Fasika Aberra, who serves as vice president of the Medical School’s Black Medical Association, preceded her second year with an experience shadowing a community hospital’s lone physician in her native Ethiopia. The hospital is run by the Missionaries of Charity, established by Mother Teresa. “My connection to the hospital goes back to my high school years of volunteering, which was one of my earliest exposures to caring for the most needy,” Aberra says. “The hospital has not changed much from the time I left.”
Each morning before rounding with the physician, who cared for everything from infant ear infections to the many HIV patients’ opportunistic infections, Aberra visited the mentally challenged children. “Feeding and cleaning them made me count my own blessings as well as develop my comfort level with those who might be considered difficult to care for.
“Empathy and gracefulness in the face of adversity were the greatest lessons I got out of my experience,” she says. “However, I also got the opportunity to learn more physical exam techniques that aren’t frequently used here.”
For each of the students, their varied experiences and intensive studies worked to prepare them for the second year’s main event …
Officially known as Step 1 of the U.S. Medical Licensing Exam, it is widely regarded as the most important and most difficult exam medical students will face. U-M’s second year is shorter than most medical schools’, and as a result Michigan students take the Step 1 exam earlier than many others. This adds to the second-year workload, but affords students in their third year the opportunity for extra clinical rotations prior to the time of residency applications. U-M medical students are not only more competitive as a result, but they also gain more background with which to make informed specialty decisions.
Course work was completed in late March, and students then had five weeks during which to study and prepare for Step 1. They can remain in Ann Arbor, take the opportunity to be with family, or study anywhere, in any environment they choose. It may sound like a break to some, but these are five weeks of, in most cases, 12-15 hours of study nearly every day.
“No matter how you slice it, studying for the boards is a daunting experience,” Brown admits. “But in the weeks before the study period began, professors from our first and second years came out of the woodwork to teach review sessions on high-yield material. These sessions were taped and made available to us online to use when we got to the particular topic during our preparation.”
Aside from the sheer amount of material, Brown found challenge in facing full days of 12 or more hours of studying from the same book, 35 days in a row. No longer did lectures, labs and patient encounters mix up her day. To counter the monotony, Brown paired with best friend and fellow medical student Raina Vachhani, who would call her at 8 a.m. to coax her out of bed to start the day. “We switched things up by studying at her house in Owosso, Michigan, for a few days, by exploring new libraries and coffee shops around campus, and sprinkling in a few days off. Despite our best attempts, however, there were times when the most exciting part of my day was opening a new pack of highlighters.”
Consisting of seven blocks of 48 questions each, for a total of 336 multiple choice questions, the exam allows students an hour to complete each section, with short breaks between sections. Administered at standardized testing sites in Ann Arbor and elsewhere, location and timing are about the only choices involved; students select their test day during a prescribed period of time. Schedules are rigid and security is tight; in addition to multiple forms of identification, fingerprinting, and storage of all personal items in lockers, exam-takers have to reverse every pocket in their clothing each time they access the room. Cameras closely monitor the testing room.
Aberra chose the last optional date to take her boards, to afford herself as much time as possible to prepare. “The study period is given to us to recall and learn to integrate information and start thinking more like a clinician,” she says. “Pushing it to the last day made sure I had enough time for my final review.”
Most students study from a 400-page book, First Aid, provided to each student at the beginning of their second year by the Medical Center Alumni Society. Brown says, “It really helped boost my confidence to remind myself that as a Michigan medical student I had become accustomed to being tested on 500 pages of new material a week. Of course, I would tell myself, I can learn 400 pages in five weeks!”
But what most helped Brown keep her confidence going was advice Professor of Pathology Andrew Flint, M.D., gave them. “Every day as I studied,” she says, “I could hear his voice in my mind: ‘I can promise that not one of you will come back to your 25-year reunion and say, if only I had gotten a few more points on my boards. You will look around the room and think how proud you are of your classmates, how much you love your family, and how grateful you are that you ended up in your field and practice.’ ”
Still, in the moment and at the time, the Step 1 stakes are high. While it’s true that Michigan medical students, among the best and brightest in the country, typically score well and passing isn’t usually an issue, numerical scores in addition to passing or failing add import and dimension to a student’s performance. One of those scores is the one that truly matters: It’s the one residency programs use to stratify applicants. Some specialties have higher cutoffs than others, and a low score can limit a student’s residency options. No wonder the stress can soar. And with grading replacing pass/fail in year 3, suddenly medical school has become a more competitive venture.
Each of the students found his or her way of coping. The Romeros tried to view Step 1 as just one more test along the way, and the study period as an “incredible opportunity to hang out together and consolidate all the information we had learned during the first two years,” Ron says. Like Aberra, they chose a test date toward the end of the study period, and made sure to take off every Sunday and almost always got eight or nine hours of sleep.
Aberra admits to times of frustration and stress during the study period, but made the best of the limited time she had and reassured herself that she had prepared to the best of her ability. “It was challenging to integrate all the basic science information from different sequences into clinical scenarios. But after a few practice tests, I realized that most of the scenarios were familiar because they’ve been taught to us in the last two years.”
Patel looked at the boards as just one more hurdle he had to jump in pursuit of his career objectives. Unlike most of his classmates, he decided “to use zero books” and just use practice questions as his main foundation, finding that doing questions forced him to engage in the material, critically think about the topic, and reason through the answer choices. “The question banks that I used do a very good job of explaining the question, the correct answer, and just as valuable, why the other choices are incorrect. If these explanations were insufficient or if I wanted more information about something, I just went online and looked it up.”
As did the Romeros, Patel took a half-length practice exam at his testing center; his main goal was to get a sense of the logistics — driving route, testing environment, what the assigned locker would accommodate, where the bathrooms were, what the temperature was like. “Getting rid of all those small details that could cause unnecessary problems come test day is a good thing,” he says.
And, so, what was it like?
“It’s one of the most challenging exams I have taken so far,” Aberra says, “mentally, physically and emotionally. Regardless of how many questions I felt like I answered correctly, coming out of that exam was a great relief!” The students agree that despite Herculean preparation, the exam was a bit of a surprise — “more conceptual and less fact-based than we thought it would be,” Ron Romero says, “but we left the test knowing that we had done the best we could.”
Patel agrees: “A fair number of questions were more challenging than a lot of us were expecting based on practice exams.” A complicating factor is the presence of numerous, randomly-placed “experimental” questions that don’t count toward a student’s score, but are used to gather pilot data by test writers for potential use in future exams. “A lot of us are convincing ourselves that everything we didn’t know were experimental questions!” jokes Patel.
After just a few free days, year 3 orientation and clinical rotations got underway on May 5.
Aberra sums it up succinctly: “M2 year was a short but vivid experience.”
The Romeros are amazed at how quickly medical school is going. “At first,” says Jen, “we thought about the years involved, how old we’d be when we finished, but now, it’s just going so quickly! I’m so proud of us!”
Timeline of Medical Study