Tuesday, September 29, 2009

Human Body block evaluations

With two units under my belt, I think it's time to describe the evaluation process. Evaluations for Unit 1 (back and extremities) and Unit 2 (thorax, abdomen, and pelvis) each consisted of 4 components: 1) Dissection quiz, 2) Dissection lab practical exam, 3) Clinical quiz, and 4) Written exam.

Dissection quiz (30 points)

The purpose of this is to see how good of a dissection job we did. Since the dissection was a group effort, each dissection group of 8 students receives a group grade. The instructor asks us to identify 15 structures, 2 points per structure. We must first correctly identify each structure. This usually isn't too difficult between the 8 of us. Then, we are evaluated on whether the structure is intact or not and whether we adequately cleaned it. The reality is that most groups do very well on the dissection quiz, which helps to boost our overall grade a bit.

Dissection lab practical exam (75 points)

On the morning of the dissection lab practical exam, the instructors wake up at an ungodly hour and "stage" the cadavers. What this means is that they pin certain structures that we will be asked to identify during the test and drape the cadaver with a sheet in such a way that exposes just enough of the cadaver to allow us to figure out what the structure is. Really, in this way, they're testing our knowledge of certain anatomical relationships.

There are 50 "stations" total, with one structure at each station (which means each station is worth 1.5 points). Some of the stations aren't at cadavers but instead present a painted bone and ask what muscle or ligament attaches to the painted surface. Other stations present a cross sectional image of the body with an arrow pointing to a particular structure and ask for its identification.

Before the test, we all line up outside in the hallway and nervously chat with each other while waiting for the instructors to invite us in. Then, we're each given a clipboard and an answer sheet with a number at the top of the page. That number is the station number where we start at (1-50). Only one student stands at each station at any given time.

The test starts with recorded instructions played over a loud speaker telling us that we'll have one minute to identify the structure at each station, that a tone indicates that our time is up and we have to move onto the next station, and that we may not touch or move any of the cadavers. The first tone starts us off, and we rotate through each of the 50 stations. After we've gone though all 50 stations, we're given 10 minutes during which we can hop around to any of the stations that we were unsure about to check our answers or change them.

My experience with the lab practical has been mixed. Sometimes I identify the structure right away and spend the rest of that minute collecting my thoughts, calming myself down, or trying to figure out a previous structure that I was unsure about. Other times, I have absolutely no idea and spend that minute looking at surrounding structures for a clue as to what it is.

The dissection lab practical exam is definitely the most difficult and stressful part of the evaluation process for me.

Clinical quiz (25 points)

The clinical quiz is a pretty straightforward multiple choice test taken and scored online. It's a "take home" quiz that becomes available 48 hours prior to and must be taken before the written exam. The material is pulled from a few clinical lectures that we get toward the end of the unit and also from the standardized patient sessions. Pneumothorax, inguinal hernias, and irregular heart sounds were all big topics on the Unit 2 clinical quiz.

Written exam (150 points)

Most of the points from the unit come from the written exam. It is also pretty straightforward, but there's much more variety in the types of questions asked.

One question type on the Unit 1 written exam asked you to match a given nerve with a list of bones to which the innervated target structures attach. So, for example, the inferior gluteal nerve innervates the gluteus maximus muscle, which attaches to the sacrum, inominate (hip), and femur. Another question type goes one logic step further, asking you to match a lesion in a given nerve with a functional deficit of movement. This deftly lumps together innervation, muscle attachments, and muscle actions all into one question.

Both exams had blood flow questions, which I actually enjoy. In these questions, you're asked to trace the blood flow from the aorta, through the capillary bed of a given target muscle, and back to the right atrium of the heart. The question and answer look something like this:

Question:
Trace the flow of blood from the arch of the aorta to the right atrium passing through a capillary bed in the right gluteus medius muscle.

Answer:
Arch of the aorta > Thoracic aorta > Abdominal aorta > R common iliac a. > R internal iliac a. > R superior gluteal a. > Capillary bed > R superior gluteal v. > R internal iliac v. > R common iliac v. > Inferior vena cava > Right atrium

To make things interesting, Dr. Carry will also throw in a few blockages, which forces us to take a slightly different route to the capillary bed through what are called anastomoses, or communications between two different arteries. These communications are the body's way of keeping itself alive in case something goes wrong, like a blocked artery.

Walking down the halls of Ed1 (the building where most of the first and second year classes are held) before the exams, you would see maps of arteries and veins scrawled all over the whiteboards in the study rooms. Committing these schematics to memory serves as a guide for learning which artery supplies which structures and as a jumping off point for understanding more anatomically relevant relationships.

A substantial portion of the questions are fill-in-the-blank, most of which test knowledge of anatomical relationships between structures. There are also a few multiple choice and true/false questions to round things out.

The written exam is loosely proctored, which means that we are given a firm 4 hours to complete the test but are allowed to take it outside the lecture hall anywhere on campus. I'm not sure if other medical schools operate this way, but here, the nature of our Honor Code affords us this privilege.

Monday, September 28, 2009

When will I start feeling like a doctor?

A friend wrote to me with a thought that I want to share:

It will be interesting to know at what point in your training you start feeling less like a civilian and more like a doc. Maybe when you start you start working with patients?

I can say with certainty that I have not yet reached that point and don't expect to until well after I'm wearing a long coat. It's safe to assume that most of my classmates probably haven't yet, either, but I'm curious to hear their perspectives.

We do start a preceptorship, after the Human Body block ends, when we will be working with real patients under the direction of a mentor. There's also a range of electives that provide us with the opportunity to work with underserved populations in a clinic setting: Warren Village (pediatrics), Stout Street (homeless), and Clinica Tepeyac (Spanish speaking immigrant population).

Thursday, September 24, 2009

Another exam-relevant horoscope

Here's another horoscope forwarded to me that is particularly relevant to preparing for the Unit 2 tests and quizzes:

LEO (July 23-Aug. 22). Instead of wondering why you've been dealt a certain hand, you're figuring out how to play it. What you've learned pays off for you. You will respond to problems with an intelligent and precisely correct answer.

Wednesday, September 23, 2009

Dreaming about dissection

A few nights ago, I had a dream about dissection. When we first started the dissection, the cadaver's hands, feet, and head were all wrapped in cloth. We removed the cloth from the hands and feet to dissect those structures, but the cloth covering the head will not be removed until next week when we begin the Head and Neck unit.

In my dream, I was standing over Gloria (my dissection group named our cadaver), removing the cloth from around her head. I pulled away the last pieces of cloth and looked at her face for the first time. Except, the skin of her face, her hair, her eyes, they all looked alive! Her wrinkly skin was flushed rather than embalmed. She had a full head of thick, wavy, gray-blond hair. And her light blue eyes - she had her eyes open! - were looking up straight into mine. Her eyes seemed to have sadness in them.

This sight obviously freaked me out. I looked down at Gloria's dissected body, to make sure that she was actually dead, then back up at her face and into her eyes. I took control of the dream, at that point, observing within the dream that Gloria was in fact dead and that this was my subconscious mind's way of processing some anxiety that I have about seeing Gloria's face for the first time. The vivacity of her face faded to match the gray coldness of the rest of her dissected body, her eyes slowly closed, and the dream ended.

Tuesday, September 22, 2009

Honor Council class representative

I was recently elected Honor Council class representative! Eight people ran for the position, all of whom would have made an excellent HC representative. I'm very excited that my classmates gave me this opportunity.

Haverford College (where I went for undergraduate) has an honor code very similar to what we have here: one that is social as well as academic, and owned by the students. I served as an Honor Council class representative at Haverford, which is one reason why I ran for this position in the first place. I'm looking forward to seeing how the two experiences compare and what ideas from Haverford's Honor Council I might be able to translate here.

To give us a sense of ownership over the honor code, a group of a dozen or so classmates together wrote the class honor code, which is more of an "honor statement" that accompanies the medical school's honor code. This happened during orientation week, on the bus ride back from the retreat, and was supposed to have been included in the White Coat ceremony. Because of logistical problems, the class honor statement never made it into the program. Here it is below, unveiled for the first time:

Class of 2013 Honor Statement:

As future physicians, we hold ourselves accountable to develop a sustainable foundation of excellence, integrity, and compassion. We understand that, in order to be trusted, we must demonstrate that we are trustworthy. To best serve our patients, we endeavor to nurture the spirit of collaboration and mutual respect. We pledge to carry these ideals into our local and global communities and to be a force for positive change.

Time dilation: Unit 2 exams approach

Wow, it's hard to wrap my brain around the fact that I've been in medical school for just a little over a month. What's even crazier is that my first exam was less than 2 weeks ago, and the Unit 2 test is already this week. It feels like I've been at this for at least 6 months, already.

The evaluations for Unit 1 covered the back and upper and lower extremities. They consisted of a clinical correlates quiz (25 points), a group dissection quiz (30 points), an individual dissection laboratory exam (75 points), and a written exam (150 points). The evaluations for Unit 2 (which covers the thorax, abdomen, and perineum) will be very similar, with the group dissection quiz and individual dissection lab exam up to bat first on Thursday and Friday.

The lab practical was definitely my weak point in Unit 1, so I'm spending some late nights in lab this week, elbow deep in viscera and such. Going through the dissection guide and identifying structures is really the best way (for me) to prepare for the lab practical. But identifying a structure isn't just pointing to it and saying "That's the gastroduodenal artery." To actually help me learn the material, it sounds more like, "That's the gastroduodenal artery. It's coming off the common hepatic artery from the celiac trunk, bifurcates into the superior pancreaticoduodenal and right gastroepiploic arteries, and passes posterior to the duodenum." And we have to do that for every structure.

I actually just came from dissection lab just now, and it's a party up there: break dancing, Wayne's World impressions, "That's what she said" jokes. My classmates sure know how to make anatomy fun. Especially Anand, who apparently does and says crazy things in the hopes that he'll "make the Blog." Well congrats, buddy, you made it!


In a future post, I'll give a better idea of what these tests are like - examples of typical questions and a description of the lab practical test format.

Thursday, September 10, 2009

So glad it's over

I feel like I've been lost to the world for the past week or so, as I've been putting in 15 hour days trying to cram every last bit of anatomy knowledge of the back and extremities. Has health care reform been passed, yet?

I'll write soon about the test format and my thoughts/feelings going into and coming out of the test. For now, though, I am enjoying what is left of my "vacation" before Unit 2 starts tomorrow morning.

Wednesday, September 2, 2009

Today's horoscope

Don't pay attention to the odds or the statistics. If you have faith in yourself and your dreams, with certainty you will succeed.

Much needed words of encouragement. Thank you!

Tuesday, September 1, 2009

Really absorbing the material

The past few nights, I dreamed very vivid dreams about anatomy. Interestingly, these dreams have been devoid of any emotion - positive or negative. I would have expected some sort of anxiety to have played out through my subconscious mind. Instead, I moved through anatomical structures, calmly and methodically identifying them. Last night, for instance, after studying the circulatory system, my dreams were filled with arteries and veins and anastomoses. This is either a good indication that I'm really absorbing the material, or an early sign of anatomy-induced insanity.

Mood swings and meditation

In one moment - usually after conquering a body of material - I am confident that, with another week of studying, I may in fact be able to do fairly well on the test. At pretty much all other times, though, I feel completely overwhelmed and paralyzed by the impossibility of knowing Everything. I need to chill out.

It may be time to start meditating. In the past, I have tried a breathing method of meditation: inhale for 5 seconds, exhale for 5 seconds, and continue that for a minute or however long. I've also talked with classmates who meditate using their stethoscope to listen to their own heart beat. My daily bike rides from school to home are also meditative - a physical release and mental break in cool evening air and under the clear Colorado night sky.

This past weekend, I decompressed by hiking in the Rockies - a major perk of going to school in Colorado. Would it be more beneficial to go on another mental health hike the weekend before my first test in medical school, or should I hole myself up and study the entire weekend?