Subaqua Sternal Rubs

an actual post on this blog! To catch everyone up, yes, I passed Step I, and now am doing my first clinical clerkship in Pediatrics in Brooklyn. After a long time of being without, I finally got internet in my apartment today, so you are all being graced with a new post. Unfortunately, though it will have to be a bit short, since I have my final exams (oral and written) in Pediatrics in a week. Though I promise I will be updating more regularly shortly. Really, I swear!

My hands are shaking so much it's hard to type. Just on a whim, I checked OASIS to see if there was any news on my Step I score. Turns out it was mailed yesterday (so I should have it in plenty of time to start rotations). With my heart pounding, I tried the "OASIS trick" where you try and register to take Step I again, and I got this message:

Our records indicate that you have already passed this Step or Step Component or the equivalent NBME® Part. The USMLE Policy on Reexamination generally does not allow applicants to retake a Step or Step Component if they have already passed that Step or Step Component or the equivalent NBME Part.

While I won't know my actual score until I receive the score report in the mail, I really don't care what it is right now: all that matters is that miraculously I seem to have passed.

It's official, I no longer have to submit myself to radioactive toxic waste in Dirty Jersey:

Hi Carsten!

We have been able to accomodate you at NY Methodist Hospital for cores. You will receive confirmed placement shortly.

Clinical Placement Coordinator

Now that I have my confirmed placement, I have to start looking for apartments quick - I start August 28th. Crazy thing is, I can't find anything decent for under $1,500/mo in Brooklyn! If anyone knows anybody that died in NYC recently, please let me know!

That's all I can say about my USMLE Step I exam experience: It's Over. I knew some without looking at the question, I knew I should have known some, and I had no idea what they were talking about on some of them. Of the latter, I just hope they were among the 50 "experimental questions" and not among the 300 questions that were scored.

I took the exam on July 20th, and there is nothing to do now but wait a nebulous "4 to 6 weeks" for my score report to see if I was able to cram enough useless information in my brain over the last two years to satisfy the National Board of Medical Examiners. I call a lot of the information useless because no practicing physician knows half of it (I know, I asked!). They say you really learn medicine in the clinical years by doing. I'm definitely looking forward to this, provided I passed that minor roadblock on the way.

Posting should pick up again soon. I spent the last week on Lake George camping without internet access (hence the delay in posting), but I have a few shifts scheduled in the hospital ED and on the ambulance over the next few weeks to provide me with at least some fodder for this blog.

Today I got a nice letter from the ECFMG (Educational Commission for Foreign Medical Graduates), who are the fine folks who handle all the paperwork and register me to take my USMLE Step I exam. The letter starts off:

Dear Dr. Stracke:

Well that's nice of them - they gave me a field promotion, since I didn't think I graduated medical school for another 2 years…

The letter goes on to say:

Your score report for USMLE Step I/Step II is available.

Even better news! Now not only do I not have to graduate medical school to be a doctor, but I don't have to take the licensing exam either! I just hope that my score report shows that I passed the exam (even though I am not scheduled to take it for another month.)

It's official — I am finally done with the Caribbean forever. Though it wasn't with the usual German efficiency (8.5 hours vs. normal 3), grades for yesterday's Pathophys exam were up, and I officially passed. I am really to exhausted to write much, and hot (since I am in the lecture hall without A/C - disconnected internet at home), but needless to say I am ectstatic about finally being a 3rd year (well, I guess I do have that pesky Step I still in the way). Going out to a celebratory dinner tonight, then I have two days to pack and get ready, and then my flight home is Monday morning. Can't wait to see everyone!

to being done with Basic Sciences. Passed my Pharmacology final today, just one more exam (Pathophysiology) on Thursday which I really can't fail, and I will finally be DONE! Finally moving on to clinicals. I can't tell you how excited I am.

And then I remember I still have to take the USMLE Step I.

Anyways, 6 days, 10 hours and 59 minutes until my flight takes off, and I leave the Caribbean forever. (Or at least until I come back for a vacation in 10 years…)

You know you are mentally ready to go home when:

-you start running out of bismuth subsalicylate (Pepto-Bismol ®) from eating your own cooking.
-you start driving on the wrong (or the right, depending on how you look at it) side of the road.

For some reason, the Business Office here at the Kingstown Medical College made a singular check for all SVG CPR instructors out in my name for the recent recertification sessions. So, couple of days ago, I had to go into the capital city to cash this massive check (EC$1,576) at a bank. After my tenth time around the block looking for a parking space, I was in the right hand lane, and attempting to make a right hand turn. On that block, the parking is on the right hand side of the street, next to the fruit and vegetable market. Somehow my brain thought that meant I should be turning into the right hand lane, and unfortunately I had forgotten that this section of the street was two-way traffic, and I had just turned into the on-coming lane. Luckily there were no "Reggae bus" drivers speeding at 800mi/hr, and I managed to squeeze into the correct left lane with no damage to the vehicle, other than a few glares from other drivers.

In other news:

Read the rest of this entry »

Had my OSCE yesterday. And not to further antagonize the worry-worts, but I did rather well without doing much studying (maybe an hour and a half in total).

The OSCE is the final practical exam for Advanced Clinical Skills/Physical Diagnosis. It consists of 7 stations - 4 patient history and/or physical in 7 minutes or less stations, as well as 3 ancillary stations (EKG, X-Ray and Prescription Writing). My patients included a "frozen shoulder" after playing tennis, an HIV+ flight attendant having diarrhea for two weeks, a middle-aged male with angina, and a female with monthly abdominal "bloating." The "standardized patients" were very good - they were flown in from Grenada, so we had seen a couple of them before (like my oil-down woman), but that was cool. I missed a couple of points on the abdominal exam, because the tutor thought I should do every abdominal exam in the book, even if they weren't consistent with the patient's symptoms. Oh well. All the patients complimented me on my bedside manner, thoroughness, and style. Nice to hear just before going into clinical rotations. (I think this is half the point of the OSCE…)

For my X-Ray interpretation, I had an IVP which showed unilateral hydronephrosis (backing up of urine into the bladder). A couple of people were complaining that the x-ray was unfair because it didn't have the little clock on it to show how long after the injection of the dye the x-ray was taken. Come on people, really. What they really should have been complaining about was the EKG station - the quality of the copy was so poor that the leads weren't labeled, and it was hard to count boxes for heart rate, etc., since they didn't come out either. Though it really didn't matter that much, since the tracing was pretty obvious with the P-R interval shortening, the peaked bimodal QRS's, and possibly some T-wave inversions (but I couldn't tell which leads since they weren't labeled…) I finally diagnosed a case of Wolfe-Parkinson-White syndrome. For my prescription I got a patient with angina again, so I prescribed sublingual nitroglycerin as needed for pain. Actually, I used some medical abbreviations like PRN, SL, q5, call 911, etc. In retrospect, maybe I should have spelled it out. Hopefully, they use the same abbreviations in Scotland where the Clinical Skills Chairman is from!

With that exam down, only two more to go: final exams in Pathophysiology and Pharmacology in two weeks. Ahh! Better start studying.

Per the score report on ANGEL, I managed to pass the BSCE II without studying (not that I am surprised by this, as indicated by the number of exclamation marks in the title.) And not that I don't have a long way to go for USMLE Step I studying, but at least I know a least a little bit of the material presented over the last two years stayed in long-term memory… Anyways, no time for celebration — time to study for my OSCE tomorrow…