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The Numbers Game: What Scoring a 260 on USMLE Step 1 Really Means
Posted by Sarah Coates
*Blog post updated June 17, 2020 to reflect most recent USMLE data below.*

I have been putting off the writing of this post for a while. I’m not sure why. I guess I wasn’t sure how to say anything genuine that would convince you guys that you shouldn’t be hard on yourself for falling short of the lofty goals that you set for yourself before beginning the arduous process of studying for the USMLE Step 1.

Perhaps it’s because I was in your shoes once, and no amount of reason could penetrate my longing for that perfect score, the one that I believed would either complete my application to dermatology residency (and therefore complete me), or dash my chances at my dream job against the harsh rocky shores of reality.
(MedEd)itorial: The Hidden P Waves
Posted by Sarah Coates
“What’s the definition of atrial fibrillation?” she began with an air of informality that made me look up to be sure that my attending was, in fact, talking to me.

When I realized she was serious, I replied, “Unsynchronized electrical activity within the myocardial cells of the atrium that ultimately makes it impossible for the atria to beat as a functional unit, manifesting as an absence of P waves.”

(I’m kidding. I stared at her incredulously.)

She looked back at her computer screen for a moment, and promptly swiveled in her chair to ask the nurse standing behind her to retrieve “an extra long rhythm strip” from the telemetry monitor for the patient in 2G41.
The Biggest Mistake USMLE Step 1 Students Make: A Tutor's Perspective
Posted by Sarah Coates

"Dear Sarah,

You’ve been tutoring for a few years and have worked with a lot of students, providing them with the right resources and guidance. However not everyone, I am sure, reached their goal.

"Based on your experience, what's the biggest mistake your students make that hinder them from surpassing their goal, even after giving them the proper tutoring and help? This way, I could try to avoid those pitfalls and not make the same mistake."


Float On: Medicine is an Art, Not a Checklist
Posted by Sarah Coates
I just finished my first week of night float.

Working nights at the community hospital in Portland, Oregon, where I’m completing my preliminary year in internal medicine, means admitting up to five patients each night and cross-covering the entire teaching service of 40+ patients with one other resident.

As a morning person, staying up late and flipping my schedule by 180 degrees didn’t exactly come naturally. As a new doctor, making challenging medical decisions didn’t come naturally either. As a recent fourth year medical student, sustaining my attention and behaving responsibly for twelve hours straight came least naturally of all.
Things I Wish I Had Known About Clerkships
Posted by Sarah Coates
The things I wish I had known about clerkships before third year began are the same as the things I wish I had known about life, but which I’m grateful to have learned the long way.

And those things mostly amount to this:

Life is about people.

I wish there were a less patronizing, less Hallmark way to utter the simplest truth I know, but I’m not sure there is.
(MedEd)itorial: On Your Path to MD, the Truth Will Set You Free — Typically Right After it Pisses You Off
Posted by Sarah Coates
When I was younger, I used to so look forward to the first day of school; to the advent of school supplies and assignments and structure. However, in February of this year, I can't say that I was thrilled to put down The Goldfinch  and pick up a syllabus that morning. Waking up and preparing for school again felt like an assault on my freedom.

For anyone who's been there, fourth year is so  unstructured — you've survived 75% of your USMLEs, and are now in a string of pass/fail clerkships punctuated by periods of travel and self-discovery. I came into that environment after a research year, during which I structured my time as I saw fit and did so both happily and productively.

When February hit, I wondered, "Is this how it's going to feel every day for the rest of my life, now that I’ve had some time to experience what life is like when you don’t live and die by your study schedule?" 
Spaced Repetition Saves You Time and Sanity for USMLE Step 1
Posted by Sarah Coates
Sometimes I feel frustrated by how simple the truth is.

Perhaps this is because I don’t like to think that the challenges I face are manageable using universal strategies. Perhaps I like to think that my struggles are unique, or else, why would they be… struggles? For example, it doesn’t seem like something as hyped as studying for the USMLE Step 1 (a.k.a. the most-important-exam-in-the-history-of-the-world-AAAAAHHHHHHH!!!) should be formulaic or simple.

But studying for the USMLE Step 1 can be formulaic. And I want to argue that it should be formulaic.

When viewed through the rearview mirror, there are many things I’ve experienced that I didn’t understand completely as I was passing through them. More specifically, while I knew that flashcards had been useful learning tools throughout college and the first two years of medical school, I didn’t understand the concept of spaced repetition and how this technique was making it possible for me to achieve my USMLE Step 1 goals.

Bracing yourself for third year? Lock down your clerkship and Step 2 CK study timeline.
Posted by Sarah Coates

**This blog post was updated July 2019.** Life as a third year medical student is an all-consuming whirlwind:

1. You’re finally applying what you’ve learned.
2. You’re working long hours and getting paid negative dollars.
3. You’re forgetting to eat normal human food.
4. You’re getting sick on your pediatrics rotations.
5. You’re feeling sick on all your rotations because #2 and #3.
6. You’re pressed for time and therefore cannot study the same way you once did.

USMLE Isolation? You Are NOT Alone
Posted by Sarah Coates
Studying for the USMLE can feel like an exercise in social isolation.

Even for those (especially for those?) of us who live amongst our medical school classmates, which in theory ought to be less isolating, the whole process seems to reward those who either hermit up or awkwardly dodge the 500 pound elephant in the room – that we’re studying for the most important exam we will have taken to date.

The truth of this – that we are spending 10-12 hours a day preparing for an extremely important exam – is enough to drive anyone crazy. But there seems to be something about the human condition that fosters a deeper and more troublesome tendency to drive itself further into oblivion by insisting to itself that it is completely alone during difficult times.

I want to take a moment to tell you that you are not alone in this.
Think JUST Studying for the USMLE Step 1 is Enough? Think Again.
Posted by Sarah Coates
Since becoming a tutor for the USMLE Step 1 and Step 2 CK exams, there have been a few times when I've found myself confused by a student’s lack of progress. They’re “doing everything right” – following their schedule to a T, completing each assigned USMLE World question block, taking NBME practice exams with reasonable intervals in between to enable me to track their progression....

But something is off; their scores are not budging and their anxiety is mounting.
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