to specialty; for example if a question was Internal Medicine and Pulmonary, I had a document titled “IM” and a page specific to pulmonary. I would then type the name of the disorder/disease and begin writing bullet points underneath. So, for the OBGYN bleeding questions I opened my OBGYN word document and made space for each topic (uterine rupture, abruptio placenta, etc.). Then, underneath the topic, I would write exactly how the diagnosis was described in the given vignette, shortening the prompt to the most pertinent info:

▪ Placental abruption:

● “28 yo woman with severe polyhydramnios, has received an oxytocin infusion for induction of labor and suddenly has gush of copious vaginal fluid followed by heavy vaginal bleeding and constant abd pain. FHR tracing 120/min with minimal variability, contractions are occurring every minute. Uterus smooth, gravid, and tender.”

● “29 yo woman at 32 w presents with heavy vaginal bleeding that started 1 hour ago, was initially light and now severe. Prior vaginal term pregnancy complicated by preeclampsia with severe features. Current BP is 156/98. Uterus firm and tender, pelvic exam shows bleeding from cervical os.”

▪ Uterine rupture:

● “19 yo woman with abdominal pain, vaginal bleeding. Smokes PPD and uses cocaine. Abdomen tender and has irregular mass; no contractions palpated. Bright red blood noted on perineal pad and FHR tracing shows multiple prolonged decels to 100/min.”

● “33 yo woman in active labor, first child was born C/S. After pushing for 20 min, there is a sudden onset of abdominal pain. On exam cervix is 10cm dilated and 100% effaced and fetal vertex has retracted to -2 station.”

o I would then write exactly WHY I did not recognize the diagnosis from the vignette, taking time to include the key learning points and the gaps in my knowledge. I also included the specific buzz phrases that may be similar between two diagnoses and which could cause me to get tripped up. For example, using my placental abruption vignettes, this is what my reflection might look like:

▪ “28 yo woman with severe polyhydramnios, has received an oxytocin infusion for induction of labor and suddenly has gush of copious clear vaginal fluid followed by heavy vaginal bleeding and constant abd pain. FHR tracing 120/min with minimal variability, contractions are occurring every minute. Uterus smooth, gravid, and tender.”

● I mistook this for vasa previa – I got caught up in the fact that this patient presented with vaginal bleeding immediately after rupture of membranes: in fact, often a buzz phrase for vasa previa is “bleeding after rupture of membranes.” However, I must remember that placental abruption can ALSO present as “bleeding after rupture of membranes.” A key difference is that placental abruption is painFUL while vasa previa is painLESS.

● Additionally, a key point to note here is the patient has a history of polyhydramnios. I have seen in multiple questions now the association of polyhydramnios or overdistention of the uterus – the test writers must like this association!

▪ “29 yo woman at 32 w presents with heavy vaginal bleeding that started 1 hour ago, was initially light and now severe. Prior vaginal term pregnancy complicated by preeclampsia with severe features. Current BP is 156/98. Uterus firm and tender, pelvic exam shows bleeding from cervical os.”

● I mistook this for uterine rupture simply because I didn’t read closely enough

● Key clues that this is placental abruption: painFUL bleeding (describing the uterus as “tender” = painful and not to be mistaken as a sx of being pregnant, they will not write “tender” if it is vasa previa or placenta previa, both of which present with painLESS vaginal bleeding).

● How to differentiate placental abruption from uterine rupture: uterine rupture also causes abdominal pain, vaginal bleeding, and fetal HR tracing abnormalities. Therefore, do not rely on these characteristics to distinguish the two! Instead, recognize that in uterine rupture patients will classically have “palpable fetal parts on exam” [aka the uterus will NOT be rigid/firm as in placental abruption]. Additionally, uterine rupture has LOSS of contractions rather than the high frequency, low intensity contractions that are seen in placental abruption.

o Side note about uterine rupture: they will almost ALWAYS give a clue that there was a “loss of fetal station” – this is because the fetus is suddenly palpable through the rupture in the uterus and not is not felt in the birth canal anymore

o Other ways to describe “loss of fetal station”: no presenting fetal parts vaginally, “bulging bag,” fetal station was at +2 and now is -1.
– You will notice that indeed these reflections are LENGTHY. I get that, but again it is just what worked for me. After analyzing about 2 vignettes (aka 2 questions) of a topic I struggled with, I found I was usually able to pick out the common buzz phrases, the “tricks” (i.e. which buzz phrases are similar to those of other diagnoses), different ways a physical exam finding or symptom could be described (example: loss of fetal station, no presenting fetal parts vaginally, “bulging bag,” all describe the same PE findings seen in uterine rupture), etc. This strategy helped me to master the topic, and thereafter I seldom missed another related question. If I came across additional pertinent information via future questions, I would add to the document. This is how I was able to make comments such as “in certain questions I have seen it described as this…” or “they seem to like this concept a lot as I have seen it in about 4 questions now…”

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2. NBME practice examinations:

Do them. Do all of them for each subject. Usually Telegram groups will have copies of the old forms floating around, there is also a Facebook page called “The Embience” you can request access to . Learn from the NBME questions using the approach I highlighted above in the section on uworld prep. THIS MEANS DO THE 25 OR SO CMS FORMS AS WELL. Yes they are easy but they will provide you a glimpse on how the nbme test writers want you to think.I will stress here that if you have time also do THE OLDER NBMES 6,7 and 8.You will learn from them. Do every available NBME exam (I did form #9, 10, 11,12), as well as the free 120(both the old and new), and do the two UWorld self assessments
o To me, the free 120 was the most representative of the exam, but every practice question is a learning opportunity and will only prepare you more. I would recommend treating the NBME exams just as really long practice question blocks as well as practice stamina. Do not get discouraged by your performance if you miss more questions than you would like; instead, be glad the gap in your knowledge was brought to attention!

– Review ALL NBME questions with a fine-tooth comb. Even if the question was “easy” and you are 100% comfortable with the topic. This is different than what I recommended for UWorld, because the NBME exams are specifically written by the people who will be writing your Step2 exam questions. Their explanations for even your correctly answered questions can serve you as it is likely that their explanation is somewhat different than that seen in UWorld or that there is additional information that they think is important for you to know.
– Make notes on question concepts you think are most important to review.

A NOTE ABOUT BIOSTAT AND ETHICS.

– It would be remiss of me not to mention the importance of studying for Ethics and Stats on Step2; the number of Ethics questions specifically has been increasing over the past few years. Do NOT underestimate the value of preparing well for these questions. Statistical questions are freebies. Truthfully. Stats is objective, which I LOVE. If you study effectively for Stats, you will breathe a sigh of relief when you see a Stats Q on the exam because you know you’re about to get it right. Here are the high yield Stats topics I saw on my exam:

o Calculating PPV, NPV, OR, RR, RRR, ARR, sensitivity, specificity

  • This is NOT math, ya’ll. I mean it is, but the math is easy numbers and you get a calculator. What is KEY is actually UNDERSTANDING how these formulas are derived so that you know which numbers to use in which equation on the exam. I made myself flashcards on the fundamental derivatives of each formula, and then tested myself on them so they became second nature.
  • Example: Positive predictive value = probability that if the TEST is positive, the disease is present
  • I.E. If a person has a positive test, what is the probability that they actually have the disease? ? this is the way to phrase it that made the most sense in which I could quickly derive the formula myself
  • So PPV = probability of test truly being positive (aka # of individuals who have the disease and test positive) divided by all those with a positive test result (true positives + false positives)
  • PPV = TP / (TP + FP)

o How to INTERPRET results of a study:

For example, what does it mean if the 95% confidence interval does NOT contain the null value of zero? If the 95% confidence interval for relative risk includes 1, is your study statistically significant? What does it mean to have a p-value >0.05? What does it mean to have a relative risk <1?

  • These interpretation questions are sometimes stand-alone questions, often times they are asked in the context of a given “drug ad.” You will be shown an advertisement highlighting some new drug that highlights the details of a study comparing drug X to placebo and the findings. You are then asked to make recommendations for patients based on the findings, which of course necessitates a correct interpretation.

o Understanding general statistical principles:

How does the width of a confidence interval change with decreased sample size? What is alpha?What is beta?

– Overall, the Statistics questions on UWorld OVERPREPARED me for stats on the Step2 exam.

– Ethics questions are a little more “hit or miss” as they are more subjective. However, with proper practice and review you can become more comfortable. To prepare for my Step2 exam, I reviewed and did the questions on the Ethics session on Amboss the week before (you can get a free trial of Amboss for 7 days if you don’t want to pay for it, and you can usually view a couple articles for free anyway). This section was honestly invaluable. It touched on almost all the high-yield Ethics concepts that I saw on the exam, and I felt much more prepared and confident about my answers to these questions than I did on Step1. I specifically remember quality improvement being a high yield topic on my exam – a large percentage of my Ethics questions were related to quality improvement.

 

General tips on answering questions (in both UW and on test day)

Be comfortable with making an educated guess
– As I mention before, on test day I was extremely confident about my answers to only ~25% of the questions. Take a breath, trust your critical thinking skills, and go with your gut when making an educated guess. Your mind may subconsciously know the right answer – it may be pulling from distant memories of class lectures, patient interactions, or a paragraph you read in a prep book. Our brains are amazing like that. If your “gut” is telling you to choose an answer and otherwise you don’t have a reason for picking a different one, go with what your gut says. And remember that everyone else is ALSO making an educated guess. We aren’t meant to feel 100% confident about every single question, the test is not designed that way.

– First focus on ruling OUT answers
Why is this important? The answers to questions in Step2 CK are often probability-based, which is what makes them seem so tricky. Many of the questions are written as “What is the next best step?” This means more than one of the answers to the question may be “somewhat correct” to varying degrees, and the correct answer itself might be able to be argued against. The key is to focus on likelihood. Searching for the answer that is definitively correct may not be possible; instead, reflect on the key learning points about whatever topic the question is testing. Chances are if one of the answers is extremely esoteric, it is not correct. Contrary to popular belief, the test writers are NOT trying to fool you. When you are stuck between two answers, ask yourself, “if this is really the answer, then why would they (the test writers) have included this piece of information in the stem?” It is true that there are distractors in vignettes, but if it is a piece of information specifically related to the diagnosis then it is likely there is a reason for providing it.

– Read the last sentence first, then pick out the key points in the paragraph

o I don’t always recommend reading the last sentence first, but sometimes for lengthy vignettes it is helpful as understanding what you are going to be asked primes you to highlight the most important information you are being given. You don’t want to waste time on distractors, and if you read the vignette first without knowing what you’re being asked, you may be tempted to slow down and suddenly find yourself overwhelmed at what is important vs what is not.

– Find your personal method for answering questions, and hone that skill by PRACTICE

Not everyone approaches questions the same way; after doing multiple UWorld blocks it is likely that you will fall into a particular rhythm that works best for you. Once you discover this rhythm, do not try to change it entirely. Instead, reflect and refine if for example you are still taking too much time, or you are missing key details. Overall, you want to go into test day being able to apply a comfortable, systematic approach to analyzing vignettes and answering questions. Answering questions effectively is a SKILL. The more questions you practice, the better you will become. Doing questions does not only expose gaps in your knowledge, but it will expose any weaknesses in test-taking abilities as well. Doing as many questions as you can is extremely vital to your success as you will become a better test-taker at baseline with every mistake you make, irrespective of the actual content you know.

– Recognize your weaknesses.

o If you are stuck on a question for longer than 90 seconds and have not made any progress in reaching an answer, guess and move on. It is just ONE question, and chances are an additional minute or two won’t lead you to any additional conclusions. It is better to make your best guess and move on so you can devote enough time and attention to questions you ARE likely to get correct.

– Understand that Step2 is designed to test your critical thinking skills.

o Step1 is easy in that it is rote memorization, what is difficult is finding the time and will to memorize it all (lol)
Step 2 on the other hand is more difficult because it requires application. This is why I am personally very pleased that Step2 is becoming more important and Step1 is pass/fail. When you are working through questions, don’t get too stuck on the nitty gritty details. Focus more on your ability to develop a possible differential, and to use your clinical reasoning to decide what is important to do next based on the differential you have developed.

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Part 8: My Step 2 CK Exam Day

 

How did I feel walking out of step2? Was it similar to the practice exams? What kind of content did I see? What things were particularly tricky?

o In terms of ease of the Step2 CK exam, I would say my experience is a little biased by what I mentioned above – the fact that I practiced most of my UW blocks in “tutor” mode, so I was used to having instant feedback as to whether or not I had gotten a question correct. However, I anticipated feeling like “crap,” because I didn’t always feel the best while taking practice exams (where I was forced to wait until the end to see my answers) and these ended up going just fine. I thought the exam was most similar to the free 120 in difficulty, however the style of some of the questions was more consistent with what I saw on UWorld, as UWorld questions are typically longer and have more “distractors.”

o Overall, here is a breakdown of the difficulty of the questions, from my perspective:

▪ 25% of the questions were super easy, first-ordered questions that I knew with 100% certainty I had gotten correct. For example (this is not a question that was on my exam but is similar to ones I saw):

● A 21 year old college female is establishing care with you at your general outpatient clinic in May. She is not sexually active and reports no chronic health conditions. She is wanting a general physical exam to be done today as well as any health maintenance cares that she is due for. During this visit, you should:
o A. Administer the flu vaccination
o B. Discuss doing a pap smear to screen for cervical cancer [correct answer]
o C. Test her for gonorrhea and chlamydia
o D. Screen for breast cancer with a breast ultrasound
● Many of the first-ordered questions were stats questions asking the calculation of specificity, or the relationship between confidence interval and sample size. This is why I stressed the importance of knowing your stats! These should be freebie points for you.
▪ 50% of the questions were fair, but either required you to have memorized a small detail (such as certain “exceptions” in clinical management and contraindications), or they were second/third ordered questions that tested underlying pathophysiology concepts (ahhh, we all love a good arrow question, hahaha #ifyouknowyouknow). For example (again, NOT from my own exam):
● 54 yo male with CKD stage IV and recently placed AV fistula for dialysis comes in with shortness of breath, on CXR there is marked pulmonary congestion and cardiomegaly. Which physiologic changes would you expect in this patient?
o A: Cardiac output increased, systemic vascular resistance decreased, venous return decreased
o B: CO decreased, SVR increased, VR decreased
o C: CO increased, SVR increased, VR increased
o D: CO increased, SVR decreased, VR increased [correct answer]
● See how you had to first rationalize that the AV fistula is the likely cause of his sx’s (high output heart failure) and then you had to correctly determine the physiology of this?
▪ 25% of the questions were HARD. The vignettes weren’t straight-forward or the common “buzz phrases” weren’t used – which again is why you really need to make sure you truly understand diagnoses rather than just associate them with memoizable descriptions. Some of these questions were lengthy as well with many distractors and answer choices that technically COULD be correct, but are not as LIKELY as the correct answer (*rolls eyes* lol). I don’t have a great example for these except stating that they were similar to the hardest questions I saw on the NBME exams. Usually on NBME practice exams there would be 1-2 on each section that I would be completely bamboozled by and would have to just utilize my critical thinking skills and make my best educated guess. On the real exam, there were about 10 of these questions per each 40 question block. So overall not worse than the most difficult NBME questions, just a greater percentage.
– Style of questions:
o It is important to note that there were some new question presentations on the exam that I wasn’t used to, or that had low representation in the UW Qbank:
▪ Drug Ads and research study abstracts
● You would have a less questions (38) on a block if there was a drug ad or abstract
▪ There were two or three blocks on my exam which were 38 questions due to an abstract, and I was asked 2-3 questions on each.
o Emergency room HPI’s or Inpatient progress notes
▪ I never saw questions written in this style in the UW qbank (maybe there was one in a UW self assessment??)
▪ Regardless, the questions weren’t too difficult it just caught me off guard to have the patient information presented to me in this way – you have to be astute and individually pick out what is important from the history and physical exam versus the test writers providing you with the information as in traditional vignettes
▪ Usually these questions would ask what the next best step was, or what type of fluid you may want to administer, or which antibiotic you should pick. There were about 4-5 of these questions on my exam.
– Be prepared to feel defeated when you walk out of the exam, but celebrate anyway! Finishing is a HUGE accomplishment, and trust that you did your best. That’s all you can ever ask for. Step2 is notorious for being ambiguous and vague. It is normal to feel uncertain of how you did, and to be nervous about your score. But PLEASE be kind to yourself and make time for the celebration you deserve!

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MOST IMPORTANT ADVICE: Take Care of YOU

– Taking care of yourself is the most important thing you can do during Step2 prep and honestly during your career as a (future) physician.

– I credit much of my success with Step2 to the mindset I was in at the time; I was really relaxed and not feeling pressured. I was able to get into this state of mind by participating in morning reflections that grounded me and reminded me of the “bigger picture” – of who I was, all the people that love and support me, all of my identities outside of medicine, and all I have to offer the world simply by being me.

– I understand that studying for board exams is stressful. That is an understatement. But much of the stress is not necessary and is brought upon us by ourselves. Picture this: you’re stressed about your Step2 exam. You want to pass, and you want to reach a goal score. You missed some questions that were supposed to be “easy” on your morning UWorld block. Now you’re sitting and staring at the clock because you need to make time to review nephritic/nephrotic syndromes which you THOUGHT you would have down pat by now. This throws off your schedule and now you’re behind on starting your second UWorld block and OMG time is passing so quickly, how are you ever going to review all of this material? You literally only have 2 weeks left! Maybe you should skip out on getting dinner tonight with your friend; she knows you’re studying for Step2 anyway and will definitely understand. You two can catch up in a couple weeks when you’re done. Right now you have to GRIND because you cannot fail. Omg what if you fail? What if this test is going to compromise residency? What would all this be for? What would your classmates say if you didn’t match, what would your family think?…..

– Sound familiar or at least a little relatable? Lol. This is catastrophizing. What is the truth? The truth is that you CAN do this, as everything in your educational journey leading up to this moment indicates that you CAN: getting a medical degree, preparing for the STEP 1, taking the STEP 1 (doesn’t matter how many times!), taking and passing your medical school exams, taking and passing Step 2…. The list goes on. And yet, you still sit here and doubt yourself.

 

– What is the worst that could happen? You fail the exam. But actually, though. In regards to Step2, the absolute WORST that could happen is you do not receive a passing score. Would this truly be that bad? I do not want to invalidate the mental battles that would likely arise with receiving a “fail” on the exam, nor the time, energy, and financial support retaking the exam would require. However, at least for me personally, reflecting on the WORST that could happen helps take some of the fear away. If I failed Step2, I would be okay. Failing wouldn’t negate all the other successes I have had in my life, and it certainly would not change the way my family or friends think of me. And, at the core, no external “success” or “failure” will EVER change who I am as a person. Regardless of my experiences or the situations I find myself in, I will ALWAYS carry the innate characteristics about myself that will make me a wonderful physician and, more importantly, that allow me to make the world a better place in my daily interactions: my kindness, empathy, generosity, selflessness, encouraging heart, curiosity, humility, determination, perseverance, and gratitude. List the things you love about yourself and which make you unique, write them on a sticky note or piece of paper, and keep them near your study area. Step2 and these board exams seem like a big deal because, right now, they ARE a big deal. But in the grand scheme of life, what is FAR more important is your overall health and happiness. Do not get too caught up in the “weeds” that you forget what your actual purpose is in this life and the worth that you have simply by existing and being you. Your mind, body, and soul NEED breaks throughout your period of study. You need fresh air and exercise, consistent sleep, dinners with friends, laughs at funny TikTok videos or tears from cheesy new Netflix movies, and time carved out to reflect on what your “bigger picture” looks like. Take AT LEAST 1 hours each day for these things, even if you are pressed for time. We are all pressed for time, and we will ALWAYS be pressed for time in this career throughout the rest of our lives. You need to prioritize taking care of YOU – you need to prioritize your life.

Best of luck on your exams and on all your future endeavors. I am always happy to support you in whatever way I can.

With Regards-Tinsae

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PRACTICE TEST SCORE RESULTS
1.UWSA1-270  7.NBME 10-268
2.NBME 6-262  8.NBME 11-261
3.AMBOSS SA-264  9.NBME 12-269
4.NBME 7-252  10.UWSA2-272
5.NBME 8- 259  11.OLD FREE 120-95%
6.NBME 9-267  12.NEW FREE 120%-90%

 

Article Source: Match Ready 

 

Match ready is a telegram community which gives you a complete, stuructured and systematic guide to successfully secure your residency spot in the US (within 1 year). You can Join this community here

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