Exam week and most of us are feeling burned out. “I just want to get this over with,” lamented one classmate. “Studying another few hours won’t change anything.”
We had four exams, three hours each, one per day, from Monday through Thursday, starting at 8:00 am or 9:00 am. All were computer-based.
The main NBME exam was challenging and surprisingly clinically-focused. Example: “Where is the lesion for someone who has right-sided intention tremor?” (Answer: right cerebellum; not everything in the brain is cross-wired.) Type-A Anita complained, “I thought it would be much more detailed and less big picture. I studied all the wrong things.” There were numerous questions on peripheral nerve deficits as a result of disk herniation. Students complained that this subject was not covered in “significant detail” during lectures.
The anatomy exam, developed locally by Doctor J, was a blend of challenging second-order questions and basic identification questions, with both multiple-choice and short-answer styles. Students complained that the second-order questions as not testing only “anatomy material”. For example, three students complained about questions asking to locate the lesion site for various visual field deficients. Several memorable questions started with a group of stroke symptoms and asked the student to identify the blood vessel most likely affected. Students were outraged at these applied questions. “I cannot believe Doctor J put that question in. He put that in just to screw us over.”
Students were also frustrated by the locally-developed clinical exam covering the HEENT (head, ear, eye, nose, and throat) exam, the neurological exam, and child development. We looked at computer images of different retinas. Given a description of a patient’s reflexes, we had to name the peripheral nerve or spinal nerve roots that might be damaged. We looked at a computer screen image of an ear canal that we would have seen through an otoscope. We were asked to identify the age of kids based on certain observable skills and behaviors. Type-A Anita complained to several classmates, “I don’t need to know this for Step 1” (the board exam we will take at the end of our second year). The classmates echoed back, “I don’t need to know this because I don’t want to be a pediatrician.” Students complained about the image quality of the ear canal, even though a higher quality image would not have helped them answer the question. Students complained, “This material overlapped with our other exams.”
The patient case exam asked to propose hypotheses for various clinical scenarios. What tests would you order? What diseases should be on your differential for this given test result? What other information would you want to know? How would you manage this patient with Parkinson’s? What other symptoms and test results would you expect from this patient? Most students do not study for this exam. Students complained about the drugs that were covered.
After our last exam, Jane and I went to a brewery. Students trickled in as people finished. “Cheers to another step to becoming a doctor!” Dorothy Disinterested responded, “I have lost so much faith in our medical system. It scares me to think that we are one-quarter of the way to doing stuff to patients.”
Statistics for the week… Study: 15 hours. Sleep: 5 hours/night; Fun: 1 night. Example fun: We met at a classmate’s apartment for pool and darts around 8:00 pm before heading downtown for an “End of M1” celebration. My classmate and I went to a less crowded part of the bar to get another beer. We were listening to a bartender’s conversation with some of her friends. A friend asked the bartender, “What have you been up to since you graduated college?” She responded, “Working here pretty much.” My friend commented afterwards, “That’s too bad she went to college with all that debt. She could have been the manager by now if she started after high school.”