Aula Conversations

Month: March 2025

  • USMLE STEP 1 in 5 months?

    Hello everyone. Hope you all had a restful weekend.

    If you followed my Update post, I mentioned that I had a friend who took her USMLE step 1 and got her Pass in December last year, a short 5 months after graduating. Today, I’m sharing a short interview with her on her process. We’ll be talking about the preparation process, useful resources and the exam itself. So onto the interview.

    Q: Hey girl, So congratulations on passing step 1 of the USMLE. How did you find it?

    A: Hey! Thank you. I actually found the whole process rather frustrating. The exam requires you to pay attention to little details so I had to really focus on these.

    Q: We personally talked about this before but for the audience, when did you first start seriously considering taking the exam?  What drew your attention towards the US as a possibility for residency?

    A: I started thinking about it as a possibility in my 5th year. I realised that I wanted to be near family, so after a lot of consideration the US was the best option.

    Q: Yes, of course. Honestly it’s the same for me. Having a support system close by can help make residency a more enjoyable process. So, let’s talk about the preparation period. What did that look like for you?

    A: Well, I officially started preparing in July 2024, and I took the exam in the 2nd week of December 2024.

    Q: 5 months is impressive, and certainly makes it seem less daunting. What did your study schedule look like?

    A: I typically split my week. I would start with First Aid for one subject, and later on in the week, I did the UWorld questions for that subject. I also followed a study guide for USMLE that I found online, so that was helpful.

    Q: Since you were no longer at the university, where did you usually study? – library, home, café, etc.)  

    A: I studied at home for the whole period.

    Q: What study resources did you use? Was any more useful or less so?

    A: First Aid and UWorld were absolute musts. I used Sketchy for Pathology and Microbiology. Dirty medicine was perfect for Biochemistry. Bootcamp videos were also helpful, and I did the free 100 questions on NBME to test myself. I would say most of these were useful and when one resource didn’t work, I was quick to check another out.

    Q: Did you take any courses or use tutoring services?  

    A: Not at all. I would’ve liked to but that wasn’t in my budget.

    Q: When did you schedule your exam, and how did you know it was time to schedule it? 

    A: There was no special landmark or study milestone, so to speak. In October, I just booked the exam. Having a standing date helped me focus a lot more- just knowing I had set that deadline for myself.

    Q: That’s a good way to look at it. Which subjects did you find the most difficult? How did you tackle them?

    A: Biostatistics, Microbiology, and Cardiology were my weaker subjects. I tried to answer as many questions on them as I could, which helped. Just more exposure.

    Q: And which subjects did you find the easiest or most enjoyable?

    A: Psychiatry and Neurology.
     

    Q: Did you have any strategies to help you retain information better?  

    A: I tried to revisit my study material from the previous day every morning before starting a new material.

    Q: Spaced repetition for the win! Love that. As the time came closer, I’m sure you were a bit more nervous. What did that final month of preparation look like?  

    A: During the first half of the month, I was mostly going over topics I found very confusing, but for the second half I spent majority of it on UWorld.

    Q: Did you take any assessment tests?

    A; Yes, I took one in November and passed, but just at the mark. It helped me identify my weak points at that moment.

    Q: How did you structure your last week before the exam?  

    A: I went through some review notes, and UWorld questions but I mainly rested. The day before the exam, I studied till around 2pm, packed my bag for the exam, and then rested till the next day.

    Q: So how did the examination process go for you?

    A: We were required to be at the exam centre 30 minutes before the exam time. I just needed to show my scheduling permit and passport/ID card. After the sign-in, I finished 3 question sets. I took my first break for 15 minutes, after which I did 2 more sets and took another break. At this point I was very tired, so I had to take a break after every question set.

    Q: How did you feel immediately after finishing the test?  

    A: Honestly, light-headed. I just needed to sleep.

    Q: Looking back, what would you do differently if you had to take it again?

    A: I wish I had started going through UWorld questions from my first day of studying. I also wish I had started doing questions with mixed subjects, rather than focusing on one subject per week.

    Q: How did you spend the time waiting for your results? I imagine that was a stressful waiting period.

    A: I checked my email everyday. I knew it was going to take a while for the results to come out but yeah, I guess you can say I was a bit anxious to just get the results.

    Q: After confirming your pass, how did you celebrate?

    A: The results arrived 2 weeks after my exam, just before Christmas, so I had a very lovely Christmas celebration.

    Q: Now that you’ve successfully passed, do you think PTE gives you all the tools you need to pass it?

    A: I would say we cover roughly 70%. Biostatistics seemed completely new and very different compared to how we are taught the equivalent subject, biometrics for example. But with a bit more studying, you will be able to easily catch up. Concepts are the same.

    Q: Do you think this is an exam that is passable while in med school and if so, when would you recommend PTE students take it?

    A: If you can take it in your 3rd year, that would be perfect. So I would suggest to start studying for it in your 2nd year, this way you’re studying for your usual exams plus the USMLE step 1

    Q: Wow, well that’s an interesting take. I would’ve personally said 4th year as the earliest. Okay, I have one interesting question: as we all know, the societal and political climate in the US is now shaping up to be quite different compared to when you started your preparation process. It has made a lot of formerly-aspiring US residents change their minds on the decision. Has that affected your decision in any way?

    A: I’m a bit scared to be honest, but at the end of the day it’s not perfect in any one country. As I said, the plus here is that I get to be close to family and this is important to me, so I’ll keep going.

    Q: Fantastic. So what’s next for you?

    A: I’m currently searching for an externship or observership, while preparing for STEP 2 CK.

    Q: Is there anything else you would like to add? Any extra tips for out US residency aspirants?

    A: Yes! When practice your questions on UWorld, practice on the timed mode. It will help you adjust to solving the questions in good time. Sure you can fail if you get questions wrong, but you can also fail if you don’t get to finish all your questions in time. The night before your exam, make sure to get a lot of sleep. The exam is mentally tasking and you will need to be well-rested to perform at your best. One last thing- you’re not allowed to share the questions you got on the exam on any platform. If you’re caught, your exam may be cancelled.

    Q: Thank you! Congratulations again and I wish you all the best in your preparation process.

    There you have it! Step 1 done in 5 short months. It seems daunting; a whole different education system and testing style. But it’s absolutely doable. You are prepared for it at PTE. I personally have not come across many concepts in my own studying that are completely foreign to me. So don’t be fazed by the bulk of material. Start chipping at it as soon as you can. I’ve gotten the study schedule that she used, which you can access here.

    And this brings me to an idea. In the past few months, I’ve spoken with a few of fellow students who are also interested in the US route. One thing I’ve come to learn, accountability can be very helpful in this journey- being able to see each other students’ progress, co-ordinate study schedules and keep each other on track. I was thinking, how about we connect? If you would like to join a group solely for this purpose, kindly send an empty email to aulaconversations[at]gmail[dot]com with the title ‘USMLE’, or a DM on Instagram (@aulaconversations) with the word ‘USMLE’. I will set up a group and be in touch with details.

    That’s it for now. Next I’ll be talking to 6th years about my written state exam experience, so stay tuned.

  • I Took An OSCE and Here’s What Happened.

    On the 11th of March last year, a mass email was sent out from the registrar’s office, informing 5th and final year students of the possibility of taking an OSCE. This was supposed to be a no-stakes clinical exam for research purposes.

    The email called for 20 students from the English programme in the 5th and 6th years who were willing to take this no-stakes clinical exam. I constantly try to test myself and push myself out of my comfort zone, especially in academic settings, so signing up was a no-brainer. My next Google search? What is an OSCE? I had always heard of it. I knew my friends in medical schools in the UK took it, for example but I really did not know much about what it entailed and the process.

    OSCE stands for objective structural clinical examination. It is an exam format that aims to implement theoretical knowledge in simulated clinical settings. It helps to test not just clinical knowledge, but reasoning skills, resource management skills and more.

    Shortly after signing up, I received an email with all our instructions. We were asked to bring a lab coat, name tag, stethoscope, reflex hammer and notebook & pen (for note-taking). We showed up on the 4th floor of the main building in front of the MediSkills lab.

    There was a small delay, just by a few minutes and we were briefed in person on what would happen. We signed consent forms because recordings were to be taken for research purposes. We were directed to our starting stations and asked to stand in front of the door. Taped to each door was a clinical case that gave us our positions and the most general information about the patients. It went something like this:

    You are a first-year resident spending an over-night shift in the ER. A middle-aged woman, BMI 30 comes in complaining of severe abdominal pain which started after her dinner. She has no known medical conditions and has taken 2 painkiller tablets. Conduct a physical examination.

    We were giving 2 minutes to read this and take our notes and once we received the signal, we went into the room. There was a timer counting down from when you stepped in. Some rooms had actors who did a fantastic job simulating sick patients. We also had a nurse in one or two rooms to assist. In other rooms, we encountered dummies or phantoms. During this time, the examiners sat in the corner and observed, only interrupting to give a 1 or 2-minute warning on the clock. They watched our hygiene practice, interview skills, bedside manner, etc. One thing to note is that we had specific instructions. Some stations required only a physical exam, while some required just the anamnesis.

    This is where my details are hazy. If I remember correctly, we had 7 minutes to deal with the patient and 2 minutes to speak with our examiners and receive feedback from them. The examiners did not necessarily need you to make a full diagnosis but if you were able to make logical decisions and come to a reasonable conclusion, this was enough for most.

    We did 5 stations at a time with a 20-minute break and refreshments at the half-way point. Internal medicine, neurology, surgical techniques, general medicine practice all featured and we had a station where we had to break bad news to the family member of deceased patient. Altogether, it must have lasted about 2 hours.

    We had a short session where we gave in-person feedback. One of the more common sentiments was that we did not have enough time to complete our tasks. I do think this is moreso tied to the fact that we were unfamiliar with the OSCE format. In theory, we are taught this long list of questions during the interviewing process with a patient. In practice, as I am sure you know, there is barely ever enough time for that and that was really reflected in this OSCE. I had a hard time isolating just the questions relevant to the patient’s condition in such a short time.

    Another problem I personally had was that I did not really understand to what extent we had to be thorough. We had actors who played their role but ultimately were not actually patients and even dummies in some rooms, so in my first few stations I was unaware that I had to also wash my hands and glove as I would in real life. A few stations had imaging that I did not know was an option I could request. All in all, it was a rather fun and educational experience. I was nervous despite it being essentially no-stakes. I can say with a certain amount of certainty that this was the first time most of us were exposed to the OSCE; it definitely was for me. On my first station, I was rather confused on what to do and scrambled a lot, but by the 5th station, I was a lot more confident.

    Two weeks after the OSCE, we received our evaluation forms. Did I pass? No. If I am correct, passing can be confirmed when you meet the requirements for all stations and unfortunately I did not meet the requirements in my first station. I remember freezing for a good 10 seconds because the simulated patient was moaning and groaning in mock pain, and the nurse was just staring at me waiting for my instructions. A bit of a chaotic situation to be thrown into for the first time, so I didn’t expect much there.

    I believe in the long run, the plan is to implement the OSCE into our examining system and I believe this will be an excellent idea. I did some research and found that a medical school in France conducted a study that made some interesting findings regarding the OSCE. 6th year students were examined via the traditional testing methods and also with the OSCE. The study reported lower scores at OSCE exams compared to other evaluation formats, suggesting that the OSCE is able to test in a way that traditional testing formats do not. It also showed that students who had a single OSCE training session prior to the OSCE saw an improvement in their OSCE scores. So if you are unsuccessful based on these OSCE standards, try not to feel bad about it. A new testing method will always take some adjusting to. Another study from a sample group of final year medical students across a variety of UK medical schools found a positive connection between mock OSCEs and an improvement in student confidence and anxiety in future high-stake exams. The OSCE tests your clinical and theoretical knowledge, as well as your technical skills and medical competency. It is able to test a large group of students in a short period of time and because with a variety of examiners, it reduces the possibility of examiner prejudice or bias. Complementary to other forms of testing and provided that it is well administered, it will significantly improve our university experiences as students.

    So I encourage students to register for this opportunity and attend it. And if you missed it this year, it might come around again next year so keep your eyes peeled for that. It’s a great way to know how you reason in a clinical setting. And to those who have registered: At this point in the 5th or 6th year, you have all the knowledge to do well in the OSCE. Brush up on a few concepts if you need to prior to the exam. The Youtube Channel Geeky Medics has an OSCE guides series that can be helpful for you. Also remember to go through the SPIKES model for delivering bad news. Aside that, it won’t be anything crazy.

    In the spirit of sharing, I have attached my assessment sheets here. I encourage you to check them to see what is expected of you. Just an FYI: I have 11 sheets because 2 examiners separately assessed me in my first station. I also received assessments from the simulated patients and have attached them here as well. Why did simulated patients also give their assessments, you may ask… Their experience with you also gives you feedback on a patient’s experience with you as a potential healthcare provider, so this definitely matters.

    EDIT: I just remembered that we were able to get a certificate for this!

    Next up is an interview with a good friend that some of you are waiting on. Won’t be long now. Cheers!

  • Update: Post-Graduation.

    Hi guys,

    I hope everyone is doing well. It’s been an unbelievably long pause.

    If I did my calculations right, it’s week 7 of the spring semester. I have been MIA and there’s a reason for it. It’s been quite the roller-coaster but I feel as though I am now at a good enough place to share my thoughts and experiences since graduation, for those who are interested.

    For some background, I am from a third world country, and that means I do not have easy access or the right to stay within Hungary or the EU without fulfilling the proper applications via the National Immigration office. All this will make sense in a second.

    After graduation, my first priority was leaving the bubble of uni. I am sure many of you have felt this but POTE feels like its own little world and after 14 plus weeks at a time in uni, battling one course or the other, you can easily forget about the “real world”. There are many things I appreciate about that, but they are all tied to university and become unimportant postgrad.

    There were two things I knew: (1) I didn’t want to go back home just yet and (2) I didn’t know what next exactly.

    I shared the ECFMG process earlier last year. I think those who can put two and two together can make up that I have my eyes set on US residency. I had not made any concrete plans to dive into anything yet so it was time for me to figure it out. I have family and friends in North America and being closer to them was a main incentive for me looking at the US. I have a friend with whom I also share this goal, so we began working towards that.

    What does that mean? We gathered all our study resources and started studying. If all went well, we could be matching in 2026. If you have any questions, please bear with me. I will do a whole post about that in a few days.

    With regards to my residency status, I had applied for a job-seeking permit prior to graduation that would give me time to stay in Hungary to take this exam and just get myself together. It is usually issued for a maximum of nine months, but can be shorter, and it can only be applied for once, so regardless of how long you are given, you do not get to extend it. I eventually got my job-seeking permit and I was only given 3 months (until November), for reasons still unclear to me. This complicated things because based on how I was studying, the soonest I could take my exam was at the end of November or beginning of December. What next? Find a job. That was the purpose of my new permit right? So the process began while studying. I had been applying here and there but not so seriously. Now I dusted off my CV and revamped it to a much more professional one. I gave my LinkedIn profile a huge update and started putting myself out there. I can’t count how many jobs I applied to between August and November. The jobs I was looking for were jobs that would accept my medical degree and also accept my poor Hungarian, or better my English proficiency. These were jobs like Clinical Research Assistant, Medical Lab assistant, etc. I had a lot of help and connections with this and yet, I did not get a single response, not even an interview. By October, I had exhausted everything I could apply for and was seeing only the same jobs over and over again. So, I widened my pool. I would take a job as an assistant of any office, it didn’t have to be clinical. I even applied for internships. A few rejection letters, mostly no responses. Guys, some of those job listings are still out there. I wonder if they were ghost jobs. All of this sounds bleak and it is. The job market is a nightmare these days. It doesn’t mean it would be like this for you but please be prepared. In the middle of this, I was doing 8 to 10 hours a day of studying. This was putting a lot of stress on me as the days were passing by. By some miracle, I was connected to the job I now work at which changed everything for me with regards to my residency status. I wish I could talk more about it because it’s a dream fit. I have signed a non-disclosure agreement and am not at liberty to say more, however once I can I will talk about this experience.

    Settling into work was not easy at all. We had a lot of things to sort out with regards to my residency status before officially commencing. Around that time, there had been a lot of rules that were changed with regards to the classification of and processes for applying for residency for employment. I could not ask friends who were already working because they were unfamiliar with the new system, so there was a lot we (my boss and I) had to figure out. I was pulling up legal papers online and trying to translate them, aggressively googling to see what could afford me the best opportunity. At a point, I was calling and emailing the Immigration Office constantly, and showing up twice a week. Somewhat reminiscent of a toxic relationship really. The officers were not much help as many of them did not really know much about this new system and the legal implications and were unable to direct me. A lawyer was involved at some point. By this time, I had put my studying to the side. I booked my flight and got ready to go home. It wasn’t the worst thing because make no mistake, I still have a loving and supportive family back home. Luckily we were able to get everything sorted in the nick of time.

    This is not a period I like to think about much if I don’t have to. It was rather nightmarish but I came out of it and am happy that I have that experience to share with you.

    So…where am I at now?: It’s been almost 9 months since graduation. I work a lot- this takes up the bulk of my day and with what time I have left, I study. I am constantly rotating between Anki, Notability and UWorld. Work has pushed my goal back by a lot but this is work that I believe can only contribute to my career in a positive way and ultimately, some progress > no progress. I’ve gotten back to something I love- leisure reading. I work out when I have the time. I am tired at the end of every day but I am getting things done and am extremely grateful to be where I am.

    My friend…drumroll please….got her P in December and is getting ready for Step 2. I have an interview with her coming up soon so stay tuned.

    I hope this will be helpful to someone, especially those graduating in June. My only advice is to be resilient and consistent. This is the winning combination, but by 6th year I’m sure you knew that already.

    Alright, bye. See you shortly.