MD Just Graduated with MD* and Seeking Advice

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Xiphias

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I will try to make this post as concise as I can, and I apologize if I include superfluities or other statements not germane to this inquiry. If there is specific information that would be helpful in terms of understanding my situation, please let me know. Thanks!

I just graduated with an MD; however, I am definitely not celebrating like the rest of my class. I failed Step 2 CS twice, and after much deliberation by a committee at my school, was allowed to graduate without the required passing of CS; however, I cannot enter the match. My decision to go to medical school was, in retrospect, very ill-informed. I was a biophysics major and very much loved quantitative science. I also loved volunteering in inner-city Baltimore (well just gave away my school I suppose) and my experiences shadowing various specialists at the hospital. No one in my family is in the healthcare field, and looking back I undeniably made an error in going to medical school in the first place. However, I received a full scholarship and lived with my parents, so at least I don't have any student loans to pay back.

I loved the first two years of medical school (preclinical years), and it wasn't until M3 when I realized that 1) I cannot handle stress well, 2) I'm prone to MDD, 3) My public speaking skills (or perhaps social/interpersonal/communication skills in general) are horrid. I worked with my psychiatrist extensively during this time as well as a clinical advisor. I took many OSCEs and usually got slightly below average to average. I took my med school's clinical performance exam after M3 (made to model S2CS) and scored slightly above the median score for my class. I took S2CS twice (for 2' attempt I practically memorized FA-CS and my advisor, along with the SPs, told me I would definitely not fail). In Atlanta I could not control my emotions, and the only thing I could concentrate on was how much of a failure I was. Or maybe I simply do not have the clinical skills necessary to pass the exam, and the exam served its intended purpose. I don't know.

So as I said previously, I was permitted to graduate but could not enter the match. If I did enter the match, I would apply into pathology, but that's obviously not a possibility now. Unfortunately, having an MD without residency training is not much of an asset (I'd argue that it's a liability). The only jobs for which I'm qualified (that I'm aware of) are entry-level positions as lab assistants (clinical and basic science). I sent a sample resume/CL to two physician-scientists that I know very well, and they both said the biggest problem is that my MD is a red flag (i.e. applicant either has major character flaw or is not serious about job). I have worked in many biochemistry, biophysics, and microbiology labs and worked on individual research projects; however, my lab skills are not "fresh." I began applying to jobs last month, and I'm starting to get very scared. I know I have made major mistakes in the past, and I aspire to learn but not dwell on them. Perhaps I should look outside research science if there is a possibility of a position with upward mobility. Or perhaps I should spend more time networking and/or improving my networking strategy (or lack thereof).

If anyone has any ideas or suggestions, let me know. Sorry if portions were superfluous or overly verbose. I don't blame anything/anyone except myself for my current situation. I try not to make excuses as best I can.

Thank you and sincerely,

AM

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Is retaking the CS and thus becoming eligible to try to match in pathology not an option?

(Coming from the DO world so I honestly don't know)
 
Could you enter a PhD program? Your medical knowledge would not go to waste and you could focus on running a lab, etc. I can't imagine that business consulting would be a consideration with your public speaking issues. What about bioinformatics?
 
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A good cover letter, detailing your desire to re-enter lab-based research, might help explain your career change. There are many great biotech companies in the 270 research corridor. All you need is someone to take a chance on you and then you start to build your resume in that area. You will need to practice your interview skills with a coach. Consider preclinical toxicology or a similar field where your hard science knowledge and your MD degree could be be a boon.

Thank your lucky stars that you have no loans. This could be a much worse situation.
 
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I will try to make this post as concise as I can, and I apologize if I include superfluities or other statements not germane to this inquiry. If there is specific information that would be helpful in terms of understanding my situation, please let me know. Thanks!

I just graduated with an MD; however, I am definitely not celebrating like the rest of my class. I failed Step 2 CS twice, and after much deliberation by a committee at my school, was allowed to graduate without the required passing of CS; however, I cannot enter the match. My decision to go to medical school was, in retrospect, very ill-informed. I was a biophysics major and very much loved quantitative science. I also loved volunteering in inner-city Baltimore (well just gave away my school I suppose) and my experiences shadowing various specialists at the hospital. No one in my family is in the healthcare field, and looking back I undeniably made an error in going to medical school in the first place. However, I received a full scholarship and lived with my parents, so at least I don't have any student loans to pay back.

I loved the first two years of medical school (preclinical years), and it wasn't until M3 when I realized that 1) I cannot handle stress well, 2) I'm prone to MDD, 3) My public speaking skills (or perhaps social/interpersonal/communication skills in general) are horrid. I worked with my psychiatrist extensively during this time as well as a clinical advisor. I took many OSCEs and usually got slightly below average to average. I took my med school's clinical performance exam after M3 (made to model S2CS) and scored slightly above the median score for my class. I took S2CS twice (for 2' attempt I practically memorized FA-CS and my advisor, along with the SPs, told me I would definitely not fail). In Atlanta I could not control my emotions, and the only thing I could concentrate on was how much of a failure I was. Or maybe I simply do not have the clinical skills necessary to pass the exam, and the exam served its intended purpose. I don't know.

So as I said previously, I was permitted to graduate but could not enter the match. If I did enter the match, I would apply into pathology, but that's obviously not a possibility now. Unfortunately, having an MD without residency training is not much of an asset (I'd argue that it's a liability). The only jobs for which I'm qualified (that I'm aware of) are entry-level positions as lab assistants (clinical and basic science). I sent a sample resume/CL to two physician-scientists that I know very well, and they both said the biggest problem is that my MD is a red flag (i.e. applicant either has major character flaw or is not serious about job). I have worked in many biochemistry, biophysics, and microbiology labs and worked on individual research projects; however, my lab skills are not "fresh." I began applying to jobs last month, and I'm starting to get very scared. I know I have made major mistakes in the past, and I aspire to learn but not dwell on them. Perhaps I should look outside research science if there is a possibility of a position with upward mobility. Or perhaps I should spend more time networking and/or improving my networking strategy (or lack thereof).

If anyone has any ideas or suggestions, let me know. Sorry if portions were superfluous or overly verbose. I don't blame anything/anyone except myself for my current situation. I try not to make excuses as best I can.

Thank you and sincerely,

AM
You might be an ideal candidate for the Missouri Assistant Physician law that is now taking applications and giving assistant physician licenses to medical graduates who could not obtain a residency--just look up "Missouri Assistant Physician" in google and you'll see plenty of articles regarding this-- here is the Missouri Board of Registration for the healing arts link that explains it in further detail with the application to fill it--- Missouri Board of Registration for the Healing Arts

I'm sorry to hear about your situation --I hope this might help
 
You might be an ideal candidate for the Missouri Assistant Physician law that is now taking applications and giving assistant physician licenses to medical graduates who could not obtain a residency--just look up "Missouri Assistant Physician" in google and you'll see plenty of articles regarding this-- here is the Missouri Board of Registration for the healing arts link that explains it in further detail with the application to fill it--- Missouri Board of Registration for the Healing Arts

I'm sorry to hear about your situation --I hope this might help

He has to be able to pass his Step exams for that though.
 
He has to be able to pass his Step exams for that though.
He presumably passed step 1 and step 2 ck ---I don't know if step 2 cs is needed specifically? The board states "successfully completed Step 2 of the United States Medical Licensing Examination" so I guess i'd ask as a follow-up does this mean to say step 2 ck only?
 
I vote pass step 2 cs and get into a path residency

What problems are you having with the test?
 
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He presumably passed step 1 and step 2 ck ---I don't know if step 2 cs is needed specifically? The board states "successfully completed Step 2 of the United States Medical Licensing Examination" so I guess i'd ask as a follow-up does this mean to say step 2 ck only?

No. Step 2 encompasses both exams.
 
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Just retake Step 2 CS and match into pathology.
Practice really hard and maybe take a benzo or beta-blocker next time.
 
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How about going into biotech industry? Many companies value the MD for clinical trial coordination, etc.
 
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I agree that practicing to pass Step 2 should be a priority. It sounds like the only thing keeping you from passing is you and your anxiety. If you've got a psychiatrist, they should be able to give you the appropriate prescription and a counselor could help you work on mindfulness to help with performance anxiety issues. Passing it would open the most doors for you and revive the opportunity to become a practicing physician.

If passing Step 2 is really out of the question and you love path, you could potentially look into becoming a coroner. Some states require you to have an MD (which you have), and since you have no debt a salary of 60kish/ year wouldn't kill you financially. There's always research as well, but there are also other options for those with medical degree but no residency.
 
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Right now it's not the time to feel sorry for yourself and keep messing around. Man up and put the work in to pass CS. You think you're the only one to discover clinical medicine sucks or that doesn't have a perfect personality? Practice for CS and then get drugged up on benzos and beta blockers (prescribed by your psych) and finish what you started. Match into pathology and have the life you worked for this long. No giving up on the last minute.
 
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Sounds like you went to hopkins. That brand should get you to SOME place. Usually consulting but I am not sure if you can do that...
 
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Damn your story is similar to mine in a lot of ways. But I was able to get a residency spot for July 2017 despite not matching and not soaping and my advisers giving up after I initially wasn't able to get a position this year. Send me a pm. I think i can help you with a good game plan.
 
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Thank you so much for everyone's help and suggestions. Sorry for the confusion -- I just went to JHU for undergrad (a good school but definitely not as impressive as attending their medical school, although I did go to a 'top' MD program)! I will look into preclinical toxicology, and I have lots of family in MoCo/270 corridor (thanks!). Although it sounds like CS is required for the Missouri program, thanks for the suggestion. I really appreciate everyone's ideas. I will research the possibility of being a coroner (60k sounds pretty good). I will research PhD programs, and I love bioinformatics (I'd be curious to know what you think of master's programs in biomedical informatics and similar programs if you have any additional information).

In reference to the advice on pharmacotherapy, I am prescribed benzodiazepines and my psychiatrist discussed how to best use my prescribed benzo on the day of the test. I never used a beta-blocker, as he strongly advised against it for the exam. Perhaps it would have helped.

Right now it's not the time to feel sorry for yourself and keep messing around. Man up and put the work in to pass CS. You think you're the only one to discover clinical medicine sucks or that doesn't have a perfect personality? Practice for CS and then get drugged up on benzos and beta blockers (prescribed by your psych) and finish what you started. Match into pathology and have the life you worked for this long. No giving up on the last minute.

I thank you for giving your suggestion, and I'm assuming you had good intentions. I do not claim to have discovered anything with regards to the realities of clinical medicine. Nor do I claim to be the first to not have a perfect personality. Sorry for the ambiguity -- I didn't mean to come off like that. I've heard variants of 'man up' or 'tough it out' my whole life (not directed at me per se; perhaps it's just more common for those from the South to use those phrases). It doesn't offend me one bit, and I get your point. Believe me, I do not want to give up or feel sorry for myself. I respect you for giving your honest opinion.

twospadz I will PM you; thanks!!

Thank you to everyone who responded!
 
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I vote pass step 2 cs and get into a path residency

What problems are you having with the test?

Sorry I missed your question, sliceofbread136. I wish I knew the precise cause of my problems. I failed the ICE component both times, and it's unfortunate that there are no data on what portion of the ICE component one had particular problems. With the help of some amazing SPs and my advisor, we tried to replicate S2CS as best as possible. Everything was timed, and I was given the room and PN time warnings. Although it was not the norm, I would sometimes not finish PNs (I used the strategy of starting with diagnostic tests, then DDx with corroborating findings, essentially going from the bottom of the page to the top). Sometimes I would elicit key symptoms/signs but forget to write them down and then the PN is void of the key finding, although after much practice this became more rare. During the test in ATL it seems I didn't utilize any of the tools I developed. I should have practiced in a different building and setting perhaps. I was aware of my encounters going poorly while taking the test, but I really wish I knew why I didn't utilize any of the skills/strategy that I had practiced.
 
You should research if there are any companies that do mock exams under realistic conditions and do this as many times as you can. I think Kaplan does offer that. Right now is the time to attempt passing the exam as the more removed you are from graduation date the less likely PDs will take a chance on you. Good luck.
 
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You should research if there are any companies that do mock exams under realistic conditions and do this as many times as you can. I think Kaplan does offer that. Right now is the time to attempt passing the exam as the more removed you are from graduation date the less likely PDs will take a chance on you. Good luck.
Great idea -- I will look into companies such as Kaplan that offer extremely realistic conditions. And you're right: I have no time to wait. Thanks!
 
I thank you for giving your suggestion, and I'm assuming you had good intentions. I do not claim to have discovered anything with regards to the realities of clinical medicine. Nor do I claim to be the first to not have a perfect personality. Sorry for the ambiguity -- I didn't mean to come off like that. I've heard variants of 'man up' or 'tough it out' my whole life (not directed at me per se; perhaps it's just more common for those from the South to use those phrases). It doesn't offend me one bit, and I get your point. Believe me, I do not want to give up or feel sorry for myself. I respect you for giving your honest opinion.
Man, you're such a nice guy. Can't believe you had trouble with the test. I just wanted to pump you up to do it. It's just not fair to yourself to give up when you've gotten this far over some stupid little test. You'll thank yourself later once you overcome this and match.
 
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Sorry I missed your question, sliceofbread136. I wish I knew the precise cause of my problems. I failed the ICE component both times, and it's unfortunate that there are no data on what portion of the ICE component one had particular problems. With the help of some amazing SPs and my advisor, we tried to replicate S2CS as best as possible. Everything was timed, and I was given the room and PN time warnings. Although it was not the norm, I would sometimes not finish PNs (I used the strategy of starting with diagnostic tests, then DDx with corroborating findings, essentially going from the bottom of the page to the top). Sometimes I would elicit key symptoms/signs but forget to write them down and then the PN is void of the key finding, although after much practice this became more rare. During the test in ATL it seems I didn't utilize any of the tools I developed. I should have practiced in a different building and setting perhaps. I was aware of my encounters going poorly while taking the test, but I really wish I knew why I didn't utilize any of the skills/strategy that I had practiced.

None of the things you're describing from your test day sound like true knowledge/skills deficits. They sound like severe test anxiety.

That story might cause problems if you were planning on anesthesia, em or critical care, but for pathology I doubt anyone would mind much.

The reason everyone is telling you to retake the test is that you're still eligibile based on number of attempts, you seem to have the requisite skills and knowledge, and passing it will still likely allow you to pursue path (you went to a high quality us md school: your red flag in and of itself is probably ok).

Is there a specific reason you cannot retake cs, or is it just your fear of failing it/experiencing that again? I can get a phobia (they aren't rational), but that doesn't make it an acceptable reason to give up a career
 
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z assuming you demolished your Step 1 and Step 2 CK... Invest in a local tutor or ask a classmate who is very good at clinical stuff to help out. Tell him you'll buy him a beer. Ya, id help you out for some beer.


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good luck man! don't get down on yourself. As someone who works in clinical research, I can tell you that there are opportunities there as well-big pharma, CROs big and small, health communications firms. Stop thinking of the MD as a liability, that is stinking thinking and is not helping you. I know it is very hard but you have to find a positive thread-you can do it!
The below group employs, MD, PharmD's and PHDs in health strategy and communications
Culture | Omnicom Health Group
 
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Thanks for the additional advice; my school has a '3 strikes' policy for all board exams, so I would essentially have one shot. I think that fact alone, along with what I thought was superb preparation for my second attempt, probably helped push my fear of a 3' attempt into the 'irrational phobia' category. Does anyone have experience or know anything about the intensive courses offered by Kaplan, USMLESource, GoldUSMLEReview, Ximedius, etc? I've heard very good things about Ximedus and have talked to someone who said he would have failed S2CS again if it weren't for Ximedus. I haven't talked to anyone that has taken the Kaplan course or any of the other aforementioned CS review courses.

Yeah I did well on Step 1 and Step 2 CK-- I'll buy someone all the beer he/she wants in return for CS help^N. Accumbens. Thanks TeaDog for the info on CROs; I haven't heard of Omnicom but will check out the link you provided (p.s. congrats on your acceptance to med school!). ChiTownBlackhawks thanks for the encouragement! And AlbinoHawk (wow lots of hawks here, although I don't think this is a hockey reference) I agree with you 100% and you definitely helped to pump me up; you tell it like it is, and that's what I need to hear.

Thanks again to everyone for the advice and resources.

AM
 
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If you failed the ICE portion twice, it seems you might be having test anxiety. Based on your perception of your social skills, I was expecting problems with the CIS and not the ICE. Since you passed the CIS, you are not as bad as you think. You may have also suffered some bad luck.

Did your tutors review your documentation? Are you blanking out on systems to evaluate when the SP presents a complaint? Do you have a general routine/approach for most common SP medical complaints?

I would look into the detailed components of the ICE and how to address any deficiencies in those areas. If this is anxiety-related, which I suspect, perhaps a benzo may not be enough. You may benefit from therapy with an SSRI with as needed low-dose benzo and/or beta-blocker with the advice of your psychiatrist. You must test this drug regimen before another attempt at the CS exam to evaluate for its efficacy.

I hope things work out. Hopefully this Step 2 CS exam will be abolished. If all med students would unite and refuse to take the exam, that would send a strong message. Unfortunately medical training encourages kowtowing to the status quo which ultimately creates major inertia to positive change.
 
I will try to make this post as concise as I can, and I apologize if I include superfluities or other statements not germane to this inquiry. If there is specific information that would be helpful in terms of understanding my situation, please let me know. Thanks!


AM

Very sorry to hear of your woes.

The wise @gyngyn has posted a list of "what you can do with an MD degree that doesn't require residency".
 
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I will try to make this post as concise as I can, and I apologize if I include superfluities or other statements not germane to this inquiry. If there is specific information that would be helpful in terms of understanding my situation, please let me know. Thanks!

I just graduated with an MD; however, I am definitely not celebrating like the rest of my class. I failed Step 2 CS twice, and after much deliberation by a committee at my school, was allowed to graduate without the required passing of CS; however, I cannot enter the match. My decision to go to medical school was, in retrospect, very ill-informed. I was a biophysics major and very much loved quantitative science. I also loved volunteering in inner-city Baltimore (well just gave away my school I suppose) and my experiences shadowing various specialists at the hospital. No one in my family is in the healthcare field, and looking back I undeniably made an error in going to medical school in the first place. However, I received a full scholarship and lived with my parents, so at least I don't have any student loans to pay back.

I loved the first two years of medical school (preclinical years), and it wasn't until M3 when I realized that 1) I cannot handle stress well, 2) I'm prone to MDD, 3) My public speaking skills (or perhaps social/interpersonal/communication skills in general) are horrid. I worked with my psychiatrist extensively during this time as well as a clinical advisor. I took many OSCEs and usually got slightly below average to average. I took my med school's clinical performance exam after M3 (made to model S2CS) and scored slightly above the median score for my class. I took S2CS twice (for 2' attempt I practically memorized FA-CS and my advisor, along with the SPs, told me I would definitely not fail). In Atlanta I could not control my emotions, and the only thing I could concentrate on was how much of a failure I was. Or maybe I simply do not have the clinical skills necessary to pass the exam, and the exam served its intended purpose. I don't know.

So as I said previously, I was permitted to graduate but could not enter the match. If I did enter the match, I would apply into pathology, but that's obviously not a possibility now. Unfortunately, having an MD without residency training is not much of an asset (I'd argue that it's a liability). The only jobs for which I'm qualified (that I'm aware of) are entry-level positions as lab assistants (clinical and basic science). I sent a sample resume/CL to two physician-scientists that I know very well, and they both said the biggest problem is that my MD is a red flag (i.e. applicant either has major character flaw or is not serious about job). I have worked in many biochemistry, biophysics, and microbiology labs and worked on individual research projects; however, my lab skills are not "fresh." I began applying to jobs last month, and I'm starting to get very scared. I know I have made major mistakes in the past, and I aspire to learn but not dwell on them. Perhaps I should look outside research science if there is a possibility of a position with upward mobility. Or perhaps I should spend more time networking and/or improving my networking strategy (or lack thereof).

If anyone has any ideas or suggestions, let me know. Sorry if portions were superfluous or overly verbose. I don't blame anything/anyone except myself for my current situation. I try not to make excuses as best I can.

Thank you and sincerely,

AM

So sorry to here about this but I think you are intentionally or unintentionally blowing your problem out of proportion. I don't think even two CS failures DQs you from residency and I find it hard to believe entry level lab positions see an MD as a red flag. Why not try again to study for CS, take it, and then apply Pathology?
 
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You can pass the CS exam just chill- if you went to Johns Hopkins you are obviously very bright and gifted. Make it your business to pass the exam. I have 2 friends that I went to med school with (very smart guys) they were conditioned (meaning have to retake) the subjective practical part of their board certification exams. Today they are both very successful radiologists. Do what you have to do pass the damn test and I am positive you will get in to a very excellent pathology program-that's what you should do.
 
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It sort of blows my mind that someone that wants to enter pathology even needs to pass CS to begin with.
 
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It sort of blows my mind that someone that wants to enter pathology even needs to pass CS to begin with.

Thought the same thing... but then again, our educational system is cluttered with redundancy so it doesn't surprise me as much.


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retake step 2 cs and go path. seems like a perfect fit.
 
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Thanks again for the advice; my advisor looked at all my PNs and gave me extensive feedback. However, the fact that I failed the ICE portion twice, as noted above, shows that the problem lies in my ability to ask the appropriate questions, correctly perform the PE including special maneuvers specific to the case, and write a PN including all key components. It more than likely is a combination thereof I would presume. I wish the score report expounded on my problems with the ICE section, but I have to work with what I got. I definitely want to make sure I'm studying/training the correct way.

^Goro, thanks for the link and advice. Much appreciated!

^Cyal I've actually been on an SSRI for ~12y and am rx'd a prn benzo but no BB. I practiced using what he believed to be a good regimen for test day. Thanks for the advice though; I'll bring up the idea of a BB again to my psychiatrist when we meet this coming week.

So sorry to here about this but I think you are intentionally or unintentionally blowing your problem out of proportion. I don't think even two CS failures DQs you from residency and I find it hard to believe entry level lab positions see an MD as a red flag. Why not try again to study for CS, take it, and then apply Pathology?

You're right -- I'm probably blowing this out of proportion. With respect to applying to entry level lab positions, I'm curious as to your incredulity. I was, in part, reiterating what I was told by physicians that are also very active in research* (n=2 and haven't directly talked to PIs in basic science). If you have additional information let me know; the more knowledge the better! Thanks.

Sincerely,

AM
 
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