Tag Archives: advice

The Elusive Arubus Smart Card

Aruba is not cheap; like any tourist haven, the island has mastered the art of maximum cash extraction from its carefree visitors, to who hardly notice the exorbitant taxi fares and dining tabs while escaping from a hectic life in another continent.  And why should they?  With resorts regularly pricing rooms north of $300-400 per night during high season – not to mention airfare – the other costs are drops in the ocean.


However, when your ocean is more of a grudging, desert puddle, those drops are seen with a slightly different perspective: after all, what is a puddle but a meager collection of drops? When your AirBnB is running $43/night (weekly rate during low season, mind), those $20 taxi fares start to look rather obscene.  I could go about 25mi in Abu Dhabi for that rate and if it was a round trip… well, you could hire a car and driver for an entire day in Bali with a bit of bartering.  Which means I was quick to investigate other options, and in Aruba (shared taxi “car-bus” vans aside – they cost a flat USD $2 by the way), that means the bus – I mean, Arubus.



At USD $2.60 per ride (4/2016) and no such thing as transfers, Arubus can quickly become one of the most expensive public transit systems around, especially as there is no such thing as a transfer.  Want to get from anywhere south of Oranjestad to somewhere north of town (eg Eagle Beach, Palm Beach, Arashi beach)?  That’ll be $5.20.  Round trip?  $10.40.  To Baby Beach and back from the high rise hotels, with 3 “transfers”?  $15.60.  Per person.  Ouch.  Those $20, 72hr European transit cards begin to be sorely missed.

But hey, what is this Arubus Advantage Smart Card I see the occasional dutch ad for at (the very few well marked) bus stops?  Well, the fact is, no one seems to know – in English-speaking tourist-ville, at least.  Surprisingly, despite all the forums and TripAdvisor / FlyerTalk posts on Aruba, this topic is woefully under-discussed online as well.  There were plenty of folks asking for details on these “smart cards”, but no one providing answers.  The few posts I could find with any information at all didn’t really look very promising.  Cards for residents only?  No longer being used at all?  Lots of second-hand information, and most of it from 2012-2014 at that.


So, on day 2 of our visit, my dad and I made a trip to Arubus Headquarters.  On foot, of course.  It’s about a 10 minute walk North from the airport, which also happens to be where the nearest bus stop is located.  They are open on weekdays from 8am-3:30pm (yes, the website and office door say 4:00 or 4:30, but they were closing when we arrived at 3:25).  So, lets get some questions answered with sweet, up to date (2016), first hand facts:

  1. Do I have to be a resident or citizen of Aruba to get a Smart Card?
    1. No, and no.  Citizens can get the more discounted Advantage card, but the standard card is available to all.  Here is the application form.
  2. How much is it?
    1. $9 USD (15 AWG) for the card.  Additional funds can be loaded later or at the time of purchase to pay for fares, at 3 AWG each (about $1.70 US). Currency conversion happens when the card is loaded.  Smart Cards expire every three years, starting in 2014 (so the card I purchased in 2016 expires in 2017.  If I were to buy a new one then, it would expire in 2020).
  3. Do they take foreign credit cards?
    1. Not reliably.  They have a MasterCard sign, but could not process my US card.  USD was accepted, though.
  4. Do I need a card for each member of my family.
    1. No.  The same card can be used multiple times for each person in your party.  Probably don’t even have to be family, though I’d recommend the cardholder at least be present in the group, as their picture is on the card.
  5. What information and/or ID do I need to provide?
    1. I was not asked for any ID.  Put down the address for the AirBnB apartment and they took my photo.  Card was printed in <10min.ArubusSmartCard
  6. Where can the cards be reloaded?
    1. There are about 17 locations listed online.  The information card I took lists 19.  I suggest loading enough to get you through your stay upon arrival and/or purchase of the card – my first attempt to reload a card (at “S-Chow Supermarket” in Savaneta was unsuccessful because their reload machine was out of service.  The La Estrellla I tried next in Oranjestad had no issues and accepted a credit card.Reload
  7. Is it worth it?
    1. It pays for itself after 10 trips, you don’t have to fumble with cash and change, and you get a souvenir to take home.  I’d say so.


Ok, so if you found that useful, here are some common sense questions that don’t seem to be answered well anywhere about using the bus in general.  Also learned from experience (often the hard way):


  1. Is there a map and/or timetable?
    1. Yes, on the website (map and timetable).  Here is a picture of all routes.
  2. When will the bus arrive at my stop?
    1. Your guess is as good as mine.  The times listed are strictly departure times from the main terminal at either end of the line.
  3. How long does it take to get to…?
    1. From Orangestad:
      1. North
        1. 10min to Eagle Beach
        2. 15min to Palm Beach (high rise hotels)
        3. 20min to Malmok Beach  (line 10/10A; shorter operating times)
        4. 25min to Arashi Beach (line 10A; shorter operating times)
      2. South
        1. 10min to Airport
        2. 20min to Savaneta / Mangel Halto
        3. 30-40min to San Nicolas
        4. 1hr to Baby Beach (have to transfer at San Nicolas; this line also has reduced hours ~10am-5pm)
  4. Where do I catch the bus?
    1. Stops are poorly (if at all) marked.  However, google maps seems to be fairly accurate, and stops in general are pretty closely spaced.  Look for locals waiting together, or just wave when the bus is approaching; it’ll stop.
  5. Why did the driver just go past my stop?
    1. You didn’t push the button (usually on the overhead hand rails).  Do this even if you told the driver your destination – he might forget.
  6. Is it safe?  Clean?  Timely?
    1. In my experience, very much so.  The drivers I had spoke and understood English, buses were clean, other riders did not appear to be sketchy in any way, and pleasant tropical music was playing from the overhead speakers.  With only departure times posted, it is difficult to comment on timeliness, though the departure times did seem to be well adhered to.


Aruba seems to follow the trend of many tourist destinations by leveraging obscurity to provide affordable transportation options for the local populace while maximizing cash flow from tourists.  You can usually tell from the airport if your destination is such a city, as there will be no bus stop there (it will be off airport grounds, likely on the nearest city street, and quite probably not that far of a walk if you know where to go).  Arubus follows this doctrine as if it were their corporate mission statement.  From the lack of documentation on their (English?) website to the lack of clearly marked bus stops and a fare structure that punishes ignorance to the maximum tolerable penalty, there is a subtle intelligence to the whole operation.  Once you figure out how things are run, make a few mistakes and learn the unspoken way of things, the system actually works quite well for getting around the west coast of the island (and to Noord or Santa Cruz) and is far more reasonable than any of the other alternatives.


Before my trip, I read numerous reports that shared a common theme: you need a car to get around Aruba.  After 9 days, I would disagree, but with several conditions.  Bringing a family?  Get a car.  Trying to see many different attractions in a short vacation (<5 days)… get a car.  The idea of walking 1-2 miles per day, at times in the 90′ sun not what you pictured for your beach vacation?  get a car.  Staying out late (eg the am hours)?  get a car.  Content to chill at your high-rise and go on the occasional arranged excursion… well, this post isn’t really for you and you can probably skip the bus vs car argument altogether – enjoy those Hummer taxis!

Category: Travel | Tags: , ,

Anti-Shopping Spree

I don’t get traditional shopping.  Just as I feel betrayed when donating money to an organization with a poor operational overhead ratio, spending my hard earned cash on highly marked-up trinkets and goods that will either rapidly depreciate or end up contributing to the organizational nightmare occupying my basement just feels foolish. The best way to avoid the curse of buyer’s remorse, is to go “un-shopping”, whereby one takes advantage of Capitalist America’s commercial incentives and credit card reward offers to leave each store with more money than before.

An intro to Manufactured Spending

I’ve been experimenting with “Manufactured Spending” and “Travel Hacking” for the past several months, and the topic itself deserves an entire post – if, that is, the effort is even worth the time.  There are so many other bloggers out there covering this topic that I doubt a novice has much to contribute in terms of adding to the overall science and technique of this…hobby.

That said, there is value to be had in anecdotes, so here is an example of a recent shopping trip on mine, and a breakdown of how the different elements of manufactured spending worked together to produce a nice little bonus for the day’s hard work.

To take full advantage of most of these offers, a cornucopia of different credit cards are required, though even with only several, one can still come out with a decent haul.

Staples $200 MasterCard gift card
– $6.95 (fee for gift card)
+ $20 (10% off $200 cashback with Bank of America credit card offer)
+ $15 (staples rebate for buying a gift card of at least $100)
+ $2.07 (Miles of credit card at 1% on all purchases)
$13.05 cash (arguably, the staples gift card could go here as well)
$17.07 Non-cash equivalent (Virgin Atlantic miles, staples GC)

Note that the value of the gift card is not counted, as we can liquidate it without any additional fees – more on this in a minute.

Marriott $600 gift card
– $0.00 (fee for gift card)
+ $50 ($50 off $200 cashback with Amex offer, card 1/3)
+ $50 ($50 off $200 cashback with Amex offer, card 2/3)
+ $50 ($50 off $200 cashback with Amex offer, card 3/3)
+ $2.00 (miles on credit card 1/3 at 1% on all purchases)
+ $2.00 (cash back on credit card 2/3 at 1% on all purchases)
– $72.00 (cost of liquidating cards on cardpool.com)
$80.00 cash
$2.00 Non-cash equivalent (delta miles)

Gift cards can be a tricky business, and I have tended to shy away from them.  An easy $80 was difficult to resist though, and I soon succumbed.  Be sure to check the going exchange rate for cards before buying them, as liquidation can be difficult – or expensive – if you get caught unprepared and have to sell at a loss.

JC Penny $100 Subway gift card
– $0.00 (fee for gift card)
+ $10 ($10 off $50 cashback with Amex offer, card 1/3)
+ $10 ($10 off $50 cashback with Amex offer, card 2/3)
+ $0.50 (Miles of credit card 1/3 at 1% on all purchases)
+ $0.50 (cash back on credit card 2/3 at 1% on all purchases)
$0.50 cash
$20.50 Non-cash equivalent (discounted subway cards)

Hopefully I won’t be regretting this in a year or two (or be completely sick of subs).

Target REDCard $5000 load (2 cards)
 + $0 (liquidation of $200 MasterCard GC)
+ $105.60 (2.2% points on $4800 Barclaycard Arrival+, redeemable for travel)
$0.00 cash
$105.60 Non-cash equivalent (reimbursement for any travel)

There tend to be new ways to liquidate prepaid gift cards that rise and fall with their own popularity and the exploits discovered by manufactured spenders.  In the wake of Amazon Payments, Bluebird and many others who have died or become heavily restricted, Target’s REDCard is currently the best way to get rid of prepaid cards, meet spending goals to get credit card bonuses, or simply to earn points on one’s credit card. Once loaded, the REDCard funds can themselves be liquidated to a bank account directly, or indirectly by check, ATM, or bill payment.


So, for a short trip around town, I came out ahead by $238.72.  The breakdown?  $93.55 in cash, a further $35.00 in gift cards for stores I frequent and would otherwise have paid out of pocket (essentially cash-equivalent) and $110.17 towards future travel expenses ($4.57 of which are airline miles and not immediately useful).

You can see why this can get addicting.

Going Paperless

In the 20 years that I have been a student, I have always had a backpack.  I was never in want of a place to stow a binder, pockets for extra pens and highlighters, and still more compartments for snacks, a laptop, umbrella, and the various tools, trinkets and gadgets that I might (never) need to use.

Well, I’m still a student, but now I have only two pockets in a short white coat to assume the place of my trusty pack.  Suddenly, I have become over-encumbered with what would have in the past only been only a moderate load.  It wasn’t too difficult to boot the umbrella and trinkets from my cargo manifest, but the nature of the true culprit quickly became obvious: paper.  I hate paper.  It has been only three weeks since I have been forced to accelerate the demise of this pulpy, archaic medium, but I am happy to declare that progress has been made.

Looking back, it’s scary how dependant I was on 19th century (and older) technology for organizing my life.  Because of its insidious creep into every nook of my routine, there was no single solution to ridding myself of those stacks of ugly scrawl, often labored over for hours only to be buried under an unstable tower of their brethren and forgotten.  Yet slowly I have succeeded in reducing – if not eliminating – my dependance on parchment.  Here is what I have used to accomplish the task:

Notepad / Scrap paper: Google Tasks

Google Tasks open in Gmail

Google Tasks open in Gmail

Google Tasks is the best tool for anyone integrated into the google ecosystem, as it is quickly accessible from gmail.  I leave it enabled in the bottom right corner of my screen, and have lists for To-Dos, personal notes, long term reminders, and tasks specific to certain occupations, organizations or activities.  These liste are instantly synced across all of my computers, as well as my android phone (app: GTasks) and iPad (app: GoTasks).  There is a checkbox to mark a task complete, and you can also set reminders and due dates.  Say goodbye to sticky notes and that pile of cut-up recycle paper you used to keep on your desk.

Filing Cabinet: Evernote

Evernote Web Clipper browser plugin

Evernote Web Clipper browser plugin

Evernote occupies that second tier of notes – those that aren’t tasks or items to be remembered for a short time later, but rather all of those pesky little details in life that need to be remembered.  That combination for the bike lock that you always forget in the spring?  You know, the one you wrote down….somewhere?  Yup, evernote will take care of it.  Along with longer items such as notes, pictures and even audio recordings.  You’re limited to 100MB of uploaded stuff per month, so plan on paying for the premium account if you do much of the latter.  For text and the occasional picture / scan, it’s plenty. The web clipper browser plugin is also essential for saving interesting/funny things you read online.  Storing them in evernote solves the issue of trying to find them later only to realize the content was pulled, the site offline, or you just plain forgot where to look.  Of course, like Google Tasks, Evernote is available on the desktop, web, and mobile platforms, so your filing cabinet is always with you.

Scrawl: Penultimate

penultimateI use this app on the iPad for those rare situations in which you simply need to write.  The resolution and accuracy of a capacitive stylus leaves much to be desired, but it works in a pinch.  Samsung’s Note line of phones/tablets, as well as many Windows tablets such as MS Surface, have Wacom digitizer hardware, allowing the use of a proper stylus for better accuracy and ease of use.  Still, my 9″ iPad mini is about as good as a 3×5 paper notecard as far as the amount I can fit on a page.  On the plus side, it syncs to Evernote – a feat that leaves the note card feeling quite resentful and unwanted.  Good riddance.


Binders: Dropbox

Dropbox or Google Drive, you can have your pick.  Either of these are great for storing vast archives of created content or school/work documents and keeping them synced across all your devices.

Flashcards: Anki

I already wrote in length about Anki.  In short, if you have a pile of things to memorize and retain for any significant amount of time, there’s nothing better.

Textbooks: PDF

It’s amazing how many things you can find online if you dig a bit.  And by digging, I actually mean a simple google search.  If you’re lucky enough to find a decent quality PDF of the textbook you need, I still think Adobe Reader is the best app for the job (perhaps with the exception of PDF X-Change Viewer on a Windows machine).  Sadly, the CHM format is still used frequently, and it necessities using apps that are generally more buggy and less polished.

Books / Novels: Calibre and ePub

Calibre is an awesome piece of software for managing an eBook library for use with dedicated eReaders, tablets or phones.  Not only will it organize and convert your library of digital books, but it can also act as a server to allow those books to be accessed from anywhere if you happen to have a computer you can leave running all the time.  My favorite apps that support the ODPS protocol that Calibre uses as well as the widely-used ePub format for eBooks are FBReader on Android and Marvin on the iPad.










With the above tools, as well as a capable PC, smartphone and tablet, you have all that’s needed to leave paper behind in the last century where it belongs.  If you still find yourself having to use it from time to time, I think you would be well served by adding two more items to that list: a scanner and document shredder.

Why Medicine?

Recently, a friend considering medicine as a career asked me for my perspective.   I actually had a bit too much fun with this, reflecting back on how I ended up here in this little cubicle with my First Aid and a computer screen taunting me with 2200 practice questions to be studied so that I could jump through the next of many academic hoops in the long progression toward becoming a productive member of society.   Well, I may know a bit less about biostatistics for STEP 1, but the time spent reflecting was valuable to my mental health.  The curse of being a very long-sighted, future-thinking individual is that you’re willing to accept almost any punishment in the short term if it is necessary to achieve your ultimate utopian dream life.  Despite being experts on the subject of delayed gratification, even us med students can get a bit weary of the grind.  So, the chance to be introspective for a bit and recall why all this hard work was supposed to be worth it turned out to be quite refreshing.

The Questions

 How did you know that this was what you wanted to do?

I can’t say I was that person who knew from birth that they wanted to be a Doctor when they grew up.  Nor did I have any one experience or revelation that this is what I wanted to do, despite what my elegant Personal Statement may have implied.  Honestly, I could have seen myself in any number of fields (medicine, engineering, IT, military, aviation, business, consulting, intelligence, game development…you name it) – it came down to Aerospace Engineering vs Medicine in high school, and Medicine won out.  There were many reasons for the ultimate decision, including both the rational (nature of the work, didn’t want to be constrained to a certain geographical location, lifestyle, pay, work/family balance) and personal (I didn’t want to be a cog in a wheel, wanted to directly and unquestionably be doing something good for the world and be helping people, didn’t want to work for a bean-counter, didn’t want to slave for years making a revolutionary trinket that would be obsolete and forgotten a decade later, wanted independence, etc…).  In the end, I wanted a career that I could look back on years down the road and be proud not only of my own accomplishments, but more importantly in what I had done for the world; the fact that I had made a significant and positive difference in the lives of my patients.  Above all else, this is why I chose medicine, and why, no matter how hard the daily struggle, the frustrations of politics, academia and bureaucracy, or the boredom of memorizing minute facts for an exam, I will always be satisfied with my choice.

How many schools did you apply to?

Just MSU CHM.  I fell in love with the school, the collaborative (vs competitive) atmosphere and our magnificent, $100M new campus in Grand Rapids, MI.  The fact that I wouldn’t have to move was also a plus.  I applied through my undergraduate university’s Early Admissions Program, which meant that I only applied (early) to MSU, took the MCAT early (in May vs July or Aug), and got a decision almost a year early (June after Junior year).  If I hadn’t been accepted, I could have still entered the normal application process without losing any time. I wanted to stay in state for med school – there is little reason to spend double the tuition going to an out of state or private school, unless you are either dead-set on getting into a highly prestigious residency or want to practice Academic Medicine at a prestigious university. Say your life goal is to do a Retina fellowship in Ophthalmology at Johns Hopkins’ Wilmer Eye Institute.  Are you going to get one of those 4 or so spots without being from a top-10 medical school — probably not.  Can you still go into Retina Ophtho – absolutely.  Just do well on STEP 1 and perform well during your 3rd year rotations and your choice of medical school (as long as it is an accredited MD school in the U.S.) is of little significance in what specialty you can attain.

How did you prepare for the MCAT?

I got suckered into taking the Kaplan course.  Fear is a powerful motivator, and the fear that I wasn’t doing everything I could to prepare for a test that would determine my life overcame my reservations (and the protests of my wallet) for taking said prep course.  Hindsight is 20/20, and if I had to do things again, I’d have followed my gut and just used the resources recommended by other students on SDN, made my own plan, and stuck to it.  Actually, this is what I mostly ended up doing anyways, albeit with the inferior Kaplan books, a class taught by a GVSU senior that was more distraction than a help, and $1800 less to my name.  If you’re the type that needs externally-imposed structure and guidance, a prep course may be worth it, but otherwise I’d recommend against it.  Get the best books, take a solid month or so off to study them, do lots of practice tests, and take the real deal when you’re fully ready.  In the end though, it all worked out, so I guess I can’t complain too much.

What kind of things did you do to make yourself look good to med schools?

I checked most of the important boxes for the “good med school applicant”.  In order from most to least important, they would be a good MCAT score, competitive GPA, personality / “fit” for the school based on the impressions made during your interview and your personal statement, service (not necessarily related to medicine) and work experiences in the field (I was Nurse Assistant for a few summers during undergrad), research and/or publications (dissecting pig hearts was actually pretty fun) and other leadership experiences / awards (president of bla bla bla organization, prestigious scholarship of awesomeness, and the ever illustrious Dean’s List) ,etc..  Unlike residencies, which care much more about the first two items (test scores and grades), it is very important to have a “balanced” application for medical school.  All of these items are important.

Is med school impossible?

Haha, probably not the best time to ask this question – I’m currently studying for USMLE STEP 1, our first licensing exam – which makes the MCAT look like a colorful, fun toddler toy in comparison.  We refer to it as the mKitty.  Seriously, though – it’s easy to become overwhelmed with the path ahead.  The best way to tackle med school is to focus on the now.  Take things day by day, break large tasks into smaller tasks, and don’t get caught in the trap of comparing yourself to others and fretting about the little things that don’t matter.  There may be some long days, but in retrospect, time flies by and you really get a sense of accomplishment looking back on how far you’ve come.

Do you get sleep?

lol, yes.  I’m ferociously protective of my sleep.  Actually, I can honestly say I had more late nights studying in undergrad vs med school.  You could cram for organic chemistry.  Cardiology?  Not so much.  With the amount of materiel we are fed, there is little to be gained by an all-nighter.  Even procrastinators like myself figure out real fast that their definition of procrastination must at least be…adjusted a bit.  I feel like I’m cramming for STEP 1, and I’ve been studying for 35 days straight, with several more to go until the big day.  This is as extreme as it gets, as like the MCAT, the impact of your score determines the career options that remain available to you.  That said, I’ve managed to get 7-8 hours of sleep each night, work out an hour each day, find time to eat, and even sneak in the occasional break for a bike ride, movie, or night with friends.  It’s not impossible – you just have to manage your time.

Are you going to specialize?

Well, everyone “specializes” in that you will have at least a 3-year residency after medical school in which you train and become certified in a particular field.  Family Medicine is no less a specialty than Neurosurgery in this respect.  You can then go on and do a Fellowship to sub-specialize in a particular niche within your specialty.  I begin my clinical rotations this summer, and I fully expect that the experiences I’ll have over the next year will have the greatest influence on what I end up going into – regardless of my current leanings.  Really, though, this is one of the coolest parts of medicine – you have so many options from which to choose a field that fits you and your interests / needs.

For those still in undergrad and considering medicine as a career, it is important to learn as much about what’s involved in this decision as you can.  Keep asking questions, shadow some Docs, get involved in pre-professional clubs, and most importantly – have fun!  Don’t waste those blissful undergrad days working yourself too hard just for the sake of it (read – don’t torture yourself with the waste of time and sanity that is analytical chemistry for a meaningless minor, unless you’re actually interested in…titrating colored water and writing lab reports…and stuff).

Anatomy of a Board Question

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In an attempt to displace some of the frustration of studying for boards, I decided to provide an insight into why USMLE STEP 1 is such a difficult exam for medical students – such that, on average, 5-6 weeks need to be dedicated solely to the task of preparation, in addition to the time spent throughout the course of second year.  The best way to illustrate the misery of this test is simply to describe the average question that may appear on it.  Multiply this by 322, and you have the 7-hour exam that is STEP 1.

To ease the pain ever so slightly, I’ll cast it tn the context of a history question:

In the 20th century, a prominent political figure became heavily involved in the production of a new automobile known as the “People’s Car.”  A few years later, this man’s favorite pet, “Blondi”, delivered several offspring.  He named one of them “Wolf.”  Of what species or breed was “Wolf”?
A)  Canis lupus
B)  Oryctolagus cuniculus
C)  Doberman Pinscher
D)  Felis catus
E)  Golden Retriever
F)  German Shepherd
G)  Thylacinus Cynocephalus
H)  Bradypus variegatus
I)  Bloodhound
J)  Chihuahua

Now, the first question you may have after attempting to answer this is “What does this have to do with history?”  Understandably, trivia is not a favorite pastime for most people.  If this is the case, the logical approach might be to try answering one or more of the separate components of this question, hoping that this would lead to the answer.  An automobile fan may recognize that “People’s Car” is actually an English translation for Volkswagen, and thus come at the question from this angle – who was behind the success of this company?  Sadly, there are no people in the answer choices.  “Well,” you say, “I can still get this.  After all, I know the genus and species of the Wolf – and Canis Lupus IS an answer choice.”  You would be right — and yet ultimately still wrong.  Who names their wolf “Wolf”?  At this point, you will probably throw up your hands in fury and, rather than continue attempting to answer the question, complain about why it was even asked.  Who cares about the pet of a car company owner?

Now, is the purpose of this question really to test your knowledge of cars or famous pets? Of course not.  Obviously, the question was testing your understanding of historical leaders, with the simple task of identifying Germany’s leader in the mid 1900s.  Because everyone knows that this was Adolf Hitler, it would be silly to have this be an answer choice – no one would get the question wrong, and the bell curve would be all nasty and skewed to the right.  Examiners worship the uniformity of the curve like a cult, and do everything in their power to maintain it – even if it means asking the name of Hitler’s pet dog, who happened to be a German Shepard.  What, you never learned that?  Clearly, you should have studied a couple more weeks.

With the example out of the way, one can begin to identify a structure; a method to the madness:

Diagram of a board question.

Anatomy of a board question.

Knowing the structure gives you some idea of what it takes to successfully work through a question, but it is even more useful if we distill this structure into a couple of High-Yield rules:

  1. The question and answer will rarely be what is explicitly asked.
  2. The obvious answer is almost always wrong.
  3. The seemingly logical answer is also generally wrong.
  4. On a rare occasion, the obvious or logical answer will be right.

Now, the first 3 rules can arguably be explained away as methods to test your critical thinking.  Of course, the 4th is there just to play with your mind.  Similar to the way your high school biology teacher would have 10 answers in a row be “C” on your multiple choice test, just to troll you.  Combine these rules with the multi-step nature of the question, in which you must jump through a series of mental hoops just to figure out what is being asked.  Now, add 6-10 answer choices and a time limit.  The result: a multiple-choice question in which a failure to successfully complete any one of the steps necessary to answer it results in failure.  Guessing doesn’t work out too well, either.

To prove that this isn’t all hyperbole, I actually have a real question to submit as evidence:

A sample USMLE STEP 1 question

A sample USMLE STEP 1 question

I hope you can see the resemblance to my example.  Perhaps the detailed analysis and rules actually allowed you to come to the correct answer.  Of course, knowing the rules only gets you part of the way there.  You still need to know that the Erythropoietin Receptor is a Type I cytokine receptor, meaning that it is associated with a non-receptor tyrosine kinase, and that a JAK2 mutation of this non-receptor tyrosine kinase will lead to a clonal proliferation of hematopoietic stem cells, the disease for which is called Polycythemia Vera.  No problem, right?  Or at least… nothing a few more weeks of studying First Aid can’t fix.

The problem I have with these questions, is that they’re essentially training us naive young physicians to miss the forest for the trees.  You spend so much time memorizing that the creator of the Volkswagen had a German Shepard named Blondi that you forget the fact that this individual was named Adolf Hitler and was responsible for the Second World War.  The goal of these so-called “Licensing Exams” has become badly warped.  Rather than asking questions that test knowledge a competent physician should have, similar to the way an FAA exam would ask student pilots about proper navigation techniques, the USMLE examiners have somehow decided that the purpose of their test is to stratify medical students into the most symmetric bell curve possible, regardless of the cost.  The intent behind many questions is “Let’s try to ask them something they might not know” instead of “Let’s ask something that they should know.”  I’m sure this approach makes residency directors happy, as they have a convenient 3-digit number available to sort applicants with, rather than relying on more subjective determinants of ability, such as clinical performance, letters of recommendation, and impressions made during interviews.  I suppose I don’t blame them – who in their right mind wants to read 1200 CVs, anyways?

Interviewing Tips for Medical School

It is another Interview Day here at MSU CHM, which means dozens of anxious, suited up pre-meds wandering our halls, filling our elevators, and occupying our coveted study rooms for their student interview sessions.


Michigan State University College of Human Medicine – Secchia campus in Grand Rapids

Having been a student-interviewer with our admissions department in the past, I have a few tips to offer interviewees, outside of all the usual advice.

  • Do some research.  SDN (the Student Doctor Network forums) has a great index of reviews posted by interviewees for most U.S. medical schools.  This is a valuable resource for finding out the types of questions that may be asked, or at least to get a general feel for the atmosphere and structure of that school’s admissions process.
  • Know your application.  This may seem obvious, but have some unique things to add about each portion of your application – don’t just rehash what is there, as we have (probably) already read it in advance.
  • Review your online presence.  Mostly, that means Facebook.  Many student interviewers are not above a bit of investigative work / creeping your profile.  Remember, that unlike the admissions staff, we may only have one or two interviews to conduct, meaning we can spend a bit more time being thorough.   Do a web search on yourself.  If you have public information, make sure it reflects well upon you.
  • Show interest in our state.  For state schools, there is often preference given to those who express intentions to remain here to practice.  Not to say you can’t change your mind down the road, of course…cough.
  • Have some questions for us.  While most interviews require that we ask a number of pre-decided questions (that we may be allowed to tweak or tailor to our own design), they often don’t consume the entirety of the interview.  Rather than allow for the dreaded awkward silence, ask us about our curriculum, what an average day is like etc…  If you’re really sly, ask about something like community service or research opportunities – and use the conversation as an excuse to tell us what an amazing, compassionate and intellectually curious / driven person you are.


In the case of most schools, the fact that you’ve been invited to interview means you’ve already made it through the more objective (grades, test scores, documented experiences) screening.  You’ve distinguished yourself enough from the roughly 6000 applicants reviewed each year to warrant an interview (roughly 1:12 odds), and now you just have to be one of those 200 that are accepted out of the 500 interviewed.  While your stats still matter, your ability to demonstrate a “good fit” during the interview  is probably the best determining factor of being accepted.  Good luck!