My Next Practice Test

It's finally getting nice in Cleveland. I swear the springs here are the coldest, grayest springs I have ever experienced! I've been studying part time for Step 1 for three weeks now, and my score has improved substantially since I took the last practice test. Today I took another practice test, and I have almost reached my target score. Now I will be studying full time for the next five weeks, so I won't be posting very much for a while.

Last Day of Year 2 and Promoted to Year 3!

We had our last ever PBL session today followed by our last seminar. Then we all went to the office to get our letters. I am now officially an M3. The letter starts out like this:

Dear CCLCMer,

The Medical Student Promotion and and Review Committee met on May 16, 2008 to review your Year 2 Summative Portfolio. Based on its deliberation, the Committee determined that you met the Year 2 standards for all nine competencies and will be promoted to Year 3.

It then goes on to detail some of the specific evidence that the committee felt was particularly convincing. The last part says:

....your portfolio was well written, organized, and an excellent reflection of your performance. It was a pleasure to read. Congratulations on a strong performance and receive our best wishes for continued success in medical school next year.

So that's it. I now have 5.5 weeks to study for Step 1, followed by 1 week of vacation before I begin Bridge Week and my first block of rotations. (I still don't know what my rotation schedule is, which is kind of annoying. Hopefully I will find out soon.)

Lunch with My PBL Group

My group's PBL tutor took us out for lunch today. We went to Cedarland, which is a really good Lebanese restaurant on campus. (For those of you who are visiting the Cleveland Clinic, you should definitely try it. It's on Euclid and 93rd by the Guesthouse, which is unfortunately the area that is under major construction right now.) After we were done eating, the tutor went around the table and predicted which field each of us would enter. I am apparently going to go into heme/onc. I actually wouldn't mind that choice, because I think hematology and oncology are both fascinating. But I'm not sure how I feel about having to do a three year medicine residency followed by a heme/onc fellowship in order to get there!

This Friday will be the end of the best PBL group I have had since I began medical school. Even though I started out as a doubter, this group really demonstrated how awesome of an experience PBL can be. Interestingly, several of my group members were also in my PSS group during our first summer of med school (summer 2006). That was a really great group too. Anyway, I won't miss going to classes next year, but this has been a great way to go out.

CCLCM Goes Tuition Free!

Yesterday afternoon we had the most incredible thing happen. On Tuesday, an email was sent around to all of the students to tell us that an important announcement would be made the next day, and that we should try to be present for it if we could. We all suspected that it was either about changing our school affiliation or free tuition. The dean sent around an email saying that the announcement was NOT about our school affiliation. So then we all figured it would be for free tuition, and sure enough, that is what it was. Next year's first years will never pay a dime. The current students will also get free tuition from now on, as well as a refund on half of the tuition we have paid so far. So the people in my class will be getting back one year's worth of tuition, and the fourth years will be getting back two years' worth. What an incredibly awesome and amazing gift.

Here is the press release from the Cleveland Clinic:

I am pleased to announce that the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University is providing all its students with full tuition scholarships, beginning with this July’s incoming class.

Students currently enrolled in the Cleveland Clinic Lerner College of Medicine will receive additional scholarship funding to offset 50% of the difference between past tuition paid and the financial aid they’ve already received.

Cleveland Clinic will support the full tuition scholarships through existing endowment income and clinical operations. The long-term goal is to fund the scholarships entirely through endowment income.

Training the newest generation of physician scientists is an important aspect of Cleveland Clinic’s mission and enhances our long-term ability to provide patients with state-of-the-art healthcare.

By providing full tuition support, we will ensure that debt does not hinder the ability of bright and talented individuals to pursue a career in academic medicine. It is an investment in our future and the future of medicine.

Everyone was so excited! Dr. Cosgrove, the CEO of the Cleveland Clinic, was there to make the announcement, and I was able to thank him in person for doing this. After the announcement was over, all of the students poured out onto the deck and were calling their families on their cell phones. There were photographers taking pictures, Mrs. Lerner and the Board of Trustees were there, and people were laughing and crying all over the place. It was just incredible. What a feeling. I still can't believe that this has happened. I knew that the school was planning to go tuition-free eventually, but I never thought I'd be around to see it happen! Some of my classmates and I went out for dinner to celebrate.

The only downside to this whole thing is that unfortunately, the UP students are not getting the free tuition. I feel very bad about this, because our tuition for next year is up to $43,000. Hopefully Case will find a way to provide them with free tuition also.

Books for Second Year

For the summer block, I suggest buying Epidemiology by Leon Gordis and reading it cover to cover. That's a really good book, and epi is a subject that is tested on the boards. I didn't like the stats book they assigned us, and I wound up getting a better book from the TA. I did buy the JMP Manual book, and that was useful for learning stats as well as for learning how to perform various statistical tests for the stats projects we had to do. So for the summer block, those are the only two books that I would recommend buying.

There really aren't too many new books that you need for second year beyond Robbins and Cotran Pathologic Basis of Disease, which is why I haven't been writing posts about second year books. Some of my classmates felt that Robbins was too dense, but I thought it was really good. I'm not going to get to a few of the chapters at the end like the eye chapter, but I've almost read the whole book cover to cover now. There is an atlas that goes along with the Robbins book that is really good. A lot of us bought it. You can also get the Robbins Review of Pathology, which is a path question book. I liked that book as well, although I think the questions in there are a lot easier than the practice Step 1 questions I've been doing. All of the other books we've used this year are the same as the ones we used last year: Katzung for pharm, Drake's book and modules for anatomy/embryo, etc. The only other books you will need are whatever you plan to use to study for Step 1. But you really can get away without buying too many Step 1 review books, because there is a whole collection of them in the library that you can use. They pretty much have all of the popular review books on reserve.

Acids, Bases, and ARBs

We only have two more weeks of school left now. The time is really flying by. This week's theme was a whole hodgepodge of things: acute renal failure, renal clearance, electrolyte and acid base disorders. Wednesday was acid-base disorder day, and today we had a hypertension pharmacology seminar. They were both great seminars. I know I went on and on about how awesome the renal block was last year, and I am happy to say that this excellence has continued this year. Most of the renal seminars are in small groups of eight, and most of them are very interactive with good cases. I feel like I'm really getting a lot out of them. The other good thing is that since we have such a light schedule now, I even have time to do all of the reading for class along with spending a few hours each day studying for Step 1. Right now I am studying path and embryology. Embryo is not a very high-yield subject for Step 1, but I suck at it. Embryo and anatomy have been my worst subjects on all of my practice tests so far, so those are the subjects that I'm reviewing first. I'll need to go over them again at the end probably.

Intro to Step 1 of the USMLE

I took my diagnostic practice test today, which is one of the NBME exams. (NBME is the National Board of Medical Examiners, the organization that adminsters the medical boards.) I am happy to report that I am already well above the passing mark at this point. Even if I didn't study at all between now and July 1, I'd almost certainly pass the test. Of course, I want to score higher than I am right now, but it's still a huge relief to know that I am starting from this point!

For those of you who are not familiar with the USMLE (United States Medical Licensing Exam), here's a brief primer on it. There are three parts of the USMLE, which are called Step 1, Step 2 and Step 3. (Step 2 actually has two parts, but we won't get into that right now.) Step 1 is usually taken after the second year of medical school, Step 2 is usually taken in the fourth year of medical school (or possibly the fifth year for CCLCM students), and Step 3 is taken after the first year of residency. I'm going to mainly talk about Step 1 since that's where I am in the process.

Step 1 is a test of basic science knowledge. Some of the most important subjects that are tested include pathology, pharmacology, microbiology, biochemistry, and physiology. Other subjects that can show up include anatomy, embryology, psychology, epidemiology, cell/molecular biology, and histology. The test is eight hours long, including one hour total for break time. It is taken on a computer, but it is not adaptive (every question counts the same as every other). There are seven sections of 48 questions each, and you are given one hour per section. Once you finish a section, you cannot go back to that section. A passing score on Step 1 is currently 185 on the three digit scale. The average score for allopathic medical students (people working toward an MD) is around 220. No one knows what the maximum score is.

Step 1 is important to medical students because many competitive residency programs use it to screen out applicants. The next obvious question you are probably wondering is what constitutes a "good" score on Step 1. The answer to this question is highly subjective, and it also depends on what field you are trying to enter. My personal opinion is that any score above the mean is a good score (220+), and any score above 230 is a highly competitive score for most specialties.

Done with My Summative Portfolio

Our summative portfolios are due next week, but I wanted to get mine turned in early so that I could start studying for Step 1. I'm going to take my diagnostic exam on Tuesday since I don't have to go to clinic any more. (My advice to current and future second years: don't miss any longitudinal clinic days from September to April. That way, you can have no clinic afternoons for the entire month of May when you need that time the most.) The administration took pity on us and didn't require us to print out all the evidence and make those ridiculous binders like we had to do last year. One of my classmates came up with the idea of saving everything on a CD and turning that in. I thought it was a really good suggestion, but so far the powers that be haven't warmed up to the idea too much.

Not too much else exciting going on. The work load is starting to wind down so that we can have extra time to study. FCM ended back in March. We don't have any more Wednesday afternoon communication/physical diagnosis classes or Friday ARM/POD seminars. There was a meeting this afternoon about planning out the research year, but I didn't have to go since I'm only doing a month of research next year. I think this is the first time since I started medical school that I had every single afternoon off for the entire week. I've been using the extra time to work on pharm.