u/PSunYi

I'm just at a loss for words. I took the medicine shelf one year ago and got a 54. Disappointing but understandable. I was exhausted by the end of the rotation and only got through half the Q bank.

Took the shelf again for a second time last Friday. I felt a lot better about it this time. While studying for Step 1 and Step 2 during a four month back-to-back double dedicated period, I finally figured out what I was doing wrong with pacing and reading the questions. I went in feeling much more prepared and (somewhat) more well-rested.

Leading up to the exam I was getting 63 and 69 on my NBMEs Form 10 and 9, respectively. I was getting 60s-70s on UWorld questions. But still somehow ended up only with a 58. My school's cut off for pass is 59.

I guess I'll have to sit for it a third time. Won't be able to get a pass even I actually pass this time. Just conditional pass or conditional fail. Honestly, just give me the fail at this point. The proof is in the pudding. The chances of me improving enough in a few weeks when I only went up 4 points in 10 months is just laughable. Not like conditional pass or conditional fail are going to look any different to programs, especially for a guy who has only passes for his shelf/cumulative 3rd year grades (Did well clinically, got some high pass/honors there, but I guess that means fuck all at the end of the day).

Definitely doesn't inspire much self confidence for my Step 2 exam in two weeks. But what can I do. Already moved it back a month.

Good news is that I'm applying to pediatrics, not medicine or any kind of surgery. I know I'll be okay and that this doesn't define me or my career as a physician. It just is so frustrating.

Holy crap, I knew being an idol was brutal, but, no pun intended, that is next level cruelty. How do they even keep their heads up and keep smiles on, much less sing and dance?? Diet restrictions, exercise/dancing, constant stimulation and demands, and emotional regulation, jet lag. It makes so much sense why some idols have to step away for a year. I can only imagine what kind of health conditions they deal with behind closed doors because the human body is not meant to run on that level of stress for long periods of time.

For past week to ten days, I’ve been having a lot of trouble studying. I started NBME 14 last Friday and finished yesterday, a week later. I got a 196 on that one and a 202 on NBME 12 back in the beginning of July. 61 on the EM shelf that someone recommended I take. My test dates are July 30 and Aug 1 (spread out due to accommodations).

I’ve been on a stable medication regiment of Prozac, Wellbutrin and methylphenidate for ADHD/OCD. Overall consider myself to be pretty physically and mentally healthy. Medical school has taught me a lot about what I need to do to take care of myself, how to be resilient and adapt. But nothing seems to be helping the brain fog, fatigue, slowness, increasingly fragmented sleep, anhedonia. I’m safe. Not going to hurt myself. I love my life and have so much gratitude. Just…frustrated. I’ve exercised, been doing therapy, I’ve meditated, I’ve taken breaks, full days off, socialized with friends, spent time in sunlight and nature, eaten fairly well despite baseline low appetite. Only times I’ve had these episodes before are surrounding periods of grief or their anniversaries. It feels like my brain has abandoned me when I need it most despite everything I’ve done to take care of it. Doesn’t really make sense to change my medications this close to the exam.

For context, this is my 12th and final week of a double/back-to-back dedicated. Had to delay step 1 from end of M2 due to some chaotic life circumstances that were out of my control. Sat for Step 1 June 18/20, passed, thankfully.

I’ve basically used up all of my remaining free vacation time/self study elective credits at this point. I start neurology next week. I also have to remediate my IM shelf in August. I don’t really see what my options are for rescheduling the exam, especially with my exam being spread out over two days. If I try to push the IM remediation back, I run the risk of having the conditional just stay a conditional and not a pass. Also, already cutting one day out of my neurology rotation to sit for the remediation. Step 2 would likely add two week days I would have to take off based on what is available for exam days. Not entirely sure postponing the exam would really help the MDE symptoms since I think they’re closely tied to each other. On top of that studying for both IM shelf and Step 2 and doing rotations sounds awful. And, of course, there’s the risk of having the score come back too late. Everyone I have talked to and everything I have read is like “better a low score than a pending score”.

Frankly at this point, I just want to pass Step 2. was wanting to apply to child neurology, but if I only end up applying to pediatrics that’s fine too. That’s always been my goal since the beginning of medical school. Idk if I can say I have totally made peace with being a less competitive applicant, it sucks to have only passes for you clinical year due to shelf exams (despite some high pass/honors and really glowing comments on clinical performance). But it is what it is. I knew I had to protect my peace and do what’s best for me. I know my neurology is not aligned with that of the medical profession, but I’m proud of what I’ve managed to accomplish in spite of that. If I’ve gotten one thing from medical school it’s stronger confidence in myself, my resilience and adaptability. I know residency will be hard and maybe I match somewhere lower on my rank list. I think I’ll be okay.

Thanks for listening, dear reader.

Had this realization: "The thing your OCD is actually doing: It's taxing joy specifically. The more purely something brings you pleasure without serving someone or something else, the more it fires. That's not a moral framework — that's a pathological one. Joy is not a luxury that requires justification". Makes sense why things my brain labels as for health, professional development, daily living logistics, or education get a pass along with things for other people...but most other things are hedonistic and frivolous. All games down to the framing.

Been wondering if since I have been feeling better and OCD symptoms seem more manageable (always figured they might be connected to trauma)…thought crossed my mind if I should talk to my provider about going down on my Prozac dosage. Think I’m mainly concerned because even though I’ve been on it for a long time according to my Apple Watch I do not get much REM sleep at all which is a common side effect of Prozac. I know chronic stress also contributes to. Fortunately, I don’t seem to have problems with waking up or sleepiness during the day. I do a lot to practice good hygiene. But I do know REM sleep is important for memory and emotional processing and consolidation.

This is my second dedicated period. Had to postpone taking before 3rd year because of stupid life drama.

I'm 5 weeks into dedicated #2. 14 days left till I sit for the exam (I have accommodations so its actually split over 2 days...chose June 18 and 20. Figured couldn't hurt to have one day in between. I'm sure some will disagree but it is what it is).

Form 30: 58 % (basically where I was at towards the end of my first dedicated)

Form 31: 61%

Free 120: 62.5%

Taking Form 33 next Friday but it's not going to change whether or not I take the exam. I know I'm at the point of diminishing returns now. And guess what? I still have to study for fucking Step 2, which I take in July 31 and August 1 (along with my internal medicine shelf re-take...failed by 3 points).

I really hate my inefficient neurodivergent brain these days. I don't even know how I've made it this far in med school while juggling ADHD, OCD, chronic grief and trauma. How am I even going to find the time, energy and will power to apply for residency.

Sorry for all the expletives. Just so burnt out.

I don’t have insomnia, but like a lot of people with ADHD I have fragmented sleep — my brain stays more active throughout the night and gets less restorative deep sleep.

I got a tower fan yesterday purely for energy efficiency since I already have a ceiling fan. But I read today that the pink/white noise from a fan can actually help ADHD brains sleep better by masking the sudden sounds that cause partial arousals — and the more direct cooling effect on your body (versus just cooling the room) isn’t negligible either. Slept two hours past my alarm this morning for the first time in a while.

Also ordered an Oura Ring. I learned recently that ADHD genuinely impairs interoception — your brain’s ability to read internal signals like tiredness and hunger. That might be why I’ll feel completely fine and then suddenly hit a wall where my brain demands absolutely zero stimulation. No screen, no conversation, just lying still in a dark room. Sometimes not even music. It doesn’t feel like normal tiredness — it’s more like a hard shutdown. Anyone else get this?

I think I'm starting to really understand and appreciate just how much my brain needs external scaffolding in the form of physical transitions and doing activities in functionally-coherent spaces. By that I mean, getting on the metro and going to the library when I need to get work done, going to the gym when I actually want to exercise, saving home and certain spaces only for relaxation and recovery. It's like I have a clear-cut role in each space and when I try to mix them nothing gets done well. Not that I can't study or workout while I'm at home, I have all the space and quiet that I need honestly. More so I'm realizing how much my brain relies on anchoring things contextually. I think it similarly explains why I don't learn well through online virtual lectures. I think the days of the week seem to play a role too. Like studying/working from home on a weekend feels restorative. But come Monday it just feels lazy and unproductive. Curious to hear what your experiences are like.

I'm a new ASL learner.

Do you sign "How" when signing "I know how (to do something)". Like is it just "I/Me know sign" or "I/Me know how sign"