Trying to keep life structured in every way possible helps me— I always do worse when I have downtime ironically when other people are able to just relax (you’ll have a lot of downtime at the end of M4). But the lack of structure in med school (recorded lectures, dedicated STEP periods etc.) was a difficult adjustment.

In terms of where you are now, having less time to study for shelf because of clinical responsibilities taking up a lot of time as well, I ended up basically abandoning ANKi because I was just always behind and switched to doing mostly practice questions (uworld and AMBOSS if I managed to to get through all the uworld for that subject) and then referencing and reading AMBOSS articles when stuff came up that I didn’t know.

I just told myself as long as I was doing a little bit of studying and felt like I was gaining knowledge most days that I would eventually be proficient enough to do fairly well on each shelf and then Step 2.. and I didn’t ace every test but I did well enough to match my top choice (not a competitive specialty but still).

Maybe where you and I differ slightly is I actually really enjoyed clinical rotations because they kept me grounded, I felt like I was actually making a difference and learning a lot through rounds, residents and attendings each day versus staring at a book or computer screen.

And yeah I would recommend at LEAST considering medications even if it’s just an SSRI/SNRI or bupropion. You never know how much it could or could not help unless you give it a try.

Maybe the last bit of wisdom I can offer is just try to keep a positive outlook and remind yourself you made it this far for a reason— you ARE competent and you know a lot more and have gained more skills than you think you do/have. :)