Second year growing pains

Kristina, Second Year Medical Student

First round of tests for second year is finished. I’m not going to sugar coat things. This year is a pretty big step up from last year, and it is taking me a little while to get used to things.

My summer was absolutely fantastic. I went to Europe with my family, volunteered with Dr. Appel in his clinic in Chad, Africa, hiked Half Dome, explored San Francisco…it really was more than I could ask for in the almost last summer break of my life.

The first day of orientation didn’t hit me, but the first day of classes sure did! I thought initially that I would try out different methods of studying to try and improve from last year. I used a lot of flash cards for my studies last year, so this year I thought about trying to read more and flash card less.

On I went. Week one, I was a mess. Week two a little less a mess. Week three a little less a mess. Week four – not sure what happened but it was a combination of that I lost my groove and family came to visit the weekend before tests. It’s incredible how such little things can throw you off your balance. To compensate for the time lost with hosting family, etc. I made myself study absolutely alone in my house for 2 days straight right up until the tests.

This test week has probably been the shakiest one for me since beginning medical school. I’m actually a little frustrated with myself.  For the first time in my career as a student, I’m now setting up meetings with some teachers to discuss how to improve my grade in a couple classes. Although it is a bit discouraging, I learned several things about myself and my studying.

  1. Don’t study alone. I am an extrovert. So much of my energy comes from people around me. Shutting myself away was absolutely terrible for my attitude, my outlook, and my studying.
  2. Back to my old methods! Obviously my new methods of studying in the classes I did poorly are not working. I should just stay with the habits that got me through last year! Lesson learned. Pulling out my flashcard program as I type.
  3. It’s ok to ask for help. I’ve always had the tendency to not want to ask for help. When I was little and my parents offered me help, I would shout out “NO! By myself! By myself!” My pride and stubbornness have been quite strong since an early age. I think this is a good experience in humility and accepting the advice and careful criticism of my mentors and teachers. Now it’s time to practice my listening

Even though it makes me feel like a crazy person, I really do love medical school. I have learned more about myself here than in any other experience in life. Loma Linda in particular is also my ticket to becoming a great doctor, and I wanted to take every advantage of my opportunities here to become just that. Time to get back to the grind to gear up for the next test set! With new advice, God by my side, and a newfound motivation, I’m sure it will be a much better experience than this last one.

– Kristina, MS2

My First Step


The time has finally come.  There is only one thing on the mind of a second year medical student at this stage in his or her education: USMLE Step I.  Pop your head into any of the few Starbucks coffee shops around Loma Linda sometime this week and I guarantee you’ll see a couple wide-eyed, fear driven students feverishly scribbling in a giant binder or answering practice question #1,532 as the date of their test quickly approaches.

Rewind to about 3 1/2 weeks ago.  There I was sitting in my last lecture of MS2 as Dr. Werner finished up his epic course in pathophysiology by teaching us about complement disorders.  To be honest, my mind was on anything but the immune system.  Over the next two weeks, we would be spending our time taking test after test to wrap up the in-house portion of our medical education, after which we had 2-3 weeks “off” to finish preparing for Step I. It was going to take a lot of discipline and time management to juggle studying and just staying alive! Before I knew it, Dr. Werner was giving his last bits of advice, reassuring our abilities, and ending with a simple, “Well, have a good life!” And so it began. The beginning of the end of the beginning.


The Very Last Lecture…


Dr. Werner Gives Me a Good Sendoff

Flash forward to the present day.  This time around, I survived my in-house exams, and excelled! The relief (and realization that I was crazy enough to do 2nd year TWICE) was only short lived, as I knew I couldn’t celebrate a finish line until I had passed through the final gate of Step I. Onward and forward!

“Now hold on a minute Ryan,” you may be saying to yourself, “What exactly is Step 1?” For those of you who don’t know, the United States Medical Licensing Exam, or USMLE for short, is an intense, three part set of examinations that every MD student must pass in order to become a board-certified physician.  Step 1 is taken after the 2nd year of medical school, Step 2 is taken after your 3rd year of medical school, and Step 3 is taken after you have your intern year of residency (after being a doctor for a full year).


A Typical Prometric Testing Center

As for Step 1 itself, it is an eight-hour, standardized exam that consists of seven 1-hour blocks of 46 questions, with one hour of break time that can be taken whenever the examinee so desires.  Along with clinical performance, interviews, and letters of recommendation, Step 1 is widely said to be one of the most important factors in determining where a medical student works after medical school.  Score too low and a lot residency programs won’t give you a second glance; score high enough and you will be considered a competitive candidate; what constitutes a “good” score depends on what specialty a medical student wants to pursue after medical school. It takes a score of 188 to pass, with most examinees scoring around a 225.  As you can see, there is a LOT riding on this exam.

I take Step 1 on May 29, so my time to review is growing shorter and shorter. Step 1 could throw anything from the basic medical sciences, from neurology to anatomy to pathology to pharmacology, etc etc etc.  If you think that sounds overwhelming, let me assure you, it is!  Because this test is so expansive, there are many different ways students can review for it.  The majority of medical students stick to one main resource, supplemented by other books that can help areas of deficiency.  Behold, First Aid:


This 600+ page text attempts to take all the most commonly tested material (referred to over and over again as “high yield”) and squish it into one easy to read manual.  But even though it’s very accurate about what should be reviewed, most students choose to supplement their studies with additional resources, just to be thorough.  Other resources I am using include a pathology review text called “Pathoma,” the USMLE World Question Bank, an online course called “Doctors In Training,” and official NBME practice exams.  After I take Step 1, I’ll let you other medical students who may be reading know how well, and hopefully not how poorly, these resources prepared me for Step 1!

Dedicated Step I study time... 2 1/2  weeks of DIT & Qbanks all day long weeeeeeee #step1 #doctorsintraining #medstudentproblems #medschool

An Afternoon of Studying At Starbucks

So as the seconds count down to facing off against this monster of a test, I have been trying to maintain a fairly regular schedule. I’ve been waking up at around the same time every morning, I’ll spend a couple hours doing my online review course, then I’ll do a block of 46 practice questions, review those, go back over my day’s work, go to sleep, rinse and repeat! It’s pretty rigorous work trying to hit all the high points before Step 1, but as my practice exam scores have shown, review is going well so far, and my biggest challenge will be to avoid burning out.  Only 8 days left to go!


Study, Study, Study…

In other news, Loma Linda was recently visited by a representative of the Be the Match bone marrow donation program.  As you probably already know, Be the Match maintains a registry of people who could be used as possible donors to those in need of a transplant.  The need of these patients is highly specific, so only a perfect matching donor can safely donate his or her marrow.  Most who join the registry never match with someone, or if they do it is usually 10-15 years after they have joined. Well to make a long story short, I joined the registry along with a couple of my classmates, and after having been listed as a donor for less than a month, I have already matched with a patient!  My blood was drawn for confirmatory testing to ensure that I am indeed the best match, and if all goes well, I could help out a 71-year-old male with myelodysplastic syndrome! I can’t believe how fast it happened and am feeling incredibly honored that I have the ability to donate for someone.

Ok, back to it! See you on the other side!


My Upgraded White Coat Awaits…

Beginning of the End of the Beginning

I’ll start with the best part: Friday, I presented my thesis proposal––and passed! I’ve spent the rest of the weekend being ecstatic. Typically, the response from others follows a somewhat less enthusiastic motif. “Wow, that’s great…what does it mean? Do you start med school now?”

No, I’m not going to start med school anytime soon, but as far as the PhD goes, making it through the proposal process is significant. Getting a PhD is somewhat of an elaborate hazing ritual, in which pledges must prove to a council of five established researchers that they are worthy of joining their ranks. The thesis proposal is a particularly intense Harrowing, in which I must publicly present my intended doctoral work. I must also let the five scientists on my thesis committee that I know what I’m presenting and that I’m capable of completing the work. Passing means I’ve made it through the first level of graduate school, and am now a PhD Candidate. Now all that stands between me and the PhD is…a whole lot of research and writing.

For anyone that’s interested, my thesis (which I’m sure will come up again) explores the relationship between cholesterol regulation and Alzheimer’s disease. My presentation can even be viewed online. Of course, I’d be happy to answer any questions––what researcher doesn’t love the opportunity to talk about their work?

Since I’m MD/PhD, I have four years of med school after that, and we won’t go into the post-post-graduate years of residency. As my friend described it, I’m at the beginning of the end of the beginning: It’s the beginning of the final push toward my PhD, which is itself the beginning of my path through the combined degree program. Regardless, I’m allowing myself some satisfaction. I might even venture to say I’m around 25% complete, and that’s worth celebrating.

No Romance in Medicine

I have been documenting a novel syndrome. It’s not rare, yet has not been thoroughly described in medical literature. How exciting to be pioneering this! I shall call it Primary Medicine Exposure Romantic Block Syndrome. When exposed to a new environment and cognitive concept that leaves their fundamental confidences shaken, patients find themselves with an inability to manage their romantic faculties. I have seen it with my own eyes as one relationship after the other falls apart amongst my fellow classmates. An anonymous poll for prevalence rates is tempting. I’m still working on more marketable nomenclature for this syndrome if you have suggestions (whoever coined Restless Leg Syndrome, feel free to comment this post, I respect your opinion).

After the first week of tests, this weekend has served as the very cure to my constant, controlled, yet gnawing fear of both the medical knowledge and romantic abysses that seem somehow anastamosed.

This weekend was the Pine Springs Ranch retreat for the School of Medicine, where newly relieved first year students, still shaken second years, rebellious third and fourth years (sneaking away from their rotations or setting aside their review books), got together for some good ol’ campfire tunes. While there was no actual campfire, the stars were scintillating and the bugs were chittering along our harmonies.

Muita calma pra pensar, e ter tempo pra sonhar. Calmness to think, time to dream. We all stopped to think and dream on Friday night. Paige, Ben, Linden, Chris, Morgan, Justin, and I plopped down on an inclining rock clearing and watched the quiet stars as Mike played quiet chords on his guitar. We sang, we laughed out our fears and thus renewed our courage.

It was an especially exciting weekend for me, because I was finally going to sing one of my favorite tunes at the talent show, Corcovado (Quiet Nights of Quiet Stars), by Joao Gilberto and Stan Getz, a song that has stayed in my mixed CDs since I was 11. Did I mention it was to an acoustic guitar, alto sax, and electric bass? I felt like the luckiest immigrated Brazilian who misses the raw and relaxed sounds of a typical Saturday night in a bustling musical neighborhood back home. Thanks for the opportunity Drew, Daniel, and Mike (see his take on this weekend, at Quiet Nights of Quiet Stars)! Whether it was rushing through my books to get to practice on Friday afternoon, ditching the hike up to the mountain ridge in order to refine my egg shaker skills, finally singing that song on Saturday night was my cure for Primary Exposure Romantic Block Syndrome.

Medical school is not the bitter, tragic joke, some fall into believing. Did I hear this weekend of a 70% divorce rate amongst physicians? Maybe these bitter folk haven’t taken quiet walks by quiet streams, or looked out the window that looks out on Corcovado, where the Redeemer stands. Now that I have taken a step back from my past month of academic agony and romantic fear, I realize that this is possible and I could even thrive. You see, the art of medicine illustrates Joao Gilberto’s fundamental mistake of claiming the meaning of existence in romantic love. Romantic love is a little selfish in its expectations of returned affections. Love practiced in medicine reaches out to miserable humanity, giving it a hand in the ugliest, dirtiest, most ungrateful and tragic of circumstances, giving one more chance before the final flicker of life’s ember. So learn how to wisely yet unconditionally love first, medicine being a good teacher, and discerning a wise lover will be a skill that translationally follows.

“Too many cooks spoil the broth”

Having gone half way across the country for my undergraduate education in Alabama, I thought that I had the whole “adjustment factor” under control.  It seemed like moving to California would not be much different, especially since I was transitioning from one Seventh-day Adventist school to another. I thought I knew what I was doing. So I decided to shrug off the old voices of wisdom who warned to “avoid distractions!”  But I quickly came to understand the saying “too many cooks spoil the broth.”

My pride was in thinking that it was okay to change all of the good study habits that I had developed in college (crazy right?).  Growing to care for all of my new classmates, professors, mentors, and various other students, I wanted to listen to their advice.  “Do such and such and you’ll be like John who was at the top of his class in ‘07’.”  After much critical analyses, I agreed that the advice was pretty exceptional.  Unfortunately, not all of it was exceptional for me.

So then it was one week before the exam hit.  My heart raced as I attempted to readjust my adjusted study habits back to what worked for me.  Mental roadblocks, long nights of study, knees worn out from prayers, phone calls from parents telling me to study more (and angry with myself knowing they were right!) encompassed the days before exams.  All of it reached an emotional climax on the weekend before Day One of the four day test week.

Fortunately, God pulled me through this one. However, as I looked back I realized that it could have been a lot less stressful. For me, the most valuable information learned was actually something that I already knew: Sometimes, the biggest hurdles in life are the ones that we set for ourselves.