Tag: level 1

Medical Boards: What to Expect the Day of

Okay.

You’ve finally studied your heart out.

You’ve accepted that you will never be ready to fully take this exam but you are going to anyways.

Exam day has finally arrived.

Boards and dedicated are stressful. Ask any medical student! But there are some things that can help calm you down or help you familiarize yourself with for test day. Whether that be step 1 or level 1, there are few things to keep in mind and a few things to be prepared for.

Step 1:

The test in total looks something like this:

  1. 15 minute beginning tutorial
  2. 7 blocks total of questions. Each block is 40 questions and you have a max of 1 hour per block.
  3. 45 minutes of break time for the day.

When you arrive to Prometric, step 1 usually requires a piece of paper for you to print and bring with you. There is an ID # that they will have you write on your sheet of scratch paper. You will need this ID # to log into the exam every single time you come back from a break. Don’t bother memorizing this #. It will be written there for you.

Uworld is set up very similarly to step 1. It has the running questions on the sidebar, the same blue bar up top and gray background. It has the forward and backward buttons, calculator button, and labs. It also has a timer (although if I remember correctly the timer is on the bottom of the real exam). There are a few extra buttons on Uworld that are not on Step 1, but if you are someone who is anxious about navigating the exam on test day, look at Uworld set up to get an idea.

Then you have the check-in (which is very similar to the MCAT). You sign your name, they wand you, they fingerprint you, they time stamp your in and out, take a photo of you, and ask to see your empty pockets, up your sleeves, etc. For mine, we eliminated the fingerprint and wanding because of COVID. We also didn’t sign in/out for every break, but we did sign in at the start and end of the exam. You will have a locker which you can access during your breaks.

So after going through check-in you are sat in your assigned seat. I brought foam earplugs because I had a feeling some nervous ticks of other test takers would be loud; and my goodness were there some loud and annoying ones.

You login with that ID # and click that you are you and blah blah and then you start at the home screen.

For step, you decide how many blocks you do at a time and when to take your breaks. If you finish early on any testing block, they recycle that time into your break time. After an hour passes for each block, you have to submit that block of questions and move on. You get no more time for that particular block.

So you can choose to do the 15 minute tutorial or have this time recycled into your break time. I chose to quickly go through it to see if there were any additional functions that I was unaware of that differed from Uworld. I ended up with about 10 minutes extra.

I’m really annoyed that there isn’t a good screenshot of how that main test screen looks. This would have saved me a lot of anxiety as I wasn’t sure how it was going to go. Below is my “attempt” at what I remember for how it looks.

Sample screen for Step 1

As the exam continues on, the timing will change. Again, if you do not use the full allotted time for each section it will recycle and add to your break time. Below is how I ended up taking my exam:

I used the rollover time to add to my break times so I could take more of a breather. It was a long day of testing and I needed the time to reset. Plus, I knew I had extra time so I wasn’t pressed to keep watching my phone for the time on my break. I could just enjoy my break, eat, look up something if I wanted to, stretch, or just enjoy the sunshine.

During your breaks (at least at my site) you were allowed to use the restroom, get into your locker, go outside the building, get in your car, etc. They had only asked us to not go near crowds of people. Most of us if we went outside either sat on the sidewalk right out front of the building or sat in our cars in the parking lot. Others just stayed in the building.

At the end of the day we signed our name out, got a print out that was notarized, and we were done!

Level 1:

Okay, the set up for this exam is a bit different. I tested at the same Prometric site a few days later, so the process of getting into the exam was the same, and the rules were basically the same about breaks. The only difference is there was no ID # to log into with and I didn’t need a printed out sheet of paper with me.

This exam has LESS freedom to decide how you want to test. The exam is longer and more rigid in the schedule compared to step 1. Here is the following break down:

  1. 10-15 minute tutorial
  2. 2 blocks of 50 questions
  3. 10 minute break
  4. 2 blocks of 50 questions
  5. 40 minute break
  6. 2 blocks of 50 questions
  7. 10 minute break
  8. 2 blocks of 50 questions
  9. Survey

The timing is set up into two 4 hour blocks. This means that you get a 4 hour block before lunch and a 4 hour block after lunch. Within that 4 hours, it is recommended that you try to complete each block within an hour. But unlike step 1, the clock doesn’t stop ticking. This means that you need to constantly be watching your time. At around 1 hour you should be hitting submit for your block and moving on to the next one. What this does mean, is if you finish a block early, it rolls into the next testing block (as long as it is within either the first or second 4 hour block). You do not get any extra break time however.

So that means let say the following happens:

block 11 hour
block 21 hour
block 350 minutes
block 470 minutes
End of first half of examno time rolls over after submitting block 4

Once you submit a block you cannot go back. If you take more than the allotted time for your 10 minute break, it will pull from your overall 4 hours of testing time (or whatever is left).

After lunch you repeat the same process. You need to watch your time and try to submit each block within an hour. If you finish quicker, again that time will roll over for other blocks, but not be added to any break time.

Truelearn is a very similar set up to the exam interface on the level 1. Again, there are a few less buttons, but overall the set up and how you work it is pretty much the same. It looks the same as well.

Hope that was helpful! Cheers.

Medical Boards: Prep

Hello Everyone!

Long time no see. Or long time no text? Anywho, I have finally finished my USMLE Step 1 and COMLEX level 1 boards! WOO!

Since the majority of what students online look up includes a study schedule, materials, and prep in general, I will lay out what I did. I am NOT claiming to have done amazingly well on either of these exams (at the time of writing I just recently finished) but I do believe I passed (later insert: I passed both). Majority of you will receive average scores and that is TOTALLY NORMAL. Some of you will be all gunners and shit and get that high score; good for you! But for most of you, you will be aiming to pass and hopefully get at least average.

Time Allotted: Dedicated

I started 6.5 weeks out from my exam. I however, am not like most students and cannot sit and study for 12 hours a day. I’d be happy if I could get a solid 4-5 hours in a day which is why I started a bit earlier. That way, I had time to add in breaks, have enough time to play catch up, change my study habits, and make sure I could get through a reasonable amount of material. Most students who can study for about 10-12 hours a day can do well in a 4 week block of dedicated. If you are aiming for an incredibly high score, you need to do a considerable amount of studying more to get those really rare nitpicky questions/experimental questions. Or just be even smarter than the average medical student (who is already hella smart).

Some days I could study longer; this left me unable to do very much studying the next day. Some days I barely studied, if at all. And that’s okay too. Each person will need to decide how they study, how they do under stress, and how much time they need to recover in order to hit the books hard everyday for several weeks.

Materials:

The following is what I used:

  • Boards and Beyond. I did the videos for several sections. It is VERY IN-DEPTH. Hell, I learned more about the subject than I ever did in my actual courses. It is great for physiology for sure, and does a really great job of presenting information. I started with this before I realized I was hitting a wall and switched my study habits. It also has like 2000 questions or something crazy like that.
  • First Aid. Your Bible for studying. It is a review book and you should NOT MEMORIZE IT. You should understand the concepts given. A chunk of it you will already know/be familiar with, so you won’t need to use an outside source. If you don’t understand it, take the time to learn it. If you learned the material well the first go around, you’ll have an easier time reviewing it. I reviewed it in essence about twice before my exam (give or take a few sections). Once more in-depth, and once as a quick review.
  • SKETCHY. Holy hell yes. Learn these. There was a fair amount of it on my step 1, although in general I thought step did a good job of evenly picking between all topics. There was a shit ton of micro my year on my comlex. If you use sketchy, make sure you use the Pepper Anki deck or the book or whatever it is you want to use associated with it so you can lock it in your brain. Just watching the sketch will not be as helpful. You need to be able to see multiple passes so you can use the memory aids to help you on test day.
  • ANKI. I used some decks, but not all. I actually used a couple of the ZANKI decks to study for my courses, so the material for this information came back really quick. If you are a flash card person, this is the entire first aid book in flash card form. If this works for you, go for it. I used it here and there to help me. This is the site link for Zanki decks that follow First Aid: https://www.medschoolanki.com
  • SAVARESE. For OMT. Highly recommended by my osteopathic professors to study for boards. It again, is a review book. But does have review questions at the end of each chapter. Your school (at least for KCU) may have taught subjects slightly differently than the book; so if you need to review your osteopathic notes based on the topic you are reviewing in Savarese, do so.
  • Truelearn and Uworld questions. Yes. You need to do practice questions. Doesn’t matter what you use, but you need to test yourself and do a large amount. I did a little under 2000 combined before my exams. Truelearn is for comlex, Uworld is more for step. There are other level 1 banks that are more similar to comlex questions (COMQUEST, COMSE), but you need to pay for these. In general, KCU provided Truelearn access for free at the start of second year.

There are several other video programs you can use (i.e. DIT, Kaplan, etc.) if you are a video oriented person. I’ve heard of other students using DIT with good success as it also includes OMT.

There are also several other question banks you can use like AMBOSS (which was another very popular question bank to use among classmates). You will find several other options; make sure you don’t overpay for several services and overwhelm yourself when picking study materials to assist you in learning. You want to use what will be useful to you.

Study Schedule:

Well, I tried to make a schedule. I did. But I am terrible at putting too much on my plate and then feeling like shit when I don’t complete it. Or thinking I can finish something in a “reasonable” amount of time and realize my brain needs more breaks in between. Oh, and did I mention my anxiety? That got in the way a lot too. I’m an anxious avoider, so avoiding is my game. And I am number 1 at that.

Here is the link for my “study” schedule. I did not break it down by time in the day like most students. I picked an amount of material that I wanted to do that day and would try to achieve. A lot of days I put too much on my plate and ended up taking several more days to finish. Around week 3/4 I switched up my study plan of action.

My drive study schedule: https://docs.google.com/spreadsheets/d/1jQvuDTzWYgE_eNqYGpX542JmrHDRb1Bw4oCxWYJr1Ew/edit?usp=sharing

I started with Boards & Beyond. I completed either all or most of the following videos & questions with B&B:

  • Hematology
  • MSK
  • Skin
  • psych
  • renal
  • neuro
  • repro

Then after hitting a wall I decided to switch to reading First Aid and if I needed more clarification/teaching I would watch a B&B video to help. These are the following subjects I read in FA:

  • Cardio
  • Pulm
  • GI
  • Endo
  • Public Health/epi

I punted biochemistry and most of immunology. I had immunology in my master’s program and honestly the physician who taught it did such a great job that I didn’t really need to review it much. I learned what I needed to for medical school immunology but overall, didn’t review much.

I used Uworld and Truelearn questions in addition to B&B questions. I did not learn very many drugs…. but I watched what I did in B&B and tried to learn some of the other drugs in FA. However I did not commit very many to memory. Oops!

And then Sketchy for micro and Savarese for OMT.

I did 1867 questions before Step 1 and 2137 before Level 1.

Picking a Date:

I originally scheduled my exams for July 6th and 10th. Initially we were required to finish our comlex level 1 by July 17th by our school. We were not given a time to complete step 1 as this was optional for us. It was recommended to me that if I take both exams, to do step 1 first and level 1 second. That way, you don’t spend time studying for OMT before step, and only use the time between exams to study for OMT. Makes sense right? Make sure to not schedule level 1 too much later than your step so you still have all the information you studied in your noggin (and don’t have to restudy).

I took my exams during COVID-19. Many student exams were cancelled several times during a period of several months; a lot of times without being notified. It was very nerve-racking not knowing if you were going to be cancelled or not. And if you were cancelled, trying to get another seat or get a seat near where you lived/where your rotation site was. Due to this, our time to take the exam was extended until December 2020. Seems fair; except we start rotations August 1st, and were not given any additional time off to study for an exam if you were scheduled after starting at your rotation site. I feel for my fellow classmates who this happened too.

I was damn lucking enough to not be cancelled for either of my original test dates. Hopefully by the time ya’ll take your exams, you aren’t dealing with a pandemic!

When you do schedule your exams, DO NOT CHANGE YOUR DATES. It will cost you additional money. Not to mention, you will never be ready. I promise. You will push your test back till the cows come home and still not be ready. Pick a date and commit. Unless you have a valid reason to reschedule, just don’t. If you are nervous, make sure you are properly taking care of your mental health. (See managing your anxiety/depression below).

Taking Both Exams: How do I decide?

As an MD student you only take USMLE step 1. You wouldn’t be able to take COMLEX level 1 because you never learned osteopathic manipulation during your first two years. And because MD was much more widely accepted for a longer period of time than DO, a lot of residency sites know the step 1 scores they are looking for in their applicants.

DO students have to take COMLEX level 1 to get their degrees. Which is kinda bull crap because it is a longer and harder test (in my opinion). Step 1 currently is 8 hours, with 7 blocks of 40 questions or 280 questions total and 45 minutes of break time. So essentially an 8 hour test day. Level 1 is currently 9 hours, with 8 blocks of 50 questions or 400 questions total and 60 minutes of break time. Or about a 9 hour exam.

Historically, DO students looking for competitive residencies would take both exams; as most residencies who weren’t DO specific were usually unsure of the comlex scoring system and required step anyway. Or it was the case of wanting to sub specialize in an MD prominent field. So in order to just bypass the hassle of this, a fair amount of students take both. DO students are not required to take both though.

In the future, they will be merging the exams for both MD and DO students. Not sure when this will occur or how it will pan out. When this happens, there will be one exam for everyone (and likely an optional OMT section for DO students). Which makes sense seeing as they merged residencies already.

Managing your Anxiety/Depression:

Although a lot of you may not want to address this, you need to.

Boards is incredibly anxiety inducing and it is very common for students who are already burned out after their first 2 years of medical school to have a spike in anxiety, depression, and mental breakdowns. Because of this, it is common (but not always talked about) to be placed on a brief stint of antidepressants to help control this.

If you feel your mental wellbeing is becoming compromised, take care of yourself and seek help. SSRI’s/SNRI’s take 4-6 weeks to kick in. Make sure you give yourself ample amount of time to get used to the medication as well (as you may have some starting side effects like me) and for the drug to take effect. If this means seeking out assistance/guidance/medical help before your dedicated period then do it. If it means doing it at some point during your first two years because medical school is hella stressful, then do it.

I’m not judging you. And neither should anyone else. If they are, then they shouldn’t be going into medicine at all. It says more about their character than yours.

Additionally, make sure you schedule breaks, downtime, and self-care time. The longer you get into your dedicated period, the more you will need to break and care for yourself. I initially scheduled Sundays as my break day and then would freak out because I couldn’t get through what I wanted during the week. So for the first 3 weeks I skipped my break day.

That went terrible. Don’t do what I did.

Once I fully committed to taking a day off to just do nothing, clean, run my errands, etc, I was SO MUCH MORE PRODUCTIVE when I hit the books the next day.

And while you are at it, do not neglect your daily needs. Showering, eating, grocery shopping, taking care of your pets, or even working out. Make sure you are still doing it. If you need to use part of your day off to go grocery shopping/meal prep, or run other errands, then do this on that day as well. You will still have plenty of time to get your chores in and schedule some extra self love!

Well everyone, I think that is all for this post. Stay tuned for more boards content. Cheers!