step right up and pay your $$$

October 23, 2008

step 3, day 1 today! jess had asked the other day how many ‘steps’ there are, and the answer is 3 — sort of. the ‘sort of’ comes in because step 2 really has two separate tests, so really there are 4 USMLE experiences that one has to endure (and PAY for) before a united states medical license can be obtained. since there are a few pre-meds who read this (i think!), let me clarify:

step 1 is taken typically after the 2nd year of medical school. in my opinion, it is the hardest exam — lots of basic science and questions about the pathology/mechanisms of disease. it is also probably the most important one to perform well on for residency applications — although step 2 is becoming increasingly important as well. it is a day-long exam, and costs about $400.

step 2 is divided into 2 parts. it is typically taken during the 4th year of medical school.
• CK, or “clinical knowledge” is part 1. it is more clinical than step 1, but focused more on diagnosis than treatment. it is also a day-long exam. also about $400.
• CS, or “clinical skills” is the most annoying, because it is only offered in selected cities (philadelphia, atlanta, chicago, houston, and LA, if i remember correctly) and costs a whopping $1200! you wear your little white coat and go in to see fake patients, after which you write up a differential diagnosis and suggest treatments. you are also judged on your performance with these patients (ie if you spit on them and call them names, your score will suffer, and if you don’t wash your hands before touching them, you fail outright). a decent chunk of your score is based on ‘english proficiency’. it is pass/fail.

step 3 is 2 days long, taken during residency, and costs around $700. the first day (today) is pure multiple choice, and it is based on all areas of medicine (so not just pediatrics for me, even though i will NEVER treat a middle-aged man with a heart attack unless we end up on the same airplane at just the wrong moment). it is also very clinical and focuses on treatment/management as well as the diagnostic process. the second day is more of the same, plus a ‘choose your own adventure!’-type deal where you get a patient scenario on the computer and you have to choose what to order as it guides you through the situation. hopefully, none of my virtual patients will die (or have heart attacks). it is not pass/fail, but no one cares what you get.

the classic advice is to study “2 months for step 1, 2 weeks for step 2, and 2 days for step 3.” i went through one book (crush step 3) and still need to go through some of the super-fun ‘virtual reality’ scenarios. hopefully i’ll pass!

after the test, i’m going straight to cameron village (in raleigh) because tonight is clinton kelly night (who knew he had a website?). i can’t decide whether to look cute or frumpy — maybe i’d get hand-plucked from the audience for a stint on what not to wear! i would luuuuv to be on that show. some day when i’m no longer semi-poor, i am going to just give myself the permission to spend $5000 and pretend to be on it. that would be almost as good.

aaaaand speaking of spending, my orange jacket came! it is definitely bright — no one is going to lose me in a crowd! it fits well although the sleeves are a tiny bit long. i ordered the non-petite XS rather than the petite because despite being very short, i have a relatively normal sized upper body (it is my legs that are pygmy-like). i think this was the right choice because the length seems right.

i’ll have to ask clinton what he thinks!

finally — i have to mention that i didn’t even get to give my presentation yesterday! there had been some changing of the dates and someone else (a non-resident) had come to talk about social development in children and i got bumped all the way to december 10th. i guess the question is: do i add pictures? improve things a little? or just leave it be? hmmm. maybe some there is some force of nature that doesn’t want me giving crappy powerpoints . . .



workout: 5 miles easy in the AM — 8:57/mi pace on the treadmill while reading self, 0.5% incline

cooking: still on strike, but i MISS it! i like my own food better than anything you can buy, really.

mindfulness report: i think i’m doing pretty well! i actually got to attend a session last night for residents on mindfulness techniques, and we talked about strategies for staying in the moment when we are working with patients even in stressful situations or during periods of fatigue. we even meditated for a few minutes — something which i am interested in continuing, and something i definitely need more practice with.


  • Reply Kath March 10, 2019 at 7:30 pm

    Awww man – until the word verification. Can you remove that step por favor?

  • Reply Anonymous March 10, 2019 at 7:30 pm

    Cute coat!
    Wow, becoming a doc is an even longer and more painful process than I thought. My boyfriend’s first med school tests are next week. The first and second rounds of tests are being combined because they had to reschedule after Hurricane Ike. Awful.

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