Step 2 National Licensing Exam on the Horizon

As some of you who have been reading this for a while know, I feel like I shortchanged myself for Step 1 (the first national medical licensing exam). My studying was not that effective during the short time I had, given my master's thesis work. I think I achieved maybe two weeks of good solid studying, and barely squeaked by at the last minute. I later found that most people start studying months, if not years, in advance! It was too little time given how much exam material was not covered in the curriculum of our first two years, and given how little emphasis was placed on the exam by our program. I was probably naive and should have done my own research about the importance of this 8 hour exam, but when someone you trust tells you that you are worrying over nothing, you believe them. Oops.

Scholarship Exam, 1940

Thinking back, I'm not sure why I believed them. My entire life, people have been telling me that I took my academics too seriously. I have often heard that an exam or a grade was unimportant, only to study hard and then realize that it did make a difference later on. Working for a grade only when it 'counted' seemed wrong to me somehow. Shouldn't we be working hard for the sake of doing our best? What frustrated me about this Step 1 episode is that I did work hard the first two years of school, but I felt my energies were often directed toward irrelevant material, such as alternate therapies, politics, and social concerns. Those things are important, but not at the expense of learning the basics of allopathic medicine! I did not make sure that what I was learning correlated to what I needed to learn; I trusted the school to do that and they didn't. I suppose I wish our program had been, for lack of a better word, a stricter one. I also wish I was a little more realistic about the preparation needed.

This brings to mind another myth you hear when applying to medical schools: that all medical schools are pretty much equivalent during the first two years, because it's the clinical years that matter. In my opinion, this is blatantly false. The first two years are your foundation. The quality of teaching and the strength of the syllabus sets you up not only for your board exam studying, but also for the wards. If I were giving someone else advice about choosing a medical school, I would tell them to examine the syllabus for all four years carefully, and look at who is teaching the basic preclinical courses. Are they PhDs without any clinical background? Are they MDs without any teaching background? Are they junior or senior medical student teaching assistants (who are often great)? Do the same professors teach the course year after year? Lectures? Case-based (not necessarily as effective as it is popular)? Both? How well do preclinical grades predict performance on the Step? What sort of board preparation (if any) do they offer? What is their board exam pass rate (can they give you the actual numbers)? In our case, had I looked into this further, I would have seen some serious red flags in terms of the right fit.

Please don't get me wrong -- I am very grateful for all that I have gained and learned during my time in medical school. I understand that no medical school is perfect, and that often, we only get out what we ourselves put in. There are amazing things about my program, which I won't go into here. However, I do not know if I would recommend my program to other pre-medical students. I have no resentment or bitterness about what we didn't learn, but I do feel the need to be truthful about it to others embarking on this journey. For myself, my goal is to move onward with my life and career using everything I did learn.

Anyhow, my experience with Step 1 was a very high-stress way of taking any exam, especially one that turned out to be so much more important than I realized. I do feel that certain doors are now closed to me in terms of both specialty choice and competitiveness of residency programs, which is sad because I know I could have done much better. Looking on the bright side, though -- there is another licensing exam. While a decent Step 2 score may not entirely make up for a low Step 1 score in terms of residency applications, it would theoretically help. Thank goodness there is another exam! Now the pressure is on to prove myself. From every challenging experience or mistake comes a chance to do better, right?

I still have some time before Step 2, so my plan is to go through all the material once through briefly to get a feel for the scope of the material, maybe review some Goljan pathology or internal medicine, and then do as many practice questions as possible from USMLE world. It seems as though everyone uses some variation of review book + online question bank to study for this exam. However, everyone also says that you only need two weeks to study for Step 2, that it's easier than Step 1, etc. That may be true if you felt well prepared for the first Step. Needless to say, I shall not believe it:)

Many of my classmates have taken Step 2, and many are taking it around the same time I am. I hope we all have a better time of it. I will try to continue blogging as I study. Good luck to those taking the exam, and good luck to all those applying for the spring Match! I hope people end up in places and specialties they love. My plan is to smile and keep on keepin' on.

Maui in August

Oheo gulch waterfall pools

My parents gave us a honeymoon for a wedding present! We had a lovely time in Maui. Of course, the only camera I brought was my cell phone. We flew out last Friday and landed in Maui for dinner, which we ordered to our room (Ocean view! Chocolates! Patio! Stove!) at the Hotel Wailea (we were given a honeymoon upgrade). A yummy Italian meal.

The next day, we explored. We went for a run on the beach, bodysurfed, and then made an architecturally robust sand castle that withstood the tide coming in and impressed a discerning 10-year-old. We had lunch at a cafe by the beach and then swam in our pool before eating dinner, which was ravioli that we found locally and cooked on the stove in our suite. On Saturday, we hiked through the beautiful national park, including a tall, dark, ancient bamboo forest, swam in an enormous waterfall pool at Oheo Gulch (at left), and drove the Hana Highway, a winding highway along one of the most beautiful coasts I've ever seen.

We also saw some of the small towns of upcountry Maui during that trip. Lots of horses, some cows, and abundant sugar cane. You know the brand C&H sugar? California & Hawaii! As we drove, we saw an interesting mix of prosperous and working neighborhoods -- I think most of the inland neighborhoods are houses owned by everyday folk, not retirees or the wealthy. The huge differences between the resorts and the towns really illustrated how much the economy of Maui depends on tourism (and therefore the national economy). Many of the little houses reminded me of towns in India; I was expecting something much more like California. Land is relatively cheap in Maui.

Beach properties everywhere

On Monday, we spent more time at the beach, this time protected by new Quicksilver/Roxy rashguards (such a useful souvenir) that had the Hawaiian flag on them. This was to prevent more of the inevitable tan/sunburn under the powerful Maui sun. While we were out there, I spotted a boy of about 7 or 8 who was unable to get to shore against large waves and the tide, which was going out. We asked if he was okay and he said no, so B swam out to him and brought him closer to the beach, then I swam out to them, and between us all we were able to get to shore. It could easily have gone wrong. Scary. Very scary. That evening, we calmed our nerves over a delicious sunset dinner at Capische.

Iron ore in the hills but no metal in ancient Maui

Tuesday was a treat -- we took horses down into a volcanic crater. The red rock (left), the eerie moon-like landscape, and the stunning views made the strong sun worth it (we were above the cloud level at about 9,000 feet). My palomino quarter horse was named Linus because he likes to suck his tongue. Rocky, B's horse, was an absolutely beautiful bay thoroughbred-quarter horse mix. It was tricky footing, but the equines had sure feet and we had riding helmets. These horses climb up and down mountains at elevation all day -- they are ripped! Look at their muscled behinds!

Well-muscled horses ready to descend into the crater and back

General store high tea

We drove through the upcountry and had a heavy tea at the Haliimale General Store, which is an old store that has been converted into a fancy restaurant and tavern (photo at right). We didn't know that! Luckily it was casual, so they didn't blink an eye when we showed up dusty and smelling faintly of horse.

Later, when we arrived in Kapalua, we checked into the Ritz (the very posh RC). Very, um, ritzy. No celebrity sightings, however. We were greeted by leis and given an upgrade to a club room, which apparently is Ritz for "we'll give you free food and alcohol in an exclusive lounge during your stay." Neither B nor I drink much, but the food! What an amazing treat. And they had gourmet tea, coffee, and cookies all the time. We entered our room to extreme luxury -- marble counters, hardwood furniture, shell trim -- and a big bottle of champagne and chocolate-covered strawberries with "congratulations" written on the plate! I have never felt so spoiled.

Welcome to the Ritz, indeed! With champagne.

At the RC club, we ate a delicious breakfast each day facing the golf course, which gave B the opportunity to tell me about his days on the high school team. It was much more fun to watch golf in person with a personal guide to the game than it is on TV. We saw couples, families, and a few near-pros golfing during our stay. Apparently, someone once had a hole-in-one during lunchtime and the entire club balcony was watching, and started cheering. We saw a man climbing the palm tree here (level with the eighth floor!) to trim it -- which I think is even more impressive.

Our cosy breakfast nook overlooking the golf course

We rented snorkeling gear on Wednesday and played with a sea turtle, only a few meters away from the shore! They are beautiful, endangered, and curious ($2000 fine if you touch one). This guy was about three feet long from tip to tail. He was not at all afraid of us; he would have stuck around all day. The turtle was so graceful in the water, and well-camouflaged because all the green patterns on this legs and shell looked similar to sunlight refracting through water. What a peaceful, amazing sight. The Hawaiian word for sea turtle is Honu. We had a sushi dinner at Kai, a new restaurant. They had the freshest sashimi I've ever tasted.

On Thursday, we braved the waves in Lahaina and took a surfing lesson. It was awesome! We both stood up and I think we each began catching our own waves. I thought the standing up part would be the hardest, but it's not. The hard part is paddling into the wave fast enough to catch it and then steering your board once you're up. There were a few collisions out there, but no major damage done. I loved turning around to find B and seeing him on a big wave! Afterwards, we ate lunch under a huge banyan tree that takes up 3/4 of an acre and fills the town square in front of the marina and old courthouse. It was amazing. It looks like five trees have merged; and then you realize it's all the same tree!

Art fair under the huge, multi-trunked banyan tree in Lahaina town square

The next day, we had a rest from all of our outdoor activities. We drove the winding, tiny north shore highway, which is a coastal road that goes from a two-lane state highway with a guard-rail to a one-lane dirt road hugging the cliff, and no rail. Luckily our Ford Escape did great. Along the way were little turnoffs with fruit stands and even a big food cart -- how they managed to tow the cart up there I have no idea. We ended up in Kahului, at the Maui Megaplex (a tiny outdoor mall with a theater). We ate delicious Thai food in a welcoming restaurant and then heard a Taiko drum troupe in the outdoor courtyard. We drove home full and well-rested and watched a movie in our hotel room (Thor -- lots of fun).

One of the many blue lagoons with coral visible through the water

On Saturday, we decided to go snorkeling again, so we made our way to Honolua Bay. We swam out from shore about 50 yards along some beautiful cliffs that had rocky tide pools and other neat little inlets near their feet. We saw lots of beautiful fish and another turtle! He was grazing on seaweed near some rocks, getting washed around in the water as the waves pushed against the rocks. From time to time, he would come up for air and I would go with him, watching his sleek head break the water.

Sadly, a lot of the coral in this bay was dead, which has been attributed to nearby agricultural run-off from the plantations back in the 70s and 80s. Apparently one drop of round-up is a gallon of poison in the water and can kill an immense amount of coral. However, it was still beautiful and we could hear the crunching of thousands of happy fish feeding on the coral, so clearly it was still appetizing. We went home happy and exhausted.

After tea, we drove into Lahaina, where we selected small souvenirs for our families, and generally relaxed. In the evening, we ate at the Banyan Tree (a restaurant, not the actual tree). We shared a local ale and each had the prix fixe menu with goat cheese salad, hamachi starter, and then B had Ahi while I had Hapu fish. For dessert, B had dense, bittersweet chocolate cake with raspberry dressing, and I had a cheesecake with coffee ice cream. It was a little edgy and easily one of the best meals of my life. The chef there, Chef Jojo, who apparently trained with one of the Iron Chefs, came out to wish us a happy honeymoon. He was so kind! We ended the evening by counting constellations from the hotel pool under a light drizzle.

Our last glimpse of Haleakala, the volcano

On our last morning, we had time to eat our last RC breakfast before we had to check out and hit the road. On the drive, we said a last good-bye to the volcano (left). We managed to return the car and get to the airport early -- about two hours early! So B polled the info desk about what we should do. Of course, they said walk to the beach! The airport parking lot connects to a beach road, where we found kite sailing to watch. It was incredible. Some people were leaping 10 or 20 feet into the air. When it was time for our flight, we went through the security line while being entertained by hula dancers. What a nice send-off! I also thought it was neat that because there had been a canoe competition, so a lot of canoe teams were returning to other islands at the same time. And then we boarded our flight to start the journey home, arriving in SFO by the Monday morning redeye.

It was one of the best weeks ever and a dream come true.

The beautiful Hana coast