No one really gets it

I found myself sitting across the table from my engineer father and brothers, trying to explain what I'll actually be doing over the next couple of years in school:

Dad: So what are you doing next year?
Bostonian: I'm in the hospital learning how to diagnose patients and manage their medical problems.
D: But what about classes?
B: There are a couple...but only for the really important stuff
D: What about books and tests?
B: Yeah, still have lots of reading to do and a big final at the end...but I'm in the hospital for like 12 hours every day talking to patients, standing around in surgery and chasing down information.
D: So you get your own patients?
B: Nope, the residents and attendings check and redo everything that I do. I can't do anything on my own.
D: Why are you there again?
B: ...!?!?!

I guess the point of this post is that I'm not exactly sure how to explain to the average lay person what my role as a third year medical student is because I haven't conceptualized it myself.

Within the context of the delivery of health care, I am at best a leech on the scrotum of everyone on my medical team; a painless annoyance that just sits there sucking up resources, time and attention. At worst, I'm a stumbling block; everything that I'll be doing, someone will have to double check in excruciating detail and probably correct. Everything that I don't understand will have to be drilled into my head. I'll be the pain in the ass at 2 in the morning that needs to get in his delivery before the end of his OB rotation, the speed bump in the trauma room after an 18 hour day, the poor kid with the deer in the headlights look on his face who accidentally scrubs out when the attending pimps him across the sterile blueness of the operating field. The only schmuck in the hospital willingly paying out of pocket to be there, not out of necessity.

On the other hand, I''ll probably be the first one on the wards in the morning collecting labs and scurrying around to not look like a schmuck on rounds and piece together what happened over night with my patients while I slept soundly feverisly prepared passed out at my desk trying to prepare for teaching rounds. I'll be the one sitting with the patients for hours on end making sure that every detail of their history is documented. I'll be writing up the most complete notes and admits because I have extra time to wrap my head around the case. I'll be the one making the nurses', interns' and residents' lives easier by running the mid-level scut at a financial profit to the hospital.

We're sitting in orientation this week, and everyone tells us how amazing of an experience we're in for during third year and spends 5 minutes of their talk blowing sunshine and rainbows up our asses. But at the same time, I'm about to be one of the few people that even the night-shift janitor knows has no real business being on the wards.

How do you make the average person understand what you do without making their head explode in confusion/horror/pity?


Year 2 in review and Now What?

Well, I guess that I am now officially a third year medical student. How the time flies when your head is buried in Robbins for a year. I really mean that it flew by. It feels like just yesterday that I was hanging out in the ER and looking back on first year and getting geared up for second year.

It was a struggle for me at times. Sitting around reading a book, memorizing minutiae of diseases for the sole purpose of regurgitating it on an exam felt like an exercise in futility most of the time. That passive style of learning about as far outside of the context where the knowledge will be used as you can get. I think it's a pretty big oversight in the curriculum design, I'd say 90% of us just memgurgitated through the year without trying to integrate the knowledge into something that is applicable to the wards. But then again, it was better than the integrated Problem-Based format that several schools have initiated. I could see sitting around a conference table with a bunch of unprepared students getting on my nerves pretty quickly. From the rather limited small group stuff that we did do, I can say that the majority of my classmates are F'd when it comes to rounds and pimping. Sure they can regurgitate the 25 different translocations for each type of leukemia, but can they form a differential for someone who has abdominal pain??? NO! I feel completely unprepared for what is coming...thanks over-priced medical education. Way to set me up to be useless next year!

Don't even get me started on Step 1 and the debacle that is. While it was somewhat nice to review everything that I've learned so far in a fairly coherent manner, do you really need to charge me 400 dollars and pin my hopes and dreams and future income on it???

So now that Step 1 is on the books, I keep asking myself "now what?"

There is a ton of information and misinformation floating around about third year clerkships. We had a few forth years come talk about the clinical sites and they weren't able to come up with any clearly discernible differences between them. Our dean of student affairs talked about the sites as well, and without mincing words said that they are all the same. I even took some initiative and talked to older students to try to get a taste of what's expected at my clinical sites and to be honest, they've given me very little to go on in terms of what the expectations are/who the better attendings are to work with, etc. Thanks guys. I guess I'll just have to figure it out as I go.

I hopped on SDN's clinical forum....which is always a huge mistake. Between the posts talking about shoes, PDA's, resident horror stories, pissing matches and generalized gunner behavior, I decided it was a warped perspective that was better to ignore. So I bought myself a copy of the 250 Biggest Mistakes that 3rd Year Medical Students Make to try to get my head wrapped around what I'm in for in two weeks. The overarching theme of the book is to be a neurotic pain in the ass to everyone in the hospital from housekeeping up to the department chairs!!! It instructs me to make sure that I chase down every evaluator and have them clearly define how they'll be evaluating me, how they want write ups, notes, oral presentations, their coffee and their ass kissing. My complaint is that for every helpful nugget in the book (how to write up a new admission/progress notes, how to present a patient), I had to wade through the waste deep gunner advice ("Here's every question to ask your resident on the day you start") and stupidly obvious advice for those medical students with an IQ of 36 or below (Read your orientation packet before orientation). It came with a free Maxwell's (a $15 value), so I can't complain too much.

Anyway, here's my major concern:
In the span of about a week, I'm going to be tossed in way over my head (during the second week of July no less) onto what is rumored to be one of the more malignant Surgery services in the country. There's a bit of a nagging feeling that the preparation that I've received thus far may have been inadequate for what's expected. While that seems the norm for most medical students...so at least I'm not alone.

But in all seriousness: I've never presented a patient orally, I've done 2 complete physicals, I've written up half a dozen patients, I've stabbed a couple veins and I've spent maybe a total of 6 weeks working in a hospital setting...this is going to be a rough transition.

Oh well, the dude abides I guess...

STEP 1...done

Well that was fun...NOT.

Between waking up with "The Final Countdown" stuck in my head and the feeling of impending doom, I knew it was going to be a craptastic day from the get go. I woke up at 6:15 and couldn't get back to sleep for 20 minutes. So I said f*ck it, took a shower ate some breakfast and got on the road a bit early so that I didn't have to deal with traffic. I chilled in the parking lot of the test center for about an hour with a cup of coffee my first aid and the rest of the OCD folks there for their various tests. Of course the girls running the test center were a bit late, and it was raining, so we didn't get registered until after 9.

While I was sitting there in my car, the sky opened up and there was a torrential downpour with lightning striking a couple hundred yards away from the test center. It didn't stop all day, and at one point you could even here hail pinging off of the roof through the soundproof headphones. I figured it's probably a sign of things to come. It would be just my luck to die in a Prometric test center taking the USMLE...I wonder if my scores would still count????

I think the highlight of my day was seeing the little 3D metal chatski in the waiting room that said "Relax". I want to smack whoever put that there...asshole, it's not like this is going to have a bearing on the REST OF MY LIFE. Apparently there isn't an 8 hour exam for assholes who decorate waiting rooms at Prometric centers. It was an ironic contrast to the palpable despair that hanging over that room. I kind of wanted to take a picture of it to post...but after the deep cavity search, retinal scan, blood sample, buccal swab and finger printing it slipped my mind. Ok, so the security wasn't that bad, but it would have been nice if I could have put my sweatshirt on during the middle of the section or maybe a bottle of water to sip from.

Regardless, I finished it up in a little under 6 hours and I have no idea how it went except for the fact that I had 2 easy sections, 2 medium sections, 2 harder sections and I don't really remember the first section because I was still waiting for my second cup of coffee to hit my brain. I'm figuring that it will probably be around the national average.

I took it easy last night because I've had the sensation that I swallowed a mix of broken glass, rusty razor blades and lava. I figured drinking my face off would probably put me into a sorry state of affairs (right before surgery starts up...just what I need), so just had a beer with dinner.

I have an entire 6 days of freedom so I'm going to do what I can to enjoy it while the sun is out and my life is under my own control. I'm thinking a beach day, some shopping for my new apartment, reading a book that isn't step 1 related and sleep...lots and lots of sleep.



I placed a self imposed moratorium on the Bostonian Blog so that I would actually study...it lasted all of maybe 30 hours, but I just decided that it would be more fun to put it into a word document and then post once the shit-storm was over. It did do wonders for my Qbank/NBME scores. Anyway, if you'd like to follow the progression of my dispair read on.

Day 25-
YES!!!!…best QBank day yet! See what I can do when I put my mind to it! I’ve never seen so many bars hitting 100%!! I’ll take the fucker tomorrow and put it in its place! Decent residency, here I come! Might as well start the apartment hunt in Boston right now! On a less stuck up note, the weather finally cooled down, so I got in a decent run. I’m feeling pretty damned good about life all around!

Day 26-
Trouble sleeping last night, tired all day. Surprise…I dropped back into mediocrity on the Qbank front. I went to write a post on how I have the self restraint of Keith Richards at a hookers and heroin party (God he looks awful), but I restrained and decided to chronicle myself offline in less than 100 words per day. I’ve decided that I’ll post my QBank graph to prove that I’m not losing my mind. 10 days left…AHHHHHHHHH.

Day 27-
I swear that my QBank abilities are a combination of how awake I am, what I ate for lunch, and which direction the wind is blowing. I was back above average today again. This bipolar, daily up and down crap is soooooo frustrating, although I extended my up/down trend out to the actual exam day and it happens to fall on an up day…take it for what it’s worth (nothing). On a completely different note, the GF has to run home for the weekend for some family stuff, but at least that will give me some time to freak out without her thinking that I’m mad at her.

And now for something completely different: Tim Russert passed away today. He gave the commencement address at my graduation, my mother published the story of her father in one of his books and had a few occasions to meet him and speak to him personally. He did what so few in the media do in these days of partisan coverage on Fox News and MSNBC, and the ridiculously short blurbs on CNN; Mr. Russert took a guest onto his program every Sunday, sat them down and forced them to display their view points in a thought out manner, and even challenged them at times, but always in a cordial manner. We have lost one of the great journalists of our time, and a good man. My heart goes out to his family in their loss, especially so close to father’s day.

Day 28-
Strange things are happening. I grabbed my ritual cup of coffee on the way over this morning, and started right into Qbank (after a half hour of procrastination). For some reason, the up and down pattern has seemed to cease for some inexplicable reason. I stayed above average for the second day in a row…Perhaps it’s a sign that some of this crap is starting to stick! Lone Coyote said that her score mysteriously jumped up around 85% complete, but I’m only at 71%. I’m not going to hold my breath though…

Anyway, it’s one of those lazy feeling days because it’s kind of humid out and the sky is intermittently overcast, and no one else is out and about. Apparently Saturday brings the crazy law students out of hiding, you know, the ones that like to talk about Jessica Simpson’s hair out-loud while you’re trying to study or who suddenly sprint across the entire length of the library for no apparent reason in their heels (it’s VERMONT people, no need to wear heels to the library). Anyway, I’m going to keep on trucking through Neuro for the rest of the afternoon/evening and break things up a bit with my long run for the week and some dinner.

Update: Ever have one of those “I just made a bad choice” moments? I had one about 3 miles into my run. It was an out and back 6+ mile loop. I was stripped down to nothing but short in the first quarter mile because the air was so saturated with moisture that my sweat wasn’t evaporating and my sunglasses were fogging up…seriously, it sucked. Anyway, I was determined to get my milage in after the brief shower this afternoon. The sun had peaked through the clouds and everything was looking great despite the lack of cooling. So I hit the midway marker and turn around, and then I see the big black thunderstorm clouds about to swallow the sun. We’re talking lightning and thunder, the whole nine yards. So I’m sitting there 3 miles away from home, with the GF 2 hours away, wondering what I’m going to do if I get stuck in one of the violent thunderstorms predicted for the evening. So I started my run back at as fast a pace as I could maintain while pondering which barn/abandoned house I would hide in while the storms passed, counting the seconds by mississippi’s between lightning and thunder, and trying to remember that silly guestimation of how far the storm is that my dad taught me back when I was a kid. Anyway, it was a long way off and I managed to make it home safely without incident, but about 10 minutes after I got through the door there was torrential rain and thunder and lightning and wind. PHEW…good thing I made it home before that started. Note to self- don’t die while running…it’s bad for your career/life plans.

Day 29-
I’m behind AGAIN…spending most of the day catching up on reading for neuro (which I loathe…btw. That should make for a happy string of posts come October.) I jumped into an argument on the Runner’s World website under the “Ask the Running Doc” blog talking about hydration and high fructose corn syrup in hydration beverages. Big mistake. Apparently the risk of obesity caused by HFCS outweighs the potential harm of dehydration that comes with running for a long time on a hot summer day. It BOGGLES THE MIND that these people would rather risk death than consume a slightly higher fraction of fructose. It’s like they think that fructose is a virus that suddenly causes obesity in someone that is running 30+ miles a week…it’s just not a realistic fear. The more I think about it, the more I want to open a boutique runner specific practice on the side. These people are OBSESSED with their health and horrible misinformed at times by incredulous sources, and if I can make a little bit of money doing it, so be it. At least it’s not sticking BOTOX into yuppies and doing microderm abrasions/laser hair removal.

Day 30-
…just make it end already

A freaking month into this stupid process, I took a little thing called NBME form 3. I’ll begin by saying that I’m sick of having my false confidence built up, and then crushed. Instead, I’m taking a new approach. I’m going to be pissed off while I take questions because that seems to work better…especially with Qbank. So where did I end up? Dead average…How did it feel? Like I was going to rip out a 230!!! Instead I’m in the 2teens. Yeah yeah yeah…I know, quit your bitching and go study.

Day 31-
Kill me. Less than a week left and I just don’t have the energy to do much more.

100 more Qbank questions- again, I’m still all over the place…first 50 were crappy, second 50 were above average. My last 300 questions have been pretty good, but it doesn’t replace the fact that I’ve been miserably mediocre on some and less miserably mediocre on others. I find that when I scare the crap out of myself, with a performance, I do better on the next session…so I think it’s just a matter of remaining focused…for 8 hours…without the ability to drink coffee during the exam…crap.

Day 34-
I left the GF up in Vermont and headed for the parental abode in the burbs…it was nice to see everyone, but they don’t really get the level of stress. My mom kind of understands because one of the fellows that she works with explained to her that the USMLE is a form of torture designed to break the souls of all those who take it. So now she gets sort of where I’m coming from, but still not entirely. They still want me to go to a graduation party tomorrow…2 days before my freaking exam.

Anyway, the Qbank scores have spiked up into the 70’s and I take NBME 4 tomorrow for a final crushing defeat to encourage me to cram some pharm and micro and other cramable stuff for the final 36 hours…song of the moment is a tie between “The final countdown” and the free credit report dot com jingle about buying a car…they are alternately stuck in my head. I hope that isn’t a sign of my impending psychotic breakdown!!!

Day 35-
NBME 4 down! My score mysteriously hopped up above 230, which was completely unexpected with T minus 2 days to the exam. If that’s reflective of my actual performance, great! Of course, I’m still not sure exactly how to take these things and quite hesitant to allow myself even the slightest glimmer of confidence, so I’ll be sitting in front of First Aid cramming the bugs, drugs, labs, and whatever else hasn’t been sticking so far (Neuro, Heme and GU/GYN tumors-I really hate cancer).

My dad convinced me to stop by the graduation party just to say hi to everyone. Hopefully I can keep it under 2 hours. My brother also took a trip to the ED…apparently no one told him not to put his fingers near the blades of pruning sheers…he damn near pruned his finger off as well as the shrub’s branches.

Day 36-
CRAP…it’s tomorrow. I just want to get it over with at this point. I’m just barely able to pay attention to what I’m cramming (Bugs and Drugs)…maybe it’ll help, maybe it wont. I’m not going to even bother with Qbank today…I don’t want to see that damned program until step 2…and I’ll probably go with USMLE World.

Anway, as soon as I get through these last few drugs, I’m going to get my stuff together and chill out for a bit. FREEDOM IS SO CLOSE, yet so far…catch ya on the flip side.


Day 24...going into hibernation

NBME 2 was today...I went down significantly today.

Less than thrilled that I've gone from above average to below average in the course of a week. To add insult to injury, pretty much every section that I had done well on in NBME 1 (Cardio, Neuro, Heme/Lymph) was marginal for NBME 2, and some of the marginal NBME 1 subjects (Musculoskeletal, Behavioral and Genetics) I did well in for NBME 2. The big one (Path) and my most loathed subjects (Renal and GU/GYN/Breast) stayed consistent.

All I know is that at this point my former shreds of self-confidence are completely gone and I once again have no idea where I stand. On that note Bostonian will be taking a little hiatus from everything but cramming his face off for the next 12 days.

Catch ya on the flip side, wish me luck if you feel like it...it's seeming like I'll need it.


Day 23...

It wasn't until I looked at the countdown in the upper right hand corner that realized that I have less than 2 weeks left in this slog. HOLY CRAP... LESS THAN TWO WEEKS!!! I better start studying harder!

I cracked the halfway point of Qbank a little bit ago...1200 questions down so far! Only another 1100 to go. I'm still pretty burnt out from the combo of studying and the ungodly heat+humidity is conspiring to rob me of my sleep and mental outlet of running. It went from a lovely seasonable 65-70F to 95F (typical of the mid-Atlantic in August) over the course of a few hours. Thankfully the Valley we're in cools down to the 60's at night so it's tolerable after 10PM, but it still takes a couple hours to cool down/ventilate the apartment.

I tried to get a run in nice and early yesterday so I would avoid the heat. Fat chance...even though I was out on the road at 8AM (I'm not much of a morning person, mind you) I realized that it was going to be a crappy run within the first 20 steps. On the run out, I kept my pace about 30 seconds/mile lower than usual and ran shirtless to keep cool enough to move (I normally avoid it out of modesty/how nerdtastic I look with my HR strap on). I thought I was going to die, I haven't sweat that much ever! I decided to I cut a mile off the total distance to save the GF a drive to find my lifeless body on the side of the road. The run back was absolute torture. I had expected to drop the pace a bit more to keep from dying on the way back, but I could barely maintain a jog...it was only like 80 at that point, but the humidity combined with my stupid decision not to eat anything before I ran knocked me on my butt. I finished the run alive, and didn't stop sweating until I took a nice cold shower...

Lessons learned:
1) The Library has free AC, I should have been studying instead
2) It really does take 7-10 days to acclimate to gnarly heat like this...
3) Wake up earlier, eat something and don't push it too hard on hot days!
4) Cold showers are a good stand in for AC...for about 10 minutes.


Day 20...is it over yet?

Studying for these types of exams feels like one of the most mundane tasks in the world. Here's a sample run through of any of my previous 20 days:

6:30 AM- GF's alarm goes off and she's off to the gym. Grumble, grumble, grumble, pillow over face and back to sleep. Why do people mow their lawns at 6:30AM on a week day? SOMEONE MAKE THOSE DAMNED BIRDS SHUT UP!
8:00- Alarm goes off. I think about getting out of bed. GF puts the news on. I bury my face into the pillow even deeper, hoping to grasp a last few precious moments of sweet-sweet REM.
8:05- Snooze 1
8:10- Snooze 2
8:14:58- "If you hit that snooze button one more time..."
8:15- Snooze 3
8:15:03- "Get up lazy ass!"
8:17- Into shower
8:25- Breakfast/TV/Dishes
8:55- Walk over to the coffee shop and procure sweet, sweet liquid productivity, chat with proprietor lady who is super nice.
9:00- Get set up in the Carrel. Law students are EVERYWHERE...they can smell fear, hide your First aid, try to look hard at work. Open laptop, procrastinate.
10:00- Crap, it's 10 already! Open QBank- 50 random questions...go!
10:49:41- Hold breath, end test, yes i'm sure! Yes I'm still sure! Still holding breath. Stare at results with utter amazement (either good or bad). I'm still that dumb?
10:50- Review questions, log Qbank performance in OCD performance tracking spread sheet. .
11:30- Curse at myself for procrastinating so much, open books
11:31- Procrastinate...who am I kidding, there's only 30 minutes til lunch anyway, how much am I really going to get done?
12:00- Lunch!
12:30- Check email, facebook, blogs, blog comments (occasionally...thanks guys).
1:00- Shut off computer. Hide it. Actually start studying for the day.
1:04- Bored already, stare at the wall, more reading.
5:00- Decide it's time for a run and dinner.
7:00- Back to the libs to finish stuff up.
9:00- CANT TAKE MUCH MORE OF THIS CRAP...pack up and leave.
11:00- Bed

Total studying: maybe 8.5 hours
Total procrastination- well over 5 hours

The past 3 weeks have almost made me look forward to starting my surgery clerkship next month. I imagine that actually seeing patients/being in the hospital/not sitting in front of First Aid for 8 hours a day will be nice for the first 10 minutes. Then the novelty will wear off, 3 people will berate me for being in the way/being stupid, and I'll remember that it's 5:30 AM and rounds haven't even started!


Day 18: QBank can suck my nuts 2

Two words come to mind at this moment: F**K QBank

Why??? For pouring aviation grade fuel onto the growing pyre of my academic insecurity. I took my first NBME today and I did better than I thought I would. Granted, the rumor is that Form 1 is much easier than the actual exam. Then again, half of what I'm going off of is conjecture cooked up by the nut-jobs over on SDN who toss around their 120 hour study schedules, 260/99 scores, and junior AOA nominations like they're the second coming of MSG (just kidding RAG). The other half is being cooked up as I go.

At the half way point of this joyous process:
  • I can say that I'm going to pass the exam...with a 95% confidence interval
  • I have no idea where I actually stand...I cold barely pass I could do above average!
  • I'm forgetting things that I've already studied...which doesn't bode well for the day before the exam.
  • My self-confidence has wavered to a new low as you could probably tell by yesterday's post
  • The undermining of my self-confidence is causing me to lose sleep
  • Running, crappy TV, blogging, the Red Sox, and my girlfriend are the only things keeping me sane at this point
  • June 23rd is going to cause more gray hair than it's worth. June 24th is going to be the best day of medical school...unless I tank
18 days of the suck left...


DAY 17: QBank and NBME can suck my nuts

The trusty ol' self confidence meter has bottomed out burst into flames, fallen off the wall and set my entire psyche on fire. I've gone through over 900 QBank questions over the past 2 weeks and I can only say four things for sure:
  1. I have absolutely no idea of how I'm doing overall. I might as well be sitting in a Viet Cong outpost on the Mei Kong river, blindfolded and forced to play Russian Roulette against Robert DeNiro when I take these exams. Hopefully I don't end up like Walken in the end of the movie...I doubt that QBank Roulette in a warehouse would draw the same crowd of screaming Vietnamese people throwing money around. I'm probably going to end up with a similar case of PTSD, which promises for some good self-loathing induced blogging in the future.

  2. My performance varies by 10% in a matter of hours. Morning questions will be way below the average on an easier exam and the afternoon's will be above on a much harder exam...WTF??? To make it better, I can't even tell when the exams are harder or easier!!! I'll think that some of the 22% questions are easy and not have a clue about some of the 78% questions.

  3. Qbank has caused me to develop persecutory delusions of becoming a PM&R resident on Podunk County Hospital's hospice service tending to bed sores, diabetic feet, and terminal pain management with a non-English speaking FMG as my only friend. Ship me off to the 7th circle of hell why don't you?

  4. The NBME has a Kung-Fu death grip on the collective genitalia of all medical students...$45 fucking dollars a pop to put my mind at ease. It's ok, it's not like I needed to buy groceries this week or anything. $45 for 4 hours of sitting there and clicking fucking buttons to simulate the most anxiety inducing experience of my young life! I bought 4 of them!!! I probably need to have my head examined.
Tomorrow marks the half way point if this incredibly frustrating and demoralizing process. There's only 19 days of this crap to go...better get back to studying so that I can try to end up near a coast in a profession that might interest me.

Up tomorrow: NBME 1


DAY 16

The roller coaster ride of QBank continues. I bounce up and down every day never straying more than 5 points from a mean of 54% (predicting a 217). On the positive side: there is an upward trend for my average scores between weeks one and two, I haven't seen below a 50% in about a week and I finally hit 60% correct for the first time last friday. Some people recommend tracking your previous 300 questions as a marker of how you're coming along (I've pretty much stayed the same since the beginning).

I'm starting to become somewhat concerned with Kaplan's QBank score estimator. I don't quite know if I trust medical students to report their scores honestly. Bolstering that distrust is the +/- 16 point standard deviation that Kaplan tacked on it's disclaimer to account for the many ways that people use it. Basically, they're telling me that I'll score anywhere between barely passing to a legitimately good score depending on the alignment of Mars in the house of Jupiter.

Just to put my mind at ease a bit, I'm going to take one of the NBME exams this week to get a better idea of how things are really going. My goal is 225-230. I've got 3 weeks left to bring up my scores...seems pretty reasonable to me!!

To all those out there slaving away in the libraries for the step 1: good luck.
To all those about to start their residencies: enjoy the nice weather while you can.

Day 17 update: Dipped below 50% again today! Karmic retribution I tell you...or maybe the fact that I apparently don't read the questions.
Day 17 update 2: Now I bounced back above 50% on my second set of questions...I hate Qbank