Done, done, done. It’s another box that has been checked off of the list – another exam down (4 of 10 this year). It is a good feeling to have it done and out of the way. It was more of a paperwork exercise than a test of what I know – which is frustrating. It is frustrating because I felt as though I had put more effort into studying for the test, than the instructors had put in writing it. Throughout the exam there were spelling mistakes, poorly worded questions and vague answers. The kicker is that I ran into a friend who had the head of the department (the person who writes and administers the exam) as her preceptor for ortho, and this Dr. admitted to her that each year there are a number of complaints about the spelling and grammar of the questions. So the mistakes have been around for some time and yet, year after year no one has bothered to make a couple of simple corrections!
The second reason why I left feeling a little frustrated from the exam actually has nothing to do with the exam itself, but rather with the logistics of the program I’m in. The way that this year is structured has resulted in none of my exams being in sync with my rotations. So, for example, last week I was on Obstetrics where I was immersed in deliveries, C-sections, prenatal and post-natal care but I was studying for orthopedics – which is a completely different focus. I found myself trying to sneak in clinical orthopedic exams into the pregnancy assessment.
“Yes Mrs Smith – your cervix is dilated at 2 cm and you are having regular contractions. Now would you mind if I assessed the ligaments in your knee?”
“Yes – that delivery went fine. The baby is healthy, there is no tear that needs to be repaired but I thought there might be some strain in your elbow from that last push so I better take a look at it…”
Next up is my Internal Medicine exam, which comes in the middle of my …. Psychiatry rotation.
…and for some reason I am dreaming of exam questions. I know finals are close and I know that I have been thinking a lot about the material but I am still surprised to find myself dreaming about actually taking an exam. It’s actually not that I dream about a specific test per se, but rather I dream of myself in a room with a desk answering questions about material we covered in class. The dreams are even disconnected from the material I may have been studying that night. For example – last night I studied endocrine but was having dreams about blood and lymphatics. It’s quiz style – “Describe primary vs. secondary haemeostasis”, and I tend to do ok, which I guess is reassuring. It is still a little disconcerting that not even is there that subtle break from school when my eyes are closed. The up side, I suppose, is that I have just doubled my study time (lol).
It was 2 and 1/2 hours of clinical testing and I’m thinking I did alright. I know that I didn’t do well on three stations but I definitely passed the rest so I’m not to concerned…I could get burned on the marking but I really don’t think that will be the case. It’s a relief that it’s over.
So from Saturday my predictions were pretty close to true for the physicals and the histories ranged from such scenarios as: worst headache ever, depressed patient with poor libido, man with constitutional symptoms and bloody stool. I had trouble with the same stations that everyone else did, which is reassuring – perhaps they’ll scale the marks if they see that everyone was confused by the instructions, but I guess we’ll see. Of course, after the exam the ‘war stories’ begin to be told – one in particular sticks out.
Preparing for the MSK portion of the clinical exam is perhaps one of the more difficult aspects because of the sheer number of tests for each joint. It becomes a real memory game as one tries to remember the name of the test (usually named after some European physician long since passed) and how to perform the procedure. Some students were betting that the OSCE would focus on either a knee or shoulder exam, as had been the case in years prior, and so some of my classmates had prepared to do only those two exams. A bit of a gamble but I understand what they were thinking. Time is of the essence here, you put as much time as you can into the areas you think you need to, and don’t focus on those areas which you think (hope) will not be tested. Sometimes it works, and sometimes it doesn’t. In this case the money was on knee and shoulder but the roulette wheel came back with ‘lumbar spine’. A bad gamble, but not be deterred one of my classmates who was in this particular situation walked into the room, turned to the examiner and stated:
“I’ll level with you. I prepared for the knee and shoulder exams but not the lumbar spine. So I’m going to try and muddle my way through it the best I can, but I understand if you have to fail me.”
At the end of the exam the instructor’s feedback was summed up as:
“Well, I wish I could give you points for honesty …”
Today is the 2nd year Objective Structured Clinical Exam (OSCE), which probably means that…a) I didn’t sleep last night, b) I am peeing pure cortisol, and c) my shirt is dark blue from having both sweat stains meet in the middle. For those who aren’t familiar with this type of exam – the OSCE is meant to assess “clinical proficiency” and will use a simulated patient (read ‘actor’) in a variety of standardized scenarios to test this. Theoretically the OSCE presents a better opportunity to evaluate not only the student’s knowledge but also communication, professionalism and decision making abilities. Brown Medical School has a nice little write-up on their website here (http://bms.brown.edu/students/osce/index.html) with a little video which may give a better sense of what the exam is like. What you aren’t told is that the OSCE provokes fear in even the most stoic.
Today’s fun includes 13 stations, each 10 minutes long. There will be 8 minutes for the actual examination or history, and then 2 minutes given for student feedback. What I can expect is 5 histories (I have no idea what to expect here – could be anything from geriatric health to sexual medicine, or ethics – maybe all three combined? Little old lady hits on you doing a physical – what do you do??), 4 physical exams (I’m guessing 2 MSK, 1 Neuro and 1 Resp / Cardio), 1 PEP (post-exam question), 1 self assessment, and 2 breaks. I have prepared well for both the breaks and the self assessment, I know I can pass these, it’s the others that have me tense.
Today marks the end of week 9, the 1/2 point of the semester. I have just finished perhaps one of the most intense blocks of study I have had yet and now will start something completely new on Monday. The general feeling in the class is one of low grade anxiety. There doesn’t seem to be enough time to consolidate what I have just learned before being hit with new material. I hate to say it but it’s already time to get serious about the exams, even though they are 2 1/2 months away…I don’t remember doing this in undergrad or even for my Masters. I guess it just goes to show that Medical School is a different sort of beast altogether.
Finals are here and people are acting stressed. It’s hard to explain to someone how the abject fear of failing a course can keep one focused and studying for over 12 hours a day. The worst part is that it is boring! I could try and sell the time before finals as a wonderful period where all the learning over the semester is consolidated and that finals aren’t really that worrisome. I could do that, but then I would be lying. There are interesting aspects of the material, with out a doubt, but memorizing minutia is asinine. It becomes a balance between what do I need to know to be a good doctor someday and what minute detail do I need to know for the exam.
Then we must also consider the stress of the holiday season. I guarantee that the majority of us will not be thinking of Christmas gifts until our exams are over. Hell, I kind of doubt if some of my classmates will think of their personal hygiene until the exams have passed (that’s how dedicated some are). They make me look like a slacker. I really like my bed and at least 6 hours of beauty sleep. Maybe that will change someday, but not today. To recap – there are currently several hundred stressed type A personalities walking the school with poor hygiene and suffering from lack of sleep. Makes one want to stay away …
There is one good story coming from this stressful time. Each of the 2nd year students has an assigned first year “buddy”. This is to build a bit of a support network for those new to the school and to ease them in, i.e. give them some sense of what to expect. This past Tuesday (Dec 5) the second year class converged on the freshman class while they were in the middle of their immunology lecture and surprised them with small gifts and the larger gift of song. All 200 of us stood at the front of the lecture hall and to the tune of twelve days of Christmas belted out the med version of the traditional Christmas Carole. We must have sounded pretty good because we got a standing ovation from the first year class and even the professor looked like he was enjoying himself.
Today marks the start of the 6 week countdown to finals. I don’t think I have ever before in my academic career looked so far forward to an oncoming set of tests. With medical school I know that if I don’t keep an eye on what’s ahead I’ll be in trouble come exam time. The reasoning for preparing now for exams, to be held over a month away, is purely for stress prevention. With the workload increasing and promising not to let up before I write, it will be hard not have stress build. The key is to keep the stress constructive – keep it as a motivating factor instead of a debilitating one. I think I definitely work better when under a little stress, but also understand that there is that fine line between when it is constructive and when stress becomes overwhelming. With a little luck and some foresight I’ll keep my stress levels under control and go into exams well prepared.