Second Half of MSK…

courtesy of giphy.com

IT’S FINALLY DONE.

YAYAYAYAYAY!!!!

This block, which was brutal in content and in length, is finally freaking over. I have never been so excited for a course to end. In fact, right now MSK (or musculoskeletal) makes biochem look a brisk breeze in late summer in comparison (for me anyways). They both definitely sucked, but MSK by far took the cake for the most suckage that occurred. And if you ask the second years or my classmates looking for validation, MSK is the hardest course of this semester. So, I’m double glad it’s over.

A brief recap from the first half: MSK is a 6 week-long course. We had our midterm at 3 weeks in and then had our final a couple of days ago. If you are interested in my mindset, how I studied, what I could have done differently, etc, check out the first half of this post here: “First half of MSK”.

Exam Breakdown:

We again had our written exam in the morning and then had our anatomy practical in the afternoon. It was the same set up as the midterm where we all take the written together in the lecture hall, but since we have to do the anatomy lab in smaller chunks (not all of us can fit at all 50 stations in one go) we were broken up into 3 separate testing times. Last time I was in the middle group to go, this time I was the last practical group to go.

Written Exam Breakdown:

Anatomy questions: 39             [From 10 lectures]

Biochemistry questions: 4        [From 1 lecture]

Histology questions: 20            [From 5 lectures]

Pharmacology questions: 7       [From 1 lecture/DSA]

Physiology questions: 22          [From 4 lectures]

Total: 92

Yes, we had biochemistry this time on this test. Which honestly was one of the easier lectures to digest because our professor discussed what we had already talked about in biochem, just in less detail and more oriented for musculoskeletal use/correlation.

Anatomy Lab Breakdown:

There isn’t a set breakdown for how this section works, but I will explain how the lab practicals run. I’ve drawn a diagram that shows how we move in the lab during the practical. There are 50 stations, and several rest stops. There is 1 minute (or about 1 minute) at each station for you to find the pin/tag, figure out what it is, and write it down. In Joplin this year, we wrote down our answers on paper instead of using iPads. So we each started at a station and rotated through until we hit every station.

The structures that can get tested are all on a printout that they gave us at the start of this section.  Technically, they are not supposed to tag things that are not on the list. However this also means that when you put down your answers because we have a printed list, it needs to be referred to in the term they specifically give and spelled correctly (which is according to how they spell it on the sheet).

In order to study for this, we would take the structure lists and just go around to different bodies and see if we could identify what was on the list. Some bodies had things that other bodies did not, either due to it being cut or removed at that tank, or not being dissected out.

Rotation through the lab during practicals.

Key: Purple boxes are the tanks. Tanks are what we call the tables that have our cadavers on them. The row on the bottom of purple boxes simulates the back wall in the lab. On the back wall are usually bone models, ligament models, skeletons, or radiographs for us to look at. Things that we cannot see on the cadavers or cannot see well on the cadavers but they still want to test us on.

Red x’s are rest stations. There is a rest station right before the start of the tanks, a rest station right before the back wall after all the tanks, and rest stations after each row of tanks.

Blue indicates the numbers or questions. So for each body, there would be something tagged on each side. That way they could use one body for multiple questions.

Black arrows indicate the flow of the lab. So if you start at #1 and follow it down, you will see a snake rotation around the tanks.

How I studied:

I had greater motivation this time around, although unfortunately my written scores were still lower than I would have liked. I increased my percentage by 7% from the midterm though! So that means my hard work paid off…just not to the degree I was hoping for.

Due to my motivation early on (which most definitely dwindled closer to test time), I was able to really learn the first 2 days of material on Sunday before we started. Since I did that, I was mostly on top of material for that first week. In week one for this section, we had a total of 11 lectures that first week. They did tend to pile on the lectures heavily at the start of that week, as we would have 3 or 4 lectures in a day. Thankfully that first Friday we had off, and things weren’t as intense going forward. There was a fair amount of gross anatomy and histology lectures though this week, and the histology was definitely harder to digest for me. The second week we had 7 lectures to learn, and the third week we had 2 lectures of required material.

You are probably thinking Joyce, you had SO MUCH TIME then. Why was this so hard to manage? You are just being lazy here.

Yes, yes I was lazy to a degree. We did have lectures for other courses interjected into that schedule, and we also had an OS exam (osteopathic skills) on the second Friday. The day before a test they usually give us at least half a day if not the whole day off from lectures to study, which is why there weren’t as many lectures that second week. We also had an SP encounter in the third week, so we were practicing on actors with taking histories and exams which cut into lecture time. Lastly we had an injection lab skills check-off and an exam check-off sprinkled in there too!

Check-offs or competencies are where we demonstrate skills, in this case injecting different ways and doing different exams for a specific complaint, and we get graded on how well or competent we are in those skills.

So even though the anatomy load in and of itself was less as the weeks for this section went on, we still had several things to do. To be honest, because we had an OS exam on that second Friday and I had been punting OS so hard before, I mostly studied for OS that second week instead of keeping up on anatomy. And I hadn’t gone through everything for the first week either, so I was a bit behind.

But hey, at least this time around I actually got to go through all the lectures more than once!

Lecture:

  • I did not attend most lectures this time around. I found the other campus’ material to be more in-depth with more detail, and would watch their lectures after sleeping in a bit. If I was feeling well enough to get up, I would go to my campus’s lectures. Otherwise, most of lectures were watched on campus later and then I would review both sets of slides to make sure I got the information presented to both campuses.
  • I did more objectives for my histology lectures and physiology lectures this time around. It made it easier to put these confusing sections into my own words and arrange it differently than what was on the slides.
  • I spent more time looking at the slides for histology so I could identify them on the test (for histology, sometimes we get identify this slide questions and other times it is multiple choice on text about histology concepts).
  • I drew out all of the anatomy. I ain’t no Picasso baby, but drawing it was much more helpful than just starting at an atlas 50 times. I didn’t necessarily keep drawing out muscles and things every time I reviewed them, but I did in my notebook while doing my first pass/in-depth notes for the gross anatomy lectures.
  • I wrote out my notes more this time. It worked in biochem, and I was hoping more would stick/I would understand more this way. I completely used up more than half my sketchbook/notebook this time though due to it. So I’ll have to get another one!
  • I did more than one pass on the material this time.

Lab:

  • I spent more time dissecting on my own time, or trying to find structures on my own while we were still dissecting. I also found it MUCH MORE HELPFUL to learn some of the structures (if not all of them) before that day’s lab. It made going to lab much more beneficial and didn’t feel wasteful of my time as I had an idea of what I was looking for and dissecting.
  • My group and I also made sure that we tried to dissect as much as possible in the allotted lab time, and if we couldn’t get it done we decided to split up the work and come in later to finish it. That way, we weren’t behind and everything was dissected.
  • On top of going in and dissecting outside of lab, I went in and just reviewed structures on the list on a few different bodies. I would start with my own, and then work to other bodies to see if I could find the structures.
  • A few days before the test, a group of friends and I went in together and just quizzed each other on structures on the cadavers. This was great because we each knew something that someone else didn’t, and we were able to point the structures out on the cadavers and teach one another a bit.
  • I most definitely utilized the bone boxes again for the bones.

Overall Thoughts:

Like I said, overall I did do better, just not by much. I was able to go through more material, spend more time with it, and understand it a bit better. I’m happy that I improved on my studying  technique as well. There was definitely much less crying happening this time around. They have yet to officially release the scores (I just have my raw score after taking the written) and they have not graded the practical yet either. So we will see!

 

Let me know what you liked or didn’t like about this post! Make sure to comment down below to let me know what you would like to see or if you have questions.

First half of MSK

Hello!

Welcome back to this fabulous world of crazy.

courtesy of giphy.com

MSK is 6 weeks. Which is 3 weeks longer than biochem was. This time we don’t have any quizzes to help boost our grade, and we have anatomy practicals on the same day as our written tests. Testing in general is much longer (due to more questions), and as it is anatomy, it’s harder to logic your way through something as it is mostly straight memorization. I’m writing this after my midterm, thus I still have 3 more weeks to go until this section is completed.

I struggled hard with this section (so far, let’s hope I can make a comeback).

Exam Breakdown for our Midterm:

There were two tests that I took on the same day for my midterm. The written portion and the anatomy lab practical portion.

Anatomy questions: 64

Embryo questions: 24

Histology questions: 4

Total: 92 for our written exam.

Exam practical: 50 questions (mostly identify what the structure is).

Some were bones. Some were muscle bellies or tendons of muscles. Some were arteries, nerves, or veins. Some were radiographs. We even had a couple embryo questions in our anatomy practical (soooo not happy about that one). What I’m getting at is there was a wide range that was tagged for this practical.

Studying for the first half:

Yo, I need to figure out my shit for this next half. That rule of 3 from biochem? Yea I found it hard to do that. I was lucky if I got through one pass this time. Needless to say there were a lot of things I’m finding I should have done differently.

Lectures:

  • Some lectures I benefited from actually attending. Some I did not. Depending on the lecturer and if they read off their slides, it was easier to just go through the slides myself. If I was unable to attend lecture, I would try to watch it at home. Other lecturers however it was greatly beneficial to show up because they would discuss things that were not explicitly noted on their slides.
  • Again, either looking at the slides, going to lecture, or watching your lecture should be your first pass. I had trouble getting through one pass this time, and a lot of the material I tried to punt but choose wrongly. I know better now.
  • We had mostly embryo and anatomy lectures this time around. We had one histology lecture and no CIS cases (or clinical integrated scenarios). And man, ligaments and embryo were my for sure downfall this test.
  • For the second half I will definitely be looking at Dr. Anderson’s lectures from my COB days. He was pretty encompassing and for chunks of his lectures (not all), they were organized very well and pretty easy to understand. Although I definitely have my favorite and not so favorite lecturers in medical school, there is a lot of information that is not necessarily given to you in the slides that you need to know. So I will be turning to his lectures for more information to help me learn!

Lab:

  • We have required lab about 3 times a week. What you have time to do in lab does not encompass  enough time for you to get it done. In fact, what our fellows would tell us to do in lab would not be the level we needed our bodies to be at by the time we got to the practical. Lots of extra had to be done that was not apparent to me (or it didn’t click in my brain anyways) until about 2 weeks in…
  • Be prepared to spend some extra time in lab getting at and looking at the structures you need to see.
  • I personally didn’t feel actual lab time was helpful. Sure, slicing/dicing/chopping/stabbing, whatever adjective you want to use was fun, especially when I was not in a good mood. But getting to the structures was not helpful for me. Once were were there and I could actually see it, it all of a sudden became helpful.
  • I did put in some extra time in lab studying or going in to pick at structures, but I needed more. I did go to additional small group lab tutoring which greatly helped, but I didn’t spend enough time going in and just identifying structures on my time off. I also didn’t know the material super well before lab tutoring or going into lab, so I didn’t absorb as much as I would have liked.
  • What I should have additionally done was go to separate bodies with a friend or by myself and try to identify different structures. Our body isn’t going to look like other bodies. Anatomy has a similar pattern overall, but is not always that concrete pattern that you learn from your textbook. Going and looking at other bodies would have been helpful in identifying different structures, and ultimately, lead to less of a shock come practical time.
  • Atlases also greatly help you learn the structure and start to learn the orientation. However it is not 3D. Once you get your body in the position to where you can start to identify structures, this is where the atlas stops helping and the body becomes helpful. Unfortunately there is no guide though…

Bone Boxes:

  • We were given bone boxes at the beginning of the year (during orientation) to use during MSK. They are there as in lab you spend most of your time picking away at fat and fascia to see the structures. Since there is a lot in there, it’s hard to actually see the bones. You use the bones given to you to learn the bones themselves.
  • Definitely should have spent more time on this, but identifying structures on bones was a much easier portion on my practical that I thought. Thank you Dr. Anderson for making me learn all this last year!

Schedule:

Here is what my week 2 looked like:

Sorry that it’s all the same color, but my personal notes to study certain things were placed on top of my actual schedule as posted by the school. There was a lot. For some of my frustrations and experiences, visit this post: “8 things I learned (so far) in medical school.” Particularly the long days section.

Additionally on Tuesday, I had anatomy lab tutoring from 8:30-10pm which you cannot see on the schedule, because my screen isn’t big enough!! But I promise it’s there.

My week 1 was just as hectic which I won’t post. My week 3 was a little less hectic class wise, but very hectic in trying to catch up on all the studying I was unable to fit in before hand. I won’t bore you with another schedule screenshot here.

Helpful Areas for Studying:

Okay. I should have definitely listened to my tutors on this, but failed to do so. Here were the areas they told us to focus on/tips to help us succeed, and whoa yea I didn’t take it as seriously:

-Moore’s clinical blue boxes. One of our textbooks, Moore Clinically Oriented Anatomy is super lengthy in text but has these blue “boxes” with clinical correlation. In reality they are like half a page to an entire page but I digress. There were a fair amount of blue box material as exam questions and I chose to not look at it much.

-Using Gray’s Anatomy Review questions. I did do some of these, but not enough. They also recommended integrating in some questions during study sessions instead of doing it all at once. Well, I decided to do all 200 questions per section in one sit down and really didn’t get that far. Then realized I had a lot to still learn. But the stuff I knew I knew well!

These questions are tough, and are usually second order. There are first order questions in here, but if you can answer these questions fairly well, you will do well on the similar types of questions they dole out to you on the exam. Just, actually break them up like it was suggested. Because there are a TON of questions. But, don’t be too hard on yourself if you don’t get a super good score overall on them. Most of the second years used them to figure out where to focus their studying on, and I’d have to agree on that. Again, I just did this too late.

-Stay on top of this. No joke. There is a lot of information in general in each block, but as anatomy/musculoskeletal is pretty much all memorization, there is not great way to really get a handle on it unless you are regularly going over your material. You won’t be able to get every nitty gritty detail down; I mean you are a human after all, not a robot.

-If embryo is integrated like mine is during our learning (meaning there are lectures in each section pertaining to that topic, not just one block for it) DON’T PUNT THIS INFORMATION. It’s hard. Everyone knows it’s hard, and no one likes studying it. Hell, even our professor knows we don’t super enjoy studying it and that it is difficult to understand. But don’t just assume you will be able to kinda sorta guess on those questions because embryo is it’s own language. Also, nothing in this makes logical sense (to me anyways). Spend some time on it.

-I tried to do this, but failed miserably in actually sitting down and doing this (again, I keep saying this for a reason SO YOU LEARN FROM MY MISTAKES HERE PEOPLE). If it’s super overwhelming for you, then go joint by joint or section by section. Do one layer of back at a time. Then focus on shoulder. Then focus on arm/brachium, etc. This way, you can break it up into manageable chunks and can then string all the information together.

-I tried using KenHub quizzes as a last resort. It was great for identifying information, but not super helpful in the degree I needed to be at unless all your quizzes were on level 4. Even then, there were things that they were quizzing you on that you may not need (there was plenty that I did not need during that level, but it gave me the types of questions I was more likely to encounter). So using this was very hit or miss for me.

In general, anatomy atlas/apps are great at helping you learn to identify structures or start learning where you should see them, but they will not get you to the level you need for medical school. It is a great way to help you start to identify the muscles/nerves/tendons/etc to orient yourself, but you will need to go way beyond that to actually pass your test.

Compared to COB: you really just needed to be able to identify the muscle and know the origin/insertion/action/innervation. Which if you knew where it was, you were able to identify it. In medical school, you need to know all of that, but also the relationships it has with the rest of the body in that area…

What I would have liked to have done differently:

I hinted at a chunk of this already. But some additional things I wish I would have done include drawing more, and writing out my notes more. I was able to write a lot of my notes out for biochem and a large chunk stuck. It also helped me organize my notes/thoughts better for me. This time around I simply just couldn’t bring myself to study as much, and thus this portion of my studying suffered.

And well it’s anatomy. Your drawings don’t have to be Picasso, but drawing it will help you with relations. If you can visualize where something is supposed to attach and insert onto, then you can get a pretty damn good idea of what the function is. If you know the area where it is residing, you can also get a damn good idea about the innervation and blood supply (particularly muscles).

Real Talk:

courtesy of giphy.com

No joke. I’m not even afraid to tell the world this. I cried so.damn.much. during this section. I had a really hard time rebounding from biochem, and then had an OS CPA (meaning I had to show I was competent in my osteopathic skills which was a test) the following week after our biochem final. So early that first week I had a hard time snapping back into reality, and then spent the rest of the week trying to learn OS because I hadn’t spent as much time on it previously.

I know, sob story. But you will have times like this to. I basically couldn’t bring myself to snap out of being burnt out to get my butt in gear for this first midterm for MSK. But hey, it’s whatever. It’s one test and technically I didn’t fail, so at least I don’t have to remediate.

What this did teach me: again, it’s okay to not get an A. It also taught me that I took some time to do not so great, so now I need to get my ass back in gear for the second half of this section. It also taught me that being a perfectionist isn’t something I will achieve every single time. As a former competitive dancer and ballerina, this is extremely hard to accept.

So yea, there is my experience from the first half of MSK. Hopefully when I do the second half of this post after the final exam, it will be a more positive situation!

 

Let me know in the comments below what you liked about his post and what you would like to hear more of on the blog!