Knowmedge - Internal Medicine ABIM Exam Review: January 2015

Last year, I felt like a rising star. I started my chief year, applied to cardiology fellowship, and was ready to take the boards. I felt great, studied hard and long and did MKSAP twice. When I got that I had failed, I was completely devastated, crushed, immediately went into depression. I could not work, my relationship with my fiancé suffered, and I felt alienated. I wanted to quit and end it all. I didn’t know what to do. I had to pretend everything was ok for interviews and for my colleagues, when really it was not.

My Program Director got me help and guidance, I got treated for anxiety and ADHD, and then I started reading Harrison’s. Probably the best thing I ever did along along with Harrison Board Review Questions. Additionally, I sought counseling and I started working out. And not just any work out, I bought P90x. I needed to regain myself in order to survive this ordeal. I also had strong family support as well.

Later, I then received help from a mentor who taught me how to approach questions. Read the storm first, then the answers, and then the question vignette. GENIUS! Everything started to improve, so I looked for more practice questions. I ended up with USMLE World, Knowmedge, and Medstudy questions. I also had the ACP board review course, which helped some. During this time also I reviewed old material, tables, Medstudy cards, and Board Basics.

However, I still felt very alone within my own program, my PD became less of an advocate for me, my own cardiology program told me I wasn’t a strong candidate because despite my 3 years of slavery for their program through research, I still felt alienated by my colleagues, and my engagement eventually fell apart. I hit rock bottom.

Fortunately, a month after I failed, I prematched into Cardiology; one stressor was removed from the list. Additionally, my scores and knowledge improved substantially through reading and practice questions because I learned medicine and I learned how to take test questions. I could easily tell a difference in my clinical care.

So where does Knowmedge fit into all of this? I thought the questions were good, but my favorite aspects were the answer videos, the Twitter feed tips, and the last minute board review outline. All of these were great additions to my preparation, but I was still nervous and quite frankly scared.

So where did Knowmedge score big with me? It scored big through Sunir. Knowmedge allows you to give feedback for questions and you get a very quick response. I had a lipid question I contested based on new guidelines, Sunir’s reply was quick, sincere, and personable. In fact, for whatever reason, I reached out to him for help and guidance. Sunir didn’t have to write back to me, he didn’t have to give me personal guidance or coaching via email, he didn’t have to email me Knowmedge links to help me towards my preparation. He didn’t have to do all this on a Saturday. I reached out to him on a Saturday morning and from that point on he was available to listen and guide me up to the date of my test.

By the day of my test, I had felt armed and ready. My family came to visit to help me with daily living before my test. I packed a hearty bag full of snacks and lunch, did yoga the night before, and got up to take my test. I was nervous, but ok relieved that this would hopefully all be over. After 8-10 hours of questions, with push-ups, yoga, food, and a quick nap, I was done with the test.

The months go by and you after failing that the test results come back the first week of October. I knew I wasn’t going to check them at work.

October 6, 12:30 PM, I get the email. Turned my phone off, finished clinic, be honest made up a lie to go home a little early to check my score. Trembling, nervous, running round, waiting for my computer to turn on. I didn’t even bother logging into the ABIM website, I just typed my name to see if I was board certified. It said YES! It was over, I screamed and hollered through the roof called everyone, celebrated with a bottle of champagne, danced the night away by myself in my living room, and called a girl I just met to celebrate.

So here I am now, 4 months into cardiology fellowship and I reflect back to what happened to me last year. To sum it up, worst year ever. However, I am a very strong and smart cardiology fellow, probably much smarter than I would of been had I passed last year. Do I wish I had passed last year, duh of course, but this happened for a reason.

Sunir said it very well, studying for boards is a marathon. If you think you can get away with one source, you are a damn fool. You need to learn the medicine, the pathophysiology, clinical manifestations, diagnosis, and the guidelines. Every source out there is a good review, is it everything you need, absolutely not. You also need to stay healthy and have sound peace of mind. Exercise, workout, do yoga, eat and live well. Finally, believe in yourself, develop grit.

To you interns and residents that read this, you need to read Harrison’s and you need to read guidelines (USPTF guidelines). That’s is it period. This is how to learn medicine. You need to spend the time and invest in yourself. Do what your program tells you to do, but learn from the smartest people in the world, the people who wrote our current guidelines and Harrison’s textbook. Use your I service exams as a guide, DO NOT blow them off, and that’s a personal lesson. Avoid the bad habits of others, quick and dirty can get you into trouble before you it’s too late. Do medicine correctly, learn it the right way.

I read everyday, Braunwauld, Grossman, Oh, or cardiology Circulation or JACC guidelines daily because of my experience. I take my cardiology inservice exam next week. I see the bear, he is big, he is nasty, and he will try to make me feel dumb. I have three years to train and, this time, I will be ready.

Best of luck to everyone,

Jonathan, former Chief Resident, Cardiology Fellow