Which Year Of Medical School Was The Most Challenging For You? Why?

Discussion in 'Medical Students Cafe' started by Dr.Scorpiowoman, Oct 31, 2020.

  1. Dr.Scorpiowoman

    Dr.Scorpiowoman Golden Member

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    This question was originally posted on Quora.com Abraham Sukumar

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    The first two years undoubtedly. These two are the preclinical years devoted to the study of anatomy, physiology, and biochemistry. The remaining 3 years are the clinical years when students are posted to hospital wards and come into contact with the sick. The subjects for the clinical years are pharmacology, pathology, microbiology, forensic medicine, and ophthalmology with medicine, surgery and obstetrics and gynaecology following as the final hurdle. By common consent, the preclinical subjects are the most difficult, and of the three anatomy runs away with the prize of being the hardest for unlike the other two facts have to be absorbed with no scope of applying reason or logic.

    The curriculum of late has somewhat eased on the subject of anatomy. In our time (I joined in 1950) students personally dissected every part of the human body. Even the minuscule bones of the inner ear we laid open by sawing into the skull bone inside which it lay hidden.

    By the time the 16 students (working in different sessions) had completed their dissecting exercises, the body allotted to them would be in tatters. Every muscle, artery, nerve, and organ would be cut up. The brain is removed by sawing open the skull cap and sliced it up for detailed study. In the qualifying examination, the practical part was dissection. The part of the body the student had to dissect depended on his luck. It can be easy or so difficult that few pass. A pass in dissection is needed to clear the examination. Most failures were in the dissection part of the examination.

    Taking out the brain was an exercise in the practical examination. The trick was to remove the brain along with the pea-sized pituitary gland that is attached to the base of the brain by a twine-thin stalk. Our fearsome professor, who was also the examiner, will fail the student if the pituitary was not removed intact. It was tightrope walking without nets. But there was a bright side to this exercise. In about twenty-five percent of cases, the injected preservative fails to reach the brain in sufficient quantities and the brain liquefies. The lucky student who gets such a body will open the dura mater that covers the brain and receive the liquid brain in a basin, and he is through.

    Osteology, the study of bones, was another bugbear. Every prominence, every groove and every rough spot in a human bone has a name attached to it. Either a muscle is inserted to it or an artery lies in the groove, or another bone is joined to it at that point. The student was expected to know all that. Another exercise that was relatively easy was to articulate bones— bringing the bones together to form the joints. It is easy to form the knee and elbow but the bones of the foot are difficult and to articulate the eight tiny bones that form the wrist is next to impossible for students. Fortunately, it was not an exercise in the examination. In fact, it was rumoured that only two persons in the department knew how to do that—the professor and the senior attender with a flowing mustache called Stalin (not his real name which no one knew anyway). Stalin’s expert skill was called upon when skeletons were assembled for display.

    Muscles, with a few exceptions, are attached to bones at both ends. One attachment is its origin and the other its insertion. Not only has the student to know all the muscles but must at any instant recall from memory its origin, insertion, and actions. The small muscles of the hand are important. One of them is so slender that it is called lumbricals after the roundworm. If this muscle is paralysed it has a devastating effect on finger movements. Students find it difficult to understand how such a tiny muscle could do so much.

    Students have to study the anatomy of arteries with their branches, and branches of the branches, nerves and their branches, and the branches of their branches, the abdominal organs, liver, intestines, kidneys etc, and the thoracic organs, the heart and the lungs. In 1950 when we joined transistors were not even invented. Cardiac bypass surgery and inserting stents into cardiac arteries were not even dreamed of, yet our knowledge of heart anatomy was good enough to meet the challenge when it came.

    It was a difficult task squeezing this volume of information into our brains in a short period of two years.

    Medicine and surgery are difficult too, but students are well grounded in the basics when they tackle these subjects, not to mention three years ward experience which makes their study more manageable.

    In the examination, I had to dissect the front of the elbow region, an easy dissection, and in the afternoon oral examination, I was halfway through my answer when the professor waved me away. This meant that I had passed. I had gone through many examinations after that but never experienced the feeling of relief I had when passing my anatomy examination.

    The very first morning as a third-year student in the medical ward the value of what we had slogged for became apparent. We were five in the introductory posting in medicine. The assistant of the unit introduced us to the professor of medicine. After instructing his assistant to allot cases for the senior students the professor asked us to follow him. We trooped behind him down a long corridor, and after climbing a flight of steps another long corridor before coming to an inpatient ward with just four patients.

    The 55-year-old patient had got up at night to pass urine when he found his left upper and lower limbs stiff and hardly under his control. With great difficulty, he managed to go the lavatory and return to his bed. His relatives had him admitted in the hospital that morning.

    With the professor’s help, we examined the patient. Then followed the discussion. The professor never gave the answer but his probing question brought out the knowledge in us. Which system is involved? The nervous system. What part of the nervous system? The brain. Big lesion or small lesion? Small. Why? The patient was conscious and was able to walk to the lavatory and back. Where is the lesion? The lesion must be in at a point where nerves come together for though the lesion is small the whole of one side of the body is affected. A quick recapitulation of the images of the sliced brain and we could say where the nerves get grouped together. As we knew nothing of pathology the professor told us that a block in a branch of an artery that supplied that part of the brain was the cause. We were greatly impressed that the time we spent in studying the brain and the arteries of the body was not time wasted.

    Physiology and Biochemistry were difficult too. In anatomy, we learned what happens when muscles contract. In physiology, we had to find out how muscles contract. The actions of actin and myosin and the sliding theory of muscle contraction were not easy to grasp then, and not possible to recall with any clarity now.

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