GUEST BLOGGER: STEP 1 USMLE/COMLEX STUDY PLAN

I am fortunate enough to have friends/classmates that are willing to share their study plans with you guys. While my classmate wants to remain anonymous, he did extremely well on Step 1 for USMLE and COMLEX. This will give all of you osteopathic medical students an insight on how a DO student was able to balance both exams!

B is a current third year medical student in the top quartile of his class. He began studying for boards January of the test year doing DIT Primers and COMBANK questions.

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Boards are the time of year that everyone gets equally stressed out about the future of their careers. You’ve been studying hard for the entire first two years of medical school then it all comes down to this one or in my case two (USMLE and COMLEX) daunting exams. The exams are so hyped up mainly because they play a major role in the determination of the specialty you want to do which these exams were never intended to do, but with increased competition between specialties programs need a way to objectively determine the differences between prospective candidates. The most important thing to remember while board studying is that it is a marathon and not a sprint, burning out in the torturous 6-8 weeks of constant studying is real scenario. People will try to tell you what is the best method to study, but at the end of the day they aren’t you and likely learn different it is important to go at the speed you deem necessary to master the material.

Resources I used:

• Doctors in Training Step 1
• 2016 First Aid for USMLE Step 1
• Sketchy Medical (I used both Pharm and Micro, but did not like Pharm as well.)
• Pathoma
• UWorld and COMBANK Question banks

Time for studying: Approximately 60 days of hardcore board studying April 1^st – June 1^st (USMLE) and June 9^th (COMLEX).

Daily Schedule:

• 7:30am-9:30am: 40 Uworld question sets/review.
• 9:30am: Start DIT daily videos (I was on pace to finish in 27 days, I think that was 9 videos a day.)
• 12:30pm: Lunch
• 1pm-2pm: Gym session
• 2pm-4pm: Finish up DIT videos of the day
• 4-6pm: Pathoma Videos/Sketchy Micro videos
• 6-8pm: Read chapters or sections that I struggled on with questions that day.
• 8-9:30pm: Combank Questions

After I completed the DIT videos with about 3 weeks left of studying. I would complete the DIT videos on 1.5x or 2x and read chapters in First Aid that I was struggling in. I think this final push helped with the small details that I missed the first time through. I also completed 4 NBME practice tests 1.5months, 1 month, 2 weeks, and 1 week from my exam date.

About the exams themselves:

I was asked to talk a little bit about the differences between COMLEX and USMLE so I will do that now. The major difference between the USMLE and COMLEX is the level of detail. USMLE is very detail oriented, knowing the specific enzyme, pathophysiologic pathway, knowing exact mechanism of action of drugs, etc. Not to say that the COMLEX does not want this material, they do, but the USMLE takes it a step further most of the time. This took a lot of practice to master, but I feel as though Uworld did a great job replicating test questions and prepared me well. Overall, I thought the USMLE was a much better exam. The questions were clear in what they were asking and most of the time there was a clear correct answer choice. Compared to the COMLEX the USMLE questions are written better, the test layout with 270 questions and breaks is much better than 400 questions with no little to no breaks, and the video media/exhibits is much more user friendly with USMLE.

COMLEX was a very random test it felt like many of the questions were out of left field and I felt as though I could’ve studied for 6 more months and gotten the same score. It is essential to know the OPP material like the back of your hand, the questions are difficult and unlike anyway they have been presented on COMBANK and in the first 2 years of studying.

My goal for these exams was 240/650, USMLE and COMLEX respectively. I beat one goal and fell a little short on the other, but at the end of the day I was happy with what I had accomplished and glad it was over.

If I could redo: The one regret I do have is that I should have completed at least one more COMLEX practice test(COMSAE), I completed the one given to us by our school in which I did very well on it one month out from test day. At that point I focused most of my studying on to getting better at the USMLE, when I did this I kind of let some COMLEX material slip through the wayside. In the week I had between USMLE and COMLEX I should have taken one more practice test. 

Bottom line: I personally would recommend taking the USMLE as it gives DO students more options for residency and with the ongoing merger it can only help in my opinion. However, it is important to pass and if you are not confident in yourself you can always cancel the exam.

WHATEVER YOU’RE GOALS ARE FOR BOARDS MAKE SURE TO TAKE A FEW HOURS EVERY WEEK TO ENJOY THINGS YOU LIKE TO DO. HAPPINESS GOES A LONG WAY IN KEEPING MOTIVATION TO COMPLETE THIS JOURNEY!

This is just my two sense and at the end of the day you may not agree with what I said on this at all, but if I helped out any or there is more content that you would like feel free to ask.

MY THIRD YEAR EXPERIENCE: PEDIATRICS

Today's blog will feature my experience in Pediatrics.

Length of Rotation: 4 weeks
Location: Pediatric/internal medicine outpatient clinic. Sometimes at the hospital for newborns.
Environment: 2 doctors, 2 nurse practitioners, 4-6 nurses. I worked with one doctor but if the other providers had children to see, I would work with them (because babieees). I saw from 5-8 pediatric patients a day.
Attire: business casual/professional. I wore blouses with dress capris and loved my comfy Payless Shoes everyday.
Types of Patients: newborns to 16 years of age. Well child and acute visits.
Schedule Type: Routine Monday-Friday from 8:30am to 5pm

Things that were expected of me:

• Take history and do physicals on well child visits. These were different from other rotations because certain ages have a "Bright Futures" form that has certain milestones, vaccinations, etc. that you need to complete. Also, most of history taking was done through the parent instead of the patient.
• Memorize developmental milestones and vaccination schedules
• How to calculate pediatric dosages for medications
• Write SOAP notes on the EHR
• Know the most common causes of ear infections, colds, rashes, abdominal pain, etc. and how to treat it

What it was like daily: 

• 8:15am: arrive to clinic and peek at the EHR for pediatric visits
• 8:30am to noon: see pediatric patients. 
• Lunch time! Thank goodness for drug reps that bring food during most days!
• 1 to 5pm: see more patients!
• I studied in between patients but when I got home I would watch one Online Med Ed video a day and do several Med U Cases.

What I learned: Babies are cute, especially the 4 month chubby ones! But in all seriousness, I learned that you really need to know your milestones and vaccination schedule. I was often pimped at certain visits on what vaccinations the patient needs and what milestones they should meet. There are a lot of well child visits in the first several years (newborn visit, 1 month visit, 2 month, 4 month, 6 month, 9 month, 1 year, etc.) and each have a different Bright Futures form. Also knowing dermatology was clutch because babies get lots of rashes and they all look the same to me (haha).

I also had a difficult time initially examining babies especially newborns because they seem so fragile! But my preceptor told me that you have to really grab their heads when inspecting their ears. They also have pretty stable heads but definitely ask how to hold babies if you are unsure!

Things I wish I could have done more of: I wish I interacted more with the nursing staff and patients. I felt I was very shy during this rotation but I think it would have been more enjoyable had I been more social. I also wish I took the opportunity to ask my preceptor more questions but overall this rotation is pretty straightforward in what was expected of me. 

Resources used for shelf exam:

• Online Med Ed videos
• Med U Cases
• COMBANK COMAT questions
• Case Files: Pediatrics
• This was by far my best COMAT!

MY THIRD YEAR EXPERIENCE: FAMILY MEDICINE

Hi guys! Long time no blog. I have a habit of neglecting my blog when things get stressful but now that I am on a lighter schedule, I've decided to write a series that was inspired by one follower's request. My school provides a guide on each required rotation but I still feel that I don't know what to expect when it comes to a rotation. How should I approach my preceptor? How is the style of asking history and physicals different on this rotation? What should I expect to do on this rotation?

Although everyone's experience will be different depending on location of rotation, preceptor, schedule, etc. I wanted to write a blog on my experiences in each of my rotations so that you guys can have a way to compare your experiences. If you have any tips, I'd love to add them to the blog. I found it really helpful to ask my peers what they did during their rotations so I could have an idea what to expect.

Today's blog will feature my experience in rural Family Medicine.

Length of Rotation: 8 weeks
Location: Rural West Virginia, 6 room clinic
Environment: 1-2 doctors, 2-4 nurses; 2-4 patients an hour
Attire: business casual/professional. I wore blouses with dress capri/pants and loved my comfy Payless Shoes everyday.
Types of Patients: Medicare/Medicare patients, adult wellness exams, minimal acute care, chronic issues
Schedule Type: Routine Monday-Friday from 8am-5pm with free weekends

Things that were expected:

• Taking full history and physicals of adults (rarely children)
• Completing wellness exams (asking about vaccinations, colonoscopies, mammograms, surgical history, medical history, medications, etc.)
• Write SOAP notes (subjective, objective, assessment, and plan) 

What it was like daily: 

• Show up to clinic 15 minutes before my preceptor to log into the EHR and look at the types of patients that day.
• On the first initial day of every rotation, I like to shadow the doc to get an idea of how they do their history and physicals. Every rotation differs in what you ask and what you perform.
• I would go into every patient room and depending on the chief complaint, I would do a history and physical. Many of my patients were wellness exams so many of my questions involved asking about vaccinations, colonoscopies, mammograms, etc. I ended up doing modified physicals according to my preceptor's preferences.
• I was fortunate enough to be able to write entire SOAP notes while in the room with the patient. This would continue until noon and then I would have lunch.
• Patients would resume until 5pm.
• I would be home by 6pm, eat dinner, and read/study for 1-2 hours a night.

Things I learned: I learned a lot about chronic issues like hypertension, diabetes, chronic pain, etc. This rotation was really good in the sense that it eases you from didactic years to clinical years. I used a lot of my mnemonics for history and physicals and I was able to have full conversations with patients. For me, everyday was very much the same, dealing with patients and their chronic issues and medications. Being in rural WV, I did not get much variability. I was able to draw some blood and give shots but it was not very procedure-heavy.

Things I wish I could have done more of:

• I wish I asked more questions to my preceptor and wish I asked the nurses to do more blood draws and vaccinations. Family medicine can be slower pace than other rotations so it is to your advantage to do any procedures that occur. 
• Read more and maybe take my shelf exam more seriously (it was hard to jump back into studying after boards)

Resources used for shelf exam:

• Med U cases (great for wellness exams)
• COMBANK COMAT questions 
• Case Files Family Medicine