• Dr Sally Ayesa

Tips for the Part I Anatomy Exam

For the last two exam sessions, I have been privileged to help out a friends/colleagues of mine run a mock viva for the Part I exam. The convenor is a powerhouse senior registrar, and cares deeply about the future of radiology education and training. The reason that NSW has started the initiative is that we are finding that radiology registrars are having more difficulty clearing the first hurdle than in recent years.


These are some of my favourite tips for Part I candidates sitting the anatomy exam. Remember that the test is not easy. It is far beyond the complexity of a single exam you would have sat in med school, and the detail you need to know is fierce. I think, however, it helps to keep in mind that as a radiologist this stuff actually matters. You aren't just learning a fact that you can throw into the wind when you walk out of the exam. You are learning the basics of cross sectional image interpretation, which will serve as the basis for developing your radiology reading skills. I tell my part two candidates - think about where the pathology is, to give you a clue to what it is.


Time, time, time, time

For the 1st anatomy paper especially, sticking to time is the most important factor. You have eight minutes per question - no buffer. In that time, there are 30 marks up for grabs and you will be typing furiously. One of the greatest challenges you will face is forcing yourself to move on, even though your answer might not be perfect, adequate or even finished.


Hearing from some candidates who stumbled first time around, time management was their Achille's heel. They went in with a plan and it went out the window under the stress and difficulty of the exam. Understandable, but how can you prevent this happening to you on the day?


I found the best way was to practice. I would take myself to the local library (a little ambient noise, some people typing around me) with my laptop and notes and a past paper. I would time my answers, giving myself 7 minutes and 30 seconds to see how much I could get down. Depending on how proficient I was in a subject I could get 400-500 words out. It was uncomfortable, especially at first, but it helped to build the way I thought on my feet and injected some healthy stress.


In the exam itself, I can vividly remember at least one point in the exam where I found myself behind the clock. I was working on a 'write short notes' question on the extrinsic muscles of the eye and there was lots to say. Before I knew it, time was up and over for that question and I was still going. Tearing myself away was stressful, as the answer didn't feel complete - but already I was starting to panic because I was behind time. It is painful, but you just need to do it. Get something down, and click on the next question. Just keep swimming.


Structured answers

One of the best ways to organise your answers and score marks is to have a structured 'template' which you can modify for each response. This allows you to hang your knowledge in a scaffold where you can think through the structure, not miss anything important and the examiner can clearly understand your method of thinking.


If you spend some time looking over and completing past papers, you will start to see some patterns arise allowing you to break the questions into broad categories. These categories can be broken into broad gamuts which you can plug relevant knowledge into. A good skill to develop, however, is the ability to inject some flexibility into your structured answers to better suit the question in front of you. This requires you to recognise the high yield facts associated with the structure or space you are describing, but will demonstrate aptitude and skill.


Let's take an example, and consider an organ such as the right lung. Your subheadings will be something like the following:

- Introduction/overview - which gives a topic sentence about general location, function and sets the context

- Organ structure - including fissures, lobes and segments; notes on the of the pleural surfaces, bronchial tree and pulmonary lobules would also fit here

- Relations - superior, inferior, anterior, posterior, medial, lateral

- Arterial supply

- Venous drainage

- Lymphatic drainage

- (Innervation)

- Normal variants


The temptation is, however, that with a large and complex organ like the lung to spend too much time here because you have so much to say. My advice would be to write the high yield facts under each heading, then go back and fill in smaller details until you run out of time and move onto the next question.


Normal variants is a particularly useful set of facts for each structure. It is not only a useful source of marks in paper 1, but will definitely come up in paper 2. You are able to transplant knowledge between the two papers, making an integrated approach to learning the anatomy paramount. Similar with relations, attachments, arterial supplies. All come up in paper 2 and the knowledge is directly transferrable.


A learned colleague has coined the term 'tube' to describe a gamut for structures such as arteries, veins and nerves. You would adapt your gamut to include origin/termination, branches and course to help with your description. Some other examples and how you would adapt them include:

- Spaces: add boundaries & contents (and more weight to relations)

- Joints: add bones, articular surfaces & attachments (ligaments & muscles/tendons)

- Bones: add attachments & articular surfaces



Practice

The two different papers (and event different sections in paper 2) require different methods of practice.


For the labelling sections of paper 2, finding an atlas that works for you is important. I worked with the Weir & Abraham's atlas, which was good for me because my retention is better served on paper with a pen in my hand. Others have sworn by the IMAIOS anatomy program, which provides an online subscription and labelled, scrollable slices. It is also a very useful atlas to have on hand during overtime and those first months reporting.


The normal variants part of each question in paper 2 requires a little preparation. I went back through the past questions and found a lot of repeats and common themes. You can compile these into your own list and write notes, or you can borrow from your colleagues. Knowing variant anatomy is very high yield for both papers and worthwhile spending a bit of time getting across.


Timing and knowledge will be the biggest enemies in paper 1, but the good news is that there is a bank of old exams which you can test yourself on. You will notice that the same structures and concepts come up over and over, so working out what is high yield and preparing model answers is worthwhile. To start with, break up the questions into chunks (say three or four) to build your stamina and gauge your time management.


Much of the content you will learn for 'write short notes' is transplantable to the middle short answer section of paper 2. Questions will talk about relations, attachments, vascular supplies etc. which will be part of your gamuts for the longer essay questions.


Self care

Taking care of yourself in the lead up to an exam can be tough. The bad days hurt more because you are tired and stressed. The small wins are often hard to see.


If you need it, call on those around you at home and work. Your senior colleagues will be filled with good advice and hard earned lessons, and they might have a good set of notes or a textbook recommendation. Or they might just be a sympathetic ear on a day you need to decompress.


The medical imaging community is vast in knowledge, experience and support. Remember that everyone is behind you and backs you to succeed this first hurdle and move onto being an excellent radiologist. Good luck x


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