Failed step 1 AGAIN

[wyne79]

I have taken the step I 4 times now and everytime i have come either close to two points or this last time one point of the average.Off course i was aiming for higher than just the average.
I have done the Kapplan review withthe videos,used all types of materials, and now i am just totally at lost.
Can anyone please give me any advise? Has anyone been in or close to the same situation?
I am now desperate and I would hate to give up now.
I do great in the practice exams( USMLE World) but yet i flank the actual exam!!!!
I really need some advice please...anyone

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[Pinkertinkle]

By average do you mean passing (187)?

 

[wyne79]

yes ,last time i was 2pt to the passing score and this time one point of the passing score.

 

[Bubchik]

yes ,last time i was 2pt to the passing score and this time one point of the passing score.

I am so sorry it happened to you. This test is not a fair test I think.

Have you taken Kaplan prep class before: live lectures? I know that their on-line stuff is good, but the live lecture series is much better (and I do not work for Kaplan). I took it, and know several people who failed before taking the course. After the class all three got above 220.

 

[SOUNDMAN]

Are you even allowed to take it again? At our school if you fail and of the board exams three times, you are dismissed from school. It's happened a couple of times and students have appealed but they have all been denied a fourth try. So in that respect, what happens if you don't pass it? Do you have any other options or anything out there? You should think about that, even though we all know you want to be a physician, but the Steps do exist for a reason. Good luck in the future.

 

[futuredo32]

I have taken the step I 4 times now and everytime i have come either close to two points or this last time one point of the average.Off course i was aiming for higher than just the average.
I have done the Kapplan review withthe videos,used all types of materials, and now i am just totally at lost.
Can anyone please give me any advise? Has anyone been in or close to the same situation?
I am now desperate and I would hate to give up now.
I do great in the practice exams( USMLE World) but yet i flank the actual exam!!!!
I really need some advice please...anyone

Are you doing the USMLE practice questions in a timed mode like the real thing? If you're doing great on a lot of practice questions and not on the real thing, do you think that perhaps anxiety is impacting your USMLE score?

 

[wyne79]

Are you even allowed to take it again? At our school if you fail and of the board exams three times, you are dismissed from school. It's happened a couple of times and students have appealed but they have all been denied a fourth try. So in that respect, what happens if you don't pass it? Do you have any other options or anything out there? You should think about that, even though we all know you want to be a physician, but the Steps do exist for a reason. Good luck in the future.

You can take the step as many as 4 times within a 12 moths period according to ECFMG,and since your certification from the school is valid for 5 years, yes i can retake the step again. Now , the only thing is that from the time i took the first step for the first time, i have a period of 7 years to pass ALL the steps(I,II,III). As far as the school,I have been on a dismissed status since the two last time i have taken the exam.The school cannot prevent you from taking the step, but they can after you have passed the step prevent you from getting rotations.At that point your option is to transfer.But with my school worse comes to worse i will have to re-apply for 5th semester.

 

[wyne79]

Are you doing the USMLE practice questions in a timed mode like the real thing? If you're doing great on a lot of practice questions and not on the real thing, do you think that perhaps anxiety is impacting your USMLE score?

I have actually done NBME the first times, and this last time i have done USMLEWorld, and all as tutorials and as the real thing.

 

[wyne79]

Are you doing the USMLE practice questions in a timed mode like the real thing? If you're doing great on a lot of practice questions and not on the real thing, do you think that perhaps anxiety is impacting your USMLE score?

It might be anxiety, cause honestly i don't see anything else it could be.

 

[wyne79]

Are you even allowed to take it again? At our school if you fail and of the board exams three times, you are dismissed from school. It's happened a couple of times and students have appealed but they have all been denied a fourth try. So in that respect, what happens if you don't pass it? Do you have any other options or anything out there? You should think about that, even though we all know you want to be a physician, but the Steps do exist for a reason. Good luck in the future.

Also, yes I want to be a physician and yes the step exist for a reason....i would doubt myself if i wasn't one of the top 5 in my class throughout Basic Science,therefore I am in the right field...just need to find the reason why i do great in my practice or assessment test but poor in the actual exam.But thanks for the input.

 

[wyne79]

I am so sorry it happened to you. This test is not a fair test I think.

Have you taken Kaplan prep class before: live lectures? I know that their on-line stuff is good, but the live lecture series is much better (and I do not work for Kaplan). I took it, and know several people who failed before taking the course. After the class all three got above 220.

I have done the online lectures( w/ videos and books).What i cnt understand is why am i able to score an 85% in the practice exams or the assessments and not in the actual exam?
I wish they had a better way to evaluate students

 

[commander]

I am sorry that you failed, but did you say that you averaged 85% on usmle world?
You said that you took the nbme the first time as a practice and usmle world second time, how about the third time? What was your nbme score estimate? If you haven't paid the 45 dollars for a one of the forms you have not seen before, it means you are not being honest with yourself.
Here is my advice, don't write the exam unless you are scoring above 200 on an nbme form that you have not seen the question before. It is that simple.

 

[wyne79]

I have paid the $45 for a form that i have not seen b4...the third time i also did Uworld...i don't know how much more honest could i be....or even why should i lie to myself!!!!

 

[commander]

why should i lie to myself!!!!

Realize that facing reality is painful but necessary

The fact of the matter is that you did not average 85% on usmle world and that you probably scored bellow185 on the nbme assessment exam and you went ahead and took the exam anyway hopping for a different result.

 

[JeffLebowski]

I am so sorry it happened to you. This test is not a fair test I think.

...huh? It didn't happen to this person, this isn't a tree getting hit by lightning and crushing your car parked in the driveway, your preparation controls your destiny on the USMLE, not the whimsy of fate. 95% of medical students in the U.S. pass the USMLE, and on the first attempt. What are you basing your opinion on that "this test is not a fair test"?

 

[futuredo32]

I am sorry that you failed, but did you say that you averaged 85% on usmle world?
You said that you took the nbme the first time as a practice and usmle world second time, how about the third time? What was your nbme score estimate? If you haven't paid the 45 dollars for a one of the forms you have not seen before, it means you are not being honest with yourself.
Here is my advice, don't write the exam unless you are scoring above 200 on an nbme form that you have not seen the question before. It is that simple.
Realize that facing reality is painful but necessary

The fact of the matter is that you did not average 85% on usmle world and that you probably scored bellow185 on the nbme assessment exam and you went ahead and took the exam anyway hopping for a different result.

Based on your first post to the OP, I thought you were suggesting that the OP had done the same World/NBME questions repeatedly and that was how the OP got that average. Reading your most recent post to the OP, it seems that you're just making assumptions and perhaps false accusations. What would be the point of the OP asking for advice on an anonymous forum if he/she is not willing to be honest here?

I do think that the OP needs to figure out why he/she isn't passing, (anxiety, test fatigue or other factors) and work on that in addition to studying to ensure that the next attempt on Step 1 is a successful one.

 

[Pinkertinkle]

85% on Uworld is very difficult to get, since its my impression 80% on Uworld comes out to about 250 on the real thing. If someone can get 80+ on Uworld and fail step 1 repeatedly, its psychological.

 

[commander]

it seems that you're just making assumptions and perhaps false accusations.

Seriously, Do you really believe that one could average 85 on any practice exam and score bellow 185??

The last thing I want to do is argue with someone who failed the exam 3 times who is asking for our help, and I am really sorry if I called him a liar. All I am saying is that he is in the denial state (hence "being honest with yourself") and must accept reality to move forward. I was simply stating facts in my second post, it is not an assumption.

Yes, in my first post I was suggesting that seeing the same questions again and again perhaps accounted for the higher scores.

 

[commander]

85% on Uworld is very difficult to get, since its my impression 80% on Uworld comes out to about 250 on the real thing. If someone can get 80+ on Uworld and fail step 1 repeatedly, its psychological.

Agree, I would be shocked if one averaged around 85% on usmle world and got bellow 260.

 

[ZonaRidicularis]

z

 

[wyne79]

Realize that facing reality is painful but necessary

The fact of the matter is that you did not average 85% on usmle world and that you probably scored bellow185 on the nbme assessment exam and you went ahead and took the exam anyway hopping for a different result.

FYI sir/miss what would be the point of lying to myself ot=r to others and coming on this forum asking for hepl and advice.Obviously you are the wrong person to do so!!!!
And what would be the point of paying all this money to take the darned exam if i knew that i wasnt ready for it.Stop making false accusation,and please i dont need any of ur advice anymore, cause clearly you have NO IDEA WHAT YOU ARE TALKING ABOUT OR WHAT IS MY SITUATION.
tHANKX

 

[wyne79]

I REALLY WANT TO THINK ALL OF YOU FOR YOUR ADVICES,GOOD OR BAD,AND EVEN THOSE CALLING ME A LIAR!!!!
BUT I THINK I LOOKED FOR THE HELP IN THE WRONG PLACE .
AND YES REPEATEDLY I AVERAGE 80 TO 85% ON THE UWORLD ,AND NO I AM NOT IN DENIAL,YES IT MIGHT BE PSCHYCHOLOGICAL,BUT IN NO EVENT THAT I WOULD PERMIT ANY OF YOU (SPECIALLY COMMANDER)TO CALL ME A LIAR WHEN IT COMES TO MY FUTURE.
I THINK I LOOKED FOR THE HELP IN THE WRONG PLACE.THANKX AGAIN TO ALL!!!

 

[SpinalSnap]

my friend failed it 1 time. She also is a total idiot. I thought she was the stupiest person on earth. I was wrong. When in france!

 

[jackets5]

If you truly are scoring 80-85% on UWorld questions the first time seeing them it is definately psychological. You should see someone about test anxiety that is causing you to fail the exam. Every where you look on the boards people getting 80-85% of UWorld correct are killing the test 250+. If they are questions that are repeated then it may be a little different.

 

[Instatewaiter]

I am so sorry it happened to you. This test is not a fair test I think.

I am going to be harsh here. Unless you have bad test anxiety, you should not be practicing medicine in this country if you cannot pass the exam... The exam is a base level of competence that any practicioner should have.

85% on Uworld is very difficult to get, since its my impression 80% on Uworld comes out to about 250 on the real thing. If someone can get 80+ on Uworld and fail step 1 repeatedly, its psychological.

Agreed.

However, if you were scoring 80% after having gone through Uworld once then it is not a good estimate. Take another practice exam that you have never seen. If you are not scoring above a 200, study more and dont retake until you can.

I have paid the $45 for a form that i have not seen b4...the third time i also did Uworld...i don't know how much more honest could i be....or even why should i lie to myself!!!!

What was your 3 digit score and which form number of the NBME did you take?

A 2 digit score of 85 and an 85% are very, very different things.

 

[Terpskins99]

I'm surprised nobody has brought this up yet, but the OP is clearly a troll.

I REALLY WANT TO THINK ALL OF YOU FOR YOUR ADVICES,GOOD OR BAD,AND EVEN THOSE CALLING ME A LIAR!!!!
BUT I THINK I LOOKED FOR THE HELP IN THE WRONG PLACE .
AND YES REPEATEDLY I AVERAGE 80 TO 85% ON THE UWORLD ,AND NO I AM NOT IN DENIAL,YES IT MIGHT BE PSCHYCHOLOGICAL,BUT IN NO EVENT THAT I WOULD PERMIT ANY OF YOU (SPECIALLY COMMANDER)TO CALL ME A LIAR WHEN IT COMES TO MY FUTURE.
I THINK I LOOKED FOR THE HELP IN THE WRONG PLACE.THANKX AGAIN TO ALL!!!

If these are 50 timed questions per block (which any idiot would tell you is the ONLY way to do these)... there is NO WAY anyone comes anywhere close to failing Step 1 with an 80-85% average on USMLEWorld. Get real, people.

The OP should consider a change of career. The USMLE is hardly the final standardized test you will ever face. How do you expect to get past specialty boards if you can't even tackle a basic sciences medical exam? Don't tell me you are so delusional as to believe that specialty boards are any easier than USMLE Step 1. And it doesn't even end there. As an attending physician, you would be required to re-take and pass those specialty boards again for re-certification every 7-10 years.

 

[Tired]

As an attending physician, you would be required to re-take and pass those specialty boards again for re-certification every 7-10 years.

He won't have to worry about this.

An FMG who failed Step 1 three times will never find a U.S. residency program.

 

[futuredo32]

If these are 50 timed questions per block (which any idiot would tell you is the ONLY way to do these)... there is NO WAY anyone comes anywhere close to failing Step 1 with an 80-85% average on USMLEWorld. Get real, people.

The OP could be a troll, anyone posting on this board could be.

Severe anxiety could totally be the reason the OP failed Step 1. Think of how many people can give a speech at home, yet can barely pronounce a word when standing in front of a group. Do we doubt that the speaker in this situation is able to speak intelligently when they are at home?

As someone who has overcome test anxiety(though not quite to this extent), I think it's perfectly reasonable to think that the OP is telling the truth and it's too bad that he/she isn't getting more thoughtful responses.

 

[Terpskins99]

The OP could be a troll, anyone posting on this board could be.

Oh please.

Severe anxiety could totally be the reason the OP failed Step 1.

Which he would have known after the first failure. For him to suddenly figure it out after four failures and an online suggestion is a bit of a stretch.

Think of how many people can give a speech at home, yet can barely pronounce a word when standing in front of a group. Do we doubt that the speaker in this situation is able to speak intelligently when they are at home?

Great, except we don't treat patients at home.

As someone who has overcome test anxiety(though not quite to this extent), I think it's perfectly reasonable to think that the OP is telling the truth and it's too bad that he/she isn't getting more thoughtful responses.

Failing Step 1 FOUR times after averaging 80+% on USMLE World is not perfectly reasonable. Either he's a troll or he's not being honest about his situation (which is kinda what trolls do).

I gave a thoughtful response. I told him to consider doing something else. If he wants to find a way to get over his "performance anxiety", he should get a shrink.

 

[estrogenic]

i cannot believe how cold and apathetic you are. there is no need to make that person feel worse. things just really happen you know. I just hope that your arrogance will be able cushion your fall when your difficult day comes. its more difficult to learn to be empathetic to people than master the usmle steps so good luck!

 

[ZonaRidicularis]

.

 

[ILikeFood]

i cannot believe how cold and apathetic you are. there is no need to make that person feel worse. things just really happen you know. I just hope that your arrogance will be able cushion your fall when your difficult day comes. its more difficult to learn to be empathetic to people than master the usmle steps so good luck!

That's Terpskin. He's a cold bastard.

 

[Terpskins99]

That's Terpskin. He's a cold bastard.

What are you even doing here? Oh, right. You want to join the small collection of idiot premeds that believes they can give advice on how to pass boards. Good luck with that. In the meantime, do your research. The first few hundred of my posts were about helping real people get through the USMLE.

i cannot believe how cold and apathetic you are. there is no need to make that person feel worse. things just really happen you know. I just hope that your arrogance will be able cushion your fall when your difficult day comes. its more difficult to learn to be empathetic to people than master the usmle steps so good luck!

Yes, because I called out a troll in a test preparation forum I must lack empathy skills with people.

Ok fine. wyne79, if you're for real you're more than welcome to PM me and I'll be happy to help you out.

 

[GMDMD]

Great, except we don't treat patients at home.

We don't treat people with multiple choice tests either.

Although I agree it is highly unlikely that someone would fail after getting 80%+ on timed, new UWorld questions, I don't think it is out of possibility either. And that wouldn't necessarily mean the OP couldn't eventually be a great doctor (or at least as better than many of the *****s out there who get the degree). Perhaps he could do primary care / outpatient medicine and not trauma surgery which would be high stress.

To the OP, if what you say is true I would seek out a doctor of some sort and experiment with any sort of drugs to try and calm your nerves. A beta blocker perhaps? Or an SSRI? Heck smoke some weed if that calms you down. An 80%+ really does translate to the 250+ range so you'd have some leeway there.

 

[size_tens]

Failing step I 4 times in a row will almost certainly prevent you from matching at a US residency. Even if the OP were lucky enough to pass on his 5th attempt and regain admission to med school he would still have Step II to deal with. IMHO there's little reason to keep trying.

 

[Pinkertinkle]

That's Terpskin. He's a cold bastard.

Terpskin is a valued contributor to this forum, unlike some of us here.

 

[discontinuebed]

My story: ~70% on USMLEWorld, completed the entire bank

My score: ~260

There is no way the OP scored ~80% on UW (assuming it's more than 1 block of questions) and failed.

Unless he/she is trolling.

 

[discontinuebed]

He won't have to worry about this.

An FMG who failed Step 1 three times will never find a U.S. residency program.

Also true.

 

[futuredo32]

Oh please.


Which he would have known after the first failure. For him to suddenly figure it out after four failures and an online suggestion is a bit of a stretch.

A lot of us can see symptoms and diseases in our patients yet don't have the insight to see those things in ourselves.

Great, except we don't treat patients at home.

Patients exhibit symptoms at home and are treated for them all of the time.

Failing Step 1 FOUR times after averaging 80+% on USMLE World is not perfectly reasonable. Either he's a troll or he's not being honest about his situation (which is kinda what trolls do).

I gave a thoughtful response. I told him to consider doing something else. If he wants to find a way to get over his "performance anxiety", he should get a shrink.

You also called him or her a troll, which was not thoughtful. If he/she has test anxiety it IS perfectly reasonable to accept his/her statements.

I'm not going to continue to discuss whether or not the OP is a troll, it's really not helpful to the OP and helping the OP should really be the focus of this thread. Personally, I think it's gotta be pretty tough to post about Step 1 failures on SDN where so many people post about getting awesome board scores. I'd rather give the OP the benefit of the doubt and hopefully some helpful advice.

 

[ILikeFood]

Hmmm, I'll reserve my joking for elsewhere. Blood runs wild here.

 

[ILikeFood]

Terpskin is a valued contributor to this forum, unlike some of us here.

I'm a valued contributor of something too. Yes.

 

[jackets5]

performance/test anxiety is just a politically correct term for choking. Really be a man, and pass the test of move on. As a doctor you will need to preform in a much more uncontrolled setting than a prometric test center. The fact that the person hasnt figured out this "test anxiety" until posting on a message board. Im sure this isnt the first big standardized test he has taken, so im sure a professor , advisor, parent etc would have know about it. If the person goes from a predictive score of 260 which is what a 85% on UWorld is to a failing score. Either the person is trolling or they are lying, one or the other

 

[Bleurberry]

Im curious, too, after reading this thread. Someone in the 5 top of their class has a LOT of confidence going in. If it was the nerves, they'd know it immediately. So what's the OP asking us? Could it be some clandestine neurological disease impacting his score? Maybe?
If the OP was still around, I'd ask how they did on the MCAT. I can't imagine USMLE step 1 is more nerve wracking than MCAT. I could be wrong, I'm still on the sidelines, but that's my impression from friends who have taken it.

 

[smq123]

Could it be some clandestine neurological disease impacting his score? Maybe?

I guess....but....this just sounds like one of those highly unlikely, slightly ridiculous scenarios that you'd hear on House, or something.

I can't imagine USMLE step 1 is more nerve wracking than MCAT. I could be wrong, I'm still on the sidelines, but that's my impression from friends who have taken it.

If all your friends really thought that Step 1 was less nerve-wracking than the MCAT, I'd be very, very surprised.

The MCAT wasn't so bad. Yeah, it was long, but not too terrible. The day after I took it, I got on a plane and went to Europe.

As opposed to Step 1, where I walked around in a daze for an hour, obsessing over every single question that I thought I might have gotten wrong. I think that there's more pressure with Step 1 - on the MCAT, if I didn't like my score, I could have taken it again. With Step 1, if you pass then you are NOT allowed to take it again, even if you're very unhappy with your score....so there's more pressure to do very well on your first try.

 

[Law2Doc]

performance/test anxiety is just a politically correct term for choking. Really be a man, and pass the test of move on. As a doctor you will need to preform in a much more uncontrolled setting than a prometric test center. The fact that the person hasnt figured out this "test anxiety" until posting on a message board. Im sure this isnt the first big standardized test he has taken, so im sure a professor , advisor, parent etc would have know about it. If the person goes from a predictive score of 260 which is what a 85% on UWorld is to a failing score. Either the person is trolling or they are lying, one or the other

Nah, there are definitely folks who have real test anxiety -- can do well practicing in the comfort of their own homes, maybe even extremely well on UWorld in that situation, and then lousy in testing situations. But I agree it's hard to imagine they would have gotten through the MCAT and then med school tests to the point that they would be taking the boards. So while I'd say the story is "possible", it's not that "probable". Assuming arguendo that we believe the OP, I have to agree with Tired and size_tens that it's probably a moot issue at this point -- if you failed Step 1 4 times, you won't likely be able to land a US residency even if you passed on #5. Only 40% of non-US students land US slots, and it's hard to imagine someone with this kind of track record will be one of that lucky 40%. So unless you are doing this just to prove something to yourself, OP, it might be time to seriously consider hanging up the gloves.

 

[Terpskins99]

Im curious, too, after reading this thread. Someone in the 5 top of their class has a LOT of confidence going in. If it was the nerves, they'd know it immediately. So what's the OP asking us? Could it be some clandestine neurological disease impacting his score? Maybe?
If the OP was still around, I'd ask how they did on the MCAT. I can't imagine USMLE step 1 is more nerve wracking than MCAT. I could be wrong, I'm still on the sidelines, but that's my impression from friends who have taken it.

Well, the OP claims to be an FMG. So that in mind, its very likely he struggled on the MCAT's as well.

Personally, I didn't think Step 1 was nearly as stressful as the MCAT. Each block of questions only last an hour. So time management isn't as much of an issue for most people. You will rarely be forced to skip large numbers of questions as you might on the MCAT.

Also, Step 1 is almost exclusively a knowledge based exam. There is no disputing the correct answer. Yes it tests your ability to grasp certain concepts, but for the most part either you know the answer immediately or you don't.

Example: 23 year old female walks into the clinic complaining of a rash that developed on her leg following a hiking trip (picture below). What is the most appropriate drug to use?

(So you're being tested whether or not you can recognize the rash erythema migrans/"bulls eye lesion", the disease Lyme's and the appropriate treatment doxycycline.

 

[78222]

I agree with Terpskins, there is no way this person is being honest. You don't score 85% on UW unless you are just heads and shoulders above everyone else and you certainly don't go from 85% on UW to <185 on STEP I.
If the OP is serious, he really does need to rethink careers. I know it sucks but lets face it, if you've taken STEP I 4 times and failed, you aren't meant for medicine (and you will NEVER match into a US program).

 

[Law2Doc]

I agree with Terpskins, there is no way this person is being honest. You don't score 85% on UW unless you are just heads and shoulders above everyone else and you certainly don't go from 85% on UW to <185 on STEP I.
If the OP is serious, he really does need to rethink careers. I know it sucks but lets face it, if you've taken STEP I 4 times and failed, you aren't meant for medicine (and you will NEVER match into a US program).

There certainly are plenty of performance anxieties folks have, ranging from public speaking to public urination to inability to perform on tests. Such a person could score quite well at home but do lousy at Prometric. However this person would need to have gotten through the SAT, the MCAT and college and med school tests somehow, to get to this stage. So it's not impossible, just improbable.

I do agree that matching is unrealistic, and would point out that Step 1 is but one more pitstop on a long road full of tests. So even if one passes Step 1 on the 5th try, are Step 2 and 3 going to be any better? And various specialty exams? And recertification exams? this is a career full of this kind of test.

 

[78222]

There certainly are plenty of performance anxieties folks have, ranging from public speaking to public urination to inability to perform on tests. Such a person could score quite well at home but do lousy at Prometric. However this person would need to have gotten through the SAT, the MCAT and college and med school tests somehow, to get to this stage. So it's not impossible, just improbable.

Had the OP stated he was scoring 50-70% on UW, I could perhaps buy into the performance anxiety thing. However, I've seen very few SDNers who claimed an average of 85% on UW, and this forum tends to be inhabited by the top 10%. I averaged in the 70s and still ended up at ~250. Like you said, possible but highly improbable.

 

[GMDMD]

There certainly are plenty of performance anxieties folks have, ranging from public speaking to public urination to inability to perform on tests. Such a person could score quite well at home but do lousy at Prometric. However this person would need to have gotten through the SAT, the MCAT and college and med school tests somehow, to get to this stage. So it's not impossible, just improbable.

I do agree that matching is unrealistic, and would point out that Step 1 is but one more pitstop on a long road full of tests. So even if one passes Step 1 on the 5th try, are Step 2 and 3 going to be any better? And various specialty exams? And recertification exams? this is a career full of this kind of test.

Even if it's highly improbable I wouldn't be surprised to see any exceptions to the rule show up on the internet asking for advice. It is also possible that the person recently acquired the anxiety problem do to some more recent occurrence/stressor. I don't see the OP's presentation being any more outlandish than some of the crazy stories we see from patients on rotations.

Besides, Step 2 and Step3 are significantly less stressful. MCAT you can always take over again, and at that point you haven't invested 100k in graduate education.

The OP could be a troll but I don't see the motivation from the tone of his/her posts. Certainly doesn't appear to be trying to be humorous in any way. Personally, as with any of my patients, I'd rather err on the side of caution than respond with some of the callous remarks by some of the posters here (not directed at you).