Tag: USMLE

back into focus 

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as i shared in my last post, i’d unknowingly hit ‘pause’ on my life and my dreams these past couple years once a measly little exam seemingly took over my life but i’m back now reclaiming my time and my joy.

in that process i’ve made a few pretty big decisions about my future and just wanted to share with you all. thank you for your company on this journey. i used to constantly be in awe – and still am – of folks in the arts or humanities or really anything that didn’t have a set multistep plan for their careers. i used to find so much comfort in being a traditional applicant to medical school – straight out of college, no decisions to make about what to do with years off, etc. but the older i get the more i realize that no one’s life path goes in a linear fashion. we all face expected and unexpected challenges and have to roll with the punches. here’s how i’m choosing to roll with mine:

i’m going to be a psychiatrist when i grow up! i’m guessing that this does not come as a surprise to most of you. pretty sure most people knew this was where i was destined to be before i was able to fully embrace it myself. there were many things that fueled my uncertainty but most of them boiled down to giving too many effs about what other people think.once i set all that aside – worrying about ‘hanging up my stethoscope’ and not being considered a ‘real doctor’ (what does this even mean?? i’m in medical school, which contrary to the belief of people who continue to ask me if i’m going to be a nurse when i tell them that, i’m going to be a doctor!!), stigma against mental illness and providers in communities at large and within my family of origin, folks assuming that i’m only going into it to have a good lifestyle (anyone who knows me this is probably at the bottom of the list of reasons – and anyway what’s wrong with wanting balance in my life??) – i realized that by caring about what others thought i was simply holding my own happiness and passion hostage.

i came into medicine because of my passions for social justice and mental health and i can think of no better way to execute my dreams than by being a psychiatrist. i love getting to know my patients. i’m good at it.

of course i still have concerns – am i risking my own mental health? will my empath self be able to hold down the boundaries necessary to function in my own life without absorbing the struggles of others? will i regret missing the opportunity to be the patient’s first line and home base as their primary care doctor?

but there’s an underlying peace that i’ve found from leaning into this. into what feels right for me and what’s brought joy in some of the darkest days these past few years. into what i’ve always envisioned for my life.

i’m moving to NYC! i’ll be at columbia this upcoming year obtaining my MPH. my struggles with USMLE greatly robbed me of my passion for medicine. it often left no time or energy to explore my activism and advocacy. getting an MPH was always a part of my life plan but it’s something i’ve decided to pursue now (rather than later) in an effort to rekindle the flame and remind myself of my goals for my life, beyond passing an exam. i still have no idea where i’ll be living or how i’m going to balance moving several times this summer while taking shelf exams and OSCEs and step two. but for the first time in a long time, i’m truly excited about the future and it feels so damn good.

i only have a few more weeks of core rotations remaining in third year and i’m so happy and proud that i chose to advocate for myself to start rotations before retaking step one. i’m not exaggerating when i say that decision probably saved my life. in the past year i’ve learned so much about myself and the physician i aspire to be. i’m so excited to continue to move forward in my career and this life i’m building. grateful for your company through it all.

these are my confessions

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Anyone else’s mind jump straight to the Usher track whenever they hear the word confession? No, just me? That’s cool. I’ve come to terms with my embarrassing and unwavering love for Usher during my junior high years. It’s fine.

But on the real – I thought it was time for a life update since it’s been a minute. I started sharing my journey through medicine, and life in general, on here and Instagram because I wanted people to feel less alone in their struggles. In this age of social media, it’s easy to fall into the mentality that everyone has their life together except you. But that’s obviously not the case – we just choose to present our best selves to the world. And on the surface there isn’t anything wrong with that as long as we can remember that there is so much else going on that is not being shared. But in the past couple months, since finding out I failed step one again, I’ve started to feel like I’m folding into myself and only presenting the highlights of my life. And while I don’t owe anything to strangers on the internet, I feel it’s important for me that I continue to present myself honestly.

Since December I’ve hit one of the most severe bouts of depression I’ve had in my life. I’m pretty sure I’ve struggled with both depression and anxiety for most of my life but wasn’t clinically diagnosed until starting medical school. Stress has always been a huge trigger for me and obviously failure, and step one in general, is stressful. Having been through similar, but less severe, episodes in the past I tackled my depression head on with the things that have usually helped me. I continued taking my medications, working with my therapist, etc. I put away my books and I traveled. I spent time with loved ones and my kitten. And I convinced myself that I was feeling better and dove back into studying as the new year began in January.

But I wasn’t okay. I was struggling badly. I couldn’t focus. I was irritable. I had so much trouble sleeping. I was nauseous all the time. I hand anxiety attacks weekly that were almost as bad as the ones that initially drove me to seek help. So I sought council from those I trust and one of the deans at the SOM recommended that I get tested for learning disabilities in case that there was something making it harder for me to succeed and adding to my stress. I realized that it was important for me to set my ego and internalized stigma towards disabilities aside and truly find out if there were accommodations out there that would help me with both my studying and in my exam taking. It took months before I was able to find someone who accepted my insurance and saw adult patients but I finally got an appointment about a month and a half out. Those of you becoming psychologists, thank you, you are so needed.

Around this time, 45 also started his presidency in the United States. I think it’s pretty clear from my previous posts where I stand politically. The US has always had a dark history when it comes to marginalized peoples but something about the blatant disregard/outright support of the xenophobic rhetoric during the elections made the inauguration sting so much more than I had anticipated. Every executive order and tweet and confirmation has truly felt like a personal assault. It’s taken weeks for me to be okay with the fact that my resistance, at this moment in my life, is almost always in pursuit of my career. I will continue to do my best to be aware. To understand the struggles of those who look and live differently than I. To educate and have the difficult conversations. To organize. To put my body on the line as often as possible when my sisters’ and brothers’ human rights are at risk. But for the most part – my resistance is hours and hours of studying to pass an exam so that I may advocate and care for my patients. And for now, that has to be enough.

Meanwhile, I did my best to continue studying. I searched online for tutoring programs for medical students that worked through video chat. I wasn’t ready to pick my whole life up and move to another state again, as I did when attending Wolfpacc in the summer. It was clear that I had made the most progress in my studying in the months after I had returned home and worked hard on my own. I’m certain that the most helpful aspect of being at Wolfpacc was being in a supportive environment surrounded by people who truly understood the struggle but I did also miss the tutors and the structure they provided. I also missed having someone to run my study schedule by to ensure that I was as effective as I could be in my studying. I missed doing questions with a tutor and running through my thought process with them so that I could identify holes in my knowledge. And that’s when I stumbled across Med School Tutors and was immediately intrigued. I had the opportunity to do one-on-one tutoring from home with someone who would also help me create a schedule that worked for me. It sounded perfect!

Now, I don’t think that this is something that necessarily everyone studying for USMLE needs. But having been at this for so long, I knew I needed more encouragement and reassurance this time around and I’ve found exactly that in working with a tutor through MST. Their entire team has been so incredibly supportive of my goals. The thing that I love most about MST is that they share my values. When I opened up to them about how much I had been struggling, they immediately reassured me that taking care of my health, both physical and mental, is the priority. They helped me rearrange my tutoring schedule at no additional cost to work best for my needs. Having a group of people who’ve essentially been cheering me on through the struggle of doing this for a third time has been such a blessing. If you do decide to check out MST, please cite me as your referral. This post isn’t at all sponsored by Med School Tutors but I do want to disclose that I will get a free hour of tutoring if you decide to work with them.

While struggling through all this I started falling victim to some really serious negative self talk and began to struggle with so many of the things I often warn you all about: feeling shame in the face of failure, constantly comparing myself to others, etc. and it started to take a serious toll. Part of the ugliness of depression is that it’s hard to separate when your thoughts are due to the illness versus when you’re actually right in your introspection and reflection. It’s taken me some time to be able to separate those two things and journaling daily has really helped me with that. I’ve been drowning myself in self care & self love and really doing my best to replace the negative self talk with positive affirmations.

I’ve taken the last couple weeks off from studying and really focused on getting back to feeling like myself. In my appointments with the neuropsychologist, we ruled out any learning disabilities but in talking to him about everything I’ve been through and am going through the past couple years, I realized that my depression and anxiety haven’t been managed as aggressively as they should’ve been. My primary care physician had been treating me until now and she isn’t the greatest when it comes to mental illness. (Another reason why I continually come back to a career in family medicine. We so badly need primary physicians who can provide holistic care. Shout out to all my future FM docs! I’ve got so much love for y’all). While talking to a close friend about this, she asked me why I hadn’t sought care from a psychiatrist over the past couple years that I had been dealing with my undertreated depression and anxiety. And I had no real answer. I later realized that it was because I, someone who constantly advocates against mental illness not being a true disease, had been downplaying my own mental illness for years. I hadn’t sought care from a psychiatrist, knowing that my PCP wasn’t doing a great job treating me, because I didn’t think it was that bad. I expected myself to pick myself up and just brush it off. I didn’t want to be someone who had a psychiatrist, and thus, label myself crazy. Why is it so much easier to show others compassion than ourselves? If I’d sought treatment for my mental illness as I’d encourage my patients and loved ones to do, the past couple years would have been so much easier.

So in the past few weeks I’ve talked to therapists and psychologists and psychiatrists and finally feel like I’m getting the care that I need. And while I’m still not feeling 100% like myself again, I’m finally caring for myself as I’d want my patients to care for themselves. I’ve spent a lot of time protecting my heart from those who try to dismiss my experience when I share my struggles and recognizing how strong I’ve been for so many years. I’m spending the rest of this week doing things that truly bring me joy, surrounding myself with the incredible people who have held me up in these difficult times often without even knowing it and simply finding gratitude in the little things.

I found out last week that the NBME accepted my appeal to expunge my score from my second attempt – you can read about my test day experience here. That news really helped restore my faith in ‘the system’ because I’ve recently been feeling like I’ve dedicated so much of my life to a field that doesn’t truly care about its people. I also found out that I was accepted to WISE’s Muslim Women’s Summit later this year, which will help me become a more effective activist and advocate. I’m still figuring out the details of my trip to the east coast but give me a shout if you’ll also be at the conference!

I know that I have what it takes to pass this exam and have an extraordinary career in medicine. But I’m still learning and unlearning what it takes to truly care for myself and be my best self. Thank you for your company on this journey.

study tips: practice questions

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I’m currently studying to retake USMLE step one and while I’m disappointed that I wasn’t able to pass this exam the first time around, I’m definitely grateful for the opportunity to hone my test taking skills and learn how to be a better physician with the wonderful people at Wolfpacc.

One of my biggest problems while taking multiple choice exams is being ‘seduced’ by some of the other answer choices so I’ve always felt that my exam results don’t always show how much I know about a topic. In undergrad, and now in med school, I’ve always performed better on free response questions because I have the chance to display what I know about a topic. In the past, I’ve tried to answer multiple choice questions as if they were free response (not looking at the answer choices) but I finally feel like I have a strategy I can use for the many tests I will be taking over the years.

People’s test anxiety presents in different ways. For some, the days leading up to the test they’re unable to sleep properly. During the exam they’re tachycardic and cannot focus long enough to get through a question. My problem, and maybe this isn’t even test anxiety, is never truly feeling sure of my answers and doubting myself easily. I’ve gotten into the habit of never changing my answer unless I’m 200% sure that the second option is correct. But often, even when I’m just thinking about what the answer can be, I question my instincts to the point that I don’t actually know which one feels more right to me.

Since arriving at Wolfpacc, I’ve changed my study strategy so that I’m forced to answer every MCQ question as if it is a fill in the blank and I don’t fall prey to any of the other appealing answer choices. Below I’ve shared the steps I’ve been implementing this past week for UWorld questions and aim to use for all MCQ tests I take in the future:

  1. Cover your answer choices. Don’t just say ‘I’m not going to look at them’ because you will. Use a sheet of paper or something to physically block you from seeing the answers.
  2. Read the last sentence of the vignette and summarize it. Most of the time there is a lot of excess information in the paragraph above. If you read the question before reading the paragraph, it’ll be easier to identify what information is actually relevant. So take the time to really understand and simplify the question.
  3. Talk to your patient and find hints. One of the professors here has encouraged us to think of the vignette as your patient. Some of the information they tell you will be very relevant to answering the question and the rest may be useless. You have to learn to distinguish between the two. As you do more and more practice questions, you’ll pick on some patterns.
  4. Answer the question yourself. Before you’ve uncovered the answer choices, write down what you believe the answer is. Sometimes you’ll remember some details about it but won’t remember the exact answer but you should write down whatever your answer would be if this was a free response question.
  5. Uncover the answer and pick whichever one matches what you wrote down. Even if one of the other answer choices starts to look more appealing, you still need to choose the one that matches what you wrote as your own answer. This is important for when you’re going over your question set afterwards and I’ll explain why later in this post.
  6. Move on. Don’t overthink the question or your answer. Sometimes you won’t really know why you think something is the answer but you need to trust your gut.

Because I’ve just started using this new strategy, I’m doing my questions in un-timed mode and actually writing down my thought process for each question so that I can get used to it. My paper looks like the following for each question:

  • Q: the question restated here in my own words
  • Pt: information from the vignette that is applicable to answering the question being asked – keep this short (5-6 words max)
  • A: my own answer to the question, without having looked at any of the answer choices.

Now, when you’re doing practice questions you have to remember that reviewing the entire test, including the questions you got correct, is just as important as answering the questions. This is when you correct both your technique and any holes you have in your knowledge.

For answers you get correct, make sure that the answer you wrote down matches exactly the answer choice selected. If it does, just move on – you don’t need to read the explanation or anything else from that question stem because you had the correct thought process and arrived at the right answer.

If you get an answer correct but your written answer doesn’t match the answer given in the options exactly but is generally related, you have a small hole in your knowledge and need to read the summary sentence at the end and add that to your written answer in your notes. If that still does not clarify the connection you missed, you should review more of the explanation.

If you get an answer incorrect, you repeat the same process as above but read the entirety of the explanation because this is a clear hole in your knowledge. The reason I’m recommending that you choose the answer that best matches the answer you’ve written, instead of choosing the ‘more right’ answer, is because it will be easier to correct that hole in your knowledge. If you change your answer and get it right, you’re less likely to take the reviewing process as seriously because you got it right but it’s still a hole in your knowledge. On the real exam, if you’re 200% sure that the other answer is correct and the one you came up with on your own isn’t, of course you should pick the right one. But when you’re doing practice questions, you’re still learning and you learn the most from questions that you get wrong.

Also, I usually use a different color pen to add my notes for questions I get correct (usually blue) and questions I get incorrect (usually red). If I’m ever reviewing this notebook, I usually focus on the notes I’ve written in red since those indicate the biggest holes in my knowledge.

Don’t get hung up on how many you get right or wrong. Focus on improving your technique and finding the holes in your knowledge. As you get more comfortable with the new technique, you should not have to write out as much and start doing the question sets in timed mode. And, of course, this technique may not work for everyone. It’s just something that I’ve been trying and feel more comfortable with. Happy studying!

r & r in redlands 

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The past few months, pretty much since 2016 started, have been nonstop studying – exam after exam. And it also felt like the stakes were getting higher and higher as time went on. Now, I’m in independent study time for USMLE step one and the pressure is on. This exam is known to be the most difficult of many licensing exams and also plays a huge factor in what and where you’ll practice medicine.

I’ve always prided myself in understanding that test scores do not define me or my ability to be a good physician. When struggling with the MCAT, I knew that somehow things would still work out because this was my calling. But the step one boogie monster got to me and I started doing all the wrong things: not taking breaks, staying up too late to finish my study ‘to-do’ list, focusing on quantity instead of quality, comparing myself to others and making this test my life.

Earlier this week, I performed pretty terribly on a practice exam and after crying & wallowing and talking to one of my best friends, I realized that I was essentially setting myself up for failure. So I decided to take a couple days off and remind myself of the life I live outside of this exam. I went to a neighboring city and just explored. I dusted off my DSLR and just roamed around eating great food, shopping at local stores, hung out at a local coffee house and drank delicious coffee while reading and journaling.

Going to be back at it tomorrow, while fasting for Ramadan (which I’m nervous about but also excited that I’ll be taking this exam in such a blessed time). I’ll have even less ‘chill’ time between starting third year and taking this exam but pushing it back was just so necessary for my own well being. I’m committing myself to doing my best on this; I won’t sell myself short but I’m also not going to look at what others are doing (especially if they’re vacationing while I sit here stressin’ out).

This is my journey. It’s had a lot of twists and turns and loop-de-loops but I wouldn’t trade it for anything. I’m going to be caring for actual people one day very soon and I can’t wait. But this is just something I have to get through until then. Thank you all for accompanying me on this journey – you all push me to constantly renew my intentions and better myself.


med sisters series: Ele, OMS2

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The Med Sisters Series is a series of interviews of women in various stages of their careers in medicine: pre-med, medical school, residency, fellowship and attending physicians. As women, I believe we face unique challenges within any field, medicine included. As I’ve moved along on this journey, I truly believe one of the biggest support systems we have is each other. Society works so hard to pit women against each other in every situation you can think of but, as feminists, I think it’s so important to combat that urge to try to ‘beat each other out.’ There’s room for all of us on the other side of the glass ceiling. The goal of this series is to shed light on the challenges women face in the field of medicine and how they achieve a work-life balance that works for them. This blog has always been a place for me to share the realities of this journey, both the highs and lows. I thought of this series as a way to share the perspectives of the other extraordinary women on this journey too.

Eleanora is a second year medical student in Philidelphia. You can follow along on her journey at her Instagram and blog.

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step one plan

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In order to become a practicing physician, in addition to attending medical school, we also have to take national licensing exams (USMLEs or ‘boards’). The first of these exams is known colloquially as ‘step one’ and is supposed to be the most difficult of them all. At most U.S. medical schools, students take the exam after they finish their first two years of med school. Most schools have a 6-8 week period after classes end in the second year that are designated specifically for studying for the exam. Some students take it earlier in the period and use the rest of time for vacation and others take it right before third year begins so they have more time to study.

As I’ve discussed in previous posts, it takes me a reaaaaally long time to understand and memorize material so I have to be really careful about my study schedules and make sure I review throughout each block in addition to learning new material. So when it comes to studying for step one, I know that I need to start early. Below I’ve included the resources I’ll be using over the next few months during second year and before the designated step one studying period starts. This, of course, is just what I think will work best for me. Many students wait until January to even think about the boards or don’t even study until the designated studying period starts. But I think it’s important to recognize your strengths and weaknesses and create a plan that’ll work best for you.

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