MD/PhD entering M3. My foundational knowledge has completely disappeared. Should I be worried about this?

[ChordaEpiphany]

It's been over 4 years since I took step 1 (scored 258, fwiw), and I'm mildly freaking out about starting on the wards in about a month. I knew my knowledge based would be lacking, but it's even more atrocious than I ever imagined, and it's not coming back even after 3 months of part-time studying. I feel like I'm up against a completely insurmountable obstacle, and I'll never really recover the knowledge I lost in a sufficient way to excel on shelf exams/step 2. For the last 3 months, I have had time for 2-4 hours of studying each day, and I've been doing Anki, Step 2 Amboss, and random videos on Youtube, but the more I study, the more I reveal how much I've forgotten.

For instance, I'll do a question that prompts me with a person who comes back sick from a foreign country. I read the question and have no idea what they have, but I think to myself, "it's fine, I'll spend an hour or two reviewing endemic illnesses like malaria, zika, dengue, etc... Coming to the realization that there are about 5,000 of these topics where I need to learn to recognize, diagnose, and treat is enough to make my head spin. Then I read the answers and realize that I not only need to relearn all of this information, but I need to get hyper granular on the details. The questions are 60-70% corrects (two hammer), and you still need detail down to stuff like "which specific countries are chloroquine resistant?" or "what's the specific smear finding that tells you this is malaria over some other disease?" This was all fine and good when it was the expected result after a full year of 8+ hour days studying in the library in M2. Now, there's just no hope.

Even if I dropped all responsibilities for the end of my PhD for the next month, there's not a chance on God's green earth that I'm shoving all this granular information back into my head over the next year while also doing well on wards and building on that knowledge with clinical information.

I've completed the Zanki deck and about 300 Amboss questions. I take 3 min/question, my scores are still hovering in the 40% range, and I haven't seen any noticeable improvement. If anything, I now just second guess myself with my limited knowledge and talk myself out of right answers. How do I dig myself out of this hole?

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[bGMx]

If I was you, I think I would commit full time now to doing the Amboss Step2 CK prep and just knock it out in a month (this will take a month of 4 blocks a day) while doing then Anking Step2 deck. You'll have a fine foundation for M3; then just keep up with Anking and do uWorld appropriate blocks. I think you will be fine, M3 is going to teach you what you need.

 

[GoSpursGo]

It will come back to you, and also the skills you have in thoroughly reviewing the literature will make you an asset. You may be a little behind for the first rotation or two, but you’re going to come out ahead in the long run

 

[Tenk]

It’s ok. I’ve been a doctor for over a decade and my foundational knowledge has completely disappeared as well.

 

[Kardio]

The Step 2 question averages are much higher than your scores because people do subject-specific questions as they proceed through rotations. It would be very challenging to learn each discipline’s trends with just 300 questions if you’re working through a mixed-discipline question set. If you had done 300 OBGYN questions and weren’t improving, there’d be more cause for concern.

They are also very different in style than Step 1 questions, which takes a while to get used to.

 

[LunaOri]

You will not need to know all those details, especially not at the beginning! Focus on remembering how to take a history and write a clinical note. Nobody in their right mind would expect you to know what countries have chloroquine resistant malaria—unless you use information like that every day, you will always look it up! As attendings, we use resources like Up-to-Date (CDC website is good for ID).

 

[Chromium Surfer]

I would also say Amboss is known for being super nit picky at times. I agree with Kardio that step 2 questions are different and that if you do it bypasses block your scores will gradually increase

 

[Dr G Oogle]

Just apply the same study techniques in ms1-2 to ms3, you don’t really need to know the Krebs cycle, and actual clinical medicine knowledge is not what you learn in the first 2 years

 

[neurotroph]

FWIW I took step 1 5 years ago and got the same score as you and have honored every shelf since returning to the wards in January. We'll see how step 2 goes though. I didn't do any prestudying towards the end of my PhD. You're doing too much imo. Shelf/step 2 material is way more intuitive than step 1 because you don't have to know much mechanism and you're actually getting that material reinforced on the wards. And it's been easier learning stuff the second time around because the remnants are still there. Just relax and enjoy these last moments before you're back to the med school grind because you'll burn out easily doing all of that.

 

[RangerBob]

Even as an M1/M2 I never even knew what specific countries are chloroquine resistant and what the specific smear finding is that tells you it's malaria over another disease. I don't have the faintest idea even know.

I honestly can't imagine any attending asking you the above questions, unless you're on an ID rotation. You would probably best be served by prepping for each specific rotation, so there's some relevance, and also efficiency. If have OB first, focus on the OB stuff plus general physical exam/history taking.

My attendings tended to ask a lot more clinically based questions than actual M1/M2 path/pathophys stuff.

Whenever a med student worries about the future, I remind them to have faith in the system. Somehow the medical education system turns what were once babbling babies into quite competent physicians. Most docs (even the ones who didn't go to "top 10" or even "top 100" schools) are pretty good at what they do--and almost all med students become physicians. That's quite the success story. I wish we could say the same for contractors, teachers, lawyer (politicians!), etc.

 

[Redpancreas]

It's been over 4 years since I took step 1 (scored 258, fwiw), and I'm mildly freaking out about starting on the wards in about a month. I knew my knowledge based would be lacking, but it's even more atrocious than I ever imagined, and it's not coming back even after 3 months of part-time studying. I feel like I'm up against a completely insurmountable obstacle, and I'll never really recover the knowledge I lost in a sufficient way to excel on shelf exams/step 2. For the last 3 months, I have had time for 2-4 hours of studying each day, and I've been doing Anki, Step 2 Amboss, and random videos on Youtube, but the more I study, the more I reveal how much I've forgotten.

For instance, I'll do a question that prompts me with a person who comes back sick from a foreign country. I read the question and have no idea what they have, but I think to myself, "it's fine, I'll spend an hour or two reviewing endemic illnesses like malaria, zika, dengue, etc... Coming to the realization that there are about 5,000 of these topics where I need to learn to recognize, diagnose, and treat is enough to make my head spin. Then I read the answers and realize that I not only need to relearn all of this information, but I need to get hyper granular on the details. The questions are 60-70% corrects (two hammer), and you still need detail down to stuff like "which specific countries are chloroquine resistant?" or "what's the specific smear finding that tells you this is malaria over some other disease?" This was all fine and good when it was the expected result after a full year of 8+ hour days studying in the library in M2. Now, there's just no hope.

Even if I dropped all responsibilities for the end of my PhD for the next month, there's not a chance on God's green earth that I'm shoving all this granular information back into my head over the next year while also doing well on wards and building on that knowledge with clinical information.

I've completed the Zanki deck and about 300 Amboss questions. I take 3 min/question, my scores are still hovering in the 40% range, and I haven't seen any noticeable improvement. If anything, I now just second guess myself with my limited knowledge and talk myself out of right answers. How do I dig myself out of this hole?

You’re overestimating how much you’re expected to know. I could just leave it at that and say “you’re selling yourself short”, etc. but I don’t think that’s very helpful, actionable advice.

To use the example of the sick traveler, the aim is to know the general evaluation with the smear, etc. in case you have to do it on the wards, but even in that case you’re still consulting ID even at the most academic of places. For the boards, they may give you an illness script and give you a question with a few distinct features and even if you have 5% of the encyclopedic knowledge you’re trying to obtain, you’ll be able to narrow things down to answer the question correctly.

In short, leave the volume of information to the encyclopedias and in your case don’t get bogged down in the details. You shouldn’t feel the need to ANKI antimalarials for two hours. Instead look on UptoDate, Aafp, AMBOSS, UWorld, IM board review resources so see what the basic evaluation of the case is. That’s also more of what step 2 is about anyways, granted there are still some step 1 style questions.

 

[SurfingDoctor]

Dude, nobody cares. The fact that you have a MD/PhD already puts you in a league way above most residency applicants.

 

[ChordaEpiphany]

You’re overestimating how much you’re expected to know. I could just leave it at that and say “you’re selling yourself short”, etc. but I don’t think that’s very helpful, actionable advice.

To use the example of the sick traveler, the aim is to know the general evaluation with the smear, etc. in case you have to do it on the wards, but even in that case you’re still consulting ID even at the most academic of places. For the boards, they may give you an illness script and give you a question with a few distinct features and even if you have 5% of the encyclopedic knowledge you’re trying to obtain, you’ll be able to narrow things down to answer the question correctly.

In short, leave the volume of information to the encyclopedias and in your case don’t get bogged down in the details. You shouldn’t feel the need to ANKI antimalarials for two hours. Instead look on UptoDate, Aafp, AMBOSS, UWorld, IM board review resources so see what the basic evaluation of the case is. That’s also more of what step 2 is about anyways, granted there are still some step 1 style questions.

These replies have been incredibly helpful. Thank you all for the encouragement. Having progressed a bit further, it's pretty clear that pre-clinical knowledge isn't going to help me anywhere except maybe on the shelf and with the occasional pimp question. It's still somewhat intimidating to see just how far I have to go and just how much my MD-only colleagues know, but ultimately I think H's will be earned on the basis of professionalism, personality, and attention to detail, not medical trivia. I've started to go through Amboss Qs in a single discipline (my first rotation), and after ~250 more I'm now scoring consistently 60-70%. I still get a lot of 80%+ Qs wrong that I know I would have gotten right fresh out of M2, but I think these will get ironed out throughout the year.

Dude, nobody cares. The fact that you have a MD/PhD already puts you in a league way above most residency applicants.

Anecdotally, our program director doesn't think that's really the case any more. They've had amazing success with some graduates, but they told us that most of them would have been standouts even without the PhD. We've also had some flops where students performed average on the wards and then matched pretty averagely despite fantastic PhDs (i.e., CNS papers), which threatens their ability to start a research career at all. We've also historically had trouble securing AOA because the MSTP students start off rusty. I don't think my concerns are misplaced, but everyone else is right that there is more to doing well than shelf/step knowledge.

 

[SurfingDoctor]

These replies have been incredibly helpful. Thank you all for the encouragement. Having progressed a bit further, it's pretty clear that pre-clinical knowledge isn't going to help me anywhere except maybe on the shelf and with the occasional pimp question. It's still somewhat intimidating to see just how far I have to go and just how much my MD-only colleagues know, but ultimately I think H's will be earned on the basis of professionalism, personality, and attention to detail, not medical trivia. I've started to go through Amboss Qs in a single discipline (my first rotation), and after ~250 more I'm now scoring consistently 60-70%. I still get a lot of 80%+ Qs wrong that I know I would have gotten right fresh out of M2, but I think these will get ironed out throughout the year.

Anecdotally, our program director doesn't think that's really the case any more. They've had amazing success with some graduates, but they told us that most of them would have been standouts even without the PhD. We've also had some flops where students performed average on the wards and then matched pretty averagely despite fantastic PhDs (i.e., CNS papers), which threatens their ability to start a research career at all. We've also historically had trouble securing AOA because the MSTP students start off rusty. I don't think my concerns are misplaced, but everyone else is right that there is more to doing well than shelf/step knowledge.

Most applicants are completely run off the mill. Having reviewed hundreds of these things, there are very few discriminating factors between applicants. Having a PhD is a very big discriminating factor. Speaking from my own program, they bend over backwards to try to get MD/PhD applicants to come here. Also never pans out because despite being like top 5 or 10 in the BRM funding stats nationwide, we don’t have the clinical prestige (ie the US News rankings)… even though ironically, those places generally suck at research (at least for pediatrics).

 

[Rachapkis]

You are not unique or alone. Knowledge fades over time but will come back with consistent effort. Keep your chin up, believe in the abilities that have taken you this far, and keep putting one foot in front of the other. You got this!