Coffee was made the night before, and sooner than expected it's 6:45am and I'm ready to go. I go for a walk with Hobbes for a while to calm my nerves, then hit the road by 7:10am. Construction re-routes me a few times on the way to the testing center, different even from how it was when I drove the route the day before, but that's why I left early. I still arrive at 7:30am, a half-hour before the center opens and an hour before my test time.
A lot of students from my school are there. We basically pack the small testing facility. Doors open at 8am and we file in. I check in with everyone else, then sit around as they bring each of us individually into the room to start our test, one by one.
My test time arrives. Wait 20 long minutes. They call my name; I go to the window. Nope, another person with my name. Wait 20 minutes. They call my name again, and again I go to the window. Yet another person with my name. Wait another 20 minutes, paying close attention to the alphabetical order of the last names being called, and once I'm sure I'm the next name to be called, they go straight to the end of the alphabet. Go figure.
I didn't get in until an hour after my official start time, two hours after I'd arrived to take the test. My mood was not dampened, and I was successfully calming my nerves. I put my lunch and other stuff in a locker, showed them my driver's license, and signed officially in the book. Then I'm fingerprinted, turn my pockets inside out, and lift my pant legs above my ankles to show nothing's hiding in my shoes. Then, they scan me with a hand-held metal detector up and down my front, spin me 180 degrees, and scan me up and down the back.
And then I'm in.
They lead me to a computer, and I go straight in. I waste no time with the tutorial, preferring to have that time added to the 45 minutes of break time I get for the day. For those that don't know, the USMLE Step 1 exam consists of seven 1-hour blocks, with 46 questions in each block. Fast math says that gives you ~78 seconds per question on average. Some questions take only 10 seconds to answer - the stimulus is short, it's a basic recall question, and you either memorized that fact or you didn't. Other questions have long paragraphs of lead-in information and tables, figured, or lab data that often makes a difference to how you'll answer the question. You really have to balance how you spend your time, working through the small questions quickly by admitting to yourself when you don't know an answer, saving your time for the questions that require more careful thought. Anyway, back to the story:
I'm confident and careful, working meticulously but quickly, and before I know it I've finished the first block with 14 minutes remaining to go back and review my answers. I catch an error I'd made and change one answer, leaving the rest untouched.
I stick to my plan of burning through the first few blocks while my steam is up. I don't take a break after the first block and dive right in to the second (after a few deep breaths to call up some serious focus). Still feeling good, I make great time - until halfway through the second block.
I feel a tap on my shoulder, and my concentration shatters halfway through a long question. I turn around, and the testing center employee is right behind me.
She points to my wrist, saying "You are not allowed to wear a watch in here. I need you to come with me right now."
My mind blanks, my throat clenches, and I begin to freak out. Then a dam in my mind breaks and my mind surges, thoughts rushing through faster than I've ever experienced. It's mechanical, not electronic, so according to the website I'm fine. Why didn't they mention this before I came in? They fingerprinted me, checked my ID, turned my pockets inside out, and checked my ankles - why didn't they check my wrists? Why didn't the metal detector pick it up when they scanned me - it's a stainless steel watch!! How can she be asking me to leave? I can't believe this is happening. Why did she come out right now? Is this going to nullify my exam? She wants me to leave the room with her? I can't pause the test. Even if I lock the screen, the timer will still keep ticking down. Why do I have to go with her? Can't she just take the watch? I haven't even looked at it, and I wasn't even planning on using it; I just wore it in as a backup! All that and more rushed through my head in the time it takes to blink.
Me: "Can't you just take it?" I begin to take my watch off, and she shakes her head.
Employee: "No, I'm sorry, you'll have to lock your exam and come with me."
My mind still in blitz mode, I lock my computer and quickly leave the room. As soon as we are outside, I hand her the watch, and she asks me questions. I answer respectfully, apologizing profusely, attempting to explain that the testing center's website had said that digital watches weren't allowed - nothing that can have an alarm, make a beeping noise, or perform calculations - but that analogue watches were fine. She said that some tests have restrictions that are different from the testing center's restrictions, and that my test fell into that category. She also apologized, saying that they should have caught it during the check-in procedure. She photographed my watch and had me put it in my locker before typing up my report. As she handed it back to me, I asked the big question that was still surging around and around in my mind:
Me: "Is this going to nullify my exam?"
Employee: "I don't know. I am going to make it clear in my report that there was no malfeasance here, just an honest mistake, but I cannot comment on how it will be handled by your examining organization."
That scared me. All these months studying, so intensively for the past six weeks that I'd completely cut myself off from life to prepare appropriately for this test, and it could all be flushed because of a stupid watch that I hadn't even looked at. Rationally, looking back now, the chances of that happening are minimal, but at the time I was terrified. Scenario after scenario ran through my mind and filled me with fear and doubt. My hands were shaking so bad when trying to insert the key into my locker, it took me four tries to get it open.
I had no clue how many minutes I had been away from my exam by the time she let me go back in. To log back in and unlock the computer, I had to enter in a long code that I had been assigned at the beginning of the exam. It took me two tries to type it correctly, as I couldn't see what I was typing. It was like a password field, all *********. When I finally got in, I forced myself to ignore the time on the clock, just blitzing through the questions as fast as I could make my mind go.
Unfortunately, I kept getting hung up. My concentration was shot. I'd catch myself rereading the first sentence of a question, the words making no sense, even though I knew I should know what they meant. Several times, I had to start over and read the question again once I got to the end, having forgotten the beginning because I began to think about what had just happened, wondering if all of my efforts in the test that day would be wasted if they decided to nullify my exam.
I finished the last question in that block with 40 seconds left in the allotted hour. Zero time to go back and review the questions that I was less sure about. I can't really do a good job describing on here how deep of a sinking feeling that was. I could make comparisons about my stomach dropping out from beneath me, a "sinking" feeling in my gut, cold hands gripping my spine, but none of it comes close. I had a brief vision of me standing up, screaming at the top of my lungs, then calmly walking out the door, getting in my car, and calmly driving away. It was really vivid.
I took five minutes to compose myself. I breathed deeply. I prayed, asking for strength and calmness of mind. I gathered the shattered pieces of my concentration and slowly melded them back together, like bits of Play-Doh being molded into one smooth sphere. I thought of the awesome notes that Wife had left for me to find around the house that morning as I went about my pre-exam routine. Small, encouraging phrases. I had to force my mind away from more difficult thoughts - particularly one nagging fear: If you do poorly on this exam, you won't be competitive to residencies, and you'll have to move after med school, which will make Wife lose her amazing, specialized, perfect-for-her career. If you do poorly on this exam, you might ruin a huge part of her life.
I don't know quite how, but eventually I pulled it together and started the third block. I'm sweating from nerves as I write all this out. It was hands-down the most stressed I've ever been. So yeah, I started the third block, feeling hot and cold and tingly all at the same time, knowing that I still had five hours of examination ahead of me, having no idea if any of it would do any good. I finished that block with 2 minutes to spare. Not really any time to review any specific questions, but I was being more careful and focusing longer on the questions, so I don't think I would have changed anything anyway.
I took a longer break between the third and fourth blocks, going to the bathroom, splashing some water on my face, and talking to the testing center employee a bit more. In hindsight, I wish I had done that after the second block ended. It simply hadn't occurred to me. I tackled the third block with somewhat renewed vigor, but nothing like the confidence I had starting off. I ended the fourth block with 4 minutes to spare, reviewing and changing a few answers, confirming a few more that I had been unsure of at first.
After the fourth block, I took about 20 minutes for break. I had bought a BLT sub from Subway the day before, hoping to enjoy it as a sort of reward for making it through the halfway mark. I was still so nervous, I only ended up eating a quarter of it. I couldn't help imagining that with all the adrenaline running through my system, my digestive system wasn't peristalsing like it should, and the food would just stay in my stomach until I got sick. I stopped eating, took some more deep breaths, and returned to the test.
I finished the fifth, sixth, and seventh blocks with between 5 and 8 minutes to spare for review on each one. Nowhere near my normal of 14-18 minutes in the practice exams, but whatever. Different circumstances.
After the exam, I wasn't the most optimistic. It wasn't until after talking with some friends and realizing that EVERYONE feels like they guessed way more than they thought they'd have to that I started to feel a little better. As a student from UofM's med school said as we exited the testing facility, "Looks like I studied the wrong stuff for the past six weeks." I thought back through a bunch of the questions, and convinced myself that I got more right than it felt like while actually taking the test.
Five days later, I'm still clinging to that hope. Wife and I have been on vacation for these five days, and I've done my best to minimize thinking about Step 1. Scores won't be released until the first or second week of July, well after we start our clinical rotations.
To sum up, I have no clue how I did. The only thing I truly know is that I would probably have felt better during and after Step 1 if that mishap with my watch hadn't occurred. There's no way to know whether or not it had an impact on my final score. Who knows - maybe wrecking my concentration and making me go slower through the questions made it so I changed fewer correct answers to incorrect ones. Whatever.
The key is, I took Step 1 on Monday, and I learned an important lesson: NEVER WEAR A WATCH TO A STANDARDIZED LICENSING EXAM, EVEN IF THE WEBSITE SAYS YOU'RE ALLOWED TO. DON'T DO IT. EVER.
Expect a blitz of posts in the next week as I attempt to update on everything, including the awesome vacation we're currently taking. Speaking of which, I've gotta get back to relaxing. Later.