Group 4A and Rote Memorization

A couple weeks ago, I wrote about the Anatomy Practical Exam. We walked into the lab with all the bodies laid out in horseshoe around the room. Each had arteries, veins, nerves, or other structures with tiny strings tied around them; or perhaps we found them with a pin piercing through some muscle. We walked around the room silently with a clipboard, writing down the names of these body parts. There was a minute per "question," a total of 40 questions, and 40 loud beeps after time was up at each body.

Yada yada yada. That was nothing. The real fun began today.

This week our practical exam was a group presentation in front of a Professor. Old school European dissection style. Today, we presented the lower limb. There were five compartments: thigh, butt, lower leg, foot, and bones. The four of us (Kiri, Daniel, Eric, and me) pulled out a number from a cup, and we had to point out every single structure in that compartment. I went first, drawing out the number "2" (i.e. the butt, or "gluteal region" is it is more appropriately christened). I had three minutes to spit out all of this gibberish:

"First I want us to remember that we are working within this deep fascia called the fascia lata and you can appreciate the tensor fasciae latae muscle here most superiorly and laterally, then you can obviously see the gluteus maximus, and if you peel that back you see the gluteus medius, the gluteus minimus is just underneath this muscle, and between it and the piriformis you can find the superior gluteal nerves and vessels, putting a finger on the piriformis we can note several very important structures below it and between the super gemellus, most importantly we had the sciatic nerve which turns into the common fibular and tibial nerve as it passes inferior, then the pudendal nerve which passes in and out of the greater and lesser sciatic foramina (and note the sacrotuberous and sacrospinous ligaments, superficial and deep respectively), also we can see the posterior femoral cutaneous nerve and the inferior gluteal nerves and vessels between these two muscles, below the superior gemellus please appreciate the tendon of the obturator internus and then the inferior gemellus muscle below that and of course this flat muscle here is the quadratus femoris, then we need to take a look at the muscles of the hamstring: we have the semimembranosus most medial and then the semitendinosus, and then the biceps femoris with its long and short head, these all make the superior boundries of the popliteal fossa, also remember that these muscles are vascularized by the perforating branches of the deep femoral artery."

A perfect dissection and presentation. Well under 3 minutes. Kiri picked next, and recited the thigh (perfectly). Eric appreciated the foot (perfectly), and Dan got the anterior compartment of the lower leg (perfectly). Then we each grabbed a bone from the leg and presented them to Dr. Gilliland (again perfectly).

"On the foot we need to appreciate calcaneus or "heel" with its calcaneal tuberosity and sustentaculum tali, then see the talus and its trochlea, we have the navicular, the cuboid and the cuboid groove where the fibularis longus tendon passes through, and the 3 cuniforms, metatarsals, and especially note the tuberosity on the 5th metatarsal."

How did we know it so well? Yesterday we all studied individually, then came to the lab at 7pm. From 7 to 9:30pm we drilled and drilled and drilled these dialogues into our head. From there, Dan and Eric and I meandered over the the Health Science Library, where we drilled and recited and read and reviewed what we were going to say over and over and over again. Six pages of material we sat down and memorized, solely for the purpose of spitting it all right back out in the morning. We pointed on each others' legs and feet, and practiced on disarticulated bones. I even dreamed last night of the lower limb. (I'm not joking. I woke up three times last night wondering whether I had mentioned the sural nerve and plantaris - two structures that our body didn't have). And academically, this is the most fun I've had in medical school.

There is no such thing as "quads" or "calves" anymore to me. It's the "quadriceps femoris" and the "gastrocnemius and soleus that combine to inferiorly insert into the calcaneal (Achilles) tendon." Get it straight.

(The picture shows all of Group 4A pulling back an arrow and hitting an imaginary bullseye. That's because we scored a perfect 40/40 on our presentation. Right to left: Kiri Bagley, Eric Golike, Me, and Daniel McMillan.)