“This 23-year-old young man is at approximately 6 months post-significant traumatic brain injury as a result of an assault with changes in inferior aspect of the left temporal lobe, with patient reporting headaches. He is functioning in the average range of intellectual ability with functional suppression noted on several measures consistent with residual defects from the trauma. That is, he does demonstrate clear evidence of dysnomia or difficulty naming common objects from memory, connecting words to pictures, and recalling their association along with slowing in information processing speed.
Diagnostically, current test results and history are consistent with a major Neurocognitive disorder secondary to Traumatic Brain Injury with a contusion to the left temporal lobe region superimposed on Attention-Deficit Disorder and Post-Traumatic Stress Disorder. ”
Excerpt ‘Diagnosis’ from Neuropsychologist visit on 5/20/2014
Regardless of this diagnosis, I was ready to give this whole becoming a doctor thing a shot. Sure, I felt like my mind took a little longer to process some things. Other than that, I felt normal. Unlike most other medical students, I had a fresh new scar across the left side of my head to supplement my underlying “neurocognitive disorder.” There was no time to feel sorry for myself. I was beyond excited to start my lifelong goal of becoming a physician.
“This young man would benefit from extended time to take tests, regular breaks, and quiet periods to pace his efforts as he continues to recover from the effects of traumatic brain injury in the temporal lobe area in particular. The use of compensatory strategies or accommodations also will be needed to level the playing field for him. He cannot simply learn to label anatomy parts with words as temporal lobe functions are affected at this time. He is advised to contact the academic assistant office on campus where he will attend prior to beginning classes to set up a system of accommodations and set of resources needed for learning. He’ll likely find the level of fatigue and struggle of learning post-trauma may warrant withdrawal from his courses after the first term. ”
Excerpt ‘Recommendations’ from Neuropsychologist visit on 5/20/2014
Being the previous A-student I was, I surely did not think I needed any of these accommodations. Actually, I didn’t even consider this doctor’s recommendation. I wanted to go through med school just like everyone else. I’ll admit that anatomy lab practicals were a pure struggle, histology images were nearly impossible to recall, and microbiology was no fun. I was definitely more fatigued than I had been previously while learning. The headaches at times were so unbearable I couldn’t get out of bed. Hell, I was already a hypochondriac before my injury, and sometimes I even freaked myself out by telling myself that my brain was re-bleeding. You can imagine how this year was for my parents living 1,000 miles away.
Then again, what med student doesn’t get fatigued and have headaches? What med student, absorbing all this new detail about diseases, doesn’t think he has all of them? “My stomach hurts . . . Oh man, I must have appendicitis.” I didn’t think I was any different than my colleagues. Getting back to the story, I passed all required courses in the first year. I was not an A student, but I did not fail a single course.
The second year was a little more bearable. I had slightly fewer headaches and the mental fatigue was mildly improving. Making online flashcards for the clinical courses really helped my recall ability on exams. I passed all the required courses and even earned a few A’s. The first two years were so densely packed with information that by April of my second year I was mentally drained. There was still the beast at the end: Step 1. We were given April and May off, except for osteopathic classes, to study, and had to take the exam by June 10. I wasn’t sure how to study for this and tried what seemed like 100 different resources. In the middle of my studying, I felt so mentally out of it that I had to take a break.
I moved back to my cabin in northern Michigan and tried to relax before hitting the books again. I saw my neurologist, Dr. Barbara Jahnke, and she told me that recovering from a TBI takes years and I must be patient. Not to mention, while in Michigan I came down with histoplasmosis pneumonia, but we will save that for another story. I couldn’t get back into it. Studying one day and reviewing just would not stick. I really tried to stay positive, but this was the first time in my recovery period that I felt like my brain was just not working.
Long story short, Step 1 was a disaster. I scored a poor 446 on COMLEX and 210 on USMLE—almost too embarrassing to admit here. Internal Medicine was my dream. But I would go to any program that accepted me after that performance. I was more worried about getting my mind back on track. I was beginning my third-year rotations in Tampa, Florida, and couldn’t afford to do poorly again.
Shelf exams were every month and I could not fall behind on studying. I promised I would never overwork myself to the extent that I did in Step 1. Looking back, I should have taken longer breaks, studied over a longer period of time, and overall been healthier. I saw Dr. Jahnke again, as she was the doctor that was always on my side. Sensing my discouragement, she told me, “Alex, you are going to be a great physician. Do not let anything hold you back. You can and will succeed.” (God bless you and rest in peace, Dr. Jahnke, who passed away that same year from cancer.)
As a third-year on my first IM rotation, I bought Step Up to Medicine thinking I would just read this for my shelf exams. I read the first few pages and instantly knew this book was not for me—too many words. A few days later, I stumbled upon a service called OnlineMedEd. I needed a source that was not just notecards and not just reading a book, which, among other things, got me in trouble during Step 1. I watched one of their free videos, on CAD, and was immediately impressed by the presentation of the information and how Dr. Williams made it seem so simple. I proceeded to watch all the cardiology videos and knew this was the source for me.
The mixture of witty comments, simplicity of information, and thorough explanations of the material presented was outstanding. These “lectures” were more of a treat, not a nuisance like most medical-school lectures full of extraneous information presented slide by slide. I purchased OnlineMedEd’s premium content subscription and from there my clinical education truly accelerated.
OnlineMedEd’s PACE method, along with the available content, was exactly what I needed to excel during my third year, as I learned the hard way the year before that overworking and cramming was not healthy for my bruised brain. I would read the notes, watch the videos, do associated clinical cases and questions, and use notecards to reinforce what I learned. Also purchasing their “QuickTables” to put into my white coat pocket on the wards was an A+ idea. I made sure to watch at least one video per day and paced myself throughout the year.
OnlineMedEd was amazing for each shelf exam, and at the same time, it provided daily study for the Step 2 examination so it kills two birds with one stone. It highlights the really important aspects of each disease and uses Dr. Williams’s approach to how he would deal with the disease in real life. I could talk all day about how great the service is, but I will get to why I know OnlineMedEd works.
Dr. Williams is an amazing educator. He is someone you can and should trust will teach you the pillars of medicine, as I have stated above. However, this is not the only thing he teaches you. Dr. Williams teaches you how questions are written and how to think like an exam writer. This was HUGE for me. Approaching my Step 2 examination I was truly able to look at a question – read the last sentence, then skim the fluff at the top and come to the answer quickly. I finished both the COMLEX and USMLE Step 2 exams relatively quickly, and definitely much faster than Step 1. I used all of OnlineMedEd’s services plus more questions from Uworld to study for Step 2. Cramming was something I was able to avoid entirely. I truly believe this was because OnlineMedEd laid out exactly what was needed to do well.
As Joel Embiid of the Philadelphia 76ers would say, you have to trust the process. And in the world of medical education, OnlineMedEd has the most effective process. I followed their three-month study program prior to my COMLEX and USMLEs, which is definitely doable even while on rotations. I followed the PACE method every rotation and then rewatched all the videos prior to Step 2 during the three-month study program.
I’m being honest in saying that OnlineMedEd made the USMLE feel like an attending quizzing: “Hyperkalemic patient with EKG changes, first drug to give?” Of course, this is easy to answer after you’ve heard this question on every in-hospital rotation in your third and fourth year. COMLEX was only slightly different because the questions (in my opinion) were more convoluted and I barely studied the OMM portion. OnlineMedEd made my life much easier on test day, as I was so confident in my initial answer choice that when my brain went dead with about 100 questions to go on COMLEX (and with about 50 to go on USMLE) I actually felt good afterward. I know this is all subjective, so here is the objective information. My results:
COMLEX Level 2: 622 (+176 from level 1)
USMLE Step 2: 258 (+48 from step 1)
Residency placement at my #1 choice
This two-part story went through the past six years of my life. It was not meant to make you think I’m some crazy miracle story. It was truly meant to tell you something REAL: gun to my head, traumatic brain injury, countless sleepless nights, throbbing headaches, and debilitating neurofatigue topped off by a dismal Step 1 score.
If you only remember one thing from this post, I’d like you to remember this: Life is going to continually test your strength and commitment to your goals but it is SOLELY up to YOU how you will react and respond. Your obstacles don’t have anywhere near the strength that you do. We are humans and have the amazing inherent ability to control our thoughts and actions. You don’t always get a second chance to redo the day before. But, when you wake up it is a new day for you to win or lose. Don’t lose hope!