The Road to Residency

Tips to Prepare for USMLE Step 1 by Dr. Teoria Murray.

God has truly blessed me with strong, phenomenal, professional young women who are open to sharing their experiences and encouraging others in their journey. Today's post was written by Dr. Teoria Murray; may you find useful tips as you prepare for the USMLE Step 1 exam.

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Tackling the USMLE Step 1- One IMG’s Story

If you are a medical student or graduate anywhere in the world, chances are you have heard of the dreaded United States Medical Licensing Examination. This 3 step hurdle has been known to stir up fear, anxiety and frustration in the hearts of those with the goal of entering a US residency program. As a 2018 graduate of the University of the West Indies in The Bahamas, I was no exception to this rule. After completing medical school and then internship, I set my sights on the Goliath USMLE Step 1 and completed this task (mostly) unscathed. In this post I will share with you the insights I gained in the process so you can hopefully have an easier experience than I did. 

1.     Set clear, realistic goals

Medicine is vast with an estimate of over 120 specialties and subspecialties in the United States. What is the specialty of your dreams? Based on your research and experience thus far, what area do you think you could wake up and still enjoy practicing for decades to come? You may not have a clear frontrunner in mind and that’s okay. Maybe there are two or three that spark a light in you. Do not set a low bar for yourself because of the perceived disadvantage of being an international medical graduate. Look up the average IMG Step 1 score for your target specialty and aim above that. As you take practice tests, track your progress toward this goal. Work towards it. Pray about it. Hang it high in your mind as an achievable goal. 

Source: Charting Outcomes in the Match: International Medical Graduates, Characteristics of International Medical Graduates Who Matched to Their Preferred Specialty in the 2018 Main Residency Match. https://www.nrmp.org/wp-content/uploads/2018/06/Charting-Outcomes-in-the-Match-2018-IMGs.pdf

2.     Create a study schedule

Once you know your goal score, you also need to decide the amount of time you will dedicate to studying. Generally, it is recommended that IMGs spend at least 6-8 months studying for Step 1 for 6-8 hours a day on most days. When I made the decision to take Step 1, I realized that the long days of hospital-based medicine led to exhausted nights and I wouldn’t have the discipline or energy to study like I needed to. This led to the tough decision of taking 5 months away from work for dedicated study. If you can do this, that’s great! However, many persons can’t realistically afford to do so. In that case, study time will have to be structured around your work schedule and other responsibilities. Towards the end of the study period, set aside a dedicated study time for serious review. 

There are lots of study schedules out there than you can adapt to your personal needs and it may take some trial and error to find one that works for you. There are templates for 6 weeks, 3 months, 6 months, 12 months and everything in between. I settled on Cram Fighter’s 4 month schedule because of the time left before my exam at that point, but if I could do it again I would have chosen the 6 month option. You can have a look at some sample schedules here. 

 3.     Choose your resources wisely

The amount of information that’s available to us in the 21^st century can be both a blessing and a curse. On one hand, there’s so much useful information. On the other hand, there’s just SO MUCH useful information. How do you choose? The key isn’t how many resources you use but how well you utilize them. In this case, less really is more (especially since you will likely go through the material multiple times). For Step 1, the core resources are UWORLD, First Aid, and Pathoma (UFAP). To supplement these, I found Sketchy Microbiology and Pharmacology useful. Picmonic is also a good visual aid to cement these concepts. However, take consideration of your learning style as well. If you find yourself to be a more visual learner, you may use online learning systems like AMBOSS, Boards & Beyond or Lecturio to guide you through UFAP. The possibilities are endless, so the best advice I can give here is to CHOOSE EARLY. Then evaluate your decision and decide if changes need to be made but do this within the first weeks of study because changing tactics late in the process can be a costly mistake.

 

4.     Spend more time on weaker areas

Step 1 is divided into the major areas of Anatomy, Behavioral sciences, Biochemistry, Biostatistics and epidemiology, Immunology, Microbiology, Molecular and cell biology, Pathology, Pharmacology, and Physiology, with some genetics and nutrition sprinkled in. We all have those subjects that come easier to us. I would find myself almost enjoying studying behavioral sciences and pathology most days, but other areas of study seemed more painful than pulling teeth. (Biochemistry, I’m looking at you.) This is a discomfort you want to face head on. The subjects that you least enjoy studying and that you score lower on in practice tests are the ones that need your attention. Review them early and often.

5.     Practice, practice, practice

Get UWORLD early in your study period. You may be tempted to wait until you have seen all the information to start practicing exam questions. After all, that’s usually the way most of us did things up until now. You learn the information then practice exam questions when you almost feel ready. Step 1 is a whole different ball game. UWORLD is a useful tool with over 2000 questions and explanations. The questions are very close to those that will appear on the real thing so you want to give yourself time to get comfortable with the question format and the thinking that goes into answering them. The UWORLD subscription also comes with a simulated exam (UWSA) that is a bit shorter than the real thing but can give you a taste of what it will be like. 

You will also want to take NBME exams. These are the closest to the real deal you will see before exam day and tend to approximate your Step 1 score +/- 9 points. It is recommended that you take at least 3 or 4 of these prior to the actual exam as a concrete way of measuring how effective your studying is. If your NBME score 1 month from the big day is still a far cry from your goal, it may be a good idea to postpone your exam and give yourself more time to study.

6.     Take care of your health

As robotic as the rigors of USMLE prep can make you feel, you aren’t a machine. You will still need sunshine, fresh air, water, exercise, and some social interaction. In the era of COVID-19 this may take some creativity, but a healthy body, mind and soul will go a long way in boosting your productivity. Set fixed times for study and stick to them, without multitasking. Schedule study breaks and take them. Eat healthy foods that can fuel your brain whenever possible instead of junk food that can make your brain feel foggy. Don’t use caffeine as a substitute for sleep. This is a marathon not a sprint and you don’t want to burn out. Do things you love. Stay in touch with your loved ones. Read a book or watch a show that has nothing to do with medicine, even if only for 30 minutes every day. 

7.     Give yourself grace

Preparing for and passing the USMLE is taxing. Some days you won’t feel like studying. Study anyway. Some days you won’t meet all of your goals. You may score lower than you expected on a UWORLD question block. Your NBMEs may be less than stellar. You may doubt yourself, your abilities, your goals, your calling, and all the signs that led you to believe you were on the right path. Don’t beat yourself up. Take a deep breath. Stretch. Pray. Reach out to someone you know is always in your corner for a pep talk. Talk things through with other colleagues preparing for the exam or who have taken it recently. But whatever you do, don’t give up. You already know that you are capable of amazing things. God has brought you this far and it’s only up from here. So keep pushing and at the top of this mountain, when you realize it was all worth it, reach back and encourage those still climbing. 

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Dr. Murray is a recent graduate of the University of the West Indies, currently practicing medicine in The Bahamas. Feel free to post your comments below if you would like to hear more from here in reference to the USMLE Step 1 examination. 

Study Smarter; Not Harder

“As every divided kingdom falls, so every mind divided between many studies confounds and saps itself.” ― Leonardo da Vinci

Preparing for end of clerkship and essentially my final M.B.B.S. examinations has revealed that the way I studied for the first three years of medical school is not sufficient. Did you read the quote captioning the photo? da Vinci my man, you're speaking to my soul there.

Before sitting down to embark on studying for a major examination that covers numerous disciplines or specialties, the best thing you can do is to learn to study smarter and not particularly harder.

Today's post will highlight a few things I've learnt from several YouTubers who are medical students, law students and even juniors and seniors in high school who introduced me to a whole new meaning of effective studying. During my research for this topic and self-experimentation, I've found a few adoptable tips to share with you.

1. Don't Worry About Whether or Not You're Smart Enough

According to Douglas Barton in his TedTalk entitled "What Top Students Do Differently", his research showed that students when asked whether or not their academic performance  was influenced by their IQ, the majority believed that it had some influence and worried that based on their IQ, they weren't particularly smart enough and because of this didn't expect good grades.

Mr. Barton went on to mention that contrary to popular belief, one's IQ is not predictive of academic performance. As top students know this, rather than spending time worrying about whether or not they are smart enough, they are instead incorporating the practice of past papers and practice examinations in their study schedules which has shown increases in academic performance amongst students.

Seems easy enough right? Well it is once you have the self-motivation, discipline and resilience. During my undergraduate studies as a Biology major, practice examinations were an obvious "MUST DO" simply because it was the easiest way to gauge my understanding and made it easy to figure out my current strengths and weaknesses and made asking questions based on this easier. I'll be honest, as the delivery of medical information during medical school differs from those Biology days, it has been a bit difficult to incorporate this throughout the term as opposed to leaving it to weeks before the exam.

In order to stick with your studies and debunking the myth that you're not smart enough because of a number, you must first believe that you have what it takes to commit to the task at hand and to bend but not break when you experience failure or lack of motivation.

2. Just Aiming to Work Hard

If only what we aimed for was so easy to achieve. Merely "aiming to work hard" at the start of the semester or academic year is NOT sufficient for academic success or change in performance. 

As the year began, you may have resolved to "work harder" and now that we're 13, going on 14 days into the year, you're not sure where you're aiming now because it seems unattainable. Well that's because you have to go beyond aiming to work hard and improve your inadequate study skills. 

insanity

ɪnˈsanəti/

noun

the state of doing the same thing over and over and expecting different results

In order to see improvement, you have to learn to work hard doing the right thing! The top students across 4 continents when surveyed showed that rather than simply reviewing or rewriting notes and memorising lectures, they did several practice examinations and reviewed the explanations of their answers because they realised that examinations aren't testing just what they knew or were taught, but how they use what they were taught. 

Have you been sticking to the same study routine from high school and wondering why you're not receiving the grade you like after putting in so much time and effort studying? Take a step back and look at how you're studying. Is it smart or simply hard?

3. Create a Schedule 

Planners and all things stationary related is one of my "happy things" but I'll be honest when it comes to a study schedule that I can stick to on my own, I just haven't mastered it. 

Mr. Barton's study also showed that top students approach construction of their study schedule differently from most students. Rather than first filling their timetable with restricted study days and times, they commit designated days and times to the things they enjoy FIRST! Once the schedule was filled with their non-study activities then they realistically filled in their schedule with their areas to study. 

What he found was by doing this, they ensured that after each study session they were doing something everyday or every other day that they enjoyed which translated to optimum balance of their time and energy and lead to overall happiness with their day and week and their study session. 

Go figure. I knew I wasn't being realistic with my study schedule when looking back in my planner at all the empty checkboxes; this then led to guilt and of course some depression followed. 

I tried this theory out this week which actually helped make the recent gloomy weather a little better because not only was I happier, I stuck to the majority of what needed to be done. 

4. Study in Groups

As a medical student, it is important to learn to study and work in groups. With the change in demands from year to year, there is strength in numbers and studying amongst your peers helps with clarification of theories or principles you do not grasp and it helps build your team-work skills. 

Now the way to study in groups is to ensure your sessions are dedicated to studying. It helps to create a schedule and to hold each other accountable during the session. Before each session prepare for what will be discussed or reviewed. Remember your time is precious and each second is worth gold so don't waste it on idle chit-chat. 

Post below some tips you've adopted to ensure you're studying smarter and not harder. For more information on Effective studying check our the following TedTalks here and here. 

Come go for your Yellow Corn Grits

Travel has never been easier. One can choose to travel by boat, or air throughout The Bahamas and regardless of your mode of transportation, an adventure is yours to have, if you simply decide to travel. 

Harbour Island, or 'Briland' is a small island northwest of the island of Eleuthera. It is known for its pink sand beaches, picturesque landscapes and Loyalist cottages. Each island of The Bahamas, offers visitors a unique experience as no two are the same despite what may be said. The residents are different in their own special way and the hospitality gets sweeter the more you travel down the archipelago. 

While in Briland, I took the advantage of exploring this gem of an island and I must say, if you've yet to visit, this is one island you must add to your bucket list. 

I traveled to the island by way of boat-specifically-the Fast Ferries. I took the last boat leaving Nassau, headed to Current Eleuthera and was met by family there. From one dock to another to catch the water taxi to Harbour Island, we made it just in time for one of the last ones over and before the rain began. Just a disclaimer however, during the summer months, particularly on the out-islands of The Bahamas, mosquitos are in abundance and the limited street lights, allow them to come out in large numbers to feast on tourists and locals alike, who aren't coated in insect repellant. 

Since I stumbled upon AirBnB back in 2012, I can't recall the last time I voluntarily stayed in a hotel. My family and I were able to secure a three bedroom, two bathroom cottage for a fraction of the price of staying in a hotel. One main advantage of booking through such a site as AirBnB is that you're afforded the luxury of cooking for yourself which can reduce the cost of your trip if you're traveling with a large group and can travel with your groceries. 

The weather wasn't the best during my visit as I left during the peak of hurricane season but the trip was enjoyable nonetheless. 

This little island is truly a gem. Golf carts is the main mode of transportation and on every corner there's an opportunity for a 'selfie'.

Where's the water?

Freely walking

The people are friendly, the island has it's moments of "liveliness"  and there are some locals who hold true to their Bahamian roots and culture and offer items such as handbags and hats made from straw 'plait' which they design and sew together all in store. A and A Hidden Treasures is definitely a hidden treasure that won't remain hidden for too long as their work is meticulously done, reasonably priced and authentic; which is so hard to find.

 Overall, Briland although it's quickly becoming modernized with the increase in vehicles infiltrating the island and in some areas the emergence of outdoor bars who aid in noise pollution with their music; it still has an aesthetic that is all its own and rest and relaxation can still be attained. It was a much needed staycation for me, even though I still traveled with my Surgery notes and had some time to study in a new environment, it offered some peace of mind.

Where are you planning on going for your next trip? Let me know in the comments section below. If you've visited Briland either in the past or recently, what were some things you enjoyed about your trip? Do share.

Helpful Study Aids

"Successful people are not gifted; they just work hard, then succeed on purpose."-G. K. Nielson

It can be hard to maintain a certain level of momentum throughout the semester in medical school. I honestly do no know how the gunners amongst us do it. There are times when my understanding of basic medicine simply leaves me as I read and study Pathology, and that alone can be discouraging as it requires having to revisit the notes I complied from the first two years of medical school, in order to understand a new concept or idea.

In this post, I will discuss some study aids I have found helpful over the years and how I have adjusted my studying to incorporate new aids.

  Top 4 Study Aids.

1. Mind Maps/Summary Maps

The sole purpose of a mind map is to allow you to visually organize information, generally around a single concept. It can be drawn multiple ways, however, I find starting in the center and working out to work best for me.

Personally, mind maps can be  time consuming especially if they are done neatly and properly and manually. Due to this, I tend to do them at the end of a topic as a means of review and a way to gauge my level of understanding on a particular area.

The option does exist for those of you who may be interested in trying this form of study and are more computer literate. There are multiple apps specifically designed for the creation of mind maps. I use Mindnode, the 'lite' free version which can be found in the App store. 

If you are more interested in mind maps you can learn more about them here. 

2. Flashcards

Flashcards are used to exercise ones mental recall. Some people like them, others detest them. I for one find them useful for certain subjects of study such as Anatomy, Hematology and at times Diseases based on organ systems. 

During years 1 and 2, flashcards were my go to study aid. They were quick, colorful and easy to tote. I could test myself on during my daily commute and I was able to sort the cards into piles based on the concepts I understood and those that I needed to review a little more in depth. 

The only disadvantage of manual flashcards is that at the end you're stuck with a collection of cards that you may or may not use again.

Personally, I have a hard time going over my pre-made flashcards mainly because it is easier to use quizlet and most times I have to spend time sorting through the cards to find a specific thing. If I am not studying however, and would just like to refresh my memory on certain concepts they do come in handy in that regard as it is easier to review a set of cards rather than reading a chapter in a textbook. 

For those of you, that prefer using your computer, phone or tablet there are numerous sites that would allow you to create flashcards; namely Quizlet and Cram. There is also Kitzkikz that allows you to   create your cards online and have them printed. I haven't tried out their service so I cannot rate them but I am interested in giving them a try.

3. Color Coding

Did you know that color coding can be linked to making you an efficient thinker? Well apparently it can.

By color coding your notes, you automatically correlate certain colors with specific things. For example my main color codes specifically for my (lecture) notes are as follows:

* orange: locations

* pink: specific features/characteristics

* yellow: general information that I should know

* blue: things that I MUST know and commit to memory, either for examples or overall practice of medicine. 

* purple: headings/names

* coral: definitions

I must admit, it makes me all warm inside to pick up my binder of notes and to be able to identify certain things such as special features of specific bacteria all based on my choice of highlighter. It also makes finding certain things easier especially in a 20+ page printed lecture.

4. Folders/Note Storage

This is the ultimate must in proper organization of my study materials. For me, planning what I will study on certain days and sorting my notes in color coded folders or a big tabulated binder does wonders for keeping me focused. 

I recently came across Ellen's blog on Tumblr, where she has free printables that can be downloaded, printed and used for any student. Since I've been using her study planner, it has helped me tremendously keep track of what tasks I have to do, gauge my understanding of a topic, and it offers other ideas for ways to remain motivated as I study.

I found a few colored page protectors for $4.00TTD that I have been using mainly to keep track of my pending lectures to be read and annotated etc; and so far that seems to be working. The thought occurred to me to try assigning certain tasks for example: answering objectives, working on PBL, and practicing questions etc certain colors and assigning those colors to certain days. If I decide to switch to that method I'll be sure to let you all know how it's going, but in the meantime I'll stick with my current set up. 

So there you have it. What aids do you utilize when you study? How is it working for you? Do you lean more towards flashcards or mind maps? Manual or computerized? Share your study aids in the comments below.