Anatomy Final Exam
June 7, 2014 § 5 Comments
Thursday marked the culmination of 4 semesters of anatomy. It was a day I’ve dreaded since I first learned of its existence, a battle I feared I would never overcome. When I started anatomy in the fall of 2012, I was completely blindsided. It required an entirely different language, a different way of looking at things, of understanding how things were related to each other and how the physical laws apply to the body. We have come so far in our two years here and the one class that has been with us throughout this entire process is anatomy.
With each semester, I learn more about myself as a student. I evaluate, I analyze, I critique, I evolve. That said, many, many changes have been made since I started Semmelweis. This was what I feared. I feared that the apparent holes in my knowledge from those first months would hinder me now. That I wouldn’t have time to fill in the knowledge I lacked. During the first semester, we covered the whole of the locomotor system. That includes all of the bones, ligaments, muscles, vessels – you name it. I remember having such a hard time remembering where all the muscles originated from, where they inserted, which action they evoked at which joint, which artery supplied blood to them, which nerve innervated them, which group of muscles they belonged to and which class of muscles they fit based on their structural characteristics. It felt like just too much to ever learn.
What I didn’t realize was that, in the semesters that followed, I would develop a way of thinking, a way of connecting themes and processing massive amounts of information, that would allow my to fill in these holes without issue. Although I made up for the lack of knowledge later, the anxiety remained. There is an unbelievable amount of information that we are expected to know for anatomy. Skjalg’s professor mentioned to him that the anatomy program here is one of the most, if not the most, comprehensive anatomy programs in Europe. At this point, we know everything about the anatomy of the human body from the organelles of the cells out. We’ve studied all the organs at macroscopic and microscopic level and how they developed in the embryo. We can describe exactly where they are localized in the body, group them by similar function, developmental origin, microscopic structure, you name it. We have learned the entire healthy human body, and to such levels that even Google can find only one result:
The days leading up to the exam were terrifying and the hours before were just short of excruciating. Jannie and I alternated between fits of tears and panic and Skjalg played the level-headed middle man when he dared. We gave ourselves 13 full days to study. We knew it was a lot of information to process and repeated to ourselves that we wouldn’t be able to go through everything, but I don’t think we ever really accepted it, at least not until we were forced to. As the days dwindled down in number to just two or three, and we realized that we really wouldn’t have time for everything, the anxiety began to magnify with each passing minute. I tried my best to maintain my composure, but it got harder as my conscious flagged more and more topics I didn’t know well enough. The topic list was 300 topics long. On top of that, there were 100 histology slides (microscopic anatomy) that we needed to be able to identify and explain. It just wasn’t possible.
Here are the topic lists, if you’re curious:
By the end of the 13 days, we’d studied 186 hours (167.5 of study time, 18.5 of break time). And yet, we still felt as unprepared as we’d ever felt in our lives. We did our best to stay positive and enjoy ourselves. This included me sneaking pictures of Jannie and editing them, us wearing motivational post-its on our foreheads, random dance breaks, balcony talks, hot cups of tea and shooting evil eyes to people on the street (to anyone NOT studying).
On the morning of the exam, I found it hard to get anything into my head. On the verge of a panic attack, I decided to go for a walk, rather than wake Skjalg up and expect him to usher it away. I’ve always found water calming, so I headed straight for the river. It’s not quite the oceans of California, but it serves as a decent substitute. I settled on a flight of concrete steps leading into the water. I stared at the green, opaque waves and attempted to wrangle in my thoughts. I accepted that I was unprepared. I accepted that I would fail. I accepted that I would dust myself off and keep going, no matter the outcome. As waves crashed against the steps, I found a sort of peace within myself. The panic settled and I made the trip back home, to cram in as much as I could in that final stretch.
As we made our way to the anatomy building, I noticed a sort of finality to every step we took, every turn we made. This might be the last time we walk down this driveway. This might be the last time we walk through this doorway. This might be the last time we climb these steps. I brushed away each thought as it creeped into my mind. Nonsense to think of such things before a final you are so sure you are going to fail…
We locked our things in the second floor lockers and then waited at the base of the giant staircase. There were about 15 of us examined that day and we were examined in the 100 year-old lecture hall, part of a long-standing tradition. Here is an excerpt taken from the anatomy homepage, ana.sote.hu.
The final anatomy exam is a great tradition of the department. This has been changed substantially over recent years – the current form of the examination was introduced by the late professor Szentágothai in the sixties. The majority of the final exams takes place in the lecture hall which enables us to provide for the traditional framework, some solemn atmosphere and openness of the examination. The openness for the students participating in the exam provides for a double goal – on the one hand it ensures the clarity and fairness of the exam, on the other hand, it helps reduce anxiety and inhibition. For this is one of the biggest and most difficult examinations of the medical studies, which is mystified by many. The 10-15 students taking the exam on a given day answer questions of a panel of professors. Each student is dealt with by three examiners: one concentrating on macroscopic demonstration and dissection, another on the histological specimen demonstration and the third conducts the oral examination. Students also have to perform minor dissecting tasks during the exam. A given length of time is provided for preparation of the microscopic exercise and the oral examination. The oral exam comprises six questions on slips of paper picked by students. The list of all questionson the paperslips is disclosed in advance. Students are graded in each phase of the examination and at the end of the day the scores are aggregated to form the mark assigned for the anatomy final exam. The examiners participate in each phase of the examination. The examination takes place in a cycle with the sequence of the phases fixed. Where a student fails in one phase, his or her examination is stopped. The examination may be repeated after 10 days. About 20-25 percent of students fail in the first examination but only 5-10 percent has to repeat the semester. The majority of these students fail in more than one subjects. The average of the anatomy final exams – 3.0-3.2 (English program mean )- is considered as acceptable.
The exam was over before I knew it. I remember random details, but not the entire picture. I remember worrying about whether or not they would supply gloves and then somehow picking a lab coat that had about 6 pairs of them stuffed in the pockets. I remember worrying that my knees would give out when my name was called. I remember my heart stopping, just for a moment, when I heard who my practical examiner would be (the same one I’d had for my last midterm). I remember feeling the anxiety slip away slowly as I watched others during their practical exams, as I watched the professors wait patiently for them to answer, guide them through tough points and sometimes even laugh or smile. I remember floating through my practical portion on complete auto-pilot, anticipating an obstacle that never came. It was seamless and fluent. I felt respected for my knowledge and I wasn’t chastised when I made a small mistake. I was given an opportunity to correct it and then given positive feedback. Absolutely nothing like the horror stories I’ve dreamt up these past two years.
When I passed the practical portion and was told I could move on to histology, I began to get my confidence back. I’m still here, maybe this is possible! But then I realized that it depended on my slides. When I saw them – even before I looked at them with the microscope – my confidence grew stronger. One I could identify from 3 feet away: glans of the penis. It has a characteristic large outer circle filled by an inner smaller circle – a slide that I’d studied just that morning. The other I was able to recognize after a few seconds at closer glance: endochondral ossification (the formation of bone from cartilage in the finger of a fetus) – a slide I’d studied intensely last week. When it came time to present my slides to the second professor, I returned to complete auto-pilot. I made sure to present it in the same way that I had recognized which tissues they were. Half of the exam is your ability to present your knowledge, the other half is the knowledge itself.
Suddenly it was on to the theoretical portion. This was where I started getting nervous again. This was where I felt least prepared. There were 300 topics divided into 50 cards, 6 topics each, plus 1 cell biology topic. One wrong choice and I would have to do it all over again. I drew my green and tan cards and reported the numbers to the attendant professor. I was then given a few sheets of blank paper and told I could take a seat to the far left. I peaked at my topics on the way. There was one I was 100% sure of, three that I was 50% sure of, two that I would have to figure out completely on the spot and one that I knew almost nothing about. The one thing that made me feel like there was hope, was that I had chosen the topic card matching my favorite number: 21. A funny note here: one night last week, I went through the topic list and highlighted in pink all of the topics that I felt I knew nothing about (horrible thing to do before bed!). My plan was to focus first on those topics and then on my “need to review” topics marked in purple. This is my topic card with the highlights. I never got around to reviewing them before the exam. Just goes to show how little confidence we have during exam period – and how little we can trust our judgement!
I filled up my blank pages with as much information as possible. I was going to throw everything I had at those topics! Towards the end of my preparation time, I looked at the examiners that were left and tried to determine who would be the one to exam me. My own professor was there and we cannot be examined by our own professors, so he was out. Four left. Minus the two I had for the previous portions. Two left: the head of the English program of anatomy and the same professor I had for my last semi-final. Since we are only supposed to be examined by each professor once, this left the head of the program. But it didn’t end up that way! “Fiorentino, Bianca. Oh, it’s you! Hello, again.”
The theoretical portion went more or less smoothly, but no auto-pilot for this round. I was surprised at how much I was able to recall with some prompting – in addition to what I had already noted down during my preparation time. I’m a visual learner, so I made plenty of drawings and I think that helped present my knowledge. English being the professor’s second/third/fourth language, it’s always beneficial to communicate through visuals. In my opinion, my weakest topic was neuroglia. It’s not a difficult topic, but I haven’t touched it since early January. Luckily, I was able to talk my way through it. My examiner was actually my co-professor for histology 3rd semester, and with a little prompting, I was able to recall the drawings he’d made.
When he started to talk about some anonymous evaluation I needed to fill out, I had no idea what was going on. I asked him if I’d passed and he seemed a bit taken aback and laughed, “Yes. Of course you passed.”. That feeling…that little rush of disbelief and relief…there is nothing like it.
We had to wait in the corridor while the others finished up. After all the students are examined, the professors collaborate and determine the grades of each individual. The room was filled with such a mixed array of emotions, from ecstatic phone calls to family, shrieking girls and hugs, somber disbelief and complete lack of emotion (me – I was in such a state of disbelief that I felt nothing, it didn’t even hit me that we passed until I started writing this blog post). Out of the almost 15 that started the exam, 3 failed: 2 during the histology portion and 1 during the theoretical. At about 16:00, 3 hours after the start of the exam, the rest of us were called back into the lecture hall for the final results.
The professors stood in a row as we filed into the room. The program head gave a little speech about our exams that day and welcomed us back in the fall as teaching assistants. She then began to call out the names of each individual, followed by their final grade. Each person stepped forward, collected his/her index, was wished congratulations and given a final handshake. As the grades were read out loud, my desire for a 3 or 4 grew stronger. Now that I knew I’d passed, I didn’t want to just pass. When my name was called, I went into complete shock. “Fiorentino, Bianca. Congratulations, it’s a 5“. In the moments that followed, all I could think or say was, “I have no idea how that happened.”.
To celebrate our success, Martha, Jannie and I met with Martha’s fiancé and some of his friends at a local bar for some celebratory beers. After that, it was home to bask in the post-exam bliss.
That’s all I can reflect on for now. I can’t believe it’s over…what an amazing feeling it was to come home and put all of this away. Bye, bye anatomy!