Step 1 Anxiety

[Throwaway1234a]

---

Members do not see this ad.

I think I'm on the cusp of an anxiety attack.

I've been studying for a month, trying as hard as I can to hammer down my weak points. There are many. Now I'm just a few days off of my exam.

I used UWorld. I used Pathoma. I did the NBMEs and the UWSAs. It isn't pretty. I'm not going to be getting 275 or whatever the standard SDN score is. Sure, my scores are going up. I've memorized the biochem diseases which make no sense and the entire psych section. And all the drugs. And most of the micro. And I'm sitting here, reading through Pathoma again on my 3rd go and just trying to internalize whatever I can.

I am absolutely terrified. Horrifying terrified.

I feel like everything is riding on this exam I'm about to take. My entire life is going to be summarized by a single test. My self worth even. I'm afraid I'm going to forget everything and blow it. I'm afraid that I'm just not good enough; a fraud who doesn't belong here. I can't remember anything.

I used to think that I was a capable person, that I was smart and I could learn but I don't have that confidence anymore. I feel like it comes so easy for everyone else when I can barely figure out HOW to study a topic, let alone give myself enough time TO study once I learn the best technique.

And I'm terrified. I'm terrified because I KNOW how important this test is and when I see people posting up scores of 250, 260, 270 like its nothing it makes me feel inadequate. I'm lonely because there is no one I can discuss these feelings with. You can't admit to anyone that you're losing it inside or ask them what to do, what they do, to do better.

I see others performing how I believe I should be able to perform and I feel helpless. So, I put up a front of confidence. Really, I'm not confident at all. I'm terrified that I'm going to put up a 220 or something and never be able to pursue the specialty I want. I didn't come here to do family practice. I came here to be something everyone in my life told me I could never be and I feel like, in the absence of a time machine to go back to February and just cut class and study for this goddamned test, I wonder if I'm about to prove those people right.

I'm terrified that I am going to fail. Not just the exam but at life.

I can't talk to anyone about this. I feel like any sign of weakness and people will use it against you. We're supposed to be colleagues but lets face it, if the numbers weren't important we wouldn't be competing for them.

Does anyone else feel this way? Is it just me? Did I just make some other person very happy to know that someone else is unsure of himself and now there's an opportunity?

I believe I'm not the only one but how can I know?

I hate this.

 

[ipizzy]

It sounds like you are going through hell. I'm really sorry that you're feeling this way, all I can do is reassure you that you're going to be OK. I know this probably sounds like an empty or canned response but try to remember that anxiety can really distort the way we look at things. Facts I know about you: you're in medical school, you're going to be a doctor, and I don't think even a 220 (which is a perfectly respectable score) would close all doors. (Let's be honest; SDN is basically a giant circle jerk for kids pulling high scores).

I don't think it is a sign of weakness to feel this way at all. I had a discussion with a physician at my institution yesterday about my own severe anxiety over not being able to keep up with third year, and he reminded me that physicians/residents/interns/med students are all imperfect, human beings. More of these people than you know are struggling with self-doubt, feelings of inadequacy, depression, and the sh*ttiness that life in general can throw at you. We are not alone and there are people in this rooting for us.

Maybe take a break from studying tonight, reconnect with some friends or family, watch some crappy TV, and promise yourself to start fresh in the morning. If you want to talk some more, please don't hesitate to PM me. And hang in there, you're almost done

 

[akot]

The last thing you want to do be so harsh on yourself few days before the exam. You may not be in the 99% but by the looks of it you have studied really hard and have done everything that you could possibly do to kick STEP 1 in it's gluteus maximus!! 🙂

I think we sometimes have such high expectations of ourselves because our competition are best of the best in the country and it's hard not to have this constant fear of failure. However, you need to remind yourself that this one test although plays a significant role in the specialty you are going to choose but it does not tell you what kind of doctor you are gonna be and most importantly what kind of human being you are gonna be. Step 1 is just a number for the residency application -- your discipline, determination and your passion for medicine will speak volumes for the rest of your life and that is the bigger picture that we often forget in this rat race.

I believe that you are going to rock this test and trust me they are 1000s of other medical students who are just as freaked out as you so take a breather and believe in yourself. Do the best you can and as my mentor always says you might not always get what you want but you will get what you need. Goodluck my friend.

 

[openmindcnhealu]

I sympathize with you a bit. I have the big exam in a week. Some weeks ago i began looking at the step exam from a more philosophical perspective. As we learn these pathologies we realize there is a great amount of biochemical variation between people. A little more than dicovery channel quotations of how we are only 2% different from chimps would have you believe. As the 20/100,000 3/100,000 1/8 breast cancer in women stats all start to stack up you realize so much that can go wrong. You may think maybe my brain has mutations for the "smart" proteins or there is needless hypermethylation of histones for those genius genes. Then you take into account the different learning styles, Myers' briggs personality types, and finally the ominous notion of various environmental factors: nutrient def./toxins/social circumstances, that interact with your set of genes and then it hits you. The step isn't fair, the mcat isn't fair. Most assessments of human intellect are not fair because everything that determines a person's potential consists of a bunch of moving pieces with unknown variables and butterfly effects from the interactions. The most successful are those who stumbled upon methods to learn the most quickly, and review material at the most appropriate intervals before it is forgot. There are too many resources in the form of memory books and brain nootropic supplements. The contradicting sound chamber of commerce often prevents us from finding the right ones for our circumstances. Quite insanely we crutch on the few well known memory aid systems like mnemonics and wrote memorize poorly edited review books.

So the administration of a standardized exam that will return a number institutions use to objectively determine your potential is obviously unfair. It is the system we agreed to as a western civilization. What i do and advise you to do is to take your mind off the outcome of the exam. Imagine some other near future disaster that can remove you from the medical field entirely. You will see that no moment in the future has certainty and discernible character. It is wise to focus of future possibilities where you adhere to whatever moral code you created for yourself knowing that such adherence will at least minimalize the intensity of unknown future adversities.

I agree it can be disconcerting seeing people with time to get engaged in medical school claiming 250+ step scores living seemingly perfect lives, often from wealthy physician families. Realize are many others on this forum who see this and don't post realizing they are not as fortunate. the most important thing to take from this wall of text is reflection on the imperfection of the measurement sticks we use for human potential. Realize that study 14hours a day for weeks is not healthy and a sign that something is wrong with the system we set up. Realize that people thought thought the world was understood in the 60's and the internet didn't even exist. Realize that millions fail to reach even a tenth of their potential simply because they were born in a small village with poor sanitation and a despotic government. The horrors may not overwhelm us if we effectively contrast.

 

[hotchik]

I think I'm on the cusp of an anxiety attack.

I've been studying for a month, trying as hard as I can to hammer down my weak points. There are many. Now I'm just a few days off of my exam.

I used UWorld. I used Pathoma. I did the NBMEs and the UWSAs. It isn't pretty. I'm not going to be getting 275 or whatever the standard SDN score is. Sure, my scores are going up. I've memorized the biochem diseases which make no sense and the entire psych section. And all the drugs. And most of the micro. And I'm sitting here, reading through Pathoma again on my 3rd go and just trying to internalize whatever I can.

I am absolutely terrified. Horrifying terrified.

I feel like everything is riding on this exam I'm about to take. My entire life is going to be summarized by a single test. My self worth even. I'm afraid I'm going to forget everything and blow it. I'm afraid that I'm just not good enough; a fraud who doesn't belong here. I can't remember anything.

I used to think that I was a capable person, that I was smart and I could learn but I don't have that confidence anymore. I feel like it comes so easy for everyone else when I can barely figure out HOW to study a topic, let alone give myself enough time TO study once I learn the best technique.

And I'm terrified. I'm terrified because I KNOW how important this test is and when I see people posting up scores of 250, 260, 270 like its nothing it makes me feel inadequate. I'm lonely because there is no one I can discuss these feelings with. You can't admit to anyone that you're losing it inside or ask them what to do, what they do, to do better.

I see others performing how I believe I should be able to perform and I feel helpless. So, I put up a front of confidence. Really, I'm not confident at all. I'm terrified that I'm going to put up a 220 or something and never be able to pursue the specialty I want. I didn't come here to do family practice. I came here to be something everyone in my life told me I could never be and I feel like, in the absence of a time machine to go back to February and just cut class and study for this goddamned test, I wonder if I'm about to prove those people right.

I'm terrified that I am going to fail. Not just the exam but at life.

I can't talk to anyone about this. I feel like any sign of weakness and people will use it against you. We're supposed to be colleagues but lets face it, if the numbers weren't important we wouldn't be competing for them.

Does anyone else feel this way? Is it just me? Did I just make some other person very happy to know that someone else is unsure of himself and now there's an opportunity?

I believe I'm not the only one but how can I know?

I hate this.

You may not like what I post, but I'm gonna be honest with you...

You put way too much weight on this one test...residency positions are not 100% based on your USMLE 1 score.

Also, life is more than just a career... how bout family? friends? will getting a good score get you more of these?

I think the reason you are feeling this way is cause you got a narcissistic belief that you need to be the best (can't stand being average), and if you don't achieve that, then you lose confidence and suck. Trust me, there's always someone better than you no matter what. Take pride knowing that you're smarter than probably 90% of the people in the US.

I empathize with your situation alittle, but you lose me when you say "I didn't come here to do family practice.." You are implying family practice is a crap field...I'm kinda hoping you rethink your situation because family practice is an awesome field to go into, not just a field for rejects who scored low on step 1.

btw just to push your buttons since you pissed me off with that stab at family medicine...my practice scores to date are:

UWSA1: 800/265
UWSA2: 800/265
NBME 12: 252
NBME 13: 259

And guess what...I'm going into family medicine!!!

Bottom line: take a chill pill...just do you best...don't get jealous when you see someone do better than you, rather, be happy for them. You won't find happiness in life on the path your on

Hope this helps...I'll probably get alot of criticism for this post, wat ev...

 

[Lonely Sol]

You may not like what I post, but I'm gonna be honest with you...

You put way too much weight on this one test...residency positions are not 100% based on your USMLE 1 score.

Also, life is more than just a career... how bout family? friends? will getting a good score get you more of these?

I think the reason you are feeling this way is cause you got a narcissistic belief that you need to be the best (can't stand being average), and if you don't achieve that, then you lose confidence and suck. Trust me, there's always someone better than you no matter what. Take pride knowing that you're smarter than probably 90% of the people in the US.

I empathize with your situation alittle, but you lose me when you say "I didn't come here to do family practice.." You are implying family practice is a crap field...I'm kinda hoping you rethink your situation because family practice is an awesome field to go into, not just a field for rejects who scored low on step 1.

btw just to push your buttons since you pissed me off with that stab at family medicine...my practice scores to date are:

UWSA1: 800/265
UWSA2: 800/265
NBME 12: 252
NBME 13: 259

And guess what...I'm going into family medicine!!!

Bottom line: take a chill pill...just do you best...don't get jealous when you see someone do better than you, rather, be happy for them. You won't find happiness in life on the path your on

Hope this helps...I'll probably get alot of criticism for this post, wat ev...

I agree with you, hotchik (btw, holy crap on those scores!..hah)...Life is too short to be only worry about this test...Being book-smart is not gonna make you a better doctor. You have to have social skillz and be able to cope with stress. This exam stress is just the first step in many stressful situation you will be faced with throughout your life, both personally and professionally!

I understand your mad at ureself for not doing well..but being bad at yourself wont make you perform well on the exam. Just relax..and focus on ure weaknesses as far as this exam goes

Good Luck with your future endevours!

 

[Untraditional]

just to push your buttons...

UWSA1: 800/265
UWSA2: 800/265
NBME 12: 252
NBME 13: 259

.

Why was that necessary?

This is exactly the kind of stuff OP was talking about. You're just validating him.

I didn't know that bullies gravitated to FP.

 

[iCY]

sounds like a troll. theres been alot of troll posts around here recently

you are a future doctor and currently an adult. get your **** together. People who get 250s here do so because they work hard for it all year. If you didn't do well all year, you really can't expect yourself to be scoring that high.

 

[MrBeauregard]

UWSA1: 800/265
UWSA2: 800/265
NBME 12: 252
NBME 13: 259

And guess what...I'm going into family medicine!!!
.

Why was that necessary?

This is exactly the kind of stuff OP was talking about. You're just validating him.

I didn't know that bullies gravitated to FP.

Yeah, that was pretty unnecessary. You definitely proved OP's point.

And take a look at the NRMP match data: FP consistently has around the lowest board scores. Does this mean those students aren't as smart? Absolutely not. But the data is there showing the scores are lower. I'm pretty sure that's all OP was pointing out, not that FP is a field for dummies.

Anyways, to the OP:
It's really tough getting on SDN and seeing all of these stellar scores. You must realize that SDN, for the most part, represents the top 10% of medical students. Those in the middle of the pack (and lower) probably don't frequent this forum all that much, or if they do, they don't post. As a result, there is some extreme sampling bias going on here.

My advice to you (and to myself): Step 1 is not the end-all-be-all. It is a single test. Your worth is not found in your score. You are more than the the number you receive. You are a competent, compassionate, and whether or not you believe it, a smart and capable person (you wouldn't be here if you weren't). You will be a physician one day, and that's a respectable thing and something you should take pride in. You'll be seeing patients day in and day out in twenty years, and the questions you missed on Step 1 won't ever cross your mind again. Your ability to treat disease and help the people who call you "doctor" will mean more to you than a score on a test ever will. Take a break. Do some self-reflection. And if you feel like it, pick up the books and hit it hard these last few days. See Step 1 not as an obstacle or impedance, but rather as a challenge. Be excited to study and realize how awesome it is to be privy to the information we receive. Be confident in what you know. And let your score be what it will.

Good luck to you (and to everyone else taking this test this year)!

 

[ohyeahbaby]

It sounds like you are going through hell. I'm really sorry that you're feeling this way, all I can do is reassure you that you're going to be OK. I know this probably sounds like an empty or canned response but try to remember that anxiety can really distort the way we look at things. Facts I know about you: you're in medical school, you're going to be a doctor, and I don't think even a 220 (which is a perfectly respectable score) would close all doors. (Let's be honest; SDN is basically a giant circle jerk for kids pulling high scores).

I don't think it is a sign of weakness to feel this way at all. I had a discussion with a physician at my institution yesterday about my own severe anxiety over not being able to keep up with third year, and he reminded me that physicians/residents/interns/med students are all imperfect, human beings. More of these people than you know are struggling with self-doubt, feelings of inadequacy, depression, and the sh*ttiness that life in general can throw at you. We are not alone and there are people in this rooting for us.

Maybe take a break from studying tonight, reconnect with some friends or family, watch some crappy TV, and promise yourself to start fresh in the morning. If you want to talk some more, please don't hesitate to PM me. And hang in there, you're almost done

what an awesome reply 👍

 

[MedFarmer]

lol forum actually turned out to be pretty funny. Everyone makes the stereotype jokes that FM are the medical students who couldn't do well enough to do a specialty, the ortho guys are the jockey meat heads, the radiologists/pathologists are the antisocial night crawlers who rather check out your feet than your face, dermatologist are the fake docters who pop pimples, the ophthalmologist is the doctor who fakes an interest in the eye but has only an interest in money, neurologist are the quacks that can identify any problem but cant fix any problem... etc.

The truth is... they are all ordinary people. Just some people have different interests than others. And scoring a 220 will not close doors, it just means you will have to work harder to show an interest in the specialty you want throughout 3rd and 4th year. There are plenty of people in surgery and other competitive fields with 220s, this is not the end of the world.

 

[hotchik]

Why was that necessary?

This is exactly the kind of stuff OP was talking about. You're just validating him.

I didn't know that bullies gravitated to FP.

Necessary to piss OP off since he was frustrated with people posting their "high" scores on SDN...why piss OP off? Cuz he was insulting family medicine... 🙂

 

[Ok2Panic]

I'm not sure I entirely understand what the hell is happening here. As far as I can tell, the only "affront" that the OP made towards Family Practice is that he didn't want to end up in that specialty. How is that insulting the specialty? Or just any excuse to post your practice test scores?


Anyway, OP, I'm with you. A lot of your post really echoed verbatim some of the things that have been running through my mind the past couple of weeks. But I have to reiterate what ipizzy said. This is not the end of the world, this test is not a measure of your self worth, and you need to take a deep breath and do something else for the night. I don't really have much to say other than that you're definitely not the only one.

 

[Untraditional]

Necessary to piss OP off since he was frustrated with people posting their "high" scores on SDN...why piss OP off? Cuz he was insulting family medicine... 🙂

Well, if we give him the benefit of the doubt and assume this wasn't a troll post isn't this attitude that he simply didn't work hard enough and should suck it up exactly what he's saying has made him anxious?

It seems to me that he's frustrated with working hard for little return and is unable to identify what he's doing wrong with his effort.

But, I digress. I'm sure you'll do great in your top FP residency with your aggressively spiteful approach toward such people! 👍

 

[theRainmaker78]

Necessary to piss OP off since he was frustrated with people posting their "high" scores on SDN...why piss OP off? Cuz he was insulting family medicine... 🙂

I'm in the same position as the OP. Feeling the exact same way. But I have to agree with this post from hotchik. There was no reason to hate on Family Practice. Becoming a doctor is an honor and privilege, and looked up to regardless of specialty.

Anyway, hotchik needs to expect people to think that about Family Medicine and not take offense to it.

 

[MedFarmer]

I agree, the negative comments effect people and I think we should try to not make comments like that even if it is unintentional. I initially loved family medicine when i started medical school and I am not sure if it was because of all the negative comments I got from upper classmates or my own classmates, but it was really hard to keep a positive attitude during my shadowing experiences at FM practices and it started to kill my interest for the specialty. My close friend however still actually enjoys it, but he is also afraid what others will think of him and he does not want society to think he is stupid or did not score well on his boards if he goes into FM.

But to turn this forum away from bashing the OP... we all feel overwhelmed, depressed, and even to the edge of wanting to give up. It sucks, but you just have to push through. I have internal crisis every week, but you just have to move forward and move on. This is not the end of the road nor will it be whatever score you get high or low.

 

[Snoopy2006]

Necessary to piss OP off since he was frustrated with people posting their "high" scores on SDN...why piss OP off? Cuz he was insulting family medicine... 🙂

Way too defensive. I can walk into a room of 50 doctors and find someone who'll make fun of almost every specialty out there, or think poorly of it. So what? Why do you need validation from others? Taking shots at someone verging on a panic attack is pretty childish.

Family Practice is amazing! Please don't throw your scores at me!

OP: If you're "worried' about blowing the test on a "220," you're in better shape than a large percentage of med students across the country. If you've gotten to this point, it's likely test-taking is a skill you've excelled at. You have the knowledge, so have some faith in yourself. Even an average score can be supplemented with great shelf scores, research, letters, etc.

And on the other hand, while I disagree with the poster throwing their scores at you, I can see why your comments about FP were taken the wrong way. Looking down on your future colleagues isn't the best way to endear yourself to others. If you're coming on SDN looking for help/advice, it's probably best not to insult other med students/doctors.

 

[ButterIsMagical]

Okay, look. I did this last night. It was awful; my score dropped back to pre-study levels (which actually isn't the end of the world but HUGELY demoralizing), and I spent the whole night crying to various family members and being generally embarrassing and silly. Did I wait too long after finishing DIT to take it? Was my score improvement a fluke? What if I belong at this average-ish score? Should I have just gone to get a PhD, like my original plan? To which my boyfriend responded, "What if I had a two foot long dick? ... But then why would I want it to be smaller?"

Idk, I feel better today. It sounds like you're doing what I did -- focusing so much about the future and residencies that you're getting distracted from the immediate future -- step one. Focus on the material! This stuff is cool! Science! And things!

And second, when I broke down my percentage scores, I saw that I was actually scoring higher, but the curve varied a lot from test to test. So, there's a lot you can't control about your test because of the way it's scored. Oh well! Might as well just do the best you can because that's all you can control. Or, as my mother advised, you could unleash a virus among all the other students taking step one on that day. This is also an option.

(Also, because you're still going to be thinking about it, residency match data shows people with 220's getting into every speciality. Even with a 220, you can get into ANY speciality, except for plastics. For plastics, god help you - 50% of the people with >260's still don't get in. BUT, there's still some guy with a 218 who got into plastics. So there's that.)

 

[Aclamity]

Everyone feels this way, but seriously dude you need to stop complaining and get laid or something. This "woe is me" attitude isn't going to get you anywhere. If you're worried about getting a "220 or something"--if that's TRULY your fear--you're in a MUCH better position than the people who are just hoping to pass. With a 220 you can still do almost everything you want (assuming you're at an MD school and don't care about location that much).

what are your practice scores like? Look at them and realize that most people get around their practice scores, so if yours are good then just be comforted by that.

Also, I hate to be "that guy," but from your post it sounds like you fell into the trap of memorizing for the sake of memorizing (e.g. you say you've memorized the biochem diseases that make absolutely no sense). ALL the biochem diseases should make sense, and they do. So I'm not sure how/what you studied. I guess it's too late to change anything now, but don't let that kind of stuff happen for Step 2.

Which brings me to my final point: there is ALWAYS step 2. step 1 is not the be-all-end-all that you make it out to be. Good luck man, I hope you get what you want

 

[newdoc2013]

OK i started to read your post then i got too stressed to finish it. I think at this point the most high yield thing you could do is chill and go to a movie or something. Take some time off. While there is a lot riding on this exam, it is definitely NOT everything.