Yet another Recap

A cup of coffee, check.
Rainy weather, check
Studies done, check (or should I write czech?)

Last time I posted a decent strip of text in this thing they call blog was almost a year ago. You see the pattern, the further one advance in these studies, the more difficult it gets to get some time over for other stuff.
The last year was a turbulent but yet exciting one.
I must admit, year 2 of medicine took me by surprise. I was told that it'd become easier but oh what a  fool I was to begin the year with hopes of an easy life.
There is no such thing.

For those who are not acquainted with the 3nd year study plan we have two main courses; Physiology, Biochemistry and Genetics.
The latter is one of those "stuck-in-between-two-semester"-courses, where we take the final exam in the end of winter, i.e. February. The problem is that you have no time but to barely keep up with the lessons during the first half, and then you have double the trouble before the exam.

I wont elaborate much further on the individual courses, just settle with the fact that it was yet another year of heavy studies - although much different from the first.
Reading and understanding it taken to another level, physiology is not so much about memorising as is Anatomy. Biochemistry on the other hand, is an endless road down the land of metabolic pathways and such, which I found initially overwhelming but later much appreciated.

After not too much trouble with the physiology final exam, in the week number 2 of the examination period, I took another two weeks boot-camp for biochemistry and it was obviously too little time to cover it all to a satisfying level - so I ended up walking out on the exam with a rather painful D in my book.
The result was of course a summer spent reading the chemistry back and forth, booklet cover to cover - although I did not really mind. Once my mind was settled with the thought of a "shorter-than-normal" vacation all I had to do was to see the good with the bad.

Due to troublesome dates of examination terms I ended up taking it in the beginning of September, just days after finishing my summer intern-ship at the surgery unit back home and with mere weeks left for next year's enrolment.
Going through this "sudden-death"-like exam with an excellent grade was like dropping the largest of stones off my shoulders and I could finally enrol for 3rd.

Well, already 1 month into the third year (time really pass by quickly), I have completely changed my study strategics - getting ready for another amazing year -  but that is another story I'll share later.

Histology Final Exam

The last days have held nothing but good weather, hence the long trip with the boat both north and south of the west coast. However, we didn't have to travel far - the very best spots are close to the harbour.

The jet ski have been a steady companion and together with the newly imported GoPro HD camera mountable on pretty much any solid surface I've snapped some rather amazing photos and videos - videos that are to be retouched and edited into a neat film later when the weather is getting worse.
As promised, I will give a recap on my preparation of the final exam from histology.
Straight after anatomy I booked histology in the end of June. However, as I finished anatomy the relief took over and the motivation of studying was completely absent. I took almost a week off, spending time with Kristýna and fixing in the apartment. The fact that Kristýna wouldn’t be done with school until the end of July, due to internships, made me rearrange my plan. One day before the deadline I cancelled the term in June. My plan was that, since I would stay in Prague until August anyway I might take the time to study properly.

Rushing things are never good, but after the event I think it was a bad choice.
As I previously posted, there was quite an unfortunate issue with the sign up system and I did not get a term. I could blame it on the system, but I’d rather be honest and say that it was my bad from the beginning to cancel the first term. However, more students were struck by the lack of slots in the July term and together we managed to open up more slots.
I now spent almost 4 weeks of studying the histology with increasing intensity towards the end. It was very difficult to sit inside studying when the sun was shining, knowing that I could have been done already. Kristýna was a huge support, kicking my ass to study and took me places to rest my head in between.

The histology questions are divided into three categories; cytology, systemic histology and embryology. I finished off the first part during the first half of the second week of repetition. It took me way more time than I had anticipated. My plan was to finish the systemic histology in the next week and leave one week for embryology. I was told that embryology was manageable in one week but since I didn’t really keep up during the lessons it would prove to be a lot tougher. The systemic histology took a bit longer as well, and in the end I had only 5 days for embryology.

Drawings are essential for embryology in order to understand the developmental steps which are rather complex. There are different books to study from and I recommend one that is well illustrated.
The day before the exam was like every other day before an exam, freaking out feeling like a complete idiot with no knowledge stuck in the head whatsoever. My exam was scheduled at Friday and my flight to Sweden the very same day. I knew it would be stressful so I contacted the histology department in order to change it to Thursday. It was a bit of a problem but after much doubt they agreed and let me in to the exam – as the first student. I got Prof. Kucera, a young professor who I had no contact with earlier, since he was not holding any seminars.

The exam is held in two parts, first the oral examination and then a practical microscopical examination from three slide preparations. The oral part contains one question from each chapter, as mentioned earlier; cytology and general histology, systemic histology and embryology. My three questions were:

-          Blood Smear, preparation and interpretation.

-          Islets of Langerhans

-          Development of the Heart

Really nice questions, indeed. However, I had quite a hard time at the exam. I didn’t know the questions as well as I’d hoped.
It was a success after all, and I could finally finish the first year.
Now a lot of preparation must be made for the upcoming second year. But first, vacation.

The Blessings and Curses of SIS

When I first signed in to the SIS - the student information system of the school - I was impressed. The system seemed like an amazing way to keep track of all the bureaucracy regarding the University. This is where students can virtually go to the Professor's offices to claim exam terms, reflect upon courses and keep records of their grades etc.
It all worked well until today where an error was presented. I had but one fear when I entered this university; that failure would be not due to the lack of knowledge but due to the system. I have heard stories from persons where the system brought them into trouble and I believe this is what is going on for the students struck by this issue.

I had just finished Latin with a not so satisfying exam but with an all the more satisfying final grade and I have now only the final exam in Histology left to conquer.
Today was also the official release of the next exam period in the end of this month. 25 slots were increased to 40 and I understood that this will not be enough in comparison to the amount of students that wanted these terms.
Even if being ready minutes to 14:00, the official release time, the 40 slots was gone in a matter of seconds. Signing up for the term is more of a challenge than actually taking the exam.
The SIS-server somehow got overloaded and a lot of students were not equally able to "compete" for the terms, me among them.
This results in a postponing of the exam to early September, which I however do not find as the most disturbing part, but the fact that I will only have two attempts in total is a more unpleasant and unfair issue.
My intention is of course to conquer the credit in one attempt but if worst comes to worst not having as many attempts as other students makes it quite unequal, in my opinion. You might argue that we should have planned it better but I respond that this is just a grain in the heap.

There are too many students taking histology after anatomy, which I do not argue against, after all I planned my exams the same way. The number of students with histology left and the hope to make it in the month of July is too greatly outnumbering the amount of available slots. Given freedom to decide when to have your exams is a great tool - but only if the options are numerous enough. One choice is not freedom of decision - nor is two or three in this matter.
When there is not enough terms to grant every student three attempts, as policy states, there is something that doesn't add up.

Next term is released on the first of August with a capacity of 35 slots. I hope that this number increase because if not, the competition will look the same. And by taking in to account that a good 10-15% of the 40 that recently signed up might fail their attempt decreases the chances to win the "fastest connection get the sign up"-game even further.

I will continue my studies as planned and see what solution will be the best...

The Final Battle

The day before my exam I was still in the roller coaster clinging tight to the seat waiting for the ride to culminate. Kristýna had come return home to Prague a couple of days earlier (oh, how I was happy about that) and we spent the night having a picnic by the river, going over some last topography and finished it off by watching the amazing film Perfume - The story of a Murderer. If you haven't seen it I recommend you to do so.
 I woke up earlier than I had to and got ready to eat and suit up. Eating is the worst thing before exams and even thou Kristýna made me an amazing sandwich with everything you'd ever wish for I was not able to eat even half of it. I turned to my backup plan: smoothie. You can put almost anything in there and it's easy to take in, even when nervousness inhibits your appetite.
 The walk to anatomy department was very hot, it was indeed a god day, so I had to take my jacket off. The atmosphere in the building was really at unease. Most of the students from both the national and international parallel were already there - and I thought I was early with 15 minutes on the safe side. I found three friendly faces outside and we immediately started to share our thoughts about what was about to follow. I honestly cannot recall the great many things we discussed; "what-if"'s, "I-think"'s and "I've-heard"'s. I am, as you might have understood from earlier posts, not a man that speculates - however, even I had a difficult to brace myself.

The announcement finally arrived and we were summoned in the small lecture hall. A division was made and we international students ended up together with what I guess were 1/3 of the national students. We placed ourselves accordingly to the organization made by the exam assistants and after a quick introduction the slides began. I will not give details about the test itself, since a summary can be written in an earlier post.
 It was much more difficult than I anticipated. The slides were often of unknown origin, i.e. they are from an atlas or painter I, and I believe many other international students, did not recognize. With this said, the ability to be able to apply your specific knowledge from one atlas to schemes from another is very much valued. After all, the anatomy, in theory, is almost all the same - with variation of depth of details of course.
After handing in our tests we were sent off to the lobby with time to kill - and anxiety to suppress. We gathered again and started to deal with reason and non-reason. With no certainty of one’s grade, and I should here mention the 21/30 to pass limit, we all compared answers and possible mistakes.

I scored 22 and a sigh of relief, yet slight disappointment, left my lungs. I was through to the next round. Students who did not pass the introduction test had to leave and those left among me, a good 60%, left off into different directions depending on what examiner they got. Of us international student I believe no one got the same examiner. There were two of the examiners I really dreaded; Prof. Elizka and Prof. Druga. They are both amazing anatomists, the former in lymphatics and the later in central nervous system, which is a good reason why one should be humble once facing them.

I was led to the practical part of the exam first and to my surprise the professors were not examining here. It was both organized and held by docents and their assistants which, was sort of a relief at the moment. This part did not present much fear nor problem to pass for me. The knowledge from the studies during the summer dissection course, not too long ago, was still rather fresh and well embedded in my spine. Since I had to wait a good hour to get into the practical I understood that I would be one of the last to go to the oral part – a prediction that later proved to be correct.

Inside Prof. Elizka’s office posters of lymphatic systems were hanging from the walls both high and low and boxes with unidentifiable items were placed into towers in every corner. It was a very comic scene that hit me as a nice mind break in all the stress. Take notice, I would never call a Professor’s office messy so what I describe is a creative chaos much convenient to the person behind it, but certainly not for a confused and stressed out student.

Five national colleagues were already present preparing their presentations by scribbling down as much as their brainpower could afford in the pressing heat from outside streaming in through an open window in the corner. I looked around and nodded politely in a good luck meaning manner to those who met my gaze. The assistant that had showed me the way to the office showed me my seat and I was given a bunch of papers from a stock of what looked like a well written, formal document in Czech. “Not what one expect on an exam…” I thought and followed it up with “…but recycling papers are a great thing…!”.
I prepared my pencils and the assistant approached with a bucket. Inside were the questions and I randomly picked a number coding for this set of questions:
- Muscles and Fascias; of the back.
- Kidney; structure, syntopy and blood supply.
- The Eye; blood supply, ciliary and pupillary reflex.
- CNS; spinothalamic-, spinoreticular- and spinotectal tracts.
 I was at first puzzled by the set of questions and did not know where to start. I began by drawing as much as I could about the kidney since it was, in my opinion, the easier question. After that I sort of jumped from one drawing to another since I didn’t know how much time I had left. I understood from the order of students that I would be the last one which meant that I had four students ahead of me equal to about 20 minutes minimum each. After I had drawn for what felt like 3 hours I was finally done and couldn’t possibly get more out of my head. My six pages were filled with drawing from different angles showing different structures and I began to plan in which order to present them. Since I didn’t write more than one sentence I also had to come up with what to actually say.

This is the actual schemes I drew, however one page is missing:




 All of a sudden my time was up and the last student before me unfortunately for him did not pass but fortunately for me I now thought that this opens up a chance for me to perform better an impress. Because that is what it is about – to impress the examiner with your knowledge and ability to present it.

In a regular fashion Prof. Elizka wanted me to begin with the CNS question about the spinothalamic tract. I presented my scheme, which he was very pleased with, and I just brainstormed as much as I could. He then did an unexpected move and asked me about the reticular formation, a complete different structure within the brain but with connections to the spinoreticular tract. I was at first caught off guard but came back in the game and could move on to the second question. With the nice backup of my schemes (I once again argue in favour of schemes) could rely on always having the knowledge approved in illustration. I have really no idea how long my exam lasted, time is not of the essence as you are getting hit by question after question but I remember that it ended in a neat discussion about Sweden since Prof. Elizka recently visited a congress there.

In risk of being too self confident I can end by saying that I was very satisfied with my performance and I am glad that the grade reflects my ambition. After the even I can say that it is a very good experience to be put in the hot seat in front of someone of great importance and with a level of studies that exceeds your own by a thousandfold.
Gratitude is also to be able to have such an examiner that allows discussion about the subject and lets you correct yourself if proven wrong. Being well prepared is the key retrieved by repetition and practice in presentation of the subjects.

Next challenge is Histology which I fear will be far much worse. For now, good night and may reason strengthen your mind...

Preparation Propaganda

I’ve already implied many times that my main way of studying anatomy is through drawing. For anatomy all you really need is a good atlas, a source for regional dissection topography and a source for PNS and CNS pathways. I can write a whole chapter on which literature to prefer and for the beginning of next semester I hope I can share my thoughts to the first year students.

The first thing I should have done differently in anatomy was to print the exam questions in the beginning of the course, not in the end. It is true that you answer a lot of the questions during the year but it is one thing to know the fact and to be able to present it. I started with the first questions and it took me a great deal of time to write it all down. I understood that this was not the way to go so I started to build simple skeletons of the questions with criteria I had to cover.

By putting up a simple model of each question and by repeating the anatomy in the atlas I was able to recall the knowledge – it is true that once you’ve touch a subject, even just briefly, the knowledge comes back to you. There are some questions that require more theory than others, for example the general structure of bones and muscle, so those you must read up on a lot. More straight forward anatomy questions I found being up to date in my head and I spent little or no time on those.

I was told that being able to draw something about everything was a good way to go and I spent a lot of time repeating my schemes and drawings just to get the details right. My girlfriend Kristyna, who’s in fifth year of her studies and an anatomy assistant, helped me out by listening to me – mostly via Skype since she were by this time about to end her vascular surgery Erasmus exchange in Helsinki, Finland. Reading up on the questions and presenting them for someone is a great, and perhaps the very best, way to practice for the oral part of the exam.

I also found out that having a drawing to relay on during the presentation is, at least for me, essential. If I forget something I can go back to the drawing, re-present the statement and even expand it by adding things as I go.
Some of my preparations were drawings only, and I just kept the written things in my head, some examples below:

The Structure of the Final Anatomy Exam

I will write as if anatomy is a subject of the past without revealing too much - thus keeping the final battle review unwritten for yet some time.
There's a lot to cover leading up to the exam and one part is the preparation work and the anxiety that comes with it.

The system of the University is built up so that you need one ore more credit(s) from each subject in order to advance to the next semester. Credits are obtained in the end of each course, or earlier if one manage to pass a special test. They are earned by staying within the limited amount of absences, usually four, and by passing all the checkpoint tests during the course.
Of course all the tests tended to accumulate during the end and one have to plan it correctly. As the analogue signatures of credits are getting signed in the index book, or "the golden book of God" as one of my friends once put it, one can seriously starting prepare for what really matters: the final exams.

The Anatomy exam can be broken down in three steps starting off with a straight forward slide test composed of 30 images, schemes or drawings with one unidentified label respectively. You need 21 correct answers to pass to the next round.
All indexes of the students that passed are then collected and randomly distributed to the professors, thus, you never know which examiner you will face until after the slide test (not that it would matter).
The students that failed are being called and sent home while the rest are placed with their examining professor. Two further tasks must be conquered; the practical dissection and the oral examination. Some students begin with the practical part and some directly to the oral.

The dissection is rather straight forward. You enter the dissection rooms to your examiner who starts of at one of six stations: bones, cadaver (muscles), thorax, abdomen, brain and CT/X-Ray. You answer the questions and are graded accordingly.

In the last part of the final exam, the part that you in my honest opinion ought to fear the most, you will be forced into a face off with one of the professors. The oral part is composed of no less than 191 questions, or rather, categories. Out of the 191 you pick a randomized number coding for a set of four question. Here are the division, total number of questions for each category (in brackets) and some examples:

Skeleton and its connections, muscles, fascias, osteofascial compartments (30)
-Bones and joints of foot including X-ray images, plantar arches and their support
-General features of striated muscle, its auxiliary structures, motor end plate, motor unit, muscle spindle, Golgi tendon organ, denervation atrophy
-Muscles and fascias of thigh, femoral triangle (draw transverse section and boundaries)
Gastrointestinal tract (17)
-Pharynx – description, syntopy, blood supply, innervation, swallowing reflex
-Liver - structure, nutritional and portal vascular bed, intrahepatic bile ducts
Respiratory system (8)
-Trachea and bronchi, bronchial tree - description (draw scheme), structure, syntopy, tracheotomy
-Pleura – visceral and parietal, borders of pleura, pleural dome and recesses, pneumothorax
Urinary and reproductive system (15)
-Urinary bladder – structure and position, fixation and syntopy in male and female (draw scheme)
-Prostate - structure, topographic relations, prostatic urethra, ejaculatory ducts
Heart (7)
-Heart - description, chambers, heart wall arrangement (draw section through ventricles)
-Coronary arteries, coronarogrpahy, veins and nerves, lymphatics
Arteries (9)
-Common carotid artery, internal carotid artery
-Abdominal aorta, unpaired visceral branches and their clinically important anastomoses
Veins (8)
-Cranial veins, sinus durae matris, intracranial tributaries of internal jugular vein
-Superficial and deep veins of lower and upper extremities, varicose veins
Lymphatic system (8)
Central nervous system – CNS (29)
-Cerebellum – structure, subdivision and functional organization
-Association and commissural fibers of hemisphere, internal capsule (draw scheme of tracts in internal capsule)
-Lemniscal system (dorsal column tract), proprioceptive and tactile sensation
Peripheral nervous system – PNS (20)
-General structure of the spinal nerve, perineurium, vertebromedullar topography, segmental innervation, radicular areas, dermatomes
-Radial and axillary nerve, paralysis
-Abdominal and pelvic sympathetic system, pre-vertebral plexuses and ganglia
Sensory organs, skin, endocrine glands (13)
-Eyeball (draw sagittal section), cornea, sclera and vitreous body
-Choroidea, iris, ciliary body, eyeball chambers, circulation of aqueous humor, glaucoma
Regional Anatomy (27)
-Topography of abdominal wall, blood supply, innervation and surface projections of abdominal organs
-Inguinal region, inguinal canal, hernias (draw schema of inguinal canal)
-Topography of supramesocolic part of peritoneal cavity (draw transverse section through lesser sac)

The complete list of questions is available here.
As you can see the categories are rather wide and wont cover all the possible questions the Professors can come up with - more or less anything they have touched (and to be honest also not touched) during the year.
I am amazed over the fact that all of us, who passed, have managed to learn such magnitude of information in 9 months of time. Combined with the knowledge of Histology we should be able to zoom in on any part of the human body and be able to explain the structures building up that part, both macro- and microscopically.
I hope the rest of my colleagues will fight for a good grade this week, the fourth round of examinations, and that their outcome will be satisfying.

Luck comes with the prepared...

Great Measures in Busy Times

As usual, I make a meme-spoof...

So here I am again, in a defensive stance against myself and the optimistic thought that keeping this journal alive would be a piece of cake. It most certainly is not.
You all most probably know why, especially if you've gone through the same thing and for those who yet have the experience ahead of them I will in the following posts tell you a bit of what to expect.

Since the previous time I posted here, about a sunny day filled with highlights if I recall it correctly, there have been both ups and downs.
March 22nd is the date stamp and, to be perfectly honest, all that follows is rather blurry.

I can happily say that I am alive and more than just alive. I lived through what might have been the most intense three months of my life "so far" - and with that said in quotation marks - I expect more of it.
If I look back the winter was just about to turn its back on us and spring came rushing in through the door. Anatomy and histology was just about to step up their games by introducing the head-on Anatomy Dissection course simultaneously with the Peripheral and Central Nervous System (henceforth PNS & CNS), all together stretching over one month.
I was prepared for a rough ride but when Histology finally swapped into developmental Embryology, a complete different subject, it just hit me in the face like a metal bucket filled with icy water - and by that I mean water first and bucket next.

As the finish line got closer for every day and with more and more material to conquer I entered a sort of pseudo-doubting roller coaster. The only way to cling on to sanity was to prioritize, hence, histology simple had to end up on the self for the time being.

With my mind freshly set on Anatomy there were days I felt I had it under control. I passed all my practical tests with good marks and was, with a good push in the back from Kristyna and my colleague Gal, almost ready to book a pre-term final exam.
CNS dragged me back into obscurity and that was the phases I gently swayed between; pre-term or not pre-term. Gal is amazing and I admire her for staying on track with her plan. Damn sure, she did it to the end - as one of the very first to fight and survive against the professors of Anatomy.
I failed in staying to the plan and scheduled my anatomy one week after the school ended, something that after the event seems to have been a good move anyway. Since I'm not much for "what-if's" I tend to save my energy not speculating whether it would have been better to do the pre-term.

The last day of school came to an end and the real preparation could begin.
My own final battle with Professor Elizka sure is a nice story, with an outcome that I am mightily proud of, and I am sure I will find the inspiration to give you the details in a separate post later on.

But for now I'm satisfied, and done, with wrapping up the prologue...