Answering from Fear vs. Answering from Confidence
Steven R. Daugherty, Ph.D.
Director, Education and Testing
Kaplan Medical
Emotions are the motive force that guides our actions. What we feel has an awful lot to do with what we do. And in few places is this as true as when answering questions on the USMLE.
For some people the looming exam evokes fear. "How will I be judged?" "Am I up to the task?" "What if I fail?" For others the coming of the USMLE is a challenge that energizes. "Here is the chance to show what I have learned." "This is the forum in which I will show myself and the world that I deserve to be a physician."
Many people preach that the goal of the student during the exam should be to be calm and as emotionless as possible. Many people will tell you that during the exam, emotions are a stumbling block. Nothing could be further from the truth. The fact is that the exam will evoke strong emotions. Making the best use of your emotional reactions to the exam has a great deal to do with your final outcome.
Strong emotions are not bad. Emotions serve as the gateway to the cognitive processes demanded by the exam. The right emotional set lays the foundation for optimal cognitive processes. Emotions are the physiological backdrop within which our thoughts and mental processing occur. To do your best you do not want to be emotion free. Rather, make it your goal to harness those emotions you feel. Emotions provide the energy to keep you going when you are tired and to maintain your focus when you are distracted.
All decisions are emotional. Without emotion no decision would ever get made. The key to successful decisions is not a lack of passion, but having the right emotional basis by which cognitive decision-making can proceed. Doing well on the exam is not just about knowing, but more fundamentally, about being able to act, to make decisions. Answering the each presented question requires you to break free from the mere facts to the level where you understand what is being presented, what is most important and, therefore, what must be done.
Think about your preparation for the USMLE as essentially a contest between fear and confidence.
Fear is aversive. We don't like fear and usually act to get rid of the feeling as quickly as we can. Because fear is aversive, it leads to thoughts of escape. In the face of fear we do not want to engage and solve, but disengage and run. Fear causes us to make impulsive choices to feel better, not thoughtful decisions which stand the test of time. Fear drives us to act, but drive out rational cognitive analysis at the same time. Driven by fear, we seek to get an answer in order to get rid of the question. And our whole motive changes from getting the great score to simply getting rid of the bad feeling.
Confidence is positive. Confidence has us jumping into the problem with the anticipation that we can handle whatever is presented. When we are confident a problem is not a burden, but something which energizes us as we seek to understand and to master. From this perspective, each question becomes a challenge. And our goal is transformed from avoidance to one of mastery. Confidence gives us a solid emotional platform on which we can build with our recollections and thoughts. Confidence takes the first step to success by assuming that we will succeed.
The difference between fear and confidence rests with a simple thought. If you think you can handle the exam, you are confident. If you think you can not, you will be afraid. Please note that which ever stance you take is not based on rationality, but on what you assess reality to be.
Can you handle this exam? The fact is that of course you can. You would not have made it this far in your career if you lacked the capacity. Perhaps you have not done everything right or perfectly you entire career. That does not matter. No one expects perfection. All anyone expect is for you to be the physician you are. A physician does not walk into the examination room with fear and trepidation, but with confidence. Each patient is not a problem. The patient is your job. Tending to the patient is you calling.
How do you get to confidence? What makes the difference between the disruption of fear and the energy surge of confidence? It's all about preparation. Confidence does not come from simply reading the content, but from doing things with it. Confidence is born in the flash of insight, in the ability to face something new and figure it out.
When you are well prepared, you are confident. When you are not well prepared, you fear. It's really as simple as that. Put in the time learning to think and not just memorize and you will no longer fear the outcome, but rise to the challenge. That is the confidence that leads to success.
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| 2007 Match Applicants Advised to Get Step 2 CS Test Date by July 1, 2006 International medical students/graduates planning to participate in the 2007 Match are strongly encouraged to apply for Step 2 CS and to schedule their testing appointment by July 1, 2006, according to a notice posted March 3, 2006 on the ECFMG's official website (www.ecfmg.org). This recommendation stems from the need to have taken the Step 2CS exam before Dec. 31, 2006 in order to ensure that the score is available before the Match deadline in February, 2007. This does NOT mean that you must take the exam before July, but rather that early registration is the best way to secure a testing appointment at one of the national CS testing Centers. As of March 2006, the earliest available test dates at any clinical skills evaluation center is in late May or early June 2006. The demand for test dates during the second half of 2006 is expected to be particularly heavy. Similarly, the demand for Kaplan's Step 2 CS preparation courses is also expected to be heavy in the latter half of the year, making it a wise move to register and schedule early in order to ensure that you will get a slot for both the Kaplan CS preparation course and for the Step 2 CS examination as soon as possible. Early registration and scheduling offers several benefits:
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A 13-year-old girl is brought to the doctor’s office by her anxious parents. They are very concerned about the change in her urine color; in fact, it seems that there is blood in it. The child has been in good health except for a recent respiratory tract infection. Physical examination reveals mild edema in the lower extremities and increased blood pressure. Examination of the skin is normal. Serum creatinine and blood urea nitrogen are also normal. Examination of the urine reveals gross hematuria and elevated protein. Antistreptolysin O assays are negative. Histologic examination demonstrates mesangial proliferation. Immunostaining is positive for deposition of IgA, C3 and properdin. Which of the following is the most likely diagnosis?
(A) Acute post streptococcal glomerulonephritis
(B) Alport syndrome
(C) Berger disease
(D) Henoch-Schönlein purpura
(E) Minimal change disease
The correct answer to the question above is: C.
1. Post streptococcal glomerulonephritis is a distinct disease from Berger disease. It is mediated by the formation of IgG antibody complexes deposited in the glomeruli. Serum tests reveal antibodies to several streptococcal proteins. These patients only rarely progress to chronic renal failure.
2. Alport syndrome is an X-linked disorder in the alpha-5 chain of the collagen type IV molecule. This disorder is associated with deafness.
3. CORRECT: Deposits of IgA, C3, and properdin in the mesangium occurs in IgA nephropathy, also known as Berger disease. Berger disease initially presents in children, most commonly, following a respiratory tract infection. It can, however, occur following urinary or gastrointestinal tract infections. Patients may have a mild nephritic syndrome with edema and some proteinuria. The proteinuria is not to the level seen in nephritic syndrome. The gross hematuria only lasts a few days but often recurs a few months later. Although initial serum creatinine can be normal, chronic renal disease can occur in up to half of the patients after several decades.
4. IgA deposits are seen in Henoch-Schönlein purpura; there are, however, purpuric lesions.
5. Minimal change disease is the most common cause of nephrotic syndrome in children. It is not associated with deposition of IgA.
Can You Name It?
Mechanism of Action:
* This agent is an IL-2 receptor antagonist, which binds with high-affinity to the Tac subunit of the high-affinity IL-2 receptor complex and inhibits IL-2 binding.
* The therapeutic effects include inhibition of IL-2-mediated activation of lymphocytes, a critical pathway in the cellular immune response involved in allograft rejection.
Indications:
* This agent is indicated for prophylaxis of acute organ rejection in patients receiving renal transplants.
Route of Administration:
* Solution for IV injection: 25 mg/5 mL (a clear, sterile, colorless concentrate for further dilution and IV administration)
Selected Adverse Effects:
* Most Common: immunosuppression and development of immunosuppression
* Other:
o Gastrointestinal System (constipation, nausea, diarrhea, vomiting, abdominal pain, pyrosis, dyspepsia, and abdominal distention)
o Central and Peripheral Nervous System (tremor, headache, dizziness)
o Urinary System (oliguria, dysuria, renal tubular necrosis)
o General (posttraumatic pain, chest pain, fever, pain, fatigue, hypertension, dyspnea, pulmonary edema, coughing, impaired wound healing without infection, insomnia, back pain, tachycardia and blood disorders (Bleeding and Clotting Disorders).
Drug-Drug Interactions:
* cyclosporine, mycophenolate mofetil, ganciclovir, acyclovir, azathioprine, corticosteroids = increased incidence of adverse reactions.
Special Considerations:
* Contraindications: Hypersensitivity to this product; past history of anaphylactic or severe systemic reactions to human globulin.
* Warnings/Precautions: Immunosuppression; Development of Infections; Pregnancy category C; Dosage adjustments necessary in pediatric patients and geriatric patients.
Drug of the Month: daclizumab (Zenapax ®)
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