Pre-Med Series: MCAT & Planning

The MCAT!

The most dreaded part of our medical school application that we need to check off.

The sleepless nights. The anxiety. The torture of relearning all of the basic sciences again. The ‘I”m only good enough if my score is high enough’ crap line of thinking.

The thing that apparently will tell us how we will do in medical school, but usually has no bearing on any actual medical application.   

Make that MCAT your bitch. 

If you can keep this attitude, and not allow your anxiety to take over, you should hopefully overcome the test anxiety that the MCAT brings and automatically do better.

This is likely going to be a long post guys, sorry (but really I’m not that sorry).

How To Sign Up for the MCAT

First things first, you need to set a date. The MCAT isn’t cheap, but setting the date ahead of time should hopefully be slightly cheaper, and allow you to start planning ahead how much time you are going to allot for studying. You also want to make sure that if you are going to spend the money on the MCAT, you don’t end up taking it and losing out on that money.

Step 1: Go to this website: https://www.aamc.org

Step 2:  Click on the MCAT link under pre-med students (shown below).

Step 3: There should be a large orange-ish/pink button on the right that says “Register For the MCAT Exam”

Step 4: You will have to make a username & password to sign up and eventually check your scores.

**make sure you remember what this information is so you can retrieve your score!

Step 5: Follow the steps/fill out the required info and pick a date.

Make sure your address on your application MATCHES the ID you are using. YOU MUST use a government ID, such as your license or passport. You cannot use your school ID. 

When you are close enough to your exam time, they will not allow you to change any of your information. Thus, make sure everything is correct and your address matches. If you show up and anything is different, you will not be taking the test.

Breakdown:

There are 4 sections.

  • Biological and Biochemical Foundations of Living Systems
  • Chemical and Physical Foundations of Biological Systems
  • Psychological, Social, and Biological Foundations of Behavior
  • Critical Analysis and Reasoning Skills (CARS)
Graphic courtesy of Next Step Test Prep

Scores in each section can range from 118 to 132. The overall average is 500, while the highest you can get is a 528.

Competitively, as long as you are above a 500 (usually in the 505 range and above) you are doing fairly well. If you are aiming for a top 10 medical school, then you obviously need to have a much higher score. If you are aiming for a second, third, or even fourth tier school, you do not need as high of a score, provided the remainder of your application is well rounded.

They put the harder sections first to wear you down. So your chemistry/physics section is the first right off the bat, then CARS, then you get into biology and finally the psych/social section. This is in hopes that you will not perform as well in the biology or psych/social section as most students inherently do better in these. (I know, not fair).

Planning and Studying:

Depending on your time and how much information you need to relearn, or how well you wish to do, will ultimately determine how intense your study schedule is. Generally 3 months is pretty adequate. You can accomplish this usually in one summer if you a diligent enough and treat studying like a full time job. Extremely prepared would be taking 5 months to prep and study.

Or you can be like my boyfriend and try to squeeze it all in in 3 weeks because we learned half of it the first semester of our master’s course… (Don’t do this. Really. I strongly advise against this awfulness).

I’m not going to provide a study schedule here. Why you ask? Well one I took it too many times and that was the weakest part of my medical application. I’m amazed I got in with my shitty score. And two, I don’t remember my study schedule. I took it back at the beginning of 2017 and blocked that part of my life out from my memory (which happens to be the last time I took it). There are plenty of overly ambitious study schedules online for you to look at (and likely feel inferior to) if you need to see examples. I just tried to get through 2-3 lessons a day and that was a struggle in and of itself for me.

What I do suggest is plan out your schedule. Try to push yourself so you can get a fair amount done, but don’t overload yourself each day. You will fall behind. I repeat: you will fall behind on your schedule. Once your brain starts to fatigue and be unhappy with you for this constant studying, you will start to not stick as well to your schedule. But try your hardest to stick to it. If you need to make revisions, make revisions so you can still feel accomplished without feeling crappy that you couldn’t get through everything as planned that day.

It’s also a good idea to do a practice test before you start, so you can see where you are at when you mind is healthy and unstressed. It’s a good baseline to see where you need to focus your studies on. You will also need to sprinkle in practice sets to start learning how questions are asked, and eventually start practicing full length tests to prepare yourself for the grueling day of taking the test itself.

Taking the MCAT is a game and you have to be in the right mindset. Sure, you need to know the material, but you mostly need to understand how they ask questions (which is very different from majority of the tests/questions you’ve encountered before) and to train your mind for the marathon of test day. Mental fatigue is a real thing with this test.

What I Experienced from Taking the Test:

The new MCAT (which has been around since 2015 I believe) has more of a mix of subjects in each section than it did previously. This means you can see organic chemistry in more than one section. They also pulled in biochem (which was not previously a topic you had to study), which can also be sprinkled into many passages in different sections.

My test didn’t have as much organic chemistry in it as my boyfriend’s did, but there is a shit ton of biochemistry on mine and in his. So KNOW YOUR AMINO ACIDS. They like to state the amino acid one way in the passage (i.e. in full name, the 3 letter version, or the 1 letter version) and then ask you to answer the question in a different form. (Those bastards!). Knowing these will also help you answer what the overall charge of a protein is (they do have some of these questions) or if a certain amino acid will fit based off charge alone.

In general, whether you do a class or self study, following the set of books will usually cover all of the topics they will likely hit on in one way or another. Whether it be an entire passage based on it or just a stand alone question. They also like to lump multiple different topics into one passage (this is to confuse you) and then ask a question that feels like it has absolutely no bearing from the passage given. I used the books in their entirety to study, but my boyfriend only used the books to learn topics he was unfamiliar with.

Tip: For areas where you need to learn equations, I suggest you make one notecard with all of the equations related to that topic (i.e. all the kinematics equations). This way you can see how they are interchangeably related or how they can slightly change one on the test that you may see in the passage. Your brain will also make the connections easier if it is all there together.

Tip: You will also have several answers using equations where you do not necessarily need to know the exact correct answer. You should be able to narrow down the inappropriate answers given based off of positive/negative answer and orders of magnitude. This way you can narrow down your answers and give a better guess if you cannot for the life of you figure it out.

Tip: For organic chemistry, they like to test lab apparatus a lot. So make sure you at least understand how certain lab procedures work. They may also test reaction equations, but honestly learning every single reaction is a waste of time. Knowing the general/overall picture can help you as long as you understand why it would act the way it would act, instead of memorizing each specific step in all of the (many many) reactions in organic chemistry.

Tip: Don’t discount the psych section. I realize you may think it is easy, but they can get pretty specific on this test, so make sure you at least take practice questions and go over the material. No point is screwing yourself over in a section that you could get a great score in!

Tip: For CARS, this is hard to study for. The only way to improve your score is by just taking passages. You will be given topics on a range of different things such as humanities to different disciplines of science. They are complex arguments/articles that you will be asked complex questions on. You will be asked questions on being able to get into the author’s head and answer for them. Most of the questions asked DO NOT ask for information directly in the passage. Psh, that’s too easy. They ask you shit on what would the author say? Or what statement would the author not agree with? You know, stuff that you can refer back to the passage on.

What was Helpful for Practice Tests:

  • Use the AAMC question blocks that they have. You can manipulate it to time yourself/show the answers/etc. They are going to be the closest thing to wording that you will find on the day of the test.
  • If they finally have practice tests up on the AAMC, use those to take some of your practice tests with. They were not available when I took the MCAT, but they should be now that it is a few years later since changing it.
  • Only purchase what you are going to use. So if that means only purchasing one question book/set at a time, do it. Don’t blow all your money on shit you won’t use like I did.
  • My boyfriend found Gold Standard to be a great resource for practice tests as well. He did however find the physics section to not be up to par on their practice tests.
  • I mostly used the Kaplan tests that came with my Kaplan books. Both Exam Krackers and Kaplan tend to be highly specific based off what you learn in the book, but these are designed to help you with content and help you get in the mindset of taking the test, less for wording. So again for wording, I suggest you use the AAMC tests.

What helped the most: practice, practice, practice. Getting on a schedule (some people get up early and study during the time it would take them to take their test in order to get their brain and body ready for test day). But make sure you are studying consistently so your body/brain can adhere better, and get a good night’s sleep. You will need to allow yourself some time to take care of things like grocery shopping, some social time, and other errands.

Confidence: Your mental health and confidence needs to be at a good place before you take this test. This is something I struggled hard on. I was not in a great mental space for many of the times I took the MCAT and only did better when I had an ounce of confidence verses when I did not. You are never going to feel fully prepared, but you have to trust that you know what you know. Poor confidence= increased test anxiety = worse score.

What was a waste of time: For my boyfriend, it was doing stand alone questions. For me, those helped boost my confidence. I didn’t like using too many different MCAT tools. Stick to one or two and if you have time, you can resource other materials for testing purposes. I also don’t suggest filling out your MCAT book with class notes. The books themselves are pretty comprehensive, you don’t need to add additional shit in them to learn. I would honestly only refer to your class notes if you were able to simplify something in a much easier way so when you relearn it for the MCAT you are spending way less time on it.

Good luck and kick some ass on your MCAT! I have faith in you! And don’t worry, if your first go around isn’t the score you can be happy with, you can always take it again.

I hope this post was helpful to a few people! Comment below with any questions or what you would like to see next!

Scribing: What to expect your first week of training

Okay. I can do this. I finally got the email telling me that they are interested and I’ve passed all their benchmarks. They know I don’t have any experience, they said they would teach me everything! So why am I so nervous?

My ticket is paid for. They will pick me up from the airport and take me to the hotel where we will all be staying. They will be shuttling us everywhere and we are going to be in classroom training for a week. But why, oh why, am I still so nervous even though they’ve given me all this information?

The unknown. The unexpected.

How hard is this going to be? I’m a perfectionist you know. Am I even going to be good at this or am I finally going to meet a hurtle I can’t jump? Is this my demise where I find out I don’t have what it takes to become a scribe and my dreams of getting experience and going to medical school have just flown out the window?

Going into classroom training my first time as a new scribe was nerve-racking to say the least. I had no idea what I was doing, and not to mention my underlying anxiety that was severely mismanaged (well actually not managed at all at this point) was getting the best of me.

Sound familiar new scribes?

You aren’t the only ones that have freaked out about a new experience. Hell, show me someone going into training or a job interview for the first time who hasn’t been nervous. Either they are lying or are a cocky bit of bull-shit who will likely think they are too good for this and actually suck hardcore (those are by far my favorite type of people to watch fall flat on their face. No judgement…I’m not judging, you’re judging!)

It’s been quite a bit since I was the new trainee (2011 to be exact), but I remember vividly how I felt. And it was hell on my anxiety for the entire week I was in classroom training. Mix having to learn lots of new content, being tested along the way and having to pass, learning to all of a sudden rely on my typing skills instead of my handwriting (what? who does that?), and lots of sleep deprivation because I was scared of not passing; just a bad combination. Actually to be honest that week was hell.

But I passed, and so can you. 

Photo Credit:
https://weheartit.com/entry/216353594

Just stop and take a deep breath.

I won’t bore you with the details of my intense anxiety and sleep deprivation because honestly it was a massive blur once I started. There were a lot of people I started with and some most definitely failed out before we were done with classroom training. Others failed during floor training or decided this wasn’t for them. But let’s start with some common questions that you may have.

Potential First Day Questions:

What should I bring?

You will need your scribe manual, a pen/pencil, and your login information. If you weren’t given a scribe manual before, you should get it on your first day or a version of one. For your login information, if you are signing in/out online, bring this username and password (so you can get paid!) and if you happen to have your login information from the EMR training course you were likely required to take, bring that as well. If you really want to you can bring a notebook.

What should I wear?

Professional dress. No need for suits, but please do not show up in jeans and flip flops. If you were given information on scrubs/color/brand beforehand you may show up in your scrubs and close-toed shoes. But usually by the first day you haven’t sorted this out yet. And be comfortable! You will be there for a bit, so make sure you are comfortable so you can optimally learn.

How long will I be there?

Each classroom training day is a bit different. When I went for my initial classroom training I was there all.freaking.day. It sucked. But for the second company I worked for and for the homegrown program I worked for, usually 2-4 hours each classroom training shift.

Should I have taken a medical terminology course?

Honestly, I don’t think it’s that helpful. One, you waste tuition money by taking it if it is offered at your university and they are usually a joke of a class. Two, you probably forgot everything from that class anyways. Three, you are going to learn it all again, so really I don’t find it useful.

Am I meeting professionals here? Am I meeting my physician(s) I will work with here?

The only professional(s) you will meet are your trainers likely. Maybe their boss if he/she decides to make an appearance – which is highly unlikely by the way. Usually they will just phone in and give you some blah blah about how they are always there if you need it and they are so happy you are joining the team and just barf stuff. Really, I rolled my eyes every time I had to call my manager for that, but its necessary, I get it. Makes you feel welcome or something like that.

And good joke about meeting your physicians you will work with! They don’t want to see you until you have an inkling on how to be a scribe because they don’t have time to waste dealing with someone who doesn’t know what they are doing. So it’s just going to be you and your trainer and your other classmates.

Oh god am I meeting patients on my first day?!?

Nope. Face it you are going to suck and have no idea what you are doing that first week. We aren’t bringing in patients yet!

Where am I meeting? What about parking? 

For one company I was taken to and from my hotel to the place where they were holding classroom training. For the other company and the homegrown program I always sent out a detailed email about where parking was, if you had to pay for parking, what the building address was, and where within the building to meet and I always gave my cell phone in case you newbies got lost. Because half of the class always got lost…

Your trainer or scribe company should be doing the same thing.

On-boarding:

This is the thing that should be started from day one of you signing your tax documents and hiring documents. These are the things required by both your scribe company and the hospital you will be working for that will say you are medically clear and can obtain your badge. No badge = no working in the hospital or clinic.

I repeat, no badge = no working in hospital or clinic!

Common things you will need to complete and turn in during the on-boarding process:

  • Vaccinations. Each site is different but usually requires MMR, varicella, tDAP, and some places also require hepatitis B series. You will likely need to get titers as well to show you are immune, but this varies based on clinic site and company you work for.
  • TB test. Yup, need to know if you have been exposed or not. If you have, you need to have been treated and this needs to be thoroughly documented. You are about to work with patients, usually whom are sick. The hospital doesn’t want to be liable for you possibly spreading TB if you have it. But honestly, most of you will have a negative test. Some of you will just have to get a chest x-ray instead to show you are all good!
  • All tax documents filled out and returned. All direct deposit paperwork filled out. If you want to get paid I suggest you do a direct deposit. Most companies now will send you a card with your wages on it if you don’t set up direct deposit. IDK about you, but I don’t want that. I want my money and I want it now!
  • Badge clearance. These instructions will be given to you once you have usually turned in all of your vaccinations and TB testing requirements and so forth. Again, you need this to enter and work in the clinics!
  • Completing all hospital required courses/mandatory training. Most of this is just saying you attended the EMR course and can functionally use it. But when I held classroom training I made sure my scribes knew how to navigate the chart during our training sessions which made their mandatory training easy. But they still had to go just to click the checkbox off.
  • Scrubs! This one isn’t mandatory but you will need these before starting your shift. Unless your company makes you wear a different uniform, you will likely be in scrubs.

Breakdown of Content for Each Day:

Day 1: General overview.

  • General housekeeping items like how to clock in, what to wear/importance of dress, proper behavior in a clinic, etc.
  • Usually a very general powerpoint presentation on the overview of the chart and charting areas itself.
  • Learning objective vs subjective is big on this day.
  • First look/walk through of the EMR in a controlled practice environment and allowing you to play around with it.
  • Discussion of quizzes. Usually you have a quiz at the start of the next section going over what you learned in the powerpoint for this current session. Usually you have to pass with an 80% or better. If you are unable to pass a quiz, most places will let you fail one quiz and retake it the next day on top of the additional quiz that was already scheduled. However, most places will not allow you to fail more than one quiz.

Day 2: Chronic illnesses (or some variation on chronic disease)

  • Quiz Time!
  • Presentation on chronic illnesses that are usually present in all types of clinics/medicine. Such as diabetes, heart disease, kidney failure, etc.
  • If time more playing around with the EMR.

Day 3: Subjective Day!

  • Quiz Time!
  • HPI  & ROS presentation. This talks about everything regarding History of Present Illness or HPI and the Review of Systems or ROS. All of the elements, what types of HPI’s and ROS’s there are, etc.
  • HPI practice first. 
  • Then usually HPI + ROS practice. These should be done in the EMR if able to do so, so you learn how to navigate your charting system.

Day 4: Physical Exam Day!

  • Quiz Time!  
  • Then the powerpoint which will make your head spin. PE or physical exam has the most content to learn. This is the hardest powerpoint to digest and learn and most people fail the quiz on this.
  • HPI, ROS, PE practice in the EMR.

Day 5: Results

  • Quiz time! 
  • Powerpoint usually on being able to capture results and where they go and different types of labs /imaging that can be obtained.
  • If you are allowed to, you will learn how to enter orders so your physician can sign them.
  • So much more practice here.

Day 6: Plan/MDM

  • Quiz time again!
  • Powerpoint usually explaining this section of the chart and different types of plans that you may see. This varies widely between specialties, offices, and provider preferences by the way.
  • So many more practice scenarios. By now you will be practicing doing the whole entire chart.

Day 7: HIPAA & all practice

  • Quiz!
  • You go over HIPAA rules (this is the one where I got to scare all of you so you wouldn’t do anything shady). This is usually a pretty short powerpoint.
  • The rest of this is all practice.

Final Exam

Yes, you have to take a final exam. This is usually a combination of your pre-classroom training test and what you learned in classroom training. There are a lot of questions, but the also means you can get a fair amount wrong and still pass!

HOLY CRAP that was long. But you got though this post just like you will get through classroom training. Just remember, you aren’t the only one who is nervous about this and freaked out by this process. Your trainer was in the same place you are now when they were newbies too. Put in the work and you will do fine.