25 Things I Learned From Studying And Taking USMLE Step 1 and 2 CK

Excuse my absence the last few weeks, but I was busy studying for USMLE Step 2 CK. Going through review books and practice questions, I came to realize that I had learned many important stereotypes and other truisms from this exercise, of which I'd like to share a few with you. 

1. Anyone who visits Connecticut gets Lyme disease (Borrelia burgdorferi infection).
2. Anyone who visits Arizona has coccidiomycosis.
3. Young African American female? Lupus.
4. Young African American without Lupus? Sarcoidosis.
5. Farmers have no clue how to use organophosphates properly.
6. Shipbuilders work primarily with asbestos to make ships. 
7. No matter what disease you have, quitting smoking will make it better. 
8. If you have Hashimoto's disease (lymphocytic hypothyroidism), you're way more screwed than you might have originally thought.
9. Foreigner with a cough? Tuberculosis.
10. If you are ever bitten by a scorpion, the only organ system that will be affected is your pancreas. 
11. Anyone stung by a bee goes into anaphylaxis, so everyone should have an epinephrine pen. 
12. Everyone from the Mediterranean has thalassemia until proven otherwise.
13. Every old person over the age of 65 has cancer until proven otherwise.
14. Every woman has autoimmune disease, gynecological cancer, or osteoporosis until proven otherwise. 
15. If you do not have a DSM IV psychiatric diagnosis, something's wrong with you. Don't believe me? Check out what new addiction is being added to DSM V. 
16. Children only have 4 orthopedic problems: development dysplasia of the hip, Legg-Calve-Perthes disease, Slipped Capital Femoral Epiphysis, or Osgood-Schlatter disease.
17. No matter what the ethical dilemma is, never consult your hospital's ethics committee - you know ethics better than they do, or the dilemma really isn't that perplexing.
18. No matter how ridiculous the patient is, you will never fire the patient and always respond calmly and professionally.
19. Pathology slides on questions are to be ignored because the answer is usually in the prompt. 
20. Ditto for x-rays. 
21. The number of drug interactions you need to know is the square of the number of drugs you know. 
22. Your patients will always have 5 possible diagnoses of which you choose one that seems most appropriate. 
23. Medicine is too general and too specific all at once. 
24. The test-making business is a pretty sweet racket if you can get in on it. 
25. Doctors never make mistakes.

Heh, my facetiousness aside, I do sometimes wonder how all this repetition of stereotypes affects how we ultimately end up viewing patients when we go into practice. Hopefully we're still able to keep our eyes open to things that don't fit the 'classic' picture. 

Would More Medical Students Choose Primary Care if They Received Specialist Salaries?

This is a guest post by James over at poorMD.com

Fewer and fewer medical students are choosing to go into primary care fields despite the emphasis and growing need for more internists and family practitioners. When choosing a medical specialty, medical students have many factors to consider: lifestyle, personality match, competitiveness, length of training, and salary (compensation) are some of the major considerations. Let's break down each of the considerations a poor medical student must make when choosing a career: 

Lifestyle: The generalist's lifestyle, while not the greatest, is also not the worst.  In terms of hours worked, it is not as demanding as something like surgery or obstetrics.  

Personality: All sorts of personalities could fit into a primary care field such as family practice, internal medicine, or pediatrics.  Wasn't the whole reason for going to medical school was so you could help patients?

Competitiveness: If you choose not to go into family practice because of competition, you probably never should have made it into medical school.

Length of Training: With generalist training only needing three years as opposed to the five plus years required of specialists, this should be considered an incentive to go into primary care.

Salary (Compensation): The average earnings of a primary care doc is about 55% of the average earnings for all other non-primary care specialties.  Here, I think we've identified a reason for the primary care shortage.

There are many reasons why fewer med students are choosing to go into primary care, but the financial aspect must be a huge consideration.  If I'm graduating with $180,000 of medical student loans, having deferred gratification by going to college, med school, and then residency, and am looking to buy a house and raise a family in the near future, why would I go into primary care, when I could make double or even triple as much as a specialist?

According to the AAMC, family practitioners can expect to make about $142,200 after three years of residency where as a radiologist's salary can see $325, 438 after five years of residency. Sure, the training to become a radiologist is two years longer, but for those extra two years, you can potentially see more than a doubling of your income. 

The fact is, medical training is long and grueling.  Individuals pursuing a medical degree have made huge investments into our futures and hope to see a good return on investment or ROI.  Specializing takes just a few more years and produce greater returns; I've already come this far, what's a few more years?  Show me the money!  So to answer the question posed in the title of this article, YES more medical students would choose primary care if they were compensated better!

The American College of Physicians in their "State of the Nation's Health Care 2009" said:

Medical students and young physicians should make career decisions based on their interests and skills, instead of being influenced to a great extent by differences in earnings expectations associated with each specialty. Yet there is extensive evidence that choice of specialty is greatly influenced by the under-valuation of primary care by Medicare and other payers compared to other specialties.

As the old adage goes, "Do what you love and the money will follow."  I wonder how much in student loans that guy must have had or how long he spent in school.  While I enjoyed my family practice and pediatrics rotations in medical school, I also enjoyed radiology and orthopedic surgery.  But after evaluating what was most important to me, I decided that spending time with and supporting my family would bring me the most fulfillment.  Luckily, I loved radiology and so far it has happened to be a perfect fit.

James, a radiology resident, runs poorMD.com, a website dedicated to providing financial tips and other practical advice to medical students, residents, and fellows. If you're interested in reading more about the situation with primary care, check out Why Incentives Matter (Even For Physicians), A Shortage of Primary Care Physicians?, and Why Primary Care Matters.

Choosing A Medical Specialty

It seems like in every class, there are two groups of people. The first group seems like they were born with a scalpel or stethoscope in hand, claiming to have known they wanted to be an orthopedic surgeon or pediatric rheumatologist since practically the day they were born. The other group is on the other side of the spectrum: they weren't sure about medical school, weren't sure how to pick their rotations, weren't sure what to specialize in, weren't sure where they were headed in general. This post is for that second group. As Match Day approaches and the 4th years effectively complete medical school, the third years now feel the full weight of the decision on their shoulders. How do I choose a  medical specialty that is right for me? 

When I addressed this issue earlier in the post "How To Choose A Medical Specialty", the image was meant as a facetious commentary on just how hard it is to choose a specialty! The decision is so difficult for some physicians that there are some who have completed a residency, went into practice, only to go back and do a second specialty in something entirely different!

Now, some of that may simply be due to personality, but how does one avoid such a fate?  While it may be cliche, I think the old idea that "Knowledge is power" applies quite well: the more you know about various fields, the more informed a decision you can make. The key is to start early. Don't merely rely on your third year rotations to expose you to everything. Some rotations will be much longer than you would like; some, too short; and some, you won't even experience at all. The latter group is the most worrisome: how can you tell if you would like something like geriatrics if you never rotate in it? If you have even an inkling of interest, it behooves you to either schedule a short elective in a field, or simply shadow a physician in that area on your day off. Now, I realize many of us may not be that self-motivated to take time on our days off to do that, but there really is no substitute for that kind of experience.

Okay, so you took my advice... and are still confused. Now what? Here are a few more resources to consider:

• How To Use FREIDA To Choose A Medical Specialty
• Medical Specialty Aptitude Test - A Tool To Choose A Medical Specialty
• AAMC Careers In Medicine Specialty Pages

I also highly recommend reading through Iserson's Getting Into a Residency: A Guide for Medical Students. While the book does focus on residency applications, the first half of the book focuses on what you need to do in medical school to prepare for applying, as well as discussing practically *each* medical specialty and what type of applicant is ideal for each one.

Hopefully this post has been helpful in pointing out some resources to use. Have you come across any other resources that you found helpful in choosing your medical specialty?


Updated 2015-12-18

Medical School Valentine's Day Gift Ideas

Valentine's Day is coming up soon, and even the medical students in your life need some love. Actually, if you believe the reports, medical students are much more depressed than the average population, so they probably need the love more than most. As you may recall from my past effort in this area Practical Gifts For Medical Students: A Holiday Gift Guide, I like getting gifts as much as the next guy, but I prefer a practical gift, one that I will use at least on a monthly basis. Not only are such gifts longer-lasting and more useful, but it reminds me of the person who gave it to me everytime I use it. The memory helps stir positive feelings in me, and helps sustain the connection I have with that person. Then again, a box of chocolates also helps me stay connected with the gift giver as their "gift" is always by my, um, side?

Anyway, giving flowers or jewelry is quite common during Valentine's Day, and I won't discourage anyone from pursuing those items if they have a good idea in mind of what they want to give. However, if you are looking for particular items that are more tied into medical school, I found a few you might like. Some are practical, some are not, but hopefully all intriguing.

Gift Ideas

Apple iPod Shuffle
I cannot begin to explain how money these Apple iPod shuffles are. Med students love the size, the style, and the colors. They are especially good for people who like to hit the gym or jog outside. Basically, it's "cute" and that's all that matters. For the medical connection, well... you could always load them up with Goljan USMLE Step 1 podcasts and study in style.

Nintendo Wii
It is a bit of a stretch to tie a Wii into medicine, but the Wall Street Journal Health Blog recently noted that some surgeons have been using the Wii for training (Surgeons Hone Skills On Nintendo Wii), so... there ya go. If there's still any doubt whether this is practical, perhaps add in a Wii Fit as well just so you know you're getting some exercise out of it.

Gift Card
You know, I was gonna come up with a long list here, but frankly, most med students I think would be happy with a plain ol' gift card. Heck, I was happy playing with the wrapping paper when I was 5, and still am now. On a more serious note, I think any medical student, guy or girl, would be happy with a gift card because they could simply use it to buy textbooks and other study materials of their choosing online. Not the most romantic thought in the world, but certainly quite practical.

Updated 2015-12-18

USMLE Step 1 Tips / Advice Summary

Over the past month, I have devoted this blog to posting all the advice I had for USMLE Step 1. I had found that over the year, many underclassmen had been asking me questions about the exam, so it just made sense to collect my thoughts in a series of posts and refer people here, instead of answering each questions individually. In case you missed a post, here is the entire list of posts containing my USMLE Step 1 Advice:

• 25 Things You Should Know About Your USMLE Step 1 Exam Day
  
• How To Relax While Studying For USMLE Step 1
  
• How To Register For USMLE Step 1
  
• My USMLE Step 1 Study Strategy
  
• Which USMLE Step 1 Qbank: Kaplan or USMLE World?
  
• Kaplan Qbank for USMLE Step 1 Tips 
  
• 21+ Online Resources For USMLE Step 1
  
• Books and Resources For USMLE Step 1

Additionally, I noticed a few other posts in the archive that may be of use to you as you study for USMLE Step 1:

• Tyramine and the Cheese Syndrome
  
• Pope's Blessing Vs. Claw Hand
  
• 8 Phun Pharmacology Phacts
  
• Extraocular Muscle Movements - Function Explained
• Why Monica Bellucci Might Take Atropine

I hope these posts have been helpful to you. In the coming months, I plan on doing a series on my advice USMLE Step 2 CK / USMLE Step 2 CS as well as my experiences on traveling and interviewing for residency programs. Thanks for reading!

Updated 2015-12-18