Mom Status

Today I met with another Mom who is planning to return to medical school and I can't help but be excited for her and energized after hearing her journey. Seeing other moms working towards fulfilling their goals outside of parenthood in their own time and on their own terms is nothing short of inspiring. I've come to understand that our contribution to the medical field is something is so essential. We bring a level of maturity and a skill set that simply can not be matched. I have no doubt that I will be a better physician from the very start because I was a mother first. I've met many moms along the way who chose to hide their "mom status" either during medical school admissions, residency application or for both. It is discouraging to me that these women felt the need to hide motherhood because it represents the egocentric, close-minded mentality that still permeates much of the medical community. I'm Puerto Rican, which is considered one of the underrepresented populations in the field, but I dare say that being a Mom is not only more underrepresented but also more widely discriminated in this field. In one of my interviews I was asked, "how will you manage being a mom and a medical student?" I responded politely but later that evening I wondered whether any of the father applicants were asked that question. Early in medical school I spoke to a mom physician who conducted interviews for one of our home residency programs. She confessed that when she gave tours of the school and was obviously pregnant, big belly in tow, she was often asked by the applicants about work-family life balance; however, after giving birth or before she was showing, the applicants never felt comfortable to ask these types of questions. Just by having a belly and outwardly exposing her "mom status" applicants felt more comfortable to ask the forbidden questions. In my second year I met another mom who was applying to a very competitive field. Ultimately she felt that disclosing would hurt her application because she may not be viewed as being rigorous enough despite the fact that she had a fantastic board score and a strong application. I'm not going to pretend that things are not harder for mom medical students but the fact that our rigor, or assumed lack thereof, is measured by our attachment and love for our children is just ridiculous. Those of us who are in medical school, pulling late nights with a sick kiddos and still showing up to take our final exams, pumping milk for our little ones in empty classrooms, trying to make financial aid money stretch for child care expenses, filling in as full-time parents when our spouse has to travel for work, making sure that school uniforms are ready for next week while we study for board exams and work on research projects and doing any number of things all at once at all times are the most rigorous people that I know. We deserve to be recognized and respected for achieving level of perseverance and diligence that far exceeds most of our peers!

Post Step One Burnout Is REAL!

I am in my scholarly activity period now and I'll admit that its been a challenge to stay motivated these days. I'm currently working on a few research projects and trying to prep for my surgery rotation which starts in July. We also found out a few weeks ago that we have to move to a different house. Luckily I was able to find a place quick and so now we are in the packing stage. I think I'd be burned out regardless of all the unrest but having to move and coming off some recent health issues has only compounded these feelings. In hindsight, it's probably good that I had this less intense time to decompress after Step 1. I'd highly recommend other moms try to plan a post-step break if at all possible. I haven't taken any spring breaks or summer breaks since starting med school so this lull is long overdue! Pace yourself if you can is my suggestion. If you don't get a real break or vacation, give yourself permission to take it easy when the opportunity presents.

USMLE Step 1 Prep For Moms.

My experience with Step 1 taught me a few important things that I would like to share with my fellow medical school mommas.

1. Start prepping on day one of medical school or set aside several weeks of dedicated prep time in the summer between MS1 or MS2. This might seem like overkill but I honestly wish I had paid more attention to Step-1 and less attention to my coursework during the pre-clerkship phase. We are on a pass/fail pre-clerkship curriculum but you would never have known it if you saw how hard I studied during those years. For me it just did not feel right to be okay with simply passing. I was a 4.0 student in undergrad and wanted to keep that level of achievement regardless of whether or not it would show on my transcript. I was repeatedly told that if I do well in pre-clerkship, my board scores would reflect my hard work. This could not have been more untrue. I am not an experienced standardized test taker and I have a learning disorder that hinders my speed on highly timed tests. Additionally, I am in my mid-thirties so my processing speed is already slower than the students who are at their peak in their 20s. But irrespective of these issues, I still do not feel that my diligence in my pre-clerkship period gave me any advantage on the USMLE Step 1 exam. In order to do well on Step 1 and not have a miserable dedicated Step study period it is essential to have completed at least one question bank and 2 passes through First Aid prior to your dedicated prep period. For parents, particularly mothers, you are much better off starting early. Because I had too little prep prior to my dedicated period, I ended up studying 12-15 hours a day with ZERO days off.  My son's school performance slipped considerably because he missed his Mom. I was unhappy and didn't have time to workout or do anything for myself - I even had Pathoma videos playing while I showered.  In the end I did well (not as well as my pre-clerkship grades) but it was not at an incredible expense to my family and my own mental and physical well-being.

2. Had it to do all over again I would have done 3 FULL question banks.  I liked USMLERx Qmax as a starting question bank. UWorld was great for the dedicated period. Your score will directly correlate with the number of practice questions you do so get started early....re-read number 1.

3. Five full passes through First-Aid. One as you go through your blocks, one the summer prior to your  MS2 year, a third during your MS2 year and two passes in the dedicated prep period.

4. If you have done 1-3 as I listed you prep period will be much more efficient. You will be much faster as you work through the UWorld questions which will enable you to study 8 hours a day and even have a day off.

5. Use your day "off" to take a practice test. They usually take about 4 hours. I would avoid trying to look up answers to your practice tests for the ones you missed. It is very time consuming and you will get little return for the hours that you spend hunting for the solutions and explanations. 5-6 practice tests is plenty. You may want to add a few blocks of questions from uworld or another bank as you approach your test day just to get a feel for the endurance you will need on test day.

6. Your school may encourage you to be okay with a lower score that is "just passing". Keep in mind that state (public) medical schools may have incentives to have a few top performers who go on to competitive residency programs and raise their Step-1 mean, whilst a bulk of their students pass and go into a primary care residency. These schools receive funding according to the number of primary care slots that they fill which includes: family med, IM, Peds and OB/GYN. If you desire to go into one of those fields, no problem, but if you are interested a field that requires a more competitive score you may feel a disconnect in the support that you receive during your Step prep. As a Mother, sometimes there is an implicit bias that you should fit into the primary care group and that is the frame of mind in which the administration will counsel you for this important exam. Don't be fooled.

7.  Have help from someone you love on your test day. I had my husband take over all childcare duties, drive me to the test center and pack my lunch so that I didn't have to waste my headspace with logistics. He left me a sweet little note in my lunchbox that really cheered me up during one of my exam breaks. This is a small thing but it helps. My husband is my partner. We have been married for 10 years, lost a child, lost a parent, endured poverty, lived abroad, you name it. It was nice to have his support in this way on the day of this test, which would impact not only my life but his as well. There is enormous pressure when you have more people on the hook, more years of debt and fewer years to get to practice medicine. When I found out that my husband had to travel for work on the week of my originally scheduled exam, I insisted on changing my date to when he was back in town - 5 days later. It wasn't easy and there was a ton of pushback from my school (another story for another day), however, it was the best decision ever! Know your rights.

8. Physiology, Pathoma, Goljan. I listened to the Goljan audio lectures during my commutes too and from school throughout the pre-clerkship period which enabled me to do 2 full passes.  Some kind soul uploaded them into 5 videos on Youtube so you can go there to listen to them.  Physiology is very high yield and often not well-taught in med school. I really liked the Pyseo.com lectures and you can watch them at 1.4x or 2x to cover the material quicker. Pathoma is a staple. I'd try to make 2-3 passes prior to step one.  If you are an auditory learner you can watch, if you learn better from reading, you can watch once and then read his study guide twice.

All for now, I will continue adding to this list as I think of more things...

There is no place like home.

Sometimes I wonder if practicing medicine will ever feel as comfortable as stepping into a ballet class. I'm on a bit of a lull right now with school so I've been taking ballet classes about 3 times a week for the past few weeks. Today I made it through the entire class which is a big accomplishment considering I haven't done much of any ballet since the summer before medical school (2015). Everything is coming back though and I'm slowly getting stronger and rediscovering my center of balance and my artistry. It never ceases to amaze me how at home I feel in the studio, no matter how much time has passed since my last class. I can be taking with a room full of complete strangers or with a new teacher and there is still an unmatched level of freedom and comfort. No matter how weak I may be physically, I can trust in my technique to carry me through. With time my strength returns and I am able to lose myself in the pure joy of finding a balance between the artistry and precision. Hold a balance just a hair longer, lengthen the movement just a bit longer, sharpen the beat, add a head or port de bras...it's like salt water taffy and I can never have enough. But I suppose there was a time that I wasn't so comfortable and ballet was new and unusual. I started dancing at 14.5 years of age, very late for a girl. I will never forget doing an audition for a summer camp after I'd only been dancing for a month. I believe it was a Boston Ballet summer intensive audition in Pittsburgh. I remember being completely lost for most of the center, particularly the petit allegro. I watched a very advanced dancer in the group before me and was in absolute awe of how comfortable and capable she seemed. I probably went home and cried that night, as I do many times when I have a particularly hard experience in medical school, but I pushed through those early years in ballet and now I have this incredible gift. In med school I often feel like I'm on the left leg and everyone else is on the right. There are moments where things come together for a brief period but then in an instant I'm back to feeling uncoordinated and awkward. I work hard each day with the hope that one day I can feel that same way about medicine as I do ballet. I want to be able to feel challenged but also have trust that my technique and knowledge base will support me. I want to push boundaries further and in order to elevate the care that I can give patients. I want to strike a balance between in the art and science of practicing medicine. I want to change a phase or an intonation in just the right way so that the patient before me somehow feels more understood or cared for. These are the hopes that keep me pushing forward.