Confronted Step 1 yesterday, for the first and -- I hope -- last time. This was a test I'd been dreading: it's been three years since I've been in basic science classes, and there was much to fear. Here at Duke, we get one long year of basic science, then hit the wards in our second year. Following that is a year of research during which cram in some studying (aka "totally relearning") when we can. To make things extra challenging for myself, I went and had a baby during my research year -- a beautiful girl who is possibly one of the worst sleepers on the planet. I'm currently wrapping up research year number two.
I'd been studying off and on since New Year's, but only really went into high gear for the last three weeks. Postponed the test three times as well. I kind of enjoyed the day when I realized that I was no longer able to postpone without re-registering. Gave me a nice sense of inevitability.
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The sign-in process at my local Prometric bears a disconcerting resemblance to being remanded into custody. You and your ID card are scrutinized with a look of extreme scepticism, as if they know you're trying to get away with something but they can't quite prove it. You're grudgingly allowed to proceed. All your belongings go into a bitty little locker, and your even have to empty out your pockets for them. At least they didn't insist upon a body-cavity search. I had brought a wool stole to wrap around myself in case it got chilly, but was informed that this was a Prohibited Item. Why? Do they think I've somehow managed to knit secret notes into the fabric? Or are they afraid I'm going to hang myself with it if things don't go well?
Either way, they needed have worried.
The test, as it turned out, felt surprisingly OK. There were one or two rough blocks, but most of the questions felt very straightforward. The emphasis was absolutely on Big Concepts rather than minutiae -- and that was great. Some subject areas are of necessity more detail-oriented than others, however, so here's a subject-by-subject breakdown.
Anatomy
Q-bank had led me to expect the worst, but this topic was welcomely under-represented on my test: 5-10 questions max (including embryology). Some were straightforward vascular or nerve Qs; some were integrated with pathology (you had to identify the condition first) +/- radiology (identify the affected area on a CT scan). The embryology ones were interestingly concept-y: description of an obscure developmental anomaly, speculate upon what it might have caused it or what it might be associated with. Not something you'd find in First Aid, or on Q Bank, for that matter, but something that drew upon
concepts that you'd find in both those sources.
Behavioural Sciences
Very QBank-esque. Predictable biostats Qs, and the usual scenarios -- for each one, you were given the option of insulting your patient or referring her to your more knowledgeable colleague as well as the (presumably correct) warm and empathetic "tell me more about..." response. A few oddball questions that you just had to guess at.
Biochemistry
Another unexpectedly scanty topic. Few questions; all of them (the ones I remember) were in a clinical context: we were given a case presentation, then asked to choose which enzyme wasn't functioning or which substrate was missing.
If you could recognize the disease, it was pretty easy to determine the answer, since the enzymes would be from completely different metabolic pathways.
Cell/molecular biology
Basic stuff, some of it coming from Bio101 rather than med school (wish I'd reviewed some of those notes instead!) A few things you had to guess at -- guessing at the function of cousins of genes you'd run into in other contexts, for example.
Micro
Again (this is my theme, I guess), the principles were more important than the details. I had quite a few questions about
how bugs make us sick, none that required me to know whether a capsid was helical or icosahedral. Also quite a few standard-issue we'll-describe-the-disease-and-you-pick-the-pathogen questions. Basic immuno questions, though often cloaked in such a way that you didn't recognize them at first.
Pathology
Pathology was everywhere! It was the rare question that
didn't have a pathological flavour to it. So much of my test involved recognizing the salient s&s of a disease (based on its gross or micro appearance or a description of a patient with the condition), then picking out the likeliest presenting symptom, or the major risk to the patient, or the correct treatment. Missing, but not missed, were any questions on HLA type or chromosome number. Nor did that horrendous FAB leukemia classification system show up -- the one that's everywhere in QBank. And not a single eponym.
Physiology
The physio questions on my test were
exactly like QBank. Had quite a few of those godawful ones that make you choose one of eighteen possible combinations of up or down arrows for seven different physiological parameters, and you get seasick trying to find the right answer. I'd spend about five seconds deciding what the answer
should be, then another three minutes actually locating it among all the other almost-identical-looking ones. I was sorely tempted to use my dry-erase marker right on the computer screen in order to keep track of the answers I'd already rejected, but I figure that might have constituted an "irregularity."
Pharmacology
Basic, though sometimes they'd get tricky with those basics -- make you think that they wanted you to pick out which drug was a p450 inhibitor, when really they were after something altogether different. On my exam, mercifully, I encountered only the major representatives of each class o' drugs. None of the more obscure poly-wolly-sylabic sulfonureas, for example, just good ol' glyburide.
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Out of time -- will add more later.