Comp Studying Time!

What's for dinner? First Aid and Oreos!

After several semesters of approaching medicine from all different disciplines, from Genetics to Pharmacology, we spend our fifth semester integrating everything we’ve learned. Although in a typical fifth semester, students take Pharm II, Behavioral II, Med Ethics, Intro to Clinical Medicine (ICM) 5, and Intro to Clinical Medicine (ICM) 6, I feel the latter two courses especially trains us for the transition to the clinical half of our education, by training us to integrate and apply everything we have learned thus far in med school.

In ICM 5, we meet in small groups several times a week to present and discuss cases. Although we all have to do pre-reading beforehand about each case, each student is assigned a case to present and lead the class in discussion. Each case is like a puzzle. For each case, we are given information about a patient, the chief complaint, history of present illness, past medical history, social history, etc. from which we discuss as a class what conditions the patient possibly has (differential diagnosis). Afterwards, we discuss which labs we need to order to rule out or support diagnoses. Afterwards, we are handed sheets of paper with results from the lab tests we “ordered” (i.e. x-ray, chem test, ecg, etc.) and physical examination results. Out of process of elimination, we narrow down the possible diagnoses one by one until we come up with a diagnosis, and then discuss how to treat, consult, and follow-up on the patient. Each case is intended to train us to think on another level, as doctors and decision-makers, applying and integrating all the different disciplines we’ve learned thus far in medical school.

In addition to learning cases in ICM 5, we concurrently take another course that is meant to prepare us for the upcoming USMLE Step 1 Exam (US Medical Licensing Exam), ICM 6. For this class, we are required to pass two comprehensive exams of everything we’ve covered in med school: the 4.5-hour NBME Comprehensive Exam and the 8-hour Kaplan Comprehensive Exam, which simulates the actual USMLE Step 1. These exams not only gauges us to see where we stand in our readiness to take the board exam, but also ensure that we are prepared to pass one of the most important exams in our lives a few months away before we leave the island.

In the beginning of the semester, we take a three-hour diagnostic exam (which we take online, anywhere, anytime, at our own leisure), to see where we are at in terms of our knowledge. We get an analysis of which subjects we did well in and which subjects we need improvement, comparing our performance to national averages. We must pass the diagnostic exam with at least a 20%, which is pretty easy to do. If we don’t get a 20%, we are required to score at least a 52% on the Kaplan comp at the end of the semester, instead of the usual 47%. Seeing these initial results, we get an idea of our strengths and weaknesses, and an idea on what to focus on and how to prepare ourselves for the two big comprehensive exams we have to take later in the semester.

For the 4.5-hour NBME comprehensive exam, we’re given three chances to pass it with at least a 64 two-digit score, equivalent to a three-digit Step score of 185 (the current passing Step score is 188). The first exam is two months into the semester. The second is three weeks later, and the third exam is 2.5 weeks after that. If a student doesn’t pass at least one of those three exams, then he/she must come back the following semester for one last opportunity to take the exam. Usually around half the class passes the first comp exam (first comp average score sways around 63 or 64 every semester), and most people will have passed it by the third. Usually only a handful of students have to come back to the island the following semester to take it a fourth time, and most of them do pass by then since they had since gotten sufficient time to study without worrying about trying to pass their other classes. Students who pass the first or second comp can take the other comps for practice, which is highly recommended. (UPDATE Fall 2011: You now only have 2 chances to pass the NBME Comp. But, alternatively, if you pass both the Path and Physio Shelf (125-questions each), you don’t have to pass the NBME Comp. Note, however, you still need to pass the 8-hour Kaplan Comp to leave the island).

The 322-question 8-hour Kaplan comprehensive exam is the ultimate exam, administered a few days before the end of our last semester on the island. It simulates the USMLE Step 1 exam in content and format and we’re given one chance to pass it (or else we’d have to come back the following semester to take it again). We must pass the Kaplan comp with at least a 47%, equivalent to the minimum passing USMLE Step 1 score of 188.  This ensures us that before we leave the island, we at least have the competence to pass the USMLE Step 1 Exam.

We have just taken our first NBME comp exam yesterday, and I must say, I felt the exam was very do-able. Nothing on there was totally unfamiliar. Being a 200-question, four-hour exam without any breaks in between, however, I must say that it was an exhausting exam, and it’s an appropriate mid-way step in our endurance training for the eventual 8-hour exam. I didn’t do as well as I hoped, scoring a 63, 1 point short of passing, but going through this experience yesterday gives me hope and direction on the next comp exam in three weeks.

Full speed ahead! It’s Comp Time!